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ONA Statement on IOM's “Future of Nursing" Report and the American Medical Association

Tualatin, OR - According to the Institute of Medicine’s (IOM) report "The Future of Nursing: Leading Change, Advancing Health,” the United States has the historic opportunity to transform our health care system and nurses will play a vital role in that transformation.

With more than 3 million members, the nursing profession is the largest segment of our nation’s health care workforce and nurses are on the front lines of patient care. The report, released on October 5 2010, is the result of a two year initiative between the IOM and the Robert Wood Johnson Foundation in response to the need to both assess and transform the nursing profession in light of major policy changes in health care delivery.

The report included four key messages: First, that nurses must be able to practice to the full extent of their education and training. Second, nurse education and training needs to be improved to provide nursing professionals with access to advanced education in a seamless academic program. Third, nurses must be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Finally, planning for future workforce needs in nursing will require better and more efficient data collection and infrastructure.

Health care organizations and associations across the country immediately applauded the report for recognizing what the nursing profession has always known: nurses are, and must continue to be, at the heart of health care reform. However, one important national health care organization was absent from the nearly unanimous praise.

The American Medical Association (AMA), the national association of physicians, medical students and residents, responded to the report with what has been its historic and usual practice; dismissing the role and contribution of nurses and other health care professionals in our health care system. The AMA stated that "nurses are critical to the health care team, but there is no substitute for education and training.”

The IOM report correctly identified the important role that nurses have played and will need to play to insure that there are sufficient professionals to provide care to our population in primary care, acute care and community based settings. Yet the AMA asserts that the role of the nurse is to simply assist the physician and substitute for physicians where there are physician shortages. This is a short sighted and impractical response, and is not reflective of the reality of the role nursing professionals currently play in our health care system.

What we know is that nurses are providing access to high quality health care throughout the country, and that advanced practice nurses, including Nurse Practitioners and Clinical Nurse Specialists, will be central to the success of the primary care home model. Additionally, registered nurses will expand their role to coordinate and manage care, engage in prevention and health promotion services and play an even greater role in creation of health policy and health system change. Nurses are not now, nor will they ever be, the second tier of health  are delivery.

It is unfortunate that our physician colleagues perceive the report as encroaching on their claimed turf rather than as a powerful call to action for a profession that has been their partner for over a century. The practices of nursing and medicine have much in common and the outcomes of nursing care (which are well documented) provide overwhelming evidence that our strongest and best health care delivery system will include a central role for Registered Nurses, on the front lines, where we have always been.

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