A new IOM report regarding the role of nurses in healthcare from the ACP news feed.
Nurses tapped for more training, bigger role in health care
The Institute of Medicine says nurses' roles, responsibilities and education should change significantly to meet the increased demand for care expected from health care reform.
Further, nurses should train alongside other health professionals and assume leadership roles in redesigning care, stated the report. Nurses should undergo residencies, increase their ranks of those with bachelor's degrees from 50% to 80% by 2020, ensure that at least 10% of their baccalaureates enter a master's or doctoral program within five years, and double the number of doctoral candidates.
There are more than 3 million nurses in the U.S., and because of their direct patient contact and the proportion of time the profession spends in direct patient care, "Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States," the report said.
Once nurses are trained, scope of practice limits should be lifted, the report stated, as should insurance and regulatory hurdles, so that the health system can reap the full benefit. Scope of practice barriers are particularly problematic for advanced practice registered nurses (APRNs), the report found.
Studies of advanced practice nurses and the experiences of health care organizations, such as the Veterans Health Administration, Geisinger Health System, and Kaiser Permanente, that have increased the roles and responsibilities of nurses in patient care show that these nurses deliver safe, high-quality primary care.
In one example, the VA had been transforming itself since the 1990s in anticipation of an aging veteran population. The results of the VA’s initiatives using both front-line RNs and APRNs showed that patients received significantly better health care based on various quality-of-care indicators such as mammography, flu and pneumococcal vaccination, cancer screening and other conditions than patients enrolled in Medicare’s fee-for-service program. In some cases, the study showed, between 93% and 98% of VA patients received appropriate care in 2000; the highest score for comparable Medicare patients was 84%. Meanwhile, spending per enrollee rose much more slowly than in Medicare, by 30% from 1999 to 2007 compared with 80% for Medicare over the same period.
The report is the product of a study convened by the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which will organize a national conference at the end of November to discuss implementation.
The conclusions aren't without detractors. The American Medical Association responded, "Nurses are critical to the health care team, but there is no substitute for education and training. Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience; most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are vital to optimal patient care, especially in the event of a complication or medical emergency, and patients agree."
ACP: InternistWeekly - 12 October 2010
This article advocated that more efforts should be put into strengthening the role of nursing as one of the elites to ensure the benefits of the healthcare reform. At the first glance, I was really excited to see that in the age of reform, voices were addressed on the field of nursing. And it successfully caught the two most critical issues that will be of the greatest awareness in the coming healthcare reform: cost and quality of care. However, the boundaries of practice limits by each of the health professional groups should be always clear enough to ensure little conflicts in obligations. And we should also carefully exam in what field, to what extent, and how fast to robust the team of nursing.
ReplyDeleteComparing to the education for physicians, education on nursing requires less postgraduate clinical experience and knowledge on intensive medical care. But by the virtue of nursing that calls for more direct contacts with patients, the education on advanced nursing pay more attention on medical humanities, psychology and sociology, which also have been proved to be of great impact on human well-beings. From this point, nurses and physicians are basically different groups of professionals and to some degree complementary to each other. Well-educated nurses can definitely function as peerless partner to physicians in many aspects just as other professionals, such as preventing medical errors, proposing possible treatment plans and rehabilitation interventions; while slutty nurses are likely to ruin the whole work by careless post-surgery care. Enhancing nursing education is of necessity and urgency to meet the goal of health system that make sure everybody on the earth earns the basic right to get access to and could afford to a healthy living. But it is unfair and unnecessary to require nurses to take as many medical courses as physicians while declining them for more eligibility in practicing advanced medical care.
It is a good idea for nurses to employ their advanced knowledge in overseeing the process of medical practices by their teams, or actively participate in promoting the capacity of providing safer, more effective and efficient care to the public. But it will be unreasonable for nurses to take the traditional responsibilities of physicians such as determining the type and dose of specific medications or doing surgeries. They are not educated to do so, and should not be trained to do so. We can also notice that the areas where APRNs were proved to be able to provide higher quality and relatively lower cost of health care are mostly those require efforts in primary care and preventive medicine, such as disease screening and vaccination. Unlike those in the hospitalization, these kinds of services typically emphasize the good collaboration between population and health professionals, high risk awareness among the population through effective health promotion, and strong commitment in dedicating time with clients. Nurses with enough knowledge in humanities and are skillful at communication are more likely to perform better than physicians who are often inspired by technically complicated procedures and less interested in listening to their patients or engaged in any health education. And it might be both financially costly and time-consuming in persuading or training physicians to do so. Why not shifting the scarce resource to educating better and more intelligent nurses as public health initiators to satisfy our objectives in cost-effectiveness practices?
Well, I am always looking forward to another “Florence Nightingale” who will guide nursing into a brand new stage that will distinguish itself as a unique, diverse, and adaptive discipline.