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The Institute of Medicine’s “Future of Nursing” Report: Recommendations, Part I

The first article in this three-part series explained the key messages of the IOM “Future of Nursing” report. This piece covers the first four of the eight recommendations in detail. Many of the nurses who come to the University of Saint Mary to earn their RN-Bachelor of Science in Nursing or Master of Science in Nursing online want to know what implications, if any, the IOM report will have on their career. This series is intended to clarify its potential effect on nursing as well as health care in general.

The Institute of Medicine’s report “The Future of Nursing: Leading Change, Advancing Health,” released in 2010, has been adopted as a roadmap for improved nursing practice in the 21st century. This IOM report offered four key messages as to how nursing should evolve in response to the current and future health care environment, as well as eight recommendations for specific ways to pursue and successfully realize the goals contained in the key messages.

The current state of the U.S. health care system is so complex that the IOM created a specific blueprint of initiatives and actions that can support the transformation in nursing for the 21st century and beyond. These actions involve a wide variety of groups and stakeholders, including federal, state, and local government agencies; state and national legislative bodies; nursing associations and professional groups; academic institutions; and community groups. The recommendations pave the way for this massive undertaking by spelling out specific action items for particular groups, providing a detailed blueprint for affecting change in the nursing profession nationwide.

Recommendation No. 1:

Remove scope-of-practice barriers.

One of the key messages of the report stated that registered nurses should be empowered to practice to the full extent of their education and training. State laws regulating the practice of nursing vary widely, as do rules in different settings and organizations. A nurse in an Oklahoma outpatient clinic may not be legally able to provide the same services as a nurse in another facility in Michigan, even if the two have the same education and experience.

The Institute of Medicine “Future of Nursing” report recommended several steps that could be taken by government agencies as well as federal and state legislative bodies. These included expanding the Medicare program to cover certain nursing services as well as to only provide federal funding for nursing education programs to states that have adopted the National Council of State Boards of Nursing rules and regulations regarding specific types of nursing practice.

The report also called on the Federal Trade Commission and the Antitrust Division of the Department of Justice to review state regulations on nurses that restrict the services they can offer. As a result of this recommendation in the “Future of Nursing” report, in 2014 the Federal Trade Commission released a policy paper that found expanding the scope of practice for certain nurses “is good for competition and American consumers.”1

Recommendation No. 2:

Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.

This recommendation promotes the idea that nurses should take an even more active role in collaborations with doctors and other health care professionals. Nurses have a unique, front-line perspective of health care, and the IOM report suggests leveraging their experiences and knowledge to research, redesign, and improve patient care at all levels.

Specific suggestions from the IOM “Future of Nursing” include:

  • Health care organizations should provide more support and encouragement for nurses to take a proactive role in developing and implementing innovative, patient-centered models for care.
  • Engage nurses and other front-line staff to provide input and feedback on the design, development, implementation, and evaluation of health information technology products and medical devices.
  • Professional nursing organizations and associations, as well as nursing education programs, should provide entrepreneurial training and development, which can help nurses create business and programmatic initiatives that can help improve care.

Recommendation No. 3:

Implement nurse residency programs.

The IOM report found that a residency period could help ease nurses’ initial transition from education to clinical practice (or the transition to a different clinical practice). Such residency programs can provide nurses with critical psychological and professional support in challenging settings or situations and can help prevent excessive turnover and burnout.

To promote the creation of residencies, the IOM suggested:

  • Educational funding for diploma nursing programs should be redirected to implement nurse residency programs in areas facing a critical lack of health care access, such as rural areas.
  • Other funding for nurse residencies across all practice settings should be procured from health care companies, government agencies, and philanthropic organizations.
  • Nurse residency programs should include evaluation planning to assess their ongoing effectiveness in increasing nurse retention rates, building core competencies, and improving patient outcomes.

Recommendation No. 4:

Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.

This recommendation has received a lot of attention from the media and the nursing field. Health care has grown so complex that nurses today need skills in critical-thinking and evidence-based practice — skills that are researched and refined in Bachelor of Science in Nursing degree programs.

This initiative has led to more flexible baccalaureate nursing programs designed to accommodate the schedules of working nurses, such as the online RN-BSN from the University of Saint Mary. The IOM report included other suggestions for encouraging more nurses to earn a BSN:

  • Nursing accrediting bodies should require nursing schools to go beyond articulation agreements and provide defined academic pathways for nurses to achieve higher levels of education. The RN-BSN is an example of an academic pathway that has gained traction.
  • To encourage nurses with associate’s degrees and diplomas to earn their BSN within five years, health care companies and organizations should offer tuition reimbursement, promote a culture that fosters and encourages more education, and provide salary increase and promotion opportunities for BSN-educated nurses.
  • Nurse leaders in academia should partner with health care organizations, as well as administrators in secondary school systems and other community organizations, to encourage and recruit nursing students from diverse backgrounds.

The transformation of nursing is already underway. The University of Saint Mary is doing its part to help prepare more nurses for the challenges of health care through the online RN to Bachelor of Science in Nursing and Master of Science in Nursing degrees.

The next article will complete the series on the IOM “Future of Nursing” report with a summary of the final four recommendations.

1“FTC policy paper examines competition and the regulation of APRNs, "The American Nurse", July 3, 2014, available at