Montana State University

Mountains and Minds

Nursing for the new West November 22, 2016 story by Anne Cantrell • Published 11/22/16

More than 15 years ago, Peter Buerhaus—then a nursing faculty member and health care workforce economist at Vanderbilt University—and his colleagues warned that the United States would face a critical shortage of nurses unless the country took measures to ensure more people entered the profession.  

The projected shortage estimated at the time amounted to more than 400,000 registered nurses by 2020—large enough to cripple the health care delivery system, leading to the closure of health facilities, long delays obtaining health care, lower quality of care and higher costs. These projections were widely covered in the national media, including the New York Times, Wall Street Journal, NPR, CNN and others.

Policymakers took note, especially after other high-profile publications provided new evidence confirming Buerhaus’ predictions. His research helped spur Congress to pass legislation and led to foundations and corporations throughout the country developing national and state-level initiatives and campaigns aimed at promoting nursing as a career.

That groundbreaking research is just one of dozens of studies that have influenced policy that Buerhaus has published in prestigious scholarly journals since he began his career as a health care workforce economist and researcher in 1990.  
Buerhaus’ research has ranged from retirement of the baby boom generation of nurses at the very same time that the nation’s 75 million-plus baby boomers would begin consuming vastly more health care services themselves to the development of quality of care measures that have been adopted by the Medicare program, federal and private sector quality improvement organizations, and those who pay for health care.   

More recently, his research has focused on how to deal with the millions of people without access to primary care, particularly in rural areas, due in part to persistent shortages of physicians.

Now, Buerhaus continues his influential research on the national health care workforce as a member of the faculty of the Montana State University College of Nursing, which he joined in 2015. Buerhaus also serves as director of the Center for Interdisciplinary Health Workforce Studies at MSU.

After graduating in nursing from Mankato State University and working as a nurse, Buerhaus enrolled in graduate school. When he took a course in health economics during his second semester in a master’s program in nursing health services administration at the University of Michigan, “a very bright light bulb went on.

“I realized way back in the early 1980s that it was only a matter of time before the fee-for-service payment system used to pay hospitals and doctors would run its course and that government and private sector payers would instead pay providers on the basis of value—the best outcomes for the lowest cost,” Buerhaus recalled.

He realized that if the nursing profession played it right—focused on providing evidence of its impact on the quality and safety of health care—nurses would be well positioned to exert a much larger and more influential role in helping guide the development of a better health care delivery system—a prediction that has panned out.  

While pursuing his doctorate, Buerhaus worked as an assistant to the CEO of the University of Michigan Medical Center’s seven teaching hospitals, which gave him the opportunity to participate firsthand in the operation and politics of a large and complicated health care system.

“On several occasions I was dispatched to Washington to talk with members of Congress and leaders of the administration on some health care issue, and flying back the same day in time to attend a class on policy making. It was a wonderful time in my life to be surrounded by so many principled leaders at Michigan, learn the ways of the nation’s capital and gain inspiration as I began my research career.”

After completing a Robert Wood Johnson Foundation postdoctoral faculty fellowship in health care finance at Johns Hopkins University, he landed a position as an assistant professor of health policy and management at Harvard University’s School of Public Health, where he developed the Harvard Nursing Research Institute and its postdoctoral program in nursing health services research.

After eight years, Buerhaus left Harvard for Vanderbilt University, where he was the senior associate dean for research and the Valere Potter Distinguished Professor of Nursing in Vanderbilt’s School of Nursing. In his 15 years there he was subsequently director of the Center for Interdisciplinary Health Workforce Studies, a cooperative affiliation between the nursing and medical schools. He also spearheaded establishing a new Department of Health Policy, which is housed at the Institute for Medicine and Public Health at Vanderbilt University Medical Center. In 2010, he was appointed chair of the National Health Care Workforce Commission, established under the Patient Protection and Affordable Care Act, to advise both Congress and the president on national health care workforce policy.

Since coming to MSU in 2015, Buerhaus has published studies showing that primary care nurse practitioners provide similar services as physicians, produce comparable quality of care, cost considerably less than physicians and are more likely than medical doctors to work in rural areas. He also said he sees a strong movement across the country aimed at using nurses, nurse practitioners, physician assistants and other health care workers more effectively and working in teams with physicians.
He also organized a meeting of the nation’s top health care workforce analysts and brought them to Montana this past July to find ways to improve forecasting the future supply and demand for nurses in the U.S.

“What is encouraging is that health care funders are investing more to mitigate the influence of social determinants of health—social isolation, low income, low education and other factors that end up with behaviors that lead to poor health and also compromise a person’s recovery when they are ill,” he said.

Therefore, Buerhaus believes nurses and current nursing students will have a bright future, but he cautions that patience will be needed as the health care system undergoes transition. His advice to students who will be part of those changes is to take time to learn and practice how to communicate their ideas clearly, to become more conscious of the need to add value to the delivery of health care through their actions, and to become well-versed in health policy issues.

“The more (nurses) can communicate clearly and understand how health policy is shaped and implemented in both the public and private sectors, the better they’ll be positioned to have a very productive and rewarding career and to have helped shape and guide changes that improve the health of all people.”