Linda Aiken knew from her first day as a new nurse that America’s health-care system sucked: “You’re giving everything you have to your patients, and you’re being undermined every minute of every day by the institution.” The quality of care isn’t the problem; it’s the delivery part that’s broken down. President Obama’s health-care reform takes direct aim at that delivery system, and the nurses we spoke to are fans.
“Health-care reform legislation is full of the language of nursing,” says Widener School of Nursing associate dean Kathleen Black. “It’s all about patient education, disease prevention, proactive health care.” Under reform, Americans newly covered by insurance will be seeking medical care they’ve put off, sometimes for years. So who’s going to treat all these people? The answer, increasingly, is nurse-practitioners, who hold master’s degrees and undergo extended clinical rotations. They’re the ones staffing those “minute clinics” popping up in Walmarts and Walgreens everywhere.
Surprisingly, doctors are pretty much okay with that. Physicians find primary care boring, and it’s not as lucrative as a specialty when you’ve spent big bucks on your medical degree. Nurses go in less invested, and they love primary care. Health-care reform now lets nurse-practitioners bill, albeit at lower rates than doctors. So they can take over time-consuming work like symptom management in specialists’ offices and hospitals, freeing doctors to see more patients and bring in more revenue while keeping patient satisfaction high.
Penn professor Mary Naylor, a nurse who studies health care and the elderly, offers an example of how the old system failed a patient—a retired, well-to-do investment broker, from a suburban community, with a wife of 50 years and three grown children. At age 76, he was on his fourth hospitalization. “He wasn’t a health illiterate,” says Naylor. “He had financial choices. But he was on a downward trajectory.” He’d noticed cognitive changes in his wife, but didn’t want to worry the kids. He sank into depression. His primary- care doctor had retired and moved to Florida. He was going to seven different providers. He got a new plan of care from each provider—and none of them was the right plan. With a nurse-practitioner’s help, he got an overall assessment, a single, workable plan of care, treatment for his wife and medication for his depression.
Nurses are uniquely situated to come up with new delivery systems; among their past innovations are patient-centered maternity care, in which the whole family is involved, and palliative hospice care. And they’re energized by the possibilities they see for the future, including more men in their ranks. More women are becoming doctors, too, which means more shared responsibility and collaboration. There are no guarantees of what health-care reform will look like when all the dust settles, but nurses don’t mind that. In their profession, the process matters, not just the outcome.