October 9, 2006 -- Today The Oregonian ran Janet Goetze's profile of Oregon nurse Teri Mills, RN, MS, ANP, (right) and her campaign to create a federal Office of the National Nurse. The National Nurse would undertake public health media campaigns and try to attract more nurses to the profession. The piece, labeled a "Monday Profile," is mostly about Mills. But it also gives information about the progress of National Nurse legislation in Congress, and about the lack of support the initiative has received from the Oregon Nurses Association, whose executive director reportedly suggests the idea won't "produce results." When we first heard of the National Nurse in Ms. Mills's May 2005 op-ed in The New York Times, the idea seemed somewhat unformed. However, the draft legislation seems to present a concrete and realistic proposal that may prove useful to nursing and public health. The Oregonian piece might have included more specifics on the legislation. The bill would give the National Nurse authority to publicize nurses' "distinct role" in health care, and patient safety issues including nursing "staff levels" and "working conditions." On the whole, the article is a good portrait of a tenacious nursing advocate and an innovative idea to improve public health.
The piece reports that Mills has taught in Portland Community College's nursing program for 25 years. Now, her proposed Office of the National Nurse would "help teach Americans how to take better care of their health." The National Nurse bill was introduced by Rep. Lois Capps (D-CA), one of the three nurses in Congress, in March 2006. At the time of this piece, it had 39 co-sponsors, an unusually high number for first-time legislation. The piece links the bill's start to Mills's 2005 op-ed, which Rep. Earl Blumenauer (D-OR) reportedly saw and entered into the Congressional Record, where it generated further interest. Blumenauer credits Mills's "determination and organizing skills" for the idea's progress, noting that she is a "buzz saw" who is "making some waves" in Washington, DC. Mills and other nurses have reportedly made several visits to Capitol Hill to recruit co-sponsors. Capps's office predicts that the bill will not pass in this Congress, but says that the Congresswoman expects to reintroduce it in 2007.
The piece reports that the bill would place the National Nurse in the Office of Public Health and Science (OPHS) "under the surgeon general." However, the Office of the Surgeon General is one of many offices under the authority of OPHS at the Department of Health and Human Services (HHS). The bill appears to envision the Office of the National Nurse as another of these offices, i.e., the National Nurse would presumably not report to the Surgeon General, but to an Assistant Secretary at HHS. The National Nurse would be appointed by the Secretary of HHS.
The piece explains that the National Nurse would "conduct media campaigns focusing on specific health issues and the steps people could take to stay healthy," as former Surgeon General C. Everett Coop did to reduce tobacco use in the 1980's. The piece notes that the bill would also give the National Nurse "responsibilities for attracting more people to nursing and nursing education" at a time when many nurses will soon retire. In explaining her motivation for the bill, Mills notes that she has seen the devastating effects on patients from preventable illness. She notes that more public information on conditions like high blood pressure could be a cost-effective way to improve health. She also stresses that nurses are the "largest health care work force," and that they already do a lot of patient education, explaining things like prescriptions and after care.
The piece might have provided more information about the bill. The proposed National Nurse Act of 2006 appears to have been introduced only in the House of Representatives. Soon after its March 2006 introduction, H.R. 4903 was referred to the Subcommittee on Health, where it remained. Under the bill, the National Nurse would use media activities to promote public health and encourage people to becomes nurses and nursing educators. In particular, the bill authorizes the National Nurse to designate and promote four "health priorities" each year, to make grants to nonprofits in order to educate the public about these priorities, and to set up volunteer "nurse teams" under the guidance of "state coordinators" to promote the priorities. In encouraging people to become nurses, the bill authorizes the National Nurse to provide "education on the distinct role of nurses in the health professions and examine...nursing issues that could increase public safety, such as issues related to staff levels, working conditions, and patient input."
The piece notes that the National Nurse idea has the support of several professional organizations, including the California School Nurses Association. However, it notes that the Oregon Nurses Association (the state affiliate of the American Nurses Association) does not support the bill. Its executive director, Susan King, notes that her group has helped increase nursing school graduation rates, and worked to improve public access to care as well as nurses' working conditions. The implication seems to be that King's group is already doing plenty to resolve the nation's nursing crisis and its health care access issues, and it doesn't need this kind of help. King's view of the National Nurse idea:
It might be nice to have a visible, single person as spokesperson...We would prefer to put our energies into actions that actually produce results.
Since no one knows what resources Congress might devote to an Office of the National Nurse, the statement that the legislation will not "produce results" sounds like a general rejection of the type of public health education the bill envisions. However, generations of nurses, as well as public health figures like the Surgeon General, have done such education. King concedes that having a "visible, single" spokesperson might be "nice." In fact, nursing has few representatives with national public name recognition, in or out of government. A highly qualified, articulate representative, with the authority of the federal government behind him or her, could increase understanding of the profession.
Of course, much would depend on the size of the Office and how much funding was allocated. The likely efficacy of teams of volunteer nurses, when so many nurses are now stretched to the breaking point and beyond in their paid positions, is also debatable. The general public health mission of the National Nurse would seem to overlap somewhat with that of the Surgeon General and other public health offices. And of course, we would not want establishment of the Office of the National Nurse to be used as an excuse for failing to provide adequate government support to other vital aspects of nursing practice, education, and research.
But with some resources, the National Nurse could help educate the public about the importance of nursing to patient outcomes, as well as the roles that resource allocation and working conditions play in the nursing shortage. In addition, there is reason to believe that even a small Office of the National Nurse could raise public awareness of some key health issues, especially if it could attract media attention. The Office could be, as Mills argues, a "pragmatic, cost-effective way to have a big impact on people's lives."
We thank Ms. Goetze and the Oregonian for coverage of these important issues. The article may be accessed for a fee here.
Read the original proposal of the N
ational Nurse that led to the formation of HR 4903.