The New Nurse as a Key to Improving Healthcare

Update: Post updated with 10/06/10 statement from AMA.

A new report has discovered the "crucial element" to achieve effective, affordable care for Americans in the new world created by health reform: nurses.

The Robert Wood Johnson Foundation and the Institute of Medicine released a report today indicating that the time has come for a shift in the nursing profession, one that requires more independent and better-educated professionals to provide better care to millions of Americans.

Former U.S. Secretary of Health and Human Services, and current University of Miami president, Donna E. Shalala heads the committee who authored the report, which calls for residency training for nurses, increasing the number of nurses attaining a bachelor's degree to 80 percent in the next decade, and doubling the number of nurses pursuing their doctorates.

In a statement, Shalala called for the development of a nursing work force which is "well-educated and prepared to practice to the fullest extent of their training, meet the current and future needs of patients, and act as full partners" in reforming the nation's healthcare system.

"Transforming the nursing profession is a crucial element to achieving the nation's vision of an effective, affordable health care system that is accessible and responsive to all," added Linda Burnes Bolten of Cedars-Sinai Medical Center in Los Angeles, another of the committee's leaders.

At more than three million strong, the committee praised nurses as the single largest segment of the healthcare network and as the ones spending the most time delivering patient care, yet facing "scope of practice barriers" hindering them to the fullest extent of their education and training. The report notes these barriers are particularly problematic for advanced practice registered nurses.

One need look no further than recent news from Colorado, where a group representing anesthesiologists and physicians is suing the state over its decision to opt out of a federal Medicare rule where advanced practice nurses need physician supervision to administer anesthesia. The head of the group suing the state said opting out is "an unnecessary lowering of the standard of care" in Colorado hospitals that would fracture the patient-doctor relationship.

But the Robert Wood Johnson Foundation / Institute of Medicine report calls for an end to state-by-state dos and don'ts for advanced practice nurses and urges state and federal legislators to let nurses perform at the level of their training and provide incentives for nurses to pursue higher degrees and additional training, incentives currently lacking according to the authors.

The report also calls for nurses to be "full partners," with physicians and other healthcare professionals, from taking on leadership roles to participating in and sometimes leading decision making for an organization as part of the post-health reform landscape.

In a statement, the AMA said it supports expanding the healthcare workforce, but reminds that there is "no substitute for [physician] education and training."

We recently wrote about incorporating nurse practitioners into your practice, extolling the benefits of added patient care and lower cost versus adding a new physician partner.

Amid a physician shortage and the growing number of insured Americans thanks to the Affordable Care Act, the healthcare world keeps scrambling to figure out how to recruit and train new doctors to meet the incoming flood of those seeking care. This report - which simply mirrors years of what nursing associations have been saying -offers a possible solution.

From accountable care organizations to patient-centered medical homes, the Affordable Care Act encourages teamwork to help Americans access the care they require. While not explicitly stated in the thousands of pages of the law, reform calls for egos to be put on shelves, for new techniques to be embraced rather than the "we've always done it this way" practices, and frankly, for physicians, nurses, and everyone else in healthcare to step out of their comfort zones for the benefit of patients.

Nurses have numbers, they have experience, and a desire to help patients. Isn't it time they took a better seat at the healthcare table?