For the 13th year in a row, Gallup announces that the public rates nurses highest when asked about the honesty and ethical standards (Riffkin, 2014). When I think about this great honor, I also think about the great responsibility that comes with it. Nurses are essential to any vision of excellence in any field of healthcare.
The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) are focused on improving the health and healthcare of the United States. They are agreed that, without nurses, we cannot achieve the goals of accessible, high-quality, patient-centered, evidence-based healthcare. "[horizontal ellipsis]the Institute of Medicine and Robert Wood Johnson Foundation were in agreement that accessible, high-quality care cannot be achieved without exceptional nursing care and leadership" (IOM, 2011, p. ix).
How did they come to this conclusion? Why are nurses so vital in ensuring public access to healthcare? I will quote the IOM report again to answer this question: "What nursing brings to the future is a steadfast commitment to patient care, improved safety and quality, and better outcomes" (IOM, 2011, p. xi). In the dictionary, advocacy is "the act of pleading for, supporting, or recommending." I believe that advocacy is ingrained in every facet of the nursing profession, and because nurses are involved in every aspect of the healthcare system, it is a natural conclusion that nurses should act as leaders in shaping and improving the healthcare system.
To support the belief that advocacy is at the heart of nursing, I will refer to Florence Nightingale's Notes on Nursing, first published in 1860. Throughout this book, she talks and provides many examples of how the nurse is responsible for ensuring that patient's environment is conducive to healing (Nightingale & Kessler, 2012). Nightingale was referring to cleanliness of patient rooms, patient hygiene, and air quality. Today, this concept applies both in its original sense as well as in the sense that the healthcare system itself is an environment in need of scrubbing and straightening. The scope of the environment could range from the patient's immediate surroundings or their relationship in the community or in the population of a nation or the world. I see a modern corollary of Nightingale's sentiment in the International Council of Nurses' (ICN) definition of nursing (Text Box 1), which can be found at http://www.icn.ch/who-we-are/icn-definition-of-nursing/icn-definition-of-nursing. "Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles" (ICN, 2014). Advocacy is a part of our daily routine, no matter what job we have. This is one reason that we, as nurses, are vital to healthcare reform; it has been our purpose from the very beginning and remains so today.
Another reason that nurses are integral to achieving excellence in healthcare is our numbers and our presence. Nurses have become the largest component of the healthcare workforce and are predicted to be even more in demand in the future. The World Health Organization (WHO, 2015) reports that there are more than 17 million registered nurses worldwide. In the United States, there are more than 3 million (American Nurses Association, 2015). Nurses are taking care of people in every part of the healthcare system: inpatient and outpatient, long-term and acute, health promotion and disease prevention, from beginning to end of life. The Future of Nursing committee, a partnership between the IOM and RWJF, felt that the members of the nursing profession have a number of "built-in" abilities that set them apart as leaders in the improvement of healthcare design (IOM, 2011). The intimacy of the relationship between patient and nurse gives us rare insight and a foundation of trust that few professions could claim. Nurses are accustomed to coordinating the services of numerous professions on behalf of our patients. We have a solid understanding of the various sciences that make up healthcare as well as an expanding knowledge base of our own. We function in a wide variety of practice settings and are known for our unique capacity to adapt both "on the fly" and over time.
In May 2001, the World Health Assembly declared that an adequate supply of well-educated and appropriately utilized nurses and midwives reduces mortality, morbidity, and disability (WHO, 2015). The IOM Future of Nursing committee is of the same mind, saying that "nursing's known strengths in care coordination, health promotion and quality improvement can be utilized in meeting most of the short-term challenges facing health care reform" (IOM, 2011). The IOM Future of Nursing report envisions "enhanced and reconceptualized" roles for nurses to meet a significant surge in demand for health services (IOM, 2011). Improved health outcomes through better management of chronic conditions, prevention of adverse outcomes, and smoother coordination of primary care services are likely key to what is needed to control healthcare costs without jeopardizing quality. There is some cause for concern; however, because all this potential for nursing to impact health policy, many nurses are not actively participating. We need more nurses to speak up, to be an active part of the vision of excellence. The WHO observes that, despite the great potential for contribution, nurses are not seen as key stakeholders at the health policy table (WHO, 2015). A 2010 RWJF survey of "thought leaders" felt that nurses would have the least amount of influence on health policy (Figure 1; RWJF, 2010). Those surveyed came from settings in universities, insurance, corporations, health services, and government.
Time is one of your most valuable commodities. Please take the time to advocate for nursing. In doing so, you are building a stronger and healthier population.
WHAT DO WE NEED TO DO?
* Appeal to your legislators to champion bills that better health or reduce health risk.
* Support your profession by joining and participating in your national organization.
* Recommend action to a friend.
The Dermatology Nurses' Association can provide you with numerous ways for you to speak up and participate in your profession (Text Box 2).
I encourage everyone to be active as we envision and shape the future of dermatology nursing (Text Box 3).
Katrina Nice Masterson
Dermatology Nurses' Association
435 N. Bennett Street, Southern Pines, NC 28387
E-mail: [email protected]
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