1. Montalvo, Isis MBA, MS, RN

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The Institute of Medicine (IOM) has been known for its landmark reports in healthcare. It recently released a new report on nursing-The Future of Nursing: Leading Change, Advancing Health-providing recommendations for nurses to transform healthcare. This article reviews the history of the IOM, presents the recommendations from its recent nursing report, and identifies implications for nurses.



In 1863, the National Academy of Sciences, a nongovernmental agency, was chartered under President Abraham Lincoln to honor top scientists and serve the nation whenever called upon. In its 150-year growth, the National Academies expanded to include four areas: sciences, engineering, healthcare, and research, comprising the National Academies of Sciences, the National Academies of Engineering, the IOM, and the National Research Council.1 The IOM was established in 1970 with the mission to inform the nation on key healthcare issues and to serve as advisor. In this capacity, the research and reports generated by the IOM assist regulators, policy makers, healthcare providers, and the healthcare sector in making informed decisions about healthcare.1


Initiatives undertaken by the IOM can be congressionally mandated, or requested by federal or private organizations. In addition to the reports it generates, the IOM convenes committees, consensus expert panels, and forums. It employs a rigorous scientific process in any study undertaken and follows the National Academies four-step process.2 (See Table 1.) The committee works initially with the sponsoring federal agency or foundation to outline goals and objectives, and subsequently maintains independence in its research review process with a final secondary review performed by an external independent group.


The IOM is widely known for many healthcare reports, in particular: To Err is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Keeping Patients Safe: Transforming the Work Environment of Nurses (2003).3-3To Err is Human highlighted the significance of medical errors in the country and that the systems, not the people, were the problem. Crossing the Chasm identified the six aims for improvement that many organizations have adopted: safe, efficient, patient-centered, timely, equitable, and efficient. These aims are articulated in the new Patient Protection and Affordable Care Act (PPACA) legislation passed in 2010. Keeping Patients Safe identified key aspects in the nursing work environment that may have an impact on patient safety.

Table 1: National Ac... - Click to enlarge in new windowTable 1: National Academies study process

The Initiative on the Future of Nursing started in 2008. A series of workshops and meetings were held, papers written, interviews performed, and data gathered and evaluated. On October 5, 2010, the IOM released its new report: The Future of Nursing: Leading Change, Advancing Health.6


The Future of Nursing report

The Robert Wood Johnson Foundation (RWJF) partnered with the IOM to identify a blueprint to address the nursing shortage and its educational system capacity to leverage the nation's largest healthcare workforce segment-nurses-to transform its workforce and delivery system. Nurses are in the unique position of providing care across all continuums and the life span, affecting the care of all consumers more than any other healthcare provider. For this reason, nurses are able to realize many of the objectives from the PPACA. To transform healthcare, its primary workforce needs to be transformed and barriers removed to optimize nurses' ability to lead change.


Four key messages were identified in the consensus process and structured the discussion for the recommendations:6


* Nurses should practice to the full extent of their education and training.


* Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.


* Nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States.


* Effective workforce planning and policy making require better data collection and an improved information infrastructure.



The report further provides eight targeted recommendations with suggested actions at the local, state, and national levels, including recommendations for specific government and private organizations. The recommendations include:6


* removing scope-of-practice barriers


* expanding opportunities for nurses to lead collaborative improvement efforts


* implementing nurse residency programs


* increasing the percentage of nurses with a baccalaureate degree


* doubling the number of nurses with doctoral degrees by 2020


* ensuring that nurses engage in lifelong learning


* preparing and enabling nurses to lead change to advance healthcare


* building an infrastructure for the collection and analysis of interprofessional healthcare workforce data.



The report provides exemplars of organizations and nurses, identifying how transformation can occur in leadership, education, and nursing practice.


Implications for nurses

The next step for the IOM and the RWJF is to outline an implementation plan based on the report. A national conference is scheduled for November 30 to December 1, 2010 to start the initial conversations on how to make the report actionable. Due to the National Academies study process of "gathering information," many of the recommendations identify strategies that are similar to existing strategies based on the ongoing work of national nursing and healthcare organizations.7


There are some key recommendations that will require change at the local, state, and national levels. In preparation for the final report and implementation plan, an initial self-assessment at the individual nurse and organizational levels may be beneficial to identify gaps compared with the recommended changes. For example, how many baccalaureate-prepared nurses (BSN) are on staff and what infrastructure is in place to support nurses returning to school to attain either their BSN or advanced nursing degree? As a nurse, what educational goals have been set individually and if not, why not? How are advanced practice nurses being utilized within the respective care setting?


Although the final action plan is pending, the good news is that ongoing work will already support many of the recommendations. Nurses have always been able to make transformational change that impacts their profession, the healthcare delivery system, and its consumers.?




1. Institute of Medicine. About the IOM. [Context Link]


2. National Academies. Our study process. [Context Link]


3. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. [Context Link]


4. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.


5. Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2003.


6. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. [Context Link]


7. American Nurses Association. ANA and CMA activities reflected in the IOM recommendations. [Context Link]