Surveying APNs to Learn What They Value Most from IOM Document

About seven years ago, the Robert Wood Johnson Foundation and the Institute of Medicine (IOM) began a two-year initiative to evaluate the nursing profession. The goal was to learn best practices to help nurses overcome barriers to leadership and realize their full potential, so they can make positive changes that advance healthcare. The more than 3 million nurses in the U.S. make up the largest segment of the healthcare workforce and, therefore, have the ability to make far-reaching changes in the healthcare system.

From the initiative came the 2010 report “The Future of Nursing: Leading Change, Advancing Health,” which provided eight recommendations and, thus, a blueprint for transforming the nursing profession.

The intent of this landmark document was to investigate change, but advanced practice nurses (APNs) at Cleveland Clinic wondered how aware their colleagues were of the report and how much they valued its recommendations.

So, in late 2013, they conducted a survey. Of 600 Cleveland Clinic APNs who received the APN’s Awareness & Value of IOM Future of Nursing Report Survey by email, 111 responded. The results were “eye-opening,” says Principal Investigator Meredith Lahl, MSN, PCNS-BC, PPCNP-BC, CPON, Senior Director of Advanced Practice Nursing.

Overall, APN awareness scores were lower than value scores for all recommendations, meaning that even if they were not familiar with specific recommendations, after reading them on the survey, APNs considered them valuable. Overall, the recommendation to remove scope-of-practice barriers (No. 1) was rated as most valuable. Many APNs are not currently able to practice to the full extent of their education and training due to scope-of-practice limitations that vary from state to state.

The recommendation to double the number of RNs with a doctorate by 2020 (No. 5) was ranked lowest in value by APNs, reflecting their general satisfaction in their clinical roles, rather than focusing on faculty or research roles.

The takeaways from the survey, Lahl says, are the need to find better ways to educate APNs about this report, and the need for nurses to advance science. APNs may also need to receive other important large-scale documents on nursing opportunities and practicing to the full extent of their education and training.

“We have a large group of APNs at Cleveland Clinic,” she says. “We need to bring this collective group together to get involved with policy and help advance our profession.”

Nicolas Houghton, MSN, ACNPBC, CFRN, Critical Care Transport, agrees. Houghton joined this project because it embodies research, policy and practice. Although he says he was surprised more APNs weren’t aware of components of the report, he is excited about the possibilities that acting on the recommendations could bring.

“If we can advocate at policy level to allow APNs to practice at their full scope, we can expand access to care,” he says. “We have the opportunity to take this to the next level.”

IOM Recommendations

1. Remove scope-of-practice barriers
2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
3. Implement nurse residency programs
4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020
5. Double the number of nurses with a doctorate by 2020
6. Ensure that nurses engage in lifelong learning
7. Prepare and enable nurses to lead change to advance health
8. Build an infrastructure for the collection and analysis of inter-professional health care workforce data