Three Years Later, Institute of Medicine Report is Fueling Innovations in Nursing Practice and Education

Report is a blueprint for change and a motivational tool to transform nursing and improve health care.

    • October 7, 2013

A decade ago, nurse leaders in Rhode Island were growing concerned about an alarming trend: Nursing students from the state’s impoverished urban core were dropping out of school because they lacked adequate preparation in math and science to handle college-level courses.

“Their version of the American dream wasn’t coming true,” said Donna Policastro, RNP, executive director of the Rhode Island State Nursing Association. “They were dropping out of nursing school and not fulfilling their dreams of becoming nurses.”

The state was suffering too. It was losing future nurses who were needed to curb looming shortages at a time when demand for nursing services was projected to soar due to the aging population and an influx of people newly covered by health insurance. It was losing students who would be able to help diversify the profession. And it was losing opportunities to prepare young adults with the kind of skills they would need to find future employment.

Then Policastro had the proverbial “a-ha” moment. She thought: What about a “middle college” for lower-income students that would prepare them to succeed in nursing school in the same way that private “prep schools” prepare wealthier students for university life?

Fast forward to the fall of 2013, and the first cohort of students in the Rhode Island Nurses Institute Middle College Charter High School is entering its fourth and final year of the program—and preparing to enter baccalaureate degree nursing programs next year.

During the program, students spend their sophomore, junior, and senior years of high school, as well as a fourth “bridge year,” at a college-like campus in Providence. The school has a specialized focus on nursing and health care and includes rigorous instruction in math and science; has a racially and ethnically diverse student body; and has been recognized for academic excellence.

It is the first school of its kind in the nation, and it is one of a number of groundbreaking innovations in nursing and nursing education that have sprung up around the country in the wake of a landmark nursing report released three years ago by the Institute of Medicine (IOM).

The nurse middle college had been in the works for a number of years, but the IOM report fueled momentum behind the project, Policastro said. It “gave us more teeth” to move forward with the program, she said. Pamela McCue, RN, MS, the school’s chief executive officer, agreed. It “really rallied the nursing community” and helped build support. The report “very much strengthened the final approval of the program,” she said.

The report—The Future of Nursing: Leading Change, Advancing Healthincluded calls to  advance nurse education; remove barriers to practice; cultivate more nurse leaders; diversify the profession; collect better data about the nursing workforce; and promote interprofessional collaboration and education. It has served as a blueprint for change and the foundation for a national campaign backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to implement its recommendations. Action Coalitions—state-level groups of nurses and nursing allies—are the driving force behind the Future of Nursing: Campaign for Action. Comprised of members representing nursing, health care, government, business, academia, consumer groups, and other sectors, these Action Coalitions are now in place in all 50 states and in the District of Columbia and have collectively raised more than $6 million so far.

Advances Across the Country

In its three years, the Campaign has supported advances at the national and state levels.

Seven states have removed major barriers to practice and care, and one state—Nevada—gave advanced practice registered nurses (APRNs) full practice authority and expanded prescriptive authority. The Federal Trade Commission has challenged limits to nursing scope-of-practice in a number of states. And the National Governor’s Association and the American Hospital Association released recommendations urging that all clinicians practice to the top of their education and training.

More and more nurses are being appointed to leadership positions around the country, and the American Academy of Nursing developed an initiative to advocate for the appointment of nurses to influential leadership positions. Leading minority nurse associations have joined a “diversity steering committee” to advise the Campaign for Action on strategies to diversify the profession. And four major foundations, including RWJF, came together to support a new Coordinating Center for Interprofessional Education and Collaborative Practice, which will work to accelerate teamwork and collaboration among nurses, doctors, and other health professionals.

At the same time, nurse education reforms are taking shape across the country, thanks in part to RWJF funding to support nurse education reform models.

In Minnesota, nurse educators have launched a massive new education program, the Minnesota Alliance for Nursing Education (MANE) to increase student access to a baccalaureate program and attainment of a bachelor’s degree in the science of nursing (BSN). Under the program, 650 nursing students a year will be dually admitted in a baccalaureate-degree nursing program via partnerships between Metropolitan State University and seven community colleges. Students enrolled at a MANE community college will receive associate degrees in the science of nursing (ADNs) upon successfully completing five semesters. Officials expect that at least 40 percent of the program’s students will seamlessly continue through dual admission to complete the BSN.

The IOM report strengthened momentum for MANE, according to its project director, Faye Uppman, MS, RN. MANE was already in development in 2010, Uppman said, but the IOM report lent it “substance” and “validity,” and support from the Minnesota Action Coalition helped it “move forward.”

In Wisconsin, meanwhile, the College of Nursing at the University of Wisconsin-Milwaukee unveiled a new online competency-based curriculum this fall that allows registered nurses (RNs) to earn BSN degrees on their own schedules and at their own paces—the kind of educational reform that is a key goal of the IOM report.

Under the school’s new “flex option,” nursing students are able to get credit by demonstrating competency in the essential areas of nursing knowledge and skills that they may already have, reducing the need for duplicate classes. “We believe this is an innovative approach to meeting the recommendations of the IOM report on the future of nursing,” said Sally Lundeen, PhD, RN, FAAN, dean of the college of nursing at the University of Wisconsin-Milwaukee.

The “first-in-the-nation” program has drawn enthusiastic support from Wisconsin Gov. Scott Walker, thanks in part to Lundeen, who worked with his administration to build support for the program. “This is great news for students and workers,” Walker said in a statement when the program won approval, calling it a “bold and innovative improvement” to public education.

At the national level, leaders from national organizations representing nurse education and community colleges issued a joined statement in support of all nurses moving to advance their education.  

And Medicare is, for the first time ever, paying to support the training of nurses with a new $200 million demonstration project in five hospital systems.

The Campaign’s biggest accomplishment, however, is its mammoth size, scope and function, according to Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America.

“The Campaign is about strategic activation of individuals and organizations across a very broad spectrum of nurses and physicians and business leaders and policy-makers,” she said. “Getting that machinery going in every state, and keeping it going, initially with no funding … is a huge achievement.”

The charge for the Campaign going forward is clear.  “At every level—federal, state, and community—we must continue to advance the recommendations of The Future of Nursing IOM report and the burgeoning success of the Campaign for Action to improve patient care, with nurses leading the charge,” wrote IOM President Harvey V. Fineberg, MD, PhD and RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, in a commentary published last week on the IOM website.

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