Reflections on IOM Future of Nursing Recommendations

Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80% by 2020

            The recommendation by the Institute of Medicine (IOM) to increase the proportion of nurses with a Baccalaureate (BSN) degree by 2020 is informed by several premises. First, the current workforce has over a million nurses who are beyond the age of 50, which implies that they shall all be retired in a decade or so (Andrews, 2014). Additionally, increasing burden of chronic diseases and the aging of baby boomers has led to a forecasted shortage of 1 million nurses by the year 2030. This is besides the fact that nursing programs are still inflexible with numbers in most higher education institutes due to shortage of nursing educators/instructors. The current percentage of Baccalaureate prepared nurses stands at around 50-55% and thus the recommendation seeks an increment of up to 30% on the current market standing.

            In light of the above, I expect to form part of the largest pool of nursing professionals, with better pay and more responsibilities. As a Baccalaureate nurse, my position shall be the most common in the nursing domain with responsibilities ranging from primary care to supervision.  The salary shall also be definitely higher than that of Associates and Diploma nurses who are likely to become a rarefied group in the profession. More importantly, I anticipate the salary to be even higher than that of current BSN nurses. These expectations are based on the evident reality that 80% of nurses with BSN will still be inadequate to deal with the prevailing healthcare burden (Andrews, 2014). With many nurses retiring from the baby boomers and the burden of chronic diseases increasing, the shortage shall persist. The increased level of education for nurses shall only help in increasing the scope of practice and hence partly compensating for the inadequacy in numbers. However, the failure to match supply with demand will ensure high salaries and more work to be done by nurses overall.  Therefore, I anticipate a rewarding career, more responsibilities and forming part of the dominant nursing workforce.

            As a BSN nurse, I also view my position as that of many who shall be on transit for even higher qualifications in the industry. Granted, the BSN shall still be competitive and the core of the nursing profession, but the desire to go up shall be irresistible. This is because of the even better opportunities that shall come with a second and third degree. With the shortage of nursing instructors limiting the intake of nursing programs worldwide, advanced nursing degrees shall have ready market in research and education (Andrews, 2014). I shall therefore be among those who view the BSN as a stepping stone to higher levels of education. There shall still be issues with time and money given that scholarships are still hard to come by, but advancing education in the field is worth it. Not only are there better rewards but also interesting career options but in clinical practice and non-practice settings. That is the direction I expect to take eventually.

Recommendation 5: Double the number of nurses with a doctorate by 2020.

            The current percentage of doctorate prepared nurses stands at only 1%. This is quite unfortunate given that the group forms the orthodox nursing educators. As such, every other target on expanding the nursing workforce depends on the presence, ability and capacity of this small group who are majorly tasked with training, consultancy and research (Broome, 2012). If the number of Baccalaureate nurses and other cadres was to increase, the key remains in working on this target of Ph.D. prepared nurses. They act as the catalyst to not only increasing the nursing workforce but also advancing nursing research and providing other high level interdisciplinary services in healthcare. It would be quite a feat to form the small group of nurses who shall occupy this position by the year 2020, given the demands in terms of time and finances. The position has proven hard to attain over the years because of the two conditions.

            Advancing my education to the Doctorate level shall be the height of my nursing career, reaching a level with barely any competition. First, it is an achievement met by only a small group in the industry with the resilience and resources to commit to all the years in class and thus offers a competitive edge in any position. There is a form of honor that is thus attached to it, with those reaching the level enjoying lots of opportunities in clinical practice, nursing education and research (Portal, 2011). They are regarded as experts and high level consultants who offer proportionate support to other highly trained professionals in interdisciplinary care teams. Attaining the position will therefore be a badge of prestige and honor as well as a doorway to better rewarding opportunities in research, education, advanced clinical practice and general consultancy. There is also a lot to be gained through practice at such a high level including personal satisfaction from better clinical outcomes and training of other nurses successfully. The higher level of expertise ensures that one offers better care and contributes more to bettering health. Classroom experiences and the success stories that follow also offer a great deal of satisfaction to the Ph.D nurse.

            I also anticipate competing globally as a doctorate Nurse. The shortage of doctorate level nurses is not only a local problem but experienced universally in different healthcare systems (Portal, 2011). Particularly, there are few nursing educators around the world and reaching such a level shall thus open opportunities to teach, conduct research and offer consultancy abroad. I therefore expect to compete in the global sphere, for both teaching positions and others. The doctorate level is so narrow that one no longer considers local competition as it is unsubstantial. That said, the cardinal objective shall be to offer services locally given the insatiable demand for such highly trained nurses and only consider extremely lucrative opportunities at the global scale.

Recommendation 6: Ensure that nurses engage in lifelong learning.

            The nursing profession is not juts pegged on skills but also on accumulation of knowledge. The nursing school is the basic level at which the learning begins with the equipping of the basic tenets of practice, but does not end there. An effective nurse has to commit to lifelong learning by attending seminars, conferences, trainings and more importantly, advancing their education (Steelman, 2014). As such, continuing after BSN or Associates/Diploma is a key part of lifelong learning that every nurse and the healthcare system at large should seek to encourage. At a personal level, I intend to engage in lifelong learning for the benefit of my own career and the patient population. This implies that I would not only be a dynamic nurse seeking career advancement but also a fulltime learner looking to build knowledge and skills for high levels of service delivery.

            Commitment to lifelong learning shall render me a nurse on transit at all times. No position shall be permanent or comfortable, with the opportunities to learn and advance unlimited in scope. Notably, the path from BSN to a PhD nurse is quite a lengthy one that requires a serious commitment of effort and resources. There are several transitions to be made in the classroom level as well as in practice given that each level comes with unique authority. I shall therefore be a nurse in transit, always taking the next turn in the path to the top. The current level entails offering primary care with little leadership and supervisory roles, but soon after the second degree there shall be transition into advanced practice which includes leadership and some element of specialization. In addition to the standard educational path, there are seminars, trainings and short courses that I can pursue in order to broaden skills, authority and justify leadership credentials. These shall further contribute to transitions in level of knowledge, qualifications, practice and even rewards. The nature of nursing requires such a dynamic experience, with previous knowledge becoming obsolete, positions losing their importance and new opportunities calling.

            The commitment to lifelong learning also means that my nursing career shall feature classrooms and a student status throughout. There shall always be something to learn both in the classroom and in practice settings. The standard view is that one moves from being a student to a professional after completing their studies and becoming a registered nurse, but that shall not be the case. Practice shall go hand in hand with further training with the student status sustained throughout the career. Lifelong learning is one of the toughest but necessary commitments one makes as a nurse, without which their position and progress becomes untenable. I therefore see my role as a student maintained throughout the career life cycle.


Andrews, N. (2014). Advancing toward an 80% BSN workforce by 2020. American Nurse Today9(1), 36-38.

Broome, M. E. (2012). Doubling the number of doctorally prepared nurses. Nursing outlook60(3), 111-113.

Portal, Y. (2011). Doubling the number of nurses with a doctorate by 2020: predicting the right number or getting it right?. Nursing Economics. 45 (6), 17- 23

Steelman, V. M. (2014). Engaging in lifelong learning to lead the way. AORN journal99(5), 557-559.

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