As the nation continues its historic effort to overhaul health care under the 2010 Patient Protection and Affordable Care Act, nurses have been working quietly for the last decade to implement their own brand of reform. Nurses have been redefining and expanding their roles, championing quality of care improvements, spearheading research innovation, advocating for patient rights, and challenging the status quo.


As the largest segment of the health care workforce, with more than 3 million professionals, nurses touch every facet of care — and their impact has been mighty. Here are nine ways the nursing field is changing health care.

1. Clinical research advancements. Patients may not realize it, but much of the care they receive in a hospital was developed from research conducted by nurses. Nursing research takes place in hospitals and universities around the world, influencing every aspect of care, from infection control and epidemiology, to HIV/AIDS prevention, pain management and end-of-life care issues.

Nursing research provides the basis for clinical care best practices used by hospitals, physicians, insurers and other health care investigators. Leading the way in nurse research are schools like the UCLA School of Nursing and Johns Hopkins School of Nursing that receive funding from such organizations as the National Institute on Aging, the National Cancer Institute and the National Institute of Nursing Research.

2. Attention to a high-quality nursing environment. Nursing has improved hospital patient care and outcomes in many ways, but a pivotal change came a decade ago when the American Nurses Credentialing Center created the Magnet Recognition Program. The program recognizes leading hospitals with nursing environments that ensure high-quality patient care and outcomes. Today, the nation's top hospitals vie to meet a rigorous set of requirements and earn this designation, which has become an important element in U.S. News & World Report magazine's annual Best Hospitals list.

3. Nurse specialization. Because of ever-expanding health care knowledge, today's nurses are more specialized than ever. Specialties include geriatric nursing, medical-surgical nursing, operating room nursing, pediatric nursing, intensive care nursing, labor and delivery nursing and psychiatric nursing. Just as many physicians choose a specialty that allows them to provide more focused care to patients, so do nurses. Patients are the beneficiaries.

4. Advanced education and training. Years ago, most nurses earned only a licensed practical nurse degree, but there has been a shift toward more education, continuing education and clinical experience. Today it is increasingly common for a nurse to have a bachelor's, master's or doctorate degree. More education and a focus on clinical experiences enhance patient outcomes, resulting in less costly stays and fewer readmissions.

5. National health care policy. Because nurses are on the front lines of health care delivery, they touch the lives of most Americans. So it's critical that nurses make their voices heard on key issues that affect them and their patients, including staffing levels, patient satisfaction, patient safety, quality of care, affordability and access to care. Over the last decade, nurses have been more vocal in advocating for important policy issues. Led by national nursing associations, nurse unions, nurse academicians and health care leaders, nurses are formidable advocates of health policy changes that strengthen the role of nursing, uphold standards of quality and support patient rights.

6. Nurse ethics and patient advocacy. Did you know that every nurse has sworn to uphold a code of ethics? For most, this means they have a nonnegotiable set of moral standards that govern the way they interact with patients, patient's families and other medical professionals. Just as doctors are concerned with treating disease and finding a cure, nurses are dedicated to treating the person and easing suffering. That perspective defines a nurse's ethical viewpoint.

Current ethical issues include decisions about end-of-life care; holistic, alternative or natural medicine versus Western medicine; and laws and policies affecting cost and access to care. With everyone from the media to politicians to the courts getting involved in these issues, today more than ever, nurses must stand firm in advocating for the patient's needs, demonstrating unbiased compassion for every patient's rights.

7. Improving international care. Nurses have extended their reach beyond the borders of the United States to collaborate with policymakers, administrators and researchers in places as far away as China, India and Africa on such issues as tobacco control, HIV/AIDS research and patient safety. Through an international exchange of ideas and collaborations, nurses are addressing important health challenges and pushing the scientific, medical and ethical frontiers as never before.

8. Advocating for social justice. Whether working locally with underserved immigrants, conducting research in the refugee camps of Sudan, or working to end gender-based violence in Rwanda, nurses are increasingly a force for social justice. By engaging governments, policymakers, nongovernmental agencies and communities, they bring to light important topics such as the right to education, the right to income-earning opportunities, and freedom from gender-based violence. Nurses help connect the dots between human rights and improved health.

9. More nurse leadership at hospitals. Today's hospital leaders are recognizing that a nurse's role can extend far beyond the patient bedside or even the clinical laboratory. Nurses have a great deal to contribute toward a hospital's strategic and financial plan. Their ability to balance the physical and emotional needs of patients with the complexities inherent in running a hospital is unmatched. Increasingly, nurses are members of the hospital's C-suite and are serving on hospital boards of directors, lending both clinical and business acumen to every important decision the hospital faces.

Nurses continue to be the heart and soul of health care institutions across the United States and around the world, changing health care — and the lives of individuals and families — for the better.

Courtney H. Lyder, N.D., G.N.P., F.A.A.N., is the dean at the UCLA School of Nursing, a professor of medicine and public health, executive director of the UCLA Health System Patient Safety Institute, and assistant director of the UCLA Health System.