Breaking Barriers: Towards High Quality, Effective and Safe Health Care
Breaking Barriers Towards High Quality, Effective and Safe Health Care
With more than 3 million in numbers, nurses comprise the largest section of health care professionals in the US. They spend a huge portion of their time to deliver healthcare services which makes them a viable force in ensuring and safety of care.
A careful examination of the nurses’ capacity to support the health reform is essential, especially with the passage of laws such as the Affordable Care Act, American Recovery and Reinvestment Act, among others, which aim to improve the design, financing, and delivery of health services (Sochalski and Weiner, 2011).
Nurses have significant roles in such initiatives, and if engaged and assigned into leadership roles, they can elevate their practice and contribute in bringing significant changes in the institutions that provide care (Institute of Medicine, 2011); however, many barriers limit the scope of nurses’ role in care, given their lack of training and adequate educational background. To address these hindrances and achieve the goals of the government’s health initiatives, the Robert Wood Johnson Foundation has forged a partnership with the Institute of Medicine (IOM) in 2008 to assess the current state of the nursing professions to institute reforms in the nursing profession. It has resulted in the formation of a committee that would oversee the examination of the nursing workforce in the US and how it achieves the standards of the reformed health care and public health system (IOM, 2011).
Among the issues that the committee has focused include:
Reconceptualization of the nurses’ role with the current societal issues, shortage in workforce, the general workforce situation, and advancements in technology;
Increasing the capacity of nursing schools, expansion of faculty, and redesigning of nursing education to ensure an adequate number of competent nurses that can meet the standards of current and future health care;
Study and analysis of innovative solutions on delivery of care and health professional education, with focus on nursing and its practice;
Ensuring retention of competent nurses in multiple care settings such as ambulatory, acute, community, long-term care, primary care, and public health.
According to IOM (2011), the committee’s goal is to produce a report that recommends action-oriented plans considering the future of nursing in the public and institutional policies. It aims to determine the nurses’ contribution in the development and implementation of effective and efficient health care service and public health system. It also seeks to formulate recommendations geared in achieving reforms in nursing practice, education, and workforce development at the local, state, and national levels. After careful examination of the abovementioned issues, the committee has arrived at four key messages:
Nurses must be able to practice the education and training they have obtained to the full extent;
Nurses must be able to obtain further education and training through a reformed educational system that promotes continuous academic development;
Full partnerships among nurses, physicians and other healthcare providers and professionals must be implemented to redesign the health care in the US; and
Better data collection and improvement of information infrastructure to ensure effective workplace planning and policy-making.
The committee has presented these findings to a national conference which has set a dialogue for further discussion on how such can be translated into clear and specific actions.
Since many of the health reform programs such as the primary care medical homes and accountable care organizations (ACOs) need interventions mostly from the nurses’ scope of work, the IOM report serves as an action blueprint for implementation of programs that would develop the nurses’ capacity to lead and deliver the quality care to patients (Sochalski and Weiner, 2011). The report addresses significant nursing issues such as practice, education and workforce development directed at the policy-level.
In terms of education, the IOM report can serve as guide to improve the system and curricula to ensure the seamless transition from associate to bachelor to masters and doctorate degrees. It would also improve the delivery of care since the nurses’ competencies have developed. A clear example of this is study conducted by Lee et al (2013) where the number of patient deaths decreased by 2.12 up to 7.47 per 1000 patients because the nurses are equipped proper degrees and sufficient training.
It also supports the need of nurses to practice the education that they obtained. Because of many state regulations to the nursing practice, many nurses’ scope of work is limited and often, not able to practice their education or specialization. The report can back amendments to existing policies on the nursing practice in states.
As for workforce development, the report plays an important role in building the collaborative relationship of physicians, social workers, therapists, pharmacists and other professionals to nurses. It would foster an enabling environment for shared leadership and decision-making based on their fields of specialization.
The IOM report has already emphasized the commitment of nurses in delivering high-quality care in line with the current regulatory, business, and organizational situation; however, delivery of better health care does not solely rely on nurses despite their competencies (IOM, 2011).
Nurses need to to unite with government agencies, business sector, health care professionals and institutions and professional organizations to advance the cause for better health care. Said recommendations primarily seek to instill changes at the policy-level where governments and other key players have roles in reforming and transforming the health care and public health systems. Advocacy at various levels plays significant role in translating these recommendations into more concrete actions.
The national campaign, Campaign for Action, banners the campaign for delivery of effective, high-quality, and safe health care through nursing. Its local counterparts, the state-based Action Coalitions are found in in 50 states and 1 district and promotes the recommendations of the IOM through a multi-platform campaign. It engages various sectors including lawmakers, health professionals, academe and business leaders to support the key action points on nursing practice, education and workforce development such as improved access to care, inter-professional collaboration, nursing leadership, increased diversity in the practice, workforce data collection, and building healthier communities (Reinhard and Hassmiller, n d).
Texas Team Advancing Health through Nursing Action Coalition (Texas Team) is one of these action coalitions. It has united 343 member organizations, hundreds of nurses, and state leaders that support the recommendations of the IOM report.
Among the advocacies pushed by the Texas Team include the increased proportion of BSN graduates by up to 80% in 2020 and doubled number of nurses with doctorate degrees by 2020, among others (Texas Team, 2015). These initiatives advance nursing education and training, and practice because it seeks to increase the number of competent nurses that have undergraduate and graduate level training. The Texas Team has collaborated with the Texas Nursing Associate Education Committee and the Texas Organization of Baccalaureate and Graduate Nursing Education (TOBGNE) to formulate strategies on curriculum development, policy advocacy, and grants sourcing to achieve the 80% goal.
Sustainability and funding are among the factors that may affect the coalition’s initiatives. The indicators set by the Texas Team entails long-term and sustainable measures to the ensure the gains of the initiatives.
The Texas Team have already initiated several fund-raising activities supported by business and the RWJF (Texas Team, 2012). Nursing advocates can continue raising funds to support projects of the team through strategy formulation, sustainability planning, and partnerships with business and private sectors. Local governments can also support a few projects by aligning of portion of their budgets to scholarships and encourage return-service among nurses who obtained advanced degrees. The key is to source out for long-term program support to continue the initiatives, and to contribute to the over-all campaign to institutionalize reforms in the nursing practice to achieve the desired high-quality, safe, and effective health care.
References
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, At the Institute of Medicine, Robert Wood Johnson Foundation, & Institute of Medicine (U.S.). (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality. Health Affairs, 32(3), 579-586. doi:10.1377/hlthaff.2012.0504
Reinhard, S., & Hassmiller, S. (n.d.). The Future of Nursing: Transforming Health Care. The AARP Journal. Retrieved from http://journal.aarpinternational.org/a/b/2012/02/The-Future-of-Nursing-Transforming-Health-Care
Sochalski, J., & Weiner, J. (2011). Nursing Practice and Skills to Future Needs, Not Past Demands. In The future of nursing: Leading change, advancing health (pp. 375-400). Washington, DC: National Academies Press.
Texas Team Advancing Health through Nursing. (2012). Status update prepared for Texas Team Coalition members. Texas Team.
Texas Team. (2015). What We Do — TX Action Coalition. Retrieved from http://www.txactioncoalition.org/what-we-do/
