Think About It

A forum for discussion of the latest news and ideas in nursing management and healthcare.

Monday, June 30, 2014

Health reform: What it really means for nurse leaders
While the political machinations surrounding the Patient Protection and Affordable Care Act, 2010 continued to swirl in the public fora, translation and application of its requisites are now well into the fourth year of implementation. While there will likely be political and legislative adjustments along the way (this is America, after all), the strong likelihood is that most of its implications, which affect its implementation for providers will continue to steadily unfold over the next 6 or 7 years. Specifically, the elements and characteristics of accountability and the “triple aim” will continue to drive the design and construction of health services for the foreseeable future.
What’s important for nurse leaders is the recognition that much of the demand for value-based healthcare is a positive force and a strong influence for the future correct calibration of health services. Clearly, for far too long, the focus of health services has been strongly medical model delineated with primary emphasis on therapeutics, intervention, and treatment strategies. While there has been a huge effort to give what’s essentially lip service to creating a healthy society, most of the health resources of the United States have been directed to supporting the predominant part of the system, which is essentially late-stage, late-engagement, high-intensity intervention in the illness process. A microscopic amount of social and financial capital in the United States has ever really been devoted to producing a net aggregate level of health for the citizens of the wealthiest nation in the world.
Of course, the expectation is that leading the way for this transformation will be nurses whose key characteristic and social purpose has ostensibly been to manage and advance the healthcare continuum of those we serve. While the vast majority of our nurses have been co-opted historically into the illness model because of the structural, financial, and service predominance of it, establishing the highest level of health for persons is an historic centerpiece of nursing practice. Now the time has arrived where both the opportunity and obligation have converged under the auspices of health reform to actually initiate and sustain a system for health for the American people. Truly, a convergence for nursing between purpose and need now serves as a driver for the future of nursing practice.
It’s now incumbent upon nurse leaders to be able to alter the contextual and conceptual framework for nursing practice in significant and innovative ways. Nursing practice now must move out of compartmentalized, diagnostically identified, iterative, and functional delineations for care delivery into more linked, integrated, team-based, facilitated, continuum-driven care models. Creating a seamless interface between components of healthcare users’ personal health needs and the positioning, availability, and location of services to meet those needs now drives the design and construction of nursing care service models. This means altering care delivery standards, practices, scheduling, assignments, roles, competencies, and relationships with both populations and the network of providers that will be aligned to best serve them.
Nurse leaders at every place, especially at the service level, must now stop negotiating the potential for changes in nursing practice. The potential is now past. Much of the work of nurse leaders is helping the profession engage the realities of transforming practice, coping with the implications of personal change, helping staff surrender attachment to clinical sacred cows and past rituals and routines. All of this in an effort to lay the groundwork for a different conversation about just what the future of nursing practice is and how it plays out in the day-to-day role of the nurse. Nurse executive leadership must create the “burning platform,” which serves as a drive for strategically aligning practice priorities with shifting organizational service demands and the requisites of “the triple aim” of service excellence, consistent quality metrics, and service affordability. The emerging requisite for transparency in these arenas of performance now leave little option for failing to demonstrate both the relevance of nursing practice and its impact on the metrics of service excellence, quality, and affordability. Directors and unit managers must now do the heavy lifting of recalibrating practice around populations, episodes, and continua, in a horizontal relationship that favors highly interactive team decision making and collaborative practice and creates mobility in scheduling, assignments, and practice in the fluid and portable engagement of the user of health service where they live and within their lives.
There’s no doubt that this is a seminal moment in the longer life of the nursing profession. Certainly as Nightingale’s life indicated, nursing’s relevance is verified by the positive impact it demonstrates on the health circumstances and lives of those it serves. As the condition and circumstance’s shift and emerging opportunities provide a greater potential for impacting the health of our nation, nurses must continue to exemplify through their social compact and commitment that they’ll take on the challenge to do just such work. One hundred years hence from Florence Nightingale’s time, we’re challenged much as she was to raise the standard, write a better script, and push the walls of our profession’s commitment to health to the next level. That was the demand of nursing leadership then and remains the requisite of nursing leadership now.
Tim Porter-O’Grady, EdD, APRN, ScD, FAAN