“Ensuring Nurses Reach Their Fullest Potential”

Dr. John Rowe has been involved in health care policy issues that focus on nursing throughout the last decade. He chaired the 2008 Institute of Medicine Retooling for an Aging America: Rebuilding the Health Care Workforce and served on the IOM Committee that developed the 2010 landmark report, The Future of Nursing: Leading Change, Advancing Health.

He currently serves on the strategy advisory committee of the Future of Nursing: Campaign for Action, a group of distinguished leaders in business, health care, and education who shape the vision of the campaign. Rowe has often spoken publicly about removing the barriers that prevent APRNs from practicing to the full extent of their education and training. He wrote “Why Nurses Need More Authority” in The Atlantic Monthly in 2012, which argued that one of the best ways to alleviate the primary care provider shortage is to expand the scope of practice for APRNs. He formerly served as the CEO of Aetna, and before that of Mount Sinai-NYU Health. He has also served as a professor at Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital and has authored more than 200 scientific publications mostly on the aging process. He leads the MacArthur Foundation’s Network for an Aging Society. He will receive the Second Century Award at Graduation.

Q: Nurses entering the workforce today face challenges resulting from an aging population suffering from chronic disease, as well as a health care delivery system that is shifting from acute to non-acute care settings. How can nursing schools better prepare their graduates to meet the evolving needs of their patients?

Clearly, since nurses will be called upon to provide much of the needed care for this population, we need a greater emphasis on geriatrics in nursing curricula to place additional emphasis on care at the end of life and prevention. In this changing health care system, nurses will also need to better understand the technology of health care and the new models of care that are being implemented. Nursing students also need additional experience working in interdisciplinary teams and experience in training and leadership. But the critical limiting factor is lack of sufficient faculty to teach in these areas, so this should be the first target.

Q: You mention the lack of faculty to educate nurses in sufficient numbers to meet the health care challenge of an aging population. According to the American Association of Colleges of Nursing  in 2011, U.S. nursing schools turned away more than 75,000 qualified applicants from baccalaureate and graduate nursing programs due to insufficient educational resources, including the number of qualified faculty and clinical preceptors.  What can be done to address the shortage of resources to head off an impending crisis in the nurse workforce?

The average age of faculty in nursing schools is getting older and we expect that there will be a wave of retirements over the next decade. In addition, we’re losing current and potential nurse educators to jobs in clinical and private sector settings that pay more. Many nurse educators are all too familiar with this challenge, but we have to do more collectively to ensure that the nursing workforce supply can meet the demands of the future. There is another hopeful trend and it involves Accountable Care Organizations. As they mature, I believe many of these partnerships of providers and payors will recognize that their success in delivering high quality affordable care is dependent on the quality and size of their nursing workforce. When they do, they will make the appropriate investments to strengthen nursing education and training.

Q: You have supported NPs as independent clinicians, but several physician groups, including the American Medical Association, have spoken out against full autonomy for NP practice. How can these two sides find common ground?

I believe resistance by physician groups to independent nurse practitioners will dissolve, and nurses nationwide will be permitted to practice to the full extent of their training and demonstrated competence as states feel the impact of the expected rising shortages in the numbers of primary care physicians. The success to date in the state and federal sponsored exchanges of the previously uninsured coupled with the increasing numbers of states that are expanding Medicaid eligibility will add to this pressure. The Institutes of Medicine (IOM) have provided the definitive word on this idea of allowing APRNs to do more, in their landmark 2010 report "The Future of Nursing." They conducted an exhaustive review of all the available studies of the efficacy and safety of care provided by APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians. Apparently the physician organizations are threatened by some mix of concerns about lost income and their traditional position as "captain of the ship." Those opposed to expanding the scope of nurses' practice also argue that physicians having years of additional training must necessarily know more than an APRN ever could. Of course they know more, but it is well established that they do not know more about providing the core elements of basic primary care.

Q: Under your leadership, Aetna’s task force on Racial and Ethnic Disparities in Health Care was formed to address gaps in access to quality care for its members. How can schools of nursing address disparities among their students and faculty?

This is an important and long neglected issue which should be a focus in nursing curricula. When it comes to quality of care, this area holds great promise for improvement. At Aetna, when we began collecting data on the race and ethnicity of patients, it helped shine a bright light on the disparities that weren’t so evident before we had the data. We looked at disparities in how patients use emergency rooms, get access to specialist and fill prescriptions – all information that could help develop treatment programs, educational materials or other approaches to address the differences.

Q: What advice do you have for Columbia nurses graduating this month as they move into the workforce?

After a brief celebration, I think new graduates need to hone their clinical skills, before they decide on further education. Clinical excellence is at the core of success in any aspect of nursing. Whatever students choose to do next, they are poised to become the next generation of nurse leaders. We need nurse leaders in education, and we also need them in clinical settings and organizations, at both the management and governance level. We need more nurses interacting and influencing major health decisions alongside the other health professionals who make up the interprofessional team. And we need to ensure that nursing leadership development and mentoring programs are—and remain—a priority so nurses can reach their fullest potential.