As the government prepares to overhaul the nation’s health care system, health care leaders are urging Congress to tap into the power of nurses.
“We want to say loudly and clearly that nurse practitioners are going to be key to health care reform in the Obama era,” said Donna Shalala, Ph.D., A.B., president of the University of Miami in Florida and the former head of the Department of Health and Human Services under President Clinton. Giving nurses a greater role in health care delivery will give more patients access to quality, affordable primary care services and make the system more efficient, while utilizing existing resources, she said.
Shalala spoke at an event organized by Raise the Voice, a campaign of the American Academy of Nursing and funded in part by the Robert Wood Johnson Foundation (RWJF). It aims to use nursing solutions to improve the nation’s health care system. Pennsylvania Gov. Ed Rendell, J.D., and leaders of non-profit health care organizations joined her on the May 8 news teleconference.
The national debate over health care reform has focused on expanding health insurance, but to be truly effective it must transform delivery of care as well so that more people can access affordable care when they need it, Shalala said. Health care centers managed by nurses, rather than physicians, are a key way to do that.
Often located in supermarkets, pharmacies, “big-box” discount chain stores and other sites in hard-to-reach urban and rural areas, nurse-led facilities are open during nights and weekends and provide patients with quick, comprehensive and affordable primary care services. As such, they are an attractive alternative to the emergency room, which is often the only option for patients who need professional health care services during off-hours. They also cater to the needs of low-income, uninsured or underinsured patients who can’t afford the high cost of physician services, especially for minor ailments.
Already, more than 250 nurse-managed health care centers are operating around the country. Several are located in Pennsylvania, where Rendell recently signed into law a bill that lifted state health restrictions so nurses could provide a fuller range of services. Calling the law a “major success” because it dramatically increased access to affordable care, he said he hopes it will serve as a model for national legislation.
If implemented nationwide, nurse-led health centers could reach more than 20 million Americans, according to the American Academy of Nursing, because in addition to expanding access to care, such centers will offset problems arising from the shortage of primary care physicians.
Nurse-led centers will also help the country absorb an influx of new patients if the government enacts legislation that leads to expanded insurance coverage, said Tine Hansen-Turton, M.G.A., J.D., president of the National Nursing Centers Consortium. That will help the country avoid the kind of problems encountered in Massachusetts, which recently expanded health care insurance coverage but did not adequately expand health care system to absorb new patients, she said.
Obstacles to the spread of nurse-managed care include turf battles with physicians, who may be reluctant to cede health care powers to nurses, and challenges associated with health insurance companies that will need to restructure payment methods, Rendell said.
But the single biggest barrier is money, according to Susan Sherman, president of the Independence Foundation, a non-profit organization that provides funding for nurse-led health care centers. “The challenge we face now is funding, funding, funding,” she said. “Private funding alone is not enough to ensure sustainability of these centers.”
Shalala, Rendell and others are cautiously optimistic that Congress will set aside more money for nurse-led centers in upcoming health care legislation, noting that President Obama and Senate leaders have indicated they are aware of the need to involve nurses in health care reform. But to ensure that happens, nurses must be at the negotiating table, Shalala said. “Health care reform without a critical role for nurses is not a health care reform that’s going to be very successful in this country.”