RNs are the Rx

Nurse ex­ecs must pro­mote qual­ity, con­tin­u­ing ed­u­ca­tion and nurs­ing ca­reers

Modern Healthcare - - Opinions Commentary - Ch­eryl Hoy­ing

Easy so­lu­tions have been hard to come by in the con­tin­u­ing dis­cus­sion about health­care re­form, but one fac­tor has been plen­ti­ful: a nearly end­less va­ri­ety of opin­ions, expressed from a num­ber of per­spec­tives. Law­mak­ers, po­lit­i­cal con­sul­tants, hos­pi­tal ad­min­is­tra­tors, physi­cians and many other groups all have im­por­tant voices to con­sider in the con­ver­sa­tion.

In pro­vid­ing the bulk of care on a day-to­day ba­sis, nurses have a unique breadth of per­spec­tive. Their in­put in the search for an­swers re­gard­ing health­care re­form is ab­so­lutely vi­tal.

Nurses, of course, rep­re­sent the front line in the de­liv­ery of health­care in a mul­ti­tude of set­tings, from hos­pi­tals, clin­ics and longterm-care fa­cil­i­ties, to schools, homes, of­fices and mil­i­tary bases. Taken as a whole, the per­spec­tive of nurses cov­ers the en­tire con­tin­uum of care. They have per­haps the best view­point to ob­serve the over­all sys­tem in ac­tion and com­ment on ways to make it more ef­fec­tive and ef­fi­cient.

For ex­am­ple, health­care re­form is ex­pected to add an­other 32 mil­lion peo­ple to the cur­rent sys­tem, stretch­ing health­care providers and fa­cil­i­ties to un­prece­dented lev­els of ca­pac­ity and op­er­a­tion. We can­not ex­pect vast new build­ings and le­gions of ad­di­tional staff to ac­com­pany this in­flux. In­stead, we must fo­cus on im­prov­ing the flow of pa­tients through our ex­ist­ing sys­tems, find­ing ways to im­prove ef­fi­ciency and make the best use of fa­cil­i­ties and staff around the clock. Rec­om­men­da­tions from nurses in ad­dress­ing this chal­lenge will be in­dis­pens­able, be­cause they are in­stru­men­tal in co­or­di­nat­ing the de­liv­ery of care and help­ing pa­tients nav­i­gate the of­ten con­fus­ing ar­ray of op­tions avail­able to them. The hands-on ex­pe­ri­ence of nurses will help iden­tify new paths to ex­plore and de­ter­mine which ideas may be fea­si­ble.

Nurses also can be a con­duit of valu­able in­for­ma­tion from the pa­tients them­selves. Health­care con­sumers are far more knowl­edge­able to­day about their care than in years past. Be­cause nurses have on­go­ing con­tact with them and their fam­i­lies, they of­ten re­ceive sub­tle in­sights into the work­ings of the sys­tem and the ac­com­pa­ny­ing im­pact on pa­tients.

A crit­i­cal fac­tor in the dis­cus­sion is the fact that, even con­sid­er­ing this surge of new pa­tients en­ter­ing the sys­tem, safety and qual­ity must re­main the pri­mary em­pha­sis of ev­ery­thing we do. Again, nurses are the key to iden­ti­fy­ing the op­por­tu­ni­ties and the lim­i­ta­tions in­her­ent in any changes to the sys­tem that may im­pact the abil­ity to keep pa­tient safety the top pri­or­ity.

All of this in­sti­tu­tional knowl­edge within the nurs­ing pro­fes­sion is a pow­er­ful tool to help evolve the health­care sys­tem, but first it must be elicited and then used for it to have its due ef­fect on the process. To dis­cover and un­lock the po­ten­tial of this deep pool of in­for­ma­tion, nurse lead­ers are es­sen­tial.

Many nurse lead­ers at all types of health­care fa­cil­i­ties place a strong value on shared gov­er­nance mod­els that con­tin­u­ally in­clude nurses in in­for­ma­tion loops and get­ting reg­u­lar feed­back on op­er­a­tional is­sues and where im­prove­ments are pos­si­ble. Nurse lead­ers need to be ask­ing nurses the right ques­tions to get the best and most mean­ing­ful in­put pos­si­ble. Nurses should iden­tify what op­er­a­tional prac­tices are lead­ing to the best or most im­proved out­comes. They will have in­sights on how to be more cost-ef­fec­tive, where sav­ings can oc­cur while not di­min­ish­ing the qual­ity of care or pa­tient safety, and how to max­i­mize the use of the fa­cil­ity to de­liver more care to more peo­ple while us­ing the same amount of space and equip­ment.

An­other role for nurse lead­ers is to be tire­less ad­vo­cates for on­go­ing im­prove­ments in care de­liv­ery. Technology that al­lows nurses to do their jobs bet­ter, such as the in­creas­ing use of elec­tronic health records and tele­health, is one of the key com­po­nents to en­sur­ing this im­prove­ment. The Amer­i­can Or­ga­ni­za­tion of Nurse Ex­ec­u­tives is help­ing nurse lead­ers de­sign, im­ple­ment and eval­u­ate pa­tient-care de­liv­ery sys­tems, as well as the technology that sup­ports the sys­tems.

The av­er­age age of a nurse in the U.S. is 46 years old. We must con­stantly pro­mote nurs­ing ca­reers in or­der to con­tinue serv­ing suc­ceed­ing gen­er­a­tions of pa­tients. Nurse lead­ers will need to keep their eyes on en­roll­ment rates at nurs­ing schools as well as grant pools that can help re­cruit and un­der­write stu­dents’ ed­u­ca­tion as they pur­sue nurs­ing ca­reers.

In­deed, nurse lead­ers should pro­mote con­tin­u­ing ed­u­ca­tion at ev­ery turn. The 3 mil­lion nurses cur­rently reg­is­tered in the U.S. may be a pow­er­ful force in help­ing to ad­dress short­ages of doc­tors as new pa­tients flood the sys­tem. As more nurses ad­vance their ed­u­ca­tion and ca­reers, grow­ing ranks of nurse prac­ti­tion­ers will be able to han­dle a va­ri­ety of health is­sues pre­sented by this new clien­tele. The health­care sys­tem also would ben­e­fit greatly by more nurses ob­tain­ing Ph.D de­grees in or­der to de­velop new re­search that will lead to ad­di­tional in­sights.

The an­swers to trans­form­ing our health­care sys­tem will not come eas­ily. An in­valu­able source of in­for­ma­tion, ideas and lead­er­ship through the process is the nurse and nurse leader. They see, per­haps bet­ter than any­one, the tremen­dous im­pact that changes in the sys­tem may have on the lives of our pa­tients, for bet­ter and for worse. We wel­come our place within the dis­cus­sion and look for­ward to ful­fill­ing this vi­tal role.

Nurses can view the whole

sys­tem and find ways to make it more ef­fec­tive

and ef­fi­cient.

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