Healthcare Leadership, Policymakers Should Listen to Nurses, Says Gallup Survey

A new Gallup Survey of opinion leaders from across the country found that most believe nurses should have greater influence in many healthcare areas—from reducing medical errors to improving efficiency and reducing costs—but that significant barriers continue to block them from fully achieving those goals.

The survey, called "Nursing Leadership from Bedside to Boardroom: Opinion Leaders' Perceptions," was conducted on behalf of the Robert Wood Johnson Foundation and released at a briefing in Washington on Wednesday. It was compiled from interviews of more than 1,500 "opinion leaders" in the fields of insurance, corporate, health services, government and industry thought leaders, and university faculty.

In the survey, conducted between Aug. 18 to Oct. 30, 2009, most of the opinion leaders agreed that nurses are one of the most trusted sources of health information. However, they saw nurses as having less healthcare reform influence than government, insurance, and pharmaceutical executives.

A majority said they felt that nurses should have more influence on health policy, planning, and management, said Risa Lavizzo Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. "[But] what this confirms is that they are underutilized in leadership roles."

Among the survey findings are:

• Opinion leaders said that nurses' primary areas of influence were reducing medical errors (51%), improving quality of care (50%), and coordinating patient care in the healthcare system (40%).
• A majority of opinion leaders said they would like to see nurses have more influence in a large number of areas, including reducing medical errors and improving patient safety (90%); improving quality of care (89%); promoting wellness and expanding preventive care (86%); improving healthcare efficiency and reducing costs (84%); coordinating care through the healthcare system (83%); helping the healthcare system adapt to an aging population (83%); and increasing access to healthcare (74%).
• Three-quarters of opinion leaders said government officials will have a great deal of influence in healthcare reform in the next five to 10 years, compared to 56% for insurance executives, 46% for pharmaceutical executives, 46% for healthcare executives, 37% for doctors, 20% for patients, and 14% for nurses.
• The top barriers to nurses' increased influence and leadership are not being perceived as important decision makers (69%) or revenue generators (68%) compared with doctors; nurses' focus on primary rather than preventive care (62%); and nursing not having a single unified voice in speaking on national issues (56%).

To move forward, nurses need to pull together "the stories, the knowledge, the experiences" that they encounter every day, said Reed Tuckson, MD, executive vice president and chief of medical affairs at UnitedHealth Group, who spoke at the briefing.

"It seems incredible that in a time when our challenges are the worst that they have ever been and that they are getting more complex—that we were somehow not making use of all our assets," he said. If nurses fail to get "fully engaged at every level of the delivery system—from policy formulation to operations—we all will suffer," said Reed, who added that his mother was a visiting nurse in Washington.

Nurses must find new ways to contribute to the solutions—especially in areas such as healthcare reform, said Mary Naylor, PhD, FAAN, professor at the University of Pennsylvania School of Nursing and director of the New Courtland Center for Transitions and Health.

"We must continue to document how we as nurses are making a difference. We must substantially increase our efforts to move our evidence into practice and policy to influence all of the decisions," Naylor said.