Here comes the National Nurse (maybe)

A new bill seeks to elevate nursing, which could lift healthcare. Reporters might take note

A few days ago, the unlikely congressional team of Eddie Bernice Johnson, a Democrat from Texas, and Peter King, a Republican from New York, introduced H.R. 485, The National Nurse Act of 2013. It’s not a big bill, but it’s not unimportant, either, and it would be nice if some reporters took a look. Co-sponsored by 32 bipartisan members of the House, the bill seeks to elevate the status of the chief nurse officer (CNO) of the US Public Health Service to a level on par with the Deputy Surgeon General’s. The idea is to bolster the public health work of the Surgeon General’s Office, as Johnson wrote to me in an email:

Just as nurses and physicians work together to care for patients, so should they collaborate to promote health. The National Nurse for Public Health would support and expand on the work of the Surgeon General, while helping it to reach a wider audience.

In other words, this new office would give the surgeon general a more visible partner in improving America’s health, by moving the CNO—currently Rear Admiral Kerry Paige Nesseler—into a more senior and autonomous role. This could be semantics, or it could have real, practical implications for moving the national perspective on health from treating disease to preventing it. Again, some words from Congresswoman Johnson:

The National Nurse for Public Health could have a significant impact on the Nation’s public health through promotion of education, community service, and media campaigns. This position would also likely lead to increased recruitment to the nursing profession, addressing a critical workforce shortage in our health care system, and to the U.S. Public Health Service.

It’s a notion that makes sense, given the health-promotion, disease-prevention role that nurses play in American life (not to mention their domination, for the past 20 years, of the profession in national “most-ethical” polls). Although prohibited from expressing her personal opinion on this issue, the Surgeon General herself, Vice Admiral Regina M. Benjamin, points to nurses as key to tackling America’s public health priorities in published reports. In its discussion of community diabetes care, a priority of Healthy People 2020, the Surgeon General’s 2011 National Prevention Strategy report, cites numerous published studies in which nurse-delivered, nurse-led, nurse-managed, or nurse-coordinated care leads to successful patient outcomes. The stipulations of this bill are also aligned with recommendations from the Institute of Medicine and Robert Wood Johnson Foundation in their well-received report, The Future of Nursing: Leading Change, Advancing Health, released in 2010.

The National Nurse cause has been around since 2005, when an op-ed appeared in The New York Times by Teri Mills, a nurse practitioner and educator who is the indefatigable grassroots leader of the national nurse movement. Since then, her base of supporters has grown substantially, their message has become clearer, and their grasp of Capitol Hill machinations more sophisticated as four bills have been unsuccessfully introduced in the House since 2006.

Also since then, nobody but the nursing trades and a smattering of blogs has made any mention of this. That’s true too for this recent introduction, with a few of exceptions: Pete Kasperowicz’s rehashing of Johnson’s press release on on February 5th, Tony Yee’s rehashing of that post on February 7th’s, and Michelle Cottle’s rant on February 10 in The Daily Beast. None of the three provide real information about the legislation. In Cottle’s column she speculates, without benefit of data, on the position’s budgetary impact.

This may not be the sexiest or biggest piece of legislation around, but there are questions to be asked and answered. As in, “What’s the difference between this new bill and HR 3679, a similar bill that was introduced and died in committee during the last Congress (112th)? Hint: it has to do with appropriations, which is the main beef of critics of the bill. A brief review shows that the new version, a product of seven years of evolution and compromises, asks only for a bump in salary that comes with a full-time job and a higher notch in the Federal pay-grade hierarchy.

And there’s this: “Is this a no-brainer, or are we dealing with something more complicated here?” Hint: I’m just saying, it’s worth a look. Expanding and enhancing the public health role of the nursing workforce is central, not only to the ideology, but to the economics of the Affordable Care Act. This is based on well-documented research identifying nurses as the value-drivers in healthcare, especially when working in advanced practice capacities or when employed to educate patients and families. Think about it: you’re in the hospital, ready to be discharged. Who’s in the room? Is there a physician with you, taking the time to discuss your homecare plan? Or is it a nurse you see at your side, answering your medication questions and explaining the “whys” behind the “whats” of your plan?

A couple of news hooks may be coming up: First, when the bill hits the House floor for debate. Of course, as with any bill, that might or might not happen soon, or even ever ( is great for staying on top of congressional debate schedules). Still, there’s buzz about Jeff Merkely, a Democrat from Oregon and the leader of the Senate Nursing Caucus, introducing a companion bill in the Senate.

Whatever the outcome of HR 485, healthcare leadership includes nurses like never before and that, in itself, is worth noting. Just look at Mary Wakefield, head of the US Health Resources Service Administration and Marilyn Tavenner, acting administrator and COO for the Centers for Medicare & Medicaid Services. We make a big deal about women in Congress, or in the cabinet, or in corner offices all over corporate America. And I’m all for that. But when it comes to healthcare journalism, you can’t leave nurses out of the story.

The Second Opinion, CJR’s healthcare desk, is part of our United States Project on the coverage of politics and policy. Follow @USProjectCJR for more posts from this author and the rest of the United States Project team.

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Sibyl Shalo Wilmont is a healthcare journalist and emergency department nurse with insider experience in the pharmaceutical industry, academic medicine, and patient advocacy. She is a graduate student in Hunter College's dual-degree Master's in Community/Public Health Nursing/Master's in Public Health program. Follow her on Twitter @nursesibyl. Tags: , , , ,