The Institute of Medicine’s “Future of Nursing” Report: Key Messages

In 2010, the Institute of Medicine (IOM) released its groundbreaking report “The Future of Nursing: Leading Change, Advancing Health.” This IOM report had and continues to have an impact on nursing at the individual, organizational, and policy levels that is almost impossible to overstate.

The ultimate goal of the Institute of Medicine “Future of Nursing” report is to improve health care and patient outcomes for diverse populations across the lifespan, with nursing as a critical element required to meet that goal. The IOM report details the way changes in health care due to technology, demographics, and other factors are affecting expectations and demands on nursing. It also presents specific recommendations for how the nursing field can take collective action to adapt policies, education, and practice to successfully adapt to this shifting environment.

This is the first of three articles summarizing the IOM “Future of Nursing” report. This article explores the four key messages of the report, which outline the major areas of transformation. These summaries should help nurses who are considering furthering their education understand how the IOM report will affect their practice, both at their current education level and with an advanced degree.

Key Message No. 1:

Nurses should practice to the full extent of their education and training.

Nurses may have an exceptional amount of education and experience, but the reality is that there are various barriers that may not allow them to use it to their full potential. Obstacles include:

  • Historical, regulatory, and policy barriers.
  • A complex, fragmented health care system.
  • Rocky transitions from nursing school to practice.

The IOM report found regulations to be a particularly limiting factor that create inflexible working environments. For example, each state has its own Nurse Practice Act that covers education program standards, scope of practice, licensure requirements, and more. The report stressed that politicians, not the medical establishment, decide such legislation.

Differences in nursing scope-of-practice also occur across specialties, settings, and organizations, leading to a lack of consistency in the health care industry. The ”Future of Nursing” report also noted a need for more structures and resources to support new nursing graduates in the transition from school to work.

Key Message No. 2:

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

The Institute of Medicine “Future of Nursing” report pointed out that nursing core competencies have greatly expanded in the last several decades, encompassing public health, geriatrics, leadership, teamwork, and change management, to name just a few. In addition, nurses are caring for complex patients, using more technology, and digesting and synthesizing information from a variety of sources.

All of these factors point to a need for more education that is structured to provide a direct and simple progression to higher degrees. While many such programs are in place already, such as RN-BSN programs, the IOM report suggested that the progression be expanded.

The report also noted that online programs, such as the online RN to BSN and online MSN degree programs offered at the University of Saint Mary, are an example of the type of innovations being used to help more nurses earn higher degrees.

Key Message No. 3:

Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States.

As full partners in health care, nurses must take responsibility for their contributions to patient health and work collaboratively as a team with other health care professionals, from doctors to dietitians.

To achieve and further this goal, the IOM report suggested that leadership skills be recognized as a core competency at all levels of nursing, and should be implemented throughout nursing curricula. As nursing leaders, nurses should:

  • Identify problems and inefficiencies.
  • Design and implement strategies for improvement.
  • Assess the effectiveness of those strategies.
  • Adjust and/or redesign strategies as needed.

The IOM also stated that nurses should take on leadership responsibilities on a policy level in addition to their own practice, “from the bedside to the boardroom,” as the report put it. “Nurses must see policy as something they can shape rather than something that happens to them.” Joining committees, commissions, and boards will give nurses a voice in policymaking.

Key Message No. 4:

Effective workforce planning and policy making require better data collection and an improved information infrastructure.

The IOM “Future of Nursing” report recommended that the health care industry create an organized method of collecting detailed data on:

  • The numbers and types of health care professionals across the U.S.
  • Where they are employed.
  • Their roles, activities, and duties.

This information will help identify where health care needs are being met and where they are falling short, as well as illustrate possible overlaps in responsibilities and tasks among primary care providers. It can then be used to assess and plan for future nursing workforce requirements more effectively, and can also help suggest and guide any necessary changes to nursing practice and education.

Of course, collecting and coordinating all of this is a massive undertaking. The Affordable Care Act authorized the creation of a National Heath Care Workforce Commission and a National Center for Workforce Analysis, which will help get efforts for this information collection and analysis underway. The IOM report strongly suggested making the public and timely monitoring, review, and coordination of current health care workforce data a priority for these organizations.

The Institute of Medicine “Future of Nursing” report also offered eight recommendations as a roadmap to achieve the goals outlined in its key messages. The next two articles in this three-part series will cover those recommendations. You can also learn how the online RN to Bachelor of Science in Nursing and Master of Science in Nursing degrees at the University of Saint Mary align with the goals and core competencies suggested by the IOM report to help prepare you for the exciting changes and challenges in nursing today.