For example, a nurse sources information about the patient and family, understanding what's holding them back, what's going to help them get better, what's important in terms of customizing the care for that patient.
And when the nurse intervenes because the nurse recognizes that the patient or the person or the family that they're caring for has bigger problems at home—they have opioid-addicted, suicidal siblings, or an aging parent who is unable to [be a caregiver]—the nurse is the one who puts the puzzle together.
We also need to be demonstrating the huge value that nurses have so that we can advance issues such as staffing, to make sure that organizations are taking it seriously, that they need to staff in a way that's good for patients and good for nurses.
On the new roles for nurses:
In the past, I think nurses were pigeonholed. You either work in a hospital, or you work in a clinic, and homecare was still relatively new. Now when I think about nursing in the United States, I think about our desire to move to preventive and community-based care, and we have nurses leading the way.
We have parish nurses. We have homecare that is high-tech—some of it is home monitoring, with remote monitoring. There are community-based organizations where nurses have a caseload of patients and families that they follow.
We have ways in which we're really engaging communities. We're using our advanced practice registered nurses along with staff nurses in primary care practice. We're using that expertise to make sure that people are following the requirements for immunization schedules, getting their preventive healthcare, and addressing their chronic conditions.
What we have done is really broadened the skill set requirements for nurses, and in doing so, it's given nurses more flexibility in terms of where they can provide care.
But, when I think about the future, I think about us still having a heavy concentration of nurses in a hospital, and at the same time, really tapping the expertise of nurses to be significant caregivers in the community.
The primary change that I would like to see is that nurses become leaders within their communities. We will have taken out the hierarchy that says nurses need to wait for orders.
On the importance of advocacy:
One of the conclusions that I've made in the last several years is—I don't say this in a negative way—but we often put forward the excuse that "I'm too busy to get involved in policy work or advocacy because I'm always busy taking care of patients."
Managers are always busy going to meetings. Executives are always busy in meetings or making visits to board members. There's always something that can keep you from the critical activities that you believe you should be doing.
To me, if we really believe it's important for nurses to influence the changes in healthcare, we need to find a way to support each other and to get the people on the front lines in front of the policymakers and in front of decision-makers in our organizations.