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REMARKS BY DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
Place:  THE FRIENDS OF THE NATIONAL INSTITUTE OF NURSING RESEARCH DINNER, WASHINGTON, D.C.
Date: September 16, 1998  

It's a pleasure for me to join you tonight to mark the fifth anniversary of the National Institute of Nursing Research. I know that one of the hallmarks of nursing researchers is the ability to combine laboratory expertise with bedside experience. And anyone who has spent time in hospital halls and patient wards has certainly seen it all...but maybe you haven't heard it all. Consider these excerpts from actual patient records-as written by actual doctors and first read by nurses. One doctor wrote, "The patient has no past history of suicides." An obviously unflappable physician noted, "The patient expired on the floor uneventfully." Another commented, "When she fainted, her eyes rolled around the room." I'm a little concerned about this physician's attitude when he wrote, "Discharge status: Alive, but without permission." I do like this one, "Coming from Detroit, the man has no children." Finally, one exasperated doctor noted, "The patient refused an autopsy."

I don't know what the nurses who read these rather interesting patient histories must have thought. But I do know they understood that there was quite a gap between what the doctors wrote, and what they meant. Similarly, even with all of our medical miracles and scientific marvels, we still have many gaps in our current health care system...Gaps in our understanding of how to best meet the needs of patients and their caregivers...Gaps in our knowledge of how to translate scientific advances into cost-effective health care that doesn't compromise quality...And gaps in our understanding of how to care for individuals across the life-span.

That's why, five years ago, I took great pleasure in signing the Federal Register notice that established the "National Institute of Nursing Research." And that's why I'm here to reaffirm this administration's commitment to nursing research as it investigates causes and better care-and as it works to open windows on prevention and unlock doors to treatment.

We understand the special role that only nursing research can play in our health care system. Only nursing research is always patient-focused. Only nursing research takes a comprehensive approach to human health and illness that addresses the needs of all ages, genders and conditions. And by weaving together the threads of prevention, primary care, and patient management into our health care tapestry, only nursing research can help us create a seamless system of care-without any gaps.

Over the past five years, we've seen just how much the research funded by the National Institute of Nursing Research has contributed to the creation of a seamless health care system-how much it has added to our health care tapestry. People should know that nursing research proved-for the very first time-that gender affects the effectiveness of pain relievers. Nursing research also developed a successful elementary school program that lowers cardiovascular risks in children. And nursing research produced a model of how to reduce high blood pressure in young, urban African-American men.

These are great accomplishments-accomplishments to be proud of. But they are steps to build on-not to rest on. And as we celebrate and commemorate your achievements tonight, I'm reminded of a story about the great Oliver Wendell Holmes. Holmes once boarded a train only a short distance from here at Union Station. In the general commotion, the great jurist promptly lost his ticket. The Conductor immediately recognized him and said, "Don't worry Justice Holmes, I know that when you find your ticket you'll mail it in to the company." "Mr. Conductor," Holmes replied slowly and deliberately, "the question isn't 'Where's my ticket?' but 'Just where am I supposed to be going?'"

Tonight, we need to ask ourselves a similar question. As we enter the 21st Century, where must nursing research go? In what direction must it lead? Perhaps, ironically, it must lead us "Back to the Future." Back to the health care of Dr. Welby and Dr. Quinn-who weren't just concerned with curing a disease...but with caring for a patient. This traditional approach holds three challenges that nursing research-and nursing researchers-must meet. They are the challenges of age, illness, and quality-and they represent gaps in our current health care system.

The first challenge for nursing research is to help improve the quality of life for Americans as they age. Thanks to advances in medicine and public health over the past century, Americans are now blessed with the gift of longevity. Nearly 46 million Americans are 60 or over, and the fastest growing segment of our population is the 100 plus age group. But a longer life is not necessarily a better life. As our population ages, we must do much more to ensure that Americans not only have more years in their lives-but more life in their years. We need nursing research to continue to develop and test novel health promotion strategies-like the benefits of exercise for older adults. And we need nursing research to help find innovative ways for older persons to preserve cognition, the ability to function, and the overall quality of their lives.

And that brings me to my second challenge. If we want to improve the quality of American life, we must help people of all ages better manage chronic illness. For too long, chronic illness has remained hidden in the shadows-while medicine and research focused the spotlight on acute illness. But chronic illness is the leading cause of death and disability. It affects 100 million people. And with the elder boom, we can anticipate a steady increase. When it comes to chronic illness, we need nursing research to continue to point the way in three areas: It must show us how to help patients' manage their symptoms and control their pain...How to prevent complications of disease and disability...And how to help family care givers best meet their relatives' needs-and their own needs-so that everyone can enjoy the best quality of life.

And that brings me to my third and final challenge-the challenge of quality. Patients today know that our health care system - although the best in the world - isn't always "as good as it gets" for everyone. And they are demanding the highest quality care. They want to see a specialist when needed. They want to know all medical options. They want adequate recourse if denied care. And they want to hold research to the highest standards.

President Clinton has exhorted Congress to pass a "Patients' Bill of Rights" that will guarantee access, choice, privacy, and recourse for shoddy care. With the stroke of his pen, the President has already guaranteed these rights for everyone in a federal insurance plan-that's 80 million people, one third of all Americans. And the ripple effect will be like dropping a stone into a still pond.

Before they retire for the season, Congress needs to pass a Patients' Bill of Rights that ensures that everyone-regardless of the type of health insurance they have-enjoys these same rights. A comprehensive, enforceable Patients' Bill of Rights is the right prescription for what ails our health care system. It will provide a giant booster shot for health care quality. And it will ensure that every type of health insurance delivers the best possible care for everyone...every day...everywhere.

Guaranteeing the rights of consumers is an important first step in ensuring the quality of our health care. But to paraphrase the poet, we still have miles to go. We must seize the opportunity to not only ensure quality-but to improve it. And nursing research has a vital role to play. By always focusing on the patient, nursing research can shed light on how to reduce the risk of illness; to speed recovery; to ease symptoms; and to reduce hospital stays-all without sacrificing quality. And nursing research can help introduce evidence based reforms in health care-and so guarantee that efforts to improve quality will be supported by proven science.

Meeting the challenge of quality-like the challenges of age and illness-will not be easy. But I've no doubt that nursing research can and will do it. And I'm reminded of a true story that occurred in big city hospital. A very elderly woman walked into the emergency room barely able to breath. A nurse immediately responded. When the woman was stabilized, the nurse asked her why she had walked over instead of calling 911? "It's really quite simple," she replied sweetly, "my phone doesn't have an eleven on it."

That woman may not have known whom to call-but we certainly know that we can always call on nursing researchers to help address the gaps in health care...To help create a seamless system of care...To help deliver a future of health and hope, of promise and possibility, of medical miracles and scientific marvels...And to help take us "Back to the Future."