Nursing Practice Components of Health Services and Delivery Systems Paper I have attached an example, and I put some article I found. You need to find anot

Nursing Practice Components of Health Services and Delivery Systems Paper I have attached an example, and I put some article I found. You need to find another article and add it.

Here is the rubric.

Paper Criteria

Points

Expectations

Introduction

5

Clearly introduces the topic and areas to be addressed in the paper.

Historical Perspective

18

Clearly and substantially identifies the history and historical impact of chosen topic. Depending on the topic, this section may be lengthy or fairly short.

Current State

20

Clearly discusses the current state of the topic. This may include current systems, technology, utilization of topic, or current standards related to topic of choice.

Evaluation is based on thoroughness of discussion.

Future Implications/ Developments

20

Clearly discusses the future impact and implications of the topic. This may include future systems, technology, utilization of topic, or future standards related to topic of choice. This impact may be local, state, national, or global.

Evaluation is based on thoroughness of discussion.

Impact on Advanced Nursing Practice

20

Clearly discusses the impact of the topic on Advanced Nursing Practice. Can include historical, current, and future implications to practice. Includes information gleaned from conversations with APNs.

Evaluation is based on thoroughness of discussion.

Conclusion

5

Conclusion includes a discussion of topic and areas addressed within the paper. Summarizes paper contents.

References

4

References are relevant, current, and appropriate for the topic and are correctly cited. Minimum of 10 references utilized.

APA Format/Grammar and Spelling

8

APA formatting is correct throughout paper. Paper is well structured with logical flow and correct grammar.

Total Points

100

Here is the rubric presentation.

Criteria

Points

Expectations

Introduction

3

Clearly introduces the topic and areas addressed in presentation.

Historical Perspective

5

Clearly and substantially identifies the history and historical impact of chosen topic.

Current State

7

Clearly discusses the current state of the topic. This may include current systems, technology, utilization of topic, or current standards related to topic of choice.

Future Implications/ Development

7

Clearly discusses the future impact and implications of the topic. This may include future systems, technology, utilization of topic, or future standards related to topic of choice. This impact may be local, state, national, or global.

Impact on Advanced Nursing Practice

7

Clearly discusses the impact of the topic on Advanced Nursing Practice. Can include historical, current, and future implications to practice.

Conclusion

3

Conclusion includes a discussion of topic and areas addressed in the presentation.

Presentation Criteria

3

Shows insight & creativity in presentation with effective visual aids, professional. Within 10 to 15 minutes in length.

Total Points

35 points Running head: TRENDS AND DIRECTIONS
Characteristics of the Healthcare System: Trends and Directions
Indiana University Kokomo
1
TRENDS AND DIRECTIONS
2
Characteristics of the Healthcare System; Trends and Directions
In today’s ever changing healthcare system, advanced practice nurses (APNs) certainly
have the potential to make a huge impact. Advance practice nurses can give credence and
stability to the trends and directions that healthcare takes. APNs have the ability to provide the
understanding needed to lead to the best outcomes. With healthcare being a controversial topic in
the political arena, there are more trends, directions, and changes in the future of healthcare.
Through the journey, advance practice nurses will continue to promote healthcare delivery to the
population. Discussed below are trends that the APN faces or can impact.
Nurse Staffing Issues and Opportunities
A major trend for acute care nurses in the state of Indiana over the past year has been the
reality of reduction in force. There are four major health systems in central Indiana and they
have been growing by merging with many smaller independent hospitals. As the systems grow,
a reduction in force has been a common theme. There is a tendency to blame the Health Care
Reform Act for the reductions.
According to Ron Stiver, Senior Vice President of Engagement and Public Affairs for
Indiana University Health, “the assertion that health care reform is the reason behind hospital
cuts is ‘overly simplified’. IU Health is making cuts partially because of the health law…but also
because the state has not expanded Medicaid, the hospital system has fewer inpatient volumes
and payment rates for its services have been declining (Leonard, 2013, p. 1).”
Although the United States uses a larger portion of the GNP on health care, our outcomes
and patient satisfaction scores only rank in the middle when compared with other industrialized
nations. Charles Rangel, the Democratic Congressman from New York who is the main sponsor
of the Health Reform bill says that there are many organizations who blame health reform for
TRENDS AND DIRECTIONS
3
actions that they don’t want to take responsibility for. He says although it has helped reduce
costs, there is nothing in the law that implies that hospitals should reduce staff (Leonard, 2013).
The trend will be to move more patient care to the outpatient and home care settings, and
there will be increased focus on population health. There will be many opportunities for advance
practice nurses. A study by the Robert Wood Johnson Foundation in collaboration with the
Institute of Medicine looked at the future of nursing. The health reform legislation by Obama
and the American Recovery and Reinvestment Act of 2009 include initiatives to redesign the
organization, financing and delivery of health care.
According to Sochalski and Weiner (2011), the shift to out of hospital care will rely on
RNs and nurse practitioners to practice in these settings. Advance practice nurses will lead care
coordination in private practice setting as well as in new settings such as Patient Care Medical
Homes (PCMH) and Accountable Care Organizations. The Guided Care Model is a PCMH
program which cares for older adults using an interdisciplinary team to coordinate care for
complex medical problems. The Guided Care nurses are based in primary practices and
coordinate the care. The Guided Care nurses work with the patients on a long term basis,
provide transitional care, and assist patients with skills necessary to manage their own care. A
randomized trial of the Guided Care program resulted in a 24 percent reduction of inpatient
stays, a15 percent reduction in emergency room visits, and saved Medicare $75,000 per Guided
Care Nurse (Sochalski & Weiner, 2011).
The future coordination strategies and integrated delivery systems require an RN
workforce that is linked to the patient, which can transition with the patient across settings, and is
ultimately accountable for outcomes. RNs working is the context of care coordination will be
employed by ACOs, practices, or contracting organizations and will be responsible for the care
TRENDS AND DIRECTIONS
4
management of complexly ill patients. It is estimated that 16,000 to 20.000 nurse practitioners
and certified nurse midwives will be needed to meet the advanced demands (Sochalski &
Weiner, 2011).
Health Promotion in Indiana
Health promotion is a major trend everywhere. To promote health is providing better
outcomes while being accountable to the dollars spend on healthcare. Health promotion in
Indiana is guided by The Indiana State Health Improvement Plan, also known as I-SHIP. The
plan was created through the collaboration of an executive committee of various leaders that
represented health care providers, academia, non-profit health organizations, state and local
public health departments, and state governmental agencies. The prevalence of morbidity and
mortality in the state and the priorities identified by the Center for Disease Control (CDC) were
used by the committee to determine the health promotion efforts for Indiana for the period
between 2011 and 2016. Six health priorities were selected, and activities planned are based on
primary, secondary, or tertiary prevention.
The six goals are:
•
Assure Food Safety by reducing infectious/intoxication associated with foodborne illness outbreaks due to pathogens commonly transmitted through
foods.
•
Reduce Healthcare Associated Infections by reducing the standardized
infection ration for healthcare associated infections in healthcare facilities.
•
Reduce the burden of HIV, Sexually Transmitted Diseases and Viral Hepatitis
by decreasing incidence in Indiana.
TRENDS AND DIRECTIONS
•
5
Reduce Infant Mortality by decreasing the percentage of preterm births in
Indiana.
•
Increase Hoosiers at a Healthy Weight by reducing the prevalence of Obesity
in Indiana.
•
Decrease Tobacco Usage to reduce the tobacco burden on Indiana (Indiana
State Department of Health, 2011, p. 42).
Care was taken to avoid duplication of the work by clearly defining the areas for
improvement and the approach to the prevention, and having separate groups work on each.
Advance practice nurses contributed to the work of the committees to promote the health of
Indiana residents.
Autonomy of Nurse Practitioners
As a result of the Affordable Care Act and the aging population in the United States the
trend will be that there are not enough primary care providers to care for the American
population. Access to health care will be severely limited. Primary care providers will be
outnumbered by patients. “A report published in the American Academy of Family Physicians
commented on the primary care physician shortage and noted that healthcare access is the most
challenging problem facing our healthcare system especially in underserved and low income
areas” (Pericak, 2011, p. 5).
One solution to the disparity is to increase the autonomy of nurse practitioners. Each
state has different scopes of practice for advanced practice nurses. There needs to be
standardization and autonomy throughout the country. One of the issues is the turf battles
between physicians and nurse practitioners in the development of policies. “Even though NPs
and MDs practice well together, it is at the policy level where doors are closed to healthcare
TRENDS AND DIRECTIONS
6
access” (Pericak, 2011, pp. 5-6). Physicians lack knowledge of the scope of practice of nurse
practitioners (NPs) and have had little to no formal education about collaborating with NPs.
Advance practice nurses need to come together to think in larger perspectives which
include social, economic, and political barriers to healthcare, instead of thinking for themselves
as individuals. As a cohesive body, advance practice nurses could have a large influence on
policy as well as on population outcomes. The amassing of the body of knowledge of advance
practice nurses as a united group can have a huge impact on the public policies that allow
advance practice nurses to practice independently, but in tandem with physicians. Building on
the trust that nursing enjoys in the public view, advance practice nurses will be able to swing
public opinion to seeing a nurse rather than a physician unless specialized care is needed.
“Even when advance practice nurses know what needs to be done, physicians must be
engaged in the decisions, and be respected as ‘captain’ of the ship. Mutual respect has grown
now that physicians are starting to receive more training alongside PAs and NPs” (Frellick, 2011,
p. 48). Physicians are starting to recognize the importance and value of these professions,
especially in meetings the needs of the growing patient population.
The portion of the US primary care workforce currently held by nurse practitioners is 19
percent (Green & Lu, 2013). Increasing the NP workforce can help mitigate the shortage of
primary care physicians. As an example, nurse practitioners can be instrumental in the provision
of care in the medical homes, and in expanding healthcare availability to rural and low income
areas.
Our healthcare system is in need of transformation. “The current and future needs of our
population must be met by a healthcare system that is affordable and sustainable, and one that
TRENDS AND DIRECTIONS
7
can provide access to high quality services to all Americans. NPs can literally be the change that
they want to see in the existing American healthcare system (Pericak, 2011, p. 6).
The Evolution of Nursing Practice
The Future of Nursing: an Institute of Medicine / Robert Wood Johnson Foundation
report was issued in 2010 and reported in the most recent issue of ISNA’s bulletin. The study
explored the evolution in how healthcare is provided and the ever changing responsibilities of the
nurse. The hospital environment was the main avenue of health care in the past, but now instead
of focusing on episodic care the focus is on the continuum of care. Quality of care has become
as important as providing care.
One of the issues is that there are many methods of becoming a nurse. Education can be
obtained through ASN programs all the way up to DNP. There are many different types of
programs preparing an individual for registered nursing. There is no standard entry level. “This
diversity in the educational process has resulted in great confusion, both within the profession
and in the eyes of the public. “One of the key characteristics of a profession is that it has a clear
educational path to prepare its practitioners” (Independent study: The evolving practicing of
nursing, 2014, p. 7).
Four key messages came out of the Evolving Practice of Nursing study:
•
Nurses should practice to the full extent of their education and training.
•
Nurses should achieve higher levels of education and training through an
improved education system that promotes seamless academic progression.
•
Nurses should be full partners, with physicians and other health care
professionals, in redesigning healthcare in the United States.
TRENDS AND DIRECTIONS
•
8
Effective workforce planning and policy making require better data collection
and an improved information infrastructure (Independent study: The evolving
practicing of nursing, 2014, p. 8).
There are barriers to nurses practicing to their fullest extent. State regulatory scopes of
practice are not uniform across the country. If the roles of nurses were clearly defined though
out the nation, the public and other professions would have a better understanding of nursing
practice, and nurses would be more mobile in their ability to practice. Specifically the role of the
advance practice nurse needs to be uniform throughout the country. The contributions of advance
practice nurses would be highlighted and they could be used more effectively.
Education needs to be universal and the BSN should be the entry level for professional
nursing. All professional nurses should sit for the same board exam across the country. Nurses
with less than a BSN should not be eliminated from the workforce as the need for health care is
growing. However, those nurses should take a different exam and be licensed under a different
title than registered nurse.
Nurses have an influence in advocating for better, safer care for patients. Nurses should
have an equal voice as physicians and health care executives in determining future design of our
health care system. Nurses must have leadership skills, critical thinking skills, and opportunity
to influence the future. Advance practice nurses have the perfect skill set to be a major player in
the provision of health care.
Accurate data needs to be collected to determine the demographics and the areas of
practice of the current nursing work force. As healthcare is redefined it will be important to
know where the areas of need are and target educational programs to fit those needs. Federal and
TRENDS AND DIRECTIONS
9
or state funding could be channeled to improve the availability of advanced practice nurses in
underserved areas. Accurate data will support the need.
The Evolving Practice of Nursing Recommendations
The report for the Future of Nursing study includes several recommendations for nursing
which include:
• Remove scope of practice barriers.
• Expand opportunities for nurses to lead and diffuse collaborative improvement
efforts.
• Implement nurse residency programs.
• Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
• Double the number of nurses with a doctorate by 2020.
• Ensure that nurses engage in lifelong learning.
• Prepare and enable nurses to lead change to advance health.
• Build an infrastructure for the collection and analysis of inter-professional
healthcare workforce data (Independent study: The evolving practicing of
nursing, 2014, pp. 8-9).
Practice barriers need to be removed by standardizing the scope of practice for advance
practice nurses across the nation. Currently the scope varies widely from state to state. Because
of the variance there is no standard level of expectations for APNs in the medical or public
sectors of the population. Standardization would increase the professional image for APNs.
All levels of nurses should be active in the promotion of safe patient care. APNs should
lead process improvement teams and should collaborate with other health care disciplines to
TRENDS AND DIRECTIONS
10
promote best practice. They should bring research and evidence to the bedside as well as to the
community to promote health and wellness.
Nurse residency programs are needed to assist nurses in the development of skill and
critical thinking necessary to become confident in their journey to proficient practice. It takes
time for new nurses to grow in their role and the profession needs to support them as they grow.
Nurses are notorious for “eating their young” and expecting them to function as a seasoned nurse
within the first year of their practice. Residency programs will help bridge the gap between
orientation and independent practice.
Furthering the education of nurses will better prepare them to take care of patients in the
ever-changing health care system and increase the professionalism of nursing. Academic
education of nurses should be enhanced by making seamless transitions from one degree to the
next in our universities and by supporting that education through grants and scholarships by
organizations and businesses. Increasing the number of doctorate nurses will bring research to
the profession and enhance education of future nurses. Salary and benefits must be aligned with
other professions with similar degrees. Nurses should be educated and have support to develop
leadership skills. Once they have developed leadership skills, nurses should be given the
autonomy to lead.
Lifelong learning is critical to nursing as the health care industry changes in a rapid pace.
Nurses must be competent in the new technologies and interventions as they develop. Health
care organizations need to be supportive of continuing education and nurses need to be
responsible for gaining that education.
TRENDS AND DIRECTIONS
11
An infrastructure should be developed so that data is easily accessible and it can be
analyzed to promote health and wellness. Advance practice nurses are in the perfect position to
analyze the data and use it to improve health care in communities and hospital environments.
Adjusting Nursing Careers to Keep Up with the Times
Major changes in healthcare are reshaping how healthcare is provided. The role of the
nurse is expanding and evolving more than ever before. These changes require nurses to have a
new mindset. Hospitals are no longer the foundation for healthcare delivery as health care has
moved out into the homes, community, and alternate patient settings. The number of acute care
beds is decreasing and the patients that are inpatients are sicker than in the past. The shift comes
from decades-long movement to improve quality and use a more cost effective approach
(Cardillo, 2014).
Cardillo (2014) comments:
If you continue to view nursing through the lens of the old hospital-based model,
you might have cause to panic. But if you open your eyes and your mind to a new
delivery model with expanded opportunities for nurses and better outcomes for
patients, you’ll have cause to celebrate (p.8).
Credentials and clinical skills alone will not support and sustain nursing. Nurses need to shift
from a task oriented focus to a case management view.
There are several methods that nurses can use to adjust their careers to keep up with the
changing environment. Cardillo (2014) lists tips to help: “broaden your horizons, shift your
focus, tune in, adopt an advanced-beginner mindset, boost your emotional intelligence, get
connected, beef up your credentials, explore your options, and update your image” (pp.8-10).
Nurses need to learn about population care coordination, case management, wellness coaching,
TRENDS AND DIRECTIONS
12
and disease management. Nurses should shift focus from the sickness model to the wellness
model. There are many opportunities for nurses to have a positive impact through wellness
programs, stress management therapy, and advocating for health.
Nurses need to learn about the causes of the current healthcare movement, including the
research behind it. They should follow what is happening in healthcare politically and
scientifically. Nurses can better plan their future if they keep informed about information and
trends. Reading professional journals is important for nurses. Changing roles places the nurse in
an advanced beginner level again and it is necessary to build confidence in a new role, even
though the nurse has been an expert in previous roles. Nurses need to set realistic goals for
becoming an expert again.
Emotional intelligence is very important in today’s world. Nurses need to know their
strengths and weaknesses; be in tune with others feelings; and be confident and optimistic.
Nurses should take on projects that make them stretch and that highlight their skills.
Communication skills are very important. Nurses should join and be active in professional
associations. Nurses should be creative and investigate careers away from the typical isolated
careers that most nurses have. Networking, communicating, and developing relationships with
nurses in other hospitals and even in other states will help nurses stay in tune with what is
happening in the field, and will provide openings for future jobs.
Nurses must pursue education continually and should get advanced degrees and
certifications. Nurses often delay getting such advanced education because of life commitments,
but there will never be a perfect time. The complex health system and the competitiveness for
positions make credentials very important in …
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