The Institute of Medicine: “The Future of Nursing”


The Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health report is a detailed nursing environment analysis. It examines the quality of service given to patients and the nature of the nursing workforce. It provides solutions for the problems affecting the nursing fraternity and measures to improve service quality. This report’s sole purpose is to improve patient outcomes and concurrently better nurses’ workforce and working conditions in the United States.

Factors that Led the Robert Wood Johnson Foundation Committee Initiative to Write the IOM Report

When the Robert Wood Johnson Foundation (RWJF) approached the IOM in 2008, they wanted to create an initiative that promotes good health in the United States while ensuring the needs of nurses and the whole nursing fraternity are considered. They aimed at creating a system that rewards hard work and health with value and appreciation rather than just work. ‘How can the system accommodate the increased demand while improving the quality of health care services provided to the American republic?’ (Wood, 2010, p.28). That was the question posed by the RWJF at the beginning of the report to ensure that its readers understood their point of view and would try to implement the mentioned ideas as per the requirements stated. The RJWF’s vision was to make quality health available to the various population in the United States hence promoting deliberate wellness, preventing diseases, improving health aftermaths while simultaneously providing compassionate care for citizens. The report’s purpose was to enhance nursing education, training, practice, leadership, and working conditions to refine healthcare.

The Key Messages of the IOM Report

Nurses should exercise the full scope of their education and training

Nurses have the most crucial work in the healthcare sector because of their direct interaction and proximity to the patient. For this purpose, nurses should practice to the magnitude of their education and training. However, they face specific barriers like regulatory and policy barriers, a fragmented healthcare system, and the school’s complexity to practice transition. The report points out that nurses may not have enough time with patients to provide their best services. Their time is tied up mainly on the administration of medication and documentation of details. The report recommended the enhancement of the technology to reduce these functions and subsequently improve the patient-nurse relationship. Consequently, the nurses will realize their potential as caregivers and practice more of their education and training (Young et al., 2017). Moreover, it will reduce the lack of consistency in promoting better healthcare throughout the country. On implementing this suggestion, specific barriers and regulations have been removed, leading to an increased nursing practice scope.

Nurses should get higher levels of education and training

The future of nursing report highlighted the deficiency of nursing education in the 21st century. In a century where there is growing interest in nursing every year, consideration needs to be put on nursing education to increase competency and better health care. Conferring to the IOM report, the number of students applying to study nursing is greater than the number of practice placements. Subsequently, institutions of nursing education gradually increase the number of application declines every year.

Another factor leading to this declination is inadequate faculty per subject in nursing institutions. Therefore, the IOM report recommended that nurses attain higher education levels to be conversant and competent with the ever-growing technology and practices. Higher education will also ensure that the faculty in nursing institutions are improved for better education and patient-nurse relation resulting from increased intakes and placements (Kovner et al., 2018). Team training with physicians and other healthcare system workforce as students, residents, and practicing nurses was recommended in the report. Accreditation processes, where the skills are vetted through demonstrations and managerial ability, were also suggested in the report. Implementation of this has led to an increased number of experienced nurses.

Partnership with other healthcare professionals

The report points out that nurses should be included in policy-making rather than making them feel like policies are imposed on them. When nurses are given full partnerships with other healthcare workforce members and are involved in making decisions, the quest for better health becomes collective. For this to be realized, nursing education should include leadership programs that train nurses to be leaders in their respective fields. Assessment should encompass nurses’ ability to identify problems, design and implement improvement tactics, assess their efficiency, and amend where necessary. The enactment of this recommendation has made healthcare better as nurses are included in research, policy-making, and decision making as much as they are involved in caregiving hence providing better first-hand service.

Better data collection and information system for an improved workforce

For the messages mentioned above to be implemented, data must be collected throughout the country, showing the workforce in every health institution and their duties. The data should include the number of specialists in the country, their employment institutions, and their healthcare provider responsibilities (Spetz et al., 2016). Through this data, areas of shortage can be identified and be filled with the appropriate specialist. Information obtained will ensure that the nursing workforce’s requirements are met and the future of nursing is effectively planned. The application of this procedure has assured that all vacant positions related to patient wellbeing have been filled, ensuring better service management and the workforce of the health care fraternity.

State-Based Coalitions

The RWJF introduced state-based coalitions to monitor the implementation and progress of the recommendations in the Future of nursing report. These action coalitions ensure that nurses work practice to the magnitude of their capabilities and provide quality health care for patients. Action coalitions also create a link between the nurse and the government and help warrant nurse-patient interaction hence implementing the affordable health care act.

California Action Coalition

The Californian Action coalition has attempted to implement the IOM report. Some of these initiatives include:

  1. The total number of nurses with a baccalaureate degree in nursing has been increased. As of 2020, this number had risen by 80% from the beginning of implementation in 2011 (Young et al., 2017). Consequently, practicing nurses’ health care is of better quality, with 61.5% of nurses holding a degree (Spetz, 2018). The degree enhances the nurses’ judgment and leadership ability improving the patient outcome.
  2. The scope of practice barriers have been removed, allowing nurses to practice their different skills, ensuring that all patients are cared for and given direct attention. Therefore, the nursing profession is boosted by increasing direct patient-nurse interaction, hence better provision of health care to everyone in the state.


The only barrier facing California’s initiatives is the lack of funds for students interested in studying nursing in the baccalaureate program. As much as the coalition tries to implement the report’s recommendations, this setback slows down their mission. However, measures have been put to overcome this obstacle. Training institutions have been requested to collaborate with private and public organizations to provide students with loans to fund their education and training. With this, the goal of increasing the number of nurses will be reached.

Ten years later, the Future of Nursing report has improved the country’s state of health care. While enhancing the patient-nurse interaction and the quality of services provided by nurses, it has also improved nursing working conditions countrywide. Consequently, the report has enriched patient outcomes as health professionals work hand in hand with nurses to ensure quality healthcare. Therefore, the report is efficient in improving the quality of health care services provided to Americans even with the increasing demand for accommodation.


Kovner, C., Djukic, M., Jun, J., Fletcher, J., Fatehi, F., & Brewer, C. (2018). Diversity and education of the nursing workforce 2006–2016. Nursing Outlook, 66(2), 160-167. Web.

Spetz, J. (2018). Projections of progress toward the 80% Bachelor of Science in Nursing recommendation and strategies to accelerate change. Nursing outlook, 66(4), 394-400.

Spetz, J., Cimiotti, J., & Brunell, M. (2016). Improving collection and use of interprofessional health workforce data: Progress and peril. Nursing Outlook, 64(4), 377-384. Web.

Wood, R. (2010). The future of nursing: Leading change, advancing health (1st ed.). The National Academic Press.

Young, H., Bakewell-Sachs, S., & Sarna, L. (2017). Nursing practice, research, and education in the West. Nursing Research, 66(3), 262-270. Web.

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