What nursing recommendations are published in the IOM report the future of nursing?

Ten years ago, the Institute of Medicine (IOM) issued a report with eight recommendations for how nurses could improve healthcare in the United States.

The goal of the IOM Future of Nursing report, titled “The Future of Nursing: Leading Change, Advancing Health,” was to provide a prescription for nurses to facilitate the nation’s shift from hospital-based services to a system focused on prevention and wellness in the community. It was a bold move that has influenced nursing education and practice for the past decade.

In response, the Robert Wood Johnson Foundation and AARP launched a campaign — The Future of Nursing: Campaign for Action — to advance the IOM Future of Nursing report’s recommendations and created action coalitions in all 50 states and Washington D.C.

Sue Hassmiller, PhD, RN, FAAN

With the 10-year anniversary of the report rapidly approaching, leaders like Sue Hassmiller, PhD, RN, FAAN, director of the Campaign for Action, are prepared to show the progress that’s been made and areas that need more attention.

One of the campaign’s goals was to increase the number of nurses with baccalaureate degrees, because nurses with more training are better equipped to manage the increasing complexity in nursing care, according to the IOM report. In 2010, 49% of employed nurses in the U.S. had BSN degrees, compared to 56% in 2017, according to IOM report updates.

“The number of nurses who have earned BSNs has gone up dramatically, and even more than we anticipated,” Hassmiller said.

And 2012 marked the first year in the nation’s history that the number of nurses graduating with BSN degrees surpassed the number earning associate degrees.

In California, the percentage of BSN graduates increased from 54% in 2010 to 60% in 2017. Much of that progress can be attributed to the fact that the state’s action coalition worked to foster academic partnerships between universities and community colleges, said Mary Dickow, MPA, FAAN, program director for HealthImpact.

HealthImpact is an organization based in Oakland, Calif., that works to improve healthcare in California through innovation, interprofessional leadership and nursing excellence.

“We wanted to create a system that was as seamless as possible for students to progress from an associate degree program to a BSN program,” Dickow said.

In Los Angeles, for example, academic leaders from local community colleges worked with leaders from the California State University system to address barriers preventing students from graduating. In these schools, a high percentage of students were racial and ethnic minorities who needed support with academic and financial challenges, so the schools started pairing these students with navigators who could provide guidance.

Mary Dickow, MPA, FAAN

Students also often struggled to complete their clinical rotations during the day because they were juggling jobs with the demands of nursing school. This prompted the schools’ clinical partners to allow more flexibility when scheduling hours for students.

Now, California plans to launch the state’s first concurrent enrollment system, which will allow students to be concurrently enrolled at Riverside Community College and either California State University Fullerton or CSU San Bernardino.

This new system allows students to receive financial aid from both institutions while completing the program, Dickow said. In the past, students had to pay out of pocket to complete the university requirements. If students remain enrolled full-time in the program, they will complete their BSN coursework six months after earning an associate degree in nursing.

IOM Future of Nursing: Scope of practice and workforce diversity

Significant strides have been made related to increasing the number of nurse practitioners who can work as primary care providers — an IOM Future of Nursing goal aimed at increasing access to care.

Since 2010, nine states — Connecticut, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Rhode Island, South Dakota and Vermont — have removed legal barriers that restricted nurse practitioner practice. Now NPs are allowed to provide full care in 22 states and the District of Columbia.

In 2016, the Veterans Administration agreed to allow nurse practitioners, clinical nurse specialists and nurse-midwives to practice without the supervision of a physician, regardless of the practice restrictions in the state where the VA facility is located.

Another goal highlighted in the IOM Future of Nursing report was the need to increase diversity in the nursing workforce because this would facilitate a deeper understanding of the factors that affect patient health and emotional well-being.

While Hassmiller is pleased that about 30% of all graduates were minority nursing students in 2017 — an increase of about 7% from 2010 — she acknowledged that more Hispanic nurses are needed. Hispanics and Latinos represent nearly 20% of the U.S. population, but less than 10% of the nursing workforce.

Though progress has been slow in this area, Colorado has had more success with increasing diversity.

When Karren Kowalski, PhD, RN, NEA-BC, FAAN, became president and CEO of the Colorado Center for Nursing Excellence in 2011, she was concerned about the lack of diversity in her state’s nursing workforce.

“I saw that about 6% of the nurses were Hispanic, and our state projection for the Hispanic population was 40% by 2035,” she said. “I knew we had to do something about this.”

With grant money from the Robert Wood Johnson Foundation, Kowalski’s team studied the problem and discovered that minority nursing students were often dropping out.

“We believed that the most powerful thing to help them was mentoring from a working nurse,” she said.

The center was awarded a diversity grant from the federal Human Resources and Services Administration (HRSA) to fund a new mentoring program, which included a two-day training for nurses to become mentors. The nurses learned how to talk to students and about financial, tutoring and travel resources to support mentees.

“One of the critical lessons for mentors was learning the importance of letting students do more of the talking,” Kowalski said. “We encourage mentors to ask students questions and serve as a sounding board to help them solve problems.”

The program launched in 2015 and now provides mentoring to 40 students each year. It has been so successful that 90% of these students graduate each year.

IOM Future of Nursing: Leadership and the future of nursing

While it may take many years to increase diversity in the workforce, Hassmiller is optimistic that the IOM Future of Nursing report’s recommendation related to nursing leadership is achievable in the near future.

To increase the number of nurses on boards, the Campaign for Action helped found the Nurses on Boards Coalition, which matches nurses with board opportunities that fit their interests and areas of expertise. As of June 2019, more than 6,200 nurses reported serving on boards, and the organization’s goal is to boost that number to 10,000.

Progress like this has spurred RWJF to fund yet another future of nursing study. This time, the focus is on the nurse’s role in addressing the social determinants of health and health equity.

Hassmiller is serving a two-year term as National Academy of Medicine Senior Scholar in Residence and Adviser to the President on Nursing to help lead the study.

The report will be launched in December 2020, and the committee chairs are inviting nurses throughout the country to become involved by attending or listening to live webcasts of Town Hall Meetings.

Nurses also can send any comments, reports or relevant studies for the committee to consider to [email protected]

What recommendation did the IOM Future of nursing report in 2011 make for nurses?

What was one of the major points or recommendations in the future of nursing leading change advancing health report?

What influence does the IOM report have on nursing education and nursing leadership?

What was the purpose of the IOM report?