October 8, 2010

The Institute of Medicine’s new report on the Future of Nursing was constructed by an interdisciplinary committee that included physicians. The committee’s mantra is that the report’s recommendations were developed with a focus on what will improve health care in the U.S. and the health of its people. The recommendations acknowledge that nurses can and must play leadership roles in redesigning and providing care. (This video

features former AARP CEO Bill Novelli talking about the importance of nurses leading in the redesign of health care; he was a member of the IOM Committee.) This doesn’t mean nurses run everything but that they are key members of interdisciplinary teams and may lead these teams, as nurses already do in some places.

So it was quite disappointing to see the response of the American Medical Association to the report.  Organized medicine continues to frame their arguments through a lens of quality and safety. But it’s a false argument, as the evidence in the IOM report documents.

The AMA response also reflects a poor understanding of what is needed in a transformed health care system. If we’re to improve the health of people while reducing costs, we must shift to a focus on health promotion, chronic care management, care coordination, and self-care management. Physicians are not prepared to provide these services.

The AMA (and others who want to better understand the current turf battle waged by organized medicine) should read legal scholar Barbara Safriet’s work, including her section of the IOM report on the Future of Nursing. She documents that medical practice acts were written so broadly that they try to encompass all of health care. In today’s world, the knowledge explosion should force us to consider who is educated to do what piece of health care. Safriet has delineated the statutory and regulatory changes that are needed to support contemporary interprofessional practice that can be led by professionals that can include not just physicians but nurses, social workers, psychologists, and others.

I would argue that nursing is the profesison that educates its practitioners about the physical, psychological, social, and environimental dimensions of individuals, families, and communities. This education prepares nurses to bring an important, holistic vision to the work of health care and positions them to be great leaders of interdisciplinary teams. But context is also important and team leadership should not be the purview of any one profession. TCAB, Transfroming Care At the Bedside (an initiative for improving care in acute care facilities that uses nurses and other providers of care as change agents), demonstrated that sometimes the best person to lead the team initiative may be a nursing assistant. And a social worker would probably be the best person to lead an interdisciplinary team (that includes physicians and nurses) that provides care to people with chronic mental illness who have established solid relationships with their community mental health service.

The AMA needs to examine its motives and aims. This is the time to focus on what people need to promote their health in affordable, accessible, equitable ways.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing