The contributions nurses make to the health and well-being of the patients we serve has a long history of positive results and outcomes. Prior to the early 1920s, nurses worked with physicians as independent practitioners. Nurses were sovereign in their decision making, and performed their jobs without interference or governance from any other discipline.
In the early 20s, the American Medical Association (AMA) began to see nurses as a threat to the fiscal stability of their medical practitioners. Paul Starr’s enlightening book, “The Social Transformation of American Medicine,” outlines the purposeful and direct effort by the AMA to pass state and federal laws that put nursing under the direct control of doctors. They were successful, and these laws, and more, are still in place today.
Yet, this stronghold is beginning to weaken. As modern healthcare puts more and more strain on our resources, nursing is reestablishing itself as a viable, strategic, and independent profession. At the heart of this trend is the push for nurses to take their rightful role, in tandem with doctors, in the move to improve medical care in this country.
Over the last forty plus years, nurses have had been able to further their education by obtaining Advanced Practice Registered Nurse (ARNP) or Nurse Practitioner (NP) degrees. These graduate degrees, frequently coupled with internships, give nurses the same level of education as physicians. However, the approach to their education is often very different.
Nursing is a very broad and all-encompassing practice that includes the physical, medical, pharmacological, psychological, social, ethnic, and spiritual aspects of people and their healthcare needs. Studies done with Nurse Practitioner outcomes show that, universally, NPs deliver as good or, in some cases, better care than physicians. Additionally, their patient satisfaction rate is often equal to or better than physicians.
This positive view of nursing is shared by an Institute of Medicine (IOM) report released early this month. The result of a Robert Wood Johnson Foundation Initiative on the Future of Nursing, the report recommends that nurses, “Act as full partners in leading advances in the nation’s healthcare system.” Nowhere is this truer than in home health.
There are numerous models and studies that indicate when nurses are allowed to take leadership roles in the field, the quality of care goes up and the cost goes down. More and more the model of success in home health is to use NPs and ARNPs to provide primary care in the home. Although today nurses are still required to work under an MD, the IOM report suggests, “Healthcare reform and greater patient needs require (the) transformation of the nursing profession to include more…independence.” Greater independence could lead to nurses working as autonomous practitioners and relieving the primary care shortage, especially in rural areas.
The IOM report also suggests that for the healthcare system to achieve optimal benefit from nurses in the field, “The scope of practice imposed by regulatory and institutional barriers should be removed.” These barriers are particularly frustrating for APRNs. Recent studies by the Veterans Health Administration, Geisinger Health System, and Kaiser Permanente have all shown that APRNs deliver safe, high-quality primary care, yet they are still required to function under the supervision of a doctor. As the explosion of baby boomers makes its way into the home healthcare system, this ability to deliver that safe, high quality primary care, will make a dramatic difference in the wellbeing of elders all across America. Their ability to do so independently would also have a dramatic influence on costs.
If medical leadership can begin to change its attitude and once again view nurses on a more equal footing, we might be able to transform how healthcare is delivered. As we all know, the knowledge and expertise of the care provider often defines the quality of the outcomes. Specific recommendations in the IOM report include, “Residency training for nurses, increasing the percentage of nurses who have a bachelor’s degree to 80% by 2020, and doubling the number of nurses who seek doctoral degrees.” How does this impact home health?
Imagine you are the owner of a home health agency with a full complement of RNs, PTs, OTs, STs, MSWs and Aides on your team. Imagine the power of adding an NP or an APRN to your team who could function independently and see your clients in their homes. NPs and ARNPs, in conjunction with other homecare staff, would dramatically improve outcomes for your patients, reduce their need to travel to a medical office or clinic, and begin to reverse the trend of declining health for seniors with chronic disabilities. Additionally, NPs and ARNPs on your team would add a potentially strong revenue stream to your agency’s budget
On a larger scale, this expanded team could also begin to reduce return hospitalizations and the cost to the health care system, overall. Legislators, CMS, and other governing bodies are beginning to recognize that home health is the least expensive option in the healthcare environment. Home is also the place people want to be. The addition of NPs and ARNPs, empowered to fully practice to levels congruent with their education, could dramatically change health care in America. In this encouraging environment, it’s time for nurses to speak up and be heard.