It is National Nurses Week, and I wanted to take a moment to recognize nurses everywhere for all that they do in so many different roles.
Those who know me know that I am a tremendous supporter of nurses, and particularly supportive of Magnet hospitals because of what that designation means concerning the culture of nursing – shared governance, continued development and promotion of professional practice, continuing and advanced education, nursing research, incorporation of evidence-based best nursing practices, and excellence in the delivery of nursing services, among other things.
I was honored to be asked by Joanne Clavelle, DNP, RN, NEA-BC, our Treasure Valley chief nursing officer, to write a chapter for a book co-authored by one of her professors.
That book, Nursing Leadership from the Outside In, by Greer Glazer and Joyce Fitzpatrick, was released April 28.
What follows is an excerpt from the chapter I wrote, titled, “Perspectives on Nursing Leadership: From a Physician Chief Executive Officer.” I believe that nurses will be critical to the success of our transformation, and we will need strong nurse leaders. By sharing this, I mean to inspire those current and future leaders.
The Nurse Leader of the Future
Just as health care is preparing to go through the biggest change in nearly 50 years, so too, the role of the chief nursing officer/nurse executive will change dramatically. The chief nursing officer/nurse executive will be critical in redesigning the health care delivery system of the future.
What will change? Everything! First of all, the very care management model must change. It is too fragmented, too inconvenient, too ineffective, and too physician-centered.
What will the new care management model look like? The reimbursement system must eventually change from fee-for-service to payment for value.
When this happens, physicians will no longer be rewarded for personally-performed services, but rather for obtaining better outcomes (improved indicators of health/disease management and lower total cost of care) for a panel of patients. This will be the change that will be needed to help move towards team-based care in the outpatient/ambulatory arena.
This will mean that physicians will now utilize physician assistants and advanced practice nurses in the management of their patients. Once this happens, patients with chronic medical diseases can be actively managed in between office visits, decreasing the current fragmentation that characterizes our model of care. The chief nursing officer/nurse executive will be critical in the creation and implementation of this new care model.
The above changes to the care model are inevitable. However, those health systems that want to be the best will further adapt the care model to be patient-centered and family-centered. This is another area for leadership from nursing and quite a number of other disciplines.
It starts with looking at everything we do from the standpoint of the patient and those who provide the support system for the patient, both in the inpatient and outpatient settings.
For example, how effective is our patient education? For the patient who has been admitted to the hospital, are we really effective in educating the patient when they are ill, on sedating medications, and sleep-deprived? In the physician’s office, how much of the information we provide patients will actually be understood and retained?
We need to utilize technology and develop education that can be listened to/viewed at home and that has a stop and replay function. We need content that can be shared with all caregivers and that can be forwarded to a family member out of town.
Patient-centered and family-centered care is far more than just education. It also has to do with how we treat patients. Are we having all of our day surgery patients and their families show up at 6 a.m. even when we know some of these patients will not have surgery until late morning or early afternoon? If a single mother became ill in the evening, could she schedule a visit with her physician online for the next day so that she could still get her children off to school and know that she could get home in time to be there when the children returned home from school?
Are we engaging patients and their caregivers in the patient’s care or still treating the patient as a recipient of care? More than that, are we changing our care processes to activate patients (those with the capacity and competency required) so that they take accountability for their care and utilize us as consultants and advisors to them?
Nurses and nurse leaders can and must lead this change in the care model together with physicians and other providers.
There will be many new roles for nurses and the chief nursing officer/nurse executive must help develop these roles, help nurses be trained and further educated for these roles, and must develop new ways of assuring the competency of staff for these new nursing roles.
Besides the increased use of advanced practice nurses in the team-based care of patients, nurses will have a new and expanded role in population health. We must find ways to promote health and intervene in the lifestyle management and preventive care of those high-risk individuals who are not yet patients.
With a movement towards providers assuming greater risk for the health care of a population, the focus will be on trying to avoid costly illnesses and trying to care for those with chronic diseases in the lowest cost environment for which the desired outcomes of care can still be achieved.
This means an expansion of home health and palliative care and the development of new roles for nurse educators, patient navigators, and health coaches. Nurses will be even more involved in wellness, prevention, and screenings with special focus on at-risk populations.
While some primary care and specialist physicians will continue to manage patients with chronic disease in their offices, I believe we will see more chronic disease management being conducted by nurses, physician assistants, advance practice nurses, nutritionists, and other providers in patient-centered medical homes or chronic disease centers of excellence coordinated by teams and evaluated by compliance with evidence-based practices, bundles of care process measures, and metrics of disease management outcomes. The chief nursing officer/nurse executive will play a critical role in the design and oversight of these programs.
Finally, I believe that there will be pressure to increase the types of services available to patients at home and work, and for those patients that must be seen, to increase accessibility to care through extended hours of offices/clinics.
For those patients who cannot be cared for at home or in an office setting, use of urgent care clinics will be promoted over that of emergency rooms for appropriate cases. This coordination likely will involve more nurse triage and call centers.
Finally, for those patients who do end up in hospitals, I believe we will have to move towards true 24/7 operations, a significant challenge for our nurse leaders.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.