June 2013

Transformative Education, Transformative Care

By Bobbie Berkowitz, PhD, RN, FAAN
Dean, Columbia University School of Nursing

American Flag Caduceus

Several times a year, a group of deans from the nation’s leading schools of nursing gather in Washington DC to meet with regulators and policy makers on issues of importance to nurses and nursing. Last month, our group -- the Deans’ Nursing Policy Coalition -- met with Patrick Conway, MD, chief medical officer of the Centers for Medicare & Medicaid Services and director of the Center for Clinical Standards and Quality, and Rick Gilfillan, director of the Center for Medicare & Medicaid Innovation. 

These discussions touched on a wide range of topics: expanding nursing’s scope of practice, equitable reimbursement for advanced practice nurses, the need for more evidence-based care, and expanding the role of nurses in the Center’s innovation grant program.  Linking these topics is the Accountable Care Act’s goal of transforming how health care is delivered and paid for in this country.  The conversation concluded with the officials saying how much they welcomed the perspective of nurse leaders, and how rare it was that they heard from the nursing community.

While I am pleased we have access to policymakers and are succeeding in conveying the desire of nurses to play a more active role in national policy making, I wonder why these conversations don’t happen more often at all levels of decision making.

I think a major reason is that nurses may not be viewed as having the experience or knowledge needed to contribute to the dialogue on such issues as redesign of health systems or the development of models of payment. Or to put it another way, policy makers and regulators do not instinctively connect nurses with health care’s big picture debate.

But nurses are doing enormously important work in this area. For example, Patricia Stone, PhD., RN, FAAN, and her colleagues at the school’s Center for Health Policy are conducting research that compares the effectiveness of different models of care that has strong implications for policy and regulatory decision makers.  Dr. Stone also serves on an expert panel of the Centers for Medicare & Medicaid Services, where she is helping identify measures providers will need to adhere to be fully reimbursed for their services.

Still, we as nurses need to do a better job of showing that we have the knowledge required to engage in policy and leadership conversations. Certainly, our clinical experience provides a unique perspective that adds value to the debate. We need to frame that expertise so policy makers take notice. For example, before automatically putting a physician in charge of a patient-centered medical home, let’s talk about who’s really best prepared to organize and manage that care.

All nurses don’t have to be policy experts, economists, or healthcare system designers. But many do need a broader base of understanding about how care is affected by such issues as payment reimbursement and quality.

That’s why transforming how we educate future health care providers is crucial for transforming health care in this country. At Columbia Nursing, we are constantly thinking about what’s truly valuable in order to be effective patient advocates and health care providers. But more is required. The cost of health care in this country is on everyone’s mind. Nurses should have a say about how health care is delivered and paid for. But no one is going to invite us to provide that input simply because there are over three million of us. We need to raise our visibility and expertise profile. A good place to start is for schools of nursing to engage in an educational rebirth that will provide nurses with the credibility to play an active part in improving the nation’s healthcare regulatory and policy framework. That is our aim at Columbia Nursing.