Recent changes in the healthcare sector have emphasized population well-being, quality of care, and service value. As a result of these reforms, registered nurses in the United States face both opportunities and challenges (Salmond & Echevarria, 2017). As a result of their numbers, nurses are vital in the ongoing transformation of the system and will also be impacted by the restructuring. These observations are echoed in the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, which examined the nursing workforce (Institute of Medicine, 2010). The report investigated how nurses’ roles, responsibilities, and instruction can be improved to meet the increasing demand for services caused by the Patient Protection and Affordable Care Act (ACA) and the Health Care and Education Affordability and Reconciliation Act (HCERARA) (Dooley, 2019). As a result, this paper aims to discuss the effect of the IOM analysis and state-based policy coalitions on nursing practice, education, and workforce development and how they contribute to the advancement of the nursing profession’s goals.

The IOM study investigated how nursing could improve the healthcare landscape and create a system that addresses the demands for safe, high-quality, patient-centered, effective, and affordable care. Through its work, the IOM’s Robert Wood Johnson Foundation Initiative on the Future of Nursing provided a roadmap for a different healthcare world while recognizing the demands and limitations of the modern healthcare system (Institute of Medicine, 2010). The committee envisioned a scheme that offers services to the nation’s varied populations, intentionally promotes longevity and disease avoidance that reliably improves medical outcomes and provides compassionate treatment over the lifespan (Institute of Medicine, 2010). The committee believed that nurses are vital to improving the healthcare system because they spend the most time delivering emergency services. As a result, nurses have distinct experiences and the opportunity to work with other healthcare providers to increase treatment quality and safety, as envisioned by the ACA.

During its proceedings, the committee proposed four key messages that will be addressed in this section. The first message was that to transform the procedure, and nurses must use all of their skills and training. To capitalize on APRNs’ overall capacity and education, federal and state policies must be revised and standardized to ensure Americans have access to essential healthcare services and that nurses’ unique contributions to the healthcare system are maximized (Tierney et al., 2020). The second message stressed the significance of transforming education and ensuring that nurses attain greater levels of learning and preparation through an educational system that encourages sustained student achievement. The message was based on the premise that significant improvements in the United States’ healthcare system and practice climate necessitate equally substantial changes in nurse education both before and after licensure.

The third message stressed the importance of reforming leadership and seeing nurses as full partners in reorganizing health care in the United States, alongside physicians and other health care providers (Institute of Medicine, 2010). While not all nurses start careers with ambitions to become leaders, strong leadership is pertinent to reforming the US healthcare system. In a changing structure, nurses with resilient abilities are expected to take on reconceptualized roles in different settings, educating and re-educating themselves in the process. The fourth message stressed the value of advanced information systems and better data on the healthcare community for adequate staff preparation and policymaking (Institute of Medicine, 2010). Planning for radical reforms related to healthcare reform is difficult without a clear understanding of the necessary contributions of these varied professionals and the statistics and makeup of the healthcare workforce. In reality, the interpretation is difficult to achieve without precise, fine-grained data on the current workforce and forecasting workforce needs.

State-based action coalitions carry out campaigns at the local, federal, and state levels. Community activists, including representatives from health associations, businesses, education, and other sectors, work to improve communities through nursing (Hassmiller & Reinhard, 2019).  State-based policy coalitions put the IOM report into motion by collaborating with nursing education partners to implement uniform curricula in all states, advancing practice by disseminating best practice mechanisms that demonstrate the benefits of nurses practicing to the full extent of their education and training and advancing nursing leadership. The coalitions formed task forces to increase awareness about nurses’ efforts to improve the state’s healthcare system. Furthermore, the unions promote educational opportunity and encourage nurses to put their curriculum and training skills to use by developing mentorship services that help students build confidence and expertise.

For example, the Arizona Action Coalition has initiated a series of initiatives to help execute the IOM report’s recommendations. First, the coalition raised awareness and used database resources to address the need for a long-term, transparent, reliable, and effective system for collecting data from healthcare workers from various disciplines (“Arizona State Implementation Program project”, n.d.). Furthermore, the task force increased resource awareness, eliminated silos and barriers in institutions and entities across the stake, and linked Arizona to coalitions in other states. The second campaign is concerned about diversity. To locate nursing advisors for two nursing programs, the team worked with the National Association of Hispanic Nurses (NAHN), the Black Nurses Association, and the Philippine Nurses Association (“Arizona State Implementation Program project”, n.d.).  The diversity council was established to mentor and assist students in accomplishing their goals of strengthening the health of Arizona’s underserved populations and delivering resources to a diverse population.

The Arizona Action Coalition has made substantial strides in adopting the findings of the IOM survey. The union has nominated champions for its services and has helped to achieve these results. Although its success, the partnership is confronted with several challenges, including competing state interests, facilitation concerns, and collaboration among multiple stakeholders. Furthermore, the Arizona state government did not prioritize developing a website, which hindered access to funds and grants. Management changes created a barrier to gathering healthcare workers data from those providers because it took longer to establish a bond with separate licensing agencies who changed leadership. On the other hand, the coalition resolved the challenges by forming task forces and campaign committees to raise funds for the campaigns, including grants.

Finally, the healthcare sector in the United States is marked by a high degree of heterogeneity in multiple sectors, which poses significant barriers to providing open, high-quality coverage at a fair rate. The IOM report made recommendations for reorganizing the healthcare system, reducing heterogeneity, and rising efficiency while decreasing costs. The proposed recommendations place a premium on optimizing nurses’ competencies, ensuring that all nurses have the highest level of qualifications, and involving nurses as full partners in care delivery. These recommendations are intended to reshape the nursing profession on a technical basis, ensuring that all nurses are trained to meet the increased demands of the restructured healthcare system. The initiatives have resulted in rapid improvements in the healthcare system, such as population health, care quality, and service value.

References

Arizona State Implementation Program project. Campaign for Action. Retrieved 8 May 2021, from https://campaignforaction.org/sip-state/arizona/.

Dooley, T. P. (2019). Reexamining the Impact of Medicaid Expansion in a Post-Affordable Care Act Environment from a Critical Race Perspective. Journal of Public Management & Social Policy, 26(1), 3.

Hassmiller, S., & Reinhard, S. (2019). The Robert Wood Johnson Foundation and AARP Story:. Nurse Leader, 17(5), 399-403. https://doi.org/10.1016/j.mnl.2019.07.005

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

Tierney, M., Finnell, D. S., Naegle, M., Mitchell, A. M., & Pace, E. M. (2020). The Future of Nursing: Accelerating gains made to address the continuum of substance use. Archives of psychiatric nursing, 34(5), 297-303.