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Journalist’s Tradedivided 363 sick and frail elderly hospitalpatients into two groups. The controlgroup received routine dischargeplanning and, if referred, standardhome care. Those who were in thesecond group were visited within 48hours of being admitted to the hospitaland then every 48 hours during thehospitalization by an advance-practicenurse who specialized in geriatrics.Once the patient was discharged, thesame nurse visited him or her at homeat least twice and was available in personor by phone for the next month.These nurses focused the patients’medications, symptoms, diet, activities,sleep, medical follow-up and emotionalstatus. They collaborated with physiciansto adjust therapies, obtained referralsfor needed services, set up supportsystems, and helped the patientsand their families adjust to life at home.The outcomes tell us a lot about theefficacy of this approach. Six monthsafter discharge, 20 percent of the groupwith master’s-degree nurses was hospitalizedagain compared with 37 percentof the control group. Only 6.2percent of the group monitored bynurses had multiple hospital readmissions,compared with 14.5 percent ofthe control group. When they occurred,hospital stays were much shorter forthe first group—1.5 hospital days perpatient compared with 4.1 days for thecontrol group. Health care costs forthe group with transitional care were$600,000 less than costs for the controlgroup. Medicare was saved an averageof $3,000 per patient. At a time whenthe mounting costs of health care areroutinely covered on the business pagesand on television news, the fact thatevidence such as this was ignored ispeculiar.Patients and their families know howdevastating cycling in and out of ahospital can be. As Mary D. Naylor,associate professor of nursing and thelead author of the study said, “We’restill relying on hospitals to respond towhat we know are, in many cases, preventablereadmissions. Our system ofcare is not responsive to the needs ofthe older community.” Nursing researchidentifies responsive care. Yethealth writers seem to have little acquaintancewith nursing research. One25-year veteran of the medical andhealth beat who reads several medicaljournals told me he couldn’t think ofthe name of a single nursing journal.Another health editor responded to acolleague of mine who raised the subjectwith, “Nursing what?” Even whennursing research receives the imprimaturof medicine by appearing in a topmedical journal, it is still likely to beignored.As journalist Suzanne Gordonpointed out in her recent book, “LifeSupport: Three Nurses on the FrontLines,” when coverage focuses exclusivelyon medicine, it reinforces thenotion that illness is an event ratherthan a process. When journalists coverhealth innovations only as medical interventionsthey create a simplistic andinaccurate picture of health care. Ifjournalists were to ask nurses how newtreatments really affect patients theywould have a truer picture of not onlythe efficacy of these treatments, but ofthe needs that patients have for carebefore, during and after medical encounters.While medical researchersand physicians develop these new treatments,nurses administer many of themand monitor their immediate and ongoingeffect on patients. Nurses are theones who know what impact thesemedical advances have not only onpatients’ cells, tissues and organ systems,but on their lives.For patients and policymakers, agaping informational hole remains evenfrom the vigorous coverage of managedcare. As a recent Kaiser FamilyFoundation study confirmed, reportershave brought the denials of treatments,medications and experimentalprocedures under managed care to thepublic’s attention. They have exposedthe HMO’s that have tried to preventphysicians from candidly discussing apatient’s condition and appropriatetreatment options. They have attendedto the patient backlash as well. Evennursing won a moment in the news aspart of managed care coverage. A rashof stories reported that hospitals were“downsizing” and “deskilling.” But fewjournalists examined what these cutbacksmeant in terms of patient care.Pittsburgh Post-Gazette medicalwriter Steve Twedt is one who did. Hespent a year researching this questionand talking to nurses, nursing researchers,patients, families, aides, physicians,attorneys and policymakers. “In hospitalafter hospital across the country,”Twedt wrote in his resulting 1996 fourpartseries, “nurses with years of experienceare being replaced by unlicensedaides who get only minimal trainingbefore caring for patients.” His investigation,he wrote, produced “exampleafter example of hospital patientsthroughout the nation who were injuredor killed by the mistakes or negligenceof aides performing duties theyweren’t equipped to handle.” His mosttroubling conclusion was, “Despite theprofound impact on patients, no one issystematically monitoring this sweepingchange in health care.”It has similarly escaped the notice ofjournalists that proposed remedies tothe problems of managed care do notaddress nursing care. The so-calledpatient bills of rights in state legislaturesand Congress focus on medicalcare. With limited exceptions (childbirthand mastectomies), these bills donot constrain insurers and hospitalsfrom restricting patients’ access to nursingcare. The bills that do address nursingcare—those that mandate minimumlevels of nurse staffing in hospitals andnursing homes—have gotten very littleattention.Reports on the effects of Medicarecuts in the Balanced Budget Act of1997 are also too narrowly focused.For example, Bob Herbert in his NewYork Times column (April 15, 1999)discussed the disastrous impact reducedMedicare payments are havingon teaching hospitals and their abilityto educate future physicians. Nursingwas not mentioned once in his descriptionof the dire effects the cuts arehaving on staff levels, hospital treatmentand care, and professional education.Yet teaching hospitals are nursinginstitutions as much as they are medicalinstitutions. Hospitals are the primarysite of nursing education. Nursingeducation suffers when hospitalrevenues drop. In fact, one of the ma-Nieman Reports / Fall 1999 53