The Four Key Messages that Structure the IOM Report The IOM report has four key messages. These are the need to transform practice, transforming education, the need to transform leadership, and the need for better data on the health care workforce. The key message in the first recommendation is that nurses should practice to the full extent of their training and education (Sullivan, 2018). The report recognizes that maximizing the unique contributions made by nurses to the health care team can ensure that all people access quality health services. The message recommends removing financial, policy, and regulatory barriers that limit nurses, including Advanced Practice Registered Nurses (APRNs), to working in acute care settings. Nurses must disseminate their roles and bridge gaps between coverage and access to care. The report recommends more nurses become primary care providers, care coordinators, health coaches, health team leaders, and informaticians in various settings. As Salmond and Echevarria (2017) observe, nursing roles have transformed over the years, with nurses acquiring more competencies in skills, attitudes, and knowledge that enable them to lead and ensure system wide success. They have also bridged the gaps in access to care by providing more community-based health services. The key message in the second recommendation is that nurses progress academically to improve their levels of education and training. The report encourages nurses to seek higher training and education to equip them with knowledge and skills to meet future challenges, novel and diverse health needs. Higher education also equips nurses with a deeper understanding and greater competencies. Nurses have continued to advance their training, with many nurses trained at the master and doctorate levels. Sánchez-Gómez et al. (2019) note that nurses with advanced training possess advanced health assessment skills, more professional autonomy, decision-making, and diagnostic reasoning skills. They fill several needs within the health care system. The proportion of nurses who hold degrees at the baccalaureate level and above is 56% (American Association of Colleges of Nursing, 2019). This reflects a significant increment since the IOM report was released when the national average of registered nurses with BSN or higher degrees was 49%. The third message encourages nurses to partner with physicians and other health care professionals. Partnering tends to improve coordination and communication, which improve the safety and quality of patient care. Nurses are also encouraged to take active roles in different leadership roles. This has been reflected by nurses taking forefront positions in healthcare settings and issues even globally. Lastly, the report recommends the necessity of an improved information infrastructure. Strong data support assists in making decisions for effective policy changes. There has been increased growth in nursing informatics and the use of electronic medical records, which have improved efficiency, hastened the decision-making process, and enabled more coordinated patient care, improving the quality and safety of health services. These have improved patient outcomes and satisfaction levels with great margins.
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