The latest publication in the Robert Wood Johnson Foundation’s (RWJF’s) Charting Nursing’s Future series identifies nursing initiatives across the nation that collectively point the way to transformation of the country’s health care system. “Nursing’s Prescription for a Reformed Health Care System” combines case studies with analysis and policy recommendations, and arrives on the desks of lawmakers and health care reformers just as Congress and the President begin to piece together what promises to be the most significant overhaul of the nation’s health care system since the creation of Medicare.
“Nurses have created model programs in acute care, primary care and public health settings that are improving the health status of individuals and communities,” the brief declares. “These initiatives are expanding access, improving quality and driving down costs.” The brief goes on to highlight case studies demonstrating exactly that. Among them:
Comprehensive Community-Based Care for the Elderly. The Program of All-Inclusive Care for the Elderly (PACE) uses nurses and other health professionals to provide comprehensive, integrated medical care and social services. Payment is per-patient-served, creating incentives for high-quality care that keeps patients out of acute care settings. PACE was first created in San Francisco by a community organization but is now an optional Medicaid service in 31 states and a permanent benefit under Medicare. States using PACE report that it reduces costs and improves service utilization patterns.
Nurse-Managed Health Centers and Retail Clinics. In the last 30 years, nurses have established more than 250 nurse-managed health centers around the nation, providing care in communities where disparities in health care are most pronounced. At one such clinic, 11th Street Family Health Services, profiled in the February issue of Sharing Nursing’s Knowledge, nurses have developed a variety of innovative approaches to managing chronic conditions. But nurse-led practices are ineligible under current rules for the now ongoing Centers for Medicare and Medicaid Services medical home demonstration project, which might otherwise provide much needed financial support to their efforts to provide care to underserved communities.
Transforming the Workplace to Support Quality. A recent study finds that nurses in hospitals spend just one-fifth of their time on patient care—spending the rest tracking down supplies, doing paperwork, and communicating with other team members with often outmoded systems and tools. Meanwhile, faster patient turnover in hospitals due to cost-containment policies means sicker patients and increased work from transitioning patients in and out of facilities. The result: quicker burnout and higher staff turnover. The Magnet Recognition Program of the American Nurses Credentialing Center encourages hospitals to become magnets for nurses by improving their work environment. Similarly, Transforming Care at the Bedside (TCAB), a pilot program of the RWJF and the Institute for Healthcare Improvement whose tools and messages have spread to hundreds of hospitals across the nation, has pioneered nurse-led innovations in medical-surgical units. At one TCAB site, Seton Northwest Hospital in Austin, Texas, nurses now join other members of the interdisciplinary care team on daily rounds, strengthening communication with physicians and improving patient care. Such reforms help retain experienced nurses, improve the quality of care, save money, reduce complications for recovering patients and even save lives.
The brief highlights other reform approaches, including:
“Health care reform in the United States can only succeed if we put all of our resources to their best use,” says Susan Hassmiller, Ph.D., R.N., F.A.A.N., RWJF’s senior adviser for nursing. “In the case of nursing, that will require a number of structural reforms. We expect this brief to help point the way.”
The brief is being delivered to policy-makers this month, just as major health care reform legislation begins to take shape on Capitol Hill. It is available online. Other recipients include more than 12,000 nurse leaders, academics, media and leaders of consumer groups and professional associations.