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].
Take courses related to the IOM Future of Nursing:
Developing Your Leadership Potential
(6.8 contact hrs)
As the largest healthcare profession in the U.S. and the profession positioned on the front line of patient care, nurses are crucial for leading change and advancing health. The Robert Wood Johnson Foundation and the Institute of Medicine made recommendations to transform the nursing profession in their report “The Future of Nursing: Leading Change, Advancing Health.” A key message from the report is the recommendation that nurses be full partners together with physicians and other healthcare professionals in redesigning the country’s healthcare system. This activity will provide practical strategies to help you develop your personal plan for developing your leadership potential regardless of your chosen career path.
Advanced Practice Nurse Pharmacology
(25 contact hrs)
This course will help advanced practice nurses meet the new ANCC 25-contact hour pharmacology requirement for recertification beginning Jan. 1, 2014. Written and rigorously peer reviewed by pharmacists and advanced practice nurses, this course features a wide range of medical conditions and the medications associated with them. Chapter topics include hypertension, diuretics, GI, critical care, sexually transmitted diseases, asthma, oncology, non-opioid analgesics, diabetes, weight loss, mental health conditions such as anxiety, bipolar disorder, depression and much more. The chapters highlight clinical uses, dosing, interactions and adverse effects for the common medications used in your practice. APN tips are featured throughout the chapters to help you in your prescribing practices.
HCAHPS Series: Nurse and Interprofessional Team Communication
(1.5 contact hrs)
Working in the healthcare field requires outstanding communication skills.Effectively communicating with the patient, family, and colleagues is the foundation for a therapeutic and positive patient experience. The patient’s care experience is greatly influenced by what is communicated and what the patient and family observe. As healthcare providers, we are impacted and impact others through our communication. Whether it is advocating for a patient, establishing rapport and empathy with a patient and his or her support system, or communicating with other members of the interprofessional team, our ability to effectively communicate is consistently challenged. Our relationships, personally and professionally, are built on communicating and relating to others. When we communicate effectively, patients are more likely to experience care as more positive and rate their care higher
I am shocked the 10 year effort did not address the SINGLE largest disparity in regards to diversity among nurses; Men. Yes the 12,000 lb elephant in the room is the fact that only 9% of nurses are male and for the past 10 years the IOM failed to recognize this group nor report any success in changing this number. Nursing can not survive in the future if the diversity does not approach 50/50. Nursing is the front door to health and wellness and it will take a balanced workforce in order to penetrate the toxic lifestyles of over 70% of Americans. I would like to see the IOM Future of Nursing tackle what it will take to move the percentage of men in nursing from 9% to 50%. I can say immediately every nursing organization needs to look at their branding and insure it is gender neutral. The color pink, bows, dresses and white hats are not going to get middle school boys interested in nursing. As a new student of nursing after a career in business and an MBA, the nursing industry is ripe for a major disruption as the they way the profession is perceived by the general public.
Excellent point Rob.
I am in a graduate nursing program now and reading a book called From silence to voice: what nurses know and must communicate to the public, by Buresh and Gordon (2013), and they speak to your point about how the public does not know what nursing does and hospitals, even with magnet status, don’t really let you know when you go to their website. I agree that when more men get involved, publicity may get better, just like with teaching, as men got involved, especially in admin, teachers got better benefits, such as state health insurance plans after retirement. I also think the idea that caring is an exclusively feminine trait is wrong, because our caring takes a lot of training and skill. Disrupt away, glad you are on board with nursing and best of luck in your program and nursing career
I do not see any mention of other nursing Healthcare team members, such as the LPN/LVN, Medical Assistants, Nursing Aide in your write up. I notice they are altering the mix of the Nursing Team in various settings outside and even within the acute care arena/units. Are we not including them in the nursing workforce analysis moving forward to face our challenges! They are currently contributing to the RNs ability to utilize their optimum education to practice and that principle should also apply to LpN/LVNs’ ability to practice to their full educational training, don’t you think?
Hello Guia,
There are many aspects of the Future of Nursing report that we did not cover in this blog, but we plan to post more blogs on the report over time. In the meantime, here is a link that will give you access to a downloadable PDF of the report, for your review.
Mr. Stehlin and Ms. Hinrichs,
You both make excellent points about male nurses in health care. Currently, I am in the final weeks of my BSN program and I am happy to share that there are several men in my class. I do have to admit that I do not have the exact numbers, but it is apparent that there are more women than men by far. The men I have been learning with the last few years are very passionate and caring about nursing. They will bring many great abilities and talents to the profession. I have worked with a few male nurses during my years as a CNA and they have all been fantastic nurses.
Ms. Hinrichs, the fact that bringing awareness and the publics’ attention to nursing will improve with the increase in men in the field is a concerning point, however, true. There is still a bias towards the credibility and professionalism of women. More men do need to join the nursing profession as do other minority groups.
Mr. Stehlin, perhaps young men in high school would be inspired to see male and female nurses at college fairs. Having male and female military nurse service members would be a good representation as well for young people. Presenting a diverse and united example of nursing to the public and students who are deciding their futures would go a long way.
Additionally, more change needs to happen at the college level when addressing nursing workforce numbers. From the perspective of a nursing student who is only the second (grandmother in her 50’s was first) in her family to attend and complete (3 weeks away from graduation) a college degree, more effort needs to be made to inform and guide students on how to attend college. Some young adults encounter barriers such as limits on available financing for college, especially when they do not have family willing or able to help. Guidance on how to navigate this and locate meaningful guidance could increase the number of nursing students. Finally, nursing school is difficult, as it should be, and the culture of nursing schools needs to change. Addressing the lack of nursing instructors will improve the situation but making sure the students are maintaining healthy self-care strategies and that there is a supportive and encouraging environment for learning from mistakes is important. There should not be an incapacitating fear of making mistakes when learning in simulations. Patient scenario simulations are the place to make and learn from mistakes without resulting in harm to living patients. If an environment of learning without fear of mistakes in these situations could become the norm, then students could increase their critical thinking and decision-making skills during school. This would also identify needed areas for improvement and knowledge of steps to take in the event of mistakes outside of school.
Thank you, I enjoyed reading this article and the comments. I must now return to my “Future of Nursing” paper so that I do graduate in a few weeks, as I mentioned.
I agree with Guia and was pleased to read the response regarding LPNs and LVNs. The COVID-19 Pandemic taught us many lessons; one of which is the need for more nurses at the bedside and in the community. I understand some states have broadened the scope of practice to include IV certification for these nurses. We need certification for our LPNs/LVNs in other specialties. I remember those who mentored and navigated my new RN grad learning experiences also included some exceptionally knowledgeable and qualified LPNs. Let’s not wait for another pandemic before we advance their practice.