Blog
Jul 28, 2010
On Wednesday, July 28, CCNA's Coalition members came together to discuss health care and the future of nursing from the consumer, business, and payer and provider perspectives. John Rother, AARP Executive Vice President for Policy and Strategy, spoke to the group on "where we need to go in health care delivery—and why that will require a much larger role for the nursing profession.”
According to Rother, the success of health reform depends on innovations in delivery that increase efficiency while maintaining quality, and nurses should play a major role in making health care reform work for patients, for providers, and for payers. He noted that the new health care law takes some important steps in the right direction, "but it doesn’t go far enough." Read the entire speech here.
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Jul 12, 2010
As senior advisor for nursing for the nation's largest health care philanthropy, the Robert Wood Johnson Foundation, Susan B. Hassmiller has had nursing in her blood from an early age. From candy striper to nurse's aide to nurse to the director of the RWJF Initiative on the Future of Nursing, at the Institute of Medicine, Hassmiller is spending her summer vacation in Europe, retracing the steps of the legendary Florence Nightingale. In this and upcoming posts in the American Journal of Nursing's Off the Charts blog, Hassmiller reports on her inspiring trip to London, at Embley Park and Istanbul, Turkey and what it means to her work today. Below is an excerpt from Sue's first post.
Eighteen years old and ‘hot to trot.’ That’s what I thought I was. Having just been admitted into nursing school, I was set to change the world…one patient at a time. They tried to teach me about Florence Nightingale, but she was someone from the past…not likely to help me learn to start IVs, put in catheters, or run ventilators. If there were iPods back then, I would have used mine to avoid lessons about how Florence Nightingale changed the face of nursing forever. Read the full post here.
Jul 9, 2010
By Phil Zarlengo, AARP Board Chair
Last month in Providence, RI, I joined more than 80 business, community and health care leaders representing health systems, community health organizations, government agencies, non-profits and nursing groups to discuss the role that nurses should have in the leadership of these organizations. While no one doubts the important role that nurses play in patient care, this distinctive meeting focused on leveraging the untapped value of nurses as leaders in the boardroom.
AARP was early to recognize how much our members and the public have to gain from having nurses on the association’s board of directors. In the years that I have been on the board, I have had the privilege of working with many of them.
Surrounded by their accomplishments, it’s difficult for me to grasp some of the results of a Gallup/Robert Wood Johnson Foundation poll of health care leaders. Those leaders put nurses at the bottom of the list of people who are going to influence health reform over the next five to ten years. More than two-thirds of them said that a major barrier to greater influence in health care leadership is that nurses are not perceived to be important health care decision makers compared to physicians.
These perceptions are overdue for a change. This plague of low expectations makes no sense when it comes to nurses. Health care governance, for example, needs directors and trustees who understand health care delivery. More than that, however, boards of governance also need leadership with firsthand, in-depth knowledge of complex organizations and how best to navigate the relationships within them. Nurse leaders have that knowledge, along with strong competencies in management, communications and leadership.
I’ve heard nursing compared to “running a bunch of small businesses all over the place.”
Those sound like board of directors skills to me.
In addition, when nurses speak, they are believed. Theirs is a trusted and credible voice. Doctors and nurses are the information sources about health and health care in whom opinion leaders have a great deal of confidence. And those opinion leaders share with me a great desire to see nurses’ influence and leadership increase. It’s hard to imagine a more valuable contribution to the success of health care reform than elevating the influence of nurses. I look forward to it!
To learn more about CCNA’s Nurses on Boards project, visit http://championnursing.org/content/nurses-boards.
Jul 6, 2010
By Tine Hansen-Turton, MGA, JD, Chief Executive Officer and Ann Ritter, JD, Director, Health Center Development & Policy, National Nursing Centers Consortium
The passage of the Affordable Care Act means that more than 30 million additional Americans will have health insurance by the year 2014. Can our primary care system handle the demand?
In Massachusetts, passage of a universal insurance plan in 2006 completely overwhelmed the Commonwealth’s existing supply of primary care physicians, and the effects are still being felt. In 2009, only 44% of internists in Massachusetts were accepting new patients. The average wait time for a new patient to get an appointment was 44 days.
Nurse practitioners can provide care that is similar in scope to a primary care physician in all 50 states. Health care innovators have capitalized on nurse practitioners’ ability to provide high-quality care in independent settings such as convenient care clinics (also known as retail-based clinics) and nonprofit nurse-managed health clinics that serve vulnerable patients. Nurse practitioners in these settings have already served over 20 million people in the U.S., and they have the capacity to reach millions more.
How can nurse-led health clinics reach their full potential? A few common-sense policy reforms could go a long way towards increasing access to primary care for all Americans.
First, insurance companies should do a better job connecting their enrollees to nurse practitioners. We conducted a national survey of insurance companies last year and found that nearly half of all major insurers in the U.S. do not credential or reimburse nurse practitioners as primary care providers.
This means that patients who want to see a nurse practitioner for primary care don’t have the flexibility to do so. It also means that many patients whose needs could be addressed in a cost-effective way by nurse practitioners have to wait weeks or months for an appointment with a physician.
Many of the insurers who refuse to recognize nurse practitioners as primary care providers are Medicare and Medicaid insurers. At the same time, nurse-led practices have been excluded from “medical home” projects designed to improve health care quality for seniors and other patients. Nurse practitioners are especially well-suited to provide affordable primary care to patients with chronic conditions. At a time when everyone is looking for better ways to control health care costs, we should make it easier for people with Medicare and Medicaid to choose a nurse practitioner as their primary care provider.
Jun 2, 2010
Representatives from our 31 state teams converged in D.C. this week to celebrate successes and share the challenges as we continue our tireless work to build nursing workforce capacity across the nation. The excitement was infectious and there was unanimous agreement of the pivotal role nurses can and will play in the implementation of health care reform.
There is much anticipation for the release of the Initiative on the Future of Nursing (IFN) recommendations that will help guide the transformation of the nursing field within this uncharted territory. There is no time like the present for change and nurses have the incredible opportunity and challenge to insert themselves as part of the solution to the systemic issues that plague our health care system.
As evidenced by the work of our state teams, nurses have a direct impact on increasing access and quality of care and reducing health care costs. Barriers like a lack of qualified faculty and disconnect within statewide curriculums no doubt exist; however, solutions like partnerships between public and private universities, shared faculty and curricula, and the use of simulation technology are all contributing to a new, more equipped nursing workforce that is more equipped to meet the demands of a changing 21st century population including long term, transitional and palliative geriatric care.
Shared knowledge, tenacity, collaboration and persistence have become the cornerstones of our collective efforts to redesign the underlying issues in education capacity that are hindering the number of qualified new nurses entering into the profession. Now, we must look to tackle other pressing issues including scope of practice, retaining the wisdom and knowledge of our experienced nurses and having a powerful presence and impact from bedside to boardroom. Our time is now. Let’s continue to build the momentum and not only visualize but realize a more effective, reformed system, that results in a healthier America.
| Susan C. Reinhard, PhD, RN, FAAN Senior Vice President, AARP Public Policy Institute and CCNA Chief Strategist |
Brenda L. Cleary, PhD, RN, FAAN Director, Center to Champion Nursing in America |
May 18, 2010
By Sheila P. Burke, RN, MPA, FAAN, Faculty, Harvard Kennedy School of Government; Sr. Policy Advisor, Baker Donelson
Since its creation in 1965, Medicare has provided support for nursing education. Back then, the majority of nurses were educated through hospital-based diploma programs.
Over the past 45 years, Americans’ health care needs have changed, and the nursing profession has responded to meet those needs. Americans are aging, experiencing more complex health conditions, and managing multiple chronic conditions. Simultaneously, their health care is increasingly delivered outside of hospitals, in an array of community settings—clinics, ambulatory care centers, and patients’ homes. Consequently, nursing education programs in our nation’s colleges and universities have gradually replaced hospital-based diploma programs, and the number of RNs graduating from diploma schools has declined. In 2007, only four percent of registered nurses were trained in hospital-based diploma programs.
Until recently, Medicare reimbursement for nursing education had not kept pace with our changing health care landscape, continuing to primarily invest nursing education dollars in diploma programs. But, with the passage of health care reform, also comes an important recognition that advanced practiced registered nursing (APRN) skills are needed for the Medicare population. APRNs, nurses with advanced graduate education and training, can provide primary care, chronic care management, transitional care and care coordination.
The Medicare Graduate Nurse Education Demonstration Program aims to increase the number of highly-skilled APRNs to care for Americans by providing $200 million to bolster the training of these key health care professionals.
It received little attention in mainstream health care media coverage, but what occurred was nothing short of transformative. The way Medicare pays for health care truly sets the bar for our entire health system. The Patient Protection and Affordability Care Act breaks the federal funding barrier for graduate nursing education and targets dollars toward educating nurses with the specific skills needed to meet the needs of Medicare recipients. In the end, patients and the nursing profession will be better for it.
May 17, 2010
By Beverly Malone, PhD, RN, FAAN, CEO, National League for Nursing
Dear Jen,
You can see from my salutation that I am not a bill collector! In fact, I am writing today to echo the sentiment you received from President Obama (which I read about in the Washington Post) in response to your letter to him: Always dream big.
On behalf of the National League for Nursing and AARP’s Center to Champion Nursing in America (who kindly gives us this opportunity to post on their blog), I want you to know how thrilled we are that your dreams include becoming a nurse. You were wise to take advantage of the president’s increased funding for Pell Grants, which have facilitated the return to school for so many.
With the continuing shortage of nurses, the profession really needs more people like you. And because nursing schools are so selective these days (according to the NLN’s annual survey of nursing schools, approximately one in four qualified applications are denied admission each year, due to space limitations), you are to be congratulated on your admission to the program at your local community college. Indeed, quite an achievement.
At the NLN we speak often of and provide opportunities for professional growth and lifelong learning. The associate degree can be a path directly to graduate study. With an MSN, you would qualify to join the ranks of nurse faculty and teach other aspiring nurses.
Nursing is a calling where you truly will make a difference. Working on the frontlines in hospitals, clinics, and other health care agencies that serve an economically and culturally diverse population, today’s nurses help improve access to quality health care every day. Since you lost your own health benefits when you were facing a health care crisis, I know you understand just how important that is.
Our best wishes for your speedy recovery. May you soon resume your nursing studies and continue to pursue all your dreams for yourself and your family!
Sincerely,
Beverly Malone, PhD, RN, FAAN
CEO, National League for Nursing
New York City
Editor's Note: This blog was written in response to the letter sent to President Obama by a Michigan nursing student: Washington Post, March 31.
May 7, 2010
By Jennie Chin Hansen, RN, MS, FAAN
AARP President
Chief Executive Officer, American Geriatrics Society
Throughout my career, I’ve worn many hats… as a nurse, a health care executive, a consumer voice, among others. In each of these roles, I’ve become progressively aware of the vital role advanced practice registered nurses (APRNs) must play in meeting our nation’s future primary care needs, especially given the anticipated shortage of primary care providers. The Association of American Medical Colleges predicts a shortage of 46,000 primary care physicians by 2025.
I recently joined other nurses, physicians, physician assistants, and researchers at a meeting convened by the Josiah Macy Jr. Foundation to discuss how we can best prepare a strong primary care workforce. We recognized the need to bring hospitals, nursing schools, and community-based care settings together in partnership for the preparation of APRNs if we want to achieve cost-effective, quality care for Medicare recipients.
We produced a series of recommendations, a number of which address the need for graduate nursing education and the need to remove barriers that limit – in many states – consumer access to APRN-provided primary care.
Congress and the President have also recognized the value of APRNs in providing high-quality primary care, particularly the need to increase funding for graduate nursing education. The Patient Protection and Affordable Care Act contains the Medicare Graduate Nurse Education Demonstration Program, which aims to increase the number of highly skilled APRNs by providing $200 million to bolster their training. This program also lays the foundation to transform the way Medicare pays for nursing education by targeting dollars toward educating nurses with the skills needed to care for Medicare recipients.
As I complete my tenure as AARP President, I am pleased that AARP successfully collaborated with leading nursing organizations – in effect consumers partnering with nurses – to help ensure Americans will have access to nurses with the advanced education and skills we need to receive high quality care.
Apr 23, 2010
By Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, University of Virginia Health System
Nurses and consumers, alike, know a partnership between patients and health care providers is key to achieving patient-centered care. Technology is bringing patients and care givers together. The use of electronic health records and emerging technologies are transforming care in the home, community, and hospital, while empowering consumers to be more involved in their own health care.
As consumers manage more of their health, electronic tools, or “eHealth resources,” typically available through the internet, empower them to access health information, communicate with health care providers, make health care decisions, and engage in chronic disease management. Nurses can help consumers navigate the ever expanding world of electronic health. Nurses link data and information with people—consumers, families, and other care givers. They help patients access information and educational materials, and serve as a resource for patients attempting changes in health behaviors such as smoking cessation or diet management. Nurses also serve as a point of contact for disease management monitoring by recording data, troubleshooting devices, sending reminders, and talking through questions and concerns.
As you know, nurses are everywhere, but sometimes the helping technologies and information are not. With a small percentage of providers actually using electronic records, nurses are often the lynchpin integrating paper and electronic data, orders, and documentation. Nurses know this is not an ideal system and are excited about the prospect of all care providers using an electronic record to improve care and outcomes. Much of the recent chatter about electronic health records has been focused on physicians. Are they ready and willing to adopt a paperless “chart” that requires entering orders for prescriptions and treatments into an electronic system? Can the developers create systems that are so easy to use and helpful that providers will lead the charge for adoption? In the past, nurses and others stepped in to collect and enter data including orders into electronic systems. Nurses want to do their fair share of documentation and processing of electronic work, but today’s enterprise electronic health records are designed for all providers to do their part.
A recent news report highlighted the successes of implementing electronic health records at Banner Estrella Medical Center, an “all digital” hospital in Arizona. All the gains benefit patients such as reduced adverse drug events, reduced nursing staff turnover, reduced length of stay, reduced pharmacy costs, and overall attainment of strategic goals for safety, and quality. While the rest of the nation catches up, nurses are bridging the gaps.
Technology is an enabler, and like the technology itself, nurses are enablers. Nurses are great partners to recognize and advance changes in workflow and lead clinician engagement to improve and use electronic systems. Informatics nurses, clinical nurses, as well as nurse managers, are contributing to the selection, preparation, implementation, and constant modification of information systems that will improve quality by making care safer and more efficient.
Editor's Note: Pam Cipriano is also Editor-in-Chief of American Nurse Today.
Apr 21, 2010
By Joanne Handy, RN, MS
Member, AARP Board of Directors
President & CEO, Aging Services of California
We’ve finally cleared the monumental hurdle of passing health reform. More people will have access to the affordable coverage they desperately need. But how can we ensure that quality care is available to everyone when many providers were stretched to their limit before the law passed?
Unquestionably, nurses, especially advanced practice nurses, can provide much of the care we need. But first, statutory and regulatory barriers at the state and federal levels that prevent scores of nurses from practicing to the full extent of their licensure must be lifted. Who knows this better than nurses? Not enough people and that’s a problem.
As an outgoing board member for AARP, I’m delighted that our Board of Directors recently approved changes to increase AARP’s advocacy for nursing. Now we can direct more energy toward transforming state nursing laws.
What our board recognized – and what nurses and allied health professionals already knew – is that these laws are short-changing consumers. Ironically, the laws remain in place as the nation struggles with a major shortage of primary care providers.
People aren’t getting the total range of health services that should be available to them. They’re being deprived, especially when it comes to primary and chronic care management, simply because laws stand in the way. State legislatures should know it; and the public needs to know, too.
In 20 years, the entire U.S. population will increase by 20 percent. But the 65+ population will grow by 79 percent; and with it, the incidence of chronic illness. For years we’ve been asking, “Who will provide the care?” We’d be better equipped to answer if we untied the hands of the professionals trained and licensed to do the job.
As health reform finally becomes a reality, I’m excited that AARP is expanding its role on this issue. Our membership understands denial of coverage. They understand care that’s financially out of reach. They know what it means to have reduced or limited access to services. Addressing their needs and the increasing health care needs of the nation, calls for creative, sensible, effective strategies – stat.
Actually, changing our laws to unleash a critical tide of care providers where they’re needed most isn’t very creative. It’s not even a novel idea. It’s just plain, old common-sense with the potential for amazing results.
