IOM Report and the Future of Nursing

IOM Report and the Future of Nursing

Grand Canyon University: NRS-440VN

In a continuously evolving health care system, nurses have consistently remained a pivotal role in the transformation of nursing practice. Spanning from the delivery of care, to research, nurses are at the center of it all. As we shift from provider-based care to team-based, patient-centered care, nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare. The influence that the IOM report and the State Action Coalition has on nursing practice, nursing education, and workforce development, and how they advance the goals for the nursing profession will be discussed in detail in this essay.

IOM and the Future of Nursing

The Robert Wood Johnson Foundation (RWJF), is one of the largest foundations worldwide with a mission to improve access to quality health care, address health issues, and develop strategies to improve health care systems and the delivery of care. The RWJF collaborates with health systems and communities to improve the physical, social, and mental well-being of people of our nation. With the primary objective of composing a report containing eight recommendations for the Future of Nursing, in 2008, RWJF approached the IOM to establish an initiative on the report, including changes in public and institutional policies at the national, state, and local levels. To identify vital roles for nurses in designing and implementing a more effective and efficient health care system, a committee examined and developed recommendations related to these issues. The eight recommendations include improving access to care, fostering interprofessional collaboration, promoting nursing leadership, transforming nursing education, increasing diversity in nursing, collecting workforce data, and building healthier communities.

(RWJF, 2018). 2010 was a significant year in healthcare, not only was the Affordable Care Act established, but the RWJF and Institute of Medicine (IOM) issued a collaborative, inspiring report, The Future of Nursing: Leading Change, Advancing Health. This report commanded significant changes in nurses’ roles, responsibilities, and education to meet the increased demands for care and to make improvements to the healthcare system (RWJF, 2018). In response to these recommendations, the Campaign for Action Coalition was established to reform health care and transform the profession of nursing.

The Four Key Messages

The first key message from the IOM report stated that “advanced practice registered nurses should be able to practice to the full extent of their education and training” (IOM, 2015). Nurses’ abilities to realize their considerable potential to lead innovative strategies and generate a widespread transformation of the healthcare system, has been limited by a variety of policy barriers. Obstacles have included limitations on the scope of practice, increased nurse turnover rates, transition difficulties from school to practice, and an aging workforce, including lack of diversity. The second key message stated that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression(IOM, 2015). Currently, a shortage of nursing faculty limits the capability to produce increased numbers of BSN prepared nurses. More BSN-prepared nurses are needed to qualify for graduate programs that prepare nursing staff. Innovative strategies and programs must fashion seamless progression through the education system to higher levels of education, including graduate degrees. Strategies must be developed to recruit and support nursing students who represent greater diversity in the nursing workforce. “Nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States” is the third key message from the IOM report (IOM, 2015). In order to take responsibility for their personal and professional growth by developing leadership competencies, nurses at all levels must have access to mentoring programs. To advance health systems, extensively improving patient care, a healthy work culture that promotes and values leadership needs to be fostered. Lastly, the fourth key message stated, “effective workforce planning and policy-making require better data collection and improved information infrastructure” (IOM, 2015). To develop planning strategies for the future of the nursing profession and healthcare system, data must be collected and analyzed to determine the quantity and positions of nurses currently employed, and in what roles they perform. This data will help to identify and implement the necessary changes and establish goals to achieve a reformed nursing workforce system.

Role of StateBased Action Coalitions

RWJF collaborated with AARP on the IOM report, Future of Nursing: Campaign for Action with a vision for all Americans to have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success. The Campaign has formed 51 state-based Action Coalitions, comprised of diverse groups of stakeholders across the country to strive for system improvements, determine best practices, establish clear goals, and evaluate research needs at a national, state, and regional level (Campaign for Action, n.d.). Action Coalitions have helped advance the goals specified in the IOM report in many ways. One example of advancement is shown in how the IOM recommended the number of employed nurses with a doctoral degree to double by this year. In 2010, that number of nurses with a doctoral degree was 10,000, and by the year 2017, 28,000 had successfully achieved an advanced degree (Carissimi & Burger, 2017). The Campaign has made significant efforts to establish partnerships between community colleges and universities, as well as develop programs, such as transition-to-practice nurse residency programs, to ensure nursing graduates receive a strong foundation of educational practices and the ability to pursue advanced studies.

California Action Coalition Initiatives

The California State Action Coalition has initiated several initiatives to advance the future of the nursing profession. The two main initiatives that will be discussed are increasing the number of nurses with BSN in the state to 80% by 2020 and removing barriers to the scope of practice. Over the past two years, the number of nurses with a BSN has increased by 8%. Approximately 62% of nurses in California have attained a BSN or other advanced degree (Campaign for Action, n.d.). To meet the steady changes in the health care system, the committee recommends more nurses obtain higher degrees and continue lifelong learning throughout their careers. Academic advancement prepares nurses to work with complex technology, analyze and interpret multiplex information to make critical decisions, and collaborate with other multidisciplinary team members. Over the past year, the California Action Coalition has worked with Health Impact to remove scope of practice barriers and positively influence the way health care is delivered. With the collaboration of the Advisory Committee, the efforts involve academic progression and residency programs so that nurses can practice to the full extent of their education and training (Campaign for Action, n.d.). These efforts will increase the number of nurse leaders and board members to integrate a culture of health and continue to advance the Future of Nursing recommendations.

Barriers to Advancement in California

For the past several years, students have endured increased tuition costs in ADN and BSN programs in California. Educational expenses play a significant role in the number of nurses seeking advanced degrees and determining which degree to pursue. As a result of the decline in state and federal funding for higher education, costs have shifted to students and their families. A significant gap between the rate of increase in college tuition and the rate of growth in household income has contributed to substantial increases in student debt with higher education now out of reach for many students or nurses trying to advance their knowledge. RWJF and Tri-Council for Nursing, along with the State Coalition and their stakeholders, developed a program, The Academic Progression in Nursing Program (APIN), to help nurses progress academically and further IOM’s recommendations that support achieving higher levels of education and training (IOM, 2015). This program supports strategies that remove barriers that hinder nursing students and nurses from academic progression. The state of California offers grants, financial assistance, residency programs, scholarships, and loan repayment programs to alleviate some of the financial burdens of high tuition fees. Contributions from AARP and hundreds of other organizations, as well as the continued efforts of nurses themselves, are helping drive the work to implement the IOM recommendations throughout the U.S.


When the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) released their Future of Nursing: Leading Change, Advancing Health report in 2010, the nursing profession and the entire healthcare system was challenged. Recommendations target reform in nursing practice, education, workforce, policy-making, technology, quality improvement, and patient safety. The Campaign continues to build on its successes and join forces with other health care groups, policymakers, and the community to build mutuality around removing scope-of-practice barriers, reforming nursing practice, and increasing interprofessional collaboration and diversity to improve health care practice in the interest of patient health outcomes.


Altman S.H., Butler A.S., Shern L. (2016). 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. Assessing Progress on the Institute of Medicine Report the Future of Nursing. Washington (DC): National Academies Press; Introduction. Retrieved from:

Campaign for Action. (n.d.). State Action Coalition. Retrieved from

Carissimi, K., & Burger, J. (2017). Bridging the gap: Seamless RN to BSN degree transitions. OJIN: The Online Journal of Issues in Nursing22(2). Retrieved from

Institute of Medicine (IOM). (2015). 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); Key Messages of the Report. Retrieved from

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