With only 3 days notice, over 60 people, mostly nurses, showed up for a town hall forum on Thursday, Dec. 18th at the UC Davis Health System Education Building. President-Elect Obama’s transition team is reaching out to healthcare providers across the nation and already 4200 groups have signed up to hold meetings between December 15th and 31st.

The format of the meeting was spelled out in a packet sent from the transition team and included questions about needed policy changes and what types of preventive services would promote health and safety.

The forum was hosted by the Association of California Nurse Leaders, California State University Sacramento Nursing Program, UC Davis Health System Patient Care Services and the UC Davis Betty Irene Moore School of Nursing (Proposed).

I spoke with two nurse leaders who shared what they heard at the meeting.

President-Elect of the ACNL, BJ Bartleson, RN, MS, NEA-BC, Director of Patient Care Services and Chief Nurse Executive, Shriners Hospitals for Children Northern California, described some of the problems plaguing healthcare. “As nursing leaders we feel we can transform healthcare through nursing. But our practice is focused in acute care because our nation’s health care system is centered in an illness model. We are trying to function in an overregulated, clogged up system that has bottlenecks and prevents us from performing more preventive measures that improve health more efficiently.

Heather Young, PhD, RN, FAAN, Associate Vice Chancellor for Nursing of the proposed Betty Irene Moore School of Nursing, UC Davis Health System, said that a national policy was needed to insure universal access to healthcare especially for the unemployed and 18-26 group who often fall through the cracks. Other issues discussed were the shortage of a wide variety of providers, including nurses, nurse practitioners, family practice physicians, pharmacists, and how to enhance funding for nursing faculty.

Young spoke about how nursing can play an important role “pushing healthcare into communities.”

“It’s not about building new buildings and expensive programs but to go where the people are. It’s not about creating new clinics, but using existing access such as schools, libraries and community centers and finding ways to reimburse non acute and preventive nursing services.

Other solutions described by Dr. Young that came out of the meeting:
• There is less and less face to face time with patients, and financial incentives go to specialists The typical five minute physician visit can be extended by working as an interdisciplinary team-physicians, nurses, pharmacists and others. Nurses need to be reimbursed for the entire scope of their practice in all settings.
• Safety for kids and older adults are important preventive issues, for example, having walking paths that are well-lit.
• In order to combat advertising that promotes unhealthy life styles such as tobacco, and alcohol, equal time must be given to health campaigns such as providing good food in schools, workplace wellness programs, and help for family caregivers.
• Address underserved communities including language barriers and health literacy
• Medical home concept which promotes ongoing relationships between physicians and patients should be extended to include nurses and others and could be called the“health home”
• Restore school nurses who have been severely cut back. .Parents of kids with complex issues need support from health care professionals. This support is now provided by unlicensed personnel giving out meds. Costs are higher when a negative incident happens

Bartleson elaborated on how the environment must be part of the preventive piece. “How do you incentivize health without forcing people to change? Educating and incentivizing are the answer. Smoking cessation campaigns, weight loss collaboratives and employer wellness programs have been extremely successful because they offer people a combination of education and peer support. Physical education campaigns in the school systems, incentivized through national and state support, like the historic Presidential Physical Fitness Campaign, could leverage an increasingly sedentary lifestyle inherent in the computer age.

Recognizing that our environment will not tolerate the excessive rate of natural resource destruction, social reform, along with health care changes, must occur simultaneously. For example, in the city of Davis there are numerous walkways and bike paths that make it safe to use alternative methods of travel that combine healthy lifestyle activities and environmentally sound approaches. A movement towards our own health, along with our earth’s health is imperative.

Other needed routine preventive services mentioned at the forum were immunizations, pap smears, dental care and hearing aids.

Both Bartleson and Young spoke of health disparities and how the system is weighted towards fragmented, episodic care and that paying attention to chronic conditions would improve care and lower costs, particularly for underserved populations.

“Solutions have to be co-created. They cannot be given to us by the leadership of the country. The 21st Century demands a different way of problem solving, said Bartleson in praise of the Obama team for reaching out.

The moderator, Debbie Ward, PhD, RN, FAAN, Health Sciences Clinical Associate Professor at the Betty Irene Moore School of Nursing (Proposed), facilitated the discussion while staff took copious notes which, at the end of the evening, were projected onto a large screen for the group to review. The four sponsoring organizations will again review the synopsis before submitting to the Obama transition team.

I'll be very interested to see how the transition team makes use of all this input from nurses and other healthcare providers.