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One of the many concerns in health care is the growing shortage of primary care physicians. This affects hospitals, health plans, physicians themselves and, most of all, communities of all sizes and demographics throughout the country. What's more, the shortage will grow in severity given the aging of America and the implementation of the Affordable Care Act, which will add more than 30 million newly insured Americans into the system. The unnerving truth is that fewer medical school graduates are choosing primary care as their focus.

Thinking more broadly, the concern isn't just the physician shortage; it is how communities will ensure that adequate health care personnel are available to care for their citizens. That is an issue in which hospital trustees can play an important role.

Make no mistake: Attracting and retaining top-quality physicians always will be the brass ring, given its appeal to health plans, local employers and fellow clinicians. But in wrestling for ways to cope with the shortage, hospitals also should look at the enormous value of cultivating and promoting a strong, well-educated nursing staff.

With more than 3 million registered nurses in the United States, nursing is the largest and fastest-growing segment of the health care industry and represents the front line in providing care and ensuring a positive patient experience. In addition to bedside excellence, today's nurses champion quality improvements, spearhead research innovation, advocate for patient rights, and help patients and their families confront complex ethical issues, such as end-of-life care.

Having a well-trained nursing team can boost patient outcomes, improve quality and reduce costs. It enables a hospital to fulfill its mission and better serve its community. And it can give a hospital a competitive advantage in recruiting other nurses, attracting physicians and differentiating itself to patients. Trustees can play a critical role in making sure that their hospital has such a nursing staff in place.

On-site Education

Huntington Memorial Hospital, a freestanding 625-bed facility in Pasadena, Calif., is one of the 6 percent of U.S. hospitals to achieve Magnet recognition, which recognizes outstanding patient care, overall nursing excellence and innovation in nursing practice. Huntington also is an active teaching hospital with graduate medical education programs in internal medicine and general surgery. But teaching and training should go far beyond physicians; and last year, guided by this belief, Huntington created the Institute for Nursing Excellence and Innovation on its campus.

While still in its infancy, some components of the institute are already in place. One is the establishment of a nurses' scholars program, in which new graduates or nurses new to Huntington are matched with seasoned members of the hospital's nursing team. The senior nurses provide one-on-one mentoring, counsel and support. In addition to preceptors for new nursing graduates, the institute will offer specialty training programs in critical care, emergency medicine, obstetrics, neonatal intensive care, surgery, pediatric intensive care and other areas.

Through the institute, the hospital also is expanding its nursing education offerings to increase the number of nurses with degrees and with specialty certification in their fields. The hospital has launched an on-site bachelor of science in nursing program in collaboration with Western Governors University, an online institution. Nursing education also will be supported through the institute's assistance in funding individual nurses to take part in projects that result in presenting and speaking at national conferences.

The institute will support the continued growth of nursing research by funding a doctoral-prepared nurse researcher and a nursing research fellowship. In fact, three nursing research studies already are under way. In the first study, Huntington Hospital was selected as one of 15 hospitals nationally to be part of a collaborative related to quality and safety in the hospital environment. The second study involves the impact of medication errors, and the third was a pilot study to validate "concern" as a predictor of patient risk for decline.

Prepare for the Future

Every hospital is responsible for making sure that patients are cared for by nurses who are fully prepared to respond to the medical challenges and responsibilities they face. Trustees, who are accountable for anticipating the current and future needs of the hospital, can play an important role in nurse development in three ways.

First, trustees must understand that a hospital is a technologically advanced and rapidly changing workplace. Not all nurses are fully prepared for this environment. Through their leadership, trustees can help provide the direction and urgency to equip a nursing team with the right skills. Doing so will improve outcomes, reduce costs and expand the nursing profession in ways that will better serve a community.

Second, trustees should support their hospital's philanthropic efforts in obtaining the funds needed to develop the nursing staff. More than ever, dollars raised through philanthropy provide the stabilizing force and financial flexibility hospitals need to serve their communities. Recruiting and training an outstanding nursing force is a cornerstone of that service.
Third, trustees must make sure that their hospital has a plan to respond to the primary care physician shortage. There are nearly 780,000 practicing physicians in the United States with less than half of them in primary care. Even before the ACA, the Association of American Medical Colleges estimated that an additional 45,000 primary care physicians would be needed by 2020 to keep up with demand. Trends show that those numbers are unattainable, meaning that it's time to explore other options. An alternative remedy is to look to nurses to do more and bring additional skills to the patient care environment. But for that to happen, training and commitment are required.

Huntington's Institute for Nursing Excellence and Innovation is designed to enhance the training and preparation of its own workforce, and serve as a model for others. It is essential that trustees get off the sidelines and demonstrate their support for these kinds of programs.

Jim Rothenberg is chairman of the board of directors and Jane Haderlein (jane.haderlein@huntingtonhospital.com) is senior vice president at Huntington Memorial Hospital, Pasadena, Calif.