Linda Aiken: Health Reform Could Be Turning Point For Nurses

The role of the nurse in primary care and in coordinating patient care is evolving. This, coupled with the movement toward health reform, presents an opportunity to modernize the scope of what nurses do to let them “work to the full extent of their education and expertise,” says INQRI National Advisory Committee member Linda Aiken, Ph.D.  Aiken, who is the Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, spoke about how her research has helped inform health reform debates and what INQRI researchers can do to make their research relevant to policy.

Q: How has your research and work helped to inform the current health reform debates?

Aiken: My research on nursing education policy has been influential in the increases in funding for Title VIII support for baccalaureate nurse education and nurse practitioner education. I have a longstanding program of research beginning with my 1994 paper in JAMA showing that Medicare funding for pre-licensure nursing education has not contributed to improving access to and quality of care for Medicare beneficiaries. That research has been influential in the design of a new funding vehicle for graduate nursing education included in the health reform bills.

My 2003 JAMA paper showing that each 10% increase in the proportion of hospital bedside care nurses with at least a baccalaureate degree was associated with a 5% decline in mortality has been cited in legislative debates in support of more federal funding for baccalaureate education.

I have contributed to the growing literature demonstrating that nurse practitioners contribute to improving access and quality at affordable costs that has been useful in inserting language in primary care pilots and demonstrations that enable qualified advanced practice nurses to lead and participate in interdisciplinary primary care models.

Q: How can INQRI researchers link their research to current debates? How can they ensure their work does not just sit on a shelf, but has impact in the real world?

Aiken: Policymakers, managers, and the public often do not understand the relevance of nursing research to real life decisions. The key to linking research to current debates is to frame research findings in the context of current debate and policy decisions.

For example when we studied the impact of hospital nurse staffing on mortality, our study took place in Pennsylvania, a state without pending nurse staffing legislation. However to illustrate how our findings could be applied more broadly, we used our findings in Pennsylvania to estimate how hospital mortality might vary under the ratios being debated in California that varied from four to eight patients per nurse.

Our finding that every patient added to a nurses’ workload was associated on average with a 7% increase in hospital mortality following common surgical procedures was influential to decisions about the final regulations implemented in California. It helped make our paper relevant to audiences that might not have thought that they would be interested in nursing prior to reading the paper.

Q: How might health reform change the role of nurses?

Aiken: The weight of the evidence in support of nurses’ expanded roles in primary care and care coordination for the chronically ill is finally being recognized as in the public’s interest. I suspect that health reform will be a turning point in the public legitimization of nurses in expanded roles and result in modernization of scope of practice and reimbursement policies to enable nurses to work to the full extent of their education and expertise.