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The Connection is an open conversation, a group blog, and a nonpartisan effort to spark a rich discourse on fundamental values in health reform. Anyone can submit a post, and a selection of posts will appear here, on the Health Affairs blog, and in an upcoming volume.
10.12.09
| From The Hastings Center
The health reform debate, like so many debates in ethics and policy related to health care, tends to assume that the representative “health care professional” is a physician. For many months, American have heard how the various reform proposals would affect physician’s autonomy, practice, income, terms of employment, and so on. No one would argue that the interests of physicians are not integral to this debate.
But let’s look at the numbers. According to recent data from the American Medical Association, there are 921,904 physicians in the United States. According to recent data from the Bureau of Labor Statistics, there are 2,505,000 registered nurses.
These millions of nurses have opinions on health reform. As a profession, they’re for it. Strongly for it. The American Nurses Association takes the position that health care is a human right, and that the failure of a society to provide basic care to its citizens also fails nurses in their professional role. The ANA argues that a public option is the option that is most likely to support the professional integrity of nurses, as shifting the system’s focus toward access to prevention, chronic disease management, and primary care will do a better job of deploying one of the system’s limited resources: nurses themselves.
There is evidence that the current health care system’s well-documented incentives, rewarding quantity rather than quality, are particularly hard on nurses, who are responsible for hands-on care and so spend significant time with patients and families. Research on the problem of moral distress in health care – those situations in which a health care professional perceives that structural conditions are preventing the professional from acting in patients’ best interests or are forcing the professional to act against patients’ interests – suggests a connection between nurses’ professional integrity and how nurses are deployed. According to one recent study comparing physicians’ and nurses’ perspectives on the care of dying patients in the ICU, 45% of nurses surveyed told investigators that they had quit, or considered quitting, a job due to moral distress.
There is a chronic shortage of nurses in the US. If the current health care system’s incentives and the outcomes it produces are putting such pressure on nurses’ professional integrity that nurses consider leaving jobs – or the profession itself – a system oriented toward those interventions that require the highest nurse-to-patient ratios will not be sustainable on the basis of workforce as well as cost.
Nancy Berlinger is Deputy Director and a Research Scholar at The Hastings Center and teaches health care ethics in the Nursing Management, Policy, and Leadership graduate program at Yale School of Nursing.
value: Efficiency, Fairness, Integrity
Annie Kreider, EdD(c), EdM, RN
10.13.09
I’m a former nurse who believes that the profession is failing in a catastrophic manner.
Nurses are still unable and unwilling to serve as proper patient advocates, and they still refuse to reach consensus on vital issues which underpin the (?) profession.
Members of the public have no idea about how poorly professional nursing is practiced until they need professional nursing services, and what they receive instead is lacking professionalism, practice autonomy and essential advocacy.
The American Nurses Association has failed to serve as a standard bearer in these areas, and into the breach have lurched unions, none of which is headed by nurses (California Nurses Association, SEIU, etc).
Nurses have passively and aggressively tried to outsource their autonomy by asking for patient ratio legislation rather than forming professional practice organizations which self regulate and contract directly with groups of patients and patient care organizations.
Their voices have only been used for photo-ops by the Obama Administration, and few nurses are involved in policy formulation and operations.
I follow the American Association Colleges of Nursing’s white papers in order to keep current on issues vital to professional nursing, because the ANA doesn’t even bother to publish white papers for the public, nor does it respond to questions by non-members – hardly a way to represent American nursing to the public and to all nnurses.
deb
10.13.09
We want to be caregivers, not gatekeepers. Big insurance and thier profit seeking bedfellows should be ashamed of forcing this role upon us under the guise of “care management”. We want to provide our care based on need, not ability to pay. After 25 years in the trenches of acute care, physician clinics and case managment I quit!
Carol
10.13.09
I agree with Deb 10/13/09, except for one thing..I am not giving up the fight..yet. After twenty years in the profession I still have some hope that it will improve. As for Annie Kreider’s comment that nurses can’t or won’t be patient advocates, I heartily disagree. I think nurses who entered this profession for all the right reasons, wanting to help people, wanting to make a difference in their lives, and
answering a calling that I think is as strong as any of a priest or minister, are truely patient advocates. Those nurses who chose to be nurses because of the good income and almost endless amount of jobs have a different attitude. They are the ones who have tarnished our profession. I know because I work with both kinds of nurses.
Maureen
12.20.09
I have 37 years as a practicing nurse.I have been disppointed in Nuring Leaders all these years. I joined th fight to remove my cap, to be able to wear pants to work, to tell the doctor to get his own chair. In have demanded that everyone respect my knowledge not just my ability to perform skills. The national nursing organizations need to stop writing white papers and become more activist in nature bringing forth the concept of an intelligent, knowlegeable nurse who utilizes cognitive forces while assisting patients/clients in their particular perceived quality of life. We as nurses must cure as ills here at home before we begin to solve the global ills.