Upon release last month of a Gallup Survey of opinion leaders about nursing leadership, Risa Lavizzo Mourey, MD, president and CEO of the Robert Wood Johnson Foundation (RWJF), said the organization commissioned the survey because of the importance related to "expanding the leadership of nurses and tapping into all the wisdom and expertise that nurses have [which] is critical to healthcare reform and the healthcare system."
In the survey of 1,500 opinion leaders, nurses were viewed as one of the most trusted sources of health information, but they were often seen as having less impact on healthcare reform than government, insurance and pharmaceutical executives, and others.
Many nursing leaders, though, think the tide may be turning in that area and that the roles of nurses—and the work that they do—will be steadily influencing the movement toward healthcare reform and emerging health policy and research issues. Overall, they need to take advantage of opportunities that are opening up to them now.
Some of those opinions were expressed at the conference releasing the survey itself. "We do have considerable evidence about nurses' contributions" in areas such as patient safety, overall quality, care coordination, aging, and prevention, said Mary Naylor, PhD, RN, a professor at the University of Pennsylvania, School of Nursing, and program director of the RWJF Interdisciplinary Nursing Quality Research Initiative.
"We know nurses are making a major contribution in terms of improving value, quality, alignment with patients' experiences, and with family caregivers' experiences relative to investment in costs,” Naylor said. "Equally important, we are making major contributions—and we have major evidence to support this—in areas where opinion leaders have identified that we have little influence around access, around cost and efficiency."
"So the tremendous opportunity here is to get that message out as quickly as we can—to share the knowledge, to capitalize on every opportunity, to communicate what we know so that we continue to have others build on our ideas," she said. "We have a treasured gift here: The public trusts us. So we have to build on that foundation. We have to accelerate our ability to influence what it is that we know they need because [the public] is actually counting on us."
With healthcare reform being on the mind of many, "This is really an opportunity for all of us to begin to change our paradigm—the way that we think of healthcare being delivered," said Rich Hader, senior vice president and chief nursing officer at Meridian Health, an integrated healthcare system in New Jersey.
"When you think about it, nursing is at every avenue of the healthcare experience—whether or not it's in prevention and wellness, or diagnostic and treatment, or rehab or end-of-life care. It is the nurse who is the consistent, focused caregiver who is able to move us through that system," he said at the RWJF conference.
"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."
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.