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Tuesday, July 03, 2007

Draft Policy to Establish Office of the National Nurse

This is a "working draft" of the latest suggested policy to create an Office of the National Nurse. This comes as a result of numerous meetings and communications with leadership of national nursing organizations, leaders in the USPHS, legislative policy aides, and others. The Board of Directors is open to hearing your thoughts too. Please email Teri .

A manuscript, Office of the National Nurse: Leadership for A New Era of Prevention, is also available in the February 2007 issue of Policy, Politics, and Nursing Practice.

Working Draft: Policy to Establish an Office of the National Nurse


Why establish an Office of the National Nurse?

To establish symbolic national leadership for a new philosophy and cultural shift to prevention in US Healthcare.
To raise visibility, enhance prestige and support recruitment to nursing and other healthcare professions.
To provide guidance for state and local leadership that can mobilize nurse volunteers and other healthcare providers at the local level to enhance prevention and improve health outcomes.

Complementing work of the US Surgeon General - via least prescriptive model

The role of the Office of the National Nurse would be to provide a visible symbol of the nursing profession at the national level. The NN would provide symbolic leadership to build partnerships and support the development of a philosophy and culture to promote disease prevention and health promotion.

To assure local autonomy, legislative guidelines that create the Office of the National Nurse will be general, not prescriptive, and result in policies and practices that build on existing partnerships and allow local PH jurisdictions to determine local actions. The Office of the National Nurse would offer guidance based on authoritative resources such as the CDC and NIH, and may suggest specific focus topics and/or activities that complement the work of the Surgeon General to promote 2010 goals. However, decisions on which strategies to adopt would be determined at the grassroots level.

Volunteer teams in local communities

A key strategy of the NN Campaign would generate Community-based National Nurse Teams to promote Prevention efforts. These teams would be comprised locally of volunteer nurses and other healthcare providers. Team activities will focus on strengthening health related linkages and creating a culture of prevention. The goal is to improve health outcomes by teaching and promoting healthier living. Teams will engage community partners to introduce, emphasize and reinforce prevention concepts and establish best practices to change behaviors. Some key focus areas would include exercise, better nutrition, tobacco cessation, and mental health. Community-based National Nurse Prevention Team goals would include reducing health disparities consistent with Healthy People 2010 goals. The teams would interface with schools, businesses, community based agencies as well as local public health leadership.

Local Leadership

Because public health is traditionally addressed at the local level, each state and public health jurisdiction will be encouraged to implement unique Community-based National Nurse Team activities to best address their identified needs. The Surgeon General may advise and offer guidance, but does not have a direct line of authority over the physicians in the nation. An Office of the National Nurse would parallel these concepts and provide structure, guidance and leadership yet allow that Community-based National Nurse Teams be responsive to local PH leadership. This model will allow a focus on local issues, and build partnerships that strengthen existing linkages to best serve local communities.

Why Nurses?

Nursing is strategically positioned to become the driving force for prevention efforts in US healthcare. Nurses are the largest group of healthcare workers in the US, numbering nearly 3 million. Nurses are in the trenches at the frontline assessing need and delivering healthcare 24/7 in every community. Gallup polls repeatedly find the public rates nurses as the most trusted profession. The nurse workforce is educated, licensed, skilled, experienced and rich in cultural diversity and bi-lingual skills. Nurses are used to coordinating multidisciplinary team efforts. These facts make nurses the logical existing resource to mobilize for prevention efforts. Nurses are ubiquitous; they work in a variety of community settings including hospitals, home health, public health, community clinics, K-12 schools, occupational health wellness programs and other provider agencies. Universities enroll thousands of nursing students every year that could earn community service hours and play active roles on the CNNTs.

The critical shortage of manpower in the nursing profession remains a challenge. Nursing needs a visible boost in recognition and prestige via an Office of the National Nurse, because recruitment of youth into nursing is critical to continue quality health services for our nation. CNNTs would allow continued involvement and draw on the experience of the boomers in the aging nurse workforce.

Assuring Support of Nursing Organizations

To assure inclusion and seek input from all nursing specialties, the Office of the National Nurse could periodically survey professional nursing organizations such as those in the Quad Council (ANA, ASTDN, APHA, and ACHNE). This would provide formal opportunity for key nursing organizations to suggest topics and influence strategies for Community-based National Nurse Team activities.

National Nurse as a Visible Symbol of Nursing - Staff Support

The position of Chief Nurse of the USPHS is uniquely qualified to become the first National Nurse, our nation's visible symbol of nursing. The USPHS Chief Nurse Officer currently has at least six major areas of responsibility:

Chief of USPHS commissioned corps with 6000 members including 1360 nurses.
Member of the US Health and Human Services
Liaison to the World Health Organization for international PH issues
Representative to the federal nursing services including American Red Cross Nurses, Veteran's Administration Nurses and Nurses on active duty in all branches of the military.
Works with professional nursing organizations including ASTDN and the ANA.

It is suggested that logistically a dedicated staffer would likely be assigned as the day-to-day liaison for the ONN and Community-based National Nurse Teams.

Multidisciplinary Collaboration with Medical Reserve Corps

The focus on health promotion will present many opportunities for multidisciplinary collaboration. Inclusive multi-disciplinary efforts will maximize support for prevention among public health agencies. The growing volunteer base in our Medical Reserve Corps (MRCs). The Medical Reserve Corps may be a likely partner for Community NN Teams. MRCs deal with emergency preparedness and hands-on care in disasters. Existing MRCs are designed to avoid having to assemble and mobilize emergency workers at the time of a disaster, and require a lengthy online application and formal orientation. In contrast, the focus of volunteers on Community-based National Nurse Teams is to enhance prevention efforts and educate the public to promote wellness. Compared to MRCs, Community-based National Nurse Teams (CNNT) will have a simpler, more stream-lined on-line application process and require only minimal orientation and training. Some volunteers may choose to become active in both programs, while others may select one program over the other based on their availability to volunteer, the different focus and simple vs. complex application and training process.

Funding and Sustaining Community National Nurse Teams

Funding for the NN Project would be a small investment considering the potential return on investment (ROI) via the healthcare cost savings that can result from creating a culture of prevention. Nationally, the ONN would be created from the existing USPHS with only a few if any new staff assignments. At the state level, it may be feasible to create a new or designate an existing state nurse position to be the official "state coordinator" of CNNT efforts. Some states may designate an existing nurse leader to be the "Lead Volunteer" for a statewide network of CNNTs.

While CNNTs are envisioned to initially be "volunteer," seeking grants for community based organizations could result in creative partnerships to fund the teams and/or provide stipends or salary to sustain leadership for team activity. There are a large number of both public and private grants that may be applicable for funding the CNNT educational activities. Grants that focus on preventing obesity via improved nutrition and increasing physical activity are a good example. An evaluation component will be a critical element of the National Nurse Campaign efforts. Healthcare foundations are likely to adopt and fund CNNTs once data can demonstrate evidence of their positive impact on health behaviors. Establishing best practices to improve community health outcomes can be validated via the research.

Some CNNT members might have a personal "favorite issue" and choose to partner with certain organizations like March of Dimes or The American Cancer Society and promote activity based on that organization's programs and educational materials. Others may be open to become involved as "presenters" for a variety of organizations with different healthcare focus issues. These CNNT nurses could develop strong liaisons between those organizations, schools, businesses and their community's public health planners. The potential rewards for our communities are obvious, and may only be outweighed by the satisfaction that could be experienced by the volunteers in this win-win concept.

The National Nursing Network Organization Team—Tuesday, July 03, 2007  

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