Leading the WayNursing Leadership

Brick by brick

By: Interview by Elizabeth Moore, content creator at ANA

Building a foundation for a stronger healthcare system

Early in her career, Betty Rambur, PhD, RN, FAAN, grew concerned about what she saw as unnecessary care. This interest led her to pursue a latticework of career moves, becoming one of the foremost voices on healthcare payment reform. Author of Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide and professor of nursing at the University of Rhode Island, Rambur currently serves as Routhier Endowed Chair for Practice. In 2020, she was appointed to the Medicare Payment Advisory Commission. Rambur, an American Nurses Association (ANA)-Rhode Island member, recently spoke with ANA about her leadership in payment reform.

Would you describe your role on Vermont’s Green Mountain Care Board?

The Green Mountain Care Board is a 5-member quasi-judicial body that oversees all healthcare in the state of Vermont. Serving from 2013 to 2017, I brought everything I know as a nurse, former nurse practitioner, and former nursing school dean to that role. I was able to remind people to consider how policies would play out at the working surface.

I applied to the board twice before being accepted. It’s important that nurses put themselves out there and not get discouraged if a plan doesn’t go the way they want the first time.

What were the keys to success in enacting omnibus health reform legislation in North Dakota?

I joined the North Dakota Health Care Task Force in 1991, representing the North Dakota Nurses Association. Later I became chair, and another nurse was co-chair. The omnibus reform bill we passed was quite radical for that conservative state. It included direct reimbursement for advanced practice registered nurses, and frankly, I don’t think that would have happened if two nurses hadn’t been there as credible voices at the table. What I learned in that role about stakeholder relationships, reimbursement, and how insurance works laid the foundation for my later work in Vermont.

How does the current healthcare payment system affect patient care?

Payment reform is the most essential piece for going forward. It’s vital that we move away from the reactive fee-for-service system. We get reimbursed when people are sick and the more intensive the treatment is, the more we get paid. There’s no way you can reach upstream social determinants of health very easily in this system. And you certainly can’t get to health equity.

The challenge is powerful interests who do well in the current system pushing against some of the payment reform models. Our nation simply can’t afford healthcare as expensive as ours that delivers far behind on quality measures compared to other wealthy nations.

What can nurse leaders do to promote payment reform?

Nurses have the potential to be the vanguard for controlling healthcare costs and focusing on value. If we understand patient care and we understand economics and financing, we can really fly with two wings. It’s foundational to know the economic basis for change as well as the ethical one.

Would you share a leadership lesson?

One thing I’ve recognized is the importance of patience. Since my days in North Dakota, I’ve been communicating about different versions of economics and payment reform, and it’s taken this long for it to become common language. I’ve learned to trust that life is long, and you can spend a lot of time doing something that feels like it isn’t going anywhere. But then you find out that it actually brought you into what comes next.

— Interview by Elizabeth Moore, content creator at ANA.

Note: Dr. Rambur’s views are her own and don’t necessarily reflect those of her affiliations.

American Nurse Journal. 2022; 27 (11). Doi: 10.51256/ANJ112252

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