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68 American Nurse Today Volume 5, Number 9 www.AmericanNurseToday.com

THE2010 healthcare re-form act (Patient Protectionand Affordable Care Act, orPPACA) gives nurses newopportunities to deliver careand play an integral role inleading change. (See http://championnursing.org/

sites/default/files/nursingandhealthreformlawtable.pdf.)Understanding these opportunities is just the first step.We need to know how we can be part of the solutionto achieve better patient outcomes at a more reasonablecost. We need to do more to prevent disease; providechronic care management to an aging, sicker, and morediverse population; and offer end-of-life care that em-phasizes comfort and compassion. Across all settingsespecially geriatricswe must do more to prepare our-selves for the future.

In this article, I outline nine challenges that individualnurses and our profession must address if we are to

help lead our country to a healthcare system that ismore equitable and provides a higher quality of care.(For a flowchart of these challenges, see Nurses role inreforming healthcare.)1. Use nurse-led innovations. Nurses know how to

expand access to care and improve quality at lowercost. Weve developed innovative care models toprove it, including nurse-managed health clinics,home visiting programs for low-income mothers, andthe Transitional Care Model (TCM). By emphasizingthe use of masters-prepared nurses to oversee carefrom the hospital to within the home, this model has

reduced rehospitalizations for elderly patients withmultiple chronic conditions. Research shows that us-ing the TCM helps patients achieve better long-termhealth outcomes and avoid repeat hospitalizations,all at a reduced cost. We need more nurses to devel-op innovations. (For good examples to follow, visit

www.aannet.org/i4a/pages/index.cfm?pageid=3303.)2. Generate evidence and engage in research.

Nurses play important roles as innovators who helpshape quality and safety. Successful models arentborn, implemented, or sustained without solid effec-tiveness data. Its up to all nurses to collect and

track data to improve their own practice as part ofbroader efforts to improve care. Nursing research

helps build the scientificfoundation for clinical prac-tice, prevention, and im-proved patient outcomes.

We must support nurse re-searchers through adequate

funding. The Robert Wood Johnson Foundation

(RWJF) is doing this by funding the InterdisciplinaryNursing Quality Research Initiative, a program thatlinks evidenced-based nursing care to improved pa-tient outcomes.

3. Redesign nursing education. All nurses need topossess basic competencies to meet the demands ofan aging and diverse society, with an emphasis onclinical training in multiple settings across the lifes-pan. The emphasis should be on quality and safety,evidence-based practice, research, and leadership.Several RWJF programs are working to incorporatethese concepts into nursing education, including

Quality and Safety in Nursing Education, the NewJersey Nursing Initiative, and the Nurse FacultyScholars program. Therefore, we need to removebarriers to attaining baccalaureate and advanceddegrees, such as by strengthening partnership linksbetween community colleges and upper-division de-gree-granting institutions and all academic institu-tions and practice organizations. The RWJF-fundedCenter to Champion Nursing in America is providingtechnical assistance to help with academic progres-

Nursings role in healthcarereformBy Susan Hassmiller, PhD, RN, FAAN

Practice Matters

Find out about new opportunities

for nursesand the challenges we

must address to maximize our

contribution to healthcare reform.

Nurses role in reforming healthcareDevelop

nurse-ledinnovations

Embracetechnology

Fosterinterprofessional

relationships

Redesigneducation

Expandscope ofpractice

Be atthe table

Generateevidence

Diversifyour

workforce

Developleadership at

every level

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www.AmericanNurseToday.com September 2010 American Nurse Today 69

sion. A standardized residency program would givenurses on-the-job learning and would better preparethem for clinical practice. Certification and continu-ous learning opportunities are essential to a profes-sion thats responsible for others lives.

4. Expand the scope of practice. Advanced practicenurses (APNs) must be allowed to practice to thefull extent of their education and licensure. Working

with physicians, they can provide cost-effective careand help address the primary care shortage. Howev-er, statutory and regulatory barriers prevent themfrom practicing to the full extent of their licensure.

With 32 million Americans about to re-ceive health insurance under PPACA, itscrucial that APNs be permitted to providethe primary care theyre trained to give.

5. Diversify our workforce.Approximately

33% of our population belongs to a racialor ethnic minority group, and by 2042 mi-norities will account for a majority of theU.S. population. To reduce health dispari-ties, greater efforts must be made to ensure that thenursing workforce reflects patients diverse back-grounds and cultural values. Furthermore, all nursesshould be educated to provide culturally competentcare. Finally, we need to bring more men into theprofession. The goal of RWJFs New Careers in Nurs-ing program is to provide scholarships to studentsfrom diverse backgrounds to attain baccalaureate

and masters degrees.6. Embrace technology. We must learn to use the

newest medical technology and electronic documen-tation systems to improve quality. Nursing schoolsshould use simulation labs and take advantage ofonline classes to educate more students. Nurses arefrequent technology users; more of us need to be atthe table to help make decisions about designingand purchasing the technologies that help patientsthe most. The RWJF Technology Drill Downs pro-gram provides a process that enables nurses to iden-tify and apply technology solutions to improve pa-

tient care.7. Foster interprofessional collaboration. Team-

work and collaboration are critical to seamless high-quality care. The process begins with understandingthe roles and responsibilities of each healthcare dis-cipline. Understandingand the trust it fostersmust start in joint nursing and medical school train-ing programs, and continue as a cultural norm inpractice settings.

8. Develop leadership at every level. Nurses shouldhave the opportunity to take on leadership activi-ties whether they practice at the bedside or sit in

the boardroom. They must believe they are capableand fully empowered to provide excellent care and

make the changes necessary to improve ineffectualsystems. Physicians and administrators must sup-port nurses in their efforts. Most of all, nurses needto help each other through mentoring, educationaland skills development opportunities, and support

networks.9. Be at the table. As the healthcare professionalsmost actively engaged in direct patient care, nursesare positioned to provide leadership in all healthcareareas, including developing systems to reduce med-ical errors, improving quality, providing better carecoordination, increasing access to care, and averting

workforce shortages. Yet clinical experience isntenough. To serve as successful and knowledgeableboard or committee members, nurses must be famil-iar with governance, strategy, fundraising, financialsystems, health law, and policy. Always say yes

when asked to be at the table. If you believe youreready but havent been asked, then ask to be in-

volved in a board or committee of interest. Nurse

Leaders in the Boardroom, another RWJF program,is working to bring more nurses into leadershippositions at the local, state, and national levels.

At the end of her life, Florence Nightingale said,May we hope that when we are all dead and gone,leaders will arise who have been personally experi-enced in the hard, practical work, the difficulties andthe joys of organizing nursing reforms, and who willlead far beyond anything we have done.

Take her words to heart and prepare yourself tocontribute to the reforms that will take place in ourlifetime. We have much to contribute.

Selected referencesNightingale F. Sick nursing and health nursing. In: Billings JS, Hurd HM,

eds. Hospitals, Dispensaries and Nursing: Papers and Discussions in theInternational Congress of Charities, Correction and Philanthropy. Sec-tion III, Chicago, June 12-17, 1893. Baltimore, MD: The Johns Hopkins

Press, 1894.

Transitional Care Model. http://transitionalcare.info/ToolQual-1801.html.Accessed August 3, 2010.

U.S. Department of State, Bureau of International Information Programs.U.S. minorities will be the majority by 2042, Census Bureau says.

www.america.gov/st/peopleplaceenglish/2008/August/20080815140005x

lrennef0.1078106.html. Accessed August 3, 2010.

Susan Hassmiller is Senior Advisor for Nursing at the Robert Wood JohnsonFoundation in Princeton, New Jersey.

Teamwork and collaborationare critical to seamlesshigh-quality care.