A message from ONA's Executive Director, Susan King, MS, RN, FAAN
The more things change, the more things stay the same. Trite phrase? Perhaps. Nurses, physicians and others are spending hundreds of hours in meetings planning a reformed health care system focused on one key goal. That is to support individuals and communities in achieving and maintaining good health or successfully manage chronic conditions. We hope that the work of health care professionals will focus more on educating, coaching, coordinating and assisting people through parts of the system and less on expensive interventions for problems that could have been avoided. In other words, a major nursing role in the "future” will look very much like nursing’s history.
Imagine a future in which public health nurses are available to their communities identifying factors that are contributing to good or poor health and playing a part in implementing needed solutions. The program currently operating in Multnomah County that is directed at the indoor air quality in homes and implemented by nurses comes to mind. And so does Lillian Wald’s Henry Street Settlement House that provided intensive service to the residents of the NY slums and education for public health nurses. What did they do? Visited families in their homes, intervened in illness, educated their patients and attended to such things as supervised exercise for children and worked to improve the health of their very poor community.
Imagine a future hospital in which nurses work with their physician partners to develop a plan of care for their patients then consult and coordinate with other disciplines when additional services are necessary. In this hospital of the future, the routine involvement of a variety of providers would be replaced with a nurse practicing at the "top of the license and education” who ensures that the patients’ needs drive care rather than a desire to inflate charges to the payer of the bill.
Imagine a primary care system that integrates all of the person’s health care needs in one place or network. No longer would a patient with severe depression be exported to a mental health care system that can barely keep up with crisis calls or automatically sent to an emergency department. Instead, the primary care professionals working in concert with mental health specialists would communicate and work together to ensure the patient receives timely and appropriate services.
This is the system envisioned by recently enacted federal and state laws. If nursing is to make this a reality we have work to do. First, our educational programs need to focus clinical practice on a broad set of practice environments and prepare students for roles outside of acute care. Second, nurses currently in practice should heed the recent Institute of Medicine recommendations and assert our role as the partner, coordinator and the manager of our patient’s care. Third, we must be more skilled at redesigning systems of care for communities that will be flexible and work. Tall order? Say that to Florence Nightingale.