Former HHS secretary Donna Shalala
Credit: Rose Hoban

Donna Shalala, former Secretary of Health and Human Services under President Bill Clinton, was in Chapel Hill Tuesday to speak to crowd of nurses, nursing and medical students, and nursing educators from all over the state.

Shalala, the longest serving Health and Human Services secretary in US history, is currently the president of the University of Miami. Recently she chaired a commission that released a report by the Institute of Medicine on the Future of Nursing.  Since the release of the report, she has been speaking about the commission’s findings.

Former Health and Human Services Secretary Donna Shalala spoke about the future of nursing to a capacity crowd in Chapel Hill Tuesday.
Former Health and Human Services Secretary Donna Shalala spoke about the future of nursing to a capacity crowd in Chapel Hill Tuesday.

In between anecdotes about her time as a high ranking public servant, and challenging the current organization of the health care system, Shalala told the crowd of more than 600 that she believed nursing is entering a “golden age.” And Shalala told the nurses they needed to engage in transforming the health care system.

Before her talk, North Carolina Health News editor Rose Hoban had the opportunity to sit down and ask Shalala some questions.

NCHN: How did you get involved with the Institute of Medicine report?

Shalala: I had a longtime interest in nursing, the professional nursing organizations know me very well, I am a non-–nurse, never took a nursing course, but I know the subject matter, I had three schools of nursing in universities that I have led. So I know something about the subject, especially from the academic point of view.

NCHN: What do you think are the biggest challenges facing nursing today?

Shalala: We are short of nursing faculty. We have a generation of baby boomers who are going to be retiring. We have to prepare the next generation of PhD’s who are going to train young people in nursing.

But the real challenge is whether nurses can work up to the level of their training. For historical reasons, states have restricted and have the power to restrict what people in the health professions can do, whether or not it is associated with evidence.

On the one hand, states invest heavily in schools of nursing and approve high levels of training, and on other hand, they won’t allow the nurses who are trained in their own institutions use that level of training.

NCHN: Isn’t part of the problem turf battles between doctors and nurses?

Shalala: I see the relationship between doctors and nurses more as a partnership. I really think that doctors also should be able to practice up to levels of training… states have also restrained specialists from being able to use their training. I think it’s a problem for the entire health establishment, but the last thing we need is for people fighting with each other as opposed to working together.

To get this health system straight, everybody has got to work up to their training.

Read the Future of Nursing Report summary (pdf)

NCHN: Any suggestions of ways to bridge those turf battles?

Shalala: Well we have had more experience in rural areas and in rural states than we’ve had in urban areas. Some of the most conservative states of the union – New Hampshire, for example – allow their nurses to work up to their training.

The evidence is very clear that nurses can do 70 percent of what a primary care physician can do. That doesn’t mean that we should get rid of primary care physicians, it means that we should use doctors up to the level of their training. There’s plenty of work for primary care physicians, for internists, for pediatricians… they ought to work up to the level of their training as well.

Shalala with midwives (l to r): L to R: Jenny Cox, Maureen Darcey, Suzanne Wertman
Shalala with midwives (l to r): L to R: Jenny Cox, Maureen Darcey, Suzanne Wertman. Shalala reiterated the point that nurses and doctors need to work together to insure all healthcare workers practice to the full extent of their training. Credit: Rose Hoban

NCHN: In North Carolina this summer there were eight midwives in the state who lost the ability to do in-home births because the doctors who were supervising them withdrew their supervisory support. That left these folks without jobs and more than a hundred families in the lurch. These are the kinds of turf battles that get fought…

We have got to look at what is good for our citizens and what’s good for our patients.

What’s good for our patients is making certain that when we invest our hard-earned taxpayer dollars in the education of health professionals that we let them practice their profession fully. We should not have artificial restraints for any reason.

All of our decisions ought to be evidence-based. And all of the evidence is that nurse practitioners can do extraordinary things of very high quality and free up physicians to do other things that they were trained for.

We’ve got to get over this, these artificial restrictions, because we are the taxpayers. We have invested in the education of these nurses, we set the standards of that training as part of state law and state regulations. So why are we on the other hand restraining that training when the evidence is that people can do the work, and that you get better health outcomes as a result? And it seems to me that taxpayers ought to demand those better health outcomes and ought to demand that their monies are not wasted.

NCHN: There was a story on this last week that quoted several economists who study nursing, and they claimed that if the economy improves at all, we may to see a shortage of nurses, the way there was a shortage in the 90s.

Shalala: It will be very interesting to see if we actually have that shortage because a lot of things have changed. A lot of people have come back to nursing and found out that the market had really changed, especially the quality of the experience. Because of high demand, hospitals, healthcare centers, doctors offices had to actually improve the environment to be able to attract nurses. So it’s a different job.

Second, there are simply more women working, we’re not talking about a lot of stay-at-home moms. And because the nursing profession allows for part time work, I’m not as sure as other people are that lots of people are going to leave now.

I am sure that lots of people are going to retire but that’s different from everyone leaving. I think there are going to be wonderful opportunities for young nurses, There are going to be residency programs that really fold them into the experience and the practice of nursing, very much the way doctors have residency programs. They won’t be as long but all of our evidence is that it reduces medical errors and ensures retention.

NCHN: Women have more opportunities now, why should they be nurses?

Shalala: You know, nursing has been one of the most adaptable of professions – for women and men. It’s reinvented itself over the decades. It’s provided leadership in healthcare. A lot of the people who run hospitals in this country had their training is as nurses. Look at the CEOs of hospitals – including my own – where the CEO is a nurse, and the CNO – the chief nursing officer – because they understand nursing care at its base.

We’re about to have a revolution in healthcare with lots of people getting coverage. We cannot afford the system as it’s currently organized because we are over-using the system. Nurses are the key, the linchpin to that redesign from our point of view.

I think we’re about to enter the golden age of nursing. I think nursing is going to be the glue that puts healthcare and this changed system together. I think there are enlightened physicians all over this country and certainly in North Carolina and I know a number of them who understand this and see their practices and their futures as very much tied to the other health professionals, not just nurses, but physician assistants and pharmacists.

NCHN: So the report is a couple of years old at this point so why are you out here today?

Shalala: It’s to make sure that we constantly energize the nursing profession to keep improving and sit at the table and help design the healthcare system of the future.

I also think it’s important to remember that this IOM report is still the best seller in the history of the Institute of Medicine! It’s number one, it’s sold more copies than any other report, that says something to you – about the profession, about the importance of nursing in our society and about the partnerships that we have to build in the future.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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