Introduction
Nursing is a responsive and influential profession that faces various challenges in providing high-quality patient care. From ethical dilemmas to financial constraints, nurses navigate a complex landscape daily. The Institute of Medicine’s (IOM’s) 2010 Future of Nursing report outlines critical messages that underscore the need to address these challenges to propel the nursing profession forward.
In this discussion, we will examine three significant problems that professionals are experiencing in their practice today and ways to address them. In addition, it will focus on the IOM report’s main message and clarify its implications for the nursing profession. Secondly, the role of IOM’s five core competencies will be highlighted and discussed in relation to how nursing practice can fulfill each of them, along with the obstacles and strategies to overcome them. By studying and addressing these issues, they improve their efficiency in delivering client-centered treatment and contribute to changing the healthcare landscape.
Challenges Nurses Face Today in Care Delivery
Ethical Challenges
Ethical conflicts are common in nursing practice, as nurses must balance fulfilling patients’ rights with upholding their dignity and autonomy. For example, the issue of end-of-life care could be a moral dilemma for them, as it may involve a conflict between respecting an individual’s wishes for palliative care and pursuing aggressive care (Haahr et al., 2019). Overcoming these obstacles requires promoting active communication among healthcare team members, embracing an ethical decision-making framework, and obtaining support from committees or institutional policies. By applying the values and ethical principles, they have the knowledge to navigate challenging situations with integrity and compassion.
Legal Challenges
Nurses should follow rigorous legal rules governing their practice, which may vary by jurisdiction and specialty. A common legal issue is having documentation that meets the legal requirements, but still needs to be completed on time, even with time constraints and a heavy workload. Electronic health records (EHRs) and standardized documentation templates simplify the documentation process, thereby reducing the likelihood of errors and the consequences of litigation (Mflathelwa Dube & Memory Zuma, 2022). Moreover, continuous learning and training about the latest legal standards and professional duties help them make conscious decisions and manage legal risks effectively.
Financial Challenges
Financial constraints in healthcare systems may lead to resource and staffing shortages, making it difficult for nurses to provide quality care. Budget cuts and payback rules can hinder access to necessary supplies and equipment, negatively affecting patient care and satisfaction. Partnering with Wellness managers and the financial stakeholders to demand sufficient funds and staffing ratios is very important for solving financial problems.
Furthermore, low-cost strategies, such as evidence-based practice initiatives and interdisciplinary care models, can help achieve optimal resource utilization while maintaining the standard of care (Chang et al., 2019). By advocating for financial investments in nursing infrastructure and promoting efficient resource allocation, practitioners can help mitigate the impact of financial stress on care delivery.
The 2010 Institute of Medicine’s “Future of Nursing” Report
The landmark report of the Institute of IOM titled “The Future of Nursing: Leading Change, Advancing Health” was a catalyst for a comprehensive vision of the nursing profession in the United States. Among its key messages, one stands out as particularly vital to the nursing profession: “Nurses need to practice up to the extent of their education and training.”
The key message of the statement is that practitioners should use all their knowledge, skills, and experience to provide patient care (National Library of Medicine, 2024). This can be achieved by maximizing their contribution. Traditionally, nursing practice has been limited by regulatory barriers, institutional policies, and social hierarchies within the systems. They are frequently underutilized despite possessing the education and training to make unique and important contributions to the delivery of individual outcomes and well-being.
The expansion of nurses’ scope of practice, aligned with their education and training, is key to several aspects. Firstly, it improves access to care, especially in underprivileged communities where a shortage of primary care providers is common. Practitioners have the competence to provide a wide range of healthcare services, including preventive care, Wellness promotion, and chronic disease management (National Library of Medicine, 2024). By utilizing the full extent of their training, patients can be treated promptly and comprehensively, resulting in improved outcomes and decreased Wellness disparities.
Additionally, empowering nurses to practice to their full capacity contributes to interdisciplinary collaboration and team-based care. The modern healthcare system’s atmosphere has become complex, making collaboration more important for providing patient-centered, high-quality care (National Library of Medicine, 2024). Practitioners bring a different view and specialize in Wellness teams that work together with physicians, pharmacists, social workers, and other Hospitalization professionals to provide quality healthcare.
Furthermore, allowing nurses to practice to the full scope of their education and training supports professional growth and career progression in the nursing field. Practitioners devote substantial time and effort to earning advanced degrees, niche certifications, and additional training to upskill. On the other hand, the absence of opportunities to apply their advanced education in the clinical environment can leave them feeling frustrated or undervalued, ultimately leading to burnout and attrition from the profession (National Library of Medicine, 2024). Hospital organizations can cultivate a culture of lifelong learning, professional growth, and job satisfaction among nursing staff by creating working environments that promote and support their practice in line with their licensure.
Core Competencies of the Institute of Medicine
Core Competency 1: Patient-Centered Care
The patient-centered approach to nursing practice is the foundation of nursing. It asserts that care is the process of providing tailored care to meet the individual, unique needs, wishes, and preferences of individuals and their families. Nursing staff can develop this competency by actively engaging patients in the care planning, decision-making, and goal-setting processes (IOM, 2024). This can be accomplished by using skills such as active listening, empathy, and cultural competence, which help them build trusting relationships and promote shared decision-making.
Time is a challenge in delivering patient-centered care in healthcare settings. In reality, nurses frequently face many competing demands and heavy workloads, which often mean they need more time to give each individual their attention. Organizations can overcome this obstacle by adopting team-based care models and technology to streamline documentation and administrative tasks (IOM, 2024). Through workflow optimization and resource reallocation, healthcare providers spend more time developing relationships with their patients and providing individualized care.
Core Competency 2: Interdisciplinary Collaboration
Interdisciplinary collaboration is the capacity of healthcare providers to work productively with colleagues from different disciplines to achieve a common objective and enhance patient outcomes. Showing this competence through participation in interdisciplinary team meetings, sharing important person-related information and insights, and working with physicians on care plans and treatment strategies (IOM, 2024) is what nurses can do. Effective communication, mutual respect, and team decision-making are the three aspects of interdisciplinary collaboration.
The sole obstacle to interdisciplinary collaboration is fragmented communication, which requires greater information sharing. The departments and specialties may use different systems for documentation and communication, making it hard to share vital patient information promptly and efficiently. One way to overcome this barrier is to implement integrated electronic health records (EHR) systems, standardized communication protocols, and inter-professional education and training modules (IOM, 2024). Nurses can coordinate information processes and improve cross-disciplinary collaboration, both of which are critical to inter-professional collaboration.
Core Competency 3: Evidence-Based Practices
Evidence-based practice integrates the most valid research evidence, clinician experience, and patient values to inform clinical decision-making and improve outcomes. This competency can be achieved by nurses bearing current research and practice guidelines in their specialty area (IOM, 2024). This may be achieved by critically appraising the evidence, determining its relevance to practice, and then utilizing evidence-based approaches in their treatment plans.
In implementing evidence-based practice, factors such as resistance to change and a tendency to cling to traditional ways of delivering healthcare stand out. Nursing staff may encounter reluctance or objections from co-workers accustomed to existing approaches, which can be a barrier to implementing evidence-based interventions. Nurses can overcome this barrier by engaging in continuing education and professional development, such as participating in conferences, joining a journal club, and seeking mentorship opportunities (IOM, 2024). By building an environment of lifelong learning and innovation, practitioners can address the task of promoting the implementation of evidence-based practices and raising the level of patient care.
Core Competency 4: Improvement of the Quality
Quality improvement is a systematic approach to continuously monitor healthcare processes and outcomes, identify opportunities for improvement, and implement evidence-based practices to ensure the quality and safety of patient care. Nurses can demonstrate this competency by participating in quality improvement initiatives and collecting and analyzing data to identify performance gaps and trends (IOM, 2024). They are also vital members of multidisciplinary teams that plan for and implement changes and evaluate the outcome.
A limitation of the efforts to improve quality is the need for more resources and competing priorities within healthcare organizations. Limited budgets, insufficient staffing levels, and administrative barriers can stall the implementation of improvement initiatives and slow down the attainment of desired outcomes. To address this issue, nurses can speak up to secure dedicated resources and support for quality improvement activities, participate in interdisciplinary collaboration, and identify initiatives with the greatest impact on patient outcomes (IOM, 2024). Quality improvement must be a culture that people embrace, and practitioners should demonstrate the importance of their roles.
Core Competency 5: Informatics
Informatics refers to the use of information and communication technologies in nursing practice to improve the quality and efficiency of nursing care. Nurses can meet this competency by utilizing EHR systems, clinical decision support tools, and Telehealth technologies to retrieve and handle patient information, communicate with interdisciplinary team members, and coordinate care across settings (IOM, 2024). Technological competency in nursing is one barrier due to limited training and support for nurses to use technology proficiently within the settings.
Practitioners may be unable to handle the situation, as they need more knowledge, abilities, and confidence to navigate complex EHR systems, resolve technical problems, and use informatics tools to their full potential (IOM, 2024). The organizations may address this challenge by implementing advanced informatics training and education programs for nursing staff, offering ongoing support and resources to adopt and master technology, and cultivating a culture of innovation and continuous learning. One way to achieve this is to enable the nurses to view informatics as a helpful tool for improving patient care and workflow efficiency.
Conclusion
In summary, the nursing profession faces a variety of challenges in providing quality care, including ethical dilemmas, legal requirements, financial constraints, and ongoing professional development. Despite the challenges, nurses can improve patient care and expand the nursing profession by tackling them directly and implementing innovative solutions. The Institute of Medicine’s key messages and core competencies serve as a guide for nursing practice leadership and for improving healthcare quality. By believing in these values and working together to overcome challenges, practitioners can become the driving force in Medicare and enhance the general well-being of individuals and populations.
References
Chang, L.-Y., Yu, H.-H., & Chao, Y.-F. C. (2019). The relationship between nursing workload, quality of care, and nursing payment in intensive care units. Journal of Nursing Research, 27(1).
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses experiences of ethical dilemmas: A Review. Nursing Ethics, 27(1), 258–272.
IOM. (2024). Institute of Medicine core competencies.
Mflathelwa Dube, E., & Memory Zuma, S. (2022). Professional nurses’ challenges regarding drug supply management in the primary health care clinics. International Journal of Africa Nursing Sciences, 16.
National Library of Medicine. (2024). Key messages of the report. The future of nursing: Leading change, Advancing Health.