What most people remember from a hospital stay is how they are treated by the nursing staff. Nurses are the glue that keeps everything coordinated in almost every healthcare setting, and yet in too many instances they are taken for granted. That’s a principal finding of recent survey conducted by the Princeton, N.J.-based Robert Wood Johnson Foundation.

The 1,500 survey respondents were drawn equally from academia, insurers, caregivers, healthcare administrators, government and a category labeled “industry thought leaders.” The survey found that nurses’ voices were the least influential at a time when their influence is seen as critical to accomplish the goals of healthcare reform. Seventy-five percent of opinion leaders say government officials will have a great deal of influence in health reform in the next five to 10 years, compared with 56% saying that about insurance executives, 46% about pharmaceutical executives, 46% about healthcare executives, 37% about doctors, 20% about patients and just 14% about nurses.

Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, told Modern Healthcare: “At a time when trust is eroding for other professions, it remains very high for nurses. And among health professions, it remains very high. That is an asset that we as health professionals need to build on-the fact that trust is high and has remained high over a long period of time.” Lavizzo-Mourey’s sentiments are echoed by survey respondents, 90% of whom said they would like nurses to have more influence in the development of policies to reduce medical errors and improve patient safety. Another 89% said that nurses ought to have a more influential voice in developing policy to increase quality of care.

In my opinion, nurses are the ones on the firing line day in and day out, and for them not to have a prominent role in developing healthcare policy is totally irresponsible and plain stupid.

So you have to ask yourself why nurses don't have more influence in healthcare reform policy? Apparently for the study many nursing executives were interviewed about the “contentious” effort to expand nurses’ “scope of practice,” which translates into doing more of what doctors do today. Naturally, many physician groups often argue that advanced practice nurses lack the training to safely perform primary-care tasks such as prescribing medications. Nurses, on the other hand, respond by saying that health systems rely too heavily on doctors, who are expensive and often in short supply for primary care.

Another area of physician-nurse rivalry that comes out in the study is the perception that doctors have more influence in the policymaking world because they generate revenue. Peggy Naleppa, recently promoted to president and CEO of the Peninsula Health System in Salisbury, Md., tellsModern Healthcare: “It’s a very archaic culture that would defer (nurses’) input based on the fact that they do not bill for their services. And it’s unfortunate. A more contemporary model would have them at the table.” Nurses, she says, “know the reality of providing care. They know the implementation.”