December 5, 2013
Studies Assess Impact Of IOM Report On Nursing Reforms
Researchers find progress and barriers to recommendations on residency programs and academic progression
Two new studies by researchers at the George Washington University School of Public Health and Health Services (SPHHS) examine how well hospitals and other health care facilities are doing when it comes to a call to reform the nursing profession. A 2010 Institute of Medicine (IOM) report warned that the nursing profession must change or it would not be able to meet the growing demands that are emerging as a result of health reform, new technologies and an aging population.
In the first study, Patricia Pittman, PhD, an associate professor of health policy at SPHHS, and her colleagues examined the degree to which health care employers have implemented one key IOM recommendation—the goal of achieving a workforce in which 80 percent of nurses have a Bachelor of Science in Nursing (BSN) by the year 2020. Nurses need more educational training in order to handle greater responsibilities and the increased complexity of the health care system, the IOM report noted. To achieve the 80 percent goal, the IOM suggested that health facilities take a series of measures to encourage nurses with an associate's degree to complete a BSN.
To find out how well that recommendation had been faring in the real world, Pittman's team surveyed 447 nurse executives in hospitals, nurse-led clinics and home and hospice care companies. The researchers found that nearly 80 percent of those surveyed said that their institutions preferred or required newly hired nurses to have a bachelor's degree. In addition, the study found that 94 percent of facilities offered some level of tuition reimbursement to encourage nurses to go on and complete a BSN.
Only 25 percent, however, required nurses to earn a BSN within a period of time, a key part of the IOM recommendation. And only 9 percent offered a pay differential to nurses who complete a BSN.
The authors conclude that if health care employers are serious about wanting a more highly educated workforce, they will need to go beyond the current 'soft policies' and adopt more forceful measures, such as requirements for degree completion and wages that reward nurses who have worked to get a BSN or advanced degrees.
The likelihood of employers adopting such hard measures any time soon, however, will at least partially be determined by the supply and demand for nurses in the marketplace, Pittman said. The study, "Healthcare Employers' Policies on Nurse Education," was published in the November/December Journal of Healthcare Management.
The second study examines the extent to which health care employers are deploying another major recommendation of the IOM report—the adoption of nurse residency programs.
The IOM said that nurse residency programs help give newly minted nurses the skills they need on the job and reduce turnover. Indeed, past studies show that between 35 and 65 percent of nurses change jobs within their first year of employment, a problem that drives up costs for hospitals and other facilities.
Pittman and her team surveyed hospital nurse executives and found that, despite the financial challenges being faced by hospitals and the increased supply of nurses resulting from the economic recession, 37 percent of hospitals already offered a nurse residency program in 2011, and only one-fifth of those received external funding to kick off or maintain such a program.
Among those hospitals without residencies, three obstacles to adoption were cited: financial constraints, taking senior staff away from other work and a shortage of faculty who can supervise new nurses as they learn best practices.
The study also found that hospitals that offer residency programs are also more likely to offer other training programs. "This finding may suggest that the institutional culture at these hospitals may be putting a high value on both kinds of training, a value that appears to go beyond a simple cost savings calculation based on reduction of nurse turnover," Pittman said.
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