Healthcare cannot afford to overlook nurses as the nation seeks to expand access and simultaneously improve quality and reduce costs, a former HHS secretary told industry executives gathered in Chicago.

Donna Shalala, president of the University of Miami, former HHS secretary and chairwoman of the Institute of Medicine's committee on the future of nursing, said nurses enter the workforce highly skilled but in many states remain underutilized because of regulations that limit how they can practice medicine.

Shalala delivered the lunchtime address at the American College of Healthcare Executives Congress on Healthcare Leadership.

She called for states to remove regulatory barriers to a more expanded role for nurses, who she said could be deployed to provide primary care, preventive services and care management.

The healthcare industry, meanwhile, should foster teams that take advantage of all clinical providers. Without such teams, “we're not going to get where we need to get,” Shalala said.

“Healthcare requires teams training together, respecting each other,” she said.

Shalala, who described the nation's healthcare system as unsustainable, urged healthcare executive to encourage their employees to learn more about how healthcare works by asking those around them about insurance coverage and costs.

She requires her University of Miami students to ask others about their healthcare coverage and Shalala said she regularly does so. “I have the nosiest students in Miami, Florida,” she said. “The only way to understand what we're going through in healthcare is by understanding people's lives. You get a better sense of the healthcare system” and how it works and who pays for it, “if you keep asking those kinds of questions,” she said.

She said the advent of Medicare was a response to the lack of a private insurance market for the nation's elderly. “The role of government has been very successful when there wasn't a private-sector alternative, when there wasn't an affordable private-sector alternative,” she said.

Employers increasingly struggle to provide insurance, and Shalala said planned health insurance exchanges with federal subsidies for low-income buyers will “make a difference.”

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