The Affordable Care Act (ACA) is the biggest change and evolution to occur to healthcare in the United States since the foundation of Medicare and Medicaid services in 1965 The ACA calls for a transformation of healthcare to provide a safer, more affordable, more accessible and higher quality of medical care. In 2008 the Robert Wood Johnson Foundation (RWJF) called to partner with the Institute of Medicine (IOM) and in a two-year study attempted to redesign the future of nursing. The purpose was to create a blueprint on how to recreate the nursing profession in order to accommodate, participate, and lead the current necessary healthcare reform. As a result of this study several conclusions were made. Nurses should be allowed to practice to the full extent of their education. Nurses should improve and increase their education. Nurses should be allowed to assume leadership positions and be full partners in healthcare redesign. Date collection and information infrastructure needs to be improved upon. (IOM, 2010)
Nurses play an integral part in healthcare and as the largest segment of the healthcare force, they contribute in all sectors from the trenches, to the acute care setting, to the community and schools, and in the post-acute care setting. As nurses take on bigger roles, it is imperative to increase their education. One such proposed milestone is to have 80% of the nurses hold a baccalaureate degree by 2020. The general goal is for the Licensed Practical Nurse (LPN) to become an Associate Degree Nurse (ADN), and the ADN to become a Bachelor of Science Nurse (BSN), the BSN to pursue their Masters degree, and so forth. Another milestone called for the doubling of the number of Doctorate in Nursing Practice (DNP) by 2020. The progression and advancement of nursing education should progress in a seamless fashion, and it should serve as a basis for lifelong education. These higher levels of education will allow nurses to better collaborate with other healthcare professionals and coordinate the patients care.
As nurses increase their educational levels, it prepares them for playing a bigger and more significant part in the delivery of health care, particularly in areas where there are significant shortcomings. Currently there is concern for the shortage of access to primary care in the United States. The goal of increasing education is to empower the nurse to help meet this shortfall, and bridge the current gap that exists. Today there are 287,000 primary care physicians, 83,000 nurse practitioners (NP’s), and 23,000 physician assistants (PA’s) meeting the primary care needs in the US. (IOM 2010; The Future of Nursing: Leading Change, Advancing Health) Although the number of NP’s and PA’s has been increasing in recent years, there has been a decline in the number of medical students and residents entering primary care. As increasing access to services grow under the ACA, so will the number of advanced practice registered nurses (APRN’s) need to increase in order to keep pace.
In light of this report, nurses all over should seek to increase their educational level, as well as their involvement with various committees and nursing organizations in order to be able to proactively manage and lead healthcare reform. It is clear from the IOM report that they demand that nurses have advanced degrees. I would speculate that at some point the entry level into nursing would have a minimum of a bachelor’s degree, along with required continuing education from an institutional standpoint as well as from state boards. Nurses are in a unique position to help contribute significantly to the necessary changes in our current healthcare system. In order to accomplish this goal, we need take a more active role in leadership.
The third message of the IOM report is that nurses should be allowed to take leadership positions and become full partners in the redesign of our healthcare system. Nurses are again uniquely well suited to this position, as this requires a new kind of leadership, not one that just gives direction, but rather one that requires working in partnership with mutual respect and collaboration. The political process needs to be engaged effectively, and the language of policy needs to be spoken, and they should have a voice in health policy decision-making, be involved in all efforts as it relates to health care reform. Nurses should be involved in advisory committees and boards making policy decisions to improve health systems and to enhance patient care and improve outcomes.
Although the IOM report is a tipping point for nurses in America, it is not a report about nursing but rather a report on the missing piece in today’s healthcare. It does propose profound change, and will be considered controversial due to the fact that it is consequential. Previous IOM reports such as “To Err is Human” have effected significant positive change in patient outcomes and healthcare. This reports calls for nurses to increase their educational level, become better trained for a wider range of responsibilities, and to take their rightful place in leadership.
The Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health http://www.nap.edu/openbook.php?record_id=12956&page=88