Work of the Robert Wood Johnson Foundation Committee Initiative (RWJF) and the Institute of Medicine (IOM) on the Future of Nursing 

The future of nursing is under the challenge of a multitude of health issues in the US and globally. The Joint Commission is pushing for higher quality of care and improving safety by endorsing national standards for nursing performance. The National Database of Nursing Quality Indicators is tracking such quality in order to improve care. As countries such as United States introduce new health care reforms through the Patient Protection and Affordable Care Act (ACA), the need for improving the quality of healthcare, focusing on patient-centred care, and evidence-based practice is imperative to transforming our healthcare system. According to Institute of Medicine (U.S.) and Robert Wood Johnson (2011), there is significant benefits in strengthening the healthcare workforce such as the nurses in attempt to improve the quality of healthcare services.  Robert Wood Johnson Foundation (RWJF) and Institute of Medicine (IOM) noted that high-quality healthcare can only be achieved if nurses are involved in providing the exceptional nursing care, lifelong learning, expanded systems thinking, care management, care coordinating and leadership.  This report seeks to discuss the future of nursing as a critical component of quality healthcare.

The future of nursing is under the challenge of a plethora of health issues in the US and globally. As countries, such as the United States, introduce health care reforms, the need for improving the quality of healthcare becomes widely demanded across the globe. According to the Institute of Medicine (U.S.) and Robert Wood Johnson (2011), there is significance in strengthening the healthcare workforce, including the nurses, in an attempt to improve the quality of healthcare services. As such, Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) note that high-quality healthcare can only be achieved if nurses are involved in providing exceptional nursing care and leadership.  This report seeks to discuss the future of nursing as a critical component of quality healthcare.

As the world looks forward to high-quality healthcare services, nurses remain the pivotal workforce in achieving quality healthcare. Smolenski and Goudreau (2013) acknowledge that nurses have the task of ensuring commitment to patient care, patient safety and quality of the healthcare services. According to Hewitt (2016), the role of nurses in healthcare provision, such as coordination of care, promotion of health and improvement of the quality of health, is the main pillar of healthcare services; however, nurses have had challenges in areas such as care coordination, transitional care and prevention of hospital-acquired infections, as well as improvement of wellness. To this end, the IOM suggests that there is significance in modifying the nurses’ role with the aim of improving the healthcare outcomes. 

RWJF and IOM partnered in 2008 with the goal of transforming the nursing profession in order to diminish some of the nursing challenges that have been noted. According to the Institute of Medicine (U.S.) and Robert Wood Johnson (2011), the transformation of the nursing profession involves transforming the nursing workforce in terms of capacity, skills and competence in meeting the healthcare needs of the future. In this sense, the IOM has the task of producing a policy action-oriented report used in completing the future nursing policies. Nevertheless, Smolenski and Goudreau (2013) admit that the transformation of the nursing profession involves transforming the practice, education and nursing leadership, as well as ensuring proper healthcare and workforce data.

Importance of IOM in Transforming the Nursing Practice

According to the Institute of Medicine (U.S.) and Robert Wood Johnson (2011), nurses have the freedom to practice to the full extent of their education and training. Nurses have the ability to serve as leaders in the healthcare systems; however, Hewitt (2016) states that there are a number of policies that have laid barriers in the nursing practice, thus, preventing the transformation of it. Ideally, the role of nurses should not be assumed to be patient care alone. Smolenski and Goudreau (2013) reiterate that nurses should be considered as individuals with innovative ideas on how to improve the healthcare systems. Challenges, such as aging workforce, high nurse turnover, demographic and cultural challenges and fragmentation of the healthcare systems have made it difficult for graduating nurses to join the workforce. 

The differences in policies of various states of the United States have also impacted the nursing practice. For instance, Hewitt (2016) indicates that there are states where the scope-of-practice for nurses includes seeing patients and prescribing medication for the patients. RWJF and IOM reports that there are many states that have not considered such practical initiatives, which are important in transforming the nursing practice. Management of nurse transition from schools to practice is also a big challenge to the nursing practice. According to the Institute of Medicine (U.S.) and Robert Wood Johnson (2011), most nurses lack residency programs that enable them to acquire the necessary skills and knowledge for practice.  According to studies, residency programs have improved the quality of nursing professions. To this end, RWJF and IOM recommend the creation of more residency programs for all nurses graduating from nursing institutions so that they can acquire the necessary knowledge for nursing practice. 

 

The Role of State-based Action Coalitions

Washington State Proposes RN to BSN Direct Transfer Agreement to Facilitate Academic Progression

Washington State is one of the states in the US which has spearheaded the transformation in nursing education. As one way of transforming the nursing profession, the state has proposed RN to BSN direct transfer agreement. This will allow nurses to advance in their nursing profession to become highly skilled and educated in providing safe and high-quality care. Prevost and Dennison (2012) postulate that proper nursing education will allow both current and future nurses to provide safe and high-quality nursing care. As the nursing profession becomes one of the vital components of healthcare provision in the United States, the Institute of Medicine (U.S.) and Robert Wood Johnson (2011) acknowledges the need to transform nursing education. As the world changes, the nursing roles also change, leading to high demand for extensive education. Nurses need competencies in a plethora of fields, such as community/public health, geriatrics, leadership, healthy policing, teamwork, research and evidence-based practice. In order to be competent in all these fields, pressure must be increased on nursing education.  In addition to this, many studies have shown that higher educated nursing staff reduces risk of mortality, reduces infection rates and improves patient outcomes (Aiken, 2012). 

To meet the IOM’s target of 80% BSN nurses by 2020, states must ensure that they enrol more nurses for BSN programs; however, there are major challenges that affect Registered Nurses. These can be the stress of going back to school, impacts on family, lack of available resources/funding, lack of flexibility with school and work schedules, and many others. According to Washington State, most nurses play the role of making critical decisions for vulnerable patients in our hospitals. As such, they should understand the mechanics of the life-saving technologies. Additionally, the nurses must also understand the management of chronic illnesses by preventing the acute episodes of diseases and infections; however, such complex demands involving technology and professional decision-making require significant transformation of the nursing education. Most nurses work with physicians, pharmacists and researchers with high-level education; therefore, they are left under pressure to obtain similar levels of training (Prevost & Dennison, 2012).

The healthcare systems have evolved higher expectations for the quality of patient care. In order to realize the goals of nursing, nurses must have good education and training; therefore, Washington State seeks to meet the recommendations by the IOM, which ensure that the nursing profession should offer nurses seamless opportunity to upgrade their education. The state believes that nurses should have the opportunity of transitioning from RN to BSN directly. This will equip many nurses with skills and abilities to deal with the ever-changing healthcare environment. Through these stages, the nurses are able to acquire the necessary educational skills and knowledge in providing high-quality care; nonetheless, the efforts in improving the quality of nursing education can only be achieved by ensuring diversity in the healthcare practices. To achieve this, Hewitt (2016) admits that nurses must be taken through education curricula that offer them traditional and innovative strategies in giving the appropriate healthcare to patients. Therefore, the RWJF and IOM recommend that nurses must have abilities to work with diverse communities (Hewitt, 2016).

New Co-leads for Washington Nursing Action Coalition Leadership Group

The State of Washington has a new co-lead, Steven J. Palazzo, PHD, MD, RN, who joined with Debra Brinker, MSN, RN, and they will help the state in focusing on specific recommendations of the 2011 IOM National Report. Transformation of the healthcare systems requires proper leadership; however, the nursing profession must ensure that good leaders are produced through the nursing programs. In collaboration with the other healthcare professionals in the healthcare settings, the nurses must acquire proper leadership skills. This will make nurses accountable for their own decisions and actions within the healthcare settings.  According to the Institute of Medicine (U.S.) and Robert Wood Johnson (2011), all levels of nursing require leadership skills. For instance, nurses must be individuals capable of making proper judgments and policies in order to avoid errors in healthcare. Nurses also serve on advisory committees and boards, as well as commissions where they engage in policy-making. In order to participate in such capacities, nurses will require proper leadership skills. 

Washington State nurses have challenges and barriers in policy making. Most of the policies used in healthcare systems in Washington State are formulated in the absence of the nurses; however, the state has proposed the inclusion of the new co-leads in the leadership and policy making to ensure that nurses become part of active leadership in the Washington State healthcare systems. Nursing advocates in Washington State have noted that there are over 100,000 RNs and LPNs in the state; as such, most nurses are involved in direct decision making processes in most healthcare systems in the state. However, existing policies create barriers for nurses to make critical decisions concerning patients by not elaborating or clarifying their scope of practice. Nonetheless, advocates from Washington State have proposed inclusion of more nurses in health system leadership in the state.  

In the future, strong leadership capabilities among nurses will be critical, especially in ensuring that changes are implemented to achieve the high quality services. As such, RWJF and IOM cite the need to ensure that leadership-related competencies must be introduced in nursing curricula. Hewitt (2016) added that nurses should possess and demonstrate the leadership capabilities inside and outside all the healthcare settings. In the future, the scope of practice for nurses will expand, thus subjecting nurses to an array of responsibilities. Some of the nursing responsibilities will require proper planning, policy making, guiding and educating other professionals. In order to assume all these responsibilities, the nursing profession must consider leadership competency as one of the requirements for transforming the future of nursing (Smolenski & Goudreau, 2013).

Conclusion

As the world changes, healthcare needs also change. In the United States, nurses are considered as the primary caregivers. Nevertheless, the nursing profession experiences challenges, especially with the changes in the healthcare systems. According to RWJF and IOM, the nursing profession requires transformation in terms of education, practice and leadership. The scope of nursing practice must be expanded in order to allow nurses to practice their skills to full extent. In order to ensure high quality services, nurses must be allowed to advance their education in the future. Washington State has proposed a direct RN to BSN progression program to allow more nurses opportunity to advance their careers; moreover, nurses must be able to demonstrate diversity in their practice. On the other hand, Washington State has noted nurses are involved in critical decision-making for patients as well as communities. As such, the state advocates propose that nurses must have proper leadership skills in order to be competent in policy and decision making. To this end, transformation of the future of nursing depends on transformation of the nursing education, leadership and practice.

References

Hewitt, P. (2016). The Call for 80% BSNs by 2020. Nurse Educator, 41(1), 29. doi:10.1097/NNE.0000000000000184

Institute of Medicine, (. (U.S.), & Robert Wood Johnson, F. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, D.C.: National Academies Press.

Prevost, S. S., & Dennison, R. (2012). Future of Advanced Registered Nursing Practice. Philadelphia, Pa: Saunders.

Smolenski, M. C., & Goudreau, K. A. (2013). Health Policy and Advanced Practice Nursing: Impact and Implications. New York, NY: Springer Publishing Company.

Kendall-Gallagher, D., Aiken, L. H., Sloane, D.M., Cimiotti, J.P. (2011). Nurse Specialty Certification, Inpatient Mortality and Failure to Rescue. Journal of Nurse Scholarship, 43(2), 188-194. 

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