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Donna Shalala: Healthcare faces 'exciting’ and 'messy’ future

Monday June 3, 2013
Mount Sinai nursing leadership welcomed Donna Shalala, fourth from right, for her presentation during National Nurses Week. From left are Mount Sinai nurses Maria Vezina, RN; Judy Miranda, RN; Sonia Zabala, RN; Francine Fakih, RN; Audrey Schmerzler, RN; Beth Oliver, RN; CNO and Senior Vice President for Nursing Carol Porter, RN; and Carol Torchen, RN.
Mount Sinai nursing leadership welcomed Donna Shalala, fourth from right, for her presentation during National Nurses Week. From left are Mount Sinai nurses Maria Vezina, RN; Judy Miranda, RN; Sonia Zabala, RN; Francine Fakih, RN; Audrey Schmerzler, RN; Beth Oliver, RN; CNO and Senior Vice President for Nursing Carol Porter, RN; and Carol Torchen, RN.
(Photo courtesy of Mount Sinai Medical Center)
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MANHATTAN — As part of its tribute to nurses this year, the nursing department at Mount Sinai Medical Center sponsored former U.S. Secretary of Health and Human Services Donna E. Shalala, PhD, as its keynote speaker for National Nurses Week.

Shalala, who serves as committee chairwoman of the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine and is president of the University of Miami in Coral Gables, Fla., offered insights on the future of nursing and healthcare reform at the May 7 event held at the Mount Sinai School of Medicine.

In her address, "The Future of Nursing: Leading Change, Advancing Health," Shalala said the Afforable Care Act itself is not complicated, but how it will be carried out will be.

"It’s going to be an exciting time in healthcare," she said, "but it’s also going to be messy. In the process, we’re going to have to handle care differently."

Shalala said the ACA is about getting healthcare to Americans who work but still can’t afford quality healthcare.

"It’s about the the working-class people who get up every day and go to work," she said. "It’s not about getting healthcare for people on welfare. They already have Medicaid."

Shalala discussed the two stages of the ACA. The first stage, she said, is to get coverage to the large number of Americans who are not covered. The second stage deals with cost containment, which, Shalala said, will prove to be a lot more difficult because it will require a different way of thinking than the current approach. Shalala said she believes that during the next 10 years, there will be a dramatic change in how we finance healthcare in this country, and hopefully, in how we pay.

"The fee-for-service system we’ve adhered to for so long will disappear," she said.

According to Shalala, the second stage will require healthcare to be more integrative in care provision in order to provide the least costly care.

This is where the IOM’s Future of Nursing recommendations that nurses practice to their scope of practice and participate in residency programs is key, Shalala said. Healthcare professionals working in integrative teams warrants that each team member be allowed to practice up to their training. But because nursing practice guidelines are governed by states and may vary widely, Shalala suggested that nurses look at their states’ practice restrictions and become involved in changing those that limit practice."Robert Wood Johnson has a campaign for nurses to look at restrictions in their states," she said.

Residency programs, Shalala said, will allow nurses additional training that potentially could lessen the number of healthcare mistakes.

"This will allow us to provide care in the least costly way while at the same time instilling consumer confidence in the healthcare system," she said. "Healthcare reform will allow more people into the system. But at the end of the day, they are going to have to trust us."

At the end of her presentation, Shalala shared her thoughts on how reform will affect areas such as palliative care and chronic care and congratulated the Mount Sinai School of Medicine on its first endowed chair of the Department of Nursing, Carol Porter, RN, DNP, FAAN, who serves as CNO and senior vice president for nursing at Mount Sinai Medical Center.

"This endowment is a good sign of elevating the role of nursing in healthcare," she said.

Tracey Boyd is a regional reporter.


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