Two important documents were recently released from the Robert Wood Johnson Foundation (RWJF) and the Josiah Macy, Jr. Foundation. The RWJF report presents perceptions of nurses' influence and leadership. The Macy paper highlights the need to include strategies to increase the number of primary care providers (PCPs), including NPs, in healthcare reform debates. According to Dr. Risa Lavizzo-Mourey, president and CEO of the RWJF, "Nurses are highly trusted sources of healthcare information, but as we look to reform our health system, our nation is not taking advantage of all that nurses have to offer."
Can nurses influence healthcare?
The first-ever large-scale Gallup Survey1 about nurses' ability to influence health reform and improve healthcare recently released interesting results. Telephone interviews with 1,504 key opinion leaders from health services, insurance, corporate business, government, and university faculty revealed that nurses' primary areas of influence are perceived to be: reducing medical errors (51%); improving quality of care (50%); and coordinating patient care (40%). Areas needing greater influence were in promoting wellness and expanding preventive care (86%); improving healthcare efficiency and reducing costs (84%); helping the healthcare system adapt to an aging population (83%); and increasing access to healthcare (74%).
Nurses ranked seventh (14%) in regard to perceived ability to influence health reform over the next 5 to 10 years; government officials ranked first (75%), then insurance executives (56%), pharmaceutical and healthcare executives (both 46%), physicians (37%), and patients (20%). Do these views mirror those of the general public? How can nurses be consistently rated first as far as trustworthiness in national public polls but seventh in influence?
Existing barriers
Dr. Lavizzo-Mourey summarized this irony best, noting, "This survey shows that opinion leaders recognize that we are squandering opportunities to learn from nurses and implement their ideas. We must build on the widespread trust of nurses' expertise as an essential component in leading and implementing reform."
Barriers that prevent nurses from gaining influence and leadership are that: nurses are not perceived as important decision makers (69%) or revenue generators (68%) compared to physicians; nurses focus on primary care rather than preventive care (62%); and nursing does not have a single voice to speak on national issues (56%). Suggestions to increase the status of nurses as stakeholders include making their voices heard; improving access to continuing education or pursuing advanced degrees; receiving better pay, benefits, and incentives; improving relationships with physicians; improving the perception of nursing; and raising expectations and accountability.
Currently, there is an urgent need to increase the number of PCPs to improve access for millions of Americans. At the Macy conference, 49 experts from all primary care professional groups as well as experts from areas affected by the challenges related to primary care discussed who would be PCPs in the future and how they would be trained. Participants acknowledged that all health professionals needed training to lead and work effectively in teams, to work toward building a strong primary care infrastructure; to assume accountability for continuously improving access to care, care coordination, costs of care, and quality of outcomes; to involve patients as partners in care; and to use new technology.2
As we wait to see how our role will expand, be sure to catch Dr. Eileen O'Grady's keynote address on healthcare reform at the National Conference for Nurse Practitioners later this month (May 19-22, Chicago, Ill.). Every day is another opportunity for NPs to become more involved in shaping the healthcare agenda of the future.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief [email protected]
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