Preparation of Nurses For a Country’s Primary Health Crisis 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 Preparation of Nurses For a Country’s Primary Health Crisis Essay

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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
(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 Preparation of Nurses For a Country’s Primary Health Crisis Essay
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,
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.
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: Preparation of Nurses For a Country’s Primary Health Crisis Essay
■ 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
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 Preparation of Nurses For a Country’s Primary Health Crisis Essay
■ Patient-centered care planning
■ Population health management
■ Advocacy
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, Preparation of Nurses For a Country’s Primary Health Crisis Essay
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,
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 Preparation of Nurses For a Country’s Primary Health Crisis Essay
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.
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 Preparation of Nurses For a Country’s Primary Health Crisis Essay
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,
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 Preparation of Nurses For a Country’s Primary Health Crisis Essay
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.
The Institute of Medicine (IOM) recommended that nursing schools do more to
educate students about issues specific to care of older adults, such as managing
cognitive impairment and multiple chronic conditions. Nursing educational programs
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Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative www.inqri.org Preparation of Nurses For a Country’s Primary Health Crisis Essay
The IOM strongly recommended that
regulatory barriers be removed if they prevent
RNs and other nurses from utilizing their skills
to the maximum benefit of patients.
should leverage opportunities to advance faculty expertise in geriatric care, such
as through the Geriatric Nursing Education Consortium (operated by Association
of Colleges of Nursing (AACN)) and the Advancing Care Excellence for Seniors
(ACES) project (operated by the National League for Nursing). In addition,
continuing education programs should provide working RNs with opportunities to
develop knowledge and skills in caring for older patients. The Nurses Improving Care
for Healthsystem Elders (NICHE) program provides nurses working in hospitals and
health care systems with educational resources, project management support, clinical
protocols, and access to a community of learners made up of nurse practitioners
(NPs), gerontological nurses, and health coaches working in acute care facilities.
More than 600 hospitals worldwide participate in this program, which uses a “train the
trainer” approach, so that those who participate in the NICHE program are expected to
train fellow staff on the health needs of the frail elderly.
Regulation and Policy
Regulatory and policy changes are needed to support nurses practicing in new roles
to the full extent of their education. The IOM strongly recommended that regulatory
barriers be removed if they prevent RNs and other nurses from utilizing their skills
to the maximum benefit of patients. A growing body of research supports this IOM
recommendation, concluding that restrictive state regulations regarding scope of
practice hinder access to care, lower the supply of providers, and increase costs.
Employers and health care providers often have internal rules that are more restrictive
than state laws. Hospitals, clinics, and medical groups need to ensure they are using
RNs at the top of their ability and at the top of the legal authority. Goldberg et al.
(2013) have described a “top of the license model” in which physicians and nurses
jointly care for a panel of patients with nurses taking on many of the tasks formerly
done by physicians, including collecting and entering information into EHRs about
a patient’s history of the present illness, reviewing past problems and treatments,
discussing medication lists, assessing a patient’s social history, and updating
preventive care needs. Adoption of this care model depends on scope of practice laws
that allow such task shifting to occur. An updated, interactive view of state scope of
practice laws can be found here.
Insurance reimbursement rules also can hinder nurses from delivering optimal
services. Each state determines its own Medicaid payment rate for advanced practice
nurses, and private insurance companies establish their own rules. In the Medicare Preparation of Nurses For a Country’s Primary Health Crisis Essay
program, NPs must seek physician approval for home health services for their
patients. Although federal regulations prohibit NPs from ordering home health
services for Medicare recipients, a number of states have authorized this activity
through statute or regulation to improve access for patients who are covered by other
payers, including Medicaid. The ACA added an additional requirement that physicians
certify beneficiaries’ eligibility for these services and for durable medical equipment.
These inefficiencies can reduce the amount of time NPs spend with their patients
and result in care delays, especially in remote settings. The movement of health care
reimbursement away from fee-for-service payment and toward paying for improved
9 | 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
It is essential that the NCLEX reflects new
roles, including the shift of nurses from acute
to ambulatory settings and the expanding
role of nurses in care management and
coordination, informatics, long-term care, and
population health.
outcomes will likely support efforts to maximize nursing contributions to care. In
addition, new provisions for Medicare coverage of wellness and behavioral telehealth
visits and care coordination for patients with multiple chronic conditions will bring
more attention to the role of nurses in these areas.
State nurse licensing boards regulate the content of nursing education, and may need
to modify rules governing entry-level nursing programs to ensure that graduates
have the new skills and competencies needed. They also should consider adjusting
requirements regarding clinical experiences of pre-licensure students, to include more
ambulatory experiences. This will likely require new regulations regarding faculty-tostudent ratios in ambulatory settings and the qualifications of preceptors. Non-nurses
might prove to be able preceptors for some curricular components, such as population
health management and informatics.
The National Council of State Boards of Nursing provides a national licensing exam
for RNs, called the NCLEX. The NCLEX is revised periodically to ensure that
the content is current and relevant. Pre-licensure education programs design their
curricula to ensure that their graduates can pass this exam. Thus, important changes
in education are not likely to occur unless the NCLEX changes. It is essential that
the NCLEX reflects new roles, including the shift of nurses from acute to ambulatory
settings and the expanding role of nurses in care management and coordination,
informatics, long-term care, and population health.
Finally, federal and state funding agencies have a key role in tracking changes to the
health care system, identifying the new skills needed to optimize care, and supporting
innovative education programs to meet future care needs. The U.S. Bureau of Health Preparation of Nurses For a Country’s Primary Health Crisis Essay
Workforce operates several grant programs related to nursing education. The Nurse
Education, Practice, Quality, and Retention program provides grant support for
academic, service and continuing education projects. The most recent set of grants
focused on expanded enrollment in baccalaureate nursing programs, as well as
internship and residency programs; education in new technologies; nursing practice
in non-institutional settings; care for underserved populations and other high-risk
groups; managed care, quality improvement, and other skills; and retention, including
career ladder programs. In addition, the ACA authorized $200 million over four
years for the Graduate Nursing Education Demonstration to increase the number of
advanced practice RNs prepared to provide primary care to Medicare beneficiaries.
Five teaching hospitals have received funds to partner with nursing schools and
community-based clinics to offer education in care transitions and chronic disease
management, along with other areas.
Conclusion
The United States health care system is undergoing transformative change. Nurses are
the single largest licensed health professional group and they practice in nearly every
setting of the health care system, including hospitals, long-term care, home health,
ambulatory care, diagnostic and treatment facilities, and clinics. In these settings, nurses
will assume important new roles to improve care, advance health, and increase value.

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10 | 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
New roles will require that nurses be adept at recognizing the impact of community
characteristics on patients and populations; understand the complex needs of older
patients; design and implement care coordination programs; leverage data and
technology to enhance patient care; and collaborate effectively with diverse teams of
health professionals. Nursing education needs to incorporate the competencies required
for nurses to be successful in new roles, through entry-level and continuing education
programs. Educators need to pay particular attention to designing programs that
enable nurses to seamlessly gain new skills and competencies; preparing faculty and
preceptors to teach in ambulatory and community settings; and leveraging emerging
educational modes such as flipped classrooms and online education. Policymakers
need to modernize regulations to allow nurses to practice at the highest level of their
knowledge. Now is the time to mobilize educators, nurse leaders, policymakers, and
employers to advance nursing’s capacity in a transformed health care system.Preparation of Nurses For a Country’s Primary Health Crisis Essay

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care-across providers and across settings-will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.Preparation of Nurses For a Country’s Primary Health Crisis Essay

Massachusetts General Hospital is known for medical innovations such as the first public demonstration of surgical anesthesia and the first replantation of a severed arm.

Today, the venerable Boston hospital is testing out another innovation, but this time it’s in the field of nursing. When a patient arrives at Massachusetts General Hospital (MGH) now, he or she is assigned an attending registered nurse (ARN) for the duration of the hospital stay and after discharge. The ARN builds a relationship with the patient and his or her caregivers, and ensures that all members of the patient’s health care team follow a shared care plan. Unlike other RNs, ARNs are designed to promote continuity of care, ideally with a five-day, eight-hour work schedule.

“The role is designed to be a constant throughout the patient experience,” says Jeffrey Adams, PhD, RN, director of the Center for Innovations in Care Delivery at MGH and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2014-2017). “The person the patient sees every day is available ahead of admissions and post-discharge. This is different than anything we’ve seen before. We evaluate this work closely and we know ARNs have significantly contributed to improved quality and patient satisfaction.Preparation of Nurses For a Country’s Primary Health Crisis Essay

The ARN is just one of the many new roles for nurses in a changing health care system. These new roles are empowering nurses to play a greater role in improving patient experiences and population health and lowering costs. Nurses in new roles are doing that by reducing unnecessary and costly hospital readmissions and preventable medical errors, providing more affordable, more convenient, and more patient-centered primary care in community-based settings, and more.

Nurses today are playing new roles in coordinating care from multiple providers, managing caseloads of patients with intense care needs, and helping patients transition out of hospitals and into the home or other settings. They are working as “health coaches” and in other ways to prevent illness and promote wellness. And they are charting new paths in emerging fields like telehealth, informatics, and genetics and genomics, and as scientists and leaders in society.Preparation of Nurses For a Country’s Primary Health Crisis Essay

Traditional RNs and advanced practice registered nurses (APRNs), meanwhile, are playing expanded roles as the health care system evolves to meet new needs. Once viewed as subservient and subordinate, nurses are now serving as full and essential partners on interdisciplinary health care teams. APRNs are opening nurse-led primary care clinics and operating independently—without physician supervision—in a growing number of states and in new settings, such as at retail pharmacies and “big-box” stores like CVS, Walgreens, and Target.Preparation of Nurses For a Country’s Primary Health Crisis Essay

Clear Benefits Include Better Clinical Performance and Patient Experience

Ed Wagner, MD, MPH, has observed this shift as co-director of The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP), an RWJF-supported program. During 2012 and 2013, he and his colleagues visited 30 high-functioning primary care practices to learn about innovative staffing arrangements that maximize the contributions of nurses and other staff. During the visits, the LEAP team noticed that nurses are increasingly providing more direct, face-to-face care in independent nurse visits or shared visits with providers.

The benefits, he said, are clear. “The practices that are engaging nurses in these new, expanded ways are showing better clinical performance and better patient experience” scores, he noted. For patients, “it means better care, no question.”

LEAP’s findings echo a 2010 report by the Institute of Medicine on the future of nursing that said nurses must play new and expanded roles to improve access to quality care and to lower costs. “Nurses are well positioned to help meet the evolving needs of the health care system,” the report states. “They have vital roles to play in achieving patient-centered care; strengthening primary care services; delivering more care in the community; and providing seamless, coordinated care. They also can take on reconceptualized roles as health care coaches and system innovators. In all of these ways, nurses can contribute to a reformed health care system that provides safe, patient-centered, accessible, affordable care.”Preparation of Nurses For a Country’s Primary Health Crisis Essay

New Payment Systems Support New Roles for Nurses

New laws and policies are enabling nurses do to just that, according to Ellen-Marie Whelan, PhD, CRNP, FAAN, senior advisor to the Centers for Medicare and Medicaid (CMS) Innovation Center. “Health reform and changes in the Affordable Care Act create amazing opportunities for nurses, in large part because of the way we’re paying differently for health care,” she said.

The government is moving away from fee-for-service systems and toward paying for improved outcomes, which create opportunities for nurses, said Whelan, an RWJF Executive Nurse Fellow (2012-2015) and an alumna of the RWJF Health Policy Fellows program (2003-2004). Payment changes, based in part on improved patient outcomes—such as with shared savings in accountable care organizations and bundled payments—will allow nursing contributions to be maximized, she noted. Medicare coverage for wellness and behavioral telehealth visits and care coordination for patients with multiple chronic conditions are services often led by nurses.Preparation of Nurses For a Country’s Primary Health Crisis Essay

“We are going to see increased accountability and responsibility for nurses in the general areas of transitional care and care coordination,” said Mary Naylor, PhD, RN, FAAN, national program director for the RWJF-sponsored Interdisciplinary Nursing Quality Research Initiative and creator of a model in which nurses lead care transitions across settings.Preparation of Nurses For a Country’s Primary Health Crisis Essay

“Nurses,” she continued, “will not only have enhanced responsibility and accountability in traditional settings, such as patients’ homes and community-based clinics, but increasingly have roles that enable them to move across health care settings such as from hospitals to patients’ homes. Evidence reveals that such role changes will better align with the care experience and needs of patients and their families, and result in improved outcomes.”

“Some people call this the de-linking of the hospital nurse,” Naylor said. “Rather than being setting-bound, nurses will work door-to-door. These aren’t just ideas, this is happening now.”

And that’s just the beginning, Adams predicted. “I am confident we have not yet seen the full spectrum of the innovative roles that nurses will develop and fulfill. As health care incrementally transforms to embody a Culture of Health, there will certainly be increased opportunities to … place nurses at the center of conversations, development, and implementation of new roles and new models of care.”Preparation of Nurses For a Country’s Primary Health Crisis Essay

Please let me know if you have any question. This paper was written by one of your tutor and the answer was total off. Please let me know if u have questions
One last question, this is suppose to be less Plagiarism‎ right? cos the last one was 30percent plagiarism.

Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.Preparation of Nurses For a Country’s Primary Health Crisis Essay
Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
A minimum of three scholarly references are required for this assignment.
As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.Preparation of Nurses For a Country’s Primary Health Crisis Essay

Grand Canyon University: NRS 429V Family-Centered Health Promotion
After interviewing the family, compile the data and analyze the responses.
In 1,000-1,250 words, summarize the findings for each functional health pattern for the family you have selected. Identify two or more wellness nursing diagnoses based on your family assessment. Wellness and family nursing diagnoses are different than standard nursing diagnoses. A list of wellness and family nursing diagnoses, from J. R. Weber’s Nurses Handbook of Health Assessment (5th ed.), can be found at the following link Preparation of Nurses For a Country’s Primary Health Crisis Essay