The U.S. healthcare system is being pushed into crisis by a combination of factors, from the increasingly heavy demands placed on it by 76 million aging Baby Boomers, to the addition of millions of previously uninsured Americans who have access now because of the Affordable Care Act.
Not only is the current system inadequate to handle these pressures, but growing costs for high-tech equipment, more sophisticated drugs, increasingly expensive hospital stays and hefty doctor bills threaten to push the nation's healthcare expenses to intolerable levels. The challenge, then, is to increase the system's capacity to treat patients while finding less costly ways of running it -- all without reducing the quality of care.
Mission impossible? No, there are many effective steps that can be taken. Perhaps the most important is giving nurses larger, more responsible roles. The time when nurses were treated as little more than functionaries who just carried out physicians' orders is over.
So is the era when a two-year RN certificate was all that was usually required. The standard now is a four-year BS degree, and for good reason: Research shows that bachelor's-prepared nurses are associated with reductions in morbidity and mortality among hospitalized patients. And the demand for nurses with still higher levels of education and more advanced skills is escalating.
In short, nursing is evolving into an elite profession on the frontlines of healthcare delivery and innovation. Increasingly, highly educated nurses and nurse practitioners will be providing primary care services, assuming many of the duties that were once the exclusive province of MDs.
As they shoulder these greater responsibilities, they're going to need the ability to think analytically and the self-confidence to assert their opinions persuasively. This will require smart, decisive people to enter the field -- and that is exactly what is happening. The profession is attracting more and more of the best and brightest students.
Let me illustrate that point by citing two members of the most recent graduating class at my school, Hunter College.
Caterina Reshetnyak, who came to the U.S. from Uzbekistan at age 3 speaking no English, was a class valedictorian -- one of nine who, amazingly, all had perfect 4.0 GPAs. With grades like that, Caterina could pretty much have her pick of professions. She has chosen healthcare, but not as an MD. She earned her undergraduate degree in nursing and will get practical experience working as a nurse before going on for a Master of Nursing Science in midwifery. And in the years ahead she intends to keep adding more nursing certificates.
Darren Panicali's situation is a lot like Caterina's in some ways and different in others. Darren was a student in our selective Hunter-Macaulay Honors College which successfully competes with the national elite colleges. His GPA was just a tick behind hers at 3.9, and he too is going into healthcare. But he's a man, and men become physicians, right? A generation ago the answer would have been yes. But Darren has seen the role of nurses grow in importance and stature, and he understands that he'll actually spend more time caring for patients as a nurse than as a physician. That's why he, too, earned his BS in nursing, and why he plans to get bedside experience as a nurse before earning both a MSN and an MBA in Nursing Administration.
Not everyone will welcome this reordering of the medical hierarchy. So here's another reason why it is not only desirable, but inevitable that nurses will be taking on increasing responsibilities: The number of MDs who graduate from America's medical school each year (about 17,300) doesn't meet current needs, much less future requirements. The nationwide shortage of physicians by 2020 is estimated at 45,000.
Given that alarming shortfall, who is going to step into the breach? Increasingly, the frontline caregivers of the future will be highly educated, highly skilled and highly motivated nurses and nurse practitioners.