Healthcare reform requires transformation of nursing profession, IOM says

Nurses' roles, responsibilities and education should change significantly to meet the increased demand for care that will be created by healthcare reform, says a new report from the Institute of Medicine.

According to the report, prepared by a committee at the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States.

To meet these demands, the nursing profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates, the report recommended. 

Regulatory and institutional obstacles – including limits on nurses' scope of practice – should be removed so that the health system can reap the full benefit of nurses' training, skills and knowledge in patient care, the report said.

According to Donna Shalala, committee chairperson and president of the University of Miami, the report's recommendations provide "a strong foundation for the development of a nursing work force whose members are well-educated and prepared to practice to the fullest extent of their training, meet the current and future needs of patients." The recommendations would allow nurses to act as full partners in leading advances in the nation's healthcare system, she said.

"Transforming the nursing profession is a crucial element to achieving the nation's vision of an effective, affordable healthcare system that is accessible and responsive to all," said committee Vice Chairperson Linda Burnes Bolten, vice president for nursing, chief nursing officer and director of nursing research at Cedars-Sinai Medical Center in Los Angeles.

At more than 3 million in number, nurses make up the single largest segment of the healthcare workforce. They also spend the greatest amount of time delivering patient care. They have valuable insights and unique abilities to contribute as partners with other healthcare professionals in improving the quality and safety of care, the committee said.

States, federal agencies and healthcare organizations should remove scope-of-practice barriers that hinder nurses from practicing to the full extent of their education and training, the report says. Such barriers are particularly problematic for advanced practice registered nurses. With millions more patients expected to have access to health coverage through the Affordable Care Act, the healthcare system needs to tap the capabilities of APRNs to meet the increased demand for primary care, the committee said. 

Data from studies of APRNs and the experiences of healthcare organizations that have increased the roles and responsibilities of nurses in patient care, such as the Veterans Health Administration, Geisinger Health System and Kaiser Permanente, show that these nursing professionals deliver safe, high-quality primary care, according to the committee.

The healthcare system doesn't provide sufficient incentives for nurses to pursue higher degrees and additional training, the report said. Lack of academic progression has prevented more nurses from working in faculty and advanced practice roles at a time when there is a significant shortage in both areas.

The report is the product of a study convened by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine and is the result of the committee's review of scientific literature on the nursing profession and a series of public forums.