Health care systems around the globe are grappling with rising costs, aging populations and growing demand for accessible, high-quality care. In response, many countries are shifting care out of hospitals and into the community.
The United Kingdom offers a compelling example. In July, the British government introduced its Fit for the Future 10-Year Health Plan for England, a sweeping redesign of the National Health Service that prioritizes primary care, prevention and neighborhood-based services. At the heart of the plan is the creation of a “Neighborhood Health Service,” where multidisciplinary teams deliver care in patients’ homes, local clinics and through digital tools. The U.S. would do well to take note.
The American health care system is under immense strain. Patients wait weeks for primary care appointments. Emergency rooms are overwhelmed with non-urgent cases. Health care costs continue to rise, and provider burnout is reaching alarming levels. Millions of Americans still lack timely access to basic care.
Amid these challenges, we are overlooking one of our most powerful solutions: nurses.
Nurse practitioners and registered nurses form the largest segment of the U.S. health care workforce. Their roles are critical — not just in hospitals, but in the very settings where health is created and maintained: homes, neighborhoods and communities.
If we’re serious about transforming our health care system, we must enable nurses to lead the way.
Imagine an America where routine care starts not in an emergency department but in a community health hub led by nurse practitioners, supported by RNs, social workers and community health workers. Picture chronic disease management happening at home, aided by virtual check-ins and remote monitoring. Envision a system built to prevent illness rather than reacting to it. These aren’t far-off fantasies — they are proven models that already work.
Research consistently shows that nurse-led care is safe, effective and cost-efficient. Nurse practitioners manage chronic conditions such as diabetes and hypertension with outcomes that match or surpass physician-led care, particularly in underserved communities. RNs play vital roles in care coordination, education and patient navigation — often improving outcomes for individuals with complex needs. Together, nurses are uniquely positioned to deliver continuous, whole-person care that too often falls through the cracks in our fragmented system.
Yet outdated laws and policies continue to hold nurses back from practicing to the full extent of their training. In more than 20 states, nurse practitioners still face physician supervision requirements, despite overwhelming evidence supporting their autonomy. Payment structures undervalue nursing services, making it difficult to scale the kind of team-based, community-oriented care that patients need. Too often, nurses are excluded from the policymaking arenas where decisions about health care delivery are made.
England’s NHS vision isn’t about spending more but spending smarter. By investing in prevention, digital innovation and decentralized care, the U.K. aims to reduce hospital strain, improve access and empower communities. The U.S. should embrace a similar shift. We don’t need to create a new workforce — we need to invest in the one we already have.
That means granting full practice authority to nurse practitioners in every state, reimagining reimbursement models to support nurses in community-based roles, and integrating digital and artificial intelligence tools that allow nurses to monitor patients remotely and intervene early. And it means giving nurses — who bring frontline insight from across the health care system — a voice in shaping the future of care.
The U.S. has long relied on nurses during times of crisis. We now should rely on them during a time of reform. By empowering nurses to lead in community settings, we can build a health care system that is more equitable, efficient and responsive to the needs of the people it serves.
Let’s stop treating hospitals as the default starting point for care, bringing health care to where people live, work and age. Let’s follow the evidence — and the example set by other nations — and unlock the full potential of America’s nursing workforce.
Richard Ricciardi is a professor and executive director of the Center for Health Policy and Media Engagement at the George Washington University.
