Robert Wood Johnson, IOM REPORT: Review, Its Influence on Nursing, TEXAS State

Introduction

Improving the system of health care has been a major subject of focus for the U.S. government. Across the world, health care is a very important docket as it exists to safeguard people’s lives. The healthcare system in the U.S. has received a lot of attention from scholars owing to the fact that it is highly fragmented. According to the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011), this fragmentation is caused by a disconnect between demand and supply, patients and care providers, and patient needs versus provider training, among other factors. Unless this disconnect is removed, provision of quality, accessible care to all Americans will remain a dream. With nurses comprising the largest percentage of the U.S. healthcare workforce (Whitney, 2018), any discussions and propositions to redesign the healthcare system must include the input of nurses. The much-needed transformations in health care and the role of nurses are outlined in the famous Institute of Medicine-IOM-Report, whose key contents are discussed in this paper.

The Robert Wood Johnson Foundation Committee Initiative

Significant efforts have been made in a bid to improve health care in the United States. The famous Committee on the Robert Wood Johnson Foundation Initiative is a key player in these efforts. In summary, the Committee’s principal focus was to transform the system of health care by addressing the limitations currently facing healthcare in the country. It envisions a system in which quality care can be accessed by all people in the U.S.; it also seeks to promote wellness, provide compassionate care, and improve health outcomes to reliable margins (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine, 2011).

The Work of the Committee

The Committee is a team of experts that came together and discusses, debated, and assessed possible solutions to the numerous health concerns facing not only the U.S. but the world as a whole. The Initiative was created with the aim of exploring how possible it was to strengthen nurses to partner and play leadership roles in improving care delivery and the entire system of health care in the U.S. (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011). It was developed by a partnership between the Institute of Medicine and the Robert Wood Johnson Foundation.

Key Messages of the IOM Report

To realize its vision of transforming health care, the Committee made four major recommendations, commonly known as the four key messages.

      i.         Transforming Nursing Practice

The first key message in the Institute of Medicine report is that nurses ought to deploy their education as well as training fully in delivering care to patients. The Committee advocates for the removal of any financial, regulatory, and policy barriers that may hinder nurses from practicing; this way, patients can choose whom to be attended by. In addition, nursing practice should not be limited to acute care facilities; instead, nurses should be allowed to apply creativity in identifying areas through which they can serve the population, whether as health coaches, informaticians, or care coordinators. This specific recommendation has had a valuable impact on nursing practice, with a good example being the provision of patient-centered care (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine, 2011).

    ii.         Transforming Nursing Education

The second key message in the IOM Report is the importance of transforming education. Specifically, the recommendation is that nurses ought to advance their education together with training via an enhanced system of education that fosters smooth academic progression (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine, 2011). With the health care environment being a dynamic one where major changes occur frequently, it is necessary that nurses upgrade their education and skills accordingly. This is only possible with a good education system that caters for the rapid rise in number of people interested in pursuing nursing. According to the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011), over 50% increase in applications for entry-level baccalaureate programs was recorded between years 2004 and 2009.

Although nursing schools are trying their best to enroll as many students as possible, there is a serious shortage of teaching staff as well as clinical placements (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011). On top of this, the models of teaching used in the past have been rendered obsolete in the contemporary world, thus necessitating fundamental changes to the education system. At the same time, the need to adopt a multi-disciplinary approach has been found to be more effective in providing quality health care. This means that there is need for professionals with diverse specialties in health care to work together towards delivering quality care.

  iii.         Transforming Nursing Leadership

Key message number three in the IOM Report is the need for transforming leadership. The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011) recommends that nurses ought to be made full partners in efforts towards restructuring and redesigning the American health care system. The rationale behind this recommendation is that nurses possess valuable knowledge, ideas and experiences that are helpful in redesigning health care. Since the work of nurses is to provide hands-on care and communicate with patients together with their families regarding health status, besides ensuring that prescribed treatments generate desired outcomes, they play a key role in transforming nursing practice. It is therefore important that nurses be involved in making and implementing health policy decisions. Examples of ways through which nurses can transform leadership include actively serving in advisory committees and commissions created to enhance patient care; they also partner with charitable organizations and other clinicians towards improving health care.

   iv.         Workforce Development and Better Data Collection

The fourth message in the IOM Report emphasizes the importance of quality data and information in health care. The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011) recognizes that it is difficult to achieve the desired health care transformations if the number of nurses available, as well as the number that needs to be hired to cater for the population’s health needs is not known. According to the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (2011), there are major gaps in the workforce data that is currently available, thus hindering the capacity to make necessary changes.

Role of state-based action coalitions

In the different states in America, there are special organizations known as action coalitions that are instrumental in achieving the vision of the Institute of Medicine. These coalitions are spearheaded by nurses in conjunction with business partners, and their primary purpose is to transform the health care system at the local level through nursing as well as building healthier communities. The coalitions are made up of various entities including nurses, educators, and business organizations (Campaign for Action, n.d.).

How State-Based Coalitions Help to Advance IOM Report Goals

By focusing on building healthier communities at the local level, state action coalitions help to advance the goals and vision specified in the IOM Report, which is to enable America’s diverse populations access quality care. Additionally, since the coalitions are a partnership between multiple stakeholders, they may be said to advance key message number three in the IOM Report, which is about transforming leadership through collaboration.

Texas State Action Coalition Initiatives

The Texas State Coalition has developed a number of initiatives aligned with the IOM Report vision and key messages. Two of these initiatives are the Nurses on Boards Coalition and development of dashboard indicators, as described below.

a)    Nurses on Boards Coalition and its Impact on the Nursing Profession

In a bid to foster nursing leadership, a body known as NOBC-Nurses on Boards Coalition- has been formed. The goal of this body is to ensure that at least 10,000 nurses serve in boards together with other influential organizations that make strategic decisions on health. This initiative plays an important role in advancing the nursing profession as it empowers nurses to take part in making strategic decisions on issues that affect them.

b)    Dashboard indicators for tracking data

A second initiative on which the Texas State Coalition is working is to improve data for workforce planning, as recommended by the Robert Wood Johnson Foundation Committee. According to reports, the Coalition, in collaboration with the Texas Board of Nursing and the Texas Center for Nursing Workforce Studies is developing dashboard indicators that will facilitate tracking and reporting of data pertaining to the nursing workforce (Campaign for Action, n.d.). This initiative is in line with key message number four, and helps to advance the nursing profession by providing accurate information about the workforce, which may be used to address issues such as nursing shortage.

Barriers to Advancement in Texas

Even with the above initiatives, nurses in Texas still encounter substantial challenges and barriers as they seek to fulfil their responsibility to humanity. The major barriers to advancement in Texas include state laws, institutional practices, federal policies, and obsolete models of insurance reimbursement (Peterson, 2017).

Ø  Restrictive state laws

Texas is categorized among the 12 states that are restrictive in the sense that they deny nurse practitioners the freedom to utilize their licenses fully in nursing practice (Peterson, 2017). Similarly, APRNs in Texas are excluded from the list of medical workers who are authorized to admit patients and discharge them (Altman, Butler & Shern, 2016).

Ø  Nursing shortage

Another barrier to advancement of health care in Texas is shortage of providers (Statewide Health Coordinating Council, 2016). Somewhat related to this is the fact that not all Texans have sufficient access to health care; women, low-income households, minority groups, and people living in border counties have poor access to care (Statewide Health Coordinating Council, 2016).

Nursing Advocates’ Response to the Barriers

Aware of the barriers outlined above, nursing advocates in Texas are very vocal about having these barriers removed. For instance, concerning the issue of unequal access to care, the Texas State Coalition pursues the goal of promoting health equity and has launched campaigns to address socio-economic disparities. Specifically, the Coalition is committed to creating and nurturing a Culture of Health in which all Americans, their socio-economic status notwithstanding, can access health care (Campaign for Action, n.d.). To address the issue of nursing shortage, more nursing program vacancies have been opened and community colleges created.

Conclusion

Accessible, quality health care in the U.S. is possible if the four key recommendations in the IOM Report are implemented. Precisely, any efforts to improve the health care system must be developed with nurses at the center, reason being that nurses determine accessibility, quality and value of care to patients. As such, all strategies for improving health care must revolve around four points: promoting nurse education and training; allowing nurses to employ their skill and knowledge to the fullest; empowering nurses for leadership activities; and keeping track of data regarding the nursing workforce.

References

Altman, S. H., Butler, A. S., & Shern, L. (Eds.). (2016). Assessing progress on the Institute of Medicine report The Future of Nursing. National Academies Press.

Campaign for Action. (n.d.). State action coalitions. https://campaignforaction.org/our-network/state-action-coalitions/

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing& Institute of Medicine (U.S.). (2011). The future of nursing: Leading change, advancing health. Washington, D.C: National Academies Press.

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81.

Statewide Health Coordinating Council. (2016). 2017-2022 Texas state health plan. www.dshs.texas.gov/ConsumerandExternalAffairs/legislative/2017Reports/State-Health-Plan-Implement2017.pdf

Whitney, S. (2018). The future of nursing in an evolving health care system. In Grand Canyon University (Ed). Trends in Health Care: A Nursing Perspective. Retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/trends-in-health-care_a-nursing-perspective_1e.php