Nurse leaders share their ideas on the changing shape of nursing roles and care models during the HealthLeaders Media 2015 CNO Exchange.
In Austin, Texas they like to keep things interesting. The city's unofficial slogan is "Keep Austin Weird." Independent music and art are held sacred, and Willie Nelson could be described as the city's patron saint. Creative thinking is encouraged and, perhaps, even required in order to thrive in the capital city.
So it seems fitting that HealthLeaders Media chose The Omni Barton Creekside in Austin as the site for its inaugural, invitation-only Chief Nursing Officer Exchange on Nov. 11 – 13.
More than two dozen nurse executives from across the country gathered to share their at times out-of-the-box thoughts on the challenges, solutions, and opportunities facing the nursing profession.
We Can Do Better
As I write this, two charcoal drawings of cowboys on horseback hang on the hotel wall. They remind me of the lyrics to the song Anything You Can Do I Can Do Better from the musical Annie Get Your Gun. The lyrics are surprisingly appropriate to healthcare since the industry is fixated on the idea of doing things better (think value-based purchasing, improved clinical outcomes, decreased readmissions, and changing payment models).
Though many players are invested in improving care delivery and outcomes, I'd argue it's nursing that bears the brunt of the responsibility in attaining these goals because it's nurses who interact so heavily with patients and who are on the frontlines of care 24/7.
But to incite the changes and meet the goals inherent in this new healthcare environment, nurses can't rest on their laurels and continue to do things the way they've always been done. Instead, we're going to have to borrow from the philosophy that drives the people of Austin and start thinking creatively.
"We're going to have to change the whole way we deliver care," says Steven Seeley, MSN, RN, VP, COO, and CNO at Jupiter Medical Center. "It's just not going to work the way we do it now."
He believes we have to be willing to cast aside old roles and old ways of doing things. "In the future, we've got to get nurses moved away from being the task masters and really to being the coordinators of care."
From Pointillism to Panorama
This is a tough concept for many, including nurses, to get their minds around. Cynthia Latney, RN, PhD, CNO and VP of patient care services at Penrose St. Francis Health Services in Colorado Springs, CO, says she once asked her nurses, "If you had no boundaries, what would you keep doing today, and what would you give away or delegate?"
Her nurses found it a challenging question to answer, and I'm not surprised.
After all, in nursing school, we focus a great deal on tasks—Foley insertion, intramuscular injections, making beds, transferring the patients to the commode—but we don't get as much guidance or education on critical thinking, problem solving, and delegation. Old habits die hard when we enter the workforce, and we cling to those easily identifiable tasks.
If we do them proficiently, we are thought of as a "good" nurses. In this new healthcare environment, that's no longer enough.
If we want to improve outcomes, we can't be content with monitoring an acute-care patient's blood glucose level and giving insulin. Rather, nurses must start thinking about the big picture. What do patients need to maintain or improve their health once they move beyond the hospital walls? Do they have follow-up appointments with a primary care provider or endocrinologist to help manage their diabetes? Do they understand their discharge instructions so they won't be readmitted because of a medication error? Do they have a stove to cook healthy meals?
Nurses Can't Afford to Ignore Healthcare Costs
Nursing is a big job, and it can seem even bigger when you start expanding nurses' roles beyond just tasks. The good news is there is an entire care team we can partner with to help us achieve value-based outcomes.
"Let's bring all the skill sets together to really look at what we are going to achieve—an outcome, to reduce admissions, [or] to really reduce the cost on the accountable care side of things," says Barbara R. Medvec, RN, MSA, MSN, principle of BRM Initiatives, LLC, and former senior vice president and CNO at Oakwood Healthcare in Dearborn, MI.
This may mean pharmacists become responsible for medication education upon discharge and making follow-up calls to patients at home. It may mean using support staff such as CNAs or LPNs to ambulate a patient while the RN focuses on educating the family.
While some caution that in the past, certain types of nursing roles, like the admission nurse or the medication nurse, have fragmented nursing care and created silos in the care structure, others like Kathleen D. Sanford, RN, DBA, FACHE, FAAN, SVP, and CNO at Catholic Health Initiatives in Denver, say we can't be limited by what has or hasn't worked in the past.
"I believe we have to think differently," she says, "and not 'remember how it didn't work before, because now we have the tools so we can do it totally differently.'"
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Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.