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The AMA and the IOM Report on the Future of Nursing


The Institute of Medicine’s new report on the Future of Nursing was constructed by an interdisciplinary committee that included physicians. The committee’s mantra is that the report’s recommendations were developed with a focus on what will improve health care in the U.S. and the health of its people. The recommendations acknowledge that nurses can and must play leadership roles in redesigning and providing care. (This video

features former AARP CEO Bill Novelli talking about the importance of nurses leading in the redesign of health care; he was a member of the IOM Committee.) This doesn’t mean nurses run everything but that they are key members of interdisciplinary teams and may lead these teams, as nurses already do in some places.

So it was quite disappointing to see the response of the American Medical Association to the report.  Organized medicine continues to frame their arguments through a lens of quality and safety. But it’s a false argument, as the evidence in the IOM report documents.

The AMA response also reflects a poor understanding of what is needed in a transformed health care system. If we’re to improve the health of people while reducing costs, we must shift to a focus on health promotion, chronic care management, care coordination, and self-care management. Physicians are not prepared to provide these services.

The AMA (and others who want to better understand the current turf battle waged by organized medicine) should read legal scholar Barbara Safriet’s work, including her section of the IOM report on the Future of Nursing. She documents that medical practice acts were written so broadly that they try to encompass all of health care. In today’s world, the knowledge explosion should force us to consider who is educated to do what piece of health care. Safriet has delineated the statutory and regulatory changes that are needed to support contemporary interprofessional practice that can be led by professionals that can include not just physicians but nurses, social workers, psychologists, and others.

I would argue that nursing is the profesison that educates its practitioners about the physical, psychological, social, and environimental dimensions of individuals, families, and communities. This education prepares nurses to bring an important, holistic vision to the work of health care and positions them to be great leaders of interdisciplinary teams. But context is also important and team leadership should not be the purview of any one profession. TCAB, Transfroming Care At the Bedside (an initiative for improving care in acute care facilities that uses nurses and other providers of care as change agents), demonstrated that sometimes the best person to lead the team initiative may be a nursing assistant. And a social worker would probably be the best person to lead an interdisciplinary team (that includes physicians and nurses) that provides care to people with chronic mental illness who have established solid relationships with their community mental health service.

The AMA needs to examine its motives and aims. This is the time to focus on what people need to promote their health in affordable, accessible, equitable ways.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.shtml

4 Comments Post a comment
  1. djmasonrn #

    To Grtrthanmd: The fallacy in your argument is the assumption that physicians are the experts at all of health care. Physicians are highly skilled diasnosticians of disease, prescribers of medication, and surgeons/interventionists. Some of these skills are shared with other clinicians, whether PAs, podiatrists, nurse practitioners, or others. But these are not the only skills that are needed to promote the health of the nation. We need experts in care coordination, holistic approaches to complex biopsychosocial problems, coaching and health tearching, emotional support of individuals and families, etc. Physicians are not educated about these matters nor are skilled at doing them. In fact, I would argue that physicians are “lesser trained” for what we need in primary care today. I would also argue that some physicians can do some of these things very well, just as nurse practitioners can manage 90% of primary care well (as a large body of evidence shows us). Medical practice acts were written broadly to encompass all of health care, but these are outdated and are interfering with access to HEALTH care. We do not have enough health care providers. If we really focus on what people need to live healthier lives, we would move beyond the turf wars and respect the abilities of all health professionals. I’ve also worked with physicians who are terrible leaders and should never lead any team. So let’s look at who is best to lead a team in which place and for what.

    October 27, 2010
  2. grtrthanmd #

    The AMA is not an organization I am in favor of, and do not support its ventures financially. However, as a physician who has spent over half his life in school and training (literally) to become a professional with MEDICAL expertise, I grow sickened at the idea of lesser trained individuals (eg nurses, NP’s, PA’s, therapists) taking over the role of leadership in the interdisciplinary theme. Until those who aspire to independently practice and prescribe have the appropriate (not just a couple additional years beyond a bachelor’s degree) amount of knowledge, extertise, clinical acumen, and ability to critically ascertain appropriate medical response, they should stick to what it is they went to school for in the first place — nursing, assisting physicians, therapy, respectively! If you don’t like it, leave the country or go to medical school. After all, none of you who aren’t an MD/DO practices medicine.

    October 25, 2010
  3. jenbusse #

    I was also very disappointed with the AMA response. As a nurse and a future nurse practitioner, as well as someone who will work in a community setting, I know that we need more nurses in the roles recommended by the IOM report. This will become even more relevant as the Patient Protection and Affordable Care Act is rolled out and more patients enter primary care. It saddens me that that people we are committed to helping, the patients, are really the ones who lose out in this power struggle.

    October 12, 2010
  4. I read the AMA response to the Future of Nursing report and was very disappointed. Their thrust seemed to be that they trained for longer hours and that makes physicians better at everything. The AMA summarily cast out the many hours of clinical experience that nurses receive prior to even becoming an RN and the clinical time performed while working before their training as a nurse practitioner.

    As for leadership in health care, it is essential for those who will be leaders to have training in leadership. Not just a single course but an ongoing education that will give people (physicians, nurses, nursing assistants, etc.)the skills necessary to be leaders. There is nothing about having the letters ‘MD’ or ‘DO’ after your name that implies total supremacy in all areas of health care. As Mark Sanborn titled his book “You Don’t Need a Title to be a Leader.”

    Nurses are at the doorway of a new era in health care (not just nursing). It is up to us to take the action that pushes the door open and walk through. It will not be easy but we must accept the challenge that has been placed before us. As a nurse since 1973 and still proud of my profession, I accept this challenge.

    October 11, 2010

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