The health of our nation and the importance of nursing

      With the new congress sworn in and the State of the Union Address days away (at this writing), I have been reflecting on my hopes for that address, for the future health of the American public, and the role of the American Academy of Nursing (AAN) in shaping the future of health care in America.
      The Obama administration was successful in working with the House and Senate to bring about the Affordable Care Act (ACA), at least its passage and possibility. The public response has focused on the government’s interference in personal choice, as it relates to the requirement for health insurance, and the assumed costs of a system of care that will expand access to health care for more than 30 million additional Americans. The divisive discourse, riddled with the threats of loss of rights and the burden of government costs, overlooks some basic realities. For example, we understand that persons who do not assume responsibility for health care insurance coverage ultimately become the responsibility of the government and often at far greater cost than if they had been insured and accessed needed health care earlier. The public acrimony and the threats of reversing the ACA disturb me, but I am equally concerned at the absence of professional dialogue about the ways in which care delivery could be modified to save costs, even while expanding care access. Why have health care professionals allowed the message to focus on the insurance funding models rather than the reform of the care delivery models?
      My strong hope for the State of the Union message, and the public dialogue to follow, is that we will recommit to the principles that support improving health care access to those without health insurance. I hope the President and our elected officials will challenge the assumption that more and better care equates with greater cost. But it will be the responsibility of the health care community to explain how this can be done.
      The AAN has already taken on this work through its Raise the Voice campaign. The effort, originally supported by the Robert Wood Johnson Foundation, was designed to give greater visibility to the innovative ways in which nurses were addressing gaps in the health care delivery system. Through a rigorous process of competitive review, the Academy identified Edge Runners, nurses who established services that addressed a gap and were able to provide evidence of the positive impact of their work in improved clinical outcomes and reduced costs. The names of the Edge Runners and descriptions of their work appear on the Academy’s website (, providing evidence and inspiration to those who are ready to focus on reforming the way we deliver care.
      The examples are truly inspirational, including Ruth Watson Lubic’s Family Health and Birthing Center in Washington, DC, Claudia Beverly’s Arkansas Aging Initiative, Mary Naylor’s Transitional Care Model, Audrey Nelson’s Veterans Integrated Service Network, and Patricia Gerrity’s 11th Street Family Health Services. Take the time to visit the website and explore what can be done when care is designed to meet the needs of the people.
      The Academy’s Raise the Voice campaign has provided concrete examples of evidence-based nursing solutions that demonstrate clinical significance and cost savings. Having identified these successful demonstrations, our challenge is to assist the developers to “scale up” their successes. Further, we intend to identify the qualities of the environments in which these creative solutions are born and nurtured.
      For the near term, the Academy leadership will collaborate across disciplines to make a complex health care system more efficient and effective. We will support the identification of innovative solutions and work to give them visibility. Consistent with our mission, we will support the generation, synthesis, and dissemination of nursing knowledge. We will ensure that the health care innovations designed and implemented by nurses are part of the broader effort to enhance health care so that it is patient-centered, safe, equitable, and accessible for all. We will continue to nominate experts in our field to public advisory boards and focus our energies on influencing policymakers, opinion leaders, and industry executives.
      In the midst of a new political environment, the AAN is committed to forging an open and honest dialogue with both the opponents and advocates of the ACA. We believe we can expand professional opportunities for all qualified clinicians, alleviating the rising health care costs and improving the quality of care and health of our nation.
      We believe we can all do better and we believe that nursing can make a significant difference.


      Author Descriptions
      Catherine L. Gilliss, Dean, Duke University School of Nursing; Helene Fuld Health Trust Professor of Nursing; Vice Chancellor for Nursing Affairs for Duke University, Durham, NC