Re-examining the role of nurses in the US healthcare system

Donna_ShalalaDonna E Shalala, Ph.D, is a former Secretary of the US Department of Health and Human Services; president of the University of Miami; chair of the, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, and is the inaugural post for the Initiative on the Future of Nursing.

Here in the United States, our healthcare system is on the cusp of major change. As in the UK, efforts are underway to ensure that the expertise of nurses and the value that the nursing profession brings to healthcare is used to inform how our future is shaped.

The Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, which I chair along with Linda Burnes Bolton, chief nursing officer at Cedars-Sinai Medical Center, will take on some of the most pressing and systemic problems facing the nursing field. Our end goal is nothing short of transforming the way Americans receive health care services, and determining the most effective ways to apply the skills of nurses is at the center of our process.

The goals of health reform efforts in the US are not only health insurance, which seems to dominate much of our current national discussion, but also how we make quality healthcare affordable. I share wholeheartedly the belief of your Commission chair Ann Keen, which she shared with us at our recent Initiative meeting in Washington, DC, that “you can deliver quality care cheaper if you get it right the first time.” Nurses have the expertise to make that happen.

As a function of their jobs, and by the very nature of nursing, these men and women are on the front lines of patient care; they spend the most time with patients and their families, and the knowledge they bring to the table prevents costly medical errors, unneeded tests, expensive hospital stays, and avoidable hospital readmissions through effective chronic care management. As the largest group of health professionals, the experience of nurses is key to the effective design and implementation of health system change. To reform our system without gleaning from their expertise would be a fool’s errand.

One of the tasks of the Initiative on the Future of Nursing is to determine how to ensure this critical part of the workforce is adequately staffed and prepared to meet the changing needs of our society. A significant hurdle is the continuing shortage of nurses across the US. If left unaddressed, the US faces a shortage of 500,000 nurses by the year 2025, and this number is only expected to rise as our population ages and faces the enormous challenges of managing chronic disease.

The Initiative will address these challenges and examine the optimal utilization of nursing care through a series of technical workshops and forums which have already begun. Each forum will focus on particular challenges facing the nursing profession; one will address nursing in acute care settings, another will deal with nursing issues in community and public health care settings, and the third will examine the changes needed in nursing education. All of the forums will follow a town hall format to provide an avenue for input from healthcare professionals at all levels from all healthcare settings.

Similar efforts underway in the UK are both enlightening and encouraging to us. We have much to learn from one another in our parallel efforts to ensure that patients receive the right care, at the right time, in the right place, and by the most appropriate members of the healthcare team.

One Response to “Re-examining the role of nurses in the US healthcare system”

  1. It is very interesting to see the US changes to the health sector, it has been an ongoing battle in the UK to meet NHS waiting lists targets and provide care when patients need it. Still today for many of the common conditions suffered such as back pain and depression which both benefit immensely from rapid treatment we have many trusts not meeting the targets set. With medical insurance costs always on the up it is going to be a balancing act to provide affordable health insurance and align the benefits of the private sector with those of the public.