UNIVERSITY PARK, Pa. -- In an era of health care reform, the role of nurses is more important than ever. Today’s workforce seems poised to respond to the changes, with more and better-educated nurses, steady employment growth and higher earnings. But with greater opportunity come greater challenges, and the profession’s leadership must adapt to keep pace with a rapidly evolving health delivery system.
Professor Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, was the guest speaker at this year’s Jean Vallance Lecture in Nursing Innovation on March 31. Buerhaus presented his research on the current strengths and vulnerabilities of the nursing workforce in the context of uncertainties surrounding health reform.
The past five years have seen a sharp increase in nurses pursuing advanced degrees at all levels, and a corresponding increase in earnings shows that “the marketplace recognizes the value of additional education,” Buerhaus said.
In addition, more people are entering the nursing profession—enough to replace the approximately 1 million registered nurses who will likely retire by the year 2030. However, Buerhaus said, “it’s not clear whether the total national supply will match demand” for nursing services over the next 15 years, since aging baby boomers will require more nursing care services.
The implementation of the Patient Protection and Affordable Care Act has generated much enthusiasm for the potential contributions of nurse practitioners as primary care providers, especially in rural areas, Buerhaus said. Physicians are significantly less likely to practice in rural areas, which tend to have the highest rates of uninsured patients, especially in non–Medicaid expansion states.
“Primary care nurse practitioners (PCNPs) are more likely to practice in rural areas, where the need is greatest,” he said. “Lifting the scope of practice restrictions on these NPs (i.e., allowing them to work without physician supervision) is likely to expand access to care—not overnight, but over time.”
Although PCNPs provide services similar to those provided by physicians, they are more likely to care for vulnerable populations and use fewer and less expensive resources, which “could mean substantial savings for Medicare and Medicaid,” Buerhaus said. “Even better, the quality of care provided by PCNPs is better in some areas than care provided by physicians.”
Nursing also enjoys a strong positive public perception, having been ranked as the most trusted profession for the 15th consecutive year by Gallup, Inc. (December 2016). “Americans admire, trust, and respect nurses above all other professions” and rely on them for quality assurance and safety in health care, as well as advice on personal health issues, Buerhaus said. “Our study of Washington, D.C., health policy thought leaders showed that the vast majority agree that nurses are ‘very important’ to quality and safety.”
Despite the evidence showing the importance of nurses in today’s health care environment, the profession is vulnerable to a number of unprecedented challenges, Buerhaus noted.
“Most nurses are not prepared for a system of value-based payment” where value translates to health incomes relative to the costs of achieving those outcomes, he said. “We are moving away from a fee-for-service model to one of outcomes versus costs.”
In addition, the nursing workforce is seeing uneven growth across the country, with some areas not producing enough new nurses to replace those retiring over the next ten years. “One-third of the registered nurse workforce is retiring—that’s 2 million years of nursing experience leaving the workforce each year,” he said. The large baby boom generation is getting older and experiencing more chronic and degenerative conditions, increasing the overall demand for nurses as well as the intensity of care required.
New directions for health reform present additional challenges, with an increased emphasis on consumerism, elimination of personal and corporate mandates, and continued changes in insurance coverage.
“The next 10 years will be the most important period the U.S. nursing profession has ever faced,” Buerhaus said. “Nurses will face more challenges than at any time in our history, but also have unprecedented opportunities to shape the system and increase their influence everywhere along the care delivery continuum.
“Taking advantage of these opportunities will require leadership from all sectors of the nursing profession: practice, administration and management, education, research, policy, and unions, among others,” he concluded. “The challenge for nurse educators will be focusing their students to see themselves as leaders who anticipate challenges, see the big picture, motivate others to focus on opportunities, and create conditions that help achieve common goals.”
The Jean Vallance Lecture in Nursing Innovation is an endowed lecture series presented by Penn State’s College of Nursing to honor Jean S. Vallance, a 30-year resident of State College who passed away in 1997. Vallance helped organize the Family Planning Clinic, later known as Family Health Services, to bring low-cost health care to women in central Pennsylvania. She was among the first nurses in Pennsylvania to be registered as a certified registered nurse practitioner (CRNP). Her husband, Theodore Vallance, was a former associate dean in the College of Health and Human Development and avid supporter of the College of Nursing.