Nursing Profession: On The Right Path, or Falling Behind?

Significant progress has been made since 2010 in the nursing profession, but work is required for that progress to continue, according to a new report from the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine.

The new report was created to check the progress of nursing since the 2010 IOM report, The Future of Nursing: Leading Change, Advancing Health, and lay out a game plan for the next five years. The new report calls for removing barriers to scope of practice, stronger pathways to higher education, a more diverse workforce, a wider coalition to expand nurses’ roles in health professions and as leaders, and better data collection. There are 3 million registered nurses in the United States.

Overall, the report found a mixed bag of slow progress and some successes:

• AARP and the Robert Wood Johnson Foundation launched The Future of Nursing: Campaign for Action to implement the 2010 report’s recommendations.

• Since 2010, eight more states have given nurse practitioners authority for full practice and to write prescriptions. The Centers for Medicare & Medicaid Services issued a rule to permit hospitals to allow other practitioners, including advanced practice RNs, to perform all functions that are within their scope of practice. “Despite this rule, medical staff membership and hospital privileges remain subject to existing state laws and business preferences,” the Academies said in a released statement.

• The 2010 report had suggested a goal that by 2020, 80% of nurses attain a bachelor’s degree and that the number of nurses pursuing doctorate degrees should double. (For more on this topic, see our story in Same-Day Surgery “Growing trend in outpatient surgery: Requirement for nurses to have their BSN.”) There have been successes in this area, including increases in baccalaureate and BSN programs and doubling of enrollment for doctors of nursing practice degrees. Enrollment in PhD nursing programs has increased by 15%. More faculty are needed in order to increase enrollment, especially for doctoral programs, the report said.

• There still is a significant lack of diversity among nurses. There are great disparities between the number of African Americans in the general population and the percentage who are nurses. The disparity is even greater for Hispanics/Latinos. Male nurses are also a minority, the report said. “Changing the overall nurse workforce is a slow process, because only a small percentage leaves and enters each year,” the Academies said. “Any efforts to improve diversity must focus on each step along the professional pathway from recruitment to educational programs, retention and success within those programs, graduation and placement in a job, and retention and advancement within a nursing degree.” (The report is free online.)

"Nurses are taking the IOM challenge very seriously, and many are returning to academia to further their education, as we want to help meet the complex needs of today's population, especially to the underserved populations," says Kay Ball, PhD, RN, CNOR, FAAN, associate professor of nursing at Otterbein University in Westerville, OH. "The major problem is that many states, such as Ohio, do not allow nurses to practice to the level of their education and skill." Barriers range from limited prescriptive authority to needing a supervising physician, Ball says. "Nurses want to provide the best care available, but when our hands are tied, this is very difficult to do," she says.