‘Micro’ and ‘Macro’ Strategies for Nursing to Thrive as a Profession

At last month’s annual convention of the Academy of Medical-Surgical Nurses (AMSN), nurse and health care economist Peter Buerhaus received the Anthony J. Jannetti Award “for extraordinary contributions to health care.” Buerhaus, a professor of nursing at Montana State University College of Nursing, is widely known across health care disciplines for his research on health care costs and value, especially in regard to nurses and nursing. In his keynote talk, Buerhaus shared some of his recent research findings and offered some “micro” and “macro” nursing strategies for thriving amid today’s health care challenges.

Nurses maintain status as highly trusted professionals.

Click to expand. Most trusted professions, Gallup 2017 poll.

He began by reminding the group of some of the reasons that nurses are respected and trusted in America. People believe that nurses ensure quality of care, protect patients and maintain safety standards, and provide advice on personal health issues.

Studies show that we maintain this trusted status even when the media reports on the mistakes of individual nurses. And after good media attention, as when Alex Wubbels protected her patient or when nurses play key roles in disaster relief efforts, our approval ratings soar.

Accomplishments of NPs have reinforced good reputation of nurses.

Peter Buerhaus. Photo courtesy of AMSN.

Buerhaus’ studies using Medicare claims data show that the nurse practitioner workforce gravitates to wherever the need is greatest. Primary care NPs are more likely than MDs to care for vulnerable populations, women, American Indians, the poor, and disabled people.

And NPs do this at a cost that is 9 to 29 percent lower than physician-directed care—not because NPs are paid less, but because NPs use half as many services for their patients, admit them less often, and engender fewer 30-day readmissions than their MD counterparts.

Buerhaus notes that it’s no surprise, then, that the Institute of Medicine, the National Governors Association, and even the Federal Reserve are all interested in exploring how better use of nurses can improve health care.

How to leverage good will to meet today’s health care challenges?

Buerhaus believes that nurses need to develop “better messages around value,” and demonstrate within our own organizations how nurses improve patient outcomes and save money by preventing infections, decreasing adverse clinical outcomes, preventing admissions and readmissions, and increasing patients’ satisfaction with the care we provide.

Looking to the larger health care picture, we face unprecedented complexity in providing care, rapid and often conflicting changes in both clinical protocols and health care policy, an aging population, more people with chronic degenerative diseases, and projected shortfalls of both MDs and RNs. What should we be doing?

Buerhaus suggests that we first acknowledge that the nursing workforce is unlikely to be able to manage these challenges alone. Instead, we should view health care as a multifaceted societal problem and partner with social workers, pharmacists, public health departments and community health workers, the home health and long-term care communities, churches, and others. The key is to start this work in our own communities to decide what is needed locally, and devise interventions together.

Planning on a local scale for coming wave of nurse retirements.

Likewise, we can plan on a “local scale” for what will be needed in our own organizations. A third of the nursing workforce is expected to retire over the next 10 years, and Buerhaus points out that this will mean “millions of years of nursing experience leaving the workforce.”  We can plan for these losses by looking ahead in our own facilities to identify which units or departments or populations are likely to lose expert clinicians who know the organization well.

  • Might some nurses delay retirement, or agree to remain on staff as part-timers?
  • Are there new roles that might be filled by nurses who defer retirement, perhaps in patient navigation, community engagement, or prevention programs?
  • How can we bring older and younger nurses together to identify and promote the transfer of essential skills to the next generation of nurses?
  • How can we strengthen succession planning for nurse manager and other leadership roles?

It’s not up to nurses alone to solve the problems of access, cost, complexity, and increasing health care needs. But we will help move solutions forward by recognizing our own strengths and working collaboratively on the challenges ahead.


2017-11-17T10:20:27+00:00 November 15th, 2017|Nursing, nursing research|0 Comments
Clinical editor, American Journal of Nursing (AJN), and epidemiologist

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