Can Nurses Drive Health Reform?

"What we need to make sure that we're able to do as nurses" is to be able translate what is "happening within our science" and be able to transmit that information into practice, said Hader. For many years, nursing, along with other medical professions, had been told in their academic programs that "this is how you do it . . . because it's been always done that way."

"We need to be able to continue to research more—to have better science that can actually dictate our practice that is based upon knowledge and information," Hader added.

In an interview, Diane Gurney, president of the Emergency Nurses Association, says, "I think we've come a long way from where we used to be, but we certainly can do better. We should have more influence, and I predict we will have more influence. I think we are in very exciting times."

She says she agrees with the Gallup Survey finding that while many nurses groups may speak out about issues, they don't have a "single voice" speaking on national issues. "We have a lot of 'one voices.' Everybody has their voice ... but we're in silos," she says. "We have to focus on those things that we can agree upon and maybe leave out the sacred cows—our own specialties— aside."

Carol Raphael, president and CEO of the Visiting Nurse Service of New York, said last month at a Brookings Institution forum on healthcare reform and older Americans, that new opportunities are emerging in which nurses can assume new roles. One example is the expansion of medical homes, which will place emphasis on the primary care team, which includes nurses.

Another model is transitional care—care after being released from a hospital. "I have to say I have seen a lot of heads of hospitals begin to pay enormous attention to the issue of readmissions. It is definitely on their radar screen," she said. "And while we all say transitions are vulnerable points, I think they're also an opportunity to begin to integrate, to build partnerships."

Her organization has trained its 2,500 nurses to use an algorithm—for those who are being discharged from a hospital—to predict patients' risks of rehospitalization. "If they come out high, we move in," she said. "And we now have begun some really strong partnerships with hospitals in targeting their population."