More than two dozen thought leaders in nursing came together earlier this fall at a summit sponsored by UC Davis. Their mission was a lofty one – to identify current and future challenges in health care and create a roadmap for a nursing education curriculum that can meet the needs of the 21st century. The Betty Irene Moore School of Nursing at UC Davis has presented a rare opportunity − and challenge − to nurse educators: Plan a completely new school from scratch.
Health-care delivery today
The nation's current health-care delivery system must be fundamentally retooled, according to Deborah Ward, an expert in health policy who recently joined the new nursing school as its first faculty member.
Although the United States has the most expensive health-care system in the world, it is unique among industrialized countries in that health care is not available to the whole population, she said at the late September summit. Furthermore, "the outcomes are highly variable: only 50 percent of the time do patients end up receiving the recommended standard of care."
Unmet needs in U.S. health care can, in part, be attributed to the fragmented delivery system now in place, said Heather M. Young, associate vice chancellor for Nursing at UC Davis. She pointed to the delivery of health care through various silos: hospitals, clinics, pharmacies and skilled nursing facilities – institutions that tend to operate in parallel, independent of one another.
"There is not much communication across systems," Young said. "Medical records are not always shared, and health-care providers do not usually communicate effectively across institutions. This creates many barriers to optimal care. The individual we are caring for gets lost in the shuffle."
Young also lamented that while health-care delivery increasingly depends on sophisticated, hightechnology medicine designed to take care of acute medical problems, an aging population, beset by chronic and complex health-care needs, are often inadequately served by the current system.
Summit participants agreed that nursing education needs to evolve toward a new curriculum that creates leaders who understand the bigger picture of health-care needs and who can take on roles that go beyond delivering health care via specific skill sets. They envision new roles for nurses as communicators and integrators of health-care delivery to complement their traditional roles of delivering medical care.
Facilitating health communication
Summit attendee Jennie Chin Hansen, a registered nurse and president of AARP, sees a new role for nurses to "democratize" health care so that everyone has access to knowledge that they can use to improve health. Nurses should continue to provide information to individuals and families, but they also now need to tackle critical issues of how populations learn and how they change their behavior.
She pointed out that certain population groups − such as migrant workers and non-English speakers – pose different needs in obtaining health-care knowledge. Nurses could take on the role of "bundling" information to suit the needs of a community and train ancillary health-care workers within such populations to more effectively deliver usable solutions that would be salient and meaningful to the designated population.
Chin Hansen said that the strides that UC Davis has taken in developing telehealth technology has important implications for improving health care to rural areas.
"So often there is a bottleneck in delivering health-care information," she said. "Our role is to open it up so more people can access information to enhance their own health and well-being."
Integrators of health-care delivery
Chin Hansen stressed that graduatelevel nursing education should focus on understanding health care at a systems level in addition to skillbuilding and acquiring a knowledge base. Graduates need to be able to evaluate health outcomes, economic incentives and government policies. At the same time, such public-health concepts need to stay grounded in the real needs of a community's health.
"Nurses need to work within their community to ensure that their efforts fit the needs," she said. "We don't need another ivory-tower approach. UC Davis, situated at a rural-urban interface and having an ethnically diverse and aging population, is particularly well-situated to deal with the new challenges in our society."
Summit attendees agreed that a new interdisciplinary approach to nursing education is essential.
Young envisions a graduate group at the master's and doctoral level in nursing science and healthcare leadership consisting of faculty experts in nursing, medicine, health information, business, psychology, cultural studies, pharmacy and statistics.
Participants supported the goal of the new nursing school that educates health professionals together, including nursing students, medical students and other health-care team members, so that each can more fully understand the other's scope of practice and respective contributions, and learn how to more effectively weave together their efforts to improve the health of their patients.
Reorienting and retraining faculty to teach in such an environment also will be needed.
"The current system is not adequate for today, much less for tomorrow," said Chin Hansen. "The new school will need faculty who are traditionally competent and also are willing to reframe the curriculum and take real risks in how nursing is taught in the context of the healthcare system as it is and how it should be for the future."
A fresh start
Summit experts were unanimous in their appreciation of being able to take part in planning a new school from the ground up. They expressed optimism that while making an important contribution to health care in Northern California, the new school has the potential to become a center of excellence and a national model in nursing education.
"Rarely does one have the luxury to have the time to reflect on the optimal way to create something new," said Young. "This is a wonderful and unique opportunity to tap national experts and provide an arena to discuss change to create a better system. The Gordon and Betty Irene Moore Foundation has given us a gift that goes beyond the financial."