Shawn Kennedy, MA, RN, AJN interim editor-in-chief

RWJF reaction panel: Richard Hader, CNO, Meridian Health System, NJ; Mary Naylor, prof. of gerontology, UPenn.; Beverly Malone, National League for Nursing; Patricia Gerrity, 11th St. Health Center, Philadelphia; Susan Hassmiller, RWJF sr. advisor for nursing

Last week I attended a press conference in Washington, D.C., where the Robert Wood Johnson Foundation (RWJF) released a Gallup poll it had commissioned to find out what 1,500 opinion leaders (or as Gallup editor-in-chief Frank Newport put it, “the people who run things in this country”) think about nursing leadership and nurses’ influence on health care reform. 

It’s no surprise that most (69%) see nurses as having little influence on health reform. Nurses ranked at the very bottom—immediately below patients, who were below physicians in the rankings. Mary Naylor, an innovative leader from the University of Pennsylvania and part of a reaction panel, hit the nail on the head: “Everyone should be concerned that the largest group of health care providers and the consumers are the least influential.” (Those seen as having the greatest influence are government officials and insurance executives—no surprise there, either.)

In identifying what impedes nurses’ ability to be in leadership roles, here’s how the opinion leaders weighed-in:

  • 69.3% noted that nurses are not seen as important decision makers as compared with physicians.
  • 68% noted nurses were not seen as revenue generators like physicians.
  • 62.4% think nurses are focused on acute care and not prevention or health maintenance.
  • 55.8% think nurses lack a single voice in speaking on national issues.
  • 50.9% think nurses lack opportunities to move into leadership positions.

The good news is that the opinion leaders, for the most part, feel that nurses should have more influence in policy, planning, and management, especially around patient safety, improving quality, preventive care in the community, coordinating care, and “helping the system adapt to an aging population.” The top three suggestions, in answer to an open-ended question on what nurses need to do to gain more influence, were: nurses need to make their voices heard (15%), nurses need to have higher expectations and accountability (12%), and nurses needed to improve their image (10%).

The bottom line. While some might dismiss this as just another survey showing that nurses are well thought of, this survey is important because the “opinion leaders” agree that nurses have important contributions to make as planners, policy makers and leaders. They know that nurses are key to reducing errors and adverse events and improving quality, safety, and access to care. 

So how many nurses do you know on hospital boards or boards of trustees? I like the comment made by panel member Richard Hader, chief nursing officer at Meridian Health Systems in New Jersey: “Nurses should not work for organizations that don’t have nurses at the highest levels of decision-making.”

It would be easy to blame nursing leaders for the lack of power nurses have. I’m not letting them completely off the hook (we do need to work on speaking with a unified voice), but what we need is for ALL nurses to sing the same song—all nurses need to make visible to their patients what it is that nursing contributes to their care. Patients don’t see the coordination of care and services, the catching of errors, the constant calls to labs and physicians, the review of lab and blood tests to monitor progress, the meetings and planning to implement quality initiatives. All this happens outside of the patients’ view. I have relatives who didn’t know if they’d even seen a nurse some days while they were in the hospital because so many people came and went without identifying themselves. But they always knew if they saw a physician. So speak up—tell your patients who you are and what you are doing to make their health care better and safer. If you don’t, how will they ever know?

(For more on the survey, see also this blog post by Susan Hassmiller, senior advisor for nursing at the RWJF, at the RWJF Health Reform blog.)

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