Institute Of Medicine (IOM): Future of Nursing, Role of Nurse Practitioners (NP)

Introduction

The nursing profession currently has over three million people, becoming the biggest division of the health workforce in the US. With nurses being at the forefront of patient care, they have a pivotal role in assisting to ensure that the Affordable Care Act of 2010 reaches its set objectives. The Nurse Practitioners (NPs) therefore have to adhere to their roles to secure a better future to the nursing profession. However, they have subsequently experienced several barriers that inhibit their response to the rapid and evolving health care changes. Consequently, there is a need to overcome these challenges to make sure that these professionals are in a better position to lead change, thereby advancing health. In 2008, the IOM came up with a comprehensive report that proposed an action-oriented plan for nursing’s future. Nurses often practice in various settings like the hospitals, clinics, homes, schools and other health centers. Their competencies and educational levels vary considerably from nurse scientists that conduct evaluations and research on proper methods of patient care, to licensed practical nurses that directly provide care to patients. Therefore, this report substantially discusses the future of nursing with an extensive consideration of the challenges that nurse practitioners face, their roles and implications of the IOM’s report. In addition, the report provides the implication for nursing practice and some recommendations for ensuring the development of an appropriately educated and trained nursing workforce to provide patient care. 

Problem Statement

The current time is experiencing numerous changes in the care delivery, advancements in technology and the elevation of expectations from patients. Therefore, the role of nurse practitioners has grown and equally evolved, which necessitates these professionals to have access to the latest information necessary for assessing and treating patients. The role of evidence-based practice is enormous in enhancing the changes experienced in the health care sector. Without a proper evidence-based approach, there have been several misfortunes in the area of health, not all of which means any developments in the patient health outcomes. For instance, the patient safety becomes at stake when nurse practitioners use improper care procedures. Consequently, the quality of like also goes down as there arise events of inappropriate treatment options. Additionally, the failure to enforce the use of evidence-based practice triggers the increase in healthcare costs because most of the care practices that the nurses use are ineffective, hence wasting the available resources. Finally, medical complications have been a fundamental problem arising whenever there lack evidence-based practices for decision making among the nurses. In England, the number of medical complications that cause death due to this is 840 – 4000 annually (Hogan et al., 2012). 

There are additional barriers in the nursing profession, which are nurse characteristics, organizational features, nature of nursing research and the care environment. Whereas some nurse practitioners lack the knowledge required in undertaking analyses, some do not have the interest, appraisal skills and confidence to make appropriate care decisions (Hogan et al., 2012). Besides, the majorities of them have inadequate education preparation for their roles, have negative beliefs and attitude, and have the assumption that they have little authority in changing the procedures for care. Studies indicate that only a third of nurses tend to adhere to the evidence-based practice guidelines. When young nurse practitioners get into the industry and try to use the evidence-based learning to the institutions, they meet the challenge from the older nurses who tend to avoid these practices, and so the cycle continues. The future of nursing, therefore, lies in the hands of the nurses and their efforts to ensure that they implement their roles diligently to overcome the cycling trend that repels evidence-based care.

Review of the Literature

The Future of Nursing

In the nursing profession, there are currently many opportunities for implementing numerous changes in the health system globally. The current nurse population in the US is approximately 3 million, which is more than any other segment of health care workers in the country. Across the country, more than half of the nurses’ population is located in the hospitals leaving only a limited number to other sectors of the health care industry. The community and public health centers harbor, long-term care institutions and schools each take less than 10% of the nurse population. In all these facilities, the NPs have three key roles, which include directly caring for the patients. The nurses diagnose the majority of the chronic and common illnesses with authority to physically examine, teach and counsel the patients. Another responsibility is to coordinate care while also advocating for the sick, while the third is to conduct research and evaluation of the best practical approaches to provide patient care. NPs use much of their time to document, providing medication and communicating about the patient. Nevertheless, only 20% of their time often ends in the provision of direct care to the sick (Shalala et al., 2011).

Across the medical field, there are usually nurses who deliver primary care amenities. The number of NPs and other physicians is progressively on the rise. From 1995 to 2009, there has been more than a double increment from 0.23 to 0.43 in the NPs for every primary care MD (Kershaw, 2012). On the same note, the physician assistants for each primary care MD have also risen in the same period. Studies indicate that there is a possibility of raising the supply of the NPs within a short time to assist in meeting increased care demand as well as providing care for the 32 million Americans who initially received no insurance (Kershaw, 2012). Nurses need to fully learn and train to be fully equipped for their practice. Nevertheless, the guidelines defining the range of practice limitations are different for every state depending on the political decisions.

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Due to the growing demands of health care, there is a need for nurses to be fully competent in multiple areas like collaboration, research, teamwork, system improvement, public health, and leadership. Moreover, they have to expand into the information management roles that require knowledge of the use of technology. Currently, there is a continuous transition to higher degree programs in the nursing profession. The advanced practice registered nurses tend to spend a more educational period (six years) compared to the registered nurses and nursing care providers (Sochalski & Weiner, 2011). By 2010, the number of nurses with baccalaureate degrees was 50%. However, the estimates for 2020 indicate that the number is likely to rise to 80%. Moreover, by 2020, the number of nurses with doctoral degrees will probably double. This future increment is likely to come through the rise in tuition reimbursements, expanding clinical partnerships and the increase in higher education faculties. Moreover, this future expansion will derive its cause from the current rise in scholarships and forgiveness of loans for NPs (Puetz, 2013).

The Role of Nurse Practitioners in the Future of Patient Care Delivery

First, nurses have a role in ensuring that the services they provide are patient and family-centered (Naylor & Kurtzman, 2010). In the current health care settings, the patients have subsequently become more informed and knowledgeable, as they are currently able to use technology to access some of the latest care decisions. Consequently, nurses have to be their guide and strategists in navigating the health systems. Secondly, they may ensure this role through initiating and promoting a safe environment that facilitates care and the healing process that is attainable through effective communication and building of mutual respect and trust. Another way that the nurses may provide care that is patient and family-centered is through acting by the nursing ethical code that requires NPs to empower patients in active plans on how to manage their care and prevent illnesses. In a nutshell, the role of the provision of patient and family-centered care makes NPs have to play a role of being ‘guests in the patient’s world’ (Naylor & Kurtzman, 2010).

Nurse practitioners also have a role in ensuring they have the knowledge, which is access-based. The future of nursing leans on advancements in technology and medical science, all which need a lifelong learning process (Zaccagnini & White, 2015). The NPs therefore are answerable for keeping pace with the growing knowledge and evidence through understanding ways of accessing, assessing and applying knowledge and information needed for practice. Additionally, nurses have to understand when to access additional resources obtained from teams like through consulting social workers or pharmacists. Nurses also have to realize that the environment that they operate is active and changing, which necessitates them to share and evaluate knowledge openly with other members of the interdisciplinary team. Consequently, the use of evidence-based practices will eventually result to a future nursing profession that adores discovery and innovation (Zaccagnini & White, 2015).

Nurse practitioners also have a role to ensure that they accurately synthesize the knowledge that they have concerning the care for patients. They have a duty of using their intuition and creativity to go beyond the physicians’ medical analyses (Naylor & Kurtzman, 2010). They have to evaluate all information at hand before making decisions. Also, the continuous technological advancements and developments in the nursing, genetic and biological sciences require the practitioners to have an in-depth synthesis of information continuously. It may assist them in evaluating ambiguous and complex scenarios of patient care in ensuring they provide excellent and safe treatments. Therefore, instead of being implementers, nurse practitioners’ role becomes more of strategists due to their ability to plan, monitor, document, evaluate and revise patient’s plan of care (Naylor & Kurtzman, 2010).

Another role of the NPs is to ensure they set up extensive relationships with the patients to aid trust and enhance the quality care delivery (Dawson-Rose et al., 2016). They have a superb privilege of serving as partners in the care process. When delivering their mandates, the NPs come across as well as create several care relationships with their patients and colleagues. Apart from the professional associations, they may also set personal relationships with one another by having teamwork and mutual negotiations and therefore carry such experiences to their encounters with the patients. Through such associations that form in the dynamic nursing environment, the future of this profession is likely to benefit in several ways that preserve the experiences of the patients, hence attaining desirable health outcomes. Just like the clinical relationship, there is much value on the therapeutic associations between the nurses and their patients (Cronenwett et al., 2007). 

Moreover, the NPs have a role to ensure quality and safety of the patient care.  They have a duty of driving the reshaping of health policies to find better patients and communities’ health outcomes. Their mission does not stop with ensuring a professional identity that includes caring, honesty and knowledge and integrity, but they have to indicate that they commit to provide care that promotes quality and patient safety (Zaccagnini & White, 2015). The future of nursing requires that the nurses move away from emphasizing on critical thinking while delivering care to stressing on the reasoning in transition and clinical reasoning. Among the ways that the nurses may ensure they attain this role include through their continued adherence to evidence-based care and being mindful of the accreditation and regulatory requirements.

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Implications and Recommendations for Nursing Practice

First, the barriers of the scope-of-practice are limiting the roles of the nurses. Currently, the tasks that the nurses handle in their work environments lie significantly on the rules governing their scope of practice and not their levels of education and training (Fitzpatrick, 2010). However, there is need to allow nurses to practice their duties depending on their extents of education and training. Presently, the nurse practitioners, anesthetists, midwives, and clinical nurse specialists all receive licensing as APRNs. It has therefore limited their scope of work great because there lacks proper consideration of their capabilities in caring for patients. However, some actions need an implementation to overcome this. First, the Congress may need to amend the Medicare program as a way of authorizing the APRNs to perform admission assessments and also to certify patients who take health services at home (Darnell & Hickson, 2015).

Redesigning the nursing profession in the US calls for collaboration between nurses and physicians as well as staffs in the medical field (Naylor & Kurtzman, 2010). Among the people who need to take the lead to enhance this include the financiers, nursing organizations, education facilities for nurses, and healthcare groups. Such collaborations need to enable the nurses to freely conduct research and come up with redesigning and improvement plans in the health system. The medical institutions have the option of supporting and helping the nurses to lead to develop and adopt care models that are patient-centered and innovative. Secondly, these institutions may also have to engage the nurses and interdisciplinary staff in working with manufacturers and developers to design, implement and evaluate the health and medical products. Further, the various association for the nurses should avail entrepreneurial education to NPs so that they can initiate effective and successful programs. 

Currently, the number of nurses holding baccalaureate degrees as well as those at the doctorate level is slightly low, which has a consequence of limiting the delivery of patient-centered and safe care. However, this needs a serious improvement because today the needs of the patients are much complex, necessitating the care providers to have essential competencies for delivering high-quality treatments like leadership, evidence-based care, collaboration, teamwork, research, system improvement and health policy (Zaccagnini & White, 2015). This implication may have various recommendations like the partnership among the health care institutions and academic nurses, community organizations, and schools in recruiting and advancing diverse students of nursing. Additionally, the education for the nurses needs to include chances for the continuous transition to higher degree programs. For instance, an LPN with a diploma may need to have a smooth transition to an ADN with a degree, after which they may obtain their master’s, Ph.D. and eventually obtain DNP degrees. Nevertheless, this progression process needs to ensure that the nurses learn closely with other interdisciplinary staff.

There is much need for improvements in the data collection and expansion in the information infrastructure to enhance the effectiveness of the workforce planning and making of policies. With the enormous developments in the future for nursing, there will be a likelihood of better plans in educating and deploying nurses. With the improvement in place to collect and analyze data of the workforce, it will be easier to analytically assess as well as foresee the staff needs by demographics, region, functions, and skills, which will be necessary for informing the changes in education and nursing practice. The Affordable Care Act of 2010 created the National Center for Workforce Analysis that assist in collecting and analyzing the personnel data. According to Shalala et al. (2011), the National Health Care Workforce Commission that has the mandate of gauging the health staff’s needs. These two programs need to ensure that they facilitate collaboration with the Department of labor, nursing workforce centers and state licensing boards to make sure there is the availability of publicly accessible and timely data.

Conclusion

The US still has numerous opportunities for transforming the health system and one of these ways include involving the nurses in initiating such change because their number is higher than other segments of workers in the health sector and may have a fundamental role in such a transformation. The future of nursing or the power to make such changes in the area of health does not depend solely on the nurses themselves, professional bodies, insurance companies or the government. It is through their joint efforts and partnerships that they are likely to meet their future objectives. Nurses face several challenges in their work environments including lack the knowledge required in interpreting the analyses, lack of the interest, appraisal skills and confidence to make appropriate care decisions. Besides, the transition process of nurses to higher educational level proves to limit their roles. Since the roles they are capable of handling in the care process largely depends on state laws and not their education and training, this has largely limited their involvement in the care process. Some of their roles include providing patient-centered and safe care and ensuring their decisions are evidence-based. Nevertheless, there is still need to allow nurses to fully get the necessary education and training, obtain seamless academic progression and work in partnership with interdisciplinary teams.