Last week, hundreds of nurses rallied on Capitol Hill, carrying signs and calling for health care reform legislation. The California Nurses Association-National Nurses Organizing Committee and other nursing unions want lawmakers to pass legislation that would bring all Americans into a single-payer government system.

Not all groups that represent nurses have taken such a dramatic approach — nor do they all agree that a single-payer system is a key goal of reform legislation.

But as health care is poised for center stage in the coming months, nurses clearly want to be part of the action.

Nurse lobbying groups want a more prominent role for their members in the health care system, arguing that nurses can help reduce costs and, according to some clinical studies, even make for better patient outcomes, especially when treating chronic ailments. But the different organizations sometimes find themselves at odds with one another and with doctor groups.

One health care lobbyist said nurses’ groups disagree with one another at their own peril.

“When you’re on the Hill, and things are moving fast, there just isn’t time for Members to figure out all the differences,— this lobbyist said. “You don’t want to divide and conquer.—

But the nurses are also teaming up with new allies as part of coalitions.

“We’re in these broad-based coalitions that we have not played with before,— said Pat Ford-Roegner, CEO of the American Academy of Nursing, pointing to insurance companies, medical device groups like AdvaMed and the Biotechnology Industry Organization. “We want to make sure this is the time we have health reform.—

Michelle Artz, a top lobbyist for the American Nurses Association, said the organization wants to make sure nurses are well-represented in health care reform.

“We want to make sure this isn’t a physician-centric dialogue,— she said.

[IMGCAP(1)]The ANA is not actively lobbying for a single-payer model when it comes to health care reform.

“In our ideal world,— Artz said, “a single-payer system is the way to go. However, we really recognize that’s not where the dialogue is now. We’ve been really trying to focus our efforts on the pieces that are moving. We just feel the realities of how this is unfolding right now are taking a different path, and we want to make sure that nurses are on that path, recognized and heard.—

One bill that the ANA is getting behind is the Preserving Patient Access to Primary Care Act (H.R. 2350), which Rep. Allyson Schwartz (D-Pa.) introduced late last week.

The bill considers nurse practitioners and nurse midwives as primary care providers.

“This bill would allow a nurse practitioner to be a team leader,— Artz said. “That’s the piece that would be most exciting. … We are really grateful for Congresswoman Schwartz’s vision and leadership, and we’re hoping that that model can move forward in health care reform.—

Schwartz said nurses have an essential role in health care reform.

“As we look at health care reform, we are focused on three aspects: containing costs, improving quality and expanding access,— Schwartz said. “We know that one of the best ways to do that is to improve primary care and management of people who have chronic disease. … Nurses working with physicians and nurse practitioners who often see patients directly, both have very important roles, and that was acknowledged in the legislation.—

Michael Lighty, director of public policy for the California Nurses Association-National Nurses Organizing Committee, said his labor group is making a top priority H.R. 676, a bill sponsored by Rep. John Conyers (D-Mich.) that would provide for comprehensive health insurance coverage for all U.S. residents.

Lighty said his nurses work at patients’ bedsides and see the dysfunction of the health care system every day.

“The only way to guarantee a single standard of care — a system where you don’t have bronze care for one type of patient and gold for another — we need everybody in one system,— Lighty said. “We don’t talk about getting everyone covered. We talk about everyone getting the care they need.—

Lighty said the Senate Finance Committee “hasn’t given us that seat on the Senate side,— but the group is pursuing inroads on the House side, including holding a meeting with Majority Leader Steny Hoyer (D-Md.).

“It is difficult,— Lighty said. “There are deep-pocket stakeholders that represent industries that have spent billions in lobbying.—

Other nurses groups are focused on more specific aspects of health reform legislation.

Jan Towers, director of health policy for the American Academy of Nurse Practitioners, said that when Members are drafting health care reform, her group wants to make sure that nurse practitioners, not just physicians, are actually written into the law as primary care providers.

“Generally speaking, the physician community has been very supportive, but the AMA has a problem with anybody that’s not a physician,— she said.

In a statement, the American Medical Association noted that doctors’ medical training lasts “11-15 years or more after high school,— and that patients “deserve the highest quality care provided by health care professionals who are appropriately educated.—

Nurse practitioners are inclined to practice preventive care and management of chronic care, and can often do so at a cheaper cost, Towers said. “We are more cost-effective,— she said, pointing to studies that show a positive impact on patient outcomes.

“Some of the nursing models are the best models for managing chronic disease,— she said.

Still, conflicts, especially with some doctors groups, abound.

“It’s always a challenge,— Ford-Roegner said. “Advanced practice nurses are not interested in becoming doctors. They want to be able to practice to the full scope of their abilities.—

She said that when nurse practitioners lead teams to manage patients with chronic ailment like diabetes, studies have shown high levels of patient satisfaction and high quality of care. “I might argue that nurses are better at collaboration,— she said.