Revamp Nursing To Help Save The Health Care System?

Last month, the Institute of Medicine put out a sweeping, 600-page report called "The Future of Nursing: Leading Change, Advancing Health." It's about how America's 3 million nurses can help save the health care system as it struggles with shortages of both doctors and nurses, and rising patient demand from newly insured people and an aging population.

The report calls for nurses to help lead the redesign of the health care system; to practice at the highest level their education and training allow; and to make the nursing education system better.

Really, it made me think, why have I not heard more about nurses and health care reform? Anyone who's ever spent time in a hospital knows who really runs the place...

This week brings some meaty discussion of the report's recommendations, and revives the decades-old argument between doctors and nurses about how broad the nurses' "scope of practice" should be. (Nurses: "We can fulfill many of doctors' traditional functions, such as prescribing medicine and ordering tests." Doctors: "Uh oh. No, you can't. You don't have our education.")

The surgeon and author Pauline W. Chen writes about the Institute of Medicine report at nytimes.com, and NPR's "Talk of the Nation" devoted more than a half-hour to the topic. The full transcript is here.

Though Dr. Chen's piece supports the idea of expanding nurses' roles, she writes that significant physician pushback is looming:

The expert panel [that wrote the report] is scheduled to convene again at the end of this month, this time to discuss implementing their recommendations. They will have their work cut out for them. Critics like the American Medical Association have charged that the report overlooks the extensive education and training of physicians and ignores the importance of physician-led teams in ensuring patient safety. In its official statement, the AMA warns that “with a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.”

Readers, what do you think? Can and should nurses do more?