IOM report recommends more education, fewer practice restrictions for APNs

posted 10.14.10

A report released Oct. 5 by the Institute of Medicine and Robert Wood Johnson Foundation recommends elevating the role of nurses in the health care system to care for an influx of patients expected as the government rolls out provisions of the federal health reform law.

“The Future of Nursing: Leading Change, Advancing Health,” initiates a two-year project that will serve as a “blueprint for the future of nursing.” Through four main suggestions, the report calls for the transformation of nursing education and the removal of practice restrictions from nursing professionals.

The report begins by addressing individual state laws that govern licensed nurses’ scope of practice and dictate the extent of patient care they can safely provide under their education and training. Of the 3 million nurses in the country, a majority are registered nurses. However, the report focuses its recommendations towards one segment of the nursing profession: advanced practice nurses. There are about 250,000 APNs in the United States. Regulations on the scope of practice of APNs vary by state. Texas is one of 36 states that require collaboration between a nurse and physician for diagnosis, treatment, and prescribing of pharmaceuticals. These are the practice restrictions the IOM committee suggests should be updated with incentives provided by the federal government for state reforms.

“The Future of Nursing” goes on to recommend that nurses should achieve a higher level of education and training through an improved education system that promotes academic progression. It argues that nursing education can be improved to provide a seamless transition into higher degree programs. In addition, the authors recommend training nurses and doctors together to foster collaborative practice environments in the future.

Third, the IOM report argues that nurses should be considered full partners with physicians and other health care peers in an effort to “cultivate and promote leaders within the nursing profession—from the front lines of care to the boardroom.” This partnership would give nurses more responsibility in system maintenance, improvement plans, and goal-setting. Promoting leadership development would start in nursing school.

The final IOM argument focuses on creating a system of comprehensive health industry data. This encompasses the types of health care professionals currently in the industry, the number available now, and what will be required in the future to aid the progression of nursing professionals.

In a interview with AAFP News Now, AAFP President Roland Goertz, M.D., M.B.A., of Waco, advocates physicians and nurses working together “in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician.”

Goertz criticizes the study for ignoring the majority of nursing professionals and focusing on APNs. “Nursing, as a whole, is not just about advanced practice nursing. In my community, the largest need from a nurse staffing standpoint is not advanced nursing degree people but bedside nursing—nursing that works side-by-side with teams of practices in the area.”

To view the IOM report and accompanying press release, go to the report secion of the IOM website. For Academy coverage, read TAFP President Melissa Gerdes’, M.D., reaction to the study in an Oct. 7 TAFP news story, and the ANN story mentioned above. For more information on different professionals’ scope of practice, browse an extensive list of scope resources on AAFP’s website, www.aafp.org/online/en/home/media/kits/fp-np.html.

By Melissa Ayala, TAFP publications intern - Fall 2010