Payment systems need to be changed to recognize the time nurses spend with patients and their families, instead of forcing nurses to squeeze such interactions into their spare time. Chow asked what would need to change from a technology and a systems perspective to make this happen. For example, what if nurses partnered with hospitalists to admit patients? The physician could handle the medical diagnosis and orders while the nurse handles everything else. The nurse could be a single point of contact for the patient and family during a hospital stay as well as during discharge and transition to the home. The nurse could even visit the patient at home, potentially for several months, as happens with Mary Naylor’s Transitional Care Model.² “We need nurses to think like entrepreneurs and be willing to be designers and experimenters.”

Chow also suggested that consideration be given to assigning patients a primary nurse. Patients may have a primary physician and a primary medical assistant. But they do not have a primary nurse.

Federal waivers for state experiments with new practice models could enable expansion of the scope of practice for nurses. In California, for example, a statute enabling health workforce pilot projects has expanded the scope of practice of clinicians beyond current law to test the safety and quality of new, innovative practices. Bringing such waivers to the federal level would allow experimentation that challenges state scope-of-practice laws.

In Great Britain, Prime Minister Gordon Brown issued the following mandate to the Commission on the Future of Nursing and Midwifery: Reposition nurses and nursing in the eyes of the consumer. That mandate fits with the mission of the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, Chow said. The chair of the commission, Ann Keen, advised Donna Shalala, the leader of the Initiative on the Future of Nursing, to “have courage, come to the forefront, and stand up for the care you know nurses can do.” Chow issued similar advice to the committee: “Timing is everything. Be bold and seize the day.”