When we talk about health care reform, one of the key elements sometimes left out of the conversation is the important role that nurses will play in achieving in the desired outcomes – affordability, improved access, prevention, and better health outcomes.
PBN spoke to Rick Brooks, the director of United Nurses & Allied Professionals in Providence, about his ideas and insights about the future role of nurses in the evolving health care landscape. Will there be a continuing nursing shortage? How will contract negotiations scheduled with Rhode Island Hospital be affected?
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PBN: How is health care reform changing the role of the nursing profession here in Rhode Island? Will it create a greater need for nurses, sparking another shortage?
BROOKS: It is a bit soon to predict the impact of health care reform, but it is likely that nurses will have an expanding and evolving role in our health care system in the years ahead. As greater emphasis is placed on primary care and wellness, we are likely to see an increasing demand for nurses in outpatient settings with perhaps a corresponding drop in demand on the inpatient side.
We also expect to see increased demand for nurses who have a bachelor’s degree or higher. Our nursing schools and work force development system will need to be adaptable and have sufficient resources to meet these changing demands and avoid future shortages.
PBN: In the new contracts being negotiated between hospitals and health insurance companies, there has been discussion about how to lower costs, improve access and quality of care, with incentives to improve outcomes. What role will nurses play in these new models for health care service delivery?
BROOKS: Many of the quality measures by which hospitals will be evaluated and paid in the future are known to be “nurse-sensitive indicators,” meaning that nursing care is a major factor in determining the outcomes. Research has shown, for example, that the number of patients per nurse directly affects the frequency of pressure ulcers (bed sores), hospital-acquired infections and patient falls.
In order to improve the safety and quality of patient care, hospitals will need to work closely with nurses and their unions to ensure that nurses have adequate staffing, training, resources, and opportunities to be full partners in efforts to improve patient outcomes.
PBN: Next year, as you move into negotiations with Lifespan, how can the nurses’ union avoid some of the pitfalls that have befallen the teachers’ unions in Rhode Island?
BROOKS: Teacher unions have been unfairly portrayed as uncaring. Our union has always worked hard to make clear that the interests of our patients and our members are very closely aligned. We know that when health professionals get the respect and support that they need to do their jobs well, patients are the beneficiaries.
In our negotiations at Rhode Island Hospital next spring, as in all our negotiations, we will work hard to expand the role and voice of nurses and other health professionals to ensure safe, quality care for our patients, and job satisfaction for our members.
PBN: How do you see the business model for the acute care community hospital in Rhode Island evolving? How will the nursing role change, as the business model changes?
BROOKS: Traditionally, hospitals have been paid under a fee-for-service model, which means that the more patients they see, and the more procedures they do, the more they get paid.
More recently, however, Medicare, Medicaid and private insurance companies have been designing new ways to pay hospitals that will incent them to keep patients healthy and out of hospitals. This will require hospitals to partner with physician groups and other health care providers to develop new business models, with very different objectives.
While there will always be a need for acute care hospitals and nurses, there are likely to be new opportunities for nurses in community settings such as primary care, home care and hospice care.
PBN: What have been the results and outcomes of the Stepping Up program with Dorcas Place and Genesis? Has it helped to improve the ability of Rhode Island nurses to enter the workplace?
BROOKS: Several years ago, our union led the formation of Stepping Up, in order to provide a pathway to health care jobs and careers for low-income Providence residents and entry-level hospital employees.
In partnership with Dorcas Place, Genesis Center, Rhode Island Hospital, Women & Infants Hospital, the Community College of Rhode Island, the Teamsters, the SEIU, United Way of Rhode Island and several other funders, Stepping Up has inspired nearly 250 participants to learn new skills, continue their education, and pursue a degree in nursing and other “high-growth, high-demand” health care jobs.
In coming years, we will see many of these participants become nurses and technologists, which will help to ease future labor shortages and create a more culturally and linguistically diverse work force.
