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Review: The Institute of Medicine: The Future of Nursing
The Institute of Medicine’s (IOM) report on the future of nursing took a holistic approach to nursing practice and education. The following essay reviews three of the highlights transforming practice, education, and leadership.
Transforming Practice
The IOM Report (2011, p. 22) noted a fact that nurses have known for years “system-wide changes are needed that capture the full economic value of nurses.” The two main areas needing improvement according to the report are quality of care and safety (IOM, 2011). The most practical step to for me to take to initiate better care quality and safety is to first improve communications. Communication is essential for improving the practice because information needs to be collected and acted upon, and then information on the success of the improvements needs to be collected. I want to make this cycle of communication integral to my nursing practice so that improvement will be ongoing. Nurses have to accept that all patients cannot be cured, but we can offer these patients the best care possible. Our other patients can receive our ongoing support for preventing disease and making health choices (IOM, 2011, p. 23).
Transforming Education
The IOM Report (2011, p. 183) warns nurses that big changes are ahead and education is critical to initiating the change and making the change happen. Therefore nursing education needs to accepted as continuing education because changes are being made for nurses “before they receive their licenses and after” (IOM, 2011, p. 184). A new nursing curriculum is in place at many nursing departments (Theander et al., 2016). Confidence in their professional abilities is an important factor for good patient care (Theander et al., 2011). Theander et al., (2016) studied the level of feelings of self-competence in nurses who have graduated with the new curriculum. The newly-graduated nurses who have been taught with the old curriculum or the new curriculum were found to measure their self-competence as “high” (Theander et al., 2016, p. 178). The study results are positive because now we are all learning to focus more on “patient-centered nursing” so our value as nurses can be measured and compared (Theander et al., 2011, p. 179). Patients are the individuals who will gain the most from curriculum changes that helps focus on the needs of individual patients instead of their medication or insurance coverage.
Transforming Leadership
Transforming leadership as called for in the IOM Report (2011) calls for leaders who can adapt to change and who can help others adapt to change. The IOM Report (2011, p. 221) specifically calls for nurses to become comfortable in the role of leadership because nurses are becoming “full partners with physicians and other health professionals.” Nurses are not recognized now for their leadership qualities, even though history shows nurses have been innovative and strong in many situations (IOM 2011). In order to be a full partner and to accomplish a leadership role a health care framework needs to be developed that offers opportunities to nurses to train as leaders (IOM, 2011; Brown, 2015). The transforming leadership component was well-researched and developed “on the basis of solid evidence” (IOM, 2011, p. 242).
A design template recommending the content of necessary classes and for strategies to use while educating nurses was developed for nursing programmes (Brown, Dewing & Crookes, 2015). The focus of developing the new curriculum design template was on clinical leadership (Brown et al., 2015). The template calls for curriculum that builds good leaders and includes learning competencies recommended by IOM (2011) such as negotiation, strategy, communications, systems thinking and creating communities for learning. The target of the new educational process is “novice registered nurses” and teaching them clinical leadership (Brown et al., 2015, p.2). Clinical leadership is described by Brown et al. (2011, p.3) as made up of four major components: managing others, managing self, leading other, leading self. The roles for leading self are based in the “knowledge of ethics” as well as the ability to cope with change, treat all people equally and a capability of managing conflict resolution (Brown et al., 2015, p. 3). Managing self is centered on a nurse understanding the role of a registered nurse and capably carrying out the tasks that are necessary in that professional role (Brown et al., 2015). The producers of the nursing education template envision the process of learning clinical leadership will take place over the three years of training (Brown et al., 2015). Brown et al. (2015) foresee the new curriculum process as transforming and emancipating both students and teachers.
Summary
The IOM’s vision for the future of nursing is positive towards nurses because nurses will be given the tools during their education to become respected full partners with doctors and other professional health care roles leading to a transformation in clinical practices. The registered nurses will be taught within the nursing curriculum how to carry out clinical leadership and transform patient care to a higher quality than ever before. Change will come about because nurses are learning how to improve self-competence, their leadership qualities and how to manage themselves successfully in their professional role as a registered nurse. Two of the major qualities for nurses to develop in order to meet the future needs of patients are competence and empowerment.
References
Brown, A., Dewing, J., & Crookes, P. (2015). Clinical leadership as an integral curriculum thread in pre-registration nursing programmes. Nurse Education Today, (in press; online only) http://dx.doi.org/10.1016/j.nedt.2015.11.024
IOM (Institute of Medicine). (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, D.C.: The National Academies Press.
Theander, K., Wilde-Larsson, B, Carlsson, M., Florin, J., Gardulf, A., Johansson, E., Lindholm, C. Nordström, G. & Nilsson, J. 2016. Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence. Nurse Education Today, 37, 178-183. http://dx.doi.org/10.1016/j.nedt.2015.11.012
