Advocating For The Nursing Role In Program Design And Implementation Essay

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.Advocating For The Nursing Role In Program Design And Implementation Essay

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In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

To Prepare:

Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
Select a healthcare program within your practice and consider the design and implementation of this program.
Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
The Assignment: (2–4 pages)Advocating For The Nursing Role In Program Design And Implementation Essay

In a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions:

Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
Who is your target population?
What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

Advocating for Nursing Role in Program Design

Assignment: Advocating for the Nursing Role in Program Design and Implementation

In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.Advocating For The Nursing Role In Program Design And Implementation Essay

To Prepare:
• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation. Advocating for Nursing Role in Program Design

The Assignment: (2– pages)
In a 2- page paper, create an interview transcript of your responses to the following interview questions:
• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?Advocating For The Nursing Role In Program Design And Implementation Essay

The health care system is undergoing rapid changes that put new emphasis on
population health, quality of care, and the value of the services delivered. These
changes present both opportunities and challenges to the 2.9 million registered nurses
(RNs) employed in the United States. There are about four times as many nurses in
the health workforce than there are physicians; nurses, by sheer numbers, will play
a significant role in this transformation, and will themselves be transformed in the
process. Because immediate concerns about RN shortages have abated, there is an
opportunity to turn attention and resources away from expanding the educational
pipeline toward redesigning the system to support nursing practice in a transformed
heath care system. In this Research Brief, we describe the changing roles nurses have
in the delivery system and assess the educational, policy, and regulatory structures that
must change with them. We address the fundamental question: how can we create the
right mix of nurses in the right locations, specialties, and practice settings, with the
skills and competencies needed to meet these goals?
New Nursing Roles in a Redesigned Health Care System
Health care payers, including the Centers for Medicare and Medicaid Services Advocating For The Nursing Role In Program Design And Implementation Essay
(CMS), are shifting away from fee-for-service payments that reward volume toward
paying for value, including improved population health outcomes. HHS Secretary
Burwell recently announced that by 2018, 50 percent of Medicare payments will be
tied to value through alternative payment and care delivery models, such as PatientCentered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs). As
payment models shift, health care providers—including hospitals, clinics, physicians’
2 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
There are about four times as many nurses in
the health workforce than there are physicians;
nurses, by sheer numbers, will play a
significant role in this transformation, and will
themselves be transformed in the process.
offices, and long-term care settings—are redesigning how they deliver care and how
they redeploy the workforce in new roles and settings. Health systems and payers
are increasingly focused on “upstream” preventive and primary care and the health
workforce is shifting from acute to outpatient settings.
In redesigned health care systems, nurses are assuming expanded roles for a broad
range of patients in ambulatory settings and community-based care. New job titles and
roles are emerging, particularly in population health management, patient coaching,
informatics design and analysis, geriatric care, and managing patient care transitions.
Nurses are increasingly employed as “boundary spanners,” connecting patients
with services in health and community settings. As the Institute on Medicine noted,
nurses are increasingly called upon to collaborate as members of interprofessional
teams. These emerging and expanding roles for RNs will require the application
of nursing skills in new ways, as well as the development of new skills. However,Advocating For The Nursing Role In Program Design And Implementation Essay
current educational programs vary considerably in their ability to prepare nurses for
the evolving health care system, a system that will emphasize accountability for the
health of populations and place nurses in roles that address the increasingly complex
needs of patients with multiple chronic conditions. In this new system, nurses
will need to consistently apply skills associated with a continuous learning health
system, including care coordination and transitional care; optimize care through use
of data and evidence, often gleaned from electronic medical records; collaborate
interprofessionally, and actively engage in performance improvement. Below we
summarize key dimensions of each of these opportunities and their relevance to the
preparation of the emerging nursing workforce.
Population Health
Public health nurses have long played a role in developing, implementing, and
monitoring programs to advance the health of populations through health promotion
and disease prevention. Today, there is growing recognition that many individual
health problems have antecedents in the community, and can be prevented through
improved population health programs. In serving their patients and communities,
nurses and other health care providers must understand and navigate the social,
political, and economic factors that influence individual and population health.
For nurses to be effective in care management and coordination roles, as well as
in primary care in general, they will need to address how the community affects
each patient, and how interventions at a broader level—either for a patient panel or
community—can improve individual outcomes. This perspective demands greater
knowledge of epidemiology, sociology, and social determinants of health.
More recently, the term “population health” has emerged within the U.S. health care
system to refer to accountability for the longitudinal care and outcomes of an identified
group of patients whose health care needs are typically addressed across multiple
sectors (e.g., primary care, hospitals, post-acute settings, home, and hospice).Newer
models of health care delivery, such as ACOs or PCMHs, have incentive structures
that tie “value” to health indicators in these patient groups, identified by their clinical
conditions and/or non-clinical characteristics such as socioeconomic status.
3 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
A growing share of long-term care is being
provided in home- and community-based
settings, through home health, adult day care,
and other support services.Advocating For The Nursing Role In Program Design And Implementation Essay
Complex Older Adults and Their Family Caregivers
The rapidly-growing population of older Americans will demand more health care
services in general, as well as more long-term care. A growing share of long-term
care is being provided in home- and community-based settings, through home health,
adult day care, and other support services. Through the Medicaid program, CMS
has provided incentives to states to encourage greater use of community services.
Consequently, a number of innovative state-led reforms in the provision of long-term
services and supports are being tested. In addition to providing valuable clinical care
to older adults, the nursing workforce will be central to meeting this growing need in
the following ways:
■ By assessing the long-term needs of individuals with physical and cognitive
impairments, developing customized care plans, coordinating care across providers
and settings, and overseeing the adequacy of services. Established and emerging
programs for older adult and long-term care populations are leveraging nurses to
improve care transitions, preventing physical and cognitive decline while ensuring
that older adults can live in the community.
■ By engaging family caregivers, broadly defined to include relatives, neighbors, and
friends in the implementation of older adults’ plans of care. Addressing the unique
needs of this “invisible workforce” will be a major challenge in the transformed
health care system.
Care Coordination and Transitional Care
Care coordination involves working with patients to help organize the services they
receive, ensure that their preferences and needs are met, share information across
health care providers, and facilitate the appropriate delivery of health care services.
New financial incentives have emerged; for example, as of January 2015, Medicare is
paying $42.60 per month for care management of patients with two or more chronic
conditions, like heart disease and diabetes.
Many types of interventions fall under the umbrella of care coordination, including
care transitions, guided care, and collaborative care models. Numerous programs
have demonstrated the value of care coordination, as well as the capacity of nurses to
design, implement, and participate in care coordination projects and practices. While
transitional care has traditionally focused on providing continuity between health
care settings and providers, care coordination is more broadly defined to encompass
both health care and social services, including the physical, behavioral, social, and
economic dimensions of care. The use of evidence-based models to guide system Advocating For The Nursing Role In Program Design And Implementation Essay
transformation is growing. A recently completed national scan funded by the Robert
Wood Johnson Foundation revealed that 59 percent of clinicians or clinical leaders
from nearly 600 distinct health care sites (e.g., hospitals, home care agencies) reported
use of the Transitional Care Model, a proven nurse-led team based approach, as a
foundation for system change.
4 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
The use of lay community health workers
to improve population health is increasing,
but a 2013 systematic review by the
Agency of Healthcare Research and Quality
revealed limited evidence of improved
patient knowledge, behavior change, health
outcomes, and cost effectiveness.
The American Academy of Ambulatory Care Nursing recently developed RN
competencies for care coordination and transition management, and an online course
to impart these competencies, including:
■ Support for self-management
■ Education and engagement of patients and families
■ Cross-setting communications and care transitions
■ Coaching and counseling of patients and families
■ Nursing process: proxy for monitoring and evaluation
■ Teamwork and collaboration
■ Patient-centered care planning
■ Population health management
■ Advocacy Advocating For The Nursing Role In Program Design And Implementation Essay
The roles and optimal mix of clinical and non-clinical professionals in coordinating
care is not clear. A recent survey of 48 PCMHs in New York found that RNs and
other employees (including clinicians such as social workers and support staff such
as medical assistants and peers) were responsible for care coordination in roles
such as care managers, care coordinators and patient navigators. Their functions
varied considerably. Some also were employed as health coaches, helping patients
understand and manage their conditions, including patient education activities,
motivational interviewing techniques, providing referrals to community-based
services, and visiting patients in their homes. Nearly three-quarters of responding
organizations used peer staff rather than licensed health professionals in some of
these roles. The use of lay community health workers to improve population health is
increasing, but a 2013 systematic review by the Agency of Healthcare Research and
Quality revealed limited evidence of improved patient knowledge, behavior change,
health outcomes, and cost effectiveness.
Some programs use nurses to improve organizations’ capacity to coordinate care. For
example, Minnesota’s Health Care Homes program established the job category of
Nurse Planners, who are responsible for supporting integrated care across multiple
Health Care Homes. Their specific responsibilities include developing resources
such as care coordination and patient and family engagement toolkits, and offering
technical assistance to help Health Care Homes improve their capacity to function
in an integrated way. Nurse Planners also lead the certification and re-certification of
clinics as Health Care Homes, and recruit primary care clinics to join the program.
The developers of the Health Care Homes program initially anticipated that nonclinical professionals could manage this work, but quickly determined that the clinical
background of nurses was ideally suited to this organizational coordination role.
5 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
A hallmark of the transformed health system
is a new level of collaboration across the
health professions, including physicians,
nurses, social workers, physician assistants,
pharmacists, and medical assistants.
Use of Data, Evidence, and Other Performance Improvement Skills
Increasingly, nurses are using data from electronic health records (EHRs) and
patient registries to identify unmet health needs and to target population health
interventions. Health information technology allows health care providers to
access patient and community information rapidly, as well as supports efficient
communication between providers. When designed well, these systems improve
care coordination, increase quality of care, and lower costs. Telehealth systems
allow health care providers to remotely monitor and communicate with patients,Advocating For The Nursing Role In Program Design And Implementation Essay
allowing for timely identification of emerging issues and consultations that are
convenient to patients. Effective use of health information and telehealth systems
are considered essential for successful care coordination.
Nurses will increasingly use health information technologies to advance evidence-based
practice. Data embedded in EHRs can be used to rapidly assess the effectiveness of
interventions for specific patients, as well as to assess broader relationships between care
processes and patient outcomes. Nurses can leverage these systems both to better meet
immediate care needs and to guide organization policies toward care improvement.
Interprofessional Collaboration
A hallmark of the transformed health system is a new level of collaboration across
the health professions, including physicians, nurses, social workers, physician
assistants, pharmacists, and medical assistants. Nurses’ clinical knowledge and
presence across all care settings will likely make them primarily responsible for
navigating interactions between patients and providers along the continuum of
care. They can play a key role in developing systems to ensure that primary care
patients receive appropriate specialist consultations, physical therapy, nutrition
counseling and education, medication reconciliation with pharmacists, and assistance
with socioeconomic issues that affect patients’ abilities to care for themselves.
The Interprofessional Education Collaborative has developed the following core
competencies for interprofessional collaborative practice:
■ Values/Ethics for Interprofessional Practice (work with individuals of other
professions to maintain a climate of mutual respect and shared values)
■ Roles/Responsibilities (use the knowledge of one’s own role and those of other
professions to appropriately assess and address health care needs)
■ Interprofessional Communication (communicate with patients, families,
communities, and other health professionals in a responsive and responsible manner
that supports a team approach)
■ Teams and Teamwork (apply relationship-building values and the principles of team
dynamics to perform effectively in different team roles)
Despite recent advances in the identification of these competencies, few health
professionals participate in interprofessional educational activities. It is essential
6 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
Nurses will need a more flexible educational
system that promotes seamless academic
progression and allows them to gain and
refine skills and competencies throughout
their career.

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that nurses and other health professionals avoid the “turf wars” that inhibit effective
collaboration, and leverage the skills of all health professionals at the highest level. In
many states, licensure and scope of practice acts reflect the intense competition that
exists among providers, rather than being structured to enable all health professionals
to maximize their contributions to a transformed health system.
Redesigning Education, Regulation, and Policy to Support
New Roles
In their systematic review of transitional care programs that help patients with
complex chronic conditions, Naylor et al. (2011) noted that health care licensure,
certification, and accreditation requirements need to better reflect emerging roles
and accountabilities. Ricketts and Fraher (2013) have called for better connections
between education and practice so that the transformative changes underway in
front-line care delivery systems are incorporated into the curriculum and clinical
placement requirements for nurses, physicians and other health professionals. Dower
et al. (2013) have noted the importance of restructuring the regulatory system to
accommodate the more flexible deployment of the workforce that will be needed to
staff new models of care.
As new roles diffuse through the health care system, nurse educators and employed
nurses need to focus on building the skills to meet patient needs in a rapidly changing
and increasing value-focused care environment. To accomplish this, nurses will need
to identify and advocate for the education and regulatory changes to support the
nursing workforce as they shift employment settings and take on new roles.
Education
With concerns about a nursing shortage waning, the education system can shift
resources from expanding the pipeline to redesigning education to prepare nurses for
new roles. Nursing curricula need to incorporate the competencies (knowledge, skills,
and behaviors) described above to prepare the workforce to undertake population
health initiatives, support older adults and other complex patient groups, provide
care coordination, manage care transitions, analyze and act upon data from EHRs,Advocating For The Nursing Role In Program Design And Implementation Essay
patient registries and other sources, optimize the use of evidence and performance
improvement skills, and work as members of teams within and across settings.
Educational redesign needs to focus not only on revising the curriculum for
nurses in the pipeline, but also on retraining the 2.9 million nurses already in the
workforce. More than half of respondents to a survey on barriers to implementing
care coordination roles in new models of care identified lack of work experience as
a challenge to hiring new nurses and also as a barrier to moving already employed
nurses to new roles in PCMHs.
Nurses will need a more flexible educational system that promotes seamless academic
progression and allows them to gain and refine skills and competencies throughout
their career. This is particularly critical for nurses who are being laid off from acute
7 | LDI/INQRI Research Brief—Nursing in a Transformed Health Care System: New Roles, New Rules
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org
Traditional nursing education models will need
to include more online education, simulation
and flipped classrooms.
care settings and need to find new jobs in ambulatory and community-based settings.
Education opportunities will need to be convenient in terms of location, and financial
incentives will be required encourage nurses, and the health systems and practices that
employ them, to take time away from work to gain new skills and competencies.
One of the biggest barriers to preparing the nursing workforce is the lack of faculty and
preceptors who are familiar with the new roles demanded of nurses in new models of
care. While nurses have traditionally filled care management and coordination roles in
acute settings, the degree to which the skills and competencies acquired in acute settings
will translate into the roles nurses will fill in ambulatory settings is unclear. Educational
programs may face challenges in identifying faculty and preceptors who can teach key
skills across a variety of care settings. Educational programs also will face the challenge
of continuing role ambiguity. The redesign of health care organizations is occurring
rapidly, and many roles may be phased out while new ones emerge. Educators will need
to navigate shifting roles and adjust competencies needed according to the complexity
and diagnoses of patients and settings in which nurses will work.
Another barrier faced by educational institutions is the lack of community-based practices
in which to place nursing students. Most nurses still receive the majority of their clinical
education in inpatient settings. Yet for nurses to learn to practice in new models of care,
clinical rotations need to include exposure to high-performing teams in ambulatory
settings, and provide longitudinal experiences with patients and family caregivers.
Traditional nursing education models will need to include more online education,
simulation and flipped classrooms. An analysis of seven of the largest online RNto-BSN education programs in the U.S. found that about 21 percent of all RN-toBSN graduates came from these online programs in 2012. Many online educational
programs, both continuing education and degree programs, are highly regarded,
but more evaluations are needed to determine the quality of these approaches and
the types of knowledge best suited to simulation, online education, and flipped
classroom approaches.
New education opportunities are likely to emerge for nurses to develop skills
and knowledge specific to emerging RN roles. For example, the University of
Pennsylvania’s School of Nursing and the American Academy of Ambulatory
Care Nursing (among others) have developed certification programs to support
nurses and other health professionals in evidence-based care transitions and care
coordination. Common themes in their curricula include patient and family caregiver
engagement and education; cross-setting communication and transition; teamwork
and collaboration; patient-centered care planning; decision support and information
systems; and advocacy. This type of certification program is available to all RNs, and
some of these competencies could be incorporated into the curricula of many entrylevel RN educational programs.

Conventionally, health care systems were focused on the cure of disease instead of the prevention of disease. With today’s evolving health care changes, the shift toward effective prevention techniques is more important. The nurse’s role in preventative health care is to utilize evidence-based research and recommendations to improve the health of patients. Nurses are the catalysts for healthier lifestyles through encouragement and teaching, helping patients to potentially receive preventative services such as counseling, screenings, and precautionary procedures or medications. Nurses can impassion those to engage in healthy lifestyles through education, mentorship, and leadership.Advocating For The Nursing Role In Program Design And Implementation Essay

Encouraging Healthiness and Disease Prevention
Nurses working in various venues have a great responsibility in preventative care and wellness. The backbone of the nursing profession has always been recognized as that of a caring profession and one that excels in disease prevention and health promotion. Nurses are strong advocates for patients because they navigate the health care system.

Nurses can work formally or informally as case managers. There are formal roles for nurses as case managers where the nurse’s only role is to help patients and families navigate through the health care system. Informally, all nurses work with patients and families to make sure that they receive the holistic care that is needed for optimal outcomes. Nurses work as consultants in communities and organizations to define the health care needs of that population, promoting activities and community development for the citizens who live there. Nurses are most recognized as the primary caregivers of patients in various venues. They are the ones who provide the hands-on care.

One of the most critical roles that nurses have in health promotion and disease preventions is that of an educator. Nurses spend the most time with the patients and provide anticipatory guidance about immunizations, nutrition, dietary, medications, and safety. Nurses are consistently working to prevent illnesses such as heart disease, stroke, diabetes, and obstructive pulmonary disease; they do this through a variation of tactics that include education, risk factor prevention, and the monitoring of safety hazards either in the workplace, community, or home.Advocating For The Nursing Role In Program Design And Implementation Essay

Nurses are best qualified to take on the job of health promoter due to their expertise. There are few health care occupations that have the high level of health education knowledge, skills, theory, and research to be able to focus on prevention because it is considered part of their professional development focus. Voluntary credentialing is available on a national level in the form of a certified health education specialist from the National Commission for Health Education Credentialing, Inc. (NCHEC). Competencies include health education needs assessment, program planning, implementation and evaluation, research, service coordination, and health educational needs, concerns, and resource communication no matter where the service is provided, such as in schools, communities, and clinics.1 There are also specialties in occupational, environmental, and public health nursing.

Culturally different ethnic groups and subgroups often are particularly challenging and involve extensive persuasion for identification and change in the health behaviors of those individuals, families, groups, or communities. Cultural considerations are needed to help promote programs, and communication is essential in building a relationship of trust and mutual respect.Advocating For The Nursing Role In Program Design And Implementation Essay

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Cultural diversity requires a sensitivity and awareness that should be mirrored in the phases of planning, design, and implementation of programs and education. Educational programs in the workplace help with both common and unique situations that may occur in an occupational setting and provide resources for future occurrences that may come up. Nurses must ensure that barriers, such as misinterpretation from communication barriers and stereotyping from those who might be viewed as different, do not occur. Skills such as active listening, clarification, and reflection can help overcome and avoid some of these barriers Advocating For The Nursing Role In Program Design And Implementation Essay