“Value” in Challenging Times

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• Linda L. Lindeke, PhD, RN, CPNP, President and Fellow

“Value” is a buzz word in the current flurry of health care reform discussions. Many voices are chiming in to say that the U.S. health care system is not uniformly delivering value. Cost, quality, and access are key components of health care value. Examples of problems include the following:

•In Massachusetts, about 75% of children have regular medical and dental care, whereas more than half of children in Idaho do not have such care.

•In Michigan, 5% of children lack health insurance: in Texas, that rate is 20%.

•In Vermont, children are hospitalized for asthma at a rate of 55 per 100,000 population; in South Carolina, the rate is 314 children per 100,000 (Shea, Davis, & Schor, 2008).

Do those wide variations surprise and disturb you? The Institute of Medicine (IOM) defines value in health care as “getting the right care at the right time to the right patient for the right price” (IOM, 2009). The U.S. health care system has many problems in meeting what the IOM calls its Value Proposition.

Achieving value in health care requires demonstrating what works and speaking the truth about what does not work. The current context for health care reform is very challenging. Jobs are disappearing, along with employer-based health insurance. Public and private deficit levels are climbing. These are truly both the worst and best of times, and “value” is a goal for all aspects of our professional and personal expenditures.

Pediatric nurse practitioners (PNPs) bring great value to health care. However, our impact is barely visible because of numerous system barriers involving reimbursement, credentialing, data reporting, marketing of the role, and more. We are making progress to increase our visibility, and our NAPNAP One United Voice program is a bold move to strengthen our chapters and membership. A strong NAPNAP infrastructure will help members express our value to multiple audiences and thus improve children's health. The new NAPNAP Strategic Plan focuses on that goal in multiple ways.

PNPs have many compelling stories, and we have the skills and networks to tell them. The American Nurses Association (2009) is urging nurses to speak with a united voice and has compiled the following list of reasons why:

NAPNAP amplifies your individual messages and directs those messages strategically. NAPNAP is skilled in speaking to power, in finding the right listeners, and in crafting critical messages for maximum effectiveness. On your behalf, I have spoken to leaders of the American Nurses Association, the National Council of State Boards of Nursing, the American Academy of Pediatrics, and the IOM, to name just a few organizations. Many other members speak on your behalf to the Centers for Disease Control and Prevention, the Food and Drug Administration, the Maternal Child Health Bureau, members of Congress, at Congressional hearings, and to many other groups. NAPNAP has joined with many nursing and health care coalitions and organizations for health care reform efforts and to advance our Health Policy Agenda (for example, the National Quality Forum, the Nurse Practitioner Roundtable, the Coalition for Patients Rights, American College of Nurse Practitioners, and American Academy of Nurse Practitioners). Your NAPNAP membership gives you value through the individual member services and benefits, chapter activities, a national infrastructure, and advocacy for children's health and our PNP role. In his book The Audacity of Hope (2006), President Obama described the responsibility that comes with privilege. By virtue of our profession, NAPNAP members are indeed among the privileged. Of nearly 3 million U.S. nurses, only 13% have graduate degrees (Health Resources & Services, Division of Nursing, 2007, p. 11). Participating in health care reform is indeed a PNP responsibility.

NAPNAP is not self-serving. While developing our PNP roles for more than 35 years, we have kept the focus on children and families. Nurse scholar Julie Fairman's book (2008) on the history of nurse practitioners has the eye-catching title of “Making Room in the Clinic.” Children are been squeezed out of health care reform because of the clout of the aging demographic of baby boomers. By NAPNAP advocacy, we make sure there is “room in the clinic” for both children and PNP practice. We know that NAPNAP members deliver “the right care at the right time to the right patient for the right price” (IOM, 2009). Fairman emphasized NAPNAP's core values and placed them in a historical perspective:

The changes that occurred in the 1960s and 1970s did indeed make room in the clinic for nurse practitioners… This is a virtual space where negotiations with physician colleagues take place, a physical space to practice, and a political space to form relationships with individual patients and institutions. But the space, perhaps, truly belongs to the patients (Fairman, 2008, p. 195).

President Obama inspires action, and economic stresses bring problems into clear focus. In his inaugural speech he spoke of “risk-takers, doers and makers of things” (Obama, 2009). What an apt description of our NAPNAP members! I am hopeful that nurses will work together in partnerships to reform health care and make nursing's value visible.

Here is my personal wish list for health care reform:

I humbly thank you for the honor of serving as your president this past year. I value each of you, and I wish you hope and audacity!

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References 

1. American Nurses Association. Value of nursing talking points (provided to its Organizational and Work Force Advocacy Affiliates by L. Stierle, CEO, January 23, 2009). Silver Spring, MD: Author; 2009;
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2. Fairman J. Making room in the clinic. New Brunswick: Rutgers University Press; 2008;
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3. Health Resources and Services, Division of Nursing . Findings from the March 2004 National Sample Survey of Registered Nurses. Washington, DC: Department of Health and Human Services; 2007;Retrieved January 31, 2009, from hrsa.gov/bhpr/workforce/0306rnss.pdf
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4. Institute of Medicine. (2009). Retrieved March 13, 2009, from http://www.iom.edu/?id=56943.
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5. Obama B. The audacity of hope. New York: Three Rivers Press; 2006;
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6. Obama, B. (2009). Inaugural address. Retrieved February 3, 2009, from http://news.yahoo.com/s/ap/20090120/ap_on_go_pr_wh/inauguration_obama_text.
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7. Shea K, Davis K, Schor E. US variations in child health system performance: A state scorecard. Commonwealth Fund. 2008;94. Retrieved January 30, 2009, from http://www.commonwealthfund.org/usr_doc/Shea_Child_Health_rev_6-6-08_optimized.pdf?section=4039
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