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IOM's Long Road to Reform Nursing Begins

 |  By  
   December 14, 2010

In October, the Institute of Medicine released its landmark report, sponsored by the Robert Wood Johnson Foundation, The Future of Nursing: Leading Change, Advancing Health. The report outlines how nurses are crucial to meeting the country's healthcare needs and says that to handle the increasing complexity of care and greater responsibilities, nurses will need higher levels of education and training.

The report calls for 80% of RNs to have BSNs by 2020 and for the number of nurses with doctorate degrees to have doubled in the same timeframe.

Recently, the IOM took the first step in outlining how to make this happen. The National Summit on Advancing Health through Nursing, held November 30 — December 1, in Washington, DC, brought decision makers and thought leaders—including Don Berwick—together to discuss how to implement the report's recommendations.

"The Foundation is committed to using the IOM Future of Nursing report as it is intended to be used, as a roadmap for future direction and action," said Risa Lavizzo-Mourey, president and CEO of RWJF said in a statement."We are doing this by convening leaders from all sectors, both public and private to join us as partners in this national movement to make these recommendations a reality."

The Future of Nursing: Campaign for Action, is working on five main areas:
• Preparing and enabling nurses to lead change
• Improving nursing education
• Removing barriers to practice
• Creating an infrastructure for interprofessional healthcare workforce data collection
• Fostering interprofessional collaboration

To begin with, the campaign has enlisted five states to work on developing best practices and programs that can be replicated elsewhere. These Future of Nursing Regional Action Coalitions (RACs) are located in New Jersey, New York, Michigan, Mississippi, and California. They have been tasked with capturing best practices, determining research needs, tracking lessons learned, identifying replicable models, connecting with the other RAC programs, and monitoring progress.

The stewards of the IOM report have a huge task on their hands. Some of their recommendations seem positively Herculean, such as the call for 80% of the country's RNs to have baccalaureate degrees by 2020. As I wrote in the summer, this issue has been argued about in nursing for decades and no topic has the capacity to divide the rank and file of the profession quite like this one.


Yet evidence shows that higher-educated nurses produce better patient outcomes. We also know that to fulfill the recommendations of the committee, and meet the future healthcare needs of the country, we need a well-educated, well-trained nursing workforce.

Another Herculean battle to overcome is the recommendation that scope of practice barriers be removed. The state-by-state differences in the regulations regarding advanced practice nurse practitioners are absurd. That one state considers nurse practitioners competent to see patients and prescribe medications independently while another requires physician oversight to do the same is ludicrous.

Meeting the needs of our aging population is going to require multitudes of healthcare providers of varying levels and specialties, and it only makes sense to use our limited resources to the extent of their capabilities and to find ways for everyone to work together for the good of patients.

It will be interesting to follow what happens as the real work begins.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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