Nurses Need to Pull Up a Seat at the Table, Hassmiller Says

Noting that fewer than 6 percent of hospital board members are nurses, the coauthor of a report on the future of nursing said nurses' roles are often poorly understood by decision makers and the public
The Lund Report

February 20, 2013 – Nurses need to make their voices heard when decisions are being made, both at the institutional level and at the policy level, according to Susan Hassmiller, PhD, RN, FAAN who spoke at the Oregon Center for Nursing conference last week on the future of nursing leadership.

“We need to be keeping more data, recording our expertise and speaking up for ourselves so when people say quality of care, they will also say, quality of nursing,” Hassmiller said.

Hassmiller's keynote speech included a breakdown of the Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health, which she said is so popular the website actually crashed shortly after it was posted, due to overwhelming traffic. The report is still the number one reason people visit the Institutes of Medicine website, she said.

“Probably 90 to 95 percent of reports sit on shelves,” said Hasmiller, who works for the Robert Wood Johnson Foundation, which helped produce the report, and served on the committee that put it together.

Now that the report has been available for several years, the question is how to implement its recommendations, which include increasing the number of nurses with a bachelor's degree or higher to 80 percent by 2020, as well as to increase the number of nurses with doctorates, in order to deal with the faculty shortage.

“I think [the faculty shortage] is the biggest crisis we face,” she said, noting that the average age of a nursing faculty member in Oregon is 56, which means there will be an even worse shortage in a few years as baby boomers retire.

Hassmiller attributed the nursing faculty shortage to poor compensation – “It's very difficult to convince a nurse to take on debt to get a PhD to get a lower salary than they would get normally” – as well as other barriers.

After asking nurse managers to raise their hands and seeing that the majority of the room did, Hassmiller said nurse managers can be one of the major barriers to nurses moving ahead in their career. One reason is practical and understandable: managers want people on the job and may not feel like they can afford to be flexible. Unfortunately, she said, some managers just don't want the workers under them to get more education.

“Being a longtime nurse educator, I think one of the barriers is that we don't really teach how to be a nurse educator,” one audience member said. “When you practice, you go home and you have your life. When you teach, you don't.”

The report's recommendations also include strengthening diversity in the nursing field, and addressing the primary care shortage. Oregon is unique in that mid-level providers such as nurse practitioners and certified nurse-midwives can actually practice at the top of their training, whereas in many states nurse practitioners don't have practice rights to match the training they receive in school.

“Some of those nurse practitioners are being trained and educated and then leave the state,” Hassmiller said, which is a “crime” not only for the providers of nursing scholarships, but also to patients.

She said while the report was being prepared, former Department of Health and Human Services Secretary Dr. Donna Shalala testified on Capitol Hill about an issue relating to patient care, and came back to the Institutes of Medicine meeting saying there were no nurses at the hearing. Suddenly, Shalala understood why the report was being put together, Hassmiller said.

“I think nurses are the reality check in all of this,” she said, referring to federal and state reforms that are changing how care is paid for and delivered. “It's our responsibility and duty to be at the table. We won't always be asked.”

Somewhere between 4 and 6 percent of all slots on hospital boards are occupied by nurses, depending on which data one looks at, and they need to do a better job making their work understood by policymakers and the public – not for their own sake, but for everybody's.

“I feel so strongly about this. This is not about nurses and what's going to make nurses happy,” Hasmiller said. “We have an essential role in patient care in this country.”

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