In 2010, the Institute of Medicine (IOM) published a sweeping view of the future for nurses and nursing. The Future of Nursing (FON) report described changes in nursing that it deemed necessary to further transform healthcare systems in ways that improves access, promotes wellness and prevents disease, and improves health outcomes and care across the lifespan.1 Nurses must be innovators and pioneers in strengthening formal alliances between medicine and nursing. Economic, social, and demographic changes demand that we set aside our differences and move forward together not only for our own success but also, importantly, for the health and well-being of those for whom we are sworn to care. This call to action cannot be delayed nor entered into in a half-hearted manner. As leaders in cardiovascular nursing, we must light the way and then walk the path that others may follow.
In 2004, the 35th Bethesda Conference on the Cardiology Workforce Crisis2 explored the acuity and severity of the shortage of cardiovascular specialists and made pragmatic recommendations for alleviating workforce and patient access problems in the future. Provision of cardiovascular care by physicians and advance practice nurses and physician assistants comprises 1 of the fastest growing models of team-based care. The American Association of Nurse Practitioners describes team-based care as being collaborative, patient centered, and composed of 2 or more providers whose expertise and discipline are dependent on the needs of the patients.3
The roles of nurses and other nonphysician providers have evolved and are expected to further evolve as 32 million newly insured individuals seek primary and specialty care as a result of expansion of coverage through the Affordable Care Act and as the population ages. As the demand for cardiac care increases beyond the supply of cardiologists in training, barriers to optimum utilization of nurses, nurse practitioners, and clinical nurse specialists in the care of cardiovascular patients must be addressed.
The FON recognizes the challenges facing healthcare as an opportunity for improvement and makes the following 4 recommendations that would advance nursing contributions to patient-centered cardiovascular care1:
- Nurses should practice to the full extent of their education and training;
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression;
- Nurses should be full partners with physicians and other health professionals in redesigning healthcare in the United States; and
- Better data collection and improved information infrastructure is necessary for effective workforce planning and policy-making.
The IOM report also identifies educational, clinical, interprofessional, collaborative, and advocacy/policy activities that will enable nurses with a wide range of education and training to maximize their contributions in the delivery of high-quality, cost-effective care.
Practice to the Full Extent of Training
The IOM report recognizes the need to reduce geographic variations and disparities in care, encourage adherence to guidelines, and ensure transparency and professionalism.1 Achieving these goals requires that nurse and advanced practice nurse members of the cardiovascular team practice to the full extent of their education and training. Recently, the Heart Failure Society of America and the American Association of Heart Failure Nurses reported a joint statement supporting the practice of advance practice nurses to the full extent of their education and the full partnership of nurses in the redesign of healthcare.4
Nurses need to be committed to a continual process of learning: learning from each other, learning from other disciplines, and learning from our patients. A continual approach to learning is imperative to improving professional accountability to each other and our patients.
Many cardiovascular nursing and multidisciplinary cardiac organizations provide lifelong continuing education and specialty education to meet the needs of nurses at all levels. Furthermore, nurses participate on multidisciplinary program planning committees and develop programs specific to nurses. Multidisciplinary education promotes collaborative practice and the highest quality patient care.
No matter the model that is selected by inpatient or outpatient cardiac team practitioners, there is a need to understand the shared knowledge, skills, and goals of all team members. Moreover, it is important to discuss differences in disciplinary knowledge, practice wisdom, experience, and training, which define the unique strengths each member brings to the team. Ultimately, characteristics of team members, based on combinations of personalities, experiences, communication styles, and expertise, will mean uniquely individualized teams.
From a healthcare perspective, team collaboration has a greater focus on patient-centric care rather than discipline-centric care. No discipline “owns” the patient. The patient’s needs determine the actions of the team. The team is bound together by common goals, personal and disciplinary respect, and acknowledgement of the value of each contribution. Nurse-led and multidisciplinary cardiovascular organizations must remain at the forefront of the design and implementation of integrated, collaborative healthcare teams. Collaborative, community-based models recognize that each member is responsible for the common goals of care and accountability to patients and other team members.
Research and Evidence-Based Care
Nurse scientists have a strong history of addressing patient and healthcare system needs beyond the historical medically focused drug and device therapy discoveries and usage. Nurses have diverse programs of research that include testing clinical practices without a strong evidence-base, untested hypotheses, and innovations that have the capability of being transformational in terms of improving efficiencies, costs, and clinical effectiveness. Many examples of nurse-initiated cardiovascular research have been incorporated into evidence-based practices.
The variety of programs for evaluating and improving quality care exist today. Within current systems, some provide metrics about the contributions and utilization of team members. Metrics about the contributors to success are critical to understanding and duplicating best practices. The experience of the data collectors, researchers, and administrators of quality programs can be leveraged to strengthen leadership in information infrastructure for the study of the effects of an optimum workforce on the quality of cardiovascular care.
The FON report is an opportunity for all cardiovascular nurses to strengthen their national leadership roles in healthcare policy, collaborative practice, quality and performance excellence, research, and workforce information. We must seize these opportunities and move forward tenaciously, persistently, and confidently with the assurance that there has never been a time when the healthcare needs of cardiovascular patients were a better match for the professional knowledge, skills, and practice wisdom of nurses.
Nancy M. Albert
John D. Baker
Joy C. Burnette
Margo B. Minissian