IOM's Nursing Workshop Pushes for Greater Nurse Involvement in Care

Overcoming challenges in nursing is essential to overcoming challenges in the healthcare system as a whole, according to a new workshop summary report released Wednesday by the Institute of Medicine.

In October 2009, the Cedars Sinai Medical Center in Los Angeles hosted the first of three public forums of the Initiative on the Future of Nursing, a collaborative effort between the Robert Wood Johnson Foundation (RWJF) and IOM. This forum focused on quality and safety, technology, and interdisciplinary collaboration in acute care; and speakers suggested new strategies to allow nurses to provide higher quality care.

Most nurses work in hospitals or other acute care settings, where they are the patients' primary, professional caregivers and the individuals most likely to intercept medical errors, the summary said. However, since hospital systems and acute care settings are often "complex and chaotic," many nurses spend unnecessary time hunting for supplies, filling out paperwork, and coordinating staff time and patient care—reducing the time they are able to spend with patients and delivering care.

While a number of important points emerged at the forum, several resonated with panel members:

• The knowledge of frontline nurses gathered from their interactions with patients is critical to reducing medical errors and improving patient outcomes.
• Nurse involvement at a variety of levels across the acute care setting—in decision-making and leadership—benefits the patient, improves the organizations in which nurses practice, and strengthens the healthcare system in general.
• Expansion of the time that nurses spend at the bedside is an essential component of achieving the goal of patient centered care.
• High quality acute care settings require integrated systems that use technology effectively while increasing the efficiency of nurses—and giving them increased time to spend with patients.
• Multidisciplinary care teams—characterized by "extensive and respectful collaboration" among team members—improves the quality, safety, and effectiveness of care.
• Many of the innovations that need to be implemented in the healthcare system already exist somewhere in the U.S., but barriers to their dissemination keep them from being adopted more widely.

The IOM committee, which is chaired by University of Miami President Donna Shalala, will take the workshop findings and develop a set of recommendations that are expected to be released this fall.