CHICAGO — With a wave of new patients expected to access primary care services when insurance provisions of the Affordable Care Act kick in starting in a little over 20 months, hospitals and other providers are bracing for a major shock to their already stretched delivery systems. And a growing chorus of health care leaders is calling for nurses to lead the way in filling expected gaps in primary care.


I heard two of those voices Wednesday at the American College of Healthcare Executives' 2012 Congress, as Harvard Public Health Professor Jack Rowe and Tami Minnier, R.N., chief quality officer at the University of Pittsburgh Medical Center, discussed the implications and reactions from the field to the landmark 2010 Institute of Medicine report on the issue, Leading Change, Advancing Health. The report's big-picture takeaways include more responsibilities for nurses, increased educational opportunities and the removal of scope of practice barriers — issues that writer Whitney L. J. Howell explores in depth in this month's H&HN.

Rowe — who served on the Robert Wood Johnson Foundation Committee of Nursing that helped draft the report, noted that as global payments and accountable care organizations loom, nurses with increased responsibilities and better qualifications are going to be critically important.

"The more highly educated nurses have lower readmission rates, high quality outcomes and better coordination," Rowe said.

Getting there isn't easy, of course — while the report calls for doubling the number of nurses with doctoral degrees by 2020, Rowe noted that 40,000 qualified applicants are turned away from nursing school each year because of a lack of capacity. And calls to increase the number of nurses in the U.S. aren't exactly new, he added.

"These are the exact same words as [another] blue ribbon panel 20 years ago, but they wanted it by 2010."

Nursing advocates also have to contend with existing barriers around scope of practice arrangements in order to allow advanced practice nurses and BSNs to deliver more primary care services. Still, providers in 48 states have implemented some of the report's recommendations, and Minnier explored how the report has informed a new nursing care model at UPMC that emphasizes the importance of responsiveness to patient needs.

"[Hospitals] get complaints like 'They didn't take me to the bathroom, they didn't answer the bell,'" Minnier said. "In reality, that is the core of why they're in the hospital. They need meds and treatments, but they also need the basics."

The changes have led to an 85 percent reduction in call bell response time and a 70 percent increase in compliance with turning and repositioning patients.

"It's a new nursing care model. Same work, same money, same space, and… a 60 percent increase in some of the outcomes."

I had a chance to interview Minnier after her presentation for a future H&HN Daily videocast — look for it this April.

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