The IOM’s ​“Future of Nursing” report – What’s worked, and what hasn’t yet been achieved

In 2010, the Institute of Medicine (IOM) issued the report The Future of Nursing: Leading Change, Advocating Health. Now that five years have passed since its original publication, a new report from the National Academies of Sciences, Engineering, and Medicine examines what progress has – and hasn’t – been made.

The new report finds that the nursing community was galvanized in 2010 at the state and national levels, and significant progress was made toward achieving many of the recommendations of that original report, which were geared toward helping nurses meet heightened demand for health care services and improving the nation’s increasingly complex health system.

However, continued progress will require increased focus and effort in several areas.

Removing scope of practice barriers

Since 2010, eight states have changed their laws, giving nurse practitioners full practice and prescriptive authority, bringing the total number of states with such laws to a total of 21. Some other states also made incremental progress, but nurse practitioners in many states are still restricted in their practice.

At the federal level, in 2012, the Centers for Medicare and Medicaid Services issued a final rule broadening the concept of medical staff, making it possible for hospitals to allow practitioners such as advanced practice nurses, physician assistants and pharmacists to perform all functions within their scope of practice. Even so, medical staff membership and hospital privileges remain subject to state laws and local business preferences.

Strengthening pathways to higher education

In 2010, only about half of the nation’s nurses held a baccalaureate or higher degree, with less than 1 percent holding a doctoral degree. Baccalaureate degree program enrollment has increased substantially since then.

• Entry level enrollment increased from 147,6356 to 172,794 in 2014.
• Accelerated enrollment increased from 13,605 to 16,935 in 2014.
• RNs who enrolled in bachelor of science in nursing completion programs nearly doubled ­– going from 77,259 to 130,345.
• Enrollment in doctor of nursing practice (DNP) programs more than doubled, from 7,034 to 18,352.
• Enrollment in PhD in nursing programs went up 15%, to 5,290 students.

However, schools need more faculty in order to further increase enrollment at all education levels. The new report calls for continued work toward strengthening academic pathways toward a baccalaureate degree and for promotion of nurses’ pursuit of doctoral degrees – particularly PhD.

Increasing diversity in the workforce

In 2010, African Americans, Hispanics/Latinos and men were underrepresented in the profession when compared to the overall United States population. The new report concludes that it is too soon to tell whether progress has been made in this area, as it takes many years for nurses to enter and leave the workforce.

Collection and analysis of data

The 2010 report recommended that the National Health Care Workforce Commission build an infrastructure to enable improved collection and analysis of health care work force data. However, Congress did not fund the Commission, so this recommendation could not be implemented. The new report notes that major gaps continue to exist in the data, making it difficult to get a true picture of the numbers and types of health care professionals, where they are employed, and what roles they fill.

Following the publication of the original report, the Robert Wood Johnson Foundation and AARP launched the Future of Nursing: Campaign for Action in order to work toward bringing the report’s recommendations to fruition. The new report recommends the Campaign play a role in convening, supporting and promoting collaboration between nursing-related organizations to consider how they might collect better data and report on it.

In response, Pamela Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association, praised the new report as an important step in examining and assessing changes in the nursing profession and the broader health care setting, and said:

"We appreciate the Committee’s thoughtful report about what has been accomplished and what needs to be done to continue to move the Future of Nursing report’s recommendations forward to meet the growing demand for high-quality, cost-effective health care services. We agree progress has been made since the Future of Nursing Report was issued in 2010; however, if we hope to achieve the vision of a patient-focused health care system, we must ensure the nation’s 3.4 million registered nurses are able to fully contribute. We agree now is the time to accelerate the work to expand access to education, remove barriers to nurses’ full practice, improve data about the nursing workforce, and increase the number of nurses in leadership positions. The American Nurses Association is actively engaged in this work and agrees that interdisciplinary collaboration and support from various stakeholders, including the business community and consumers, are essential."

The new report, Assessing the Progress on the Institute of Medicine Report The Future of Nursing, is the result of a study by the Institute of Medicine and was sponsored by the Robert Wood Johnson Foundation.

Pre-publication copies are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 1-800-624-6242.