A message from ONA's Executive Director, Susan King, MS, RN, FAAN
To say that our health care system is in transition is an understatement. It is experiencing chaos fueled by uncertainty, anticipated changes, fear and speculation. For nurses, regardless of the environment, our responsibility is to the patient in front of us which, more and more often, doesn’t seem to fit the institutions in which we practice.
The current environment isn’t so very different, however, than the early days of our experiment with managed care in the 1990s. At that time, some politicians campaigned on "the end of patient choice” and "intrusion into our relationship with the provider.” At the same time, hospital administrators made precipitous decisions to cut clinical staff in anticipation of decreases in hospital care. Here, the Oregon Health Plan was implemented bringing in more people with greater coverage and we began to recognize that our primary care system was inadequate.
Fast forward to our efforts to "transform” the system at both the national and state level today; While much is the same as 20 years ago, certainly the impact of the economy has created more pressure both to find a way for people to get care but also to reduce costs. As I have said in this column many times, nurses know that there is enormous waste in the system. We also know that while we are responsible for delivering efficient and effective care, much of the money being spent in our systems has nothing to do with quality care or makes it more difficult to deliver that care. We see billboards that seek to attract patients to specialty care which is duplicated in facility after facility; we see palatial health care facilities that are poorly designed and we experience electronic health record systems that make documentation much more burdensome to nurses and physicians and simply don’t fit with the requirements of clinical practice and we see a resurgence of consultants who are called in to make unpopular and most often unworkable changes.
It is hard to estimate the resources that are being wasted both in hard dollars and in the negative effects on the practice setting. One facility in Portland spent over 2 million dollars on a set of recommendations that either were already in progress or were rejected soon after they collected their fee and left. The lack of collaboration by clinicians and their administrative partners is remarkable given all of the literature and supposed knowledge about how to accomplish change.
As nurses, we have a responsibility to create a new health care system that supports patients in their efforts to stay healthy or regain their health. That will require both proactive and reactive efforts. On the proactive side, nurses must insist that standards of care, legal requirements and our code of ethics are not violated in the name of efficiency and change. We have an obligation to practice at the highest level of quality and resource utilization and to continually examine our practice for the outcomes our patients need. On the reactive side, we necessarily need to educate our patients and the public at large about how changes might affect them and what they need to ask for when they seek care. For example, elimination of the interaction between public health nurse and at risk new mother in favor of a cheaper substitute will have consequences. Of course, we can work with partners such as community health workers but they are just that – partners. Increasing patient risk by doing away with rapid response teams in hospitals and assigning their immediate availability to a nurse who already has an assignment is dishonest. Patients and potential patients cannot be lied to by advertising.
The next few years are going to be very unsettled as more individuals obtain health coverage but we try to move our illness system into a new model. Many nurses may find it necessary and wise to look at a change in practice setting and obtain knowledge and skill in that area. But whatever practice we choose, it must be guided by the principles embodied in our standards of care; now and always.