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Nursing’s Growing Role

Rebecca Hendren, for HealthLeaders Media, July 13, 2010
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As nurses break out of anachronistic models, the new focus is on nurse-led care delivery systems and harnessing the economic power of nursing.

Not so many years ago, nurses wore white uniforms and stiff white caps. They gave up their chairs for physicians at the nurses station. They cared for patients who stayed in the hospital for days or weeks to recuperate from surgery. They received a technical education, often in a diploma program, and carried out task-based nursing duties. This picture is as antiquated now as today's nursing model will be in 20 years.

Today's non-cap-wearing, scrub-bedecked nurses are increasingly well-educated at colleges and universities that focus on care coordination and critical thinking, as well as clinical skills. They care for higher-acuity patients with more comorbidities and increasingly complicated care needs in the course of shorter lengths of stay. Nurses today are technologically savvy critical thinkers who coordinate care across a broad spectrum of healthcare. To be successful, they must be well-educated, well-trained, and able to lead patient care.

In 20 years, this picture will have changed again. Changes are in store for the provision of care; changes wrought by healthcare reform, increasing numbers of insured patients, an aging population, and the projected shortage of physicians.

Nurses will assume ever-greater leadership. Nurse-led primary care will be the norm, and advanced practice nurses will no longer have to justify their role. Physicians will be relieved of much of the burden of routine care coordination, allowing them to devote their attention to diagnosis and treatment of patients.

That is the tomorrow that healthcare leaders are building today.

Nurse leaders at the bedside
"In nursing, we have to get away from the task-oriented focus of bedside nurses who are focused on medication administration, activities of daily living, and so on," says Jill Fuller, RN, president and CEO of Prairie Lakes Healthcare System in Watertown, SD, whose organization is trailblazing a system of nurse leadership at the bedside that may just be a model for the future.

Nurses providing leadership at the bedside is a critical part of the future of patient care and organizations committed to providing high-quality patient care. Patient safety associations have long recognized the importance of strong nursing leadership at the bedside as a way to prevent medical errors and ensure patient safety. Initiatives such as the Institute for Healthcare Improvement's Transforming Care at the Bedside offer strategies to redesign nursing care to reduce non-value-added, non-patient-care tasks and improve nurse and patient satisfaction.

Although the recession has given us a respite from the nursing shortage, as the economy recovers, the shortage will reappear. To retain nurses and encourage nurse leadership, nursing processes need to be redesigned to remove petty timewasters from nurses' days and help them focus on what we really need them to be: leaders at the bedside. Nurses are the ones who are with patients 24 hours a day. As healthcare becomes ever more complex, it needs nurses who are leaders. This means redesigning practice models to reduce burnout and dissatisfaction and to help nurses do what they really want to do: care for patients.

Fuller's organization has been working hard to figure out how to do this and its revolutionary professional practice model is one for the future.

Prairie Lakes Hospital is located in rural South Dakota, 100 miles from the closest academic medical center. The 81-licensed-bed, nondenominational hospital sees all kinds of patients in its 50-staffed- and licensed-bed med-surg unit, from cancer patients to pediatrics. Nurses at the hospital have gone from concentrating solely on what they are going to do with their patients (task-based, narrow focus) to thinking about what the team as a whole will do (care coordination, broad focus).

The organization called for input from staff nurses and was intrigued by what they came up with. Rather than having a model of care imposed from above, nurses at Prairie Lakes designed their own model. They threw away the traditional model of care and created one that sets nurses firmly at the forefront of leading patient care in the hospital.

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