Harbingers of Change: 1993

Abstract

With the election behind us and new leadership in place, a serious debate on health care has begun. What can we expect from this debate? We can anticipate that women will have only a small influence on healthcare policy. Although women have had the vote since 1920, and despite gains in the 1992 election, women remain poorly represented in the ranks of power, policy, and decision making. Women occupied a mere 3-8% of the legislative seats in the country in 1975. By 1987, this figure had risen slightly to 5.3%. These data, although somewhat old, are significant because they frame a time period known as the "Decade for Women" (United Nations, United Nations, 1991United Nations The world's women 1970–1990. Author, 1991Google Scholar). There are approximately 2.1 million nurses in the United States and about 600,000 physicians. But nurses will not be invited to participate in the policy debate. We will be invisible unless we effectively assert ourselves as a profession. Assertiveness is back in vogue, and here are some of the ways we predict nurses will advance our profession's agenda for healthcare reform in 1993. Nursing's move to autonomy and independence is here to stay, and we can expect that competition between physicians and advanced practice nurses will escalate. The economics of primary care have created more opportunities for nurse practitioners and nurse- midwives. Tertiarycare centers also are increasing the need for nurse practitioners, especially in areas such as neonatal intensive care. Individual nurses may feel pressured to return to school this year: associate-degree nurses for baccalaureates, nurse managers for master's degrees, and faculty for doctorates. Our educational institutions will need to find ways to articulate the many levels of nursing education so that nurses can move efficiently from one degree to the next. We expect the demand for graduate education for directcare providers to increase dramatically, further challenging the nursing schools to respond. We expect that nurses this year will seek greater collaboration with other health-care professionals, including physicians. The basis for collaboration will be mutual respect and recognition of autonomy. Both individuals and organizations must reevaluate the traditional view that health care is directed by a single discipline. The physician-centered model, upon which our current health-care system is based, is dysfunctional. A perspective that recognizes the discrete skills and knowledge of all members of the health-care team will allow us to effectively confront health-care issues. This year will be the year of the woman (and yes, we do need it even after the "Decade for Women"). The drive for equality is not finished, nor is it likely to be finished in 1993. We expect this round to incorporate the traditional caring values associated with women and nurses. Many forces are in effect this year that can propel nursing forward. First, nurses offer health prevention and health maintenance services that are increasingly valued by informed consumers. Second, nursing services are cost effective. Third, the nursing profession is seen as a more attractive career choice in the '90s than it was in the '80s. Salaries for nurses are more commensurate with the level of responsibility than at any earlier time. Finally, greater numbers of nurses hold university degrees and, as a result, nurses and nursing have gained confidence. Confident, autonomous nurses will want to work collaboratively with physicians to take care of patients. Collaboration is based on mutual respect among equal parties. In 1992, we have watched NAACOG become AWHONN (the Association of Women's Health, Obstetric, and Neonatal Nurses). This move brings the organization out from under its parent organization, ACOG. A parent-child relationship may be based on respect, but it is not collaborative. The parent is the dominant party, and the relationship is hierarchical. This type of relationship became unacceptable to NAACOG members in 1992. We are proud to display the new organization's name on the JOGNN masthead. JOGNN is now an official publication of AWHONN, formerly NAACOG. Welcome to 1993- Karen B,Haller, RN, PhD Editor