University of Minnesota
March 18, 2009
Nurses like the University's Patricia Painter, right, are at the forefront of research
Photo: Tim Rummelhoff
Nurses are the linchpin of health care reform
By Deane Morrison
The police brought her in late at night, traumatized by the sexual assault she had just endured. But the woman had at least one piece of luck: Conducting the pelvic exam at Regions Hospital, St. Paul, was a forensic nurse who knew how to collect evidence.
Coaxing the details of the attack from the woman, the nurse learned that the assailant had used the victim's cell phone. So she swabbed it for DNA. At the trial, that evidence helped convict the man.
The nurse was a colleague of Carolyn Garcia, an assistant professor of nursing at the University of Minnesota, who also works as a sexual assault nurse examiner at Regions. The story highlights the increasingly expansive roles nurses play in health care. With the U.S. population aging, chronic conditions like Alzheimer's disease and type II diabetes on the rise, and primary care doctors often scarce, nurses are assuming greater responsibilities and leading the wave of health care reform.
At the University, the School of Nursing has already sown the seeds of such a future. A key element is preparing advanced practice nurses like Garcia, who holds a doctorate and is certified as a public health nurse.
The school has recognized that to lead the coming transformations in clinical and community health care, most advanced practice nurses—such as nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists—need a clinical doctorate covering areas like research, policy, and clinical scholarship, rather than the master's degree that has historically been the norm.
Accordingly, the school is transitioning to the Doctor of Nursing Practice degree for advanced practice nurses, says Connie Delaney, dean of the School of Nursing. "In fall 2008 we admitted our last class of master's degree students," she adds.
Delaney specializes in informatics, the discipline concerned with managing and extracting useful information from databases. The school established the country's first DNP program with specialties in informatics and in integrative health and healing; the second is a joint program with the University's Center for Spirituality and Healing.
The work of several University nursing faculty illustrates the dynamic work of tomorrow's nurses.
Seeing the whole person
The great strength of nurses rests in their capacity for taking a holistic view of patients.
"Our practice is focused on health promotion and disease prevention," says Mary Chesney, a clinical assistant professor and pediatric nurse practitioner. "For example, when caring for an elder person in the early stages of Alzheimer's disease or arthritis, a geriatric advanced practice nurse will also focus on how cognition and mobility issues affect the person's quality of life."
"In villages and small cities, certified registered nurse anesthetists are critical for maintaining hospitals and doing outpatient or surgical procedures. They take the burden of being the only one on call off the doctor."
In the child health field, Chesney once coordinated care for fragile children who were seeing up to 10 specialists at a University-affiliated primary care center. She made sure they received immunizations and other general care, monitored medications to head off any harmful interactions, and helped parents with documents necessary for such purposes as receiving Medicaid or putting a child back in school.
"They have to have that go-to support person," Chesney says. "Many research studies have looked at the quality of care by nurse practitioners and nurse-midwives, and we've scored very high. We can do 60 to 80 percent of what a primary care doctor does, but we need more of us. In villages and small cities, certified registered nurse anesthetists are critical for maintaining hospitals and doing outpatient or surgical procedures. Nurse practitioners take the burden of being the only one on call off the doctor."
Nurses, says Chesney, are well positioned to help the health care reform movement achieve its three aims: improving the health of the population, improving patients' experiences so they feel they're in the driver's seat, and controlling costs.
Nurses often care for people with progressive conditions, says Joseph Gaugler, an associate professor and psychologist.
For example, residents of nursing homes may lose touch with distant family members, but Gaugler is working with nurses on a "digital mailbox" to restore that connection. The concept is simple: residents hand-write notes, which are automatically uploaded, scanned, and sent via the Internet to family members, who can respond with notes or pictures of their own.
"Nurses are integral to setting up the networks," says Gaugler, who is piloting the system in ThreeLinks Care Center in Northfield, Minn. "They can introduce the technology to residents, provide information on them, or be part of the residents' networks."
On the ground
Freud may have asked what women want, but it's researchers like associate professor Melissa Avery who are answering.
In a series of focus groups held around Minnesota several years ago, she listened as Latina, American Indian, Asian, West African, and white women told of their needs and burdens. One finding: Women from a reservation were interested in having a doula, someone to support them through pregnancy and labor.
Working with the University's Powell Center for Women's Health and reservation staff nurses, Avery, a certified nurse-midwife, helped secure funds to support a doula program. Her connections led her to launch a pilot study of whether exercise during pregnancy can help American Indian women treat gestational diabetes. And she has just applied to the Centers for Disease Control to fund another pilot project to test whether a combination of exercise and a better diet can prevent gestational diabetes.
"It's a way to help women help themselves," says Avery of her work. "Also, it's an example of nurses working with underserved populations. Nurses have a history of doing this kind of work."
Garcia, too, continues that role through her work with the Latino communities of the Twin Cities.
"Four of 10 Latinos don't finish high school," she says. Talking to girls, she finds that besides the usual stresses causing them to drop out, they may do so because their parents are being deported or they have to replace an injured parent doing factory work.
Among several projects, Garcia has a pilot program in which mothers and daughters are given digital cameras and asked to document an issue of concern to them such as poor nutrition, crime, or poverty.
"It helps mother and daughter connect and gives them positive reinforcement," says Garcia. "At the end, they create a photo exhibit and invite their target audience to view and respond to it."
When she was a graduate student, Garcia had a similar project in which immigrant Latino girls and boys took pictures of healthy or unhealthy things in their environment. They photographed trash, parks, polluting factories, smoking, an apple being washed, and pregnant friends.
From a bridge, one boy shot Interstate 35W and its myriad cars.
"I saw it as congestion," Garcia recalls. "But the boy had this reason for taking the picture: 'I can see the blue skies and the cars,' he said. 'But if I were in Mexico City on this bridge, I couldn't see the cars or the sky.' It's fun, exciting stuff."