IOM report The future of nursing: Leading change, advancing health issued in 2011, covers a number of critical issues currently encountered in the nursing profession. The purpose of the report is to present a vision of the future for the nursing profession that would facilitate the maximizing of the nurses’ potential and role. The issues covered include, among other things, the expanding scopes of practice due to the passage of the Affordable Care Act and high turnover rates. While the report also suggests strategies to overcome these challenges, such as the promotion of teamwork or improving the workplace environment, its lack of specific focus limits many recommendations to little more than uncontroversial platitudes.
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One of the key recommendations made in the report is dealing with such a challenge as high turnover rates among nurses. The report specifies that turnover and the insufficiency of retention measures are one of the primary reasons why the healthcare system does not have a sufficient number of competent nurses (“Future of nursing,” 2011). Consequently, the report suggests that measures should be taken to limit the nurse turnover and lower its rates, thus improving the situation with professional and competent caregiving and avoiding the corresponding costs.
The primary strategy offered to achieve this goal is the improvement of the nurses’ workplace environment and, by extension, the rates of job satisfaction among the nurses. The premise behind this proposed strategy is that the nurses who operate in better environments and have higher levels of job satisfaction will not be inclined to quit. This assumption is fully in line with the existing research: for instance, Kovner et al. (2016) demonstrate that job satisfaction is one of the best predictors of unit retention in healthcare.
Apart from that, Nantsuwapat et al. (2017) also point out that the workplace environment in hospitals is a key factor influencing job dissatisfaction, burnout, and turnover rates in nurses. The report does not elaborate on the specific measures that have to improve this environment in healthcare institutions but alludes to several examples of successful strategies pursuing increased nurse retention (“Future of nursing,” 2011). Thus, one may conclude that the approach to the challenge of nurse turnover rates is sufficiently thorough and rests on recent scientific achievements.
Another recommendation made in the report is handling the expanding scopes of practice that arise due to the passage of the Affordable Care Act by promoting interprofessional teams. The authors of the report recognize that the nursing workforce will likely never have sufficient numbers to fully meet the needs of patients, nursing students, and healthcare system simultaneously (“Future of nursing,” 2011). Thus, they proceed with the premise that nurses will have to operate with insufficient numbers and the foreseeable future, and the strategies to deal with the increased scopes of practice have to consider these limitations. With this in mind, the report suggests that the teamwork approach is the only way to handle the challenge of the ever-expanding scopes of practice.
For nurses specifically, the strategy of implementing this recommendation would mean a consistent delegation of some of their responsibilities via in-group mechanisms. The teams in question should include healthcare professionals, ranging from physicians and nurses to pharmacists and therapists, and also patients themselves and their families (“Future of nursing,” 2011). According to the report, the registered nurse should delegate to frontline healthcare workers, such as community health workers, nursing students, and social workers (“Future of nursing,” 2011).
The focus on uniting the efforts of different healthcare professionals is consistent with the recent scholarly literature on nursing that portrays interprofessional practice as “the desired standard” (Parker & Smith, 2015, p. 20). In this respect, the report’s recommendations and strategies once again rest on a solid foundation of contemporary nursing theory. However, much like in the previous example, the document does not elaborate on the details of the proposed strategy.
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This lack of specific guidance is the major limitation to the practical usefulness of the recommendation offered in the report. It is hardly arguable that a better workplace environment and higher rates of job satisfaction will likely decrease turnover rates among nurses. The calls for interdisciplinary practice are also a staple of contemporary discussions regarding healthcare. Yet while the report reiterates these well-known aims, it offers little advice on achieving them on the ground level.
The authors themselves admit that, due to both time limitations and the scope of the problem, they had to cover each topic at a high level and only provide broad recommendations (“Future of nursing,” 2011). While this situation is understandable, it still largely limits the report’s recommendation to uncontroversial platitudes without enough specific guidance on their implementation.
As one can see, the 2011 IOM report covers a broad range of issues in contemporary nursing. In particular, it advises decreasing nurse turnover rates by improving the workplace environment and suggests handling the increased scopes of practice through interdisciplinary teams and delegation. While these recommendations are fully in line with contemporary research, the report rarely, if ever, elaborates on the strategies of their implementation. This broadness of scope, acknowledged by the authors themselves, constitutes a major limitation to the practical application of the report’s recommendations.
Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J., Brewer, C., & Chacko, T. (2016). Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey. International Journal of Nursing Studies, 60, 251-252.
Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R, Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91-98.
Parker, M. E., & Smith, M. C. (2015). A guide for the study of nursing theories for practice. In Parker, M. E., & Smith, M. C. (Eds.), Nursing theories & nursing practice (19-22). F. A. Davis Company.
The future of nursing: Leading change, advancing health (2011). National Academies Press.