The release of the Institute of Medicine (IOM) report in 2008 served as a hallmark in transforming health and nursing. Further, 2011 marked yet another crucial milestone for the nurses with the launch of the report dubbed “The Future of Nursing: Leading Change, Advancing Health.” This document explains the action-oriented blueprint and significant recommendations to advance and enhance the nursing profession. However, although the report contains remarkable suggestions on improving the quality of education of the nurse, it concentrates much on nurse education, incorporating very little on other crucial facets. First, it fails to address the challenges associated with the scope of practice. Secondly, the report fails to provide solutions to the pedagogical problems for the nurse educator and the advanced training registered nurse. Finally, it presents unnecessary pressure for nurses to further education at every level. As such, this work seeks to assess the three implications of the report and the benefits of the advanced health nurse with a master’s degree.
IOM’s Recommendations and its Implications
To transform the nursing profession and improve healthcare, the government tasked the committee of Robert Wood Robinson and IOM with the critical responsibility to remodel the health care system. This task provided the United States a chance to improve health provision particularly for nursing, as the biggest personnel in the health sector. In 2011, the committee presented collective recommendations towards four critical areas (IOM, 2011). The first recommendation touches on ensuring nurses maximize their practice through holistic training and the acquisition of education. Secondly, the committee provides that nursing education should be prioritized. Thirdly, the report ensures that there is provision for opportunities for health practitioners to take up leadership positions as well as operate as full partners in redesigning improvement efforts and healthcare. Finally, the committee proposed the improvement of policymaking and data collection for workforce development (IOM, 2010). Although the report on “The Future of Nursing: Leading Change, Advancing Health” addresses vital areas that will enhance healthcare, it fails to address challenges relating to the scope of practice, pedagogical methods, and the high pressure to perform health duties and advance education at every level. However, because of the importance allocated to school, the advanced nurse operating in a state with a full scope of practice enjoys the favorable outcomes of acquiring a master’s education. As such, there is a need to polish the document to improve service delivery.
The scope of practice is a crucial barrier to the nurses carrying out their mandate to the highest level of their training and education. In their assessment, Schmitt, Sims-Giddens, and Booth (2012) note that the scope of practice refers to the practice laws and the licensure that permits NPs to manage and initiate treatments through making prescriptions, interpret order and diagnose tests, as well as evaluate patients as enshrined in the licensure authority of the State Board of Nursing. Nonetheless, it is worth noting that the meaning of the scope of practice varies depending on the state bringing forth three categories of states. The first one comprises of a third of states that have implemented complete practice laws and practice authority licensure. The second category consists of states that adopt reduced licensure and practice. This category comprises of states where NPs are permitted to use a single component of the competence practice (Schmitt, Sims-Giddens, & Booth, 2012). However, the collaborative treaty prohibits these NPs from engaging in any outside health discipline to offer care to patients. Finally, the third category comprises of the states that ban both licensure and practice for the NP. This scenario translates to the NPs participating in a single component of NP practice (Schmitt, Sims-Giddens, & Booth, 2012). On top of this, these nurses constantly require team management, delegation, or supervision by an outside health discipline to take care of patients. The independent nurses on the other hand, have the authority to offer full practice, can consult, and refer patients to other health institutions, maintain national certification, have complied with the practice regulations for licensure, and possess the educational qualifications (Schmitt, Sims-Giddens, & Booth, 2012). These individuals are thus directly answerable to the State Board of Nursing and the public for acquiring the set rules on professional and practice conduct. Consequently, the scope of practice differs in various states depending on political reasons and not the safety concerns, training, or ability of the nurse.
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Because of the restrictions on the scope of practice in some states, there is undue pressure between the physicians and the Advanced Practice Registered Nurse (APRNs). These tensions impede service provision and the quality of health care offered. Research by Schmitt, Sims-Giddens, and Booth (2012) illustrates that although some states operate within the regulated scope of practice, a few NPs had a scope of practice that resembles that of the fellow physician. Nonetheless, their assessment also reveal that such restrictions by state administration have negative impacts on the patient resulting in delays in service provision, discharges to hospice or home, orders for medical equipment, and referrals. As a result, health practitioners possessing similar national certification and educational preparation may experience challenges depending on where they are deployed. Further, the problems on the scope of practice result in inadequate primary care providers since some nurses are unwilling to work in states that limit their scope of practice.
While the IOM recommendations present viable options and solutions to improving healthcare, it presents challenges to do with nurse practice and teaching methodology. First, some physicians possess higher supervisory powers that create an impression of APRNs being incapable of offering safe care and quality health services, causing confusion (IOM, 2011). This mentality stems from the fact that physicians’ training is more rigorous and takes longer. This confusion on the responsibility of the nurses impedes service provision (Fitzgerald et al., 2012). As a result, there are challenges to do with access to primary healthcare, inadequate health personnel, and poor quality of healthcare provision.
With regard to teaching, many potential APRNs trainees have insufficient faculty resources and lack admission qualifications. In their study Fitzgerald et al. (2012) reveal that these organizations struggle to appeal to professional APRNs willing and able to operate in the faculty duties. As such, there is an increased shortage in the faculty of nursing, which results in wastage of training resources. Secondly, due to insufficient funding, training centers cannot provide competitive compensation programs. Hence, nurse educators receive little pay that demotivates them. Thirdly, the APRNs who pursue the Ph.D. degrees often experience challenges after graduation that pertain to the tenure procedure within research centers (Fitzgerald et al., 2012). Often, these educational centers stress on the duties of the faculty in generating research-associated income and conducting research. These two factors deter the accessibility of trainees with Ph.D. level of education and the necessary personnel to undertake clinical management of APRNs trainees. As a result, the central role of APRN clinical training falls short of the requirements and thus is not qualified for tenure (Fitzgerald et al., 2012). Consequently, these APRNs receive lower incomes than those who underwent practice in clinical areas. Therefore, training institutions that have no recognized faculty practice programs suffer additional challenges in retaining faculty in need of practice to attain and sustain licensure and certification meeting tenure and teaching criteria.
Besides the challenges on the scope of practice, the report’s recommendations present challenges to do with pressure to balance health duties and acquire more education. The adoption of the recommendations of the IOM report has seen a shift in many nursing institutions adopt Doctorate of Nursing Practice (DNP) (Altman, Butler, & Shern, 2016). This transition results in the current APRNs devoid of a doctorate being perceived as under qualified. Besides, training qualifications on supervisory boards require faculty leaders to acquire a doctorate qualification. Consequently, supervising DNP learners may upsurge faculties’ amount of work. As such, Ph.D. holding nurses might possess less advance practice qualifications to impart specific content in APRNs competencies (Fitzgerald et al., 2012). These changes affect the quality of health care offered and create a shortage of primary caregivers. It also affects the accessibility to health services.
According to Spetz (2018), California is a state that restricts the scope of practice of nurse health practitioners because it requires the NPs to prescribe and practice under the supervision of a physician. California, together with forty-five more states requires NPs to complete a doctorate, postgraduate, and masters from an accredited program. The NPs also acquire certification from a widely recognized body offering certificates. As such, the state can expand the scope of practice for master’s NP to allow better service delivery. Besides, studies reveal that although physician supervision is crucial to quality healthcare provision, the quality of healthcare offered by the physician and that provided by the NP is comparable with no significant difference in the quality of service provided away from the supervision (Spetz, 2018). As such, expanding the scope of practice for nurses with a master’s degree would help California improve health care access, quality, and provision. Since the scope of practice depends on the legal structure within the state that oversees the medical services delivery, California can expand the scope of operation for licensed health practitioners (Spetz, 2018). This can be done through state legislation amending, passing, and considering the laws around health provision practices. The state can also involve the regulatory bodies like the health professions boards and the medical boards that would help amend the laws through enforcement and writing of regulations that increase the scope of practice for the NPs with masters.
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The restricted scope of practice utilized in California presents challenges such as increased rates of emergency and hospitalization visits, reduces the utilization of primary care, creates inaccessibility health services, and inadequate human personnel (Spetz, 2018). Amendment to the scope of practice would increase staff. With the eradication of a restricted range of practice, the number of health practitioners seeking jobs in California would increase. Hence, the NPs would have a better working environment with permission to attend to patients, diagnose, treat, order, prescribe medication, and even make referrals to patients away from physician supervision (Spetz, 2018). By large, this amendment would improve access to healthcare in California due to efficiency. More patients would also be willing to seek primary healthcare, an action that would reduce the emergency and hospitalization rates.
Overall, the recommendations of the IOM report have a wide range of implications, both positive and negative. Key on the consequences of the implementation of the document is the fact that the state governments varied the scope of practice for advanced practice registered nurses. The nurses operating in states with a limited scope of practice experience challenges that impede health care provision. The range of practice also adversely affects the relations between physicians and nurses as well as the teaching logistics. One significant barrier created to nurses is that there is increased pressure to perform health roles and pursue further education to meet the qualifications of the job. The states that acquire a full scope of practice, however, enjoy immense benefits that range from increased human personnel, improved access to primary health care, and increased quality of health care provision. Therefore, various states should adopt the full scope of practice for licensed nurse practitioners through amending health laws to revolutionize health care provision.
- Altman, S. H., Butler, A. S., & Shern, L. National Academies of Sciences, Engineering, and Medicine. (2016). Removing barriers to practice and care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US).
- Fitzgerald, C., Kantrowitz-Gordon, I., Katz, J., & Hirsch, A. (2012). Advanced practice nursing education: Challenges and strategies. Nursing Research and Practice, 2012.
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- Schmitt, T., Sims-Giddens, S., & Booth, R. (2012). Social media use in nursing education. Nursing World. Retrieved 8 December 2019, from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No3-Sept-2012/Social-Media-in-Nursing-Education.html
- Spetz, J. (2018). California’s nurse practitioners: How scope of practice laws impact care. California Health Care Foundation, 1-21. Retrieved from https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf
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