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Real Health Reform Demands an Expanded Role for Nurses

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Congressional passage earlier this year of the comprehensive health reform law not only creates the opportunity to insure an estimated 32 million Americans who are now without coverage, but lays the foundation for providing higher-quality, more affordable and accessible care for everyone.

The law, however, is just a start. Now the hard work of fulfilling the promise must take place, and that will require a significant transformation in the way healthcare is delivered in this country.

For this transformation to be successful, nurses must play a major and expanded role that matches their education and capacity to practice. Nurses are positioned to provide healthcare services to the newly insured and to coordinate increasingly complex care for a wide range of patients.

Unfortunately, there are many major obstacles blocking the nursing profession's ability to provide and improve both primary and advanced care. These include restrictions on scope of practice, reimbursement-related limitations, existing governmental policies, professional tensions over turf and some current limitations within the nursing profession itself.

Change is not easy. It can be disruptive and threatening, and enhancing and expanding the roles and responsibilities of nurses could meet with uninformed resistance. But changing the way healthcare is delivered in this country by ensuring that nurses play a more prominent and crucial role is not an option, it is a necessity.

Nurses represent the largest sector in the health profession, with more than three million registered nurses in our country today. Nurses are in regular and close proximity to patients, are well prepared to provide the full continuum of care and can and do partner with other health professionals in hospitals, schools, health clinics, long-term care facilities, and community and public health centers.

A report issued this month -- "The Future of Nursing: Leading Change, Advancing Health" -- by the National Academy of Sciences' Institute of Medicine and the Robert Wood Johnson Foundation -- persuasively makes the case that a new model of healthcare delivery must accompany healthcare reform, and that model will depend on nurses to deliver quality care to a growing number of Americans.

The report lays out a blueprint for the new role for the future for the nursing profession, outlines the barriers to change and has a series of recommendations for action at all levels to match the needs for healthcare within the agenda of healthcare reform.

This report should be mandatory reading for policymakers and the healthcare community, and its recommendations need to be taken seriously and adopted.

As the study notes, the nursing profession must make strides in making the educational system seamless to ensure the best evidence-based education for nurses. It calls for 80 percent of all nurses to have baccalaureate degrees by 2020 and proposes doubling the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers.

It also recommends that the healthcare system provides residencies and that nursing associations and nursing schools and government healthcare decision makers should also provide nurses greater opportunities to gain leadership skills.

But the report rightly points out that the nursing profession cannot institute many other necessary changes by itself, meaning that federal agencies, the states, businesses, healthcare institutions, professional organizations, the insurance industry and other health professionals should consider revising their reimbursement policies.

Among other recommendations, the report calls for the elimination of regulations and institutional limits on what nurses are allowed to do, within the "scope-of-practice" rules that limit the care they are well qualified to give. This includes allowing nurses to perform hospital admission assessments, certify patients for home healthcare, hospice and skilled nursing care, and provide additional primary-care services.

Among the rich evidence upon which the recommendations are built, some come directly from work done by professors and researchers at the University of Pennsylvania School of Nursing, including the benefits of nurse-led teams to manage the discharge of chronically ill adults to avoid revolving-door re-admissions; the role of nurse practitioners in community-based coordinated care; the appropriate government payment polices for nurses; and the realigning of Medicare funds to support nurse residences.

The report and the future role of the nursing profession will be discussed during a symposium at the University of Pennsylvania School of Nursing on Oct. 14, and hopefully it will become a topic for serious discussion around the country in the weeks and months ahead.

The role and importance of nurses in healthcare certainly will grow in the coming decades, but there are significant challenges to making it happen and doing it right. Yet, along with the challenges and obstacles come a tremendous opportunity and a chance to turn many of these important recommendations made by the Institute of Medicine and the Robert Wood Johnson Foundation into reality.