In the beginning of November, I spoke about nurse-led change at the American Academy of Nursing’s annual meeting. If we are going to reform the health care system, I said, nurses must be at the forefront of change. Nurses have the most contact with patients; they are the most highly respected profession in America, according to the Gallup Poll; and they are 2.3 million strong. They are in the trenches, making health care happen every day, one patient at a time.
In order to create change, nurses need to identify the deficiencies in our health care system, understand what strategies are available to fix them, and make possibly uncomfortable choices in favor of change. Here are a few inconvenient truths that nurses must confront:
- Health care reform = better care for older adults. Caring for older adults is nursing’s core business. Although older adults represent only 13 percent of the population, they are 46 percent of patients in critical care; 50 percent of hospital days; 70 percent of home health services; and 90 percent of residents in nursing facilities. Whether or not nurses are geriatric specialists, they still need to know how to provide appropriate care for older adults. Nursing education must address this issue.
- Hospital quality = nursing quality. No one has more impact on the quality of care that hospitals provide than nurses. Together with social workers, nurses play a critical role in patient and family education at discharge; in addition, the success or failure of the discharge process directly affects hospital readmission rates. Nursing procedures also directly impact the prevalence of “never” events such as pressure ulcers and hospital acquired infections.
- Team care = better care for older adults. Effective teams have a common purpose, specialization of function, defined roles, and processes for coordination in place. Unfortunately, creating them is difficult. Chris Langston, in an earlier post entitled “Team or Mob,” details the factors that work against teamwork in the health care system. Nurses—as well as physicians and social workers--need to put aside desires for autonomy in recognition that teamwork among health care professionals yields the best results for patients.
- Nursing must embrace all nurses. Fights over turf, the nursing competence of one degree holder over another, and entry requirements are counterproductive. Nurses need to unite behind change. In fact, nurses must be leaders for change, even if lacking in resources. They cannot wait for others—politicians, bureaucrats, or academic colleagues—to “allow” or “invite them” to join the debate. Nurses have the skills and knowledge we need now to revitalize and reshape the health care system to deliver better care to older adults.
What should the first step be? Please take a moment to let us know what is and isn’t working in your hospital or medical center, and what approach you think nurses should take toward change.