Registered nurses are the only clinical healthcare professionals educated within a holistic framework that views the individual, family and community as an interconnected system that can keep us well or help us heal. Our focus is not the ear or the kidney or the virus. It is the patient.
When RNs hear the term patient-centered care as though it were some newly discovered framework for reforming the healthcare system, our reaction is, What took you so long? RNs have never viewed healthcare as anything else.
RNs at the bedside have been centrally positioned to witness how a dysfunctional healthcare system has failed patients, their families and our country. This daily fact of life for RNs has kept us at the forefront in calling for sweeping change.
The American Nurses Associations Health System Reform Agenda, updated in 2008, is grounded in two decades of policy and advocacy work by ANA, and calls for guaranteed, high-quality, affordable healthcare for all. Many reform plans from other groups are compatible with ANAs reform goals. Most discuss the key areas of quality, access and cost. What most distinguishes ANAs contribution to the national discussion is our additional required element for comprehensive reform: the development and deployment of the healthcare workforce.
The current healthcare system often fails to use its resources wisely, and no one would argue that this waste must be pared away. Yet few identify the healthcare professional workforce as a resource that is also subject to being inefficiently used or wasted altogether. The 2.9 million RNs in the U.S. are a prime example.
As with all other healthcare professionals, the scope of practice for RNs is set by the state. RNs and advance practice registered nurses, or APRNs, in addition to their strictly clinical responsibilities, are also educated in chronic disease management, coordination of care, prevention, health education and wellness programs. Nurses consider every interaction with a patient or a family to be a teachable moment.
Nurses are encouraged by the seeming widespread agreement that the current healthcare system needs to focus much more on exactly these elements of maintaining or improving health and coordinating and managing the care for those individuals with chronic conditions and diseases. The ANA envisions the current sick care system being transformed to a true healthcare system, in which societys attention and resources are directed to building the economic and cultural infrastructure to optimize individuals and communities health.
Obviously, there will always be a need for hospital-based acute care, reliant on expensive technologies and procedures. The idea is to recalculate the balance in evaluating and allocating resources for the nations health.
As part of a reformed healthcare system, the healthcare community must do whatever it can to help individuals embrace the idea of shared responsibility for their health. One promising tool to achieve this partnership between patient and provider is to create incentives for patients to seek counsel and coordinate their care through a primary healthcare home in their community.
A healthcare home, rather than the popular parlance medical home, speaks of a place where one can go to get information as well as treatment. This is no semantic quibble; if we are truly committed to the notion of moving from a sick-care system to a healthcare system, then our words should match our intentions.
A relationship with a primary-care providerincluding APRNsin a healthcare home can be the foundation for exactly that, with RNs, physicians, physician assistants and others in close collaboration to help the individual patient optimize her or his health. Now thats patient-centered care.
Some groups advocate for a measured, incremental approach to health system reform that will tweak our current so-called system to expand coverage a bit here, and improve a handful of quality standards there. Nurses and other health professionals cannotwill notstop there. People are suffering and dying prematurely because the right health interventions are not occurring at the right time.
My deepest desire is that nursesa precious resourcebe used wisely in this newly imagined healthcare system.