© iStockphoto.com/Annett Vauteck

On June 12, 2009, I--along with over 200 others--attended a forum hosted by the Health Affairs journal and the AARP/Robert Wood Johnson Center to Champion Nursing in America.  The forum, “Nursing Workforce Solutions for the 21st Century Health Care: How Do We Get There?” celebrated the recent collection of papers from Health Affairs focused on "Building a High-Value Nurse Workforce."

During a panel moderated by Susan Reinhard, Senior Vice President and Director of AARP’s Public Policy Institute, Peter Buerhaus, Director, Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, alerted us to an irony in the status of the ongoing nursing shortage. The recession is causing a “false read”; i.e., the poor economy is encouraging retired nurses to return to the workforce, making the nursing shortage look less severe. Buerhaus warned we must not let this stopgap measure make us lose sight of the need to encourage new nurses into the field.

Susan Hassmiller, Senior Advisor for Nursing at the Robert Wood Johnson Foundation, charged her panelists to consider what would happen if nothing was done to address the nursing shortage in light of health care reform. Linda Aiken, Professor in Nursing and Director, Center for Health Outcomes and Policy Research, University of Pennsylvania, then pointed out opportunities presented by the recession: the field of nursing can take advantage of new federal dollars, while enjoying the largest pool of talented nursing applicants ever.

Despite the diversity of the speakers, three themes emerged. First, all agreed that transitional care models to ensure coordinated health care between settings are essential and should be supported in terms of dollars and federal policies.  Since we have funded such programs here at Hartford—such as Care Transitions and the Transitional Care Model--I was pleased to find wide support among my colleagues for these strategies.

Secondly, all agreed that nursing education is key. We need more baccalaureate-trained nurses, and society cannot afford to underestimate the value of the master’s-trained nurse. However, not everyone agrees on what nursing education should include. What is often notably absent from many nursing-driven health care reform discussions is the demographic mandate to better prepare our nursing workforce (shortage or not) to provide quality care to older adults.  I work for the Hartford Foundation because I wholeheartedly endorse our mission to improve the health of older adults by creating a more skilled workforce and a better designed health care system.  While change within the health care system may be slow as we drag our reform heels, our country will continue to age at a rapid pace.  Unless we take measures to ensure that ALL nursing graduates are exposed to aging within the course of their education (be it at the associate, baccalaureate, master’s, or doctoral levels), the health care of older adults will suffer.

This said, I applaud the authors of the Health Affairs article “Expanding the Capacity of Nursing Education” for citing the American Association of Colleges of Nursing’s tools for creating competency-based curriculum (which include a gero focus in the Essentials of Baccalaureate Education) and the “Try This” assessment series that provides best practices in caring for older adults.  These free, Web-based resources are available to all faculty to begin this important work of arming nursing students with the skills to provide good care to our older population.

The topic of disagreements about educational requirements brings me to the last, and perhaps most important, theme: nursing needs to speak with one voice.  From a policy perspective, the fragmentation of nursing is dangerous. We know there is discord within the field (DNP--doctor of nursing practice, associate's degree nurses), and mixed messages will prevent progress. There is definitely one thing the field can agree on, however: nurses are at the forefront of patient care, and nursing has a major role to play in health care reform.