Call to Action: Tapping Nurses' Leadership and Expertise

Susan Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation, writes about the need for nurses to be full partners in reforming the health care system and improving patient care.

There’s image and there’s reality, and the two are not the same where nurses are concerned.  Nurses are seen as trusted, caring, compassionate, skilled health care providers. But that image doesn’t fully capture the reality of the roles nurses play in our health care system, which are much more extensive, substantive, pivotal and robust. 

Today, the Robert Wood Johnson Foundation and Gallup are releasing an unprecedented survey of 1,500 opinion leaders that provides insight into what we need to do to ensure nurses’ place at the decision-making table—and to give health reform every chance to succeed. In many ways, the  two objectives are inextricably connected.

For years, nurses have come out on top of Gallup’s annual poll of most trusted professionals. It’s a truism that the public trusts nurses. But this survey goes deeper. It finds that diverse opinion leaders—including those in insurance, health services, government, industry and academia—say that nurses should have more influence on health systems and services. 

Despite the trust nurses have earned and the expertise they regularly demonstrate, opinion leaders predict that nurses will have less influence on health care reform than government, insurance, and pharmaceutical executives.  Seventy-five percent of opinion leaders say government officials will have a great deal of influence in health reform in the next five to 10  years, compared to 56% for insurance executives, 46% for pharmaceutical executives, 46% for health care executives, 37% for doctors, 20% for patients—and just 14% for nurses.

That’s how it is, they say… but not how it should be.  In fact, these same opinion leaders say that nurses should have more influence, and they are clear about why. Large majorities of opinion leaders would like nurses to have more influence in reducing medical errors and improving patient safety (90%); improving quality of care (89%); promoting wellness and expanding preventive care (86%); improving health care efficiency and reducing costs (84%); coordinating care through the health care system (83%); helping the health care system adapt to an aging population (83%); and increasing access to health care (74%).

They see nurses as the expert problem-solvers and innovators that they are. So why don’t nurses have more influence?  Opinion leaders see significant barriers that prevent nurses from fully participating as leaders in health and health care. The top barriers to nurses’ increased influence and leadership, they say, are that nurses are not perceived as important decision makers (69%) or revenue generators (68%) compared with doctors.  They also say nurses’ focus on primary rather than preventive care (62%) is an impediment to leadership, as is the fact that nurses don’t have a single voice when they speak on national issues (56%). 

Unless these barriers are removed, the nation will not take advantage of all that nurses have to offer and our health care system will suffer as a result. So how do we remove these barriers?  How do we ensure that nurses have more say as health care is reformed?  This survey points to a number of action steps for health care leaders, and for nurses themselves. 

Health leaders should recognize nurses as experts at implementing safe, high quality care, and seek information and guidance from them.  Certainly, no other profession offers the patient perspective that nurses bring.  That perspective should be represented not just at the bedside, but also when administrative decisions are made and policies are considered, and when boards make financial and other decisions.  One of my colleagues says that if a nurse isn’t present at a meeting about the delivery of health care, there’s a problem.  He is right!

Nurses have to step up as well and actively seek out positions on committees and boards.  Our health care system needs leadership from nurses at all levels, so it’s up to us to find and use our voice.  At the Robert Wood Johnson Foundation, we have countless examples of nurses creating solutions that make care more patient-centered and higher quality.  That needs to become an everyday occurrence at hospitals, clinics and other health settings throughout the country.

With reform on the horizon, this work is more important than ever.  The imperative today is to encourage nurses’ leadership. Unless that happens, we will continue squandering opportunities to learn from nurses, implement their ideas… and solutions for how to improve the quality of patient care everywhere.  Please join me on this quest of seeking board assignments that will make a difference…and helping colleagues with their quest.  Thought leaders believe we can make a difference…let’s prove them right!

Comments

[Dennis Nix]

I agree whole heartedly that Nurses should have a say in health reform. I can't get over the fact that the govenment will have I belive 70% of say so. GARBAGE. Also why would pharmaceuticals have 45%. Somebody better get their act together. I also believe that Nurses should go back to their original dress wear, White Dress with the White cap. This I believe would make them stand out to show how proud they are to be a Nurse and in the medical field. Today you can't tell a Nurse from a Nurses Aid. No class what-so-ever. Nurses should be respected with great honor. I rest my case.

[Eric Winter RN]

I fully agree with: "that nurses are not perceived as important decision makers (69%) or revenue generators (68%)."

When nurses do manage cash flows they do tend to be promoted; only recently are they taking on key executive roles. It is rare however, that nurses create cashflows, or have any idea how to generate revenue. MD's on the other hand, talk about all aspects of revenue as part of their socilization. Nurses are actively discouraged from finance discussions. Power & control issue. Perhaps that is the reason behind the large number of women in medical schools.

I have for over a quarter century attempted to get fellow nurses to find & use their voices with rare accomplishment. I find that when it is nurses own knowledge that they become vocal.

I believe business management needs to be part of professional nurse education and socialization. Only when they own the resources will nurses behave in the manner of leaders stewarding assets.

[Joyce Frink CRNA]

Yes, I believe nurses should have more input in the healthcare decision making.
Nures must be part of the solution.Having the trust of most people without power to make a changes in how resources are spent is upside down. Nurses need to have some
management and business coures
in their curriculum.Many nurses have BSN, MSN and PhD
degrees,we belong in the equation not at the bottom of any list.