I attended the Institute of Medicine Briefing on the Future of Nursing web cast at the Georgia Nurses Association headquarters on October 5, 2010. You can view the webcast at http://bit.ly/akj7Gw. I am delighted the Robert Wood Johnson Foundation and the IOM recognize the major role nursing plays in health care. The panel stressed the goal is to improve health care and since nurses are the main constant across the continuum, improving nursing would provide the greatest results to health care as a whole.
I wanted to share my initial observations.
First, shame on us! Why are we still leaving nursing issues to be addressed by medicine? Why is there no Institute of Nursing? If we don’t find common ground to address these issues, we risk someone else dictating their solution to us. If we don’t define the standard of care, it will be defined for us. I do not think nurses have ever been or ever will be called on to speak on the future of medicine.
One of the best lessons I learned in nursing school was setting measureable goals. During the webcast, I only heard one measureable goal. The goal was for 80% of nurses to have a BSN within 10 years. That would leave 10% to be LPN-ADN and 10% to be MSN or higher. That was the only measureable goal presented.
The panel suggested achieving a BSN would result in safer patient care. I completed my BSN after 20 years at the bedside and am very glad I did. It did not result in a pay raise but did result in $20,000 debt. I cannot say I learned anything that I took back to the bedside, however.
Another touch point spoke to diversity. We need to see more diversity in not only gender and ethnicity, but in education levels if we are going to continue to offer so many entry levels. I would venture to say the bulk of the work force is composed of LPN – BSN. Yet, the panel was all MSN or doctorate level nurses and physicians. In a past post, I shared as a nurse who still provides bedside care, for the most part, I think nursing issues are best addressed by those who are on the “front line” providing care.
Another goal is for seamless transition in education. I am all for it, but I am also aware of a friend who has “seamlessly transitioned” and will soon complete her PHD in nursing. She will teach future generations. The problem? She has NEVER provided patient care. My best instructors taught from education and experience.
Another major point was Scope of Practice. During the Clinton administration, there was a push for more Physician Assistants and Advance Practice Nurses in order to “make health care more affordable”. Yet as a consumer, I pay the same price whether I see the MD, PA, or APN. As a consumer, I prefer the most education for my money. APNs would like to work independently of physicians. I have heard physicians say this is one reason they have some hesitation when working with APNs. Physicians have told me when liability rests FULLY on the APN, they would be more supportive. In my humble opinion, it is much like a RN working with an all- LPN staff. True; each has their own license, but liability WILL fall back to the RN.
Finally, Donna Shalala who served for eight years as Secretary of Health and Human Services under President Bill Clinton addressed the shortage of nursing instructors. She said, tongue in cheek, if hospitals weren’t paying nurses so much, perhaps the academic setting could attract and retain nurses better. To imply bedside nurses are overpaid is ridiculous and insulting. A nurse with a BSN makes substantially less than a pharmacist with a BS (I know because I am married to one). A nurse with a MSN at the bedside makes significantly less than the Masters prepared physical therapist.
I am glad the dialogue has begun. We must apply the nursing process and set measureable goals so we can develop a plan and evaluate our progress.