Practice Matters

Nursings role in healthcare

reform
By Susan Hassmiller, PhD, RN, FAAN

Find out about new opportunities helps build the scientific

form act (Patient Protection
foundation for clinical pracfor nursesand the challenges we tice,
and Affordable Care Act, or
prevention, and immust address to maximize our
PPACA) gives nurses new
proved patient outcomes.
opportunities to deliver care
contribution to healthcare reform. We must support nurse reand play an integral role in
searchers through adequate
leading change. (See http://championnursing.org/
funding. The Robert Wood Johnson Foundation
sites/default/files/nursingandhealthreformlawtable.pdf.)
(RWJF) is doing this by funding the Interdisciplinary
Understanding these opportunities is just the first step.
Nursing Quality Research Initiative, a program that
We need to know how we can be part of the solution
links evidenced-based nursing care to improved pato achieve better patient outcomes at a more reasonable
tient outcomes.
cost. We need to do more to prevent disease; provide
3. Redesign nursing education. All nurses need to
chronic care management to an aging, sicker, and more
possess basic competencies to meet the demands of
diverse population; and offer end-of-life care that eman aging and diverse society, with an emphasis on
phasizes comfort and compassion. Across all settings
clinical training in multiple settings across the lifesespecially geriatricswe must do more to prepare ourpan. The emphasis should be on quality and safety,
selves for the future.
evidence-based practice, research, and leadership.
In this article, I outline nine challenges that individual
Several RWJF programs are working to incorporate
nurses and our profession must address if we are to
these concepts into nursing education, including
help lead our country to a healthcare system that is
Quality and Safety in Nursing Education, the New
more equitable and provides a higher quality of care.
Jersey Nursing Initiative, and the Nurse Faculty
(For a flowchart of these challenges, see Nurses role in
Scholars program. Therefore, we need to remove
reforming healthcare.)
barriers to attaining baccalaureate and advanced
1. Use nurse-led innovations. Nurses know how to
degrees, such as by strengthening partnership links
expand access to care and improve quality at lower
between community colleges and upper-division decost. Weve developed innovative care models to
gree-granting institutions and all academic instituprove it, including nurse-managed health clinics,
tions and practice organizations. The RWJF-funded
home visiting programs for low-income mothers, and
Center to Champion Nursing in America is providing
the Transitional Care Model (TCM). By emphasizing
technical assistance to help with academic progresthe use of masters-prepared nurses to oversee care
from the hospital to within the home, this model has
reduced rehospitalizations for elderly patients with
multiple chronic conditions. Research shows that usDevelop
Foster
ing the TCM helps patients achieve better long-term
Embrace
nurse-led
interprofessional
health outcomes and avoid repeat hospitalizations,
technology
innovations
relationships
all at a reduced cost. We need more nurses to develop innovations. (For good examples to follow, visit
Diversify
Develop
www.aannet.org/i4a/pages/index.cfm?pageid=3303.)
Generate
our
leadership
at
2. Generate evidence and engage in research.
evidence
workforce
every level
Nurses play important roles as innovators who help
shape quality and safety. Successful models arent
Expand
born, implemented, or sustained without solid effecRedesign
Be at
scope of
education
the table
tiveness data. Its up to all nurses to collect and
practice
track data to improve their own practice as part of
broader efforts to improve care. Nursing research
THE 2010 healthcare re-

Nurses role in reforming healthcare

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4.

5.

6.

7.

8.

sion. A standardized residency program would give

nurses on-the-job learning and would better prepare
them for clinical practice. Certification and continuous learning opportunities are essential to a profession thats responsible for others lives.
Expand the scope of practice. Advanced practice
nurses (APNs) must be allowed to practice to the
full extent of their education and licensure. Working
with physicians, they can provide cost-effective care
and help address the primary care shortage. However, statutory and regulatory barriers prevent them
from practicing to the full extent of their licensure.
With 32 million Americans about to receive health insurance under PPACA, its
crucial that APNs be permitted to provide
the primary care theyre trained to give.
Diversify our workforce. Approximately
33% of our population belongs to a racial
or ethnic minority group, and by 2042 minorities will account for a majority of the
U.S. population. To reduce health disparities, greater efforts must be made to ensure that the
nursing workforce reflects patients diverse backgrounds and cultural values. Furthermore, all nurses
should be educated to provide culturally competent
care. Finally, we need to bring more men into the
profession. The goal of RWJFs New Careers in Nursing program is to provide scholarships to students
from diverse backgrounds to attain baccalaureate
and masters degrees.
Embrace technology. We must learn to use the
newest medical technology and electronic documentation systems to improve quality. Nursing schools
should use simulation labs and take advantage of
online classes to educate more students. Nurses are
frequent technology users; more of us need to be at
the table to help make decisions about designing
and purchasing the technologies that help patients
the most. The RWJF Technology Drill Downs program provides a process that enables nurses to identify and apply technology solutions to improve patient care.
Foster interprofessional collaboration. Teamwork and collaboration are critical to seamless highquality care. The process begins with understanding
the roles and responsibilities of each healthcare discipline. Understandingand the trust it fosters
must start in joint nursing and medical school training programs, and continue as a cultural norm in
practice settings.
Develop leadership at every level. Nurses should
have the opportunity to take on leadership activities whether they practice at the bedside or sit in
the boardroom. They must believe they are capable
and fully empowered to provide excellent care and

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make the changes necessary to improve ineffectual

systems. Physicians and administrators must support nurses in their efforts. Most of all, nurses need
to help each other through mentoring, educational
and skills development opportunities, and support
networks.
9. Be at the table. As the healthcare professionals
most actively engaged in direct patient care, nurses
are positioned to provide leadership in all healthcare
areas, including developing systems to reduce medical errors, improving quality, providing better care
coordination, increasing access to care, and averting

eamwork and collaboration

are critical to seamless
high-quality care.
workforce shortages. Yet clinical experience isnt
enough. To serve as successful and knowledgeable
board or committee members, nurses must be familiar with governance, strategy, fundraising, financial
systems, health law, and policy. Always say yes
when asked to be at the table. If you believe youre
ready but havent been asked, then ask to be involved in a board or committee of interest. Nurse
Leaders in the Boardroom, another RWJF program,
is working to bring more nurses into leadership
positions at the local, state, and national levels.
At the end of her life, Florence Nightingale said,
May we hope that when we are all dead and gone,
leaders will arise who have been personally experienced in the hard, practical work, the difficulties and
the joys of organizing nursing reforms, and who will
lead far beyond anything we have done.
Take her words to heart and prepare yourself to
contribute to the reforms that will take place in our
lifetime. We have much to contribute.

Selected references
Nightingale F. Sick nursing and health nursing. In: Billings JS, Hurd HM,
eds. Hospitals, Dispensaries and Nursing: Papers and Discussions in the
International Congress of Charities, Correction and Philanthropy. Section III, Chicago, June 12-17, 1893. Baltimore, MD: The Johns Hopkins
Press, 1894.
Transitional Care Model. http://transitionalcare.info/ToolQual-1801.html.
Accessed August 3, 2010.
U.S. Department of State, Bureau of International Information Programs.
U.S. minorities will be the majority by 2042, Census Bureau says.
www.america.gov/st/peopleplaceenglish/2008/August/20080815140005x
lrennef0.1078106.html. Accessed August 3, 2010.

Susan Hassmiller is Senior Advisor for Nursing at the Robert Wood Johnson
Foundation in Princeton, New Jersey.
September 2010

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