It would behoove organized nursing to stop whining and abandon the "poor me" syndrome. For the past 25 years (my tenure as a nurse), organized nursing has been complaining about the same things-not enough staff, cutting staff, substituting non-nursing staff, not enough pay and "we just don't get any respect" in general.
As organized nursing continues to complain, individual nurses are continuing to make major changes in the very essence of healthcare delivery.
It seems the American Nurses Association represents "hospital staff nursing." Although they espouse concern for patient care, it's sometimes difficult to see the connection.
Nursing is the only medical profession that has historically narrowed its scope of practice. For example, podiatry used to be a profession of the feet; now podiatrists have expanded their scope to include the ankle, and I'm sure soon it will be the entire leg. Nursing, on the other hand, has given up significant clinical areas such as pharmacy, physical therapy, occupational therapy, dietetics, respiratory, etc.
When we discuss direct patient-care hours per patient day, do we include all those clinical professionals who are integral to the quality care of patients? Many physical therapists have master's degrees and are accountable for turning and exercising patients. Clinical pharmacists mix IVs, calculate medication dosages and participate in patient education. When was the last time a staff nurse provided diet information to patients? And, in many hospitals, discharge planners (nurses in another department) provide all plans for hospital discharge.
So even when nurses care for the patient, if they are not part of the variable hours per patient day of a particular unit, they are not "counted" in the staffing ratios. In addition, many hospitals have staff physicians in the hospital 24 hours a day dealing with many patient problems that nurses once handled.
In the commentary by ANA Executive Director Geraldine Marullo (Feb. 6, p. 32), she equated profitability of fledgling integrated delivery systems with the replacement of highly paid, educated and experienced nurses with nurses' aides. I suggest Marullo read nursing history. Nursing was complaining about the issue long before "integrated delivery systems" became a politically correct term. And just because a nurse is experienced, well-paid and highly educated does not mean the nurse will affect patient outcomes in a positive manner.
We need nurses and other healthcare professionals who are innovative, caring, able to meet patients' complex needs in a rapidly changing environment and who are not wedded to the way things used to be. We need to slay a sacred cow every day, something organized nursing finds difficult to do.
Integrated delivery systems will be profitable only if they provide excellent patient outcomes. The growth in capitation-prepayment of a fixed dollar amount for a patient's care-gives systems an incentive to prevent illness, treat diagnosed problems early and provide all necessary care. A missed healthcare problem only gets worse and costs more.
At Friendly Hills HealthCare Network, a truly integrated system, nurses are a part of our entire network, including key management positions. But so are physicians, clinical pharmacists, dietitians, chiropractors and physical therapists. In fact, we employ four clinical nurse specialists whose role crosses seven access points of care-primary prevention, ambulatory, acute hospitalization, tertiary, home care, long-term care and hospice care.
Out of the 120,000 patients we serve, our daily acute-care hospital census runs at about 80, while our ambulatory visits average 60,000 a week. Nurses, like all of our healthcare professionals, are accountable for patient care across all access points. In fact, at Friendly Hills we have taken a nursing model and adapted it to the entire system. It is great to hear the chairman of the medical group discuss the seven access points and how we are accountable for patients throughout their life cycle.
Integrated delivery systems provide all healthcare professionals a chance to provide quality care in an innovative model. Once incentives are aligned and cost-plus reimbursement is eliminated, we can all be profitable by keeping the population healthy.
Nursing, as a profession, has advocated patient education and wellness models for years; now nursing has the opportunity to embrace these new models and take a leadership role in this exciting and bold new world of healthcare.
`We need nurses and other healthcare professionals who are.....not wedded to the way things used to be.'