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IOM Report Proposes "Future of Nursing"

An Institute of Medicine (IOM) report released Oct. 5 calls for nurses to take on a larger, more independent role in the health care arena. Whereas nursing advocates are all for equal work and equal pay, physician organizations have a different opinion.

The IOM report, “Future of Nursing: Leading Change, Advancing Health,” recommends the Centers for Medicare & Medicaid Services (CMS) reimburse advanced practice nurses—such as nurse practitioners (NPs) and anesthetists—at the same reimbursement level as physicians. It also calls on the Federal Trade Commission (FTC) to ensure state laws do not overly restrict nurses’ scope of practice.
Specifically, the report holds four key messages:

  1. Nurses should practice to the full extent of their education, training, and licensure.
  2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  3. Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States.
  4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

American Nursing Association (ANA) President Karen Daley PhD, MPH, RN, FAAN, commented, “This report bolsters the case that ANA has long championed—that the full contributions of nurses and nursing are essential to the delivery of high quality, patient-focused care. The IOM recommendations, along with the adoption of the Affordable Care Act (ACA), serve to create a unique opportunity to restructure our current health care system into one which emphasizes collaboration and a commitment to quality.”
Physician organizations don’t feel quite the same way. Rebecca Patchin, MD, an American Medical Association (AMA) board member, said in response to the report, “Nurses are critical to the health care team, but there is no substitute for education and training.” Dr. Patchin cited a recent study that showed 80 percent of patients prefer and will wait to see a doctor in an emergency setting, and that “increasing the independent practice of nurses has not helped solve shortage issues in rural areas.”
Meanwhile, American Academy of Family Physicians (AAFP) President Roland Goertz, MD, MBA, of Waco, Texas said the report is woefully inadequate in the area of patient safety.
“I have not read anywhere in the report recommendations about standard training or standard certifications of competencies, which are embedded throughout physician training,” he said in an interview with AAFP News Now.
The report is the result of the Initiative on the Future of Nursing, sponsored by the Robert Wood Johnson Foundation. Key stakeholders, including ANA, will reconvene at a meeting Nov. 30 – Dec. 1 to begin discussions for implementing the IOM report.
Read the report online for free.

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