How NPs Can Reform Health (Care)

Health care reform has reached the epicenter of economic, political, and social debate in this country. Legislators have correctly said that the plans they are debating in Washington will affect 100% of Americans—patients and providers, employers and employees, the insured and the uninsured, and insurers.  In these times of economic, political, and social crisis, what can NPs do to help?

Health Reform Is at the Heart of Health Care Reform

If health care reform is our target, then health reform is its bull’s-eye. Improving health and preventing disease are the most effective ways to decrease both the cost of delivering care and the human suffering associated with disease. Health reform is not an abstraction. It is concrete, and it is measurable. In this column I present some simple measurements that are powerful enough to transform the health of individuals and, indeed, whole populations.

Health care reform, by contrast, is not so concrete and not so easy to measure. If health care reform is to have any chance for success, it will require cooperation among many competing stakeholders, each vying for a bigger piece of an evershrinking pie. Even if such cooperation can be achieved (and that’s a big if ), it will be doomed to fail unless health reform is at its heart.

Health Reform Should Be a Mission for All Nurses

For NPs to be relevant in whatever new health care system is devised, it is incumbent upon us to articulate a clear and measurable path to health reform and to assume an active and visible role promoting it. If the 147,000 NPs currently practicing in this country and the hundreds of thousands of practicing RNs together succeed in getting the message of health heard, chronic diseases in this country might finally begin to decline, rather than grow. Using the simple measurements in the table on this page as goals, every skilled nurse could begin launching this great endeavor today.

Chasing these goals is a patient-centered, performance-based, and cost-effective solution to health reform. No further training and no additional advanced degrees are required. All that’s necessary is for every NP and RN, regardless of specialty or practice location, to adopt these measurements as the goals and the yardstick by which patient care is delivered and measured. Once these goals are widely propagated—in clinical practice, in nursing curricula, and in everyday life—nursing will be able to start bringing about health reform.

Partnering with Patients

As educators, NPs teach. As leaders, NPs should help guide patients in new, healthier directions. I wrote my book, A Nurse Practitioner’s Guide to Smart Health Choices, specifically to give readers tools to help them set a course toward better health. By partnering with patients, NPs can help them control their health risks.

It is well known that chronic conditions such as high blood pressure, high cholesterol, excess weight, lack of exercise, poor nutrition, smoking, stress, anxiety, and depression lead to diseases like diabetes, heart disease, and cancer. I call these health risks “ingredients in a recipe that cooks up a chronic disease or catastrophic health event.” By helping patients controltheir health risks through lifestyle education and medications, NPs can dramatically improve their chances of avoiding a chronic disease or catastrophic event.

Every NP (and RN) can take ownership of risk reduction. If risk factor management is at the heart of nursing practice every day, during every encounter, we can improve a lot of lives and save some, too. Patients need more education, and NPs are the best-trained teachers and clinicians to give it. The risk reduction measurements in the table aren’t fancy or complicated. Each one of us—patients and health providers alike—should know our own measurements, understand their importance, and work to get to goal on every single measurement. Then health reform will at last be under way.

Going for the Goals

Knowing the measurements is only the first step. What really counts is taking actions that get to the goals. A body mass index of 25 may seem impossible, but getting fit isn’t. Uncontrolled blood pressure and cholesterol are silent killers, and they are far too common. Most patients do not appreciate or respect their danger. As we know, there are plenty of steps we can take to control them.

Some of my patients are surprised to learn that depression and anxiety are not their lot in life; they are disease states that can be effectively treated. When these problems lift with treatment, patients become happier and are in a better position to make necessary changes.

I have used my book with patients in my practice for several years now, and it’s been interesting to see how they interact with the information. For those who want to know (and that’s not everyone), it’s proved to be a revelation. Patients come back after reading my book and tell me that they finally really get it. Often for the very first time, all the “eat right, lose weight, and exercise” messages they hear every day actually make sense. They see how everything is connected, and they connect with how their habitual behaviors lead to disease.

Most patients don’t take action right away. It can take a year or longer before they are finally motivated to act. Change is a process that takes time. Sadly, it’s usually a scare (like a heart attack or a diagnosis of diabetes) that finally provokes behavioral change.

Therapeutic Relationship

A therapeutic relationship really helps. I tell my patients that if health risks caused pain to the same extent that they cause risk, patients would be begging me for treatment and medication. Instead, I have to beg them to take it.

The partnership patients enjoy with NPs is one of our strongest assets as clinicians, and we should leverage it for all it’s worth. Patients need ongoing education and support to understand, move forward, and remain faithful with behavioral changes and treatments. Backsliding is the norm and does not represent failure. Staying with patients through the ups and downs of the change process can make all the difference between success and failure.

NPs as Role Models

Nurse practitioners are not exempt from the health risks our patients face. As health professionals, we have the benefit of knowledge and training to guide us to better health choices, but most of us could do better.

Much is written in the NP literature about the need to improve the image of NPs and nurses in general. Although we are health professionals, many of us are overweight and under-exercised. Long hours on the job plus work and family responsibilities lead us to chose convenience foods that lack nutritional value and make it hard to control our weight. Too little fresh air and exercise keep us from being as strong, healthy, and vibrant as we could be.

If we are to have the credibility we need to bring about health reform, we must model healthy behaviors ourselves. To reform health, we must reform ourselves. To heal our patients, we must also heal ourselves.

There are many roads up the mountain, and we should partner with our patients to climb toward true health reform. If NPs dare to commit to this great endeavor, we will silence all our critics, solve our image problems, and succeed where many others have failed in reforming the health care system.

This column is also posted on Carla’s blog, http://www.maverickhealth.com/blog. She invites readers to leave comments on her blog.