October 6, 2010
A report released Tuesday may give nurses an advantage in their battle with doctors over "scope of practice" limitations. According to the National Academies, the report from the Institute of Medicine (IOM) called for a change in nurses' roles, responsibilities and education in order to meet the increased demand for care that will be created by health care reform.
With more than three million nurses in the U.S., nurses make up the largest segment of the health care workforce. However, although they spend the greatest amount of time delivering patient care, there are many barriers that prevent nurses from "practicing to the full extent of their education and training".
According to Kaiser Health News, an estimated 32 million additional Americans will have health coverage beginning 2014 through the Affordable Care Act; yet the Association of American Medical Colleges reported that there will be a shortage of some 63,000 doctors across all specialties in America. IOM's committee believes that nurses can help ease the shortage. "Transforming the nursing profession is a crucial element to achieving the nation's vision of an effective, affordable health care system that is accessible and responsive to all," said committee vice chair Linda Burnes Bolten, vice president for nursing, chief of nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles, to the National Academies.
In order to meet the demand, the report calls for states, federal agencies and health care organizations to remove regulations and institutional limits on the care nurses can provide, including "scope of practice" rules which dictate what care people who are not physicians can provide. "A qualified health care professional is a terrible thing to waste," said Cheryll Jones, a pediatric nurse practitioner in Ottumwa, Iowa.
The National Academies reported that IOM recommended nurses should also have more responsibilities in patient care and more opportunities to gain leadership skills.
To handle greater responsibility and independence, the report stated that nurses should achieve higher levels of education and training, including residency to help with the transition from education to practice. Although there are a variety of ways to attain undergraduate education--diploma, associate degree or bachelor's degree programs--currently, the health care system does not encourage nurses to pursue higher degrees or additional training. IOM wants to change that. Specifically, in addition to a residency program, IOM wants 80 percent of nurses to hold bachelor's degrees by 2020 and twice as many nurses to have doctorates. Public and private organizations should play a key role in this progression.
Many of IOM's recommendations have alarmed doctors, noted Kaiser Health News. Some have argued that even with an advanced degree, nurses do not undergo the same rigors of medical school as physicians do and because of that, safety could be compromised. "Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience, most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are vital to optimal patient care," argued Dr. Rebecca J. Patchin, former nurse who is now an anesthesiologist and member of the American Medical Association's Board of Trustees.
Doctors also worry that patients may go elsewhere if nurses were to practice without doctor supervision. "Patients and voters say 'If you're talking about taking the docs out of my health care, I want no part of it'," explained Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists.
According to Kaiser Health News, it is unclear what kind of impact the IOM report will have. A panel will meet next month to discuss ways to implement the report's recommendations.
Compiled by CityTownInfo.com Staff
"Health Care Reform and Increased Patient Needs Require Transformation of Nursing Profession," nationalacademies.org, October 5, 2010
"Nurses' Push For Bigger Role Gets Powerful Ally," kaiserhealthnews.org, October 5, 2010
"The Future of Nursing: Leading Change, Advancing Health," IOM.edu, October 5, 2010