How Nurses Can Change Health Care

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By Susan Kreimer, MS, contributor

Feb. 5, 2010 - Studies have shown that nurses are highly-trusted by the general public and have a substantial impact on patient outcomes and satisfaction ratings.  Health leaders believe they should also have more influence on making wide-scale changes to health systems and services, a new Gallup survey reveals.

Whether it's reducing medical errors, improving quality of care or promoting wellness, nurses have the knowledge and the skills to create change. But the surveyed opinion leaders also foresee substantial roadblocks to health care reform in a system where the government, insurance industry and pharmaceutical executives exert more power than nurses.

That's the thrust of a novel survey, Nursing Leadership from Bedside to Boardroom: Opinion Leaders' Perceptions. The results of the research, conducted by Gallup for the Robert Wood Johnson Foundation, were released in late January.

"Nurses are on the front lines. They are in team leader and managerial positions. People recognize the fact that nurses working in these positions are patient advocates," said Susan Hassmiller, Ph.D., RN, FAAN, senior adviser for nursing at the foundation, the nation's largest health care philanthropy, based in Princeton, N.J.

However, many fear that health care has shifted from a service model to a business model, focused on revenues instead of outcomes of care.

Rather than emphasizing how to manage and treat chronic illnesses, the central message should stress preventive measures, said Patricia Gerrity, Ph.D., RN, FAAN, associate dean for community programs in the College of Nursing and Health Professions at Drexel University in Philadelphia. But discussions involving behaviors, motivation and lifestyle changes take longer than the short office visits allotted by a faulty system.

"There's very little about health in health care reform," Gerrity said. "It's really about financing."

National opinion leaders rank six stakeholders ahead of nurses when it comes to influencing health care reform over the next five to ten years. Results are based on telephone interviews with 1,504 participants between August 18 and October 30, 2009.

Seventy-five percent of opinion leaders surveyed said government officials will have significant influence, compared to 56 percent for insurance executives, 46 percent for pharmaceutical executives, 46 percent for health care executives, 37 percent for doctors, 20 percent for patients and 14 percent for nurses.

They noted the top barriers for nurses in assuming more influence and leadership. Compared with physicians, nurses aren't regarded as key decision makers or revenue generators. Also, the system's current emphasis is on primary rather than preventive care, and nurses often aren't united on the concerns at stake.

"You hear that nursing groups sort of lobby for their own issues, and sometimes the issues are contradictory," said Hassmiller of the Robert Wood Johnson Foundation. "People pick up on the disagreements that nurses have among themselves. The noise of the internal disagreements gets in the way."

This new survey sets forth an agenda for nurses to speak in a single voice and to release consensus statements through their national organizations, said Richard Hader, Ph.D., RN, FAAN, senior vice president and chief nursing officer at Meridian Health, a four-hospital system in central New Jersey.

"Our legislators want to hear from us," Hader said, while adding that nurses have a very strong voting bloc. "My experience with [legislators] is they are truly willing to seek our guidance and suggestions."

Doctors also want a helping hand. "They've been through so much scrutiny in medical practice that they are looking for partners to be able to deliver the highest quality care at the lowest possible cost," he said.

More nurses should consider venturing into local, state and national politics and serving on community boards, as well. Their visibility will make a big difference, said Beverly Malone, Ph.D., RN, FAAN, chief executive officer of the National League for Nursing, which represents approximately 30,000 individual nurse educators and 1,200 nursing schools.
"Nursing has always been the glue that holds the whole system together, but we've been the invisible glue," Malone said. "Now, with the Gallup poll, it's obvious we're no longer invisible. I think this is a huge step forward for nurses. It's not where we want to be, but it's not where we were."

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