Nurses: The Key, Unsung Players in Health Care Reform

In the health care reform debate, relatively little attention has been devoted to the capacity and readiness of the nurse workforce. Yet it is estimated that by 2020-2025 there will be a shortage of between 500,000 and 1 million nurses. Additionally, both the Institute of Medicine and the World Health Organization have called for the redesign of nurse training and the development of critical nurse competencies to support better chronic care, self-care and lifestyle change.

In a recent supplement to the Journal Health Affairs titled Building a High-Value Nursing Workforce, John Rother of AARP and Risa Lavizzo-Mourey of the Robert Wood Johnson Foundation write that health reform and sustained economic recovery require that we “build, empower and deploy a 21st century health care workforce,” and that in the end, it will fall to the responsibility of nurses to “deliver, coordinate and direct care in hospitals, clinics and physicians’ offices.” Clearly, there can be no health care reform without supporting the nurse workforce.

Several contributors to the Health Affairs supplement highlight the impact that the nursing shortage will have on US health care, as well as integral role that nurses play in quality and efficiency initiatives within hospitals and other settings. The promise of new roles for advanced practice nurses in primary care-based chronic care management is detailed, along with recommendations for improving access to nursing education and expanding the nursing workforce. Policy leaders and nursing experts are devoting more attention to preparing nurses as players in the future health care environment. Not only will a better health care system require an adequate supply of nurses, it will require nurses with the right skill sets to support better outcomes and new value for patients and purchasers.

In the September issue of the Kaiser Health News Sandy Summers, Executive Director of the Truth About Nursing also weighs in on this issue. Ms. Summers notes that in the health care reform debate, most discussion of providers is limited to hospitals and physicians, in spite of studies which find that increasing nursing staffing can improve care and save money. Summers also notes that nurses continue to be seen only as “doctors’ helpers” with their role being limited to following physician instructions, delivering simple medical tasks, and advising and educating patients. In practice however, nurses frequently serve as points of contact for patients who struggle with chronic disease self-care, present concerns about disease-related complications and warning signs or are confused by medication or treatment regimes. When these questions and issues are not addressed, patients “fall through the cracks” and the frequent results are avoidable complications and hospitalization. Without an adequate supply of prepared nurses, it is unlikely the most costly problems of poor coordination, fragmentation, safety and limited patient self-care support will be addressed.

Primary care physician shortages and access issues will also provide new opportunities for advanced practice nurses. Already, advanced practice nurses are providing more primary care services to the underserved in urban clinics and rural areas, as well as providing care management in long-term care settings around the country for many of the nation’s most frail older adults. And in retail settings advanced practice nurses are caring for conditions such as strep throat, ear infection, or urinary tract infections—providing good access and value—and freeing physicians to care for patients with more complex, chronic conditions. Advanced practice nurses are also providing services onsite to many larger employers around the country. And in settings such as Kaiser Permanente’s Atlanta region clinics, nurse practitioners are partnering with LPNs and case managers to support primary care physicians in improving care for patients with diabetes and cardiovascular disease.

   

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