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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