The U.S. health care system should learn many lessons from the Covid-19 pandemic. A key one is that it’s time to unleash the power of the country’s nursing workforce.
Nurses have been essential in combating Covid-19, from their work caring for patients hospitalized with severe Covid-19 to treating people in their homes and administering vaccines. But even without a pandemic, it’s clear that when nurses are free to fully deploy their expertise and training, they not only improve health care quality and access but can also help dismantle systemic inequities tied to geography, racism, and poverty that affect people’s health.
Full practice authority allows advanced practiced registered nurses, including nurse practitioners and nurse midwives, to prescribe medications, make diagnoses, and provide treatment independent of a physician.
In the 23 states and the District of Columbia where advance practice nurses have full practice authority, quality of care has improved and gaps in access to care have narrowed. In contrast, the 27 states that do not give nurses full practice authority are more likely to have geographic disparities, higher burdens of chronic disease, difficulty accessing primary care, and higher costs.
As the largest and most trusted segment of the health workforce, the nation’s 4 million nurses are well positioned to more forcefully take on health inequities.
Nurses practice across a broad range of settings, from clinics and hospitals to schools, homes, public health departments, and more. They see firsthand the link for a child between health, learning, and unstable housing. They teach people how to prevent disease and stay healthy. They refer food-insecure families to food assistance programs. And they are often the only source of care for people living in remote areas.
Harnessing the full potential of nurses can help achieve what the U.S. must aim for: that all Americans, no matter who they are or where they live, have what they need to live healthy lives. But tapping into that potential requires a commitment to reframing nursing education and expanding the environments in which nurses practice and train; diversifying nursing schools so nurses reflect the communities they serve; fully leveraging nurses’ knowledge and skills by removing artificial regulatory and practice barriers that place unjustifiable limits on the work they do; and supporting nurse’s well-being so they can support the well-being of others.
Nursing will face many challenges over the next decade. Addressing the rampant and long-standing health inequities that were magnified by Covid-19 must be a core goal. As detailed in a National Academy of Medicine report on nursing, which we helped develop, meeting those challenges starts with fixing the maldistribution of the health workforce that leaves too many communities short of nurses, adequately paying and investing in school and public health nurses, and better preparing nurses to work in and with communities.
It also means addressing the burnout and trauma among nurses that were magnified by the pandemic. Policymakers and health care systems must ensure that personal protective equipment and safety plans are in place so nurses never again have to sacrifice their health for their jobs. Of the 3,600 health workers who died from Covid-19 so far, roughly one in three have been nurses.
There are steps we can take now to support and leverage nurses’ expertise and make progress on health equity.
- State and federal policymakers should permanently lift regulatory barriers that keep nurses from practicing at the top of their education, including scope-of-practice policies that limit full practice authority and restrict access to nursing care, the quality of which is well-established. In fact, the Biden administration recently lifted barriers so advanced practice nurses can now prescribe buprenorphine, widening access to care for opioid addiction. During the pandemic, eight states temporarily lifted practice barriers for nurses without degrading the care quality. California and Massachusetts have made these changes permanent. With health equity as a goal, all states should follow suit by 2022.
- Educators and health care leaders must work to diversify the nurse workforce, which has historically been white and female. People from ethnic and racial minority groups account for 40% of the U.S. population but comprise just 20% of nurses.
- Health care institutions and other employers should better empower nurses to use their expertise to improve health and well-being. They must ensure that nurses have the training, experience, support, and exposure to people in the community so they can meaningfully contribute to addressing the social factors that influence health. This includes partnering with other professions and sectors like housing and leading efforts to tackle the social needs of individuals and families and conditions impacting neighborhoods and communities that limit health.
Everyone in America should have a fair shot at being healthy. As leaders, innovators, and advocates, nurses across a wide array of settings are key to achieving this essential goal. But they must have the support and autonomy they need to do it.
Regina Cunningham is the chief executive officer of the Hospital of the University of Pennsylvania, an adjunct professor and assistant dean for clinical practice at the University of Pennsylvania School of Nursing, and a member of the National Academy of Medicine’s Committee on the Future of Nursing. David R. Williams is a professor of public health and African and African American Studies at Harvard University and co-chair of the Future of Nursing committee.