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Nursing leadership is vital to the health care system

Rochester Business Journal
January 25, 2013

In October 2010, the Institute of Medicine, in partnership with the Robert Wood Johnson Foundation, published a landmark report, "The Future of Nursing: Leading Change, Advancing Health" (see The study was broad in its scope and produced eight recommendations.
The relevance of this report is well-stated by IOM president Harvey Fineberg M.D.: "The possibility of strengthening the largest component of the health care work force-nurses-to become partners and leaders in improving the delivery of care and the health care system as a whole inspired the IOM to partner with the RWJF. ... Accessible, high-quality care cannot be achieved without exceptional nursing care and leadership."
The IOM rightfully places the responsibility for meaningful change on all stakeholders. Nurses must play a fundamental role in this transformation. As the health care delivery system moves to a team approach for patient-centered care, government, businesses, health care organizations and the insurance industry must collaborate to transform the infrastructure that supports patient-centered care.
Health care is a driving force in today's economy. It is the number one reason for personal bankruptcy and consumes 17.6 percent of the gross domestic product. Every aspect of society has a vested interest in lowering costs while improving quality and access. Such a goal requires strong leadership from the largest component of health care providers-nurses.
One of the IOM recommendations is to increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Baccalaureate nurses save lives. There is a 5 percent decrease in the likelihood of patient mortality within 30 days of hospital admission with a 10 percent increase in RNs with bachelor of science in nursing degrees. These complications were 19 percent lower when 60 percent of RNs were BSN or higher prepared, compared to 20 percent BSN or higher prepared.
Another recommendation is to expand opportunities for nurses to lead. Nursing success stories are not well-known. The Nurse-Family Partnership, co-founded by Harriet Kitzman RN from the University of Rochester School of Nursing, uses baccalaureate-prepared nurses to follow low-income pregnant women for two years following delivery. The program saves $5.70 for every dollar invested while reducing child abuse 48 percent, emergency room visits for accidents 59 percent, arrests among children 59 percent and behavioral/intellectual problems among children 67 percent.
Nurse-managed centers, of which there are 250 across the country, serve 1.5 million underserved patients, nearly half of whom are uninsured. These patients have 15 percent fewer emergency room visits, 35 percent to 40 percent fewer non-maternity hospital days and 25 percent less spent on prescriptions.
Birth centers, established by Ruth Lubric, a MacArthur Foundation "genius" awardee, have also proven the value of nursing leadership. In 1999, the infant mortality rate per 1,000 births in the District of Columbia was 12.2 compared with 6.8 nationally. Lubric was asked to open a birth center and eight years and 800 births later, it had never lost a child in childbirth and cost savings to the city were $1 million a year.
Finally, the IOM recommended removing practice barriers for advanced practice RNs including: nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. Hundreds of studies in peer-reviewed journals have proven the high-quality, cost-effective care provided by APRNs, often with difficult-to-serve populations, and with high patient-satisfaction scores.
"The only barriers limiting APRNs' capacity to practice to the full extent of their ability are state-based regulatory ones," says John Rowe M.D., former CEO of Aetna Inc. and former president of the Mt. Sinai Medical Center (also a member of the IOM Committee). In a paper titled "Broadening the Scope of Nursing Practice," Rowe and his co-authors acknowledged the evidence that primary care services-such as wellness and preventive services, diagnosis and management of acute illnesses and chronic disease management-can be provided by APRNs safely and effectively. One of the studies they reviewed demonstrated that the utilization of nurse practitioners in Massachusetts could save the state $4.2 billion to $8.4 billion over 10 years.
The evidence is clear. Nurses have a proven track record of billion-dollar savings while improving the health of populations. Nursing leadership is essential to produce a health care system with a capacity to provide the right care at the right time in the right place. Our region is fortunate to have an abundance of nurses with the expertise to lead teams of reform efforts. Our community could benefit by implementing the Future of Nursing recommendations as a joint effort by all stakeholders.

Mel Callan is a family nurse practitioner at Highland Family Medicine. She is past chairman of the Community Technology Assessment Advisory Board of Rochester and past president of the New York State Nurses Association.1/25/13 (c) 2013 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email

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