QUALITY: Nurses at the Forefront of Patient Care Innovation

“Why aren’t nurses more represented in the health reform discussion in Washington?” asked an audience member at a recent Alliance for Health Reform event, “Innovations in Patient Care: Lessons from the Field,” which addressed the often underappreciated role of nurses in improving health care quality. “We just spent the last half-hour talking about the shortages of nurses in both the clinical setting and educational facilities, and now you wonder why there aren’t any left to go into policy?” responded Audrey Nelson from the Veterans Health Administration.

The panel provided an excellent glimpse into nursing, an often neglected but vital part of the health care system. Two nurses gave examples of nurse-led innovations in patient care and safety. Mary Naylor of the University of Pennsylvania described a Transitional Care Model, aimed at preventing complications, deterioration, or hospital readmissions among patients who are released from the hospital but who are still quite sick or frail or coping with a newly diagnosed chronic disease. Nurses can help make the transition from acute inpatient care more seamless, and improve ongoing care in part by involving older patients and their caregiver as partners in care coordination and collaboration. The VHA's Nelson talked about a program that minimizes risks to both patients and nurses, for instance by making tasks like lifting patients safer. By purchasing patient lifts for every bed and instating a “minimal lift policy,” the VHA has reduced high risk tasks by 90% and experienced corresponding positive outcomes in both workforce health, and patient health.

Two physicians joined the panel to discuss the role of nurses in the larger health care system. Reed Tuckson, executive vice president and chief of medical affairs at the United Health Group, addressed the need for more highly trained nurses with greater freedom to innovate in ways that improve quality and control costs. Bill Kellerman of the American Academy of Family Physicians urged us to look anew at health care teams, with an emphasis on nurses and primary care physicians. Payment system reforms and health IT tools can help achieve that, he said.

The overall message was simple: Yes, there may well be shortages of nurses. But there is no shortage of good ideas about how to better utilize nurses. Long term solutions to the health care crisis mean smarter use of our existing health resources and ensuring that our health system—including payment systems and the culture of hospitals—allows each member of the medical team to function optimally. And maybe the best way to involve nurses in the health reform discussion is not to take them out of the clinical field, but to learn from their continual innovations in patient care and bring those lessons back to Washington.