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Spend even a little time at a hospital, clinic, or care center, and you'll notice something: nurses make health care happen.

It's nurses who deliver the majority of hands-on care. When patients are fearful, in pain, or uncertain, they look to nurses for guidance. Other health care professionals take their cues from nurses, too. When a new doctor is learning to practice medicine, nurses play a huge role in showing her the ropes.

Nurses are natural leaders. But when it comes to leadership at the highest levels, nurses are thin on the ground. In 2011, an American Hospital Association survey found that nurses hold only 6 percent of seats on hospital boards. So when decisions are being made about budgets, strategy, and policy, there usually isn't input from those who understand patient needs best.

Nurses need to step up and lead

Nurses are the face, the heart, and the hands of health care. It's time for us to be the voice, too. At nearly 3 million strong, nurses make up the largest part of the U.S. health care workforce. And because we're in the trenches every day, we have the best view of what works, what doesn't, and what needs to change. To help make health care work better for everyone, nurses have to take the lead.

The first step is education. About half of nurses have an associate's degree or nursing diploma. The other half enter the field with bachelor's degrees. In a landmark 2010 report, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation called for increasing the number of bachelor's-prepared nurses to 80% by 2020. Many public-and private-sector organizations joined in. The U.S. Army, Navy, and Air Force now require a bachelor's degree for nurses seeking promotion. Starting in 2013, nurse managers and nurse leaders must hold bachelor's or graduate nursing degrees in order for their hospitals to earn Magnet status, the gold standard for excellence in nursing and patient outcomes.

Better nurse education, better patient results

When nurses are better prepared to take the lead, health care improves. Researchers have concluded that higher education rates among nurses are directly related to patient outcomes. One report found that a 10% increase in the proportion of nurses with BSN degrees decreased the risk of patient death by 4%. It's not an exaggeration to say that nurse education is a matter of life and death.

Building the skills to lead

To develop their leadership potential, nurses will need new ways to grow as leaders. Professional associations, universities, and other education providers are stepping in to meet the need. Here's how:

• Leadership skills training. This fall the American Nurses Association (ANA) is introducing the ANA Leadership Institute to empower the leader within every nurse. The Institute's first initiative is a series of interactive webinars, powered by Capella University, to help nurses build their skills in strategic thinking, leading people, and leading for results.

• Online learning. For any working professional, it's difficult to find room for school. But for nurses, whose schedules run around the clock, it's even harder. Online learning programs allow nurses to fit school around their shifts, rather than the other way around.

• RN-to-BSN and RN-to-MSN programs. Forward-thinking nursing schools have seen the need to help RNs build advanced skills quickly and efficiently. RN-to-BSN and RN-to-MSN programs help RNs maximize their educational investment, develop advanced nursing skills, and progress to a Bachelor's or Master of Science in Nursing.

• Professional doctorates. For high-level nurse leaders and nursing faculty, the Doctor of Nursing Practice is quickly becoming a sought after credential. With a focus on applied research, this doctoral option allows nurses to develop sophisticated research skills that they can use to make a real, measurable impact on patient care. The IOM report on the future of nursing calls for doubling the number of nurses with a doctorate. A greater number of DNPs and PhDs in nursing is needed to meet the complex needs of patients and to educate the next generation of nurses.

Great opportunity, great responsibility

In the coming decades, nursing jobs are expected to grow at a rapid pace. At the same time, the profession grows more complex every day. An aging and increasingly diverse society, increased rates of chronic illness, a health care system that has become a political battle ground--all of these factors make nursing more challenging than ever.

Meeting these challenges is going to take leadership from each and every nurse. Not everyone will lead teams, head up hospitals, or create policy. But every nurse will have to become a leader in health promotion, education, and treatment. Every nurse will have to take responsibility for developing the confidence and competence to lead. Every nurse will have to find her voice.

 
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Forrester1
08:34 AM on 08/30/2012
Healthcare?
Nursing needs nursing leadership.
The void is deafening.
07:55 AM on 08/30/2012
My 87-year old male patient's wife always says, "Let's call Dr. Smith's nurse to ask her about this."
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tiredofpc
retired: RN,Adult NP,USAR
03:25 AM on 08/30/2012
Amen, sister nurses, and no, I'm not of a religious nursing order. If you want to know what's wrong and what's right with health care?? Ask a NURSE!
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Dolores DiBiase
02:39 AM on 08/30/2012
Great post and I am always surprised anyone actually notices this omission from the health care debates...Long ago, nurses were independent contractors and were not employed as they are today by a hospital, etc. Having the large corporation take over your life is not likely to get you any input in how your patients are treated, what they need, and how to do it best. Nursing leadership has for the most part, sold out to the "man." Your input is only valuable if it saves money, makes money, or dodges a law suit. The culture of nursing has also changed. My generation entered nursing knowing it was a hard, thankless occupation but the romanticism of helping your fellow human was strong..and indeed, your fellow human often was appreciative and thankful for your efforts. We were paid little in comparison to today, but there was no mandatory overtime to speak of and we had respect from the community and our peers. We looked different, too...spit and polished without balloons and teddy bears on our uniforms (except for pediatrics). Today, salaries are competitive with other professions i.e. teaching, and the folks who enter the field do so for other reasons. They, too, are committed to the bottom line and recent stories of nurses reusing disposable catheters and causing an outbreak of illness is a sad testament to that thinking. The new nursing administrator fits...new boss, same as old boss.
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09:55 PM on 08/29/2012
My experience: Like doctors, I find that most nurses entered into the field of healthcare because of the money. Their apathy towards the patient is as thinly veiled as our belief in America's healthcare efficacy. Ever notice how the AMA has been (un)strangely silent in the healthcare debate? I wonder why that is? Most healthcare "professionals" care about one thing and one thing only in the U.S. - money and lots of it. I'd like, for once, to have a healthcare professional be honest and admit to the greed and irrelevant bureaucracy that dominate our healthcare system. Until then, we'll have to listen to them talk as if they care whilst they conspire to take from us every possible dollar. This has been my experience in the U.S. healthcare system - pain, both physical and financial. Please make alleviating that one of your goals.
01:11 AM on 08/30/2012
Dude, the AMA (and for that matter all of our societies that I am aware of) have spent a huge amount of resources on the debate! Look at all the dedicated issues and columns in JAMA and NEJM - our largest and most respected journals. As far as money, sure we want to make money -- find me a group of 50 talented, ambitious people who don't -- but it is a terrible way to get rich. Should go to law school for that. The majority of us are salaried now, so you are wrong in every sentence of your post.
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tiredofpc
retired: RN,Adult NP,USAR
03:29 AM on 08/30/2012
Belga....unllike you, I find, and have found for over 40 years, that nurses, like me and thousands of others do the daily, dirty, hands on care of patients and KNOW what patients need in terms of care in the hospital, in the community, and in the liasons in between the two. We nurses have saved lives over, and over and over again....maybe you or one of your family members will be lucky enough to have a good nurse at your bedside, maybe saving your backside, possibly the smartest part of your anatomy.
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NAMI
The Divine Socialist
08:15 PM on 08/29/2012
TRUE...........we must train more nurses and also work to improve ACA yes OBAMACARE ! which is what Rmoney wants to REPEAL
Let us make sure this does not happen ................VOTE Obama/Biden + DEM majority !
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05:25 PM on 08/29/2012
Disclaimer, I'm by no means an expert in healthcare. But it seems like the nurse/doctor dichotomy is all wrong. Right now doctors are the guy you go to see, the nurse is the assistant who checks you out to save him time. But that's absolutely not the way that things truly are. Nurses are generalists who are capable of handling the majority of ailments and patients that come into a hospital. It seems like healthcare would work much better for patients if nurses were like engineers and doctors were more like supervisors. If we let nurses use doctors more as consultants and specialists we could stop wasting their time by having the doctor go through and tell you what the nurse already knew.

The important thing would be for nurses to know when to call in the doctor, again much like an engineer might call over the project manager for consultation, and I think nurses are already pretty well versed in all of that.

In summary, let doctors do what they're good at and let nurses do what they're good at.
07:19 PM on 09/27/2012
Finally, some common sense!
I think you will find that there is a large group who enjoys the "pecking order" and wants to keep it that way.If you really want to work toward helping people then do it together, as a team. No man (or woman) is an island. Especially not in healthcare!
03:37 PM on 08/29/2012
I agree completely. Nurses need to take a more active role in making healhcare policy. One organization doing just that is The American Cannabis Nurses Asoociation. http://americancannabisnursesassociation.org/ This organization offers nurses with an interest in medical cannabis a way to join together to demand change.

I'm one of those nurses who has been working to change healthcare policy. I helped draft the Medical Cannabis Law in New Mexico and in doing so I included language recommended by the New Mexico Nurses Association, that allows Advance Practice Nurses to refer patients to our program. Cannabis is proving to be effective in treating a large number of ailments with few clinically significant adverse effects. In my own practice, cannabis is proving to be the best tolerated and most consistently beneficial medication available for treating PTSD among the hundreds of patients I currently manage in the program.

Bryan Krumm CNP
03:13 PM on 08/29/2012
I am a RN ret. and I worked in a number of hospital and clinic setting. I have found that nurses never hate their jobs/ leave their jobs because of the patients, they all leave because the administration and policies make it impossible to do their best work. Nurses are "bullied" by other nurses "eat their young" and by the Doctors who they work with/for. The only job I was every happy in was working for a non-profit long term care facility. The Doctors did rounds once a month and all situations were handled by the nurse using "standing orders" or by Fax or phone. Now that was a job you could be proud of.
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bluelyne
08:35 PM on 08/29/2012
I totally agree with you. The biggest problem in nursing are the educators (who are totally out of touch with real nursing and start the cycle), and nursing/hospital administrators. I have had very few problems with physicians. Very few, if any, decisions made for or about staff nurses are made by the nurses themselves. We are dictated to and treated most of the time with rudeness and disrespect by our managers. These managers go into management to get away from the patients. I do disagree with the push for more education on the patient care level. For years, certain people have wanted the standard for an RN to be a 4 year nursing degree. The best bedside nurses I have worked with are usually diploma grads (those programs are gone) and 2 year grads. If higher education is the answer, then why are the nursing managers so lousy and most of them have advanced degrees? You don't need a bachelor's or master's degree to give good care to your patients. Most advanced educated nurses never are at the bedside anymore. That's where the nursing shortage is. Getting more education doesn't make you less bitchy and mean to your fellow nurses. If I knew what I know now, I would never have gone to nursing school.
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tiredofpc
retired: RN,Adult NP,USAR
03:50 AM on 08/30/2012
bluelyne, I am so sorry that you now feel that "If I'd known then.. etc." Let me be completely upfront and say that I agree with you about education. Some of the very best nurses I've worked with over my 40 + year career were ADN or Diploma nurses. I happen to be a BSN nurse (1971) ending in a BSN program by dumb luck. I also became a Certified Adult NP in 1977, when it was a certificate program. Now, to take the boards, a Nurse Practitioner will have to have a PhD or DSN to sit for the national certification boards. Nursing Education for decades has been pursuing a path of higher degrees, higher education, in order to have the "correct" initials after their names. Most of this is due to Nursing's legitimate concerns regarding their "legitimacy" based on educaation. And yet, I'd postulate that nursing's best "legitimacy" comes from the bedside or hands on experience that patients have with their nurses. Our problem as nurses is to combine the education, research components of nursing practice, a necessary requirement of our profession, with equally legitimate "hands on" aspects of nursing care. Until, we as a profession, find a way to combine those opposing views of nursing, we continue to struggle to validate ourselves, leaving discouraged and disheartened nurses ready to leave the practice of nursing. Because of that, patients and patient care suffers.
Draesop
....play on! Give me..
02:54 PM on 08/29/2012
Some seem to want to dismiss this idea. Recenty (within the past 40 years) it was unusual to find a male performing the duties of a nurse. Just prior to that, it was the unusual to find a woman in many of the surgical areas as well as others outside the Pediatric field. When the idea of Nurse Practitioners arose along with their licensing for prescribing there was significant opposition from many in Healthcare including so called organized medicine. The prejudices of so called Medicine are legendary and although not limited to women does always seem to rearits ugly head when these stalwarts of patient care seek to fill glaring gaps. The problems with patient care are not costly up to date medicine, microsurgeries and same day craniectomies. It's about early detection, treatment and follow up before the need for costly tertiary life extending undertakings arise. The male dominated physician business has failed in this respect. Mary Seacole and Florence Nightengale were not invited. They kicked down doors and I am sure that those whom have expanded this professiion have improved upon those skills.
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bluelyne
08:37 PM on 08/29/2012
I've only known one med-surg male RN. If males go into nursing, they go to the ER, ICU or the OR. They are not into custodial care on the level that females are.
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Vincent Gormley
Artist, activist, volunteer, compassion lives
11:12 PM on 08/29/2012
Not true.
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tiredofpc
retired: RN,Adult NP,USAR
03:55 AM on 08/30/2012
"They kicked down doors." Indeed they did, and in Flossie's case, she showed the military during the Crimean war, that it wasn't a good idea to utilize a building built over a sewer as a hospital, AND she taught them that the basics of, a clean facility, clean bedding changed frequently, good food, fresh air and hand washing would drastically reduce their casualties from things other than combat.
Nurses have been leading the way for improved patient care for centuries...but we're mostly women, and no one has wanted to listen.
Draesop
....play on! Give me..
06:49 AM on 08/30/2012
Those of us with wives and mothers remain deaf to our peril. Our daughters graduate at a higher frequency than their brothers. Healthcare will not progress without increased leadership from women.
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02:50 PM on 08/29/2012
"Nurses are the face, the heart, and the hands of health care.." and physicians are the brain !
07:09 PM on 08/29/2012
That's absolutely right!
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NAMI
The Divine Socialist
08:22 PM on 08/29/2012
Arnaultdoc

WELL , of course the Doctors are essential too, I have 3 sisters who are Medical Doctors and also 2 family members who are Nurses ...and this article is correct too.
Many Doctors perhaps are too tired or some are lazy and the burden shifts to Nurses.
ALSO all Doctors are not as knowledgeable as they should be.
So Obamacare with the new ideas of having Doctors work as a TEAM is a good idea and will be helpful to both patients and Doctors themselves.


faved
02:22 PM on 08/29/2012
Nurse Practitioners teach physical assessment to nurses. Nurse practitioners are better at that than doctors. I have not seen a doctor in 30 years and would choose a NP over a doctor any and everyday.
If I am having a heart attack, a stroke or am butchered in a car accident give me a doctor, otherwise keep them away from me.
One of the most incompetent doctors I ever worked with had one skill and only one skill. It was physical assessment. I recommended him to others because if he found a sick patient that needed a doctor he got them to another doctor pronto.
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tiredofpc
retired: RN,Adult NP,USAR
04:05 AM on 08/30/2012
I'll give him credit for knowing he needed to refer the patient! Good on him.
02:14 PM on 08/29/2012
Kudos to Huff Po for opening this conversation. As an RN who has more than 40 years of experience, the challenge of getting the voice of professional nurses in critical leadership conversations has been uphill all the way. One obvious solution is media awareness and action. So I was pleased to see Huff Po stepping up to the opportunity to make a difference in health care by their openness to giving voice to nursing.

Gallup annually asks the US citizenry who they view as the most ethical and trustworthy of a list of professions. Since nursing was (finally) added to this list 13 years ago, they have topped the list 12 of the 13 years, the only exception being 2001 when firefighters were selected. I often think if this finding emerged for any other profession, the media would make it a front page story.

Maybe Huff Po would like to shine a bit more light on nursing; it would serve the patients well...
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tonyschiano1
Thinker
02:03 PM on 08/29/2012
Agreed!
11:58 AM on 08/29/2012
The goal is not to just know how to treat something ie what antibiotic to use to treat an infection. But why did you chose that antibiotic and how does it work or effect the body. This is learned through the basics of science and medicine ie biochemistry, microbiology, and physiology. As a result you are able to make a broader diagnosis and have a broader treatment plan. This is what is taught in medical school and becomes more specific when you enter residency and train for about 10,000 hours working 30hr calls and 80 hr weeks.
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12:13 PM on 08/29/2012
Agree, that's obvious, but I am not sure what point you are trying to make? Can you expand.
02:17 PM on 08/29/2012
Hogwash! Treatment regimes are pretty routine across doctor's practices. Doctors don't know what you think they know.
The number one most important thing in treating any sick patient is physical assessment. Give me a Nurse Practitioner any day of the week. NPs are better at physical assessment than doctors. An NP always has access to help if she or he needs it. I worked in health care at many levels for 30 years and know exactly what I am talking about.
Nurses and NPs can revolutionized the healthcare system. We need to commit to training more nurses and in particular NPs.
We are talking about routine health care of the family that most doctors perform poorly not brain surgery.
06:55 PM on 08/29/2012
NPs will be great for routine healthcare, but they keep trying to encroach further into the realm of a practicing physician. If they are practicing independently without supervision of a physician then they are trying to play the role of a doctor. They want to see the same variety of patients as PCPs. Will they know when it is the appropriate time to refer to a specialist? Will they be too hesitant to refer because they will feel like they failed their patient? Or will they be clueless because they
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bluelyne
08:42 PM on 08/29/2012
I have worked side by side with NP's. Some are smart, some are not. I think they have their place in healthcare but it depends on how skilled the NP is. I've seen stupid with a degree.