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OurBlook interview with Terry Fulmer, dean of the College of Nursing at New York University.
Nurses have kind of been lost in the shuffle during discussion of the major healthcare reform bills being considered by Congress this year. Do the bills have any provisions concerning nursing and if so, what is your opinion of them; if not, should provisions be added?
TF: I don't think that nurses have been lost in the shuffle. The Center to Champion Nursing in America has been actively involved. Various nursing groups have provided testimony on health reform. Nurses have met with the president to discuss health reform. As I write this, the Senate bill is undergoing mark-up about using Medicare money for advanced nurse education similar to the way such money is used for physician residency programs.
If there continues to be a shortage of primary care physicians, or such a shortage worsens, could nurse practitioners fill the gap?
TF: Nurse practitioners could definitely fill the gap. They already provide a substantial amount of primary care in the United States. Last year, nurse practitioners saw 600 million PC visits and this will only get stronger in the future. They address common care from home to critical care. The opportunity is to capture the nurse practitioner as a resource for healthcare reform in long-term care, nursing homes, assisted living and communities for older adults.
Is there also a shortage of nurses in the U.S. or are new ways needed to deploy them?
TF: There are currently shortages of registered nurses in some geographic areas. Our data and anecdotal information suggest that RNs (especially those who work part-time) have increased their work hours as the country has experienced an economic downturn. It seems likely that when the economy rebounds, many of those RNs will go back to working part-time and/or decrease their work hours, creating another shortage.
Is there anything else you'd like to say about healthcare reform or the nation's nursing situation or medical economics generally?
TF: There is a large overlap between what RNs and physicians do. Health reform is likely to bring changes to the health care delivery system in addition to the financing of health care. While those changes are not likely to be as great as I had hoped, nurses will be part of a changed health care system. I have already seen this in expanded roles for nurses and not just for advanced practice nurses. In other English-speaking developed countries such as Canada and the United Kingdom, nurses' roles have expanded. For example, in the UK, RNs can prescribe medications after taking a post-graduation course.
Editor's Note: Dean Fulmer is also the Erline Perkins McGriff Professor at NYU. She received her bachelor's degree from Skidmore College, her master's and doctoral degrees from Boston College and her Geriatric Nurse Practitioner Post-Master’s Certificate from NYU. She was the first nurse to be elected to the board of the American Geriatrics Society and the first nurse to serve as president of the Gerontological Society of America.
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