As a kid, Kellyn Freed got her first taste of nursing with a Fisher Price medical kit complete with play stethoscope, syringe and bandages, and a little brother who was willing to play the patient.
Last week, Freed and other students enrolled in Rivier University's nursing programs looked ahead to the future of their profession at the school's second annual health policy summit, "Improving Patient Outcomes: Exploring the Spectrum of Nursing."
Organized by grad students who are studying advance health policy, the summit focused on the role nurses can play in influencing health regulations and improving patient care. The students tapped Dr. Karen Baranowski, vice chairwoman of the New Hampshire Board of Nursing, to provide an overview of the evolving health care system and new opportunities for nurses. Other local professionals led break-out discussions on how nursing fits with the new perspective of patient-centered care.
"As one of the speakers said, this is a great period of transition, and an exciting time for nurses," said Freed, a Merrimack resident enrolled in Rivier's nurse practitioner program. New Hampshire is one of 18 states that licenses nurse practitioners to operate independent practices, although other states are now considering similar measures to ease the shortage of doctors that is expected as more and more people gain access to medical treatment through the Affordable Care Act.
And according to Baranowski, the growth of primary care and family medicine practices launched and managed by nurses with advanced degrees is just one part of the massive shakeup taking place in health care.
Baranowski said that during the current decade, an estimated $1.7 trillion in spending will be taken out of health care.
"How are we going to reconcile this magnitude of cuts?" she asked a roomful of nursing students and faculty.
Health care providers are experiencing an ongoing wave of mergers and acquisitions in the hope of remaining profitable in an environment of increasing regulations and costs, and decreasing Medicaid reimbursements and payments from private insurers.
"There are hardly any private physician practices anymore," said Baranowski, who added that smaller health care agencies are also struggling to make the bottom line work.
But Baranowski also brought some good news to the summit.
"We are finally talking more about health promotion and disease prevention," she said. "Clinically, there has been a recognition that health care isn't just about acute care."
The broader understanding of health care that is linked to cultural, socio-economic and environmental factors is opening doors for nurses who are interested in providing primary care for families, particularly in rural areas where hospitals and group practices can no longer afford to go.
Baranowski said there is also a huge need for palliative care and case management for the tsunami of aging baby boomers coping with chronic health issues such as diabetes and cardiovascular diseases.
"Care is transitioning from hospitals to the community," said Baranowski.
And young nurses like Freed are looking at ways to become part of that transition.
"I think quality is at the center of the changes," said Freed. "It's worrisome because you see how much money we spend on health care, and you look at countries in Europe that spend much less and have better patient outcomes."
Freed said more collaboration among providers, more prevention and more attention to all the details and factors affecting health have the potential to improve care, and nurses are in the right place at the right time.
"As nurses, we are known for educating, listening and following up with patients, all of those things doctors don't do," she said.
Kymm Dennis, who graduates this year with a B.S. in nursing, put it another way.
"Doctors treat diseases, nurses treat patients," she said.
And because nurses are on the front lines of providing direct patient care, they also have a broad view and understanding of risks and social and systematic problems that contribute to health problems. Their knowledge and experience with patients makes them invaluable resources when it comes to developing health policies.
But Rivier nursing students aren't waiting for an invitation to the table to discuss health policy. They are studying how to identify risks, design policy solutions and how to usher an idea from a proposal into a law.
Students in professor Bobbie Bagley's Policy, Politics and the Nursing Profession class were at the summit with poster presentations on health policy issues such as age restrictions for tanning salons, farm aid and nutrition, and regulations surrounding blood donations.
For Elizabeth Ryan, who also graduates this year with a B.S. in nursing, the challenge of influencing health policy has made her more aware of how many ways nurses can work to strengthen the health of a community.
"It's showed us that nursing goes beyond hospitals and taking care of patients," she said. "We see how interactive everything is."