Phil Authier, on nursing in the new century

By Kathy Haas, RN
April 1, 2002

You've had a lot of experience, both as a nurse and as an administrator and nurse leader. Can you talk about the direction of nursing in this new century?

First of all, I truly feel we have to come together and focus on the things we agree on, and where we can agree is the care of the patient. If we focus on the patient, we're never going to go wrong.

Second, and I don't mean it to come out negative, but as nurses we need to get out of the victim mentality. I think it's holding us back and hurting our ability to shape the future.

Nursing needs to be at the table, at all levels and at all institutions. Being vocal and being an effective contributor involves problem-solving and proposing solutions, instead of just talking about the problems.

Which is, in part, the work of AONE.

Yes, and what AONE tries to do is to provide tools to the nursing leaders to facilitate their work, to bring forward some of the best practices in recruitment and retention and disseminate them, take success stories and share them. We have a lot of talk about work environment and we hear all the time how negative it is, but everyone I talk to is doing work to improve this.

What are some of the particular challenges of your own setting in South Dakota?

One of the things-and this is real consistent with the literature-is the respect issue, and working with our physician colleagues to create a collegial atmosphere. We are working with the concept that to truly give the best service to our customers, we have to create an environment for our staff that is one of healing. So we're working on ways to provide that compassionate environment for people, because our goal is to be an employer of choice.

But the greatest innovation we're pursuing is using our staff-not just nursing, but all of our staff-because frankly, we need to get out of our silos and truly work as a team, because we nurses are only touching the patient for a very small [point on the] continuum of their illness.

What would be your wish for the end of the century for nursing?

To focus on the health of the community. That's what nursing's all about.
Who's best at chronic care of patients? Usually, what those patients need is nursing care, not medical care. Because we have an increased number of elderly, we're going to have more chronic illness and a greater need for nursing.

And who's best at education? If we focus on health instead of illness, nursing's been doing that, and nursing plays a vital role in that. We need to get out of our medical model mindset.

When we talk about clinics and talk about hospitals, we're talking about illness centers. If we're really focusing on the health of the community, can't we have some healing and wellness centers?

Are there good models for this type of health care delivery system?

The best model I've seen is a model called integrative health. To have truly integrative health, you need to involve Western medicine and complementary and alternative therapies, and you need to have a matrix for deciding what makes sense.

For example, if someone comes in with an acute abdomen, you're going to do surgery. However, if they come in with some chronic illness, you're going to try some other modalities.

What I envision is a center for the community where you focus on education and wellness. A health care facility needs to be actively involved in reducing violence, in reducing crime. They need to be involved in the social activities as well.

Now, the problem is that the reimbursement system doesn't handle that; the reimbursement system only works if someone comes through your doors, except in the case of capitation.

So the larger question is, how do you realize this?

You ask the most difficult question, one [that] nursing has been struggling with for some time. We have traditional Western medicine, with a lot of huge players, and you can't just blow it up and start from scratch. It's going to take a few years, and some pain.

But I think it will not come from the politicians, it will come from the grass roots. Because if anything, what I've learned within AONE is that change occurs, not from the podium, but from the grass roots and the people, the members. The role of the podium is to bring those examples forward, so that everyone can see what's occurring.

We need to promote the profession, fix the capacity issues in nursing programs and continue to fix the workplace environment issues, because if we don't, we're going to lose nurses as fast as we get them in. I think that we are down the road to fixing that, but I think in some cases we have a long way to go.

In others, I think we're making great strides.