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But this does not mean unlimited health care, she added. In fact, nurses, who assess and triage patients all the time, take the same discerning look at the health care system.

"Health care is a finite resource and to treat it as if it were infinite is insane," Johnson said. "How good a system do you need? Do you have to have absolutely everything? We don't need a lavish system if we work for prevention."

Assuring access means making some tough decisions as a society, Keck said. "We literally treat people to death. Other societies don't do that. We have tried to do all things for all people in all ways and I'm not sure at the end of the day that we have something that's better."

Learning curve

A nurse-run health care system would emphasize education, both for health care professionals and the public, much more than today's system does, nurses said. A Congress full of nurses long ago would have passed the Nurse Reinvestment Act to help pay for nurses' education, Capps said. Nurses also would insist on more training and education for nursing assistants, Keck said.

Many nurses envisioned nurse practitioners in every school, working as primary providers for people in the school community as well as offering health education and fitness programs, guidance on nutrition and school meals and making sure that children were exercising.

Nurses also would focus on technology to reduce nurse stress, including documentation and physical lifting.

"We've got tons of technology to tell us what's going on inside a patient," said Barbara Blakeney, MS, ANP, RN, president of the American Nurses Association. "What we don't have enough of is the technology that helps the nurse physically take care of the patient."

Designer care

Under a nurse-run system, hospitals would be designed with the needs of patient and worker safety in mind. Technology to move and lift patients would be designed within the rooms, so nurses wouldn't have to spend 20 minutes looking for a bulky piece of equipment. A "no-lift" policy, similar to what Blakeney has seen in Europe, would mean that, except for emergencies, lifting simply would not be part of a nurse's job.

Nurses also would insist on data entry systems that streamline paperwork and avoid duplication. Home health care nurses would not have to wait until their children went to sleep to spend four hours documenting their patient visits-they would type or speak the information into handheld computers or laptops as they collected it, Blakeney said.

Nurse-run hospitals would return to their true business-patient care-instead of profits and physician convenience. "This is not about making money for insurance companies," said Kathleen Sanford, RN, vice president of nursing at Harrison East Bremerton (Wash.) Hospital and administrator at Harrison Silverdale Hospital. "This is not about the opportunity to give people cushy jobs." Yes, she said, hospitals should run in the black. But money should go back into patient care and supporting those who care for patients.

Nurses would schedule operating room surgeries in accordance with when the most patients were coming in-not according to when physicians wanted to do their outpatient procedures, Blakeney said. They could close units if they didn't have enough staff and manage staffing patterns according to patient acuity.

"While physicians would continue to admit patients, I think it could be up to the nurse to discharge them," Blakeney said, because nurses are in a better position to know when patients and their families are ready for discharge.

Team approach

Nurses would improve the team approach to health care, said Judy Sweeney, MSN, RN, associate professor at Vanderbilt University and first-year-level director for the nurse practitioner program. Nurses would be working on discharge planning the moment a patient is admitted to the hospital. They would understand the importance of coordinating home health, mental health, spiritual care and other professionals into the patient's care, she said.

Physicians would continue to play an important role in health care, nurses added. They would continue to provide research, expertise and diagnose and treat illness. "That's their training," Keck said.

But in a nurse-run system, nurses would be equal partners with the physicians. Physicians would diagnose and prescribe. Advanced practice nurses could implement a plan of care and continue to assess patients, she said. "The model now is still pretty heavily focused on the physician's role."