Since last June, Pam Cipriano has served as the elected president of the American Nurses Association, the nation's largest nurse association, representing 3.1 million registered nurses. She is a research associate professor at the University of Virginia School of Nursing. She previously served as senior director for healthcare management consulting at Galloway Advisory by iVantage, and as chief clinical officer and chief nursing officer for the University of Virginia Health System, Charlottesville. Modern Healthcare Editor Merrill Goozner recently spoke with Cipriano about the changing role of nurses, hospital staffing cuts, nurses' wages and efforts to reduce occupational injuries. This is an edited transcript.
Modern Healthcare: What changes are U.S. nurses going through today?
Pam Cipriano: We have been very focused on improving quality and safety in the hospital and home environments. There are lots of disincentives as well as incentives to provide better care and better outcomes. Nurses are very attuned to the fact that the whole economic equation of how providers get paid is dependent on improving quality. Also, nurses have been masters of care coordination for a long time. When we think about care moving to settings other than hospitals and well-orchestrated transitions, nurses are the key in making that happen. Nurses are operating more and more in care-coordination roles such as case managers or navigators.
MH: We are seeing a lot of the hospitals trying to cut back on staff or to hold down costs. Is this affecting the profession?
Cipriano: We are very concerned about the curtailing of staff. One way is actual reductions in force, and the other is not filling positions when there are vacancies. If a hospital is experiencing a downturn in volume, we would expect that they would adjust staff appropriately. But that is not always happening. One of our clear directives is you have to maintain adequate staffing to preserve safety. Research shows the amount of nursing care for hospital patients keeps them from all kinds of complications, affects the mortality, and affects the outcome and overall quality of life and morbidity of patients. One of our key messages to our hospital administrators is to make sure you have adequate staffing and involve your nursing staff and nurse leadership in deciding those staffing patterns.
We also are focusing on the education and redirection that nurses need to work in areas other than the hospital. We recognize that as a country we want to reduce our dependence on hospitals. We want to provide care in the home, in the community and through primary-care medical homes. So nurses are taking up new roles and looking at how they can move from the hospital to these other venues. We don't want to dilute any expertise in these other areas. There is a false notion that patients aren't as sick outside the hospital and (caregivers) don't need the same level of education and experience. We have to make sure that nurses in outpatient areas are being key decisionmakers with patients and families and are coordinating care. Nurses are a big part of the safety net.
MH: Are hospital administrators providing opportunities for nurses in making the transition to those other environments?
Cipriano: In the settings where an administrator has an integrated system, yes. That is one of the nice attributes when you have an integrated system of care, where the hospital has its own clinics, long-term-care facility and other ambulatory-care venues. They have a desire to maintain a strong workforce, so having opportunities to move staff within those areas is something that is done routinely.