1. Bleich, Michael R. PhD, RN, FAAN


Why the IOM report is relevant for all nurses.


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It has been over a year since the Institute of Medicine released The Future of Nursing: Leading Change, Advancing Health. Despite millions of media hits and thousands of free downloads, a question remains: Has the report's content reached the bedside caregiver, and is it motivating a call to action? In recent talks to staff nurse audiences, only about one in 10 attendees has heard of the report, and even fewer have read it. Among those who know about it, the most frequent response is, "I'm not sure what the report has to do with me."

Figure. Michael R. B... - Click to enlarge in new windowFigure. Michael R. Bleich

The report represents the views of multiple stakeholders, including citizen groups and the business community, about what they'll need from our profession in the future. While it addresses topics like advanced practice nursing and education reform, it also focuses on direct care nurses. Where, it asks, will nurses work as the health care system evolves? What models of patient care will a reformed system emphasize? What expanded competencies will nurses need?


Coalitions and nursing and health organizations are using the report as an evidence-based blueprint for change. This alone should lure caregivers into wondering what future engagement with patients and families will look like, what will be expected of them, and how they'll function in a more team-oriented interprofessional workplace. Several key messages relate directly to point-of-care nurses:


* The scope of nursing practice-when nurses are encouraged to use their knowledge and skills to the full extent of both licensure and competency, this will spur changes in what nurses can do operationally. Too often, policies and protocols are written for novice RNs or implemented with constraint on the full abilities that nurses could bring to the health team. For instance, diabetic management protocols are written to the exclusion of diabetes certified nurses who are expert in this area; regulations limit nurses using judgment to manage pain according to a defined dosing range. Expect to be challenged to expand your influence on patient, family, and community caregiving.


* The ability to lead change and advance health-when direct caregivers are positioned to have a stronger voice in institutional decision making, nurses will begin to appear in unlikely places, such as boardroom discussions. Nurses have what policymakers need-stories that build the case for change and improve care delivery. Nurses need to become vocal in community forums and public debate. And with care increasingly delivered using team models to promote patient safety and improved outcomes, nurses must be able to lead as well as be an advocate for patients from a holistic nursing perspective.


* The ability to expand competencies and enjoy more employment choices-when health care shifts financial resources into community-based transitional care settings and even acute care is delivered in the home, nurses can envision a future with more autonomy and variety. Working in a new setting can reenergize a career. But a cautionary note: These opportunities may require adding competencies, so prepare to self-invest or take advantage of employer benefits, professional development offerings, or scholarships. Engaging in new practice settings or working with different patient populations could require attaining the next degree level or completing a postgraduate residency program.



I challenge all direct care nurses who have not yet read the Future of Nursing report to do so. You will see yourself in it. Major change often starts with the actions of a single individual. The report depends for its enactment on all nurses, as well as on stakeholders outside our discipline. Orienting ourselves to act-whether individually, collectively within an institutional setting, through a nursing organization, or through other venues-is crucial if we are to continue to enjoy the trust and confidence of the public.