Nurses ponder prevention role
Toolbox
By Peter Hirschfeld VERMONT PRESS BUREAU - Published: July 1, 2009
Nurses in rural areas say Vermont stands on the cusp of a health-care revolution that could change the way small hospitals serve patients and communities.
The focus on traditional care — procedures for treatment — is shifting to a new emphasis on prevention.
A panel of nurse executives from "critical access" hospitals in Vermont and New Hampshire met with students at Norwich University to discuss a coming "transformation" in the profession. Reforms afoot at the federal and state levels, nurses said, will dramatically shift the role nurses and hospitals play in patient care.
"There couldn't be more exciting times in health care reform than we have right now. It is truly a transformation," said Ann Marchewka, a nurse executive at Alice Peck Day Memorial Hospital in Lebanon, N.H. "The most exciting thing about this is we are seeing a whole revision of health care as we know it."
The potential shift from a procedure-based federal reimbursement system to an outcome-based system, nurses said, will require doctors, nurses and other health care professionals to put a new premium on prevention and disease management.
Vermont's Blueprint for Health, a pilot program testing a more rigorous prevention strategy, could become the new norm under a federal health care reform package.
"Dollars are going to be moving into prevention, chronic disease management," said Marchewka, who formerly worked at hospitals in Berlin and Morrisville. "Admissions to the hospital will be an anomaly."
The changes will amount to a cultural shift in one of the nation's largest industries, and nurses said they worry whether Vermonters are willing to accommodate the new landscape. The redistribution of increasingly limited resources, they said, will force drastic changes in patient care.
Aaron French, a nurse executive at Copley Hospital in Morrisville, said patients have become accustomed to certain style of care. Selling them on the changes, he said, could prove a tough pitch.
"One of the biggest challenges we're going to face will be societal changes about what the expectation of health care is," said French, whose hospital serves a large number of older patients. "There is an expectation among patients about what they'll receive as care, and historically, physicians tend to accommodate that."
With a bigger push toward prevention, however, a growing portion of clinical care will occur outside the walls of the hospital or doctor's office. Community health care, in which clinicians move outside hospital confines to encourage the kind of lifestyle-changing behavior that reduces chronic diseases, will pull nurses away from hospital bedsides.
"It's going to be about how we can help people make realistic goals that extend beyond office walls and then support those efforts so people are empowered," said Jill Lord, head of patient services at Mount Ascutney Hospital in Windsor.
Nurses said the evolution will be made even more difficult by budgetary constraints, as well as finding and maintaining a new workforce to replace the large proportion of nurses nearing retirement age. Janet Scherer, chief of patient services at Springfield Hospital, said the "nurse of the future" will inherit a much broader scope of responsibilities.
"The nurse of the future really needs to step back and plan care for that patient," Scherer said. "The nurse of the future needs to get the big picture, create a plan to help that person move through the system and probably be able to delegate some of that work."
peter.hirschfeld@rutlandherald.com
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