|
September 2010
VIEW FROM THE BOARD
: Unleashing the Potential of Nursing
A Role for Nursing in Health Care Reform
by Gail W. Stuart, PhD, RN, FAAN
Most people do not realize that nurses are the largest group of behavioral health care providers. That is because when behavioral workforce studies are conducted, they typically only include nurses who have graduate preparation in the specialty. However, more than 80,000 registered nurses are working in mental health organizations in the United States. Half are employed in private, psychiatric hospitals and general hospital psychiatric units; the other half are community based. In addition, there are more than 20,000 advanced practice psychiatric nurses with graduate degrees. So that brings the total number of nurses working in our field to 100,000.
Consumer and family needs, scientific developments, economic realities, and societal expectations are shaping the current roles and functions of psychiatric nurses. But it is health care reform that will have the most important impact on nursing’s role in the future. Specifically, the integration of mental and physical health care in primary care settings, the integration of substance use and general medical care, and the movement of care delivery into health care homes and accountable care organizations are challenges that will shape the nursing profession in the years to come.
In fact, all of these developments are components of the kind of care nurses can and do provide…sometimes. The nursing model is based on a biopsychosocial view of care-giving that is patient-family focused and includes prevention, education, health maintenance and coordination of care from home to hospital and back to the community. When nurses are allowed to do what they are educated to do, we see health care at its best. Yet nurses are often constrained in their practice by over-regulation of their state practice acts and constricting hospital and institutional policies. For example, nursing is the only health care profession that has its practice act under the review of another profession – medicine. It has also been observed that nurses practice best in war-related settings. That’s because in the battlefield nurses are free from organizational constraints and professional power conflicts. So if we can just "let nurses do nursing” we would be unleashing the potential of the profession.
But there is another potential here that must be addressed as well. As we move behavioral health care into the primary care sector there is the unleashed potential of nurse practitioners (NPs) who are not in our specialty. Currently there are over 158,000 nurse practitioners practicing in the United States, the large majority of them in primary care. These nurses are on the forefront of care and many of them are returning to school to learn more about behavioral health problems because they see so many of these types of problems in their practices. Furthermore we know that there is a shortage of primary care physicians and that few graduating medical students choose primary care for many reasons, including the low salary and their high medical school debt.
So I propose two radical actions to address the many needs that will emerge with health care reform.
-
The first is that all primary care be provided by nurse practitioners. Research has shown that the quality of care provided by NPs is equal to that of physicians, and patients are often more satisfied with the care they received from an NP.
-
The second is that all nurse practitioners be educated in behavioral health competencies so that they can be the front line providers of primary behavioral health and physical health care. Many graduate programs in nursing are already incorporating this content into their curriculum.
Radical times call for radical solutions. Nurses are willing and able to take on the challenges. Let’s put these and other creative ideas on the table for discussion.
Gail W. Stuart, PhD, RN, FAAN is a Distinguished University Professor and Dean of the College of Nursing at the Medical University of South Carolina. She also holds a joint appointment there as Professor in the Department of Psychiatry and Behavioral Sciences. Dr. Stuart is a founding member and current President of the Annapolis Coalition Board of Directors.
|
|