The Impact of 2010 IOM Report Peer Reviewed Journal

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2010 IOM Report

The Impact of 2010 IOM Report: "The Future of Nursing, Leading Change, Advancing Health"

One 2010 report of the IOM (Institute of Medicine) advised the profession of nursing that it needs to change in order to meet growing demands resulting from novel technologies, the aging population, and health reform (Fackelmann, 2013). This report included eight recommendations and four messages aimed at bettering U.S. nursing practices; their influence has been felt across the world. When provided proper preparation and motivation, nurses can occupy the sharp end in moving towards healthcare reform. Irrespective of political leanings or educational level, it may be agreed upon that the present U.S. healthcare structure has innumerable inefficiencies, which impair patient outcomes and increase costs (Hooper, 2011, p. 131). The focus of this paper is the IOM report's effect on current and future nursing practice, and required changes.

Four Key Messages

How is this currently impacting nursing practice?

Healthcare organizations that sincerely desire a well-educated workforce must go beyond existing 'soft policies' to adopt more stringent measures/requirements (e.g., degree completion, wages rewarding nurses with Bachelor's or higher degrees, etc.). However, the probability of organizations adopting these sorts of measures in the near future will, at the least, be partly guided by nurse demand and supply. Further, hospitals offering residency programs will more likely provide other training as well. This finding indicates that hospital culture might be giving high priority to both types of training. This value apparently goes beyond a straightforward calculation of cost savings depending on nurse turnover reduction (Fackelmann, 2013).

Section 2: How will this impact future nursing practice?

According to IOM's report, nurses possess considerable potential for leading innovative strategies and improving the nation's healthcare structure. But the healthcare sector hasn't been tapping into their full potential. Also, nurses fail to practice to their complete extent, owing to various barriers, which include:

1. policy and regulatory barriers

1. healthcare system fragmentation

1. high nurse turnover rates

1. difficult school-practice transition for nurses

1. demographic challenges including an aging healthcare/nursing workforce (Garner, 2010)

One recommendation in the report is that healthcare organizations, nursing schools and insurers ought to expand nurses' opportunities for leading efforts in practice improvements and conducting research. The aim is creating care delivery and payment models that have nurses' expanded, leadership roles for reducing costs and improving health outcomes. Nurses constitute the largest healthcare worker segment; hence, they ought to play a key role in healthcare reform achievement (Garner, 2010).

Section 3: What will need to happen for these changes to occur?

Several nursing institutions have addressed rapid health knowledge and research growth by compressing existing information into their curricula and adding content requiring further instruction. Novel educational models and approaches have to be developed for responding to burgeoning health-related information. For instance, fundamental concepts applicable across different settings and situations must be taught, and rote memorization discouraged. Moreover, competencies should move to higher-levels from task-based competencies and provide a basis for decision-making competencies and care management-related knowledge, under various care settings and clinical scenarios. Also, novel emerging decision-making competencies, as well as competencies in team leadership, quality improvement, and systems thinking should be made integral to the professional formation of all nurses (The National Academies of Sciences, Engineering and Medicine, 2011).

Section 4: How can nurses be involved?

Full partnership transcends every nursing professional level and necessitates leadership competencies and skills which should be applied in practice and by collaborating with other healthcare workers. In care settings, full partnership involves being responsible for determining waste areas and issues, planning and implementing an improvement strategy, tracking improvement, and effecting required adjustments for achieving set goals. More broadly, full partnership translates to the domain of health policy. For succeeding in re-conceptualized jobs, nurses should view policy as a thing to shape and not something happening to them. They must have a role in decision-making related to health policy and engage in healthcare reform implementation. Lastly, nurses must be active members of advisory committees, boards, and commissions, where policy decision-making is carried out for advancing health systems, thereby improving care quality (Institute of Medicine U.S., 2011).

Eight Recommendations

Section 1: How is this currently impacting nursing practice?

A couple of latest researches conducted by George Washington University's SPHHS (School of Public Health and Health Services) scholars address how well healthcare organizations perform in terms of effecting nursing reform.

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Pittman and coworkers examined how far healthcare organizations have implemented an important IOM recommendation -- achievement of a nursing workforce with 80% Bachelors' degree holders by 2020, in one study. For gauging how well this recommendation fares in practice, the study surveyed 447 nursing leaders in hospitals, hospice and home care, and nurse-led facilities. Almost 80% of participants claimed their organization required or favored new hires with bachelor's degrees. Furthermore, 94% of facilities were found to offer certain tuition reimbursement for encouraging nurses to complete their Bachelor's degree (Fackelmann, 2013).

How far healthcare organizations adopt nursing residency programs -- another key IOM recommendation -- was the focus of the other study. The same research team surveyed hospital nursing leaders and discovered that, in spite of hospitals' financial challenges and increased nurse supply, owing to the economic downturn, 37% of hospitals were already offering nurse residency in 2011, with only a fifth of them sponsored externally (Fackelmann, 2013).

Section 2: How will this impact future nursing practice?

IOM's 2010 report demands a nursing workforce with 80% Bachelor's degree holders by 2020. Currently, half the nation's nurse workforce meets this requirement. Succeeding in this goal is vital to another recommendation - that nurse PhDs increase twofold by 2020. But these goals cannot likely be met if there is no legislation mandating that fresh nurses earn their Bachelor's degree in a reasonable time period (Edwards, 2012). Nursing school leaders must collaborate with accrediting agencies, healthcare organizations, and public and private sponsors for ensuring financing, monitoring progress, and increasing student diversity, for creating a workforce equipped to satisfy a diverse patient population's demands (Morris, 2014, p. 20).

Substantial rise in the number of graduate nurses is crucial to guaranteeing a sufficient number of qualified nurses at patient bedsides, abundant credentialed nurse faculty for every educational level, increased advanced practice nursing professional for delivering primary care with enhanced care access, new nurse research scholars to add to the nursing profession's evidence base, and well-qualified senior executives and nurse administrators for guiding achievement of acceptable patient care outcomes. A 2012 Labor Statistics Bureau report projected that 712,000 fresh registered nurse posts, 706, 000 home healthcare aide and 607,000 personal care aide posts will be included in the workforce from 2010 to 2020. Further, nurses coach and supervise newly appointed healthcare personnel (Edwards, 2012).

Nursing organizations are seen to add their voices collectively. The American Association of Critical-Care Nurses, in 2010, expressed concerns regarding sufficient nurse faculty availability, citing currently increasing rates of vacancy, which would rise dramatically in the next decade with faculty retirement. They requested lawmakers to take definitive action for maximizing nursing graduate program enrollment (Edwards, 2012).

Section 3: What will need to happen for these changes to occur?

Leadership is required at all levels. The program, "Transforming Care at the Bedside" has succeeded in engaging nurses, and empowers floor nursing staff to recommend changes for patient care improvement. After short-term testing, changes that prove valuable are implemented permanently. The program resulted in improved health outcomes, including reduced hospital falls with injury/harm and 1-month re-hospitalization rates (Reinhard & Hassmiller, 2012).

Inter-professional collaboration is critical to IOM recommendation implementation. Research has depicted enhanced patient care safety and quality due to effective health professional communication and coordination. Integration/team work draws on collective and individual experiences and skills across disciplines. Everybody's input is sought and contributions respected. This allows higher-level practice by all workers. The end result is undoubted patient outcome improvements, including higher patient satisfaction levels (Reinhard & Hassmiller, 2012).

Information should be gathered for better assessing healthcare needs. IOM's recommendations attempt at improving data collection of healthcare workforce for better assessing and projecting workforce needs. Research in this area is fragmented; data must reveal combined professional healthcare demand and supply in different regions, rather than concentrating separately on each profession (Reinhard & Hassmiller, 2012).

Further, IOM recommendations necessitate healthcare worker diversification. Roughly 33% of the nation's population belong to an ethnic/racial minority group. Still, minorities account for only 18% of nurses. By 2050, Latinos, African-Americans, Asians, and Alaskan Natives/American Indians will dominate the nation's population. The profession of nursing must reflect its patient population, and every nurse must deliver culturally-sensitive care (Reinhard & Hassmiller, 2012).

Section 4: How can nurses be involved?

Nursing professionals bring a prominent voice and viewpoint to policy and management discussions. A larger number of nurses.....

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