Problem: Nurses are among those on the frontier of the nation’s health care system, meeting challenges with innovative solutions that improve patient outcomes and save money. Yet too often, these nurse-led success stories are not featured in national discussions about how to improve health and health care. As a result, nurse innovators are not being written about or funded, and their solutions are not replicated as quickly or on a grand scale.
Background: When Diana Mason was a little girl, she had her tonsils removed to prevent recurring throat infections. One nurse who treated her—the nurse she dubbed the “good” one—allowed her to eat ice cream during her recovery. Another one—the nurse she thought of as the “bad” one—did not. “I decided then that I wanted to be a good nurse when I grew up,” Mason recalls.
Fast forward to 2011, and that is exactly what she has become: a good nurse, in all senses of the word.
During a long and productive career, Mason, R.N., Ph.D., F.A.A.N., has served her country as an army nurse, served patients as a clinical nurse, served aspiring nurses as a nurse educator, and served the public as a talk show host, journalist and editor.
For more than 10 years, she was editor-in-chief of the American Journal of Nursing (AJN), the oldest circulating nursing journal in the world. She is now the Rudin Professor of Nursing at Hunter College at the City University of New York, where she co-founded and co-directs the Center for Health, Media and Policy.
Mason was recently appointed by the Robert Wood Johnson Foundation (RWJF) to serve as Strategic Advisor to the Future of Nursing: Campaign for Action, a collaborative effort to implement solutions to the challenges facing the nursing profession, and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care.
In this capacity, she will consult on the implementation of the recommendations of a groundbreaking report released last year by the Institute of Medicine (IOM) about the future of the nursing profession. She will serve as a national spokesperson for the campaign.
Through it all, Mason has also found time to be a volunteer—and nurses and the patients they treat are better off as a result.
As a volunteer co-chair of Raise the Voice, a campaign of the American Academy of Nursing (AAN) that received funding from the Foundation and seeks to highlight nurse-led and nurse-designed solutions to health care challenges, Mason has sought to identify nurses who are on the frontier of health care.
Called Edge Runners, these nurses have developed new care models and interventions that demonstrate significantly better clinical and financial outcomes. Some have done so in the face of formidable institutional resistance.
They are nurses like Ruth Watson Lubic, Ed.D., C.N.M., an 84-year-old woman who turned a supermarket in a low-income neighborhood in Washington, D.C. into a modern birth center for low-income women. The center, which provides midwifery and nurse practitioner services and health care for women and children, has had dramatic results. After six years, it has lowered rates of pre-term birth, low-birthweight babies and cesarean-section deliveries; improved breastfeeding rates among new mothers; and yielded considerable health care savings.
Yet Lubic still has trouble raising funds to cover the costs of the birth center, despite its track record. That’s partly because these kinds of nurse-driven success stories are not being told in national discussions over how to improve health and health care, Mason says. As a result, they are not being written about, they’re not being funded, and they’re not being replicated on a nationwide scale.
Edge Runners like Lubic are among our nation’s “best-kept secrets,” Mason says. “Nurses are doing phenomenal things to meet the needs of underserved people. We have to do a better job making these solutions visible and promoting them to the public and to policy-makers.”
Solution: To spread the word, build support and encourage replication, Mason and her colleagues on the Raise the Voice campaign took a two-part strategy: They required aspiring Edge Runners to provide performance measures so that they could demonstrate clinical successes and cost savings, and they promoted nurse-driven solutions like Lubic’s to the national news media, donors and other stakeholders.
To do that, they formed partnerships with supportive organizations; hired a communications consultant to reach out to the media; recruited Edge Runners to speak on panels about nursing and health care; and held a press conference and a webcast about innovative models of care designed and led by nurses.
One particularly effective effort came a few years ago at a Washington, D.C., conference of the Association of Health Care Journalists. The Raise the Voice campaign managed to get a tour of Lubic’s shoe-string budget birth center on the Association’s itinerary after a stop at an opulent, high-tech “war room” at the Department of Health and Human Services.
The striking juxtaposition of wealth and poverty sparked interest among journalists on the tour, Mason says. “It was stunning. It was in-your-face. We couldn’t have planned it better.”
Mason also spread the word about nurse innovators in the IOM report, called The Future of Nursing: Leading Change, Advancing Health. It calls for a transformation of the nursing profession, advances in nurse leadership, increased collaboration among providers from different disciplines, and reforms to the health care workforce in order to improve patient care.
For the report, Mason worked with former AJN managing editor Joy Jacobson to draft stories about Lubic and other Edge Runners who have succeeded in creating health care solutions that improve the quality of care and save money. These stories illustrate why it is important for nurses to be full partners, with physicians and other health professionals, in redesigning health care in the United States—one of the report’s key recommendations.
“These stories speak to the fact that nurses are out there innovating,” Mason says. “Nurses must be leaders in redesigning health care. Nurses must be at every table where health care is being redesigned and, in some cases, they must lead the redesign.”
Thanks to efforts like these, the word is beginning to get out. Mason cites a recent advertising campaign by UnitedHealthcare that features a man with prostrate cancer who is assigned a nurse who manages his care. “Nurses are central to the message in that ad,” Mason says. “That is really phenomenal.”
Low visibility is just one barrier to building sustainability and scalability of nurse-led models of care, Mason says. In addition to raising awareness, Raise the Voice is also working to identify health care institutions and systems that are hot-beds of innovation; help provide targeted nurse innovators with infrastructure support; and facilitate partnerships with interested parties and donors.
The biggest challenge to reaching those goals is lack of needed funds, Mason says. Funding from the Foundation enabled the campaign to build an infrastructure and sustain the project beyond the grant period, which ended in 2009. The board is now working to secure additional funding, Mason says: “We are sustaining it, but we want to do more. The Edge Runners program has become the key initiative of the American Academy of Nursing. People love it. The members love it. Even though we don’t have the all the funding we need, the Academy is still committed to the project. It is so important for nursing.”
RWJF Perspective: The Robert Wood Johnson Foundation is committed to supporting nurse-led models of care. In addition to support for the Raise the Voice campaign, the Foundation is funding The Future of Nursing: Campaign for Action, a collaborative effort to implement solutions to the challenges facing the nursing profession and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care.