September 11, 2009

Speaker looks at health reform’s impact on nursing

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Barbara Safriet, R.N., J.D., delivers VUSN’s Patricia Townsend Meador Lecture. (photo by Mary Donaldson)

Speaker looks at health reform’s impact on nursing

Vanderbilt University School of Nursing recently hosted Barbara Safriet, R.N., J.D., former associate dean for Academic Affairs and Lecturer in Law at Yale University, to kick off the first annual Patricia Townsend Meador Lecture series and to welcome new and continuing Ph.D. and Doctor of Nursing Practice (D.N.P.) students who started back to classes last week.

Safriet divided her lecture between two hot topics among health care providers — health care reform and scope of practice issues for advanced practice nurses.

Regarding reform, Safriet said that from her personal perspective,

“Nobody is really talking about health care reform. They are talking about health care insurance reform or health care financing reform. Health care delivery is not central at this point.”

She hopes that important nuance will be addressed as the reform debate continues this fall.

She pointed out that the current system is based around illness from a policy perspective, rather than health promotion or prevention. “There aren't even billing codes for health, only for illness,” she said.

She told the audience that the cost of health care is illusive because few people have ever paid for 100 percent of any one procedure.

Third-party payers and various cost-shifts keep the consumer from understanding the accurate cost of their health care and, therefore, it's hard to judge if health care reforms will be less expensive or more valuable.

Safriet made some observations in the educational arena about what could improve the health care delivery process, chiefly, restructure educational systems for all health care providers to encourage team practice approaches, de-emphasize tertiary care in high-tech facilities in favor of community clinics, stop increasing entry-level licensure for all health care providers.

Regarding scope of practice, Safriet said that “the heart of professionalism is collaboration, knowing your strengths and weakness and seeking out advice and counsel” on behalf of everyone on the health care team, not just as a requirement of nurse practitioners, advanced practice nurses and nurse midwives.

She said that scopes of professional practice inherently overlap, but often state regulations lock in specific health care providers into limited roles.

Safriet said this practice environment is a “historic artifact that preserves the status quo of the regulatory regime” and that, most importantly, it does not serve patients well.