Same Boat, Different Ocean

By Shawn Kennedy, AJN editor-in-chief

Since the Robert Wood Johnson Foundation/Institute of Medicine Future of Nursing report was released six months ago, we’ve heard a lot about how nurses need to have more representation on boards of health care institutions and be more active participants in decisions about redesigning health care delivery systems. (See our online resource page for a variety of information about the report.)

To me, it’s a recommendation that’s so intuitive and simple that it’s almost embarrassing—and the need for it only drives home how absurd our health care system can be. It’s mind-boggling to me that organizations feel they can plan effective health care without the input of nurses. Imagine aircraft manufacturers designing a plane without input from the primary group—pilots—who will be responsible for flying it safely.

I suppose many health care entities and boards  feel that they have this input from physicians—but really, in most hospitals physicians aren’t involved in the nitty-gritty operations details that either make or break workflow processes or can impede the delivery of safe, cost-effective care.  How many times have hospitals planned patient care units or purchased equipment without nursing, input only to find that the systems aren’t workable or create more work?

A hospital where I once worked bought a much-touted and very expensive portable blood collection and filtration system for use in the ED for multiple trauma victims; only hospital administrators and the trauma director were involved in purchasing the equipment. Our head nurse, who was quite perturbed that all this had happened without her input, took one look at it as it was being wheeled down the hall and started laughing—it didn’t fit through the door to the resuscitation room.

And it’s not just about processes or equipment—nurses often raise health safety concerns that others may not be aware of. Consider the public health nurse who was called in to give smallpox immunizations. She was the only one who stressed the importance of tracking patients and providing patient education about special precautions to take when you’ve received a live vaccine.

And it’s not just American nurses who are pushing for a bigger voice in planning health system changes. In the United Kingdom, nurses are up in arms over budget cuts in the National Health System (NHS) and a proposed change that has delegated NHS spending decisions to commisi0ning consortia led by general practitioners— “with no formal requirement to include nurses or other professions.”

In an opinion piece on, author Jonathan Webster writes, “If commissioning consortia do not give experienced nurses and other clinicians the opportunity to influence and jointly lead commissioning through collaborative decision-making and working, they risk losing a wealth of knowledge and expertise. A multiprofessional approach to developing consortia is yet to be established.”

However, UK nurses may be a step ahead of us here in the U.S.: an April 12 article reports that Prime Minister David Cameron has called for a “listening exercise” to hear the concerns of health professionals. With pressure from the Royal College of Nurses and the public, nurses are getting support from parliament members and some health ministers. One of them, John Healey, said that including nurses and other health professionals “was essential if the reforms were to win Labour backing.”

Dare we hope for similar support from our legislators? Given the recent chicken fight among Democrats and Republicans, with each waiting to see if the other would flinch first over the budget, I don’t think we have much hope of that. We first need the U.S. Congress to show concern for the needs of the American people rather than engaging in posturing. Perhaps Congress should be subjected to whatever they visit on the rest of us—if government workers lose paychecks, so should they; if they vote to cut back on health care, theirs should be reduced as well. Why should members of Congress be guaranteed things they will not guarantee for their constituents?

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Editor-in-chief, AJN


  1. Islande April 16, 2012 at 11:17 pm

    It is a shame that too often the nurses’ input is not even considered or sought in making health care decisions. Nurses have a plethora of knowledge and experience and tend to know what will or will not work in many situations. When health care decisions are made without an experienced nurse’s input the results can have devastating effect on patient care. I work in an operating room where our sterile core has Omnicells that are stocked with sterile supplies such as IV fluids, gowns, gloves, suction tubing, lap sponges, and other homeostasis supplies, etc. Recently, the nurse manager decided to get rid of the Omnicells and the supplies that were in them in order to save money. This decision was made without the input of the nurses that work in the O.R. Instead of going to the sterile core to grab the items you needed emergently, you now had to call downstairs to the central supply to obtain these items. The decision to remove the Omnicells proved to be disastrous because half the time the person on the other end of the phone had no idea as to what you were requesting and by the time the item was delivered to the O.R. it was either the wrong item or the surgeon no longer needed the item because it took so long to arrive and had to make do with what he had. The nurses in the O.R. knew that getting rid of the Omnicells was not a good idea. When there’s an emergency you can’t afford to wait 15-30 minutes for an item you need now. Unfortunately our outcries to the nurse manager fell on deaf ears. It took the surgeons bypassing the nurse manager and going straight to the CEO of the hospital to get the Omnicells back in the sterile core. If the nurse manager had listened to nurses she could have saved herself the headache and the embarrassment.

  2. Jessica Giraldo November 21, 2011 at 11:40 pm

    It is essential that nurses play a part in the process of making health care decisions. Nurses can contribute a broad spectrum of knowledge and expertise that others in a multidisciplinary team cannot. Nurses have the most contact with patients and as an advocate for the patients, are more aware of patient needs. Nurses can provide an overall picture of what needs to be changed and what is working from first-hand experience. Involving nurses in making decisions would be for the greater good and would create better outcomes in the health care setting.

  3. Natalia Rossin November 21, 2011 at 9:52 pm

    This article addresses the issue of nurse advocacy. It is a shame that nurses are left out of key decision making situations. The article raised an interesting point. The nurses in England are ahead of us in the U.S. because they are allowed to give input. The first thought I had was that England was the birth place of nursing. It seems they are still pioneers in nursing. We need to pick up the pace in the U.S. This course of study and certainly this article increases awareness and gives clear examples of situations in which there were failures in the practical application of new equipment and policies due to the fact that nurses were not consulted. Nurses are the arms, legs, eyes and ears of the physicians, they are more familiar with every nook and cranny of the emergency rooms, ICUs and various other areas of healthcare provision. They know more than any other provider what the needs of the various departments are and therefore should be the first line of consultation, design and policy making. Nurses have eyes on all situations that affect safety, patient care, and functionality of equipment, the appropriate type and size. Legislative support is needed and multi-disciplinary input should be encouraged and supported. It’s just a sad commentary that as advanced a nation as we are, we are so behind on effective communication and fluidity. I read a book a few years ago which addressed the concept of the balance of power. It showed that this does not only exist between powerful nations but also between social and professional arenas. I wonder if there is an underlying fear of balancing power among healthcare providers. Are administrators and physicians afraid of the potential power of nurses? Is their personal need for superiority more important than the overall standard of care?

  4. Mara Ceruto November 21, 2011 at 5:33 pm

    Times are changing in terms of budget cuts and health care reforms and now more than ever, nurses and other health care providers must instill their viewpoints to help shape the new health care system. With this blog entry, I was made more aware of the fact that this is not only a national issue but a global one. Hospitals have continually been attempting to integrate a multi-disciplinary approach to patient care. But, what we fail to realize is that a multi-disciplinary approach should also be implemented in attempting to determine how our health care should be changed to benefits the patients because each profession has a great deal of knowledge and experience to add to the decision making process.

  5. Vanessa November 21, 2011 at 4:57 pm

    I am excited to see more and more nurses taking up the mantle to be more active in the creation of healthcare policy. Nurses provide a view point of health care that only nurses are capable of giving. In regards to getting support from legislators to allow nurses to give input on health care policies, well I say there are more of us than them. There is a very large amount of Registered Nurses in the U.S. If just half of them petitioned for policy changes, well I believe there would definitely be change. In the end, it is up to each nurse to arm themselves with knowledge of legislative and health care policy procedures, and then with this knowledge, act.

  6. Cristina A Haizlett November 18, 2011 at 9:23 pm

    Any proposal should most definitely stress the great contributions nurses have to offer. Nurses are the individuals who actually deal with patients and are responsible for keeping things running smoothly. Since nurses are the ones that must carry out any changes to regulations, the weight of their opinion should be heavily accounted for. Nurses are able to see first-hand how healthcare affects patients, making their opinion essential. If nurses were able to work side by side with healthcare organizations, then the patients would revive nothing other than the greater good. There is undoubtedly, no one greater than the nurses themselves to help enhance the imminent future of the health care system.

  7. Michelle Montero November 14, 2011 at 1:51 pm

    Nurses should absolutely have more input on relevant changes to any system. Nurses are on the frontline giving the care day in and day out so that patients can have the best outcomes possible. The opinion of nurses in healthcare decision making is extremely important. Who better to help shape the future than the people who spend the most time with the patients? Working so closely with all members of the healthcare team nurses have the ability to see the overall picture of what would be best for the patietns. As a nurse I know first hand the responsiblity we have to be a patients advocate, and that is not possible without being able to put our options to actions.

  8. Brianna November 8, 2011 at 9:04 am

    I have found this article to be a very relevant topic which needs much more attention. I am a nursing student at Florida International University, while I have completed different clinical rotations at different hospitals, all these hospitals seems to have a common factor; that is the role of nurses. Typically, nurses are the eyes and ears for physicians giving them constant updates on their patients and changes on their patient’s condition. Thus, nurses not only advocate for their patients they are aware of what works for their patient and conversely what does not. The reason being is nurses spend more consistent, continuous hours in the hospital with these patients. It would be illogical not seek the opinion of those who have an abundant amount of experience with the pros and cons of hospital function, patient care, and forms of improvement.

  9. Angela Carvalho July 30, 2011 at 12:40 pm

    It is really unfortunate that nurses are not represented fairly in major healthcare decisions in most countries. We are in a unique position of participating in the delivery of healthcare from a very advantageous angle, literally at our patients’ bedsides. It is our duty and responsibility to advocate for our patients.

  10. Shawn Kennedy April 20, 2011 at 12:19 pm

    Amy – great comment re nurses and health policy. Be sure to see AJN Reports in our upcoming May issue – on a project to get more women in politics. And before all my men colleagues jump on that, yes we need more women – and more blacks and more hispanics, etc – our legislators need to be more diverse in ALL areas.

  11. Sebastiana April 18, 2011 at 11:38 am

    Nurses have direct contact with patients, family members, doctors, and all other multidisciplinary team involved with patients. For that reason nurses are the first providers that see whether the health care system is meeting patients and nursing goals. It is important to get nurses’ opinion before any new gadgets are implemented. For instance, at the hospital that I work laptops were available to nurses, but the only problem was the cart that laptops were stationed on was very heavy and hard to push around. In conclusion, nurses started having wrist and back problems resulting liability to the hospital. It would have not happened if the hospital’s information technology department had asked our opinion before ordering the carts.

  12. Amy April 16, 2011 at 10:15 am

    I totally agree that nurses have so much to add but are rarely considered when making decisions, whether they are in the political arena or in the workplace. For instance, in one hospital I worked in, a new unit was being designed and when the staff nurses saw the design, they immediately saw how workflow would be disjointed and cumbersome to navigate. Their input was requested by the administrative team, but in the end, the design did not change. This is but one example of the value nurses have but the inattention decision makers give that value. On the flip side, nurses are typically “doers”. We enjoy the act of doing our work, taking care of people, educating the public and our peers. Rarely have I heard a nurse co-worker say that she (or he) really wants to lobby legislators to change health care policy. We want it to happen, but it isn’t necessarily what we enjoy doing.

Comments are moderated before approval, but always welcome.

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