IOM Report: The Evidence Shows the Future of Health Care Rests on the Backs of Nurses

By Shawn Kennedy, AJN interim editor-in-chief

This past Tuesday, I attended the release of the highly anticipated (at least by nursing) report by the Institute of Medicine (IOM) on the future of nursing. Spearheaded and supported by the Robert Wood Johnson Foundation (RWJF), the report provides a review of nursing’s role in health care and details what changes need to occur for the future—not just of nursing, but for the future health of the health care system.

While the findings support what nursing has been claiming all along—that nurses have a critical role in health care and the health care system needs nurses to practice to the full extent of their capability—what is especially important about this report is that it is backed by the IOM’s multidisciplinary panel and an “objective evaluation of evidence according to the robust evaluation processes of the National Academy of Sciences,” said John Rowe, a committee member and professor at Mailman School of Public Health at Columbia University.

The panel at the public briefing for the release of the report included some health care heavyweights who voiced strong support for the findings:

Harvey V. Fineburg, president of the IOM: “One thing shouts out—nurses are critical to the nation’s health and central to the goals of high quality care.”

Risa Lavizzo-Mourey, president and CEO of the RWJF: “This is not a report about nursing but a report about a key missing piece to fixing health care; it establishes the centrality of nursing in providing safe, high quality, patient-centered care.”

Donna Shalala, president, University of Miami: “This report will usher in the golden age of nursing. Nursing has to be allowed to practice to the full extent of its scope of practice and to be a full partner with other professions in redesigning the U.S. health care system. It’s not about one profession substituting for another but about true collaboration.”

Later, in an interview I conducted with ANA CEO Marla Weston, she made a point of saying that allowing nurses to fully practice “isn’t just about NPs—nurses in all settings need to be allowed to practice according to their education and professional scope.  Nurses in institutional settings are often limited by bureaucratic policies and procedures.”

Prior reports by the IOM have spurred transformation of health care delivery—think of the 1999 report on medical errors, To Err is Human: Building a Safer Health System, and how that initiated a focus on creating a culture of safety and brought about new standards for hospital safety. I’m hoping the same will happen now with this report.

What the MDs say. And I hope our professional colleagues will be open to the report’s findings, though I have some doubts. The American Medical Association issued a statement that, after initially noting that “health care professionals will need to continue to work together,” goes on to reveal that the AMA believes in  “a physician-led team approach to care—with each member of the team playing the role they are educated and trained to play.” Further, it says, “increasing the responsibility of nurses is not the answer to the physician shortage.”

In that they are correct—the report is not about nurses taking on the functions of physicians; it’s about nurses doing nursing and yes, some nursing and medical tasks and procedures are the same. Physicians need to change their entrenched way of thinking that they and only they know what’s best for patients (case in point: see “No Country for Old Women,” a recent blog post by AJN associate editor Amy Collins about her grandmother) and for health care. Otherwise, we will all fail those we purport to serve.

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. […] Kennedy, AJN’s interim editor-in-chief, already posted here about the importance of the recently released Institute of Medicine Report on the Future of […]

  2. Mary Jo October 21, 2010 at 9:48 am

    I have been talking with nurse colleagues about the need to move a summary of the IOM report directly into discussion with the RN base. Effectively moving on this proposed agenda will require UNITY in nursing, something that has been elusive for decades. Now would be the time to come together. We cannot wait for a few years to let the IOM report trickle to working RNs. I think of it like that childhood game of ‘telephone’. You know the game: wisper in the ear of the person next to you, and tehy wisper what they heard to the next person, and by the end of the wispered conversation the message sounds nothing like the original. My other fear is that nurses will allow the MDs to convey the message as they defend their turf.
    Could we develop a network of grassroots ambassadors using a prepared presentation via our state nurses associations who take the IOM message directly to the vast nursing networks in rural and urban sites?

  3. Shawn October 18, 2010 at 4:22 pm

    Mary Jo,
    I, too am surprised there haven’t been more comments. I have seen coverage, though, on several sites, and there’ve been some public events hosted by nursing schools (both the University of Pennsylvania and New York University had events). Additionally, AJN is doing a report that will be in our December issue (along with a guest editorial by Sue Hassmiller, both available online, and a podcast interview with ANA CEO Marla Weston). Maybe many nurses are skeptical, and waiting to see if things will change???
    -Shawn Kennedy, AJN interim editor-in-chief

  4. Mary Jo Borden October 18, 2010 at 3:54 pm

    I’m a little baffled that the Institute of Medicine report has received little coverage or commentary via AJN or other online nursing publications. I have worked for over 3 decades with the dream of seeing something like this happen for nursing and for nurses. The IOM document is the first time in my career/adult lifetime that I can finally say that nursing has been given the opportunity to lead and be recognized as leaders in the delivery of healthcare in the US. The IOM document really hit the right tone and content in its descriptions of current nursing issues and barriers to practice, and also, identifies a clear path for nurses to highlight their strengths, connect care across the continuum, and be recognized for the knowledge and skill we bring to health cae in all settings.

    Wake up nurses – we have been handed the opportunity of the 21st century. We are the nurses who must now work to bring about this transformation of nursing about.
    Here is the link to watch the one hour presentation of the report. This is an absolutely wonderful moment for all nurses.

    Institute of Medicine Report, Nursing, October, 2010
    Nurses in Central Role in Health Reform


  5. […] IOM Report: The Evidence Shows the Future of Health Care Rests on the Backs of Nurses […]

  6. peggy mcdaniel October 8, 2010 at 6:31 pm

    I also read the summary of the IOM report, followed quickly by the AMA’s comments. Our healthcare system cannot be improved until all of the team members work together smoothly and with full cooperation and respect. It’s bad enough that Big Pharma and Insurance have undercut any real reform, now we have doctors saying that only they can “lead” patient care. I beg to differ! Nurses providing excellent care at all levels are the backbone of our healthcare system.

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