Continued from Page 1

Better than a cure

In a health care system run by nurses, nurse practitioners in community clinics would take care of people before they became ill, giving immunizations, doing screenings, providing diet and nutrition programs, treating minor conditions before they turned into something bigger and managing chronic illnesses.

"Then the only people in the emergency rooms would be those who really needed it," Keck said.

Such clinics already exist in pockets across the United States. In clinics run through a program at the University of Wisconsin, Milwaukee, College of Nursing, nurse practitioners see people "where they live, learn, work and play," Lundeen said. For example, a mother with a toddler in tow and a baby on her hip might run into a nurse she knows in the hall on the way to her day care center. The young mother mentions she's not getting much sleep because her baby is crying a lot at night.

The nurse has her step into the clinic next to the day care center, checks the baby's ears and finds an infection. While she's there, she asks if the baby is up-to-date on immunizations and gives a necessary vaccination. She notes that she hasn't seen the 2-year-old in a while. How is she doing? She asks if the mother is still thinking about getting her GED and tells her about a study program at a nearby community center. She asks if the woman's mother is still living with her. Last time, her blood pressure was high. Has she had it checked recently?

In a 15-minute encounter, the nurse uses a "pre-emptive strike" to prevent a trip to the emergency room with a screaming baby who has a raging ear infection, Lundeen said. She also brings the baby up-to-date on immunizations, checks on the 2-year-old, sends a reminder to get an elderly woman's blood pressure checked and gives the mother some peace of mind about her crying infant.

"Health care becomes part of the routine of that mom's day," Lundeen said. "It seems so simple, doesn't it? This is how people need to live their lives."

Nurses also understand how issues such as gun safety, air quality and safety regulations relate to the health of a community, said Rep. Carolyn McCarthy, LPN, D-N.Y. "It's the whole lifestyle, it's everything you do. These things are all connected to good health care." They understand the importance of having good mental health as well as good physical health, she said. If nurses made the laws, there would be parity for mental health coverage. "They know that someone can't see a therapist one or two times and expect a cure."

Easy access

Almost as important as wellness and prevention, nurses said, is access to health care. "From a nurse's perspective, access and payment should be something that's universal," Porter-O'Grady said.

People, especially in underserved areas, would have better access to health care through community clinics and an improved system of home care. In a nurse-run health care system, every new mother would receive a visit from a home care nurse to make sure that she was doing well, and that the infant had his or her first well-baby exam by a pediatrician or pediatric nurse practitioner.

"Health care was never meant to be a cash cow, something just to make money," said Rep. Eddie Bernice Johnson, MPH, RN, D-Texas. "It was meant to be a service. If nurses were in charge, I think it would be a good balance. I think the focus would be on the patient and not on the bottom line, which is the dollars."

Nurses' ideas on health care payment plans varied. Some suggested states and employers be allowed to pool their risks to increase negotiating power with insurance companies. "I think there's a place for health insurance" in a nurse-run system, Porter-O'Grady said, but it should adhere to much stricter standards than a regular business.

Capps suggested lowering the age for Medicare, expanding Medicaid to cover the working poor and creating programs to assist employers in insuring workers. Nurses would make prescription medicines part of almost any coverage, she said.

"It's not easy, but there's no reason why we can't do it," she said.

Some states, Capps noted, are looking at ways to provide universal coverage, and depending on how these systems work, the notion could become more popular in the rest of the country.

Many nurses thought universal coverage, with the federal government as the primary payer, would ensure that everyone received affordable health care. "I think most nurses would tell you that that would make the most sense," said Cheryl Johnson, RN, clinical nurse 3 at University of Michigan Health System in Ann Arbor, president of United American Nurses and vice president of the Michigan Nurses Association.