The AMA and the IOM Report on the Future of Nursing

The Institute of Medicine’s new report on the Future of Nursing was constructed by an interdisciplinary committee that included physicians. The committee’s mantra is that the report’s recommendations were developed with a focus on what will improve health care in the U.S. and the health of its people. The recommendations acknowledge that nurses can and must play leadership roles in redesigning and providing care. (This video

features former AARP CEO Bill Novelli talking about the importance of nurses leading in the redesign of health care; he was a member of the IOM Committee.) This doesn’t mean nurses run everything but that they are key members of interdisciplinary teams and may lead these teams, as nurses already do in some places.

So it was quite disappointing to see the response of the American Medical Association to the report.  Organized medicine continues to frame their arguments through a lens of quality and safety. But it’s a false argument, as the evidence in the IOM report documents.

The AMA response also reflects a poor understanding of what is needed in a transformed health care system. If we’re to improve the health of people while reducing costs, we must shift to a focus on health promotion, chronic care management, care coordination, and self-care management. Physicians are not prepared to provide these services.

The AMA (and others who want to better understand the current turf battle waged by organized medicine) should read legal scholar Barbara Safriet’s work, including her section of the IOM report on the Future of Nursing. She documents that medical practice acts were written so broadly that they try to encompass all of health care. In today’s world, the knowledge explosion should force us to consider who is educated to do what piece of health care. Safriet has delineated the statutory and regulatory changes that are needed to support contemporary interprofessional practice that can be led by professionals that can include not just physicians but nurses, social workers, psychologists, and others.

I would argue that nursing is the profesison that educates its practitioners about the physical, psychological, social, and environimental dimensions of individuals, families, and communities. This education prepares nurses to bring an important, holistic vision to the work of health care and positions them to be great leaders of interdisciplinary teams. But context is also important and team leadership should not be the purview of any one profession. TCAB, Transfroming Care At the Bedside (an initiative for improving care in acute care facilities that uses nurses and other providers of care as change agents), demonstrated that sometimes the best person to lead the team initiative may be a nursing assistant. And a social worker would probably be the best person to lead an interdisciplinary team (that includes physicians and nurses) that provides care to people with chronic mental illness who have established solid relationships with their community mental health service.

The AMA needs to examine its motives and aims. This is the time to focus on what people need to promote their health in affordable, accessible, equitable ways.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.shtml

The Institute of Medicine’s new report on

IOM Report on the Future of Nursing Released

The preliminary Institute of Medicine report on the Future of Nursing was released today at the National Press Club in Washington, DC. IOM president Harvey Fineberg, MD, spoke to the importance of this evidence-based report, nptimg that nurses work in every corner of health care and are key to fulfilling the recommendations of prior IOM reports on quality and safety in health care. The Robert Wood Johnson Foundation funded this initiative. Its president, Riza Lavizzo-Mourey, MD, noted that the report is not so much about nursing as it is about transforming health care. Donna Shalala, PhD, president of the University of Miami and former secretary of Health and Human services, served as chair of the diverse committee that developed the recommendations. While there are 8 recommendations, Dr. Shalala noted that there are four key messages:

1. Nurses need to be able to practice to the full extent of their education and training. This will require removing institutional, statutory and regulatory barriers to this aim.

2. Nurses need to pursue higher education and educational systems need to provide methods for seamless progression if nurses are to take on expanded roles now and in the future.

3. Nurses must be full partners with others in redesigning health care in the U.S.  Dr. Shalala spoke to the importance of engaging nurses to participate and even lead redesign efforts.

4.  Better data and information infrastructure are needed to improve workforce planning and policymaking.

Linda Burnes Bolton, RN, DrPH, vice president of patient care services at Cedar-Sinai Medical Center, noted that “the report speaks to the American people” because it focuses on how to promote access to the high quality, safe, affordable, equitable health care that people want to receive in their homes, workplaces, and elsewhere.

To view a web cast of the press conference, go to .  The report and web cast can be accessed at www.iom.edu/nursing.

The corrected copy of the report will be available at a future date. I was pleased to work with Joy Jacobson to write the case studies and profiles included in the report. While I already knew about most of the work that we wrote about, we conducted over 50 interviews to develop the case studies. I was regularly inspired by the innovative, visionary, committed work that my nursing colleagues have been doing and will continue to do everyday. It’s a great time to be a nurse. But it will take continuing to partner with the public, supportive physicians, other health care team members, policymakers and others to move these recommendations forward and, thus, help to transform health care in this nation.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

The preliminary Institute of Medicine report on