Introduction
The findings and implications of the “Institute of Medicine Future of Nursing Report” (IOM) have immensely challenged the entire health care sector and the nursing profession (Chard, 2013). The report not only addressed the existing issues in nursing practices, workforce planning, medical education, policymaking, quality improvement, technology, and patient safety but also provided sweeping recommendations to resolve them (Johnson, Veneziano, Malast, Mastro, & Moran, 2012). Four out of these recommendations directly emphasize the development of a new way to educate nursing practitioners and change the scope of practice to the full extent for them (Johnson, Veneziano, Malast, Mastro, & Moran, 2012). In this regard, the following essay outlines the effects of the IOM Report on nursing practice and teaching pedagogy by providing a detailed analysis of different barriers that advanced practice nurses and educators might face in achieving the positive outcomes of the expanded scope of practice.
Scope of Practice
Scope of practice is the particular domain in which nurse practitioners are considered competent to deliver certain medical services and are authorized to take necessary measures for the safety of patients independently without the supervision of physicians (Orsolini-Hain, 2012). Nurses play an essential role in the development of the health care system by leading innovative strategies. However, they often face many regulatory, historical, and policy restrictions such as fragmentation of the healthcare system, difficulties in the transition to practice from school, and many demographic challenges to utilizing their full potential for the transformation of healthcare on a large scale. The barriers mostly result from the weak structure of the US health care system. One such issue is the varying regularizations of the scope of practice across different states. For instance, some states permit nurse practitioners to examine patients without the supervision of physicians and allow them to prescribe medications accordingly before formal approval from them. However, the majority of the states do not have such regulations.
It implies that nurses are not allowed to practice merely based on some political decisions which have no concern with their education, training, ability, or safety of the patients. Therefore, the scope of practice determined by the restrictions of states’ administration can limit the advanced practice nurses to prescribe medications, assess patient conditions, admit them to hospital and analyze different tests (Battié, 2013). In this regard, the IMO report targets all nurses and recommends them to prepare for the full scope of their training and education as well as asks the government to remove restrictions of the scope for advanced practice nurses. They are skilled clinicians and can contribute significantly to the expansion and innovation of the US healthcare sector. Also, due to the increasing population of elderly people in the United States, this step can provide the much-required support of thousands of professional nurses to the healthcare sector that is struggling to provide necessary treatment and meet the needs of millions of patients. In this way, advanced practice nurses will assume the leading position to redesign the service delivery as well as innovate patient-centered care practices by the use of technology.
Effects of IOM Report on Nursing Practice and Teaching Pedagogy
The recommendation of the IMO report challenges nurses at all levels of education, training, and practice to exhibit entrepreneurial skills and improve service delivery. It also requires educators to ensure collaborative interdisciplinary education because this is the fundamental requirement for interdisciplinary cooperation in practice. In this way, nurses can also have a higher level of education and training at the primary levels that will ensure their seamless progression towards an advanced degree. Ultimately they will be able to work with other professionals as their full-time partners not just as a facilitator by participating in interdisciplinary teams and implementing an evidence-based practice that will lead to the effectiveness of the workplace. They will also contribute to effective policymaking by collecting and analyzing data for the improvement of practical environments (Chard, 2013).
However, the key message of the report is not solely for nurses. It also addresses all educators and administrators. For example, its 3rd recommendation highlights the importance of implementation of nurse residency programs and invites specialties as well as advanced practice nurses to experience them that traverse all practice settings. These programs cannot be designed, implemented, and evaluated without the mutual collaboration of the education and healthcare sectors. These factors can enhance the influence of nursing educators beyond the scope of graduation to add value to health care organizations because their teaching expertise and pedagogy will serve the success of such programs (Orsolini-Hain, 2013).
The barrier to Advanced Nursing Practice
According to Barbarito (2016), the right of APRNs to prepare for the full scope of their training is a controversial matter that has halted the states’ legislation to remove the barrier of the scope of practice for many years while legislation is still pending in some states. For instance, a severe backlash was received on IMO report from many physician groups such as the “American Medical Association” who argued that these recommendations would not necessarily improve the quality of healthcare service since nurses and physicians differ significantly in their education and training. But these claims do not have any empirical support as mentioned by Barbarito (2016), that the research literature explicitly describes that well-educated, trained, and experienced nurses can perform as better as physicians. In this regard, the potential barrier that will impede the advanced practice nurses is their perceived competition with physicians that will unfavorably disturb the quality, price, and accessibility of the healthcare services. Therefore, the direct consequences of this under-rationalized competitive effect will be experienced by patients and consumers directly resulting from the arbitrary regulations (Barbarito, 2016).
Outcomes of IOM Recommendations
The number of nurse practitioners is relatively large as compared to that of physicians who enter into internal medicine or primary care. This shortage was predicted almost a decade ago regarded to many factors such as uprising demand for healthcare caused by the aging of the “baby boomer” generation, decreased supply, increased retirement of primary physicians, and low interest from medical students. This shortfall has impacted especially the poor urban and remote rural areas. Therefore, advanced practice nurses unsupervised by physicians can fill this gap that a large population of older people is facing regarding their medication.
Moreover, the expanded scope can bring several economic benefits as one study showed that Massachusetts saved around $4.2 to $8.4 billion by its legislation. Considering all these positive outcomes, the “California Future Health” and “Workforce Commission” recommended the extension of the scope of practice to mintage the expected risks from the shortage of more than 4100 clinicians (California Future Health Workforce Commission, 2019). This act will also improve the health facilities in underserved communities of rural areas that do not have direct access to physicians. The primary role of the state administration is to achieve this all by legalizing the full scope of practice for advanced practice nurses.
Conclusion
The expanded scope of practice as per the recommendations of the IOM report has very diverse advantages for the healthcare sector. It can potentially bridge the gap between the number of elderly patients and clinicians by bringing many economic benefits. However, this is not possible without the proper support of legislation authorities that can effectively address the projected barrier of competition between nurses and physicians that can result from the expanded scope of practice.
References
Barbarito, A. J. (2016). Expanding the Scope of Practice for Advanced Practice Registered Nurses: A Legislative Call to Action. Retrieved from Law School Student Scholarship website: https://scholarship.shu.edu/cgi/viewcontent.cgi?article=1711&context=student_scholarship
Battié, R. N. (2013). Perioperative Nursing and Education: What the IOM Future of Nursing Report Tells Us. AORN Journal, 98(3), 249–259. https://doi.org/10.1016/j.aorn.2013.07.004
California Future Health Workforce Commission. (2019). Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission. Retrieved from https://futurehealthworkforce.org/
Chard, R. (2013). The Personal and Professional Impact of the Future of Nursing Report. AORN Journal, 98(3), 273–280. https://doi.org/10.1016/j.aorn.2013.01.019
Johnson, J. E., Veneziano, T., Malast, T., Mastro, K., & Moran, A. (2012). Nursing’s future: What’s the message? Nursing Management, 43(7), 36–41. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=1367058&Journal_ID=54013&Issue_ID=1366930
Orsolini-Hain, L. (2013). The Institute of Medicine’s Future of Nursing Report: What are the implications for associate degree nursing education? Teaching and Learning in Nursing, 7(2), 74–77. https://doi.org/10.1016/j.teln.2011.11.003
