This paper examines the Institute of Medicine's report on the future of nursing and its implications for healthcare delivery. It discusses how demographic shifts, chronic disease prevalence, and technological advancement demand better-prepared nurses with advanced degrees. The paper argues for expanded nursing education pathways, recognition of Advanced Practice Registered Nurses (APRNs) as independent providers, and legislative support at state and federal levels. Ultimately, the paper presents nursing as a leadership profession essential to transforming healthcare quality and accessibility.
According to the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health, the future of medicine as a whole is inexorably tied to the future of nursing. Nurses are increasingly called upon to perform complex tasks as more of the healthcare burden is shifted to nurses in the name of managed care and cost-cutting. The expanded population base of patients due to changes in legislation such as the Affordable Care Act (ACA) and the aging of the population further underlines the need for appropriate education of tomorrow's nurses and the reeducation of today's nurses. This will require major policy changes and overhauls.
Nurses must be better prepared to cope with a population that is very different from the population nurses treated in the past. Not only is the population older, but there are more chronic conditions such as heart disease and diabetes, given the rise of obesity and lifestyle-related illnesses. Although containment of infectious diseases such as the flu remains important, the model of healthcare must shift to some degree from an infectious disease focus to one of prevention through improving wellness factors.
Technology has fundamentally changed the ways in which nurses must provide healthcare. According to the IOM report, "Nurses also are being called upon to fill expanding roles and to master technological tools and information management systems while collaborating and coordinating care across teams of health professionals" ("The future of nursing: Focus on education," 2010). Technological literacy has become synonymous with competence in nursing practice.
There is a critical demand, according to the report, for improved nursing education to meet these changes. Nursing has multiple pathways to entry, but the greatest demand at present is for nurses with advanced degrees. The need for more nurses who can act as primary care providers, nurse researchers, and nursing faculty means that there is a greater demand for graduate-level educated nurses.
Increasing the number of nursing faculty is perhaps the most critical of all these needs, given that many nurses are actually being turned away from nursing programs despite the nursing shortage, simply because there are not enough qualified faculty members for staffing. So-called bridge programs, which enable nurses to enhance their current credentials, are one way to accomplish this objective. Healthcare institutions themselves must also be supportive so that nurses can balance their existing duties with their learning.
The benefits of education reform are substantial. According to the IOM, "Bridge programs and seamless educational pathways also offer opportunities for increasing the overall diversity of the student body and nurse faculty with respect to race and ethnicity, geography, background, and personal experience" ("The future of nursing: Focus on education," 2010). Cultural sensitivity and diversity in nursing are essential to meeting the needs of diverse patient populations.
The IOM argues that properly prepared Advanced Practice Registered Nurses (APRNs) can function in the place of physicians, subsuming many of physicians' duties and thereby addressing concerns about both cost and provider shortages. This must be recognized by legislators. As the report explains, "APRNs are not acting as physician extenders or substitutes. They work throughout the entirety of health care, from health promotion and disease prevention to early diagnosis to prevent or limit disability. APRNs sometimes provide services that many people associate with physicians, such as assessing patient conditions or ordering and evaluating tests, but they also incorporate a range of services from other disciplines, including social work, nutrition, and physical therapy" ("The future of nursing: Focus on scope of practice," 2010).
Nurses are less costly to employ than physicians, and the focus of patient-oriented care is particularly suited to the nursing perspective, which is always centered on the patient's holistic needs. To fully realize these benefits, the IOM demands that state legislatures recognize the ability of APRNs to provide an expanded range of services. On a federal level, the report also recommends that Congress expand its Medicare program to include coverage of advanced practice registered nurse services that are within the scope of practice under applicable state law, just as physician services are now covered ("Report recommendations," 2010).
"Nurses as agents of healthcare policy change"
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