The 2010 IOM report's influence on nursing practice and reform

¶ … 2010 IOM Report

The Impact of 2010 IOM Report: "The Future of Nursing, Leading Change, Advancing Health"

One 2010 report of the IOM (Institute of Medicine) advised the profession of nursing that it needs to change in order to meet growing demands resulting from novel technologies, the aging population, and health reform (Fackelmann, 2013). This report included eight recommendations and four messages aimed at bettering U.S. nursing practices; their influence has been felt across the world. When provided proper preparation and motivation, nurses can occupy the sharp end in moving towards healthcare reform. Irrespective of political leanings or educational level, it may be agreed upon that the present U.S. healthcare structure has innumerable inefficiencies, which impair patient outcomes and increase costs (Hooper, 2011, p. 131). The focus of this paper is the IOM report's effect on current and future nursing practice, and required changes.

Four Key Messages

How is this currently impacting nursing practice?

Healthcare organizations that sincerely desire a well-educated workforce must go beyond existing 'soft policies' to adopt more stringent measures/requirements (e.g., degree completion, wages rewarding nurses with Bachelor's or higher degrees, etc.). However, the probability of organizations adopting these sorts of measures in the near future will, at the least, be partly guided by nurse demand and supply. Further, hospitals offering residency programs will more likely provide other training as well. This finding indicates that hospital culture might be giving high priority to both types of training. This value apparently goes beyond a straightforward calculation of cost savings depending on nurse turnover reduction (Fackelmann, 2013).

Section 2: How will this impact future nursing practice?

According to IOM's report, nurses possess considerable potential for leading innovative strategies and improving the nation's healthcare structure. But the healthcare sector hasn't been tapping into their full potential. Also, nurses fail to practice to their complete extent, owing to various barriers, which include:

1. policy and regulatory barriers

1. healthcare system fragmentation

1. high nurse turnover rates

1. difficult school-practice transition for nurses

1. demographic challenges including an aging healthcare/nursing workforce (Garner, 2010)

One recommendation in the report is that healthcare organizations, nursing schools and insurers ought to expand nurses' opportunities for leading efforts in practice improvements and conducting research. The aim is creating care delivery and payment models that have nurses' expanded, leadership roles for reducing costs and improving health outcomes. Nurses constitute the largest healthcare worker segment; hence, they ought to play a key role in healthcare reform achievement (Garner, 2010).

Section 3: What will need to happen for these changes to occur?

Several nursing institutions have addressed rapid health knowledge and research growth by compressing existing information into their curricula and adding content requiring further instruction. Novel educational models and approaches have to be developed for responding to burgeoning health-related information. For instance, fundamental concepts applicable across different settings and situations must be taught, and rote memorization discouraged. Moreover, competencies should move to higher-levels from task-based competencies and provide a basis for decision-making competencies and care management-related knowledge, under various care settings and clinical scenarios. Also, novel emerging decision-making competencies, as well as competencies in team leadership, quality improvement, and systems thinking should be made integral to the professional formation of all nurses (The National Academies of Sciences, Engineering and Medicine, 2011).

Section 4: How can nurses be involved?

Full partnership transcends every nursing professional level and necessitates leadership competencies and skills which should be applied in practice and by collaborating with other healthcare workers. In care settings, full partnership involves being responsible for determining waste areas and issues, planning and implementing an improvement strategy, tracking improvement, and effecting required adjustments for achieving set goals. More broadly, full partnership translates to the domain of health policy. For succeeding in re-conceptualized jobs, nurses should view policy as a thing to shape and not something happening to them. They must have a role in decision-making related to health policy and engage in healthcare reform implementation. Lastly, nurses must be active members of advisory committees, boards, and commissions, where policy decision-making is carried out for advancing health systems, thereby improving care quality (Institute of Medicine U.S., 2011).

Eight Recommendations

Section 1: How is this currently impacting nursing practice?

A couple of latest researches conducted by George Washington University's SPHHS (School of Public Health and Health Services) scholars address how well healthcare organizations perform in terms of effecting nursing reform. Pittman and coworkers examined how far healthcare organizations have implemented an important IOM recommendation -- achievement of a nursing workforce with 80% Bachelors' degree holders by 2020, in one study. For gauging how well this recommendation fares in practice, the study surveyed 447 nursing leaders in hospitals, hospice and home care, and nurse-led facilities. Almost 80% of participants claimed their organization required or favored new hires with bachelor's degrees. Furthermore, 94% of facilities were found to offer certain tuition reimbursement for encouraging nurses to complete their Bachelor's degree (Fackelmann, 2013).

How far healthcare organizations adopt nursing residency programs -- another key IOM recommendation -- was the focus of the other study. The same research team surveyed hospital nursing leaders and discovered that, in spite of hospitals' financial challenges and increased nurse supply, owing to the economic downturn, 37% of hospitals were already offering nurse residency in 2011, with only a fifth of them sponsored externally (Fackelmann, 2013).

Section 3: What will need to happen for these changes to occur?

Leadership is required at all levels. The program, "Transforming Care at the Bedside" has succeeded in engaging nurses, and empowers floor nursing staff to recommend changes for patient care improvement. After short-term testing, changes that prove valuable are implemented permanently. The program resulted in improved health outcomes, including reduced hospital falls with injury/harm and 1-month re-hospitalization rates (Reinhard & Hassmiller, 2012).

Inter-professional collaboration is critical to IOM recommendation implementation. Research has depicted enhanced patient care safety and quality due to effective health professional communication and coordination. Integration/team work draws on collective and individual experiences and skills across disciplines. Everybody's input is sought and contributions respected. This allows higher-level practice by all workers. The end result is undoubted patient outcome improvements, including higher patient satisfaction levels (Reinhard & Hassmiller, 2012).

Information should be gathered for better assessing healthcare needs. IOM's recommendations attempt at improving data collection of healthcare workforce for better assessing and projecting workforce needs. Research in this area is fragmented; data must reveal combined professional healthcare demand and supply in different regions, rather than concentrating separately on each profession (Reinhard & Hassmiller, 2012).

Further, IOM recommendations necessitate healthcare worker diversification. Roughly 33% of the nation's population belong to an ethnic/racial minority group. Still, minorities account for only 18% of nurses. By 2050, Latinos, African-Americans, Asians, and Alaskan Natives/American Indians will dominate the nation's population. The profession of nursing must reflect its patient population, and every nurse must deliver culturally-sensitive care (Reinhard & Hassmiller, 2012).

Section 4: How can nurses be involved?

Nursing professionals bring a prominent voice and viewpoint to policy and management discussions. A larger number of nurses must be equipped to lead healthcare access, quality, value, and safety improvements. A recent American Hospital Association survey of 1,000 American hospitals revealed that nurses constituted only 6% of healthcare organization board members; doctors constituted 20% percent, while other clinicians constituted roughly five percent. Nurses must consider themselves decision-makers capable of influencing health outcomes. Well-prepared nurses' appointment to national and state level hospital boards and public policy is being promoted. Nurses may seek useful resources for better preparing themselves for such roles (Reinhard & Hassmiller, 2012).

The clinical nurse leader's (CNL) role may be regarded as crucial to healthcare reform following IOM's report. CNLs are generalist clinicians with Master's degrees. They should be equipped to bring high clinical knowledge and competence levels to practice and be a nursing team resource. CNLs must have a chance to work efficiently and effectively via collaboration, evaluation of current roles, and development of a continual role review strategy for identifying roles which best suit the hospital, the patient, and staff (Stavrianopoulos, 2012, p. 397).

Conclusion

With hospitals continually seeking better and superior-quality patient care, nurses have prominent roles. Active frontline personnel's and nurses' active involvement in hospital efficiency and quality improvement efforts necessitates action within hospitals as well as by individuals paying for services and measuring hospital quality. Hospitals must make the most of nurses' commitment to the organization and patients, as well as knowledge, for increasing care reliability, safety, efficiency, and patient-centeredness (Needleman & Hassmiller, 2009, p. w632).