Six Questions on Health Reform with Susan Hassmiller, Ph.D., R.N., F.A.A.N., RWJF Senior Adviser for Nursing

    • April 23, 2009

1.) There seems to be a consensus that our health care system is seriously flawed, which is why there is momentum for reform. How are nurses faring in today's system?

Nurses love patient care, but in the current system often don’t have enough time to pay enough attention to their patients. In acute care especially, but also in other places, nurses face increasing paperwork, regulations and other “hassle factors” that keep them from their patients. It’s a big problem. Nurses are the glue holding the system together at the front lines, where quality and safety matter most, but they need additional support to give patients the care they deserve.  

Advance practice nurses, such as nurse practitioners and nurse midwives, have made great strides in increasing access for patients, especially in rural and underserved areas. In a wide variety of settings, they play an invaluable role in helping to fill the gaps resulting from the growing shortage of primary care physicians. With an aging and sicker population, we don’t have any choice but to work together, doctors and nurses, to help serve the nation’s health care needs. Nurses have created model programs in acute care, primary care and public health settings that are improving the health status of individuals and reducing costs.

2.) Are members of Congress consulting nurses as much as they should as they develop reform proposals?

Nurses have some great allies in Congress. At the White House Forum on Health Reform, Rep. Lois Capps (D-Cal.), a member of the House Nursing Caucus, made a passionate statement on the urgent nursing shortage and the need for federal support. President Obama responded positively, acknowledging the important role of nurses and the care they provide. Members of Congress understand the important role nurses will play in a reformed health system, and have introduced legislation that would provide solutions to the nursing, as well as the nursing faculty, shortages. Congress needs to call on nurses more to learn about specific solutions to cost, quality and access problems. Members tend to rely on policy experts and physicians for health care reform solutions, but nurses have great experience with programs that promote high-quality, patient-centered care at lowered costs.

3.) Are you confident the Obama administration will support reforms that recognize the role nurses play not just in delivering health care, but in promoting quality, improving access, conducting research and more?

I think the administration recognizes the promise of nursing, meaning that they can envision how nurses can provide real contributions to improving health care. But the onus is on us, as nurses, to deliver on this promise, and we are well positioned to do so. We need to be proactive about spotlighting strong examples and powerful evidence that demonstrate the many ways nurses make a difference in terms of cost, quality and access. I think most people, including members of Congress, understand the value of nurses at the front lines in hospitals. But nurses provide value in so many different settings, including chronic care management, public health, school nursing, long term care and more.

One very promising sign is that President Obama has named Mary Wakefield, Ph.D., R.N., to be administrator of the Health Resources and Services Administration (HRSA). Dr. Wakefield understands just how crucial nurses are to providing quality care, especially to traditionally underserved and rural populations, and she is well positioned to implement policies that employ the nurse workforce to improve access.

4.) What should lawmakers do as part of health care reform to address nursing workforce issues and the nursing shortage that looms?

Without enough nurses, hospitals and health care facilities will struggle to provide high-quality, safe care to patients. The recession might slow the shortage, because many nurses who had been planning to retire are postponing and staying in their jobs. But the long-term projections haven’t changed. We could still be short a half a million nurses by 2020. Our nursing workforce is aging, and we aren’t turning out enough new nurses.

Unless that shortage is addressed, patient access and delays—already too common—will worsen. RWJF President Risa Lavizzo-Mourey, M.D., M.B.A., recently provided testimony before the House Subcommittee on Health of the Committee on Energy and Commerce. She talked about the crucial role nurses play in promoting patient safety and high-quality health care. She called for a three-pronged strategy—to address the faculty shortage, increase the pipeline of new nurses and retain experienced nurses—to solve the nursing shortage. She also talked about the need for more primary care nurse practitioners to fill the void with primary care physicians.

Lawmakers should consider the many ways nurses are contributing to the improvement of health care, such as those discussed in our newest Charting Nursing’s Future  policy brief, entitled, Nursing’s Prescription for Health Care Reform

5.) What should nurses be doing now to help make sure that lawmakers get it right?

Nurses should continue what they are doing, providing or overseeing care in a wide variety of settings, but they must be solutions-oriented in creating better ways of providing care. It’s important that nurses speak with a unified voice to ask for the things they need to improve patient care, and to articulate what nurses can bring to the table to increase coverage, improve quality, reduce costs and promote prevention. We need to hone our message and speak clearly, succinctly and persuasively about why nursing matters to the overall health of the country and why nurses must be part of health reform.

And we must seek and form collaborations with non-traditional partners. We can’t do this alone. RWJF has reached out to partners to broaden our impact. Many of our programs engage the business community, foundations, government agencies, consumers and others. The issues facing nursing are too big for the nursing field to solve alone. We can learn from the lessons and experiences of others.

6.) What role would you like to see nurses play in a reformed health care system?

I want to connect nurses’ role in a reformed health care system to patients’ needs.  Our goal is to create a healthier nation and provide high quality care at the exact time when patients need us—from birth to death and every time in between. Nurses should play a leading role in expanding health care coverage by transitioning more primary care from physicians to advanced practice nurses. We should develop policies to provide quality care in various contexts, including geriatric care, care coordination, managing chronic conditions and prevention. We know how to do all of this and should articulate it to decision-makers.