IOM recommendations...


  • Advanced Practice Columnist / Guide
    Specializes in APRN, Adult Critical Care, General Cardiology. Has 31 years experience.
Specializes in Cardiac, Pulmonary, Anesthesia. Has 2 years experience.

What do you not agree, if you don't mind me asking?

I'm personally confused on the nurse residency section. Do they mean for RNs, APNs, or both? I thought it was APN and RN until I heard the authors speak about it on NPR and she was seemed to be implying it more for RNs. I've been through a BSN "residency" and it was utterly ridiculous. I'm not sure if it was the kind she is talking about, but it was supposed to decrease BSN burnout. If anything it made me want to leave. All it amounted to was repeat lectures I had in school. How decrease falls, infection control, how to be a patient advocate. Good things, but I already had that t-shirt.

Now establishing REAL residencies, where you rotate through a bunch of different units as an RN, and REAL residencies for APNs where you rotated through several units in hospital and outpatient clinics, that would be awesome.

I'm also confused now on the "full scope of practice." how far do they want to take it? On NPR it did bot seem as though they were talking about independent practice, but that is where the fullest scope of practice is.

Anyway, it was a good (and very long) read and I'm happy to have it out there. Maybe billing independently won't be such a hassle soon.

Advanced Practice Columnist / Guide

juan de la cruz, MSN, RN, NP

9 Articles; 4,338 Posts

Specializes in APRN, Adult Critical Care, General Cardiology. Has 31 years experience.

I also first heard of this from NPR but didn't get to listen to the whole thing. I actually agree with most of what the IOM is recommending with some hesitation. My take home message from the recs is that one way to remove APN practice barriers is the need to standardize APN practice across states, hence, the reference to NCSBN. It also appears that the recs go along with the push to professionalize nursing practice by advancing our education at various levels of nursing practice. My hesitation with this plan is the reference to CCNE which, as we all know, is one of the "brains" behind the whole DNP idea. I respect NP's who have pursued or are planning to pursue the DNP but I'm not sold on the plan for mandatory requirement for a doctoral degree. I do agree that nursing as a science should be allowed to evolve further and that is why nurses with PhD's are very important.

Like you, I'm also feeling mixed on the nurse residency rec for both prelicensure or post APN program grads. I do think that part of the criticism of NP programs is the lack of hours spent on clinical rotations against a high degree of responsibility in managing patient care in our role. It seems natural for NP's to respond by seeking some sort of residency... but I'm not sure how this can be implemented without an existing system similar to medicine. I also am not sure how this system of residency programs can be standardized and made uniform knowing the fact that nursing is such a fragmented discpline (i.e., we have multiple boards certifying NP's for the same specialization). And yes, I don't think future nurses in the pre-licensure stage (post-BSN) need a residency...we never did before so what changed now that all of a sudden it has become an issue?

Specializes in Research, HIV, Surgical, ER, Primary Care. Has 15 years experience.

Interestingly, it all goes back to something my professional issues instructor (as an ADN student) and my health care policy instructor (in my BSN program) said over and over again; nurses, as professionals, will not be treated as such until there is a base level of education obtained by those of us in the field and until that becomes standard. How they explained it was that doctors, lawyers, accountants all are considered "professional" because they all attain "equal" degrees, whereas nurses don't. We have diploma, ADN, and BSN nurses all doing the same job more or less. Ultimately the difference is in the critical thinking and patient outcomes. That being said, however, I know a few diploma nurses that could run circles around a few of the BSN nurses I've come across, especially ones who enter it as a second career and possibly are motivated by money and job security more so than anything else.

I think that bringing nurses to the same level (relatively speaking) as each other and acknowledging the differences in education is an important step in the continued trend of recognizing our contributions to health care and our advancement as a true "profession".

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,232 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Juan - I always like to read your posts. Thanks.

Have read this before as its something that we have been discussing in our APN state-wide meetings.