HR 1119, The National Nurse Act of 2011

After many years of tireless advocacy on the part of some very dedicated individuals, the push to establish the position of a National Nurse for Public Health under the Office of the Surgeon General has gained considerable Congressional support (currently nine co-sponsors in the House of Representatives) and is now known as H.R. 1119: The National Nurse Act of 2011.

For those of you unfamiliar with the issue, here is some history of the Office of the Surgeon General and the drive for the establishment of the position of a National Nurse for Public Health (adapted from a previous post here on Digital Doorway):

Since 1871, the Surgeon General of the United States---the nation's "chief health educator"---has overseen and guided the health of Americans. Charged with overseeing the U.S. Public Health Service, the Surgeon General is appointed by the President and approved by Congress for a four-year term. According to the official website of the Surgeon General, this individual's duties include, but are not limited, to:

• Protect and advance the health of the Nation through educating the public, advocating for effective disease prevention and health promotion programs and activities, and, providing a highly recognized symbol of national commitment to protecting and improving the public's health
• Articulate scientifically based health policy analysis and advice to the President and the Secretary of Health and Human Services (HHS) on the full range of critical public health, medical, and health system issues facing the nation
• Provide leadership in promoting special Departmental health initiatives, e.g., tobacco and HIV prevention efforts, with other governmental and non-governmental entities, both domestically and internationally
• Administer the U.S. Public Health Service (PHS) Commissioned Corps, which is a uniquely expert, diverse, flexible, and committed career force of public health professionals who can respond to both current and long-term health needs of the Nation
• Provide leadership and management oversight for PHS Commissioned Corps involvement in Departmental emergency preparedness and response activities
• Elevate the quality of public health practice in the professional disciplines through the advancement of appropriate standards and research priorities, and
• Fulfill statutory and customary departmental representational functions on a wide variety of federal boards and governing bodies of non-Federal health organizations, including the Board of Regents of the Uniformed Services University of the Health Sciences, the National Library of Medicine, the Armed Forces Institute of Pathology, the Association of Military Surgeons of the United States, and the American Medical Association.

From a nurse's perspective, what is missing from the Surgeon General's overall equation is the more robust input of a nurse who would serve more as an equal to the Surgeon General in terms of his or her ability to effect and implement health care policy in the interest of the American people. At this time, the U.S. Public Health Chief Nurse Officer (CNO) serves as Assistant Surgeon General, representing the Surgeon General's interests and opinions, and otherwise working in a subjugated role that the medical community might deem fit for a nurse.

The goal of the organizations and individuals behind the drive for a National Nurse of Public Health is "to elevate and enhance the Office of the PHS Chief Nurse to bring more visibility to the critical role nursing occupies in promoting, protecting, and advancing the nation's health."

The proposed role of the National Nurse for Public Health would be to:

• Assist in the initiation of a nationwide cultural shift to prevention.
• Bolster efforts to focus the public on healthy living.
• Intensify roles for nurses, including students and retirees, in community health promotion.
• Provide greater support to the Surgeon General in calling for improvements in health literacy and reduction in health disparities.
• Encourage all nurses to spread prevention messages in their communities.
• Encourage participation of nurses in Medical Reserve Corps (MRC) units.
• Provide leadership to network with existing volunteer health promotion efforts.
• Strengthen linkages with providers, nursing programs, and public health leadership.
• Serve as a visible national spokesperson for professional nursing.
• Increase public awareness of nursing roles and contributions.
• Enhance nursing recruitment and education throughout all communities.
• Support and justify additional funding for nursing education, research and service.

The National Nurse for Public Health would work to slow the growth of preventable diseases; promote health awareness, increase health literacy, and reduce health disparities; promote health careers and increased resources; enhance visibility and public recognition of nursing.

It is the opinion of many involved in the call for the establishment of a National Nurse for Public Health that it is time for nursing to have a equal seat at the nation's health care table. While some might argue that the aforementioned Chief Nurse Officer of the U.S. Department of Public Health already adequately fulfills that role, most still see that role as one of subservience to the Surgeon General rather than one of professional equality. Just as nurses are rarely consulted by the media for their expert opinions vis-a-vis the various challenges faced by the nation and its beleaguered health care system, the government also fails to fully utilize nursing's unique and crucial input to the fullest extent possible, in the interest of the health and well-being of the American people.

The establishment of the position of the National Nurse for Public Health would set a new standard for a more accurate and realistic recognition of nursing's importance to health and health care in the United States. If the federal government enthusiastically and publicly embraced nursing, making its crucial contributions crystal clear, perhaps the public, the media and the private sector would all then have a greater understanding of, and appreciation for, the multitudinous ways in which nursing positively impacts the health of millions of Americans.

Most importantly, however, the establishment of this position would certainly bring an important voice even more strongly to the ongoing conversation about health and health care in America. A National Nurse for Public Health could, in effect, deliver a unified message of preventive health at a time when millions of Americans---including millions of children---live without health insurance or access to regular primary care. At a time of crisis and uncertainty vis-a-vis the health of the country, the National Nurse could very well be a welcome, stabilizing and empowering voice of reason and prevention.

I fully support the passage of HR 1119, and I urge readers of Digital Doorway to contact their representatives in order to urge them to support this important health care legislation. For more information, please visit the website of the National Nurse Campaign, join their Facebook page, or visit the take action page on the National Nurse website.

Vulnerable Elders: The VNAA vs Medpac

Just today, Medpac---the Medicare Payment Advisory Commission---issued a report to Congress recommending reinstatement of co-payments for elderly Medicare recipients receiving home health services. Medpac, an independent Congressional commission, is comprised of various professionals with expertise in health care delivery and financing, with two of the current members being nurses.

The Visiting Nurse Association of America (VNAA), has categorically denounced the recommendations, maintaining that "most home health patients are elderly, female, and living on fixed incomes." The VNAA further predicts that many patients without a Medicaid supplement will undoubtedly eschew home care services due to the additional $150 co-payment being recommended by Medpac, leaving them further vulnerable to unnecessary hospitalization and avoidable complications which could be prevented by timely and affordable home care services.

Based on information obtained from the VNAA and the Medicare and Medicaid Supplement for 2010, home health patients are overwhelmingly elderly, with 34.7% between the ages of 75 and 84, and 29.1% over the age of 85. Furthermore, 63% of these patients are female, the majority on fixed incomes. The co-payments in question were eliminated by Congress in 1972 in order to foster increased usage of home care services, which are astronomically more cost effective than care in hospitals and long term care facilities.

While both agencies obviously wish to facilitate the delivery of cost-effective high quality care for needy and vulnerable patients, re-imposing potentially prohibitive co-payments on predominantly elderly clients living at home on fixed incomes is not necessarily the most judicious choice for fixing the economic woes of the American health care system. Changes are certainly needed---many of them drastic---but I support the VNAA in its opposition to Medpac's proposed reinstatement of the home care co-payments.

As a nurse with 15 years of experience focused on home care, I have seen first-hand how elderly clients on fixed incomes must frequently make difficult choices, such as choosing between food and heating oil. Adding the differential of extra medical co-payments for elderly patients wishing to remain at home rather than become institutionalized is, in my opinion, a misguided recommendation that should be set aside in pursuit of more effective (and less draconian) economic measures.

Top Ten Nursing Blogs

Allied Health World has chosen ten top nursing blogs for 2011, and I am honored and humbled that Digital Doorway has been chosen for this award. My gratitude to Allied Health World for their recognition of Digital Doorway, but even more for their recognition of the importance of nurses---and nurse bloggers---as essential components of health care and health care blogging.

Compassion From Day to Day

I find that my days are simply filled with opportunities for feeling compassion for others. Consequently, it is those moments when I can connect with my compassion when I feel most connected, optimistic and part of something bigger than my little life.

As a nurse, one can often be consistently confronted with chances to be compassionate. In fact, nurses are often rated in surveys as some of the most trustworthy and compassionate people around, so I see my vocation as a professional doorway to practicing "compassion in action".

Working one-on-one with an elderly gentleman who lives with a variety of complaints and ailments, I use my compassion to see his suffering as no different than mine, and I strive to be free of judgment and frustration when he refuses to do what I think might be in his best interests. My frustration does bubble up from time to time, but I try to see the world through his blurry eyes, and I cultivate a gentle acceptance of his personal modus operandi.

In my other work, a woman with a history of a major stroke can say nothing more than "momma" over and over again, although we are aware that her mental and cognitive functions are fully intact. She frequently cries in frustration when she cannot make herself understood, and I do my best to look her deeply in the eyes and beam my love and admiration to her when we are face to face every other week when I come to see how things are going with the home health aides that I supervise. I think she and I have great love for one another, and although we cannot communicate conversationally like we might like to, we connect on a level that supersedes that of the spoken word.

Yet another client has a condition that puts her at great risk of repeat heart attacks or strokes, and she lives each day as if it might be her last. Her condition is uncorrectable, and although medications keep her alive, she walks a precipitously tenuous line with life on one side and death on the other. We talk deeply about her life, her past, and her fears for the future, and I listen to her with an open heart and a well of compassion for her suffering.

Aside from nursing, opportunities for compassion are everywhere: the homeless veteran begging for money on the street corner; the elderly widower making his lonely way through his latter years; the child home from school with the flu; a friend who loses a parent.

The human condition is almost synonymous with suffering, yet that suffering can be assuaged on many levels by the active practice of compassion for others, and the ability to see the suffering of another person as no different than one's own. "There but for the grace of God go I" is a crucial tenet to remember at time when one feels judgmental or impatient with the plight of other people, and it is in cultivating such an outlook that we truly embody our humanity.