Connecting the IOM Reports to Nursing Standards
Introduction
Nursing as a profession has its standards and a code of ethics. Both are important topics in nursing curricula, mostly in undergraduate programs, though they should also be incorporated into graduate course content. There is a relationship between what the IOM has been doing in its efforts to improve care and the nursing standards and the code of ethics. The following provides an overview of this relationship, in an effort to connect these important professional statements in the discussion about the need to improve the healthcare system and how this improvement might be done. As will be noted in more detail in later parts of this book, the IOM strongly supports the integration of its five healthcare professions core competencies in all healthcare professions education. Standards are a part of QI, and this includes professional standards.
Nursing’s Social Policy Statement: The Essence of the Profession (ANA, 2010)
The American Nurses Association (ANA) social policy statement recognizes that nursing has an obligation to the public or the community (ANA, 2010b). These social concerns influence how we practice and our authority to practice.
Social Concerns in Health Care and Nursing: Relevance to IOM Reports
The following lists the social concerns that the profession must be cognizant of. These areas are identified with the related IOM core competency (ANA, 2010b, pp. 4-5):
Organization, delivery, and financing of quality health care (relates to IOM core competencies on quality improvement, informatics, evidence-based practice/evidencebased management)
Provision for the public’s health (relates to IOM core competencies on patientcentered care, teamwork, evidence-based practice)
Expansion of nursing and healthcare knowledge and appropriate application of technology (relates to IOM core competencies on evidence-based practice, informatics)
Expansion of healthcare resources and health policy (relates to IOM core competency on quality improvement)
Definitive planning for healthcare policy and regulation (relates to IOM core competencies on patient-centered care, quality improvement, teamwork)
Duties under extreme conditions (relates to IOM core competency on patientcentered care)
We have a social responsibility and a social contract with our patients, whether they be individuals, families, or communities. This contract implies two partners. Patient-centered care is central, though this specific term is not used in the ANA social policy statement. The other core competencies (quality improvement, interprofessional teams, informatics, and evidence-based practice) are all interwoven into the social context in which the practice takes place, and are required for professional nursing to be effective.
Professional collaboration is discussed in the social policy statement, describing collaboration as “true partnership, valuing expertise, power, and respect on all sides and recognizing and accepting separate and combined spheres of activity and responsibility. Collaboration includes mutual safeguarding of the legitimate interests of each party and commonality of goals that is recognized by all parties” (ANA, 2010b, p. 7). We must emphasize the positive in other healthcare professions: Rather than telling our negative stories of how we are victims, we need to tell stories of effective collaboration and how to make it better. Our social contract says we must do this as a profession.
Scope and Standards of Practice (ANA, 2010)
The professional standards (ANA, 2010c) go hand-in-hand with the social policy statement (ANA, 2010b).
Definition of Nursing’s Relationship to Patient-Centered Care
The definition of nursing can be connected to the IOM quality initiative. “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA 2010b, p. 3). To meet this definition, nurses must be competent. Competency is “an expected level of performance that integrates knowledge, skills, abilities, and judgment” (ANA, 2010c, p. 12). The IOM core competencies are designed for all healthcare professions, including nursing. The competencies are the basic starting point and do not negate the need for individual professional competencies such as the ANA professional standards. To meet nursing profession standards, we must require these competencies.
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