Fran Roberts, PhD, RN
The nursing profession is often referred to as the backbone of the healthcare delivery system in the United States. After all, it is the professional registered nurse who is present during the night with hospitalized patients, when physical therapists, physicians and social workers are fast asleep. And it is the nurse who is left to comfort the family when a loved one dies and to remain steadfast with parents when a premature infant is born.
So it seems an easy and logical leap to view the nursing profession as the spine of our newly envisioned and much debated healthcare reform system. The very essence of nursing theory and practice holds healthcare is a right, not solely for the individual patient but also for their families and communities. Nurses deliver care regardless of ability to pay, cultural background or social status.
Stepping Up
With the exodus of physicians from the arena of primary care, it is the registered nurse and nurse practitioner who are stepping up to the plate. With an estimated 2% of graduating physicians entering the family practice field, nurse practitioners will become the lead providers of this care. It is primary care that is the lynchpin of any reformed healthcare plan.
Nursing is also called the glue of healthcare in the United States. This metaphor relates to the role nurses play in negotiating the complex and many times bureaucratic tangles a patient and family encounter in attempting to receive the right care at the right time. Through case management, the registered nurse advocates on behalf of the vulnerable individual, frequently serving as the translator between physician and family. Again, case management is a pivotal piece in all healthcare reform blueprints.
Rationing: a Nurse's View
A highly inflammatory term bantered about in the healthcare reform discussion is "rationing." Seen dogmatically, the rationing of healthcare is viewed as a polarized, either/or phenomenon. In one plan or another, people either receive a certain prescribed procedure (medication, technology) or not, based on predetermined criteria, frequently advanced age.
Nurses have co-existed with the rationing of healthcare from cradle to grave. When the patient's family asks the question, "What should we do with our dying father?" the question is most frequently directed towards the nurse. Professional nurses know withholding life saving or unnecessary care is a reality and one that sometimes serves the patient and their family well.
Another essence of nursing practice is viewing patients in a contextual perspective as part of their greater life. Through that view, what is the right decision for one individual may not be the best for another. The profession believes it is the individual's right to choose, based on appropriate information and his or her belief system.
A natural balance exists between those who would desire extensive treatment and those who are comfortable deciding against such care. Again, a pivotal point here is providing full disclosure of the potential outcomes, costs and risks of making such a decision. Any reform initiative must empower individuals, families and communities with education and knowledge to make informed decisions. This is what nurses do so very well.
Although these points may seem overly simple in the complex arguments raging about healthcare reform in our country, it is in such simplicity that the chaos surrounding this controversy can gain order. Nurses have led the way, economically and all too quietly, in providing a majority of care that has been given to our country. It is time for nurses to speak, and for the United States to listen.
Fran Roberts, PhD, RN, is vice president at the College of Nursing and Health Sciences at Grand Canyon University, Phoenix.
