School of Nursing and Health Studies Dean’s OpEd on Future of Nursing

October 13, 2010 — For Full Article, click here for The Miami Herald

Transforming Health Care through Nursing

Nilda (Nena) P. Peragallo Montano, DrPH, RN, FAAN
Dean and Professor, University of Miami School of Nursing and Health Studies


The report on the future of nursing this week by the Institute of Medicine Committee of the Robert Wood Johnson Foundation is encouraging and long overdue. It calls for allowing nurses to practice to the full extent of their education and training, paths to higher levels of education and training, and for nurses in partnership with physicians and other health professionals, to lead in designing healthcare in America.

The advent of healthcare reform, coupled with critical physician shortages and millions of new patients coming into the healthcare system, make this the right time to eliminate limits on nurses’ scope of practice. The committee’s report should serve as a call to action for everyone who believes patients in the U. S. are entitled to the finest healthcare available.

The nursing practices issue will decide the very fate of patient care for everyone in this country. Current rules in Florida regulate and limit the level of care provided by nurses. Florida has outstanding well-educated advanced practice nurses with all the skills and training to provide excellent patient care. However, due to existing regulations, many of these nurses are not allowed to practice to the full extent of their abilities. And patients are paying the price.

In an American Association of Medical Colleges’ report published last week, the U.S. will be dealing with a shortage of at least 65,000 physicians in this country by 2015. As a result of the Patient Protection and Affordable Care Act, an additional 32 million Americans will need healthcare coverage beginning in 2014, according a report issued by the National Institutes of Health. The current healthcare system cannot absorb the sudden influx of patients.

The increased need for primary care, the deficits in primary care providers and the research supporting the safety, quality and effectiveness of primary care provided by advanced practice nurses—those with a master’s or doctoral degree—led to the committee’s recommendations that nurses need to play a greater role of chronic disease management, transitional care (e.g., hospital to the community) and prevention and wellness. The expansion of these nursing roles will allow physicians to spend more time focusing on critically ill patients in need of advance care.

In the United States, 2.9 million nurses account for 80% of the total number of healthcare providers. The nurses who comprise the vast majority of employees in the healthcare system underscore their importance and impact on the delivery of patient care. Their sheer numbers, combined with their direct proximity to patients, and knowledge about what patients need, makes them particularly suited to advance strategies for improving care and saving resources. We cannot make significant improvements in the quality of healthcare unless nurses are on the forefront providing valuable insight and guidance as clinical and administrative leaders.

To handle these greater responsibilities and the increasing complexity of healthcare, the new federal healthcare law provides more funding for nursing education. There are multiple tracks available to convert associates degree to a Bachelors degree in nursing and to advanced degrees including Ph.D. With further education and training, nurses need to be considered “full partners” with physicians and other healthcare professionals in redesigning the healthcare system in this country.

The report should act as a catalyst to turn these recommendations into regulations and end the debate over scope of practice in states like Florida. The time has come to work together to implement an effective, affordable healthcare system that provides outstanding patient care that promotes patient safety, and is accessible and responsive to all patients. I am excited, proud and extremely hopeful that we will find a common ground in the United States and take a major step forward to improve patient care.


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