NUR 513 Topic 1 Discussion Question Two
Access The Future of Nursing: Leading Change, Advancing Health. Identify the two recommendations for nursing education you believe will be most effective or radical in creating change within the industry. Provide rationale based on your experience in practice. Do you agree or disagree with how the Institute of Medicine (IOM) describes the advanced practice registered nurse role evolving. Why or why not?
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In the Institute of Medicine (IOM) report title “The Future of Nursing: Leading Change, Advancing Health” (2011), the IOM recommended changes to the nursing profession in order to improve patient outcomes. One of those recommendations is to “ensure that nurses can practice to the full extent of their education and training” (Institute of Medicine, 2011). These is probably the most important aspect of the IOM report because although we are facing a shortage of primary care providers in the country, many regulatory bodies still put boundaries in place for nurses trying live up to this recommendation. There are currently only 20 states in America that allow Nurse Practitioners to practice without a supervising physician (Full Beaker, Inc., 2021).Another recommendation from the IOM report is that nurses should achieve higher levels of education (IOM, 2011). While I agree wholeheartedly with this recommendation on the surface, I believe that it may help and hurt the profession. Nurses should be expected to achieve higher levels of education and continue their education throughout their career because its just the right thing to do. Health care is changing constantly and nurses should keep up with those changes in order to keep patients safe. However, if the minimum educational level for entry into the nursing profession were to be changed to a baccalaureate degree it would prevent many people from entering the profession in the first place. The time and cost involved may be a deal breaker for many. In addition, with the nursing shortage getting worse every year we should not increase the time it takes nurses to obtain licensure. I know that for me, if I had to go straight through for a bachelor’s of science in nursing, rather than obtaining my associates degree, I would probably have chosen a different profession.
Full Beaker, Inc. (2021). Nurse.org Career Guide Series: Nurse Practitioner. Retrieved from https://nurse.org/resources/nurse-practitioner/#:~:text=Nurse%20practitioners%20have%20full%20practice,on%20certain%20patient%20care%20decisions.
Institute of Medicine (IOM) (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209881/
Re: Topic 1 DQ 2
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Thank you for your insights and perspective on the current limited privileges granted to nurse practitioners, in comparison with the high cost acquired should an individual pursue an advanced degree in nursing. It is fascinating that although an associates’ degree (AA) in nursing is commonly less expensive than a bachelor of science in nursing (BSN) education, the sheer time it takes to complete an AA is the exact same as a BSN – four years (IOM, 2011). I am curious how we can address the financial delta between an AA and a BSN, in order to provide more opportunity to RNs to seamlessly enter a BSN program after completing an accredited AA nursing program. Do you have any follow up thoughts?
Thank you again1
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209880/ doi: 10.17226/12956
Re: Topic 1 DQ 2
I do agree with you that one of the best recommendations by IOM about the role of the advanced registered nurse practice is to allow the nurses practice to the full extend according to their level of training and education. This has a direct impact on the effect of shortage of primary care providers in the sense that it will relieve the pressure on the already outstretched and overwhelmed primary healthcare providers. Additionally, the same concept was emphasized by the Center for Medicare and Medicaid Services (CMS) which broadened the concept of “medica staff” (Altman et al., 2016). This is meant to ensure that all healthcare facilities allow other healthcare practitioners like the APRNs to perform a number of roles that is within their area of training, practice and experience. Healthcare organizations that apply these recommendations are bound to be effective in terms of offering timely primary care for the patients and ease the pressure on the physicians. Additionally, this will encourage multidisciplinary health collaborations that are likely to result to high quality services and improved patient outcomes (Leach et al., 2017).
Altman, S. H., Adrienne Stith Butler, Shern, L., Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health, Institute of Medicine, & National Academies of Sciences, Engineering, and Medicine. (2016, February 22). Removing Barriers to Practice and Care. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK350160/
Leach, B., Morgan, P., Strand de Oliveira, J., Hull, S., Østbye, T., & Everett, C. (2017). Primary care multidisciplinary teams in practice: a qualitative study. BMC Family Practice, 18(1). https://doi.org/10.1186/s12875-017-0701-6
In reading the recommendations from the consensus report, one in particular stood out as I am seeing this with my current nursing students. The National Academies of Sciences, Engineering, and Medicine. (2021) recommends that that by 2021, nursing education programs, employers, and nursing leaders should implement evidence-based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity. What I am seeing with my students, who have entered a rigorous accelerated BSN program post COVID-19, is that they lack tools and resources to adequately care for their own mental health and personal well- being.
During lunch with a few students recently I asked what they do to care for themselves when they are struggling in school or feeling discouraged. I found that their answers, which included the staring at their cell phones as a coping mechanism, seemed superficial and anxiety inducing. While there was more to the conversation, I found that none of them incorporated a spiritual component to their well-being, nor do they have adequate tools to deal with the emotional problems plaguing them. Some of the struggles they were sharing with me were filtering down and negatively affecting their jobs and ability to cope with their course load.
I believe that any problem should be dealt with at the root cause instead of only managing superficial symptoms. Teaching nursing students to prioritize their own mental health and well- being through incorporating tools and resources that promote mental health while in undergraduate programs will, I believe, lead to a shift towards compassion and awareness that will enhance and increase their ability promote health equity in the populations they serve.
I agree with the report’s description of the evolution of the advanced practice nurse’s role and found it to be similar to that of DeNisco (2023) in basic content. I found the report’s discussion regarding the financial effects of the Covid 19 pandemic on the nursing profession particularly true. Private health insurers loss of revenue and subsequent decrease in reimbursement has caused many hospitals looking to rapidly decrease their costs. Because nurses and APRN’s are some of the highest paid members of the health care team, there has been many layoffs and cutbacks directly affecting nurses. So, what we see is that the heroes of the pandemic are now the ones directly experiencing the consequences of mismanaged finances of the large health care corporations they served.
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982.
DeNisco, S. M. (2023). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.
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