Nursing is a field of medicine that deals with primary health care into the patients or first aid care administered to patients. Primary health care has become insufficient in many countries and has led to countries coming up with programs that take into consideration health care as an emerging issue, especially in the U.S. Factors that have led to this problem include change in population and demographics, payments towards health practitioners, and more importantly, health care policies administered by authorities to their services (Stahl, 2004). The above factors, if applied to the U.S. primary health care, may improve it drastically.

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Many physicians and primary health care practitioners are of opinion that many graduates are not well qualified (Pearson, 2007). Physicians who are qualified may be subject to degradation because of poor payment systems if to compare with their counterparts who are paid well. Moreover, some extant physicians do a lot of work within their specialty but are not well paid because of the crisis in the health sector. The crisis between primary health care and physicians led to the shortage of primary health care experts, which was the field that took care of the larger population. The Institute Of Medicine (IOM) was established in early 2008 with a mandate of coming up with implementation policies that will govern health care facilities in the long run, especially in relation to nursing, which was adversely affected by role conflicting and shortage of workers due to poor working conditions and weak law enactments (Rantz, January 01, 2006).

A committee was established at the Institute of Medicine (IOM) which worked along with Johnson and Robert Wood Committee. The joint committee researched these issues and considered applicable ways and implementation programs to shape up the health care department. This committee was formed due to conflicting and different roles of nurses and utilization of nurses. The major importance of this report (IOM) was that nursing was the most influential backbone for improved health care facility. Consequently, the profession of nursing needed to be changed in order to adapt to the future emergence. This means that nurses are supposed to perform relevant roles; some of them will be new such as leadership, for example. The initiative has had a positive impact on the time it started to function.

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The positive impact has been felt because the nursing sector had the highest capacity of health workers in the field. Due to the popularity of the profession officials have realized the importance of implementation and improvement of the profession for the nearest future through policies and health care acts, which are inclusive of all stakeholders of the field (Folan, 2012). The key issue of the report was the committee’s concern about the quality of the work the nursing department was doing. The report looked into the issue of nurses’ full capacity in line with their education and training. The report addressed the health care policies which restricted the limits of nurses in the field, as well as enforced the nursing occupation basics to improve the quality of education of the future professionals.

The report was concerned about nurses to need to have progressive education and training from the beginning of their careers up to the maturity level for promotional purposes. It also formulated the need updating practices for nurses so that they could be aware of new issues emerging in the field. Education progress was a breakthrough of future nursing as it enabled nursing to revolutionize and reach the level of modern nursing where they are now able to perform new roles and extend their duties to the acts beyond its friendly and social aspects to the community at large. The report was adapted by many countries of the world which started implementing it into their policies of running health care facilities. Education on the part of nurses was said to serve not only the purposes of promotion but also the aim of providing nurses with diverse knowledge in the field that still relates to primary health care. This would, in turn, enhance their roles in the community and help them express leadership and communication skills.

A campaign to enact the plan was launched to facilitate and guide the practice of the implementation of the rule as designed by the Institute of Medicine Policies. The campaign was about total utilization of nurses. It diversified the roles of future nurses through education and training. It also encouraged communities to get involved in the campaign. The campaign led some states to come up with recommendations. Those were the following states: California, Alabama, Texas, and Arizona. The campaigns were led by people concerned about serious issues that faced patients in America. They brought improvement in the implementation in the end. Without the initiative of such action campaigns, the Institute of Medicine proposal acts would not have gained much attention and would not have been implemented.


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Californian health action plan was an outstanding action campaign that had a vision of good leadership and healthcare services delivery to the people of California. Its mission was to implement the proposal of IOM in partnership with various stakeholders. The core values of that action plan were to diversify the skills of nursing and to improve health outcomes in people. The plan served a force in the implementation of the IOM report recommendations so that on each state, recommendations were grouped according to their targets and goals.

The initiatives considered by California State promoted the creation of a coalition which would work on health state improvement and follow the recommendation of the IOM report to remove work restrictions within the nursing profession. It emphasized empowerment of nurses and expanding their roles through doing the gap analysis of the scope of work done by nurses in the state. Special acts were introduced to make actions run smoothly (Sherwood, 2012). The state of California initiated expanding the programs that would enable undergraduates to qualify in primary health to encourage them to participate and follow the doctrine developed for employees through adjustments to their salary scales. It also promoted the need to increase the number of nurses at the higher education level. All these initiatives were suggested to increase the level of services within the state. Nurses empowerment is a long-term project which advocates the needs of the U.S. population which will increase in the future. It also supports the reduction of congestion and offers quality services that are affordable within California.

Another initiative offered by California is to ensure that nurses engage in distance learning in the long run. This is done through engagement in group work and developing a mission statement as well as forming a vision based on the recommendation of IOM reports. It is what the state wants to achieve in the sphere of running health care facilities. The development of a systematic plan with students involved in it needs to be the task for the coalition. It may have an impact on resultant output will encourage young people to adopt a particular health care vision which they will pass to the coming generation. Moreover, the state has built an infrastructure (Pfister, 2010). It has been done with the aim to analyze all data of health care workforce. This enabled the state to have exact figures of health workers turnover and come up with right mechanisms to enable officials to measure the standard of the implementation process.

Primary health care services are of considerable importance especially to the majority of the population as they involve tapping of first-hand information of ailments unto patients (Reid, 2011). Hence, increasing involvement of nurses in order to diversify their work and enable them to perform other roles may bring a significant advancement to patient and nurse relationship. Although implementation of the service may have some challenges, the benefits outweigh the cost.

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