health care delivery models and nursing practice essay

NRS 440 topic 2 Health Care Delivery Models and Nursing Practice

This post discusses Health Care Delivery Models and Nursing Practice , current trends in health care delivery models, and includes discussions on how interprofessional collaboration will help reduce errors, provide higher-quality care, and increase safety and innovative healthcare delivery model that incorporates an interdisciplinary care delivery team

Topic 2 DQ 1 (Health Care Delivery Models and Nursing Practice )

Explain how interprofessional collaboration will help reduce errors, provide higher-quality care, and increase safety. Provide an example of a current or emerging trend that will require more, or change the nature of, interprofessional collaboration.

Topic 2 DQ 2 (Health Care Delivery Models and Nursing Practice)

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes

Health Care Delivery Models and Nursing Practice (health care delivery models and nursing practice gcu)

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment .

Include the following:

Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse\\\\\\\’s role and responsibility. Discuss how quality measures and to pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care. You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice .

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

What are nursing care, delivery models?

Ideally nursing care delivery models match number and type of caregivers to patient care needs determine who is going to perform what tasks, who is responsible, and who makes decisions and detail assignments, responsibility, and authority to accomplish patient care.

What is a health service delivery model?

A healthcare service delivery model is an approach to delivering healthcare . It’s a series of services that include health services and support for the community , like education about preventive care and health promotion.

What are practice models in healthcare?

A professional practice model describes how registered nurses practice, collaborate, communicate, and develop professionally to provide the highest-quality care for those served by the organization .

Course Code	Class Code	Assignment Title	Total Points
NRS-440VN	NRS-440VN-O503	Health Care Delivery Models and Nursing Practice	165.0
		Health Care Delivery Models and Nursing Practice
Criteria	Percentage	Unsatisfactory (0.00%)	Less Than Satisfactory (75.00%)	Satisfactory (79.00%)	Good (89.00%)	Excellent (100.00%)	Comments	Points Earned
Content	80.0%
Practice, Role and Responsibility	20.0%	Emerging law or federal regulation is omitted. The law or regulation presented is not relevant to health care.	Emerging law or federal regulation is incomplete. Effect on nursing practice and nurse role and responsibility is partially described.	Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is summarized. There are some inaccuracies.	Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is described. Some information or detail is needed for clarity.	care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is well-developed.

Quality Measures Pay for Performance, Patient Outcomes,	20.0%	Discussion on how , and how they affect nursing practice, expectations, and responsibilities of the nursing role, is omitted.	Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is incomplete.	patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. There are inaccuracies or slight omissions.	Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. Some information is needed for clarity.	A thorough and insightful discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented.
care delivery models and nursing		nursing care delivery models pdf
Leadership and Management Roles	20.0%	Discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient is omitted.	An incomplete and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is presented.	A summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and , is presented. There are inaccuracies or slight omissions.	A and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. Some detail or information is needed for clarity.	A well-developed discussion on professional and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. The care in a diverse health setting.
u.s. healthcare delivery models		describe how quality and safety impact delivery models in health care.
Predict Change in Nursing Roles and Nursing Practice	20.0%	Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are omitted.	Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are incomplete. The predictions are unrealistic or lack evidence for support.	Insert Satisfactory CoA summary on professional and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 care are summarized. The predictions are realistic, but there are inaccuracies or slight omissions. ntent 2 Descriptor	Predictions for how the . The predictions are generally supported and realistic.	Predictions for how the . The predictions are based on evidence and highly relevant to emerging trends.


Organization, Effectiveness, and Format	20.0%
Thesis Development and Purpose	5.0%	Paper lacks any discernible overall purpose or organizing claim.	Thesis is insufficiently developed or vague. Purpose is not clear.	Thesis is apparent and appropriate to purpose.	Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.	Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction	5.0%	Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.	Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.	Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.	Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.	Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

(includes spelling, punctuation, grammar, language use)	5.0%	Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.	Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.	Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.	Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.	Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment)	2.0%	Template is not used appropriately, or documentation format is rarely followed correctly.	Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.	Appropriate template is used. Formatting is correct, although some minor errors may be present.	Template is fully used; There are virtually no errors in formatting style.	All format elements are correct.
		Health Care Delivery Models and Nursing Practice
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)	3.0%	Sources are not documented.	Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.	Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.	Sources are documented, as appropriate to assignment and style, and format is mostly correct.	Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
		Health Care Delivery Models and Nursing Practice
Total Weightage	100%	health care delivery models and nursing practice

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Practice & Leadership in Nursing Homes: Building on Academic-Practice Partnerships

Chapter 5: Models of Nursing Care Delivery

Ann Kolanowski; Barbara J. Bowers; Joan G. Carpenter; Andrea Gilmore-Bykovskyi; Laura Block

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Introduction.

NURSING CARE-DELIVERY MODELS
MODELS OF PALLIATIVE AND END-OF-LIFE CARE
MODELS OF TRANSITIONAL CARE
DEMENTIA CARE MODEL
Full Chapter
Supplementary Content

Nursing occurs within four spheres of care, ranging from prevention to supportive care and all the areas in between. This chapter is relevant to the following spheres of care:

□ Disease Prevention/Health Promotion

☑ Chronic Disease Care

☑ Regenerative or Restorative Care

☑ Hospice/Palliative/Supportive Care

The American Association of Colleges of Nursing has identified 10 broad domains of practice for nursing. Students are expected to master these domains of practice across the spheres of care. This chapter addresses:

□ Knowledge for Nursing Practice (Nursing and Other Disciplines)

☑ Person-Centered Care

□ Population Health

□ Scholarship for Practice

□ Quality and Safety

☑ Interprofessional Partnerships

☑ Systems-Based Care

□ Information & Healthcare Technologies

□ Professionalism

☑ Personal, Professional, Leadership Development

Integrated across the domains of practice are eight concepts which the student is expected to master across the spheres of care and across the domains of practice. This chapter addresses:

□ Clinical Judgment

☑ Communication

☑ Compassionate Care

□ Diversity, Equity, Inclusion

□ Evidence-Based Practice

□ Health Policy

□ Social Determinants of Health

List care-delivery models (CDMs) common in nursing practice.

Describe the nursing role in palliative and end-of-life CDMs.

Outline the nursing role in transitional CDMs.

Summarize the nursing role in dementia CDMs.

Care-delivery models (CDMs) are infrastructures for organizing and providing care to people in a healthcare setting, the skill sets required of people who deliver that care, the context of care, and the expected outcomes of care ( Duffield et al., 2010 ). CDMs are embedded in broader models of care, such as the medical, biopsychosocial, or quality-of-life models described in Chapter 1 . In that chapter you learned that nursing homes have changed dramatically over the past century since their inception as almshouses for the poor. There are now national and international initiatives that call for more holistic, person-centered approaches to care in these settings. Additionally, nursing homes now serve a heterogeneous population, from people needing short-term post-acute care to respite or end-of-life care to long-term care and support. Consequently, the goals of care delivery have become quite varied and require great breadth and depth of nursing knowledge and skill to effectively support what people expect in the delivery of care within these settings.

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Nursing care delivery models and outcomes: A literature review

Affiliation.

1 Department of Nursing, Brock University, Ontario, Canada.
PMID: 34418101
DOI: 10.1111/nuf.12640

Objective: The purpose of this literature review was to determine the types of nursing care delivery models currently being used in acute care hospitals to determine the effectiveness of the model and the outcomes being measured.

Method: A literature search was conducted, and databases searched included CINAHL, Nursing and Allied Health, Medline, EMBASE, ProQuest Theses, and Dissertations for the years 2000-2020. Sixteen studies were retrieved. Patient outcomes measured included falls, adverse events, and infections. Nursing outcomes measured included satisfaction, communication, and perceived quality of care.

Results: Findings from this review showed there was no single model of nursing care delivery that resulted in positive patient or nurse outcomes, thus a "one size fits all" approach to selecting or utilizing a model of care is not realistic.

Conclusion: Given the number of nursing care delivery models that were hybrids, clearer descriptions of each model and further research on patient and nursing outcomes is warranted.

Keywords: literature review; nursing care delivery model; outcomes.

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Models of health care delivery.

There are numerous models of health care delivery, or ways that health care delivery systems, such as hospitals, operate. Nurses often serve as the "backbone" to health care delivery models because of the unique hands-on role they play in providing care. Columbia University School of Nursing researchers carefully examine the wide array of models of health care delivery across many settings (e.g., inpatient, outpatient) to determine which are the most beneficial, efficient, and cost-effective. Our research is examining health care delivery models that are not only integrated, coordinated, leverage technology, and theory-driven, but that also elevate the nurse’s role from caregivers to "care integrators" to maximize their positive impact on patients. Such research is driving change in health care delivery by developing and launching innovative solutions to today’s health care problems.

Researchers

Melissa p. beauchemin, phd, msn, bsn, ba, cpnp-pc, cpon.

Assistant Professor of Nursing

Research Approaches: Dissemination and Implementation, Health Services and Policy, Informatics

Research Interests: Health-related Social Risk Screening, Systematic Screening Implementation, Clinical Practice Guideline Implementation, Cancer Care Delivery Research

Suzanne Courtwright, PhD, PNP, NEA-BC

Postdoctoral Research Fellow in the School of Nursing

Research Approaches: Comparative Effectiveness, Health Services and Policy Research Interests: Nurse Practitioners, Integrated Behavioral Healthcare, School-based Healthcare, Mental Health, Primary Care, Adolescents and Young Adults, Healthcare Systems, Medicaid/Children's Health Insurance Program

Stephen Ferrara, DNP, FNP-BC, FAAN, FAANP, FNAP, FNAM

Associate Dean of Artificial Intelligence, School of Nursing
Professor of Nursing at CUMC

Research Approaches: Clinical, Health Services and Policy

Jianfang Liu, PhD, MAS, MPA, BE

Associate Professor of Quantitative Research (in Nursing) at CUMC

Research Approaches: Clinical, Health Services and Policy Research Interests: Statistical Modeling, Psychometric Testing, Experimental Design, Big Data Analysis and Management

Allison Andreno Norful, PhD, MPhil, MSN, BSN, ANP-BC, FAAN

Research Approaches: Comparative Effectiveness, Health Services and Policy, Interdisciplinary Research Interests: Nurse Practitioners, Interprofessional Teams, Provider Co-Management, Primary Care Nursing, Care Delivery, Provider Burnout, Team Communication, Quality of Care

Monica K O'Reilly-Jacob, PhD, APRN, FNP-BC, FAAN

Research Approaches: Health Services and Policy

Research Interests: nurse practitioners, home-based primary care, NP-owned practices, entrepreneurship, aging populations, Medicare claims analysis, implementation of full practice authority

Lusine Poghosyan, PhD, MPH, RN

Stone Foundation and Elise D. Fish Professor of Nursing and Professor of Health Policy and Management

Research Approaches: Health Services and Policy, Interdisciplinary Research Interests: Primary Care, Chronic Diseases, Minority Populations, Nurse Practitioners, Health Care Teams

Jingjing Shang, PhD, FAAN

Research Approaches: Comparative Effectiveness, Health Services and Policy Research Interests: Infection Control, Home Health Care, Health Policy

Patricia W. Stone, PhD, MPH, MSN, BSN, FAAN, FAPIC

Centennial Professor of Health Policy in the Faculty of Nursing

Research Approaches: Comparative Effectiveness, Economic Analysis, Health Services and Policy Research Interests: Infection Control, Palliative Care, Geriatrics, Nursing Homes, Home Health Care, End-of-Life, Community Settings, Comparative Effectiveness

Health Care Reform: Changes in the US Nursing Practice Words: 1422
Nursing Care Delivery Model Words: 1118
The Future of Nursing in an Evolving Health Care System Words: 1159
Nursing Care Models Words: 1828
Identification of a Nursing Care Model in Practice Words: 1196
Health Care Delivery Model and Nursing Practice Words: 1090
Models of Nursing Care Words: 1386
Collaborative Care Model in Nursing Practice Words: 1103
Healthcare Delivery Models and Nursing Trends Words: 1233
Total Care Model in Nursing Practice Words: 1186
Nursing Care Models’ Analysis Words: 1409
Nursing Care Models Definition Words: 1399
Occupational Health Nursing Theory and Model Words: 2786
Patient Health Care Outcome Words: 558

Health Care Delivery Models and Nursing Practice

Introduction.

Over the past two decades, the healthcare system especially in the United States has seen a significant increase in healthcare costs. As a result, the issue has raised an alarm for health care reform before healthcare costs become unsustainable. Building strategies for reform will lower health care costs and improve the quality of health care. Besides, improved quality of care translates to having good working environments for healthcare workers who are responsible for providing safe, sustainable, and efficient care to clients. In this paper, there is a discussion of a current health care law, quality measures, professional nursing leadership, and management roles congruent with health care reform.

The Current Health Care Law

The rendering of health services in most health care systems across the world remains overwhelmed by the increased numbers of patients or clients. In the nursing profession, inadequate staffing remains an issue. Understaffing in nursing units usually leads to overwhelming the nursing staff; inadequate time for quality patient care, delayed care for clients, and nursing staff burnout, and increased stress. Staffing remains one of the most challenging contemporary issues health care organizations strive to settle. A challenge that emerges is creating an equilibrium between adequate staffing for the delivery of quality services and having enough monetary resources to afford enough staff.

Among the current laws established, this paper focuses on the “Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019” (Schakowsky, 2019). The law drums up support for standard staffing ratios and to ensure the quality of care. In essence, the law seeks to ensure proper staffing for nurses and enhance the quality of health care (Schakowsky, 2019). A section of the law indicates that poor and substandard monitoring of registered nurse staffing practices leads to few registered nurses rendering health care services thus impacting the delivery of health care (Schakowsky, 2019). Adequate staffing leads to the delivery of quality healthcare at the same time acquiring optimal value from registered nurses (Park, 2017). The law stipulates that staffing should have one nurse to one patient in accidents and emergency units (1:1), one patient to one nurse in theatre units (1:1), two patients to one nurse in critical care units (2:1), and one nurse to three patients in emergency rooms, antepartum, labor, and telemetry (1:3), four patients to one nurse in medical-surgical units (4:1), a nurse to carter for five patients in the rehabilitation unit (1:5), and six patients in postpartum units (6:1) (Schakowsky, 2019). Therefore, the law advocates for nurses to deliver quality patient care and at the same time ensure the betterment of the health practice environments and reduce burnout due to workload.

Quality Measures on Performance, Patient Outcomes, and Effect on Nursing

Reforms in healthcare seek not only to promote health care quality but also to make health care costs affordable and sustainable. Pay for performance provides a platform for initiatives meant to ensure improved quality, effectiveness, and overall value of health care (Mendelson et al., 2017). Pay-for-performance provides financial incentives to healthcare organizations, healthcare providers, and physicians to deliver health care improvements and attain desired health outcomes (Mendelson et al., 2017). The health care delivery model was brought about by the Centers for Medicare and Medicaid Services (CMS), which also stresses quality measures in place. Some of the quality measure metrics include the efficiency of care, patient care experiences, the delivery of care, and health care outcomes among patients (Tinker, 2020). Patient-specific outcomes include rates of hospital-acquired infections (HAIs), fall risk management, rates of infections, vaccination status (Tinker, 2020). Offering health care providers and organizations reimbursements do incentivize the players in health care to manage health behaviors to enhance patient outcomes and reduce health care costs (Tinker, 2020). Nurses have a significant role in realizing such quality measures and have to embrace the fact that best evidence-based practices ensure the quality of care. Besides, the nursing workforce advocates for patients thus having the capability of ensuring patients receive culturally competent care and ensuring affordability of health care costs.

Professional Nursing Leadership and Management Roles

Leadership in nursing is instrumental in assisting the reform of health care systems. Nurse leaders, therefore, have an integral responsibility of promoting and facilitating channeling and collaborating at all levels in the nursing discipline. With the expansion of the nursing scope through education and knowledge, nurses assume Advanced Practice Registered Nursing (APRN) roles and become the voice of nurses through leadership. Advocacy in the nursing discipline has led to the surfacing of contemporary nursing roles such as care coordinator, patient navigator, and virtual care nurses, among others (Bauer & Bodenheimer, 2017). The emergence of such new roles is usually critical in assisting expand care to patients outside of the acute care environment. For instance, care coordinators aid in the management of care for clients with chronic ailments such as diabetes to access care after discharge from the hospital. Virtual care nurses help link patients with healthcare providers from their convenience without the need to physically avail themselves of the facilities. Considering the emergence of COVID-19, the role of virtual care is instrumental to enable high-risk patients to receive care without the need to interact with other individuals. Therefore, having nurses assuming leadership and management roles assists in the seamless transition and continuum of care.

Predicting of the Change in Nursing Roles and Nursing Practice

There is a remarkable potential in the nurses’ future particularly in improving the quality of care and reducing costs associated with health care. The commitment of nurses to shift and assume the APRN roles helps in closing the gap in primary care and community health roles. APRNs, therefore, are capable of delivering high-quality and affordable care to clients in any health care setting. Autonomy for nurses increases when they make advances in nursing education. Besides, they are crucial in the continuum of care in a variety of settings including clinics in upcountry and home care settings. Certified nurse anesthesiologists help anesthetize patients at an affordable rate. Entry-level nurses are increasingly shifting to acquire bachelor’s degrees. Consequently, such changes aid to reduce health care costs whilst delivering high-quality care.

In summary, nurses are key players in the reformation of health care systems by influencing the delivery of affordable and high-quality care. Nurses also assist in providing sustainable care for clients. They have increasingly advocated for proper nurse-patient ratios. The fundamental reason behind such an effort is reducing workplace burnout and improving the quality of care for patients. Again, nurses facilitate the meeting of quality measures to improve care and influence maximum reimbursement for health care facilities and care providers. Therefore, the nursing discipline is important in reforming the future of health.

Bauer, L., & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing Outlook , 65 (5), 624-632.

Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., Freeman, M., O’Neil, M., Relevo, R., & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care. Annals of Internal Medicine , 166 (5), 341.

Park, C. S. Y. (2017). Optimizing staffing, quality, and cost in-home healthcare nursing: Theory synthesis. Journal of Advanced Nursing , 73 (8), 1838-1847.

Schakowsky, J. D. (2019). Text – H.R.2581 – 116th Congress (2019-2020): Nurse staffing standards for Hospital Patient Safety and Quality Care Act of 2019 . Congress.gov.

Tinker, A. (2020). The top 7 healthcare outcomes measures . Health Catalyst.

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Health Care Delivery Models and Nursing Practice

📄 Words:	1450
📝 Subject:
📑 Pages:	6
✍️ Type:	Essay

Healthcare Legislation

The healthcare system is characterized by fundamental shifts from biomedical models and primary care to biopsychosocial models and community-based care, respectively. Laws have been mainly instrumental in supporting the restructuring of the system, including the roles of nurses. As the healthcare system evolves, so do the roles of nurses. The purpose of this paper is to analyze the actions taken to reform the U.S healthcare delivery system and their implication on nursing roles and responsibilities.

Medicaid Services Investment and Accountability Act of 2019

The Medicaid Services Investment and Accountability Act brought about the following changes (“Medicaid services investment and accountability act,” 2019):

Expanded Medicaid eligibility for patients receiving home care and community-based care.
Extended the qualification for Medicaid funding for individuals receiving healthcare from federally recognized community behavioral clinics
Allowed children with complex health conditions to choose a designated provider or a healthcare team to deliver health services at home.
Mandated drug manufacturers to disclose drug information – civil drug penalties would be applied to manufacturers who misclassify drugs.
Authorized the Centers for Medicare & Medicaid Services (CMS) to help states reduce institutionalized care by increasing funding to home care and community-based programs.

Implications of Legislation on Nursing Practice

The legislation promotes the use of an integrated healthcare delivery system. The current healthcare delivery to people with chronic condition can illustrate how the legislation has shaped current nursing practice. First, patients with chronic conditions often rely on collaboration between multidisciplinary teams to enhance effective disease management. Second, healthcare delivery among this population often occurs across several health settings, including hospitals, homes, and pharmacies. Unlike traditional approaches where the patients would choose providers from different healthcare settings, this statute allows patients to select an interdisciplinary team from a single hospital. This approach also facilitates seamless coordination of care and information exchange since all the physicians are under one umbrella organization. Retaining a patient under the aforementioned system promotes process efficiency, reduces costs, and the risks of rehospitalization (“Integrated care models,” 2016). It shifts the focus of nursing practice from hospitals to home and community-based and home settings. As the regulation changes the delivery of healthcare to community settings, so do the roles of nurses.

The Role and Responsibility of Nurses

In collaboration with other healthcare providers, nurses can design, implement, and evaluate the coordination and transition process. They can organize the components of care plans, assist patients in identifying healthcare options, document care, and mediate communication between individual members of the multidisciplinary team as well as between the team and patients and family. They can also lead and advocate for the dignified care of patients within the multidisciplinary team to ensure that patients’ needs are adequately addressed.

Pay for Performance (P4P) and Patient Outcomes

Operational reimbursement programs in the United States link compensation to quality measures to promote patient outcomes. The HCAHPs survey, for example, indemnifies hospitals based on their score ratings from patient experiences. In 2015, the CMS reported that it would either withhold 2% of compensations or reward top-performing healthcare settings based on their score ratings (“What is pay for performance,” 2018). Given that a considerable amount of a hospital’s income relies on these subjective experiences, healthcare facilities have to employ strategies to improve patient satisfaction and encounters. For instance, since the survey measures communication, staff responsiveness, pain management, timely care, and the setting’s environment, interventions to promote outcomes in these areas can be implemented to foster better patient outcomes.

Healthcare providers can also use CMS quality measures to improve health outcomes in their workplaces. Standardization is a mechanism or strategy that hospitals can utilize to achieve the same results in clinical practices. During quality improvement initiatives, healthcare facilities usually develop and implement approaches and behaviors based on the best evidence. Depending on the outcomes of the aforementioned projects, quality measures can either be improved upon or adopted as the standard practice at the hospital. With the replication of these procedures, evidence-based practices become systematic in the organization. Standardization increases the likelihood of achieving desirable health outcomes (Salmond & Echevarria, 2017). It can also result in capacity building, change in the facility’s culture, and learning.

Implications on Nursing Practice and Nurses’ Roles

The primary role of nurses is to coordinate and implement effective strategies in areas targeted by P4P efforts. Given that reimbursement programs give attention to care processes, nurses can align their practices with the policy requirements. For example, the P4P emphasizes the need to provide patients with adequate information and respond to their specific needs and preferences. Nurses, being the primary healthcare providers, are on the frontline of providing patients with this information. Therefore, the model promotes a nursing practice focused on patient-centered care by mandating providers to achieve the best outcomes in preestablished quality metrics.

Expectations and Responsibilities of Nursing Roles

Nurses work directly in units where the CMS collects data to measure a hospital’s performance. For example, the CMS gathers information on elements, including surgical wound infection and prevention, heart failure, pneumonia, and acute MI – myocardial infarction. Nurses can contribute to patient satisfaction in these specialties by conducting timely assessments, administering drugs and treatment plans, provide patients with prescription and discharge information. Nurse leaders can also address nursing interventions that aim to foster the impact of P4P on performance measures and the ability of nurses to contribute to the hospital’s efforts in achieving P4P outcomes.

Emerging Roles of Nurse Leaders and Managers

Advanced practice registered nurse (aprn).

The APRN role has been one of the most impactful clinical changes brought by the ACA’s enactment. A recent systematic review demonstrated that APRNs could improve cost savings and patient outcomes for healthcare settings (Joseph & Huber, 2015). According to Joseph and Huber (2015), technological solutions to healthcare problems will require APRNs’ roles and contributions. The APRNs are trained and certified professionals whose duties include examining, diagnosing, ordering diagnostic tests, prescribing drugs, and managing patients’ health-related issues. For example, concerning value-based purchasing, APRNs can develop quality improvement systems to improve outcomes in each of the measured dimensions.

Clinical Nurse Leader (CNL)

CNLs mainly focus on improving healthcare delivery systems at the point of care. Their role was conceptualized by the American Association of Colleges of Nursing in response to the need for a well-defined leadership role that would improve healthcare quality. It was created to solve problems encountered during care coordination, such as fragmentation and care gaps that led to adverse health outcomes (Joseph & Huber, 2015). CNL improves patient outcomes and costs through advocacy, education, information management, care coordination, quality & patient safety, and outcome management. CNL responsibilities in the lateral integration of care are perhaps the most relevant in the emerging healthcare trends. Given that attention is shifting from primary care settings to community-based settings, CNL can optimize community-based care delivery (Aveling et al., 2017). A lateral integrator coordinates various functions to facilitate coordination and continuity of care across different health settings.

The Future of Nursing

Use of technology.

Technology will mediate clinical workflows and practices to promote health outcomes in clinical settings. Services such as telehealth and telemedicine will relatively increase with the use of social media and electronic devices. Tools such as Artificial intelligence systems and big data analytics will be used to plan and manage health data. Risling (2017) predicted that by 2025, the nursing curriculum would include education on data analytics and wearable technologies. Therefore, skills in nursing informatics or necessary technological skills will be a core skill in nursing.

Health Promoters

The role of nurses will shift from caregiving to health promoters in the future. Various statistics show that chronic conditions and the aging population will increase (Atella et al., 2018). Chronic diseases are characterized by acute pain, low quality of life, high healthcare costs, functional limitations, and the need for self-management education. About 80% of individuals aged 65 years and above have at least one chronic disorder (Atella et al., 2018). Nurses will play a critical role in alleviating or preventing the adverse outcomes associated with the condition. They will provide health education on self-management as well as education on disease prevention to pertinent communities to help address the complexities associated with these illnesses and aging.

Due to the emphasis on patient-centered care, programs such as P4P have been established to promote patient outcomes. The P4P program requires that nurses align their roles to accord closely to the policy’s requirements. The new healthcare system’s emphasis on community-based care increased the need for effective care coordination and an integrated healthcare delivery system. Consequently, roles such as the CNL and APRN were created to satisfy the needs of the system. Therefore, it can be surmised that the new healthcare structures have changed nurses’ roles in the healthcare system.

Atella, V., Piano Mortari, A., Kopinska, J., Belotti, F., Lapi, F., Cricelli, C., & Fontana, L. (2018). Trends in age-related disease burden and healthcare utilization. Aging Cell , 18 (1), e12861. Web.

Aveling, E.-L., Martin, G., Herbert, G., & Armstrong, N. (2017). Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice. Social Science & Medicine , 173 , 96–103. Web.

Integrated care models: An overview (2016). Web.

Joseph, L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: Prospects and opportunities. Journal of Healthcare Leadership , 7 , 55–64. Web.

Medicaid services investment and accountability act of 2019 – H.R. 1839 (2019). Web.

Risling, T. (2017). Educating the nurses of 2025: Technology trends of the next decade. Nurse Education in Practice , 22 , 89–92. Web.

Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopaedic Nursing , 36 (1), 12–25. Web.

What is pay for performance in healthcare? (2018). Web.

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Health Care Delivery Models and Nursing Practice

In the recent past, the United States healthcare system has undergone sporadic changes aimed at reforming and restructuring it. These changes have been majorly driven by the Affordable Care Act (ACA) OF 2010. Various regulations have been introduced in this law, and several standards aim to improve access to healthcare, reduce healthcare costs, and improve the quality of care. Nurses have therefore been tasked or presented with new roles and responsibilities, which are vital in prompt response to the changes that the act has brought about. This paper seeks to examine the various changes that have been introduced to reform and restructure healthcare in the U.S healthcare delivery system, discuss the impacts of these changes on nursing practice and the role of nurses in implementing these changes, discuss nursing professional leadership and management roles and also give a prediction of two ways in which nursing practice and nursing roles will grow and transform within the next five years in response to upcoming trends and predicted issues in healthcare.

Current or Emerging Health Care Law or Federal Regulation

One of the most significant reforms and changes in the U.S. healthcare system in the past years is the introduction of the Affordable Care Act (ACA) of 2010. This law was formed with the central aim of reforming and restructuring the healthcare system through expanding the number of people covered by insurance, healthcare quality improvement, and healthcare cost reduction. Specifically, the introduction of ACA has led to the adoption of various rules, regulations, and standards for quality healthcare delivery. This has also included establishing changes in health insurance, Medicaid eligibility expansion, reintroduction of quality measures, and pay-for-performance initiatives. This act has also enabled the establishment of various health insurance marketplaces. It established a federal and state health insurance marketplace known as exchanges that would make it easier for families and individuals to be in a better position to compare and purchase health insurance plans with an informed decision. Moreover, the act has helped in the prohibition of discriminatory acts based on some preexisting conditions; this means that ACA has illegalized denial of coverage by health insurance companies or the insurance companies charging higher payments in the form of premiums as a result of existing medical conditions.

Effect of the Affordable Care Act on Nursing Practice and the Nurse’s Role

The adoption and implementation of the ACA have significantly impacted the nursing practice and nurses’ roles. A good example is the increment t of affordable healthcare access through expanding Medicaid eligibility. This has also been achieved by establishing various health insurance exchanges (Cleveland & Smith, 2019). The significant result of this has been increased demand for nursing services. Therefore, most nurses are expected to continuously provide proper comprehensive care to many patients who need it (Cleveland & Smith, 2019).

Moreover, ACA has also introduced various measures to ensure quality care and reward by paying for incentives due to good performance. This has had a ripple effect in the form of increasing care attention to the patients and ensuring that the outcomes of service provision of the patients are exemplary (Cleveland & Smith, 2019). Finally, nurses are also required by ACA to take up new responsibilities and roles that would make them continuously provide the best services to the patients. These roles and responsibilities include preventing diseases, educating patients, and promoting healthcare.

Quality Measures and Pay for Performance

ACA has introduced quality measures and payment for performance incentives to help in improving patient quality care. Quality measures have been known as the metrics used to evaluate the quality of care patients provide (James, 2018). These include readmission rates, satisfaction scores of the patients, and mortality rates. Pay for performance incentives, on the other hand, are the financial rewards that healthcare providers receive as a result of attaining or meeting the measures of quality (James, 2018). Patient outcomes have significantly been impacted by the quality measures and pay for performance since these measures lead to a proliferation of focus on evidence-based and the best patient–centered care.

Professional Nursing Leadership and Management Roles

As a result of ACA, various nursing roles have also emerged, such as management and leadership roles. For a proper response to the ever-dynamic healthcare environment, nurses must be aggressive in taking continuous learning of management and leadership courses to ensure patients are provided with the best quality care (Joseph & Huber, 2017). Some of these roles include managing financial resources and leading interdisciplinary teams (Joseph & Huber, 2017). Moreover, some of these roles also require nurses to understand healthcare laws and structured regulations that fully advocate for the patient’s interests and rights.

ACA has also ensured that nurse managers and leaders take different career roles. This, however, depends on the qualifications and specialties of the nurses (Joseph & Huber, 2017). Nurse leaders must consistently perform the functions of a leader in the entire medical organization, including faculty transformation, developing better innovative methods, and acting as the leaders of various departments (Joseph & Huber, 2017). On the other hand, nurse leaders are required to act as the directors of patient care. They should also be the pioneers of objectives accomplishment in the organization.

Emerging Trends and Predicted Changes

In the current world, where there is a continuous evolution of healthcare, there is a high expectation that there will be a transformation and growth in nursing and nursing roles. This is a dynamic that will come in handy in response to current trends and most of the issues that are in the healthcare sector.

Implementing new technologies is one of the trends expected to shape the future of nursing. Such technologies include; artificial intelligence, telehealth, and electronic health records. Such technologies will help nurses continuously provide quality and effective patient care (Salmond & Echevarria,2017). Moreover, new disease emergence, such as antibiotic-resistant infections, will require nurses to take on new responsibilities to prevent, diagnose, and treat various conditions.

The increment in nurses’ demands is expected to increase nurses’ retention (Salmond & Echevarria,2017). This aspect will require the nurses to focus on new roles and responsibilities to promote professional development and job satisfaction.

There has been an immense and significant impact on the U.S. healthcare systems as a result of the implementation of the Affordable Care Act of 2010. This regulation has ended up introducing various regulations and standards that would help in healthcare delivery and improve access to care, cost reductions, and improvement in the quality of care that is given. Therefore, nurses have been tasked with various roles and responsibilities that did not exist before. These roles are indispensable in responding better to the dynamic healthcare field. Moreover, adopting pay-for-performance incentives and quality measures has significantly impacted patient service delivery outcomes. This is because these measures lead to an increment of focus to the of patient–centered care that is evidence-based. Additionally, professional nursing leadership and management roles have emerged, which aim to provide a conclusive response to the dynamic healthcare environment. There is also still an expectation that nursing practice and roles will continuously be growing and transforming to effectively respond to the current trends, coming trends, and the healthcare issues that have been predicted.

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing , 24 (2). Retrieved from; https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html

Joseph, M. L., & Huber, D. L. (2017). Clinical leadership development and education for nurses: prospects and opportunities. Journal of healthcare leadership , pp. 7 , 55. Retrieved from; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740995/

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing , 36 (1), 12. Retrieved from; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/

James, J. (2018). Pay-for-performance. Health Affairs , 34 (8), 1–6. Retrieved from; https://www.healthaffairs.org/do/10.1377/hpb20121011.90233/full/

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Pharmacy Technician: Bridging the Gap in Healthcare Delivery

How it works

The healthcare world is pretty complicated, with lots of different professionals working together to help patients get the best care. Pharmacy technicians are a big part of this team. They usually work behind the scenes, helping pharmacists make sure patients get the right medicines and that everything in the pharmacy runs smoothly. But, people don’t always notice how important their job is. Let’s talk about why pharmacy techs are so crucial, what they do, how they train, and why we need more of them as healthcare keeps changing.

1 Responsibilities and Scope of Practice
2 Training and Certification
3 The Growing Need for Pharmacy Technicians
4 Conclusion
5 References

Responsibilities and Scope of Practice

Pharmacy techs work in all sorts of places like hospitals, drug stores, and nursing homes. Their jobs are pretty varied, from handling paperwork to talking directly with patients. Mostly, they help pharmacists by getting meds ready, keeping track of stock, and updating patient records. One study even said they do about 75% of the dispensing work in hospitals (Desselle, 2016).

Plus, they’re often the first person a patient talks to at the pharmacy. They give out important info about how to use meds and what side effects to look out for. This is super important because messing up meds can be a big problem. The Institute of Medicine says that at least 1.5 million people in the U.S. get hurt by medication errors every year (Institute of Medicine, 2006). Pharmacy techs help catch these mistakes by double-checking prescriptions and doses.

Training and Certification

Training to be a pharmacy tech isn’t the same everywhere. In the U.S., it changes from state to state. Usually, you’d need to go through a formal program, which could take a few months to two years, ending in a diploma or an associate degree. These courses cover stuff like drug basics, pharmacy laws, and ethics, along with hands-on skills like mixing meds and using pharmacy software.

Getting certified is also a big deal. In the U.S., two main groups offer certification: the Pharmacy Technician Certification Board (PTCB) and the National Healthcareer Association (NHA). To get certified, you usually have to pass a test that checks your knowledge and skills. The PTCB says that certified techs not only know more but also have better job options and pay (PTCB, 2021).

Also, because new meds and tech keep coming out, pharmacy techs need to keep learning. They often have to earn continuing education credits to keep their certification. This ongoing learning helps them stay up-to-date and continue giving great care.

The Growing Need for Pharmacy Technicians

We’re needing more and more pharmacy techs for a few reasons. First, as people live longer, they need more meds. The U.S. Census Bureau says that by 2030, all baby boomers will be over 65, making up about one in five people (U.S. Census Bureau, 2018). This means more prescriptions and more work for pharmacy techs.

Second, healthcare services are expanding, and new meds are coming out all the time. As pharmacists start doing more clinical work like giving vaccines and managing medication therapies, they rely more on techs to handle the usual dispensing jobs. This shift lets pharmacists focus more on patient care, which is good for everyone.

Lastly, the COVID-19 pandemic showed just how important pharmacy techs are. They played a key role in COVID testing and vaccinations at many pharmacies. This highlighted how adaptable and essential they are in public health.

Pharmacy technicians are vital to healthcare, doing essential work that lets pharmacists focus on patients. Their wide range of tasks helps keep pharmacies running safely and efficiently. With the right training and certification, they’re ready to take on the challenges of this ever-changing field. As healthcare evolves, pharmacy techs will be even more important. Recognizing and supporting their work can improve the quality of care, benefiting patients and the community as a whole.

Desselle, S. P. (2016). Job satisfaction, stress and burnout among pharmacy technicians in the United States. American Journal of Health-System Pharmacy , 73(14), 1026-1036.
Institute of Medicine. (2006). Preventing Medication Errors . National Academies Press.
Pharmacy Technician Certification Board (PTCB). (2021). Why Get Certified? Retrieved from https://www.ptcb.org/why-get-certified
U.S. Census Bureau. (2018). Older people projected to outnumber children for first time in U.S. history. Retrieved from https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

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9 Nurses Leading Change

Minister to the world in a way that can change it. Minister radically in a real, active, practical, and get your hands dirty way. —Chimamanda Ngozi Adichie, author

As demonstrated by the COVID-19 pandemic, nurses at every level and across all settings are positioned to lead. Nurses can lead teams, promote community health, advocate for systems change and health policy, foster the redesign of nursing education, and advance efforts to achieve health equity. Even so, educational institutions and health systems can better prepare and empower new and practicing nurses, including licensed practical nurses, registered nurses, advanced practice registered nurses, and those with doctoral degrees to develop and grow in leadership roles. To this end, it will be necessary to place more intentional focus on providing models and opportunities for the emergence of more diverse nurse leaders who can reflect the people and families they care for and can mentor and serve as role models for underrepresented students.

Creating a future in which opportunities to optimize health are more equitable will require disrupting the deeply entrenched prevailing paradigms of health care, which in turn will require enlightened, diverse, courageous, and competent leadership. The seminal Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century ( IOM, 2001 ) calls for broad and sweeping transformation of the health care system in order to improve the quality of care. It identifies six aims for improvement that define quality health care: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable ( IOM, 2001 ). The Institute for Healthcare Improvement (IHI) has found that progress on health equity has lagged behind that on the other five aims, calling it “the forgotten aim” of health care ( Feely, 2016 ). The Crossing the Quality Chasm report emphasizes the importance of leadership in achieving the six aims, noting that leaders have a wide variety of roles and responsibilities that include

creating and articulating the organization’s vision and goals, listening to the needs and aspirations of those working on the front lines, providing direction, creating incentives for change, aligning and integrating improvement efforts, and creating a supportive environment and a culture of continuous improvement that encourages and enables success. ( IOM, 2001 , p. 137)

It must be emphasized that having this type of leadership only at the top of an organization or initiative is not enough. Rather, leadership is needed at multiple levels to “provide clear strategic and sustained direction and a coherent set of values and incentives to guide group and individual actions” ( IOM, 2001 , p. 137) and to ensure that health equity is a strategic priority at every level ( Feely, 2016 ).

This chapter focuses on how nurse leaders can, and do, address social determinants of health (SDOH) and health equity in all settings and all nursing roles. It begins by articulating how nurses are well suited to lead in such efforts, and then outlines the committee’s vision for nursing leadership specific to these challenges in the future. Next is a discussion of the competencies that will enhance nurses’ ability to lead effective change. Finally, the chapter explores ways to help achieve the committee’s vision for nursing leadership through training and leadership development specific to advancing an agenda of greater health equity.

NURSES LEADING IN HEALTH EQUITY

Nurses have a rich history of both advocacy and the provision of holistic care that includes meeting social needs of individuals and focusing on SDOH. As presented in this report, there are numerous examples illustrating how nurses are already working effectively as leaders on equity issues across a variety of settings. If nurses are to build on this rich tradition, it will not be enough for them to see themselves as leaders; the organizations that employ them will have to provide them with ample opportunities, resources, and mentorship to fully realize their leadership potential. This is the case even for nurses who are self-employed, who can benefit from opportunities provided by the external systems around them.

Nursing’s Focus on Social Determinants

Nurses have always been key to the health and well-being of individuals and communities, but a new generation of nurse leaders is now needed—one that recognizes the importance of SDOH and diversity and is able to use and build on the increasing evidence base supporting the link between SDOH and health status. Today’s nurses are called on to lead in the development of effective strategies for improving the nation’s health ( Lathrop, 2013 ; Ogbolu et al., 2018 ) with due attention to the needs of the most underserved individuals, neighborhoods, and communities and the crucial importance of advancing health equity.

Leadership can be defined as a process of social influence that maximizes the efforts of others toward achievement of a goal ( Kruse, 2013 ). Leaders set direction, build an inspiring vision, press for change, and create new ways of thinking and doing. Nurses as a professional group manifest many of the characteristics of strong leadership—including courage, humility, caring, compassion, intelligence, empathy, awareness, and accountability—that are essential to leading the way on health equity ( Shapiro et al., 2006 ). In addition to their deep understanding of how health intersects with SDOH ( Olshansky, 2017 ), they have a holistic view of people across systems and settings, they are active listeners, they establish therapeutic relationships, and they practice person-centered care. Increasingly, nurses are serving as innovators and codesigners of health care in their roles in the public health and health care systems ( Jouppila and Tianen, 2020 ), and by continuing to learn and apply improvement and innovation skills, will be able to help create new care models for the decade ahead. Given the wide range of settings and roles in which nurses at all levels serve (see Chapter 1 ), their leadership in this regard can have broad and far-reaching impacts on equity in health and health care.

THE COMMITTEE’S VISION FOR NURSING LEADERSHIP

Implementing change to address SDOH and advance health equity will require the contributions of nurses in all roles and all settings, and recognition that no one nurse can successfully implement change without the collaboration of others. Clinical nurses manage the nursing care of patients and coordinate care, making decisions and communicating with families and other health care professionals. These nurses can influence clinical practice environments and local organizational culture, as well as organizational processes and policies, often working with members of other health care disciplines. Public health and school nurses and other community-based nurses engage with the community to identify and address individual- and community-level needs, often working with professionals from other disciplines and sectors. Some nurses serve on boards, manage organizations, direct programs, and have direct responsibility for developing policies and practices. Nurses leading community organizations often lead team members and partner with community members and organizations in other sectors. Nurses serving on health care boards can exert leadership influence on the organization’s policies and structures while not leading day-to-day organizational operations. Still other nurses work with but outside the health care system, advocating for and working toward public- and private-sector policies and structures that can have positive impacts on health and well-being. These nurses (e.g., a public health nurse advocating for more equitable transportation policy) may lead individuals and organizations as part of a multidisciplinary, multisector coalition. And nurses with formal leadership roles, such as nurse managers, chief executive officers (CEOs), and deans, can use their positions to establish organizational cultures and implement practices that advance health equity. In addition to collaboration among members of the nursing profession and across other disciplines and sectors, the creation of enduring change requires the involvement of individuals and community members. Rather than a more hierarchal system of leadership, collaborative leadership assumes that everyone involved has unique contributions to make and that constructive dialogue and joint resources are needed to achieve ongoing goals ( Eckert et al., 2014 ).

Each of the various leadership roles described above involves different skills and responsibilities, as shown in the framework for nurse leadership in Table 9-1 . It is important to note that an individual nurse may lead in multiple areas of this framework and can lead in both formal and informal capacities. While some nursing positions (e.g., CEO, dean, nurse manager) entail more explicit leadership responsibilities, all nurses can lead according to their own interests, capacities, and opportunities. For example, a staff nurse who has no official leadership position in the workplace can lead others by modeling behaviors that promote a culture of diversity, equity, and inclusion, and can also lead beyond health care through involvement in political advocacy. As noted earlier, fulfillment of this potential will require support, encouragement, mentorship, and advancement opportunities, with nurses operating to the full scope of their education, training, and expertise.

A Framework for Nurse Leadership.

The subsections below detail the leadership roles nurses can play at the four levels shown in Table 9-1 : leading self, leading others, leading health care, and leading beyond health care. Nurses engaging in each of these leadership levels are important to advancing health equity. Together, the various roles at these four levels constitute the committee’s vision for nursing leadership.

Leading Self

Before nurses can lead others, they need to be able to lead themselves. To address SDOH, nurses need to understand and acknowledge how social determinants affect them personally, and to be aware of implicit biases that may influence the decisions they make and the outcomes of the people and communities they serve. They must understand and manage their own emotional responses, invest in their own physical and mental health, serve as role models for others, and continue their personal and professional development. Nurses can lead at this level by advocating for themselves and others in the workplace, functioning as effective team players, and developing coping and self-care skills ( NASEM, 2020 ).

Part of leading oneself is seeing oneself as a leader and viewing leadership as an integral part of one’s role. One barrier to effective leadership is that not all nurses see themselves in this way or have the bandwidth to take on or understand what leadership entails ( Dyess et al., 2016 ; Sherman, 2019 ). Given the right environment and support, however, nurses can overcome these barriers. (See Chapter 7 for further discussion of implicit bias and Chapter 10 for further discussion of self-care.)

Leading Others

In the pursuit of health equity, nurses have the opportunity to lead others, including other nurses, students, health care professionals, staff, community members, and partners. Leading others may occur in a wide range of contexts, including working with clinical nurse managers, community organization leaders, nurses engaging in policy development, and educators and research teams. Leading and managing effective teams requires building and maintaining trusting relationships among team members, communicating effectively, and supporting each team member. In this role, nurses can leverage and actively promote diversity within their teams and create an atmosphere of equity, inclusion, innovation, support, and growth. As team leaders, they can use their position to motivate and empower others to work to identify and address social in addition to health care needs, take action on health equity, and provide the tools and resources needed to do so.

One example of nurses leading others in pursuit of health equity is Cultivando Juntos, a community wellness program aimed at helping farmworkers live longer, healthier lives ( Berger, 2019 ). Two nursing students designed the program, which has expanded to include a biostatistician, a postdoctoral fellow, and undergraduate nursing students. The team meets with local Hispanic farmworkers to discuss their health and well-being and to conduct demonstrations on cooking healthy food. Baseline and longitudinal data are collected across the program to track progress on outcomes that include HgbA1c and lipid levels and body mass index ( Berger, 2019 ). This program is an example of nurses leading others by bringing multiple sectors together to engage with a community in order to address the community’s needs.

Nurses Leading Health Care

Nurses lead in numerous ways within health care, both in health care organizations and beyond their organizational boundaries. Within an organization, nurses can assess the organization’s readiness to address issues of equity and recommend related improvement. For example, a staff nurse on an inpatient unit can advocate for incorporating an assessment tool that can systematically collect data on SDOH within the electronic health record. Or a nursing director within a health care organization can engage other leaders, as well as members of the community, in initiating a healthy foods program within the hospital and connecting with related community-based agencies. Nurses can also identify and disseminate best and evidence-based practices to ensure equitable health care services within departments and across patient populations, improving and sustaining a supportive culture of care for both staff and those they serve, and advocate for policy changes that address population health and SDOH at the organizational and public policy levels. Nurses leading at higher levels within health care, such as nurse CEOs, chief nursing officers (CNOs), and chief operating officers, can work collaboratively with their organization to set direction and develop a vision and strategies for advancing organization-wide goals that include the drive for greater health equity through engagement with SDOH to meaningfully impact communities served by the health system. Successful organizational leaders can span boundaries between disciplines and sectors in an inclusive way to create meaningful, respectful, and sustainable partnerships to address issues of health equity. For example, public health nurse leaders can bring together representatives of the community served along with leaders from other sectors, including health care, transportation, housing, and food security, to address community needs (see the section below on leading multisector partnerships).

Nurses also have the capacity to lead in health care more broadly. For example, a nurse can seek to influence SDOH by working with a specialty organization such as the National Black Nurses Association, which focuses on the professional development of Black nurses and the delivery of culturally competent care, or serve as a leader for the Council of Public Health Nursing Organizations (CPHNO) or the National Rural Health Association. Many nurses also serve on boards of health care organizations, where they can provide their unique perspective on health-related issues facing individuals, families, and communities ( Harper and Benson, 2019 ). And nurses can serve as leaders in a variety of interprofessional contexts within health care; an example is a nurse researcher leading a multiorganizational research team. In each of these contexts and roles, nurses can share nursing’s perspective and expertise while collaborating with others to address health disparities, SDOH, and health equity.

Leading Beyond Health Care

Nurses have myriad opportunities to lead entirely outside the traditional boundaries of health care, in both the public and private sectors. In the public sector, they can lead through positions in local, state, and national government organizations, such as departments of human services, public health, and education. Nurses can be appointed to senior government positions or stand for election to political office, positions in which they can use their expertise and voice to advocate for policy change in the areas of SDOH and health equity. Applying her expertise, U.S. House of Representatives member Lauren Underwood, a registered nurse, discussed the disproportionate health and economic impacts of COVID-19 on communities of color, particularly Black Americans, in a Committee on Education and Labor virtual hearing in June 2020, calling these disparities “the pandemic inside this pandemic.” 1 She also sponsored a number of bills to eliminate disparities, such as H.R. 6142, 2 focused on maternal health outcomes among minority populations.

A number of other nurses serve in state legislatures, the U.S. Congress, state and federal executive branch positions, and national and state commissions and committees. Nurse leaders also can bring nursing perspective and expertise to private organizations. For example, Microsoft employs a CNO, and AARP has been served by several nurse CEOs. Nurses can facilitate and convene multisector partnerships, leading efforts to disseminate and implement interventions aimed at improving population health, and can engage communities and partners through local, regional, and national networks. Just as nurses serve as board members within health care, they can also serve on boards for programs or organizations that are outside of health care but have impact on health. The Nurses on Boards Coalition works to create opportunities for nurses to participate in a wide range of boards outside of health care, from boards of local schools or places of worship to those of Fortune 500 companies and large international corporations ( Harper and Benson, 2019 ). In the next 10 years, nurse leaders in these types of positions can become drivers for change within their communities by advocating for social change and health equity, and bringing nursing’s perspective to organizational and public policy-making discussions.

LEADERSHIP COMPETENCIES FOR ADVANCING HEALTH EQUITY

While nurses’ specific leadership roles vary depending on the focus of their work, the setting in which they work, and the people whom they lead, there are certain skills and competencies on which all nurse leaders need to draw as they work to advance health equity by creating a vision and culture of equity, putting the necessary structures and supports in place, and working both within and across boundaries to achieve the vision of health for all. The committee identified eight skills and competencies that are essential for nurse leadership in nearly every setting, which are described in turn below:

visioning for health equity,
leading multisector partnerships,
leading change,
innovating and improving,
teaming across boundaries,
creating a culture of equity,
creating systems and structures for equity, and
mentoring and sponsoring.

Visioning for Health Equity

In all types of work, a leader is responsible for articulating a vision, setting direction and goals, and developing clear expectations for individuals and teams. Nurse leaders are no exception, whether the vision they create is for providing quality patient care in a clinic, meeting the needs of a community, setting the direction and goals for an organization or company, or redesigning the nation’s health care system. In the context of this report, nurse leaders at all levels and in all settings can work collectively with others to develop and communicate a clear and compelling vision for a future state of greater health equity. The creation of a vision for greater health equity can be squarely rooted in existing data demonstrating profound differences in care quality and health outcomes among people of color compared with their White counterparts ( Betancourt et al., 2017 ).

The most effective visions are a shared product ( Boyatzis et al., 2015 ). Nurse leaders can articulate ideas for a vision, and develop a shared vision by working collaboratively with others. Fully understanding the needs, hopes, and aspirations of a community or population is critical to achieving an effective shared vision ( Kouzes and Posner, 2009 ). To this end, nurse leaders can engage in dialogue with community members, whether that community consists of patients in a clinical setting; a subpopulation such as juveniles in the justice system; or residents of a neighborhood, city, or state. Regardless of the specific target community, this engagement requires a nurse leader to apply such skills as listening, acknowledging, and collaborating in order to create trusted relationships that are needed to build community-centric, community-informed solutions to complex health and social needs. Additionally, data collection and analysis to identify, assess, and prioritize opportunities for advancing health equity is essential ( Wesson et al., 2019 ).

Nurses can work with communities to identify and address their needs in a number of ways, including collecting and analyzing data, leading community meetings, presenting at city council meetings, and working to implement and evaluate strategies for eliminating health disparities. One established mechanism in which nurse leaders can engage is community health needs assessments, which are a statutory requirement for nonprofit hospitals (see Chapter 4 for a fuller description). Ensuring that these needs assessments explicitly target health disparities and prioritize SDOH and that they are conducted with input from members of the community on which they focus are examples of the considerations nurses can advance while helping to align community needs with culturally sensitive and relevant resources. Nurse leaders in both health care systems and public health (the entities involved in developing these needs assessments) can use these data to develop nurse-led and other innovative solutions for meeting the identified needs ( Swider et al., 2017 ).

Leading Multisector Partnerships

Strategic partnerships involving a broad range of stakeholders are essential to address factors that perpetuate structural inequities in health and health care ( NASEM, 2017 ). In the Framework for Achieving Health Equity of IHI, developing partnerships with community organizations is identified as one of the framework’s fundamental elements ( Laderman and Whittington, 2016 ). Nurses are skilled in working on and leading clinical teams. However, the role of the interprofessional health team is evolving beyond individual clinical encounters and extending beyond the walls of health care systems into the communities where people live ( NASEM, 2019a ; Pittman, 2019 ). Multisector models involving innovative interprofessional collaboration among, for example, police, emergency services, the legal system, housing, and public works and the health care system are showing promise and demonstrating positive health outcomes for underserved populations ( Hardin and Mason, 2020 ).

The ability to develop and lead multisector partnerships is critical to achieving health equity for a number of reasons ( NASEM, 2017 ). First, community needs are complex and wide-ranging, and necessarily involve actors from multiple sectors (e.g., employment services, education transportation, health). Collaboration across sectors is essential to break down existing silos that are counterproductive to improving health and health care ( NAM, 2017 ). Second, collaboration among partners introduces “more expertise and knowledge than what resides in any one stakeholder group” ( Wakefield, 2018 ), and multisector partnerships can leverage unique skills and resources from multiple stakeholders (e.g., faith leaders, philanthropists, researchers). Third, working with community partners can help nurses reach underserved populations, including the homeless, recent immigrants, and non-English-speaking families. Fourth, multisector partnerships increase a community’s capacity to make sustainable changes by bringing energy, expertise, and perspectives from multiple arenas. Fifth, multisector partnerships can simultaneously address upstream, midstream, and downstream SDOH and ensure alignment of efforts across these levels. Finally, bringing people together from multiple sectors can facilitate and encourage creative approaches; the intersections across boundaries are “where the promise of innovation lies” ( Pittman, 2019 , p. 27). As Johansson (2004 , p. 2) puts it, “When you step into an intersection of fields, disciplines, or cultures, you can combine existing concepts into a large number of extraordinary new ideas.”

It is important for multisector partnerships to be formal, structured, and collaborative relationships ( Siegel et al., 2018 ) in which partners have mutual respect for one another, and time and attention are devoted to maintaining those relationships ( Chandra et al., 2016 ). Trust among partners is also essential for a collaborative relationship, and once established, can serve as a foundation for future collaborations ( Wakefield, 2018 ). Nurses leading and engaged in multisector partnerships can help ensure that collaborative efforts are based on an understanding that health is a value shared among all partners ( Erickson et al., 2017 ; Mason et al., 2019 ; Realized Worth, 2018 ).

Nurses need to be able to build partnerships that include a focus on integrating clinical and nonclinical services and ensuring access to health and human services. Collaborative multisector efforts are common in the work of public health nurse leaders, and their experience and expertise can inform new approaches. Nurses currently have limited opportunities to learn from such efforts working in traditional health care systems. There is a need to start providing nurses with substantial exposure to experiences that involve developing and maintaining effective cross-sector partnerships, rather than what is often quite limited observational experience in public health and other social services settings.

While nurses have long worked at the intersection of individuals, families, other health professionals, social workers, educators, and others to improve health, more nurses will increasingly need to apply and expand this skill set to participating in or leading community-engaged multisector partnerships. The Crossing the Quality Chasm report ( IOM, 2001 ) calls for health care leaders to invest in their nursing workforce to enable nurses to achieve their full potential as individuals, team members, and leaders. Going forward, then, there is an expanding need to build and engage teams that reach beyond health care to include other sectors. Just as working in health care teams represented a “fundamental shift” in perspective in 2001 ( IOM, 2001 , p. 139), so, too, working across health and social sectors for the benefit of individuals and communities will require a fundamental shift in perspective, resources, and academic preparation.

Leading Change

Reducing disparities and achieving health equity will require nurse leaders to be skilled in leading change. To be effective, these efforts will need to be anchored in the theoretical constructs of change management and occur at multiple levels, within clinical practice, organizations, communities, populations, health authorities, and nations ( Browne et al., 2018 ). Evidence suggests that health care leaders are knowledgeable about disparities and what can be done to eliminate them, but that a number of barriers to successful change exist ( Betancourt et al., 2017 ). These barriers, including a lack of leadership buy-in, competing organizational priorities, existing culture, and ineffective execution, can be addressed through effective change management ( Betancourt et al., 2017 ). Effective change management requires that individuals learn and apply new behaviors and skills, as well as lead and collaborate with others in driving change within and outside of the organizations where they work. Empirically based interventions to drive change that can reduce health disparities include developing a vision for change (as discussed above), aligning executive support, engaging a coalition of committed stakeholders, setting expectations, establishing clear goals and a plan for change, anchoring change in the existing culture, measuring progress, iterating as needed, and communicating status reports and results ( Betancourt et al., 2017 ). Nurses at all levels can exert substantial influence on SDOH by using their experience and knowledge to engage in such change management efforts.

Innovating and Improving

Changing the prevailing health care paradigm to address SDOH and advance health equity will require innovation. The U.S. Department of Commerce’s Advisory Committee on Measuring Innovation in the 21st Century Economy defines innovation as the “design, invention, development, and/or implementation of new or altered products, services, processes, systems, organizational structures, or business models for the purpose of creating new value” ( ESA, 2007 ). For the complex work of eliminating disparities and impacting SDOH, knowledge and skill in innovation will be an important competency for nurses. Nurse leaders can facilitate the creation of innovative approaches by challenging the status quo, breaking down traditional barriers to change, teaching and encouraging team members to solve problems using design thinking, identifying best practices, and facilitating the translation and adoption of new ideas.

Virtually all nurses have opportunities to innovate by developing new ideas for improving health and translating these ideas into practice and policy. Over the past several years, nurse-designed and nurse-led innovations addressing SDOH among underserved populations have increasingly appeared in the literature. As described in Chapter 4 , for example, nurses in the Netherlands developed and implemented Buurtzorg, an innovative nurse-led, nurse-run organization of self-managed teams that provide home care to individuals in their neighborhoods (Monsen and de Blok, 2013 ). Similarly, the SOAR (Supporting Older Adults at Risk) program reimagined how to prepare and support frail older adults in the transition back to their homes following a hospital admission. The program addresses issues of transportation, nutrition, and medication access ( IHI, 2018 ).

Yet, while some nurses are already leading efforts focused on health equity in their work settings and communities, this focus is not consistent across the profession. It is a leader’s responsibility to create an environment that allows for innovation ( IOM, 2000 ). Leaders can provide a forum for continual innovation in and testing of strategies for improving population health and health equity, and ensure that their organization is flexible and able to adapt to those changes ( IOM, 2001 ). For example, leaders of front-line health teams can encourage team members to share their own observations and ideas for improving patient health and facilitate the transfer of new ideas across professional boundaries ( IOM, 2001 ). Likewise, nurse leaders working in the community or in multisector partnerships can encourage communication and collaboration without regard for traditional boundaries and recognize that innovative ideas can surface from an array of individuals across sectors, such as those working in aging-related services or Medicaid managed care organizations.

Nurses have a rich tradition of working creatively to solve problems and improve the quality of care in clinical settings ( Thomas et al., 2016 ), and these experiences and skills can apply to efforts designed to address SDOH. These types of initiatives require systematic, continuous, data-driven, and rigorous processes of assessment, innovation, implementation, evaluation, and diffusion or translation of the evidence or best practices into tangible strategies or policies for improving population health. For example, IHI’s Model for Improvement for quality improvement initiatives uses a Plan-Do-Study-Act (PDSA) cycle that involves planning exactly how the intervention will be implemented; implementing it; studying whether and how it is being conducted; and then acting to either adapt it, adopt it as a standard practice, collect more data, or abandon it ( IHI, 2020 ). This model has been used with great success in the clinical setting. Transforming Care at the Bedside (TCAB), was one such model using the PDSA cycle. A partnership between the Robert Wood Johnson Foundation and IHI, TCAB created learning collaboratives at the front lines of care on medical-surgical units that engaged nurses and other front-line staff in generating and testing ideas that led to processes and practices that improved the efficiency, safety, and satisfaction of care. 3 This process has the potential to be equally successful in addressing SDOH and health equity ( IHI, 2020 ).

Teaming Across Boundaries

As nurses work within and across organizations to address SDOH and advance health equity, they will need the skills to develop, engage, and lead cross-boundary teams. Cross-boundary teaming is a strategy for driving innovation that engages diverse stakeholders and subject-matter experts to expand the range of views and ideas on which teams can draw ( Edmondson and Harvey, 2018 ). In cross-boundary teams, individuals work across knowledge boundaries. Teams are diverse in expertise, knowledge, and educational background, characterized by deep-level differences or what Edmondson and Harvey call “knowledge diversity” (p. 3480).

Addressing SDOH and advancing health equity will require a cross-boundary team approach that includes not only people from different disciplines and sectors but also individuals and organizations from within the community. Regardless of the composition of the team, the cross-boundary team leader will need to support each team member, balance the use of resources, facilitate communication, and ensure the team’s effectiveness. A leader’s job is to “optimize the performance of teams that provide various services in pursuit of a shared set of aims” ( IOM, 2001 ). Evidence suggests that high-performing team members listen to one another and show sensitivity to feelings and needs ( Duhigg, 2016 ). To support the team and optimize its performance, a nurse leader will need to work to help its members achieve their full potential, both individually and collectively. This investment may include providing support and time for self-care, providing access to and time for ongoing professional development, and supporting individuals as they seek higher levels of education and responsibility. Facilitating nurses’ well-being and self-care is one particularly important way in which nurse leaders can support and optimize cross-boundary teams (see Chapter 10 on the importance of facilitating nurse well-being).

Creating a Culture of Equity

Nurse leaders in many positions of authority, including academic leaders ( DeWitty and Murray, 2020 ), journal editors ( Villarruel and Broome, 2020 ), educators ( Graham et al., 2016 ), and managers ( ANA, 2018 ), can act to call out and dismantle racism. To advance equity in society, nursing needs first to work to create a culture of equity within the profession itself. Nursing has a history of racism that continues to impact the experiences of nursing faculty, nurses in practice, communities, and patients ( DeWitty and Murray, 2020 ; Iheduru-Anderson, 2020a ; Villarruel and Broome, 2020 ; Waite and Nardi, 2019 ; Whitfield-Harris et al., 2017 ). The nursing profession’s substantive and sustained attention is required to address and eliminate racism in nursing and in broader organizations where nurses work. Waite and Nardi (2019 , p. 20) call on nurse leaders to “urge their colleagues and students to characterize, name, contest, and transform the norms, traditions, structures, and establishments that preserve White supremacy through continued effects of American colonialism.” Over the past few years, the nursing literature, including statements issued by national nursing organizations, has reflected increased attention to these issues.

Nurse leaders must acknowledge existing disparities and facilitate open, honest, and respectful discussions about factors that drive disparities (Oruche, and Zapolski, 2020 ; Purtzer and Thomas, 2019 ) and the challenges staff face as they engage in this work within organizations and with communities. It will be essential for these discussions to include opportunities for and support of the expression of patient and community perspectives ( NASEM, 2017 ). Specific strategies for promoting equity and inclusion include (1) creating safe spaces to engender trust and open communication; (2) reassessing recruitment and advancement processes; (3) examining and redesigning equity policies, procedures, and practices; (4) requiring a diverse pool of applicants for applicant selection; (5) moving from mentorship to sponsorship, which focuses on protégé advancement; (6) creating an infrastructure to monitor and track progress with development programs; and (7) dismantling racism, including applying an equity lens to all practices ( Fitzsimmons and Peters-Lewis, 2021 ). Nurse leaders need to set an example of inclusion and confront negative and toxic cultural norms in nursing, such as bullying and in-fighting ( Kaiser, 2017 ). Nurse leaders need to be knowledgeable about and able to lead others in cultural humility and culturally competent practices, which are critical for reducing health disparities and improving access to high-quality health care ( Powell, 2016 ).

In a recent analysis of six models of cultural competence, Botelho and Lima (2020) argue that existing approaches to the delivery of culturally appropriate care may assist with cultural respect, but tend to oversimplify patients’ cultural experiences and overlook the complexities associated with power dynamics ( Botelho and Lima, 2020 ). They propose the practices of not only cultural humility but also relational ethics 4 to facilitate cross-cultural work. To practice cultural humility, clinicians relinquish their role as experts in a culturally diverse world where power imbalances exist and embrace an attitude characterized by constant questioning, openness, self-awareness, absence of ego, and self-reflection and -critique, willingly interacting with diverse individuals. Practicing with cultural humility can foster mutual empowerment, respect, partnerships, optimal care, and lifelong learning ( Foronda et al., 2016 , p. 213). (See Chapter 7 for further discussion of cultural humility.)

Creating Systems and Structures for Equity

Nurse leaders at all levels and in all settings can help create systems and structures that promote equity and do not unintentionally exacerbate inequalities through unintended incentives. For example, working midstream (see Chapter 2 ), a nurse leader who oversees a home visiting program can educate around the concept of equitable care and establish expectations of nurses that encourage the provision of equitable care, including meeting social needs, rather than orienting nursing’s interventions to the volume of visits they make ( IOM, 2001 ). A nurse leader who manages an organization can develop organization-wide policies that put equity at the forefront of the staff’s work, and ensure that the provision of services does not exacerbate existing inequalities. Upstream, a nurse leader can influence government policy by advocating for policies that improve equity, such as a city transportation policy that prioritizes traditionally underserved rather than higher-income neighborhoods, or by highlighting exposure to noise pollution and associated health impacts related to building low-income housing near railroad tracks.

The goal of health equity is more likely to be achieved when it becomes deeply ingrained in official systems and structures and becomes inherent in a cultural shift that includes inner reflections on bias and structural racism ( Chin, 2020 ), rather than being pursued through one-off initiatives or well-intentioned efforts that are not formalized. Systems and structures are never neutral—they either entrench or dismantle existing health inequities. Nurse leaders have a responsibility to advocate for and build systems that promote equitable health for all.

Mentoring and Sponsoring

The transformation toward a health system that is more equitable and just will require explicit preparation of and support for future nurse leaders in multiple settings ( AACN, 2016 ). A key strategy for achieving this goal is mentorship and sponsorship of the next generation of nurses and nurse leaders. Mentoring is critical across the trajectory of nurses’ professional lives, particularly as they take on new and increasingly complex leadership roles ( Vitale, 2018 ). Given the overarching need for nurse leaders with expertise and commitment to achieving equity in health and health care, and given the need for more nurses with expertise in such priority areas as care for the aging, maternal mortality, mental and behavioral health, rural health, and public health (see Chapter 3 ), mentoring is critical to building and supporting the next generation of nurses.

Mentoring is associated with positive benefits, including professional development, greater skills, a better fit with one’s choice of specialty, and greater life–work balance ( Disch, 2018 ). In mentoring new nurses in the application of concepts related to health equity or in needed specialty areas as identified above, nurses with experience can encourage collaboration among nurses of different ages and at different professional development stages. In general, a lack of support and mentoring by senior nurses has negative impacts on well-being and workforce turnover ( IOM, 2011 ), and mentoring is therefore a critical part of building capacity in the profession and of mitigating the loss of knowledge and experience that results when retiring nurses leave the profession.

A particularly critical role for nurse leaders is mentoring nurses from traditionally underrepresented communities to build a more diverse nursing workforce and increase the number of nurses from underrepresented groups in leadership positions ( Phillips and Malone, 2014 ). Mentoring is a critical component of recruiting, supporting, and advancing nurses of color through the ranks of leadership ( DeWitty and Murray, 2020 ; Iheduru-Anderson, 2020b ; Whitfield-Harris et al., 2017 ). As discussed in Chapter 3 , diversity in the nursing workforce—and in nursing leadership in particular—is essential to achieving health equity. There are relatively few nurses of color in leadership positions, particularly in more senior executive positions ( Phillips and Malone, 2014 ; Schmieding, 2000 ). A 2019 National Academies report on increasing the number of professionals of color in science, technology, engineering, and mathematics found that structured mentorship programs in minority-serving institutions 5 can improve leadership diversity in nursing and the health care field generally ( NASEM, 2019b ). One such effort is being led by the Center to Champion Nursing in America (CCNA) in its convenings of mentor training programs with historically Black colleges and universities (HBCUs). CCNA will continue to convene mentoring programs in Hispanic- and American Indian–serving nursing schools as well ( CCNA, 2020 ).

Serving as a sponsor becomes even more critical than mentoring when a more active role is required to help nurses rise in leadership ranks ( Williams and Dawson, 2021 ). The expectations of a sponsor include being a staunch advocate for career advancement for the protégé, including making assignments and connecting the protégé to key decision makers while keeping her or him protected from negative influences. Sponsors take advantage of the organizations and people in their sphere to present their protégés in the most positive light, with the goal of career advancement. This more active approach has been shown to be especially helpful in helping nurses of color rise in the leadership ranks ( Beckwith et al., 2016 ).

ACHIEVING THE COMMITTEE’S VISION OF NURSE LEADERSHIP

As previously noted, many nurse leaders are currently focused on incorporating equity into their work. To achieve the committee’s vision, however, a significant investment in broader and deeper development of nurse leadership will be needed. New and established nurse leaders—at all levels and in all settings—are needed to lead change that results in meeting social needs, eliminating health disparities, addressing SDOH, and ultimately achieving equity in health and health care, with the aim of improved health for all individuals and communities. Nurse leaders need to both develop and expand the leadership competencies described in this chapter, and implement strategies targeted to achieving diversity among nurse leaders. Nurse leadership competencies and knowledge can be developed through approaches that encompass education, fellowships, and nursing organizations, as discussed below.

Increasing Diversity in Nurse Leadership

Diverse leaders can serve as particularly important role models, provide guidance and mentoring for other nurses, influence the allocation of resources, and shape policies aimed at eliminating inequities ( Phillips and Malone, 2014 ). The prior The Future of Nursing report identifies the need for a renewed focus on diversity in nursing, calling for the development of novel education models that promote respect for diversity along a number of dimensions, such as race, ethnicity, geography, background, and personal experiences ( IOM, 2011 ). Even when nurse leaders hold similar positions, salary disparities are seen among racial and ethnic groups. Among nurse leaders with the highest salaries (ranging from clinical staff to C-suite executives), only 11 percent are Black, compared with 27 percent who are Asian American, 25 percent who are Hispanic, and 21 percent who are White. Not only are few Black nurses in positions of leadership at all, but even fewer advance to careers as nurse executives ( Iheduru-Anderson, 2020a ; Jefferies et al., 2018 ).

Understanding and addressing the reasons for the diversity gap in nursing leadership is essential. The existing literature identifies racism as a significant factor ( Iheduru-Anderson, 2020a ). Nursing’s roots in the United States have been shaped within the context of colonialism, a history that has influenced the makeup of the profession’s leaders ( Waite and Nardi, 2019 ). As discussed earlier, acknowledging and addressing how racism has been internalized and how it has manifested within the field, including in the advancement of nurses of color, is key ( Brathwaite, 2018 ; Waite and Nardi, 2019 ). Other barriers include stereotyping; a lack of career development opportunities ( Carroll, 2020 ); a lack of mentorship ( Ihederu-Anderson, 2020b ); inadequate support systems; isolation; the perception of being overlooked for positions in contrast to White counterparts ( Kolade, 2016 ); and the cultural taxation or diversity tax ( Gewin, 2020 ), characterized by the role assigned to the ethnic representative of a group involving the expectation that this individual will provide unofficial diversity consultation. 6

Numerous innovative programs aimed at cultivating diversity in nursing leadership have been developed and implemented. A number of these programs target nurses early in the trajectory of development (in prebaccalaureate or baccalaureate programs), while others are aimed at later stages of professional growth. Examples of programs focused on early leadership training include EMBRACE (Engaging Multiple communities of BSN [bachelor of science in nursing] students in Research and Academic Curricular Experiences), which was developed to provide comprehensive experiences in research and leadership for undergraduate students of color who are underrepresented in nursing, and the Duke University School of Nursing’s Making a Difference program ( Carter et al., 2015 ; Stacciarini and McDaniel, 2019 ). Likewise, the University of North Dakota has a program called Recruitment & Retention of American Indians into Nursing (RAIN), which provides academic support and assistance to American Indian nursing students, from prenursing programs through doctoral education ( UND, 2020 ). (See Chapter 7 for further discussion of recruiting and supporting underrepresented students.) To fully support the goal of diversity in nurse leadership, such programs will need to be evaluated and scaled.

Nursing Education, Fellowships, and Certificates

While nursing school curricula often include some information about public health, SDOH, and health equity, they do not always prepare students to engage fully with and serve as leaders on these issues. Nursing education traditionally has emphasized the development of clinical skills over leadership and management skills ( Joseph and Huber, 2015 ). As discussed in Chapter 7 , the American Association of Colleges of Nursing’s (AACN’s) Essentials 7 provides an outline for the necessary curriculum content and expected competencies for graduates of baccalaureate, master’s, and doctor of nursing practice (DNP) programs. Introducing the concept of health equity in school is a necessary first step in professional role development and leadership, but nurses also need to take every opportunity to supplement their preparation through continuing education.

A number of fellowships support education in leadership skills with a focus on health equity and community health. 8 Nearly all of these fellowships are interdisciplinary, bringing together professionals from multiple sectors, including health care, business, community organizing, education, and the law. These types of fellowships present opportunities for nurses to grow their leadership skills, to collaborate and innovate with professionals from multiple disciplines and sectors, and to develop and implement projects within their areas of interest that relate directly to achieving health equity. In addition to equity-specific fellowships, a wide variety of fellowships available for nurses are focused on general leadership skills that can be transferred to any area and any setting, including addressing SDOH and pursuing health equity.

One fellowship specifically for nurses and focused on equity is the Environmental Health Nurse Fellowship, which trains nurses to work with communities to address environmental health threats. In 2019, the Alliance of Nurses for Healthy Environments (ANHE) launched this fellowship to focus on environmental health equity and justice and on the disproportionate impact of environmental conditions on underserved groups. The 30 fellows, all of whom are nurses, work with mentors to help communities identify environmental needs and build support for community-driven solutions ( ANHE, 2019 ).

The Global Nursing Leadership Institute 9 (GNLI) fellowship, sponsored by the International Council of Nurses and supported by the Burdett Trust for Nursing, is available to nurses worldwide. This fellowship is focused on policy leadership, with a special emphasis on strengthening political and policy understanding and influence. Its framework includes in-depth work on the United Nations’ Sustainable Development Goals, which reflect multiple SDOH. The focus of 2020 was on health disparities in the context of the COVID-19 pandemic.

Many certificate programs in the United States can help nurses develop leadership skills that can be leveraged to lead work in equity in health and health care. Examples include the Health Equity Certificate at the University of Pittsburgh School of Public Health 10 and the Graduate Certificate in Health Equity at the Vanderbilt University Medical Center. 11

The Role of Nursing Organizations

Most professional nursing organizations recognize and specifically call out leadership as an essential competency for nurses in all settings ( NAHN, 2020 ; NCEMNA, 2020 ; NLN, 2005 ; Quad Council, 2018 ). These organizations offer leadership courses, resources, and support, most pertaining to leadership in general rather than leadership on health equity, for current and aspiring nurse leaders. Nursing organizations also have undertaken specific initiatives to develop and support nurse leaders that include content related to equity in health and health care. Examples include the following: (1) the American Public Health Association Public Health Nursing Section, with the vision of advancing social justice and equity to achieve population health for all 12 ; (2) the Future of Nursing: Campaign for Action, with the vision of working toward an America in which everyone can live a healthier life, supported by nurses as essential partners in providing care and promoting health equity and well-being 13 ; (3) the Black Coalition Against COVID-19, 14 an interprofessional multisector coalition, co-led by the National Black Nurses Association, focused on urgently mobilizing and coordinating all available community assets in a collaborative effort with the government of Washington, DC; and (4) the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), which stands as a unified force advocating for equity and justice in nursing and health care for ethnic minority populations. 15 In addition, professional associations offer nurses an opportunity to build leadership competencies by leading within the association. While some nursing associations are small and others large, each can offer nurses an opportunity to meet other nurses, join boards and workgroups, and help guide the association’s direction, especially toward the goals germane to this report.

Nursing associations that are organized around a racial or ethnic identity may offer a particularly good opportunity for underrepresented nurses to hone their leadership skills. The NCEMNA is an umbrella organization of five national ethnic nurse associations: the Asian American/Pacific Islander Nurses Association, the National Alaska Native American Indian Nurses Association, the National Association of Hispanic Nurses (NAHN), the National Black Nurses Association, and the Philippine Nurses Association of America. One of the five strategic goals of the NCEMNA is to “promote ethnic minority nurse leadership in areas of health policy, practice, education and research” through the implementation of leadership development and mentorship programs ( NCEMNA, 2020 ).

CONCLUSIONS

All nurses have the capability to lead and engage in meaningful roles in addressing SDOH and health equity, with their specific roles and functions depending on individual interests, capacities, and opportunities.

Conclusion 9-1: Nurse leaders at every level and across all settings can strengthen the profession’s long-standing focus on social determinants of health and health equity to meet the needs of underserved individuals, neighborhoods, and communities and to prioritize the elimination of health inequities.

Given that social determinants that affect health exist largely outside of the health care system (e.g., poverty, literacy, housing, transportation, and food security), addressing SDOH and eliminating health disparities will require collaboration and partnership among a broad group of stakeholders. Public health nurses have a long history of working collaboratively to meet social needs and address SDOH, and their experiences can be used as models for other nurses seeking to work collaboratively across sectors.

Conclusion 9-2: Achieving health equity will require multisector collaboration, and nurse leaders can participate in and lead these efforts. Conclusion 9-3: Many community and public health nurse leaders have expertise and experience in leading cross-sector partnerships to meet social needs and address social determinants of health, and their expertise can be leveraged to inform the broader nursing profession in both practice and education.

Racism and discrimination are deeply entrenched in U.S. society and its institutions, and the nursing profession is no exception. Nurse leaders have an important role to play in acknowledging the history of racism within the profession and in moving forward to dismantle structural racism and mitigate the effects of discrimination and implicit bias on health. Role modeling listening, engagement, and inclusivity within and outside of nursing will be necessary to foster trust and achieve needed change. A critical part of these efforts will be building a more diverse nursing workforce and supporting these nurses in their pursuit of and success in leadership roles.

Conclusion 9-4: Nurse leaders have a responsibility to address structural racism, cultural racism, and discrimination based on identity (e.g., sexual orientation, gender), place (e.g., rural, urban), and circumstances (e.g., disability, mental health condition) within the nursing profession and to help build structures and systems at the societal level that address these issues to promote health equity. Conclusion 9-5: A critical role for nurse leaders is mentoring and sponsoring nurses from traditionally underrepresented communities in order to build a more diverse nursing workforce and increase the number of underrepresented nurses in leadership positions.

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The full committee hearing is available at https://edlabor .house .gov/hearings/inequities-exposed-how-covid-19-widened-racial-inequities-in-education-health-and-the-workforce- (accessed April 8, 2021).

See https://www .congress .gov/bill/116th-congress /house-bill/6142?q= %7B%22search%22%3A %5B%22Black+Maternal+Health+Momnibus+Act %22%5D%7D&s=1&r=1 (accessed April 8, 2021).

See http://www .ihi.org/Engage /Initiatives/Completed /TCAB/Pages/default.aspx for more information about TCAB (accessed April 8, 2021).

Relational ethics is defined in health care as actions that take place within relationships and consider the existence of the other (i.e., patient, nurse) ( Bergum and Dossetor, 2005 ). Core tenets include mutual respect, engagement, embodied knowledge, environment, and uncertainty; the most important tenet is mutual respect ( Pollard, 2015 ).

Institutions serving people of color are commonly defined in two distinct categories: historically Black colleges and universities and tribal colleges and universities (NASEM, 2019).

Cultural taxation refers to the phenomenon whereby faculty who are individuals of color are asked routinely to take on extra, uncompensated work to address a lack of diversity in their institutions.

The February 2021 final draft ( AACN, 2021 ) is available at https://www .aacnnursing .org/Portals/42/AcademicNursing /pdf/Essentials-Final-Draft-2-18-21 .pdf?ver=hNeCl7OjgamIA9sHgDi _Yw %3d%3d&timestamp=1613742420447 (accessed April 8, 2021).

See, for example, the Atlantic Fellows for Health Equity at The George Washington University Health Workforce Institute, the Diversity and Health Equity Fellowship of the American Hospital Association, and the Robert Wood Johnson Foundation’s Health Policy Fellows and Culture of Health Leaders programs.

See https://www .icn.ch/what-we-do /projects/global-nursing-leadership-institutetm-gnli (accessed April 8, 2021).

See https://catalog .upp.pitt .edu/preview_program .php?catoid=73&poid =23709&returnto=6375 (accessed April 8, 2021).

See https://www .vumc.org /healthequity/graduate-certificate-health-equity (accessed April 8, 2021).

See https://www .apha.org /apha-communities/member-sections /public-health-nursing (accessed June 7, 2021).

See https: //campaignforaction.org/about (accessed June 7, 2021).

See https: //blackcoalitionagainstcovid.org (accessed June 7, 2021).

See https://ncemna .org/about (accessed June 7, 2021).

Cite this Page National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. 9, Nurses Leading Change.
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METHODS. Our proposal builds on previous taxonomic descriptions of the US health care system. In response to the increasing complexity and heterogeneity of health care delivery systems, the Agency for Healthcare Research and Quality (AHRQ) funded development of a taxonomy of organizations, categorized by shared structural and strategic elements. 8 The resulting taxonomy 8 categorized 70% of ...
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The healthcare world is pretty complicated, with lots of different professionals working together to help patients get the best care. Pharmacy technicians are a big part of this team. They usually work behind the scenes, helping pharmacists make sure patients get the right medicines and that everything in the pharmacy runs smoothly.
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Objectives. The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the ...
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Creating a future in which opportunities to optimize health are more equitable will require disrupting the deeply entrenched prevailing paradigms of health care, which in turn will require enlightened, diverse, courageous, and competent leadership. The seminal Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001) calls for broad and ...

NRS 440 topic 2 Health Care Delivery Models and Nursing Practice

Topic 2 DQ 1 (Health Care Delivery Models and Nursing Practice )

Health Care Delivery Models and Nursing Practice (health care delivery models and nursing practice gcu)

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Nursing care delivery models and outcomes: A literature review

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Researchers

Suzanne Courtwright, PhD, PNP, NEA-BC

Stephen Ferrara, DNP, FNP-BC, FAAN, FAANP, FNAP, FNAM

Jianfang Liu, PhD, MAS, MPA, BE

Allison Andreno Norful, PhD, MPhil, MSN, BSN, ANP-BC, FAAN

Monica K O'Reilly-Jacob, PhD, APRN, FNP-BC, FAAN

Lusine Poghosyan, PhD, MPH, RN

Jingjing Shang, PhD, FAAN

Patricia W. Stone, PhD, MPH, MSN, BSN, FAAN, FAPIC

Health Care Delivery Models and Nursing Practice

The Current Health Care Law

Quality Measures on Performance, Patient Outcomes, and Effect on Nursing

Professional Nursing Leadership and Management Roles

Predicting of the Change in Nursing Roles and Nursing Practice

Health Care Delivery Models and Nursing Practice

Healthcare Legislation

Medicaid Services Investment and Accountability Act of 2019

Implications of Legislation on Nursing Practice

The Role and Responsibility of Nurses

Pay for Performance (P4P) and Patient Outcomes

Implications on Nursing Practice and Nurses’ Roles

Expectations and Responsibilities of Nursing Roles

Emerging Roles of Nurse Leaders and Managers

Clinical Nurse Leader (CNL)

The Future of Nursing

Health Promoters

Cite this paper

Health Care Delivery Models and Nursing Practice

Current or Emerging Health Care Law or Federal Regulation

Effect of the Affordable Care Act on Nursing Practice and the Nurse’s Role

Quality Measures and Pay for Performance

Professional Nursing Leadership and Management Roles

Emerging Trends and Predicted Changes

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