Nurses as Full Partners in Health Care

I read a recent article that outlined the recommendations from the Institute of Medicine (IOM) that included more training and independence for nurses. The Robert Wood Johnson Foundation Initiative on the Future of Nursing convened a committee to review scientific literature on the nursing profession, to hold public forums that would allow them to collect further evidence and request opinions from a variety of experts in order to generate their report.

I found several things about this report interesting. First, as far as I could tell, none of the members of the committee are nurses. I was able to find the names of all committee members and but none of them listed credentials. The committee members included representatives from such agencies as Johnson and Johnson, American Association of Retired Persons (AARP), consulting firms, and several universities. It would make sense to me that if a committee were being convened to look at developing a strong and vibrant nursing workforce, you might want someone who is a member of that workforce to give input. Now they most likely did address nurses in whatever focus groups and public forums that were held, but I can’t say that for sure.

Regardless, the recommendations are not so bad for nursing. This committee along with the IOM, realize that with more and more people requiring health care with more complicated disease trajectories, there needs to be strong nurses who are competent in their skills and abilities to care for patients as well as being given the opportunity to do so. Specifically, the report recommends to “provide a strong foundation for the development of a nursing work force whose members are well educated and prepared to practice to the fullest extent of their training in order to meet the current and future needs of patients, and act as full partners in leading advances in the nation’s health care system.” Hmm. Seems to me that nurses have asked for this for a long time and, to a large extent have been doing it. Nursing education has come a long way. I know in my state as well as many others, the push for making a bachelor’s degree be the entrance degree into nursing has been the basis for many discussions. As well as pushing for a doctorate degree to be the entrance into advanced practice.

This report focused their recommendations basically on education. They recommended that by 2020 80% of nurses to have a bachelor degree and doubling the number of nurses who seek doctoral degrees. They recommend that organizations help reach this goal by providing assistance to nurses who hold a diploma or associate degree to obtain their bachelor degree within 5 years of graduation. They also recommended that nursing schools ensure that 10% of their baccalaureate graduates enter a master’s or doctoral program within 5 years.

These are good goals to help elevate the nursing profession. But I think that the next part of the recommendation is what will be more difficult to obtain. The recommendation that nurses have full partnership in the health care system. But what I find most interesting is the recommendation that nurses act as full partners in leading advances in health care. I know that in oncology, and I’m sure in many other areas, nurses are involved in extensive research that focuses on nursing interventions that will best serve our patient populations. I know, first hand, the amount of effort and dedication it takes to develop interventions and processes based on evidence that will provide the best care to our patients. I also know that we still are not seen has having full partnership in the health care process. It’s still the physician who makes the final decision. It’s still the physician who can order whatever he or she finds most appropriate, despite what the nursing research might state. One recommendation that could help is that regulatory and institutional bodies remove restrictions that are a barrier to allowing a nurse to practice to the full extent of their skill, ability and license. The report states that “nurses are already committed to delivering high-quality care under current regulatory, business and organizational conditions, but the power to change those conditions to deliver better care does not rest primarily with nurses, regardless of how ably led or educated they are; it also lies with governments, business, health care institutions, professional organizations and other health professionals and the insurance industry.” I would ultimately say that the other health professionals that would have the biggest impact on this is the medical profession.

This is made very clear in the AMA response to the report. The AMA’s response was to call for a physician-led team approach to health care. While, on the surface, that may seem like they are agreeing with the recommendations, when you read further it is evident that the AMA does not really believe that nurses, regardless of education and experience, are full partners. Their response states that the physician is always the leader of the team and that other members should be allowed to play the role they are educated and trained to play. However, the response also goes on to state that physician training is much more extensive than nursing and therefore, they are trained better to lead the team. I understand that, in certain situations and in a medical world, the physician may have a better understanding and ability to diagnose and treat. But I also know that in many circumstances, especially in direct patient care where evidence based nursing care is a priority then nurses must be given the opportunity as well as the respect to practice to their fullest extent.