In this issue...

"It's All About the Patient"

Terry Fulmer, PhD, RN, FAAN
Dean and Erline Perkins McGriff Professor
NYU College of Nursing

"It's all about the patient." That has always been the philosophy of the nursing profession and of the nursing program at NYU. Since its inception in 1923, nursing at NYU has been committed to addressing the expectations of the public for accurate information, quality delivery systems, and ever-expanding access to humane health care.

This commitment is at the heart of the NYU College of Nursing/NYU College of Dentistry alliance. It holds that nurses, dentists, physicians and, indeed, all healthcare providers, have an obligation to collaborate across disciplines to create a more holistic healthcare environment, one that increases the value of each and every patient visit.

Our national healthcare crisis demands no less. In the United States today, an estimated 40 million Americans forgo necessary care each year due to cost, and 22,000 uninsured adults die prematurely each year as a direct result of lacking access to care, a situation that calls out for us to utilize all points of entry into the healthcare system—including dentistry—as a means of expanding access to care.

In a society in which access to health care is woefully inadequate and has severe consequences, including the promulgation of health disparities, it no longer makes sense for a patient to be able to access only one type of care at the point of service. The fact that there are well-documented common risk factors for oral health problems, such as periodontal disease, and for systemic health problems, such as diabetes, cardiovascular disease, autoimmune diseases, cancer, and premature birth, further supports the relevance of and need for interdisciplinary care.

Accordingly, the NYU dentistry-nursing alliance is developing interdisciplinary educational programs, evidence-based practice models, and research partnerships, especially those that explore the connection between oral and systemic health. These initiatives are providing dental, dental hygiene, and nursing students with opportunities to collaborate in assessing current educational, research and healthcare delivery practices; in viewing the oral-systemic link as a two-way street; and in applying this broader perspective to patient needs and pathologies that might otherwise go undetected. Most important, our students are learning to view every patient contact as an opportunity to improve the quality of care and to increase practice satisfaction. They are also learning to view increased patient satisfaction as an effective practice-building measure.

In addition, nursing and dental faculty have developed interprofessional educational and practice opportunities that familiarize dental students, faculty, and staff with the nursing profession, the role and scope of nurse practitioner (NP) practice, and the relevance of an integrated primary care model to their own practices. Dental and nursing faculty members have also collaborated to implement system changes that facilitate appropriate referrals and integration of patients' oral and systemic health needs.

This collaborative, interprofessional model comes easily to nurses. As a profession, nursing has always been interdisciplinary and collaborative; it is natural for nurses to reach out to the appropriate healthcare profession to improve the health of patients. We recognize that no healthcare provider has all the answers to a patient's healthcare needs and that the ability to collaborate with a broad network of practitioners through referrals is intrinsic to improving patient care. Indeed, it is the norm for nurses, physicians, pharmacists, social workers, and other health professionals to work in teams. Dentists, by comparison, tend to work in private, office-based practices and have a long record of being extremely entrepreneurial, which is not the norm in nursing. But this can change, with each profession gaining the knowledge, skills, and expertise to complement the other's strengths.

A key objective of the nursing/dentistry partnership is to motivate dentists and nurses to see themselves as partners in the delivery of comprehensive patient care. The College of Nursing Faculty Practice at the College of Dentistry is enabling us to advance toward this objective by making it easy for dental students to refer their patients who could benefit from evidence-based primary health care provided by NPs, who are qualified to diagnose and manage common health conditions, including chronic illnesses. In promoting patient-centered care and care coordination, these future dentists are reinventing themselves as a link to the medical network.

By the same token, nursing students are becoming more skilled in screening patients for oral health problems—in looking at the mouth and not just the throat, as in the traditional medical model—and in making appropriate referrals, thereby broadening the scope of their professional responsibilities and the range of care they provide.

I am convinced that America's healthcare system is at a tipping point. We are ready, at last, to take a close look at the healthcare models we have and to forge a plan that will increase the value of the care we provide. But that does not necessarily mean starting with a clean slate, which is probably not possible anyway. As Dr. Atul Gawande wrote in a recent issue of The New Yorker, "We cannot swap out our old system for a new one… But we can build a new system on the old one."

That is the approach guiding the NYU Colleges of Nursing and Dentistry. We are animated by the belief that, through collaboration, we can increase the capacity of both dentistry and nursing to improve the health of the public. As we go forward, we will continue to expand opportunities for nursing and dental students, as well as for our respective faculties, to work together to expand access to quality, comprehensive care, always bearing in mind that "it's all about the patient."

*Dr. Gawande's article, "Getting There From Here: How Should Obama Reform Health Care?" appeared in the January 26, 2009, issue of The New Yorker.