Policy Impact on Care
Is health care overmanaged and overcontrolled by the federal government, large corporations, and the insurance industry interests? We only have to look at the list of companies in the Leapfrog Group, a coalition of business giants formed to alert the health care industry that big leaps in patient safety and customer value will be recognized and rewarded, to find the answer to this question. The Leapfrog Group, which consists of more than 78 U.S. major employers from the depth and breadth of our country, includes such companies as AT&T, Boeing, Bethlehem Steel, Eli Lilly & Co., Ford Motor Co., General Mills, Pepsi Co., and Wells Fargo, to name a few.
Three Leapfrog Group standards for hospitals to meet to get members' business are as follows:
1. Implement a computerized physician order entry (CPOE) system.
2. Meet volume thresholds for certain complex procedures, such as coronary artery bypass grafts and esophageal surgery.
3. Hire intensive care specialists.
These standards, when met, are intended to reduce errors and improve quality of care, thus improving patient safety. A comprehensive nursing perspective is offered in the On-the-Scene by Jeri Milstead. The challenges for health care leadership have become increasingly complex, with business, law, politics, and economics being the major driving forces, rather than the essence of nursing practice-patient care. The money-politics of the Clinton health care reform attempts has affected the nursing profession adversely, although some nurses will say the Clinton administration made nursing better for patient care. As a Medicare recipient who is enrolled in an HMO plan and surrounded by less healthy seniors, I know the patient care shortfalls. We experienced major hospital downsizing and nursing staff layoffs as HMOs were formed and mergers between hospitals and business ventures took place.
Many nurses sought other careers, while others redirected their knowledge and skills to out-of-hospital settings. With the economic downturn, many job-changers are coming into nursing as second careers. This past decade also saw the graying of a major workforce supply of nurses and their retirement. The politics of health care has contributed to the shortage of nurses in practice and education. Can and should politics be a major force in reenergizing nursing education and practice?
This issue of Nursing Administration Quarterly is timely because the U.S. House of Representatives and Senate have been working on passing the Nurse Reinvestment Act (HR 3487 and S 1864). We are fortunate to have Dr. Jeri A. Milstead, PhD, RN, CNAA, CNS, Dean, School of Nursing, Medical College of Ohio, Toledo, Ohio as the issue editor for Policy Impact on Care. She is internationally known as an expert in public policy and the politics of health care. She is the editor and contributing author of Health Policy & Politics: A Nurse's Guide (Gaithersburg, MD: Aspen Publishers, 1999). Dr. Milstead served as a policy advisor in the Washington, D.C. office of Sen. Daniel K. Inouye of Hawaii, and was president of the State Board of Nursing for South Carolina. She held leadership positions in the State Nurses Associations in Pennsylvania, Ohio, and South Carolina. She maintains a private practice with attorneys, nurse professionals, and business and industry leaders consulting on standards of practice, legal issues, and health policy.
Nursing as a profession is seriously short-changed in the Nurse Reinvestment Act. Medical education receives $9 billion a year in federal funds while nursing receives $100 million. More than 5,700 qualified students were denied admission to nursing schools because of lack of faculty to teach nursing. Fifty percent of the faculty are not doctoral prepared, and faculty in many nursing schools have no preparation in teaching, other than patient education during their basic nursing education. Enrollments in entry-level baccalaureate programs increased in fall 2001, but the number of students in the pipeline is still insufficient to meet the projected demand for 1 million new nurses over the next 10 years.
As states are developing their individual strategies for addressing the nursing shortage with various legislative actions, many other political issues need to be considered as well, not the least of which is patient safety. The response to patient safety legislation has resulted in a report entitled "The Challenge of Assessing Patient Safety in America's Hospitals," which provides a framework to help health care purchasers, providers, policy makers, and the public evaluate proposed patient quality and safety standards. We will see what the response to the various legislative actions to address the nursing shortage is and how it plays out.
I do know that if we ever get our collective act together, we can make a great difference, but we never seem to agree, negotiate, and concede our differences for the larger effort of the entire profession. So we continue in our individual bailiwicks in our legislative politics, such as California and the recent staffing ratio legislation or the lack of cohesiveness for all of nursing education, including associate degree, diploma, and practical nurses along with baccalaureate degree programs. We need every kind of nurse for the future health, welfare, and safety of our nation. We have beat the drum of a baccalaureate entry requirement into nursing for too long. Look at the staff nurses giving care today, and find out that they are doing excellent jobs with diploma or associate degree preparation. As Pogo has said: "We have met the enemy and it is us!" We could be so politically powerful as the largest health care provider workforce, if only we would unite.