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Institute of Medicine Healthcare Initiative


Nurses form the largest portion of the nation’s health care workforce and can play a vital role in implementing the health care policy to ensure that all Americans have access to high-quality care. In 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) partnered and established a 2-year initiative. The program was headed by a committee tasked with producing a report in which endorsements for an action-oriented proposal for the future of nursing, including changes in public and institutional guidelines were contained.

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The Work of the Committee

The team heading the RWJF and IOM joint initiative developed the roadmap for improving the existing care system. The central aims of the initiative were to promote healthcare quality, disease management, and nursing care for patients with chronic conditions. In addition, the initiative sought to support inter specialty collaboration to improve the outcomes of health care interventions. The committee also proposed to create a billing system that rewards the quality of care as opposed to the number of services delivered. The team sought to develop a system that provides quality care to all at an affordable cost.

The committee’s deliberations focused on nursing roles, work environment, and skill requirements to strengthen the profession. It made recommendations relating to nursing practice, education, and workforce development.

Implications for Nursing Progression

The IOM committee, in their report, put forward four recommendations for improving the quality of nursing care in the country. First, it recommended that federal and state authorities should develop a policy framework to support nursing training and practice. In this context, the committee suggested a multi-stakeholder approach bringing together policymakers, Congressmen, and public health care financing agencies (CMMS) to formulate legislation guiding the nursing practice. The advisory helps states with different “licensing and practice rules and the principles regarding scope-of-practice” to prescribe the roles associated with different nursing specialties in the country (Gorman & Brierre, 2010, p. 1 ). As a result, the responsibilities nurse specialists are allowed to perform are dictated not by their education and training, but by the unique state laws under which they work.

Second, the committee recommended that nurses should be accorded training opportunities to develop their skills and acquire advanced nursing degrees. The higher training will endow nurses with the requisite competencies that will enable them to deliver high-quality care in keeping with the evolving patient needs. Nurses are prevailed upon to take up leadership roles and to “master technological tools and information management systems” to allow them to supervise health care teams in hospital settings (McNamara & Sachs, 2010, p. 3)

Thirdly, nurses are called upon to participate fully, alongside other health caregivers, in redesigning health care in the United States. Strong leadership is mandatory for the realization of the vision of transforming the health care system (Ying & Nancy, 2015). Therefore, there is a need for the nursing profession to produce leaders, policymakers, and board advisers who will participate wholly in health care reform-related implementation efforts. Interprofessional collaboration in health care should involve nurses who support other professionals in the treatment and patient care.

Lastly, improved data collection and information framework for collecting and analyzing workforce-related data was recommended to aid in “systematic assessment and projection of workforce requirements by role, skill blend, region, and demographics” (Gorman & Brierre, 2010, p. 2). It was conceived that the data could indicate trends in the supply of nursing workforce to address turnover and shortage of professionals. The endorsement of the recommendations of the IOM report by the American Nurses Association (ANA) underscores the importance of the elements and recommendations of the report in advancing the nursing profession (McNamara & Sachs, 2010, p. 3).

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The Campaign for Action

The RWJF and AARP joint initiative brings together health care organizations, academic leaders, state agencies, industry players, and philanthropic groups. It was formed as a result of the IOM report and aims to improve the health of Americans by changing the nursing profession, using the IOM report as the charter. The stakeholders drawn from different fields collaborate in implementing the proposals of the campaign.

The role of the action coalition includes setting up of goals that are in keeping with the IOM report’s recommendation. The coalition also has a mandate of forming and rallying main stakeholders representing different sectors to build a plan of action, educating policymakers and other decision-makers, and securing financial support for Action Coalition efforts. The alliance publishes its work regularly and works to advance key IOM report recommendations.

The Florida Action Coalition

The Florida Action Coalition is concerned with implementing the IOM report recommendations and transforming health care through nursing in the State. The organization seeks to support nursing training through curriculum development and providing opportunities for nurses to acquire further training. In particular, the coalition focuses on developing programs that allow continuity in nursing education. This role is essential in making nurses be effective providers of high quality and complex patient care. Most nurses do not seek higher training because of time and financial constraints. Circumventing these hindrances entails the “development of a Toolkit to help regions to develop a triad for leadership and address academic progression” (Brunnel, 2015, p.3).

Another area in which the Florida Action Coalition is working on is fostering interprofessional cooperation between nurses, physicians, and other health experts in education and practice. The present trend of professionals being trained by their peers, and not with representatives of other health care disciplines, is avoided by building relationships with various participants to oversee the success of models of interprofessional collaboration. Other barriers are the “lack of knowledge on the nurse practitioner’s role, the scope of the nursing practice” (Clarin, 2007, p. 538). Additionally, poor attitude, disrespect, and patient stubbornness affect the quality of nursing care.

These barriers can be overcome by providing formal education to other health specialists on the role and range of practice for nurses, initiating interprofessional collaboration to students early in their educational life, and holding team members liable for the improvement of communication. The Florida Action Coalition is on the forefront to promote interdisciplinary collaboration by obtaining representatives from many sectors of the economy. According to Ying and Nancy (2015), the best coalition develops practice guidelines for interdisciplinary training of health care professionals.


The United States has an opportunity to change its health care system for the better. The power to do so does not rest on nurses alone, hence, there is a need for collaborative efforts between nurses and stakeholders from other areas of the economy to help ensure that health care provides affordable quality care that is accessible to all.


Brunell, M.L. (2015). Health Policy Decision Making – Does Nursing Have a Role. Orlando, Florida: Central Florida Organization of Nurse Executives.

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Clarin, O. (2007). Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration. Journal for Nurse Practitioners, 3(8), 538- 548.

Gorman, C. & Briere, B. (2010). The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine: The National Academy of Sciences, 34(2),1-5. McNamara, M. & Sachs, A. (2010). ANA Applauds IOM’s Release of ‘Future of Nursing’ Report: Research Recommends Nurses Take a Greater Leadership Role in the Delivery and Development of Care. American Nurses Association, 10(3), 2-6.

Ying, K. & Nancy, R. (2015). Political Advocacy and Practice Barriers: A Survey of Florida State. Journal of the American Association of Nurse Practitioners: Academic Search Premier, 27(3), 145-151.

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