The IOM Report on the future of nursing

Last week a landmark report was released by the Institute of Medicine entitled, “The Future of Nursing: Leading Change, Advancing Health.” The report  identified four key messages:

• 1.       Nurses should practice to their full potential
• 2.       Nurses should achieve higher levels of education.
• 3.       Nurses should be full partners with physicians and other health care professionals in redesigning health care in the US.
• 4.       Workforce planning and policy making require better data collection and improved information infrastructure

Some important recommendations highlighted in the report include eliminating scope of practice barriers for nurses; implementing nurse residency programs; increasing the number of nurses with baccalaureate degrees and doctoral degrees; and to collect data on the interprofessional health care work force. The report concluded that nurses are essential in the transformation of health care. 

Although lauded by most nursing groups, the physician community did not have the identical reaction. The AMA responded quickly with a response stating that, “Physician-led team approach to care helps ensure high quality patient care and value for health care spending.” The AMA does not agree that nurse practitioners have the capacity to function independently due to not having the same years of training as a physician.  In addition the AAFP replied that the report did not take patient safety into account when addressing the education and certification requirements of a nurse practitioner. There are additional blog posts by physicians also unhappy with the report commenting that nurse practitioners are not as educated as physicians and do not merit the same responsibilities or reimbursement. 

As a certified diabetes educator and clinical nurse specialist (CNS), board certified in advanced diabetes management, I believe advanced practice nurses are proficient and deserve reimbursement for their expertise. Currently, most patients with Type 2 diabetes are managed in primary care; so I argue there is a clear advantage for a patient to be managed by advanced practice nurses (APN’s) who are specialists in diabetes care.  A family physician needs to digest an incredible volume of information, generated on a daily basis, where a CNS can focus on a single specialty area.  I have often found myself educating providers on how to initiate contemporary insulin therapy, yet I am then required to get the provider’s approval to order or adjust the recommended medication. Countless reports identify that diabetes is not being managed well, with a significant proportion of patients not achieving the goals for blood glucose, blood pressure and cholesterol.  APN’s are needed to shift this trend.

I agree there are environments that warrant physician oversight and a physician-led team, but not always.  There is an evident need for a new paradigm in the management of diabetes, and APN’s as the team leader might just be the suitable choice! I implore practitioners and policy makers to keep an open mind while health care is restructuring and to look beyond the title of “nurse” as being one dimensional.