Wood Johnson’s Foundation Work
The Institute of Medicine (IOM report, titled “Future of Nursing: Leading Change, Advancing Health” and made public in 2010 was the result of 2 years of hard work and collaboration between the IOM and Robert Wood Johnson Foundation (RWJF) (IOM, 2010a). The initiative sought to assess and transform the nursing profession, underlining the prevalent trends in medicine, and highlighting the aspects for evolution and development. The purpose of the report was to produce an action-based blueprint through a series of recommendations for hospitals, government institutions, nurses, and educational facilities.
During these two years, RWJF and IOM collected various data regarding various key points of the existing healthcare system in the US, namely access to care, the effectiveness of interprofessional collaboration, implementation of nurse leadership, the effectiveness of nursing education, diversity, and workforce data (IOM, 2010a). The analysis of this data allowed the two organizations to envision the state of the practice today and propose effective improvements for the future, with an emphasis on patients aged 50 and above (IOM, 2010a). Thus, the report showed its awareness of the incoming demographic crisis that is about to fall upon the western world. In order to achieve the goals announced in the report, RWJF created 51 action coalitions (one in each state), uniting practitioners, advocates, educators, business leaders, and policymakers (IOM, 2010a).
The four key messages that could be taken away from the report are as follows (IOM, 2010b):
- Nurses should be enabled to practice to the full extent of their education and training. This was a major issue in US healthcare for a while, as individuals with superior qualifications were often stuck doing menial tasks that diminished both the value of their acquired skills and the person in question. After 2010, steps were made to reduce skill-based misplacement (IOM, 2010b).
- Nurses should be given the tools to improve their education and training through seamless academic progression. The issue of nurses not applying for qualification training was and still is prevalent due to high demands on personal time as well as increasing costs. Nowadays, there is a multitude of state-sponsored programs for individuals willing to go through training (IOM, 2010b).
- Hospital hierarchy needed redesigning, in order to make nurses full partners to physicians and other healthcare practitioners, rather than assume a subordinate role (IOM, 2010b). The period after 2010 saw the rise in interprofessional collaboration, with the traditional barriers between nurses and physicians slowly being erased.
- Finally, the issues of workforce shortage were highlighted as some of the most dangerous to the promotion of healthcare, with policies and planning requiring substantial research. During the last decade, such research was made, leading to new potential policies and practices being implemented. The introduction of a floating workweek and the gradual implementation of three 8-hour shifts instead of two 12-hour shifts are examples of such (IOM, 2010b).
The Role of State-Based Coalitions
The US is comprised out of a multitude of states, each having its own specific laws, regulations, and bills that affect the delivery of healthcare in their specific localities. State-based coalitions established by RWJF seek to promote the goals as stated above, with regards to regional specifics. The aims of these coalitions are two-fold. First, they seek to create change at the local level, where individuals can feel their effects quicker. Second, they possess greater knowledge of the patients’ wants and needs, as well as the general state of medicine in the area, making their propositions more spot-on. Trying to promote a blanket solution to the four goals on a federal level without a backbone of state legislations to rely upon is often difficult, and turns out to be a bill that does not really fit any state perfectly, thus causing conflict and confusion. Therefore, coalitions help advance the goals specified in the IOM report on a local level, by conducting research, advocating and sponsoring necessary bills, providing training, and allowing for nurses, businesses, legislators, and patients to gather and form a unified position on the subject.
Initiatives in California
California is an active member of the RWJF, with its local coalition spearheading at least 10 projects currently being sponsored, supported, and promoted on the local level. Two examples of such programs include the pre-term birth initiative of California and the telehealth for vulnerable communities program. The former recognizes that the issue of preterm birth disproportionately affects the poor and women of color (“It’s telling my story,” 2016). By working with the communities and making individual voices heard, the researchers seek to learn peoples’ stories and understand how the conditions of their everyday living may affect the health and growth of the fetus. The program allowed researchers to come up with 135 questions that were later used for data collection in order to create a plan for the localities of San Francisco, Oakland, and Fresno, among many others.
The second project is associated with telehealth, which is an innovative approach to healthcare using technology. By utilizing various online and telephone methods of instruction, acquiring health data, and promoting individual autonomy, the nurse-managed clinic in Los Angeles managed to significantly reduce the number of in-patient visits, thus effectively reducing the workload on nurses while improving the quality of self-care for patients at home (“Telehealth expands,” 2016). Both of these initiatives seek to provide an evidence-based approach to problems, with the latter specifically having the workforce sub-goal in mind. Therefore, they relate specifically to the fourth key point discussed in this paper.
Barriers to Nursing and Advocacy
According to California’s Health Care Foundation, the primary barriers to nursing include issues with the scope of practice, affordability, and availability of specific medical services (IOM, 2016). The scope of practice barrier is largely associated with the delivery of primary care, which is expected to soar in California by the end of 2030. At the same time, physician supply is less than a half for this type of care, especially in rural areas. As a result, nurses and physician assistants end up performing these duties anyway, but without proper policy backup, creating complications for healthcare facilities and nurses alike. The IOM report advocates for expanding the nurse scope of practice, thus promoting the legislation calling for action in that field (IOM, 2016).
An issue associated with the first problem is followed by the issue of data gathering and collection (IOM, 2016). According to some, NPs are already providing comparable quality to physician care not only in primary care, but also in prescribing, chronic disease management, and ordering diagnostic tests. This is especially true for rural communities. However, the data available is insufficient to correctly assess the situation and use it as an advocacy point. Therefore, the lack of data represents a barrier. The local Californian coalition tackles it by sponsoring and conducting research on the matter of effectiveness of nursing practitioners in these roles, meaning that more research will be dedicated to the matter, allowing to advocate for a bill and promote changes further (IOM, 2016).
The third issue is regarding workforce utilization, understaffing, and working overtime. As it stands, many Californian clinics and care centers are understaffed, forcing nurses and doctors to work overtime. In addition to obvious physical and psychological stress associated with the practice, there is an issue of additional expenditures. Hospitals pay roughly between 5,000 and 15,000 dollars per nurse to reimburse them for the extra time (IOM, 2016). These costs are placed upon patients, which negatively affects their financial situation. In addition, overtime is associated with increased risks and lower quality of care. In California, there is a bill in a session that seeks to alleviate these costs from the customers and improve schedules for employees, which would increase availability and tackle the issues associated with overtime, overworking, and stress (“Our Story,” n.d.).
Institute of Medicine (IOM). (2010a). The future of nursing leading change, advancing health: Report brief. Web.
Institute of Medicine (IOM). (2010b). The future of nursing leading change, advancing health: Report recommendations. Web.
Institute of Medicine (IOM). (2016). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Our story. (n.d.). Web.