Journal of Nursing Education

Guest Editorial 

Clinical Education Reform: Reenvisioning the Workforce

Nancy Ridenour, PhD, APRN, BC, FAAN

Abstract

The author has no financial or proprietary interest in the materials presented herein.

Having recently completed an intense 18 months as a Robert Wood Johnson Health Policy Fellow working with the Committee on Ways and Means for the United States House of Representatives, I find myself juggling several perspectives as I reenter the world of nursing academia. Clearly, the country is ready for a reformation of how we deliver and pay for health care. Issues of cost, quality, and access are paramount in the federal discussion. Nursing has potential solutions for these issues.

As the ideas for what should be done are debated, rehashed, and revised, I am faced with an increasing sense of disquiet and, at times, outright alarm. While I wholeheartedly support the idea of providing coverage and quality care to all, I am fully aware that we do not currently have the workforce in sufficient numbers, with the correct skill sets, nor deployed in the areas of most need. What if a miracle happens and we do have health care for all? Who will provide and manage that care? It is well established that nursing faculty are in short supply and high demand. Even in the current economic downturn, it is likely that nurses will be needed in growing numbers and in expanding roles as health care reform winds its way into law and then regulations. Our country faces a health care professional workforce crisis!

What are we doing as faculty and deans to prepare for a future that cries for us to step up to the plate in a very big way? Are we still stuck in the old ways at a time that demands a much broader perspective? What are we doing to ensure nursing’s rightful place in the future of our nation’s health care? We need a reformation in how we prepare nurses to meet the challenges of the future. As our current acute care-oriented system morphs to meet the prevention and chronic illness needs of the majority of our population, it is clear that nurses of the future must be facile in leading and working in interprofessional teams. Continuity and coordination of care are milestones we must achieve. We currently have too few models of team-based clinical education. Academic nursing must meet the challenge of developing models of team building, functionality, and sustainability.

I am anticipating your first response. It goes something like this, “Our clinical sites are already stretched so thin. How can we do anything more? How will we pay for this? We tried teams before.” Here are two big lessons I learned while working on Capitol Hill:

What if we worked to secure a recurring, dedicated source of funds to the health care professions? What if we advocated for graduate medical education funding for interprofessional education, for internships for new nurses, and for residencies for advanced practice nurses? What if we requested increased funding from the National Institutes of Health and from the Agency for Healthcare Research and Quality for team science? What if we learned to overcome interprofessional territoriality? What if Medicare reimbursed at a higher rate for inter-professional teamwork, rather than the current model of overvaluing discrete procedures? What if we seriously applied simulation across disciplines to expand our clinical expertise?

Coalitions and partnerships serve to heighten awareness of the issues facing nursing clinical education and foster broad-based support. Now is the time for nurses and the profession of nursing to collaborate to bring about needed policy changes. We have several resources to assist us in our efforts. The Consensus Statement (Nursing Community, 2009) includes several legislative and…

The author has no financial or proprietary interest in the materials presented herein.

Having recently completed an intense 18 months as a Robert Wood Johnson Health Policy Fellow working with the Committee on Ways and Means for the United States House of Representatives, I find myself juggling several perspectives as I reenter the world of nursing academia. Clearly, the country is ready for a reformation of how we deliver and pay for health care. Issues of cost, quality, and access are paramount in the federal discussion. Nursing has potential solutions for these issues.

As the ideas for what should be done are debated, rehashed, and revised, I am faced with an increasing sense of disquiet and, at times, outright alarm. While I wholeheartedly support the idea of providing coverage and quality care to all, I am fully aware that we do not currently have the workforce in sufficient numbers, with the correct skill sets, nor deployed in the areas of most need. What if a miracle happens and we do have health care for all? Who will provide and manage that care? It is well established that nursing faculty are in short supply and high demand. Even in the current economic downturn, it is likely that nurses will be needed in growing numbers and in expanding roles as health care reform winds its way into law and then regulations. Our country faces a health care professional workforce crisis!

What are we doing as faculty and deans to prepare for a future that cries for us to step up to the plate in a very big way? Are we still stuck in the old ways at a time that demands a much broader perspective? What are we doing to ensure nursing’s rightful place in the future of our nation’s health care? We need a reformation in how we prepare nurses to meet the challenges of the future. As our current acute care-oriented system morphs to meet the prevention and chronic illness needs of the majority of our population, it is clear that nurses of the future must be facile in leading and working in interprofessional teams. Continuity and coordination of care are milestones we must achieve. We currently have too few models of team-based clinical education. Academic nursing must meet the challenge of developing models of team building, functionality, and sustainability.

I am anticipating your first response. It goes something like this, “Our clinical sites are already stretched so thin. How can we do anything more? How will we pay for this? We tried teams before.” Here are two big lessons I learned while working on Capitol Hill:

  • Annually, we spend inordinate amounts of time and effort to rescue Titles VII and VIII from cuts in the budget or in appropriations.
  • Medicare drives the system in terms of the size of the budget and in terms of setting policy for other payers. Nursing must address both Medicare and Titles VII and VIII if we are to make any headway.

What if we worked to secure a recurring, dedicated source of funds to the health care professions? What if we advocated for graduate medical education funding for interprofessional education, for internships for new nurses, and for residencies for advanced practice nurses? What if we requested increased funding from the National Institutes of Health and from the Agency for Healthcare Research and Quality for team science? What if we learned to overcome interprofessional territoriality? What if Medicare reimbursed at a higher rate for inter-professional teamwork, rather than the current model of overvaluing discrete procedures? What if we seriously applied simulation across disciplines to expand our clinical expertise?

Coalitions and partnerships serve to heighten awareness of the issues facing nursing clinical education and foster broad-based support. Now is the time for nurses and the profession of nursing to collaborate to bring about needed policy changes. We have several resources to assist us in our efforts. The Consensus Statement (Nursing Community, 2009) includes several legislative and policy recommendations that are being considered in Congress. In addition, several groups are working on securing a dedicated and recurring source of funding for nursing education in the form of capitation funding in Title VIII (Nurse Education, Expansion, and Development Act of 2009; Senate Health, Education, Labor and Pension Committee Hearing on the Affordable Health Choices Act of 2009). The June 12, 2009, edition of Health Affairs contains several articles focused on nursing education policy (Aiken, Cheung, & Olds, 2009; Cleary, McBride, McClure, & Reinhard, 2009). The Center to Champion Nursing in America—a joint initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation—is also calling for revamping the Medicare funding system to support graduate nursing education (AARP, 2009). This plan will increase support for clinical education for advanced practice nurses prepared to care for the Medicare population.

These are just a few examples of the opportunities for nursing clinical education in this time of change. The time is now to keep asking “What if?” and to seek solutions through collaboration with new partners to truly achieve health care reform!

Nancy Ridenour, PhD, APRN, BC, FAAN
University of New Mexico College of Nursing
Albuquerque, New Mexico

References

  • AARP. (2009). Providing the nurses we need to improve health care for all Americans: AARP health care reform priorities. Retrieved June 15, 2009, from http://www.aarp.org/makeadifference/advocacy/GovernmentWatch/Nursing/articles/providing_nurses_we_need.html
  • Aiken, L.H., Cheung, R.B. & Olds, D.M. (2009). Education policy initiatives to address the nurse shortage in the United States. Health Affairs, 28, w646–w656. doi:10.1377/hlthaff.28.4.w646 [CrossRef]
  • Cleary, B.L., McBride, A.B., McClure, M.L. & Reinhard, S.C. (2009). Expanding the capacity of nursing education. Health Affairs, 28, w634–w645. doi:10.1377/hlthaff.28.4.w634 [CrossRef]
  • Nurse Education, Expansion, and Development Act of 2009, S. 497, 111th Cong. (2009).
  • Nursing Community. (2009). Commitment to quality health reform: A consensus statement from the nursing community. Retrieved June 15, 2009, from http://www.aacn.nche.edu/Government/pdf/ConsensusStmnt.pdf
  • Senate Health, Education, Labor and Pension Committee Hearing on the Affordable Health Choices Act of 2009, 111th Cong., (2009) (testimony of C. Fay Raines).
Authors

The author has no financial or proprietary interest in the materials presented herein.

10.3928/01484834-20090717-01

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