1. Section Editor(s): Stewart-Amidei, Chris

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For some time, healthcare professionals as well as the lay community have recognized the importance of wellness activities. Exercise, proper diet, avoiding unhealthy behaviors, and preventive check-ups have all been touted as approaches to achieving wellness. In turn, such approaches provide rewards (e.g., feeling better, increasing time spent with family or at work instead of being ill, and decreasing medical costs). In support of wellness initiatives, nurses have dedicated a great deal of effort toward promoting healthy lifestyles for their patients.

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In recent years, we have seen a paradigm shift from promoting healthy lifestyles to mandating healthy lifestyles. Perhaps it is time for the nursing profession to examine this shift. While there is no question that a healthy lifestyle is beneficial, some employers may be taking this wellness promotion to a discriminatory extreme. Increasingly, employers are not hiring smokers or obese individuals, are offering cheaper insurance to employees who can document a healthy lifestyle, or are even firing employees who continue to smoke in a smoke-free workplace. Requiring a physical examination to weed out employees with unhealthy lifestyles is another example of potential discrimination. The real danger in such policies lies in making unhealthy people unemployed and uninsurable. This shifts healthcare costs away from the employer or third-party payers to the government and the patients.


In an effort to decrease costs, the Deficit Reduction Act of 2005 has allowed states to reorganize Medicaid programs. Some states have used this as an opportunity to mandate the use of wellness services. West Virginia is one of the first states to offer enhanced benefits to those who take medications as prescribed, undergo health screenings, see their healthcare practitioners as scheduled, and follow health improvement plans. However, patients do not have a choice as to which benefit plan they are assigned, and must demonstrate compliance with plan requirements. In some ways, this holds those with enhanced benefits to a higher standard. Private health insurance programs have already begun to adopt similar approaches.


There are a number of reasons nurses must be concerned about mandating wellness. First, nurses are charged with protecting patient rights. Because some wellness mandates may ethically violate those rights, nurses must make every effort to ensure those mandates actually protect patients rather than do harm. Second, mandating is substantially different than encouraging, and in some ways represents a major shift in nursing care. Are we prepared to enforce such orders? Third, wellness mandates, for the most part, have been developed by insurers and the government with minimal involvement of nurses. Nurses should be intricately involved in the design and delivery of such programs. Wellness programs designed without nursing involvement are bound to be ineffective. Nurses must play a pivotal role not only in facilitating compliance with wellness programs but in evaluating outcomes as well. Wellness programs can be costly, and cost savings must be demonstrated. There are myriad reasons why wellness programs may fail. Those reasons must be examined and appropriate alternatives explored. Overall, it is nurses who are best positioned to make wellness programs work.


The biggest question to answer is whether patients will accept a wellness mandate. Patients have to believe that wellness mandates make a difference and that they should take responsibility for their own health. There are a surprising number of people who do not hold these beliefs. Many have chosen not to take advantage of wellness options in the past and whether mandating wellness will help remains to be seen. Yet, wellness mandates are becoming a reality and we as nurses must examine every aspect. Please share your thoughts and concerns with our readers.