Transforming Nursing to Create a "Culture of Health"

    • February 28, 2013

Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation (RWJF), kicked off the annual summit of the Future of Nursing: Campaign for Action by joining a conversation with RWJF Senior Communications Officer Linda Wright Moore, MS, about the Foundation’s commitment to transforming health care through nursing. Backed by RWJF and AARP, the Campaign is driven by evidence-based recommendations from the Institute of Medicine (IOM). Excerpts follow:

LWM: One of the things in the IOM report that got a lot of attention is the notion of nurses practicing to the full extent of their capacities. There are some people, physicians, who sometimes have a little difficulty with that. And you’re a physician. So tell me about your perspective: Why is it different from that of many in your profession?

RLM: I am a physician. I’m proud to be a physician. I’m also someone who came from a medical family and learned very early on the power of interprofessional teams. …And then, I’m a geriatrician and I don’t think in my professional life I’ve ever practiced in a setting where we weren’t drawing on the expertise of multiple professions and disciplines.

It taught me that you really do your best when you work with a team. I guess I’ve just instilled that in all that I do. And I think the way that health care is moving—increasingly the naysayers and, unfortunately, too many of them are physicians, but they come in all corners of our health care world—will see the power of teams, of interprofessional collaboration, and of all of us working to the full extent of our training and practice.

LWM: Please talk about the substantial investment that the Foundation has made in the nursing profession, dating back to when it started.

RLM: … How many of you remember some of what was going on in 1972? … Remember we thought health care reform was right around the corner? And then there were some political things that happened and derailed that. That caused our Foundation to say what we, as a nation, are saying right now: There’s no way we’re going to be able to provide quality care to the people who are going to be newly insured unless we change the way our workforce is structured and the kinds of opportunities that we have within the workforce.

And that caused the Foundation to invest in primary care and also to invest in some of the very first nurse practitioner programs. Now, all these years later, we’re saying to ourselves, “We’re really at that threshold now, but we know so much more than we did in 1972.” So I think we’re at a point where we can know how to transform our health care system because we’ve got people trained to do it.

LWM: So there’s a continuum here, from where we started and helped to build the field of nursing. Why did we go forward in 2008 with a future of nursing report?

RLM: In a lot of ways what prompted it was a sense of frustration that we needed to pull a lot of information together. … We had a lot of answers to questions that were here and there. And we realized we needed a place where people could go and see a synthesis of problems and a blueprint for where we needed to go. The place it needed to be had to come from an organization that was authoritative and we knew would do a rigorous job of synthesizing all that information. And that’s really what the IOM does better than anyone else.

We also knew that it was a time when our health care system was at a crossroads. People were talking very seriously about changing the health care system, and that had a lot of fits and starts, but it was closer than it had ever been. There was a sense that old ways just weren’t going to work anymore. People were really frustrated with the quality of care we were getting for the amount of money we were spending. All of these coming together —a change in the environment, a real sense that the nation was ready for change, and that we had answers that weren’t in one place—caused us to say, “Let’s put it in one place. Let’s create a future that people will be able to galvanize around and move toward together.”

LWM: So we really do have a perfect storm. We have the Affordable Care Act, and the likelihood of lots more people coming into the system. We have the aging population, technology and this problem of cost. It’s like a perfect storm and a perfect opportunity to transform the nursing profession.

RLM: I would frame it as a perfect opportunity…We have a lot of knowledge that tells us really how things can change to create that more perfect health care system and community that allows people to be healthy. We know the role that nurses play; we have strong evidence for that. We know some of the things that can be put into place from a systems perspective to improve the quality of care. We are much more connected than we’ve ever been. And we have a better ability to use data, and to do big data, across states and across communities, than we’ve ever had before. So all of those things give us the opportunity to…learn from each other and create a movement for change.

LWM: As in any big challenge, there is a degree of risk. This is one that RWJF is taking on, but why?

RLM: I look at it this way. We can’t afford not to do this as a country. …We are becoming a more diverse society. We have more people who need coverage, but also we have more people who need to live healthier lives. And we know that that can only happen if we invest in our communities and in our health care system. We’re spending $2.6 trillion, and we know that about 30 percent of it probably could be diverted into more beneficial causes…

LWM: What will success look like if we accomplish all the change we want to?

RLM: Success, quite succinctly, looks like implementation of the Future of Nursing report. It looks like people…across America practicing to the full extent of training and education. It looks like a diverse nursing workforce that is really able to start with bachelor’s degree and continue to grow and provide the kind of care that we know is going to evolve over our lifetimes and beyond. It looks like, frankly, a country that …has a culture of health.

One of the people I was talking to recently said, “Risa, What does that really feel like?” I said, “It feels like us as a nation having the kind of values where we can say health, and the policies and practices that go into making sure we are a healthy community, are as much a part of us as the values that say we pursue life, liberty and the pursuit of happiness.” Having that kind of a future is what I think nursing, and this future of nursing, can help us get.

Read more about the Campaign for Action Summit on the Future of Nursing.

Campaign for Action Summit on the Future of Nursing

See video clips from the Campaign for Action Summit, including RWJF President and CEO Risa Lavizzo-Mourey's discussion about the Foundation’s commitment to transforming health care through nursing, and reactions from Summit participants.

See more RWJF videos

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