The Future of Nursing: A Look Back at the Landmark IOM Report
By Harvey V. Fineberg, MD, PhD, president of the Institute of Medicine, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation. This commentary originally appeared on the Institute of Medicine website.
Three years ago, the Institute of Medicine (IOM) released its landmark report The Future of Nursing: Leading Change, Advancing Health, made possible by the support of the Robert Wood Johnson Foundation (RWJF). In light of the tremendous need for nurses in health care today and in the future — due to the growing numbers of people with chronic diseases, an aging population, and the need for care coordination — the report provided a blueprint for how to transform the nursing profession. Recommendations put forth by the report committee included removing barriers to practice and care, expanding opportunities for nurses to serve as leaders, and increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020.1
Spurred by the 2010 IOM report, RWJF and AARP partnered to establish the Campaign for Action, an initiative to mobilize action coalitions in all 50 states and the District of Columbia to utilize nurses more effectively in confronting the nation’s most pressing health challenges. Although we have made measurable progress in the past 3 years, we have more work to do to fully realize the potential of qualified nurses to improve health and provide care to people who need it.
Nurses account for the largest segment of the health care workforce — totaling more than 3 million nationwide.1 However, many advanced-practice registered nurses (APRNs) currently are not able to practice to the full extent of their education and training, due to scope-of-practice barriers. This means that the same nurse practitioner would be required to have more physician oversight in Kansas City, Missouri, than across the state line in Kansas City, Kansas. As such, the IOM report made recommendations to Congress, state legislatures, the Centers for Medicare & Medicaid Services, and others to remove barriers that prevent nurses from fully utilizing their skills to meet health care needs in their communities. But this must be more than simply a recommendation — it needs to become a reality. As one of the priorities of the Campaign for Action, 43 state action coalitions have prioritized initiatives to remove scope-of-practice laws that prohibit APRNs from delivering care to the full extent of their education and training. In the past 3 years, seven states—Iowa, Kentucky, Maryland, Nevada, North Dakota, Oregon, and Rhode Island — have removed major barriers to APRN practice and care.2 In 2013, 15 states introduced bills to ensure that APRNs can practice to the full extent of their education and capabilities without the constraint of unnecessary physician supervision. 2
Another theme underscored in the IOM report is that nurses should achieve higher levels of education and training, and this depends on an improved nursing education system. Because individual and population health needs are changing, and our health care system is ever-evolving, we need nurses to know more and be better trained to provide care in a transformed system. The IOM report recommended increasing the proportion of nurses with a Bachelor of Science degree in Nursing (BSN) to 80 percent by 2020. In 2010, the percentage of employed nurses with a BSN or higher degree was 49 percent, and as of 2011 that percentage had risen to 50 percent.3 Progress is likely to accelerate in the years to come, because between 2011 and 2012 alone there was a 22.2 percent increase in enrollment in RN to BSN programs and a 3.5 percent increase in enrollment in entry-level BSN programs. 4 We can attribute some of this success to the Campaign for Action, as 48 of the 51 action coalitions are working to enable seamless academic progression in nursing. There also has been a recent upsurge in the number of students enrolled in nursing doctorate programs.
Perhaps one of the biggest achievements of the campaign and our colleagues across the nursing community is that, through a $200 million demonstration project in five hospital systems, Medicare will pay to support the training of nurses. The hospital systems are located in Arizona, Illinois, North Carolina, Pennsylvania, and Texas.5
Finally, there is an essential need for more nurses to provide leadership. From the bedside to the boardroom, nurse leaders bring critical skills and capacities for coordinating care and managing the disparate services involved in serving individual patients and advancing community health. The Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development, and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.
At every level — federal, state, and community — we must continue to advance the recommendations of The Future of Nursing IOM report and the burgeoning success of the Campaign for Action to improve patient care, with nurses leading the charge.
1. IOM (Institute of Medicine). 2011. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
2. Center to Champion Nursing in America. Current activity on removing barriers to practice and care. http://campaignforaction.org/sites/default/file/APRN%20Practice%20%20Care% 20two-pager_0.pdf (accessed October 2, 2013).
3. American Community Survey, Public Use Microdata Sample. 4. American Association of Colleges of Nursing. 2012. Survey, 2011-2012 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.
5. CMS (Center for Medicare & Medicaid Services). 2013. Graduate nurse education demonstration. http://innovation.cms.gov/initiatives/gne (accessed October 2, 2012).
Suggested citation: Fineberg, H.V., and R. Lavizzo-Mourey. 2013. The future of nursing: A look back at the landmark IOM report. Commentary, Institute of Medicine, Washington, DC. http://www.iom.edu/nursingcommentary.