I am writing this Chair's message after reading a recent report about bold new ways to restructure health care. It started with good intention. This report is from a respected source (please note that I have not provided a reference citation). My purpose in addressing this issue is not to embarrass the authors/organization but to call to our collective attention the critical need for nurses and nursing to be engaged and acknowledged in creating a new future in health care.
The report starts by recognizing the impressive response health care systems were able to muster during this past year. We adapted to unpredictable patient volumes, we remained courageous and committed, and we rapidly adapted to new technologies (especially telehealth). Each of those endeavors involved multiple nurses. The report goes on to identify strategies for the future.
As I read, I noted that physicians were cited early on (as in, they were burned out) and that nurses were not. So, I used the find function to search the Adobe document, entering "nurs" to capture both words, nurses and nursing. This is a 17-page document with references. I am fairly sure you are getting the drift of my message so far, so you will not be surprised that I found only one word that included "nurs" - and it referred to what we would think of as the float pool.
This situation contrasts to another report (204 pages sans references) that cites "nurs" 90 times. This report was prepared by a specialty within medicine to focus on best practices in that specialty area in a crisis.
Wasn't it less than a year ago that people came out on their balconies and terraces to sing, ring bells, applaud, and otherwise acknowledge the change of shift at hospitals that were overwhelmed with patients needing intense care related to COVID-19? How could nurses not be part of the future of resolving the issues in health care?
Maybe I would not have felt so strongly if I had not witnessed nurses struggle to be heard in various meetings, or listened recently to policy expert Dr. Diana Mason talk about nurses having a voice. I am discouraged by the morning talk shows where everyone speaks over everyone else, with the most persistent (and sometimes loudest) talker the one who gets to finish a thought and make a point. Yet, that seems to be what nurses are forced to do if we wish to be heard.
If health professionals are really going to embrace person-focused care, we need to rely on the people who are closest to that person. Often, that is the nurse. Beginning with the first course in a nursing curriculum, educators emphasize the importance of the nurse-patient relationship. We talk about advocating for those who are unable to advocate for themselves and to document discrepancies in care. Boards of nursing, our regulatory agencies, hold us accountable to interact with others in a positive manner and to advocate for patients. Someone in nursing is available every hour a health care organization is open. Nursing leaders are accountable in almost every organization for the greatest number of employees. How can the largest number of people who could bring about change be ignored?
When I think of equity, I usually think of how fairly individuals are treated - patients and staff alike. I understand why our profession is such a threat to so many others in education and health care. Our numbers alone can be daunting. Almost every school of nursing in an academic medical center has more students than the corresponding school of medicine. Also, in some other academic settings, the nursing program is what supports much of the need for certain courses, such as physiology or biology. We already have a good amount of influence. If nurses wish to be treated equitably, we must continue to speak up and insist that nurses are included in planning the future of health care.
We are entering a dramatic period of workforce issues. If we aren't creative, someone else will step in to claim a part of our whole. Although new disciplines are welcomed, someone (currently those of us known as nurses) has to see the whole as it relates to a person, a family, a community, or a population. That broad view of the whole cannot be lost.
In my mind, our patients expect no less of us because they trust us to put them first. Also, that is what every student in our programs learns early on. It is all about the people we call patients.