Ramsay: Nursing in the era of Vermont health care reform

Editor’s note: This commentary is by Dr. Allan Ramsay, who is a member of the Green Mountain Care Board.

During these times of rapid change in the health care system, it is good news for Vermont’s health reform efforts that a nurse has joined the Green Mountain Care Board.

Nurses are a critical foundation of the health care delivery system in Vermont. The 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” argues for an enhanced role for nursing in redesigning health care to include more preventive care and deliver essential benefits. The role nurses play in Vermont’s health care system to provide primary care, teach us how to take better care of ourselves, and keep us independent as we age will significantly expand in a high quality health care system.

The importance of advanced practice nurses (APN) and nurse practitioners is a case in point. The shortage of primary care doctors will not be solved in the near future. Even as thousands of Vermonters will now be able to obtain affordable health insurance through the exchange, Vermont Health Connect, the question remains are they able to find high quality primary care. Advanced practice nurses and nurse practitioners have the ability to step into this void. They can now provide care and prescribe medications that a few years ago only physicians were licensed to do.

Dr. Rambur knows the future of successful health care reform depends on a well supported and vibrant nursing workforce. She also knows we have a moral responsibility to ensure high quality care for all Vermonters.


The last biennial National Survey of Registered Nurses was reported in 2010. Results of this research offer a picture of a nurse’s capacity to practice successfully in an environment that is expected to emphasize teams, care coordination, and increasingly moves payment incentives toward quality, safety and efficiency. Nurses believe that if they are supported to take risks and innovate to improve the quality and efficiency of care delivery, they will thrive in the health care reform era. In 2010 86 percent of the registered nurse survey respondents said they would advise a qualified student to pursue a career in nursing.

I practiced family medicine in Vermont for 32 years prior to joining the Green Mountain Care Board. While at Colchester Family Practice I worked closely with a nurse practitioner. We co-managed very complicated patients over many years. This colleague knew when someone needed to be seen to avoid an emergency room visit, to adjust an essential medication or just for reassurance. We trusted each other’s opinion and respected our own unique abilities. Being part of a team increased quality, reduced cost, and definitely improved the experience of our patients. I am sure many of my physician colleagues around the state have had similar experiences.

Nurses continue to expand their scope of practice. The first nurse practitioner residency program in the country, established by a community health center in Connecticut, is being replicated in several other states. These are training programs geared largely toward honing nurse practitioners for community care or frontline jobs serving populations that tend to be low-income, uninsured, homeless or mentally ill. Another example is that Fletcher Allen Health Care has recently developed a nurse practitioner Palliative Care Fellowship, funded by a generous donor. Having well-trained palliative care providers in Vermont will assure we can provide the best supportive care for our most seriously ill.

Gov. Shumlin recently appointed Betty Rambur, RN, Ph.D., to serve on the Green Mountain Care Board. Dr. Rambur has served as a family nurse practitioner, nursing educator, and health services researcher. She and I were members of the Visiting Nurse Association of Chittenden/Grand Isle Counties End of Life Subcommittee. Dr. Rambur knows the future of successful health care reform depends on a well supported and vibrant nursing workforce. She also knows we have a moral responsibility to ensure high quality care for all Vermonters.

The Green Mountain Care Board‘s inclusion of a highly qualified nurse is another indication of our commitment to respecting the abilities of all health care providers and fostering innovation throughout the health care system. Our mission to make Vermont the best place in the nation to practice medicine by all health care providers has taken another step forward.

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  • Thanks Dr Ramsay for supporting the backbone of medicine. I believe one more step is to add a Common Nurse to the board. We need a hundred Common or not so common RN’s for every advanced practice nurse. Creating a competent practicing nurse requires more than education and training. Without Common nurses, it is too academic. How do you capture the power of a moment when a nurse holds their patient’s hand, Dr and NP gone for the day. There you are, young Common nurse. What keeps you there? I marvel at how much experience nurses I work with have and what they endure with “woman’s work-it never ends” So your board is saturated with Academic genius. I believe always room for some Common nurses too.

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