Beth Houser and Loretta Ford continue their conversation in the sixth installment of The
If nursing is going to be transformational in the next paradigm, we’re going to have to transform how we see ourselves. As a nursing leader, what would you say? How would you instruct us to create the next generation?
Loretta “Lee” Ford: It’s something within you. If you have the passion and fire in your belly to see things that could make a difference, then you’re going to stick your neck out and go for it. I would grab some power. Right now they are thinking about using nurses for primary care, because there are not enough physicians and we’re going to have this influx of 30 to 40 million people, right?
I would tell them, “We’ll take over primary care, only we will make it primary health care, because we don’t believe the primary-care system as it’s now run adequately deals with prevention and health promotion, and we have something to offer in relation to promoting health and changing the behavior of people. But, we don’t want to be substitutes for a dying system.” So that’s the first thing I would do. I would make sure nurse practitioners make that position very clear and reorient the whole system to primary health care and run community health centers under nursing models.
This is a political problem, not a professional problem. We know how to do all this. It’s a political problem, so we have to use political strategies. What do political strategies require? Money, relationships, and powerful celebrities who are going to support us in this and have a real commitment to it.
Houser: Shifting gears just a bit, Lee, but certainly germane to what we’re talking about: Central to a lot of reform is how we break the glass on the legal barriers or the litigious nature of our culture. What would you say about that?
Ford: I think our litigious nature is really due to a lack of communication between providers and patients. When you communicate well, patients understand mistakes will be made. If you’re upfront about it and deal with it right from the get-go, people understand that and trust you. It’s a matter of trust. It’s going to take something to keep that, but I think we’re in a good position to do so. So, first of all, communication is vital to preventing a lot of useless litigation.
Secondly, we have to really examine with the patient what is necessary and what the outcomes may or may not be. Is it worth it and what’s it going to cost? Not only cost in money but cost in suffering, anguish, inability to produce, and all that sort of thing. I think nurses at the bedside are the best antilitigationists available to anybody in the system.
Houser: What you’re saying is really evidence-based, in the sense of admitting a mistake, apologizing, and offering a rendition of how this won’t occur again. The real concern is that so much of the cost of care is bundled up in fear of litigation. It’s truly a juggernaut out of control.
Ford: If you live in fear of litigation, you will never be able to practice almost anything. What you have to do is to build in the insurance ahead of time to the best of your ability, and then communicate the risks and let the patient make the decision. Do you want to take this risk? I can’t do that for you. I’ll do the best I can to avoid it, but do you want to take the risk? If they say “Yes, I’ll go for it,” then that’s their part of the decision-making.
Houser: History is a great teacher. What does history teach us now? As somebody who’s been there, done that, what would you say to us?
Ford: We learn very little from history. Even though it teaches us lessons all the time, we can’t seem to keep from repeating our mistakes. First of all, history occurs at hindsight. We don’t have future history, so to speak. You’re looking at it from the perspective of hindsight. You can reflect on history, but it’s very hard to understand it sometimes, because you’re doing it in the context in which you live. (Since you don’t live in that same context of time—the time in which history occurred—it’s hard to understand it.)
If you have the passion and fire in your belly to see things that could make a difference, then you’re going to stick your neck out and go for it.
I try to look at whether it’s an enabling environment or not. For example, we had an enabling environment in 1960. I didn’t appreciate it until I looked back on it. We probably would not have gotten anyplace if there hadn’t been some political and social upheaval and turbulence. Today, I think we have an enabling environment before us, and what we can learn from history is that it isn’t only one thing or one person or one idea but the environment in which the idea is planted. By taking advantage of the environment—the opportunity, the chaos—the timing of change is almost more vital than the change itself. Gauging that requires you to have a broad view, a vision of not only what could be
but what was
, how it was dealt with, what was effective, what wasn’t, and would it work in this time.
Houser: So how’s the timing for nursing?
Ford: I think it’s the best in the world right now! You know, Donna Shalala [president of the University of Miami] says this is the golden age of nursing, and I believe it, because I think we have something to offer. I think we have a framework in the Affordable Care Act to build that. You know, nurses are there. They are a presence. So when we talk about making changes, we have the best opportunity in the world to bring about change, because we can do it. We can monitor it. We can evaluate it, but we’re there. You know, Tip O’Neill [former Speaker of the U.S. House of Representatives] used to say that the most important part of politics is showing up. We not only show up, but we’re in working clothes. We don’t appreciate sometimes the opportunities we have.
Houser: I think that, today, we have more value in the eyes of our physician colleagues and certainly in the eyes of the agenda makers at the political level than ever before.
I agree with that, but how far does that value go in providing the support we need from state legislators to practice to the full extent of our knowledge
? I want to see action on that! They support us because we provide them with a conduit to direct patient care, and we provide information and all kinds of recommendations that they need to know. And they’re using the idea of “team.”
Team care is not new to nursing. We’ve been doing team care forever. We know what it is to function in teams, but we also know what it is to lead teams and have a rotating captain. When you look at the team literature that medicine is putting out, it’s always, yes, we appreciate the NPs and so forth, and then, all of a sudden, you come to the end, and it’s, “Of course, the physician will remain the captain of the ship.”
Well, heck, I don’t want to be part of a ship that’s sinking. So I think, if they’re willing and are really appreciative of our value and worth, then I want to see them, as state legislators, fighting with us for the freedom to practice to the full extent of our knowledge. I want action, and I want the AMA to get off our backs!
Houser: You’re right. And it’s interesting today, Lee, edging up on 50 years after the beginning of the nurse practitioner movement, there isn’t a physician in the nation who, when he or she talks about Obamacare, doesn’t almost immediately say, “And nurse practitioners must lead the way.” Think about the power of that! Would you have ever dreamed you would live long enough to hear that?
Ford: I won’t live long enough to hear that one, I’ll tell you.
Houser: It’s happening now!
Ford: Oh, they’re not there, not as long as we report to them. Read carefully what’s written.
Houser: That’s true. They are probably still saying that from a position of control.
Ford: I think there should be a “rotating cabinet.” Sometimes, it shouldn’t need to be the nurse or the physician. Maybe it should be the social worker or the pharmacist or the patient.
Houser: I sometimes feel that nursing loses its voice because we become too nurse centric as opposed to patient-care centric. I’m sure you’ve seen, as I have, banner-carrying for the nursing flag and nursing flag alone. How would you counsel future leaders on that subject?
Ford: I always try to put in this phrase: In the public good. It’s not for us, but in the public interest that we be allowed to practice to the full extent of our knowledge. If it isn’t in the public interest, it’s not worth anything. Keeping that in the forefront of whatever we’re doing or saying is vital. It’s not for nursing; it’s only for nursing to be able to respond to the needs of the public—the health needs, not the medical needs.
The language we use makes a difference. Anytime they talk about us replacing medical care, I say, “We don’t do medical care. We do health care.” Part of that may be medicine, part pharmaceutical, part healthy lifestyle. This is a holistic orientation. It’s not medical care per se, but health care that people need. The language we use gets us into a lot of trouble sometimes, and our literature sometimes drives me crazy. What to do—I’m trying to change the world before I die, but I’m not doing too well.
Houser: Oh, think of how you’ve changed the world already.
Ford: Yeah, right! That’s another thing. There are 180,000 or whatever nurse practitioners and probably some 250,000 advanced practice nurses. Those people are changing the world, not me. Of course, I kicked it off a little bit, but that was nothing compared to what they are doing and have done over the past 50 years. Here it is, half a century, and we’re still talking about it like it was yesterday.
Houser: It all started with the vision, the belief. It was one very wise, very courageous, very strategic leader who started that.
Ford: I’m interested in the past only if I can learn from it. I do like history, but I’m interested in where we’re moving from here on out.
Houser: As we wrap up, any other thoughts you’d like to share?
Ford: I’m optimistic, I can tell you that. I think we’re going to have a chance. I see the young kids coming up, and I’m thrilled at their enthusiasm and their energy. I think they’re going to be a star. They’re a strikingly good group to lead, and I think the schools are really trying to do a great job in terms of preparing them for that. And the schools are going to have to change, of course, but the kids will change them, I’m sure. I really am optimistic about the future. Sometimes, I’m very critical of it, but criticism moves you ahead.
Houser: That’s right!