As Congress debates the reform of the American health care system, nurses and the nursing profession must be at the table. Regardless of the health care model that we eventually decide on, nurses can and should be key players in reducing health care costs and increasing efficiency while maintaining the quality of patient care.

The nation is facing a major shortage of primary care and family practice doctors. Health care coverage will potentially be offered to millions more Americans, but the question remains: Who will provide primary care? The answer: nurse practitioners. From private practice to nurse-managed health centers, NPs have proven their capacity to take on this role. More than 96 percent of NPs prescribe medications, and research has shown that the care they provide is of equal quality in patient outcomes to that of primary care doctors. A report by the Congressional Office of Technology Assessment found that NPs working in physician practices could decrease patient visit costs by a third.

Nurse practitioners are the fastest-growing group of primary care professionals in the country. Compared to physician training, the education of an NP costs four to five times less and can be completed at least four years sooner. That means more primary caregivers educated for significantly less and more people served. Yet traditionally, the federal government has spent 50 times more on medical education than on nursing education. Spending more on nursing education would pay significant and immediate dividends.

Increasing the availability and quality of nursing across settings throughout the lifespan also can produce significant cost savings. One great example is the Nurse-Family Partnership, which has helped change the lives of vulnerable, low-income first-time moms and their babies through ongoing home visits from registered nurses. This community health program has had a major impact on long-term family improvements in health, education and economic self-sufficiency. The NFP model is an investment that has saved communities more than twice the cost of the program by reducing welfare, health care and juvenile justice expenditures. The NFP model should be replicated nationwide.

Nurse-managed health centers, an innovative new model for primary and preventive care delivery, are another powerful ingredient in health care reform. Today there are more than 250 nurse-managed health centers in 40 states providing health care to millions of people. These centers could be expanded to reach more than 20 million people - nearly half of the 46 million currently uninsured.

One of the most promising models of care delivery is the Transitional Care Model, which is designed to cut health care costs by using advanced practice nurses to design comprehensive care plans that smooth the transition from the hospital to other settings. There has been great success using this model with high-risk, high-cost, high-volume patients, such as women with high-risk pregnancies and very low-birth-weight infants. The model has shown impressive outcomes in reducing expensive rehospitalization, achieving in one study a net savings of more than $18,000 per patient. More recently, the TCM has been applied to chronically ill elders being treated for common medical and surgical conditions. Again, studies showed that there were significant cost savings using a TCM plan.

At the School of Nursing, we often say that there is a nurse in everyone's future. As the nation reforms its health care system, that has never been truer.

Katharyn A. May is dean of the University of Wisconsin-Madison School of Nursing. She serves on a number of local, regional and national committees and boards related to nursing, health care and higher education.

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