Nurses as Leaders in Healthcare Reform

Mercy Ansuaje

Maythee Rodriguez

Yuvislay Clavel

Geanny Garcia

Miami Regional University

NUR4900 – Capstone RN to BSN

Prof. Laritza Varona

November 25, 2021


Nurses as Leaders in Healthcare Reform

Due to disparities, suboptimal outcomes, unsustainable costs, access problems, and fragmentation. Salmond and Echevarria (2017) explain that the great urgency of change in the role of nurses was influenced by the concerns on disease-type demographics and the cost and quality issues. There are varying programs led by the Centers for Medicare and Medicaid Services and the Affordable Care Act to improve quality and cost. These created the need for care coordination and interdisciplinary team to reduce spending, improve outcomes, and improve care especially attributed to adverse drug interactions, multiple prescriptions, repeated diagnostic testing; unnecessary emergency department utilization; and unnecessary hospitalization (Salmond and Echevarria, 2017). Due to these changing health programs, nurses are part of the transformative change which requires a change from patient-centered care, fee-for-service care, provider-based care, and episodic care across a continuum that provides quality, affordable, and seamless care.

Current Issue

The 21st healthcare has transformed, calling for 21st-century nurses to be an agent of change. This was facilitated by the release of The Future of Nursing: Leading Change, Advancing Health in 2010 by the Institute of Medicine (IOM). The report provides the role of nurses as a catalyst of change. Besides, the role of nurses’ leaders is evolving and expanding, which thus requires nurse leaders to build their knowledge base on professionalism, leadership, communication, and business skills (Bouchad et al., 2017). The health problems in the 21st century require nurse managers to build the gap between the administration and the clinical by understanding professional and personal development, the business aspect of management, and learning ways to lead with knowledge in human resources and leadership skills.

Nurses are in higher demand due to the increased aging population who are developing chronic diseases. These changes increase the healthcare cost. According to Cutler (2019), nurses reduce healthcare costs as a nurse’s cost is slightly above $1 per minute, that of a physician is $3 per minute, and surgeon costs $6 per minute. Some of the roles of the physicians and surgeons can be performed by nurses hence increasing the need for nurse leaders in healthcare reform. Besides, health institutions with a higher nurse-to-patient ratio have better patient outcomes. Similarly, the increased specialization in nursing places nurses in leadership roles.

Measures to Improve Nurse Leadership

Nurse leadership can be promoted by training nurses on change management to understand how to respond to the changing healthcare system. For example, it is important that nurses understand the economics of accountable care organization (ACO) payment models to help reduce readmissions, monitor specialist care, and meet quality goals. The second measures are the increased specialization in nursing where nurses can choose from. The ongoing reforms require all nurses to be leaders in the reform system’s design, implementation, evaluation, and advocacy. To act as full partners, nurses need leadership competencies and skills to help them operate as full partners with other health professionals.

Nurses require a style of leadership that allows collaboration and mutual respect in the delivery of coordinated care and inter-professional teams. The advantages of this leadership style are that it reduces staff turnover, reduces medical errors, and improves patient outcomes CITE. Some of the required skills for nurse leaders are foundations for quality and safety improvement, theories of innovation, ways to be effective patient advocate, basic tenets of ethical care, ways to effectively collaborate with other professionals, how to work in teams, and knowledge of the care delivery system

Nurse Leadership Outcomes

Nurse leaders are imperative in healthcare as they help healthcare organizations to improve patient outcomes and achieve optimal care quality. Nurses work closely with care delivery, giving them a unique perspective that should help inform policymakers. The outcome can be enhanced by creating nursing organizations like the Nursing Alliance for Quality Care (NAQC). The goal of such organizations is to reduce nurses’ barriers towards participating and help them influence policies that affect the value, quality, and safety of healthcare. The nurses attain the outcomes by demonstrating to policymakers the significance of nursing, encouraging nurses to actively promote quality care, support patient-focused care delivery, and high-quality care (Kurtzman et al., 2016).

To reduce care fragmentation, the nurses should lead in developing patient-centered medical homes (PCMH), which allows interdisciplinary teams to meet multifaceted needs of patients and deliver holistic, comprehensive and coordinated patient-centered care. Nurses can influence the outcome of such models through effective information flow, secure care transitions, follow up on all services, and educate patients on self-management (Pittman, 2019). As leaders, nurses require competencies in technology or health informatics to meet the changing clinical practice.

Advantages and Disadvantages of Nurses as Leaders in Healthcare Reform

The advantages of nurses as leaders in healthcare reform are to promote quality of patient care, patient satisfaction, safe medication practices, lower patient mortality, development of safety climate, and promote patient safety. The concept is advantageous in promoting efficiency, system integrity, timely care delivery, health reform objectives, and system performance. Nurses as leaders in health reform promote a high-quality health care system that helps in the delivery of efficient and safe care. The nurses work with other health professionals to deliver quality and patient-centered care. The nurses directly engage in patient-centered care. They have a critical role in leadership in healthcare areas to avert workforce shortages, increase access to care, provide better care coordination, improve quality, and reduce medical errors. The advantages of nurse-led reform are illustrated below

Nurse Led Reform: Is It Time to Rethink the Nursing Unit?

The disadvantages of nurse leaders in healthcare reform occur through ineffective leadership, which may negatively affect nurse productivity, nurse effectiveness, and nurse satisfaction. Another disadvantage is that not all facilities may have leadership resources, resulting in uneven distribution of care and care disparities. Nursing leadership faces barriers through constant uncertainty and restructuring of the health care system. Therefore, the concept of nurses as healthcare reform faces challenges that inhibit nurses from enacting their entire responsibilities as leaders. For example, nurses as leaders have a role of supervision, but other professionals view the nursing profession as lower professional in terms of hierarchy. Although the healthcare reform requires nurses to drive change, there are fewer nurses as influences in the policy-making process.

The performance of nurses is crucial to patient care outcomes, in addition to the fact that nursing leaders’ characters have been associated with nurse performance and quality of care (Kakemam, et.al, 2020). The research articles that were reviewed tend to examine the factors that the nurses consider to be influencing their performance, as well as the motivation that carried them out (Kakemam, et.al, 2020). There was an inclusion of several studies within the final analysis. The nurses categorized the factors they perceived were influential to their motivation and the capability to perform into five different classes through use of content analysis. These included resource accessibilities, leadership practices, autonomy, nurse factors, in addition to work relationships. The nursing leadership traits directly and indirectly influence the motivation of nurses through varying factors. Nursing leaders can enhance the performance of their nurses through getting to understand and address the issues affecting their capability plus motivation to work (Kakemam, et.al, 2020).

Nursing leadership is very essential in motivating the staff to achieve an improved understanding of the patients’ requirements (Kakemam, et.al, 2020). The nurses who are empowered tend to be eager to implement practices that are evidence-based to make sure there is quality of care (Kakemam, et.al, 2020). It is evident that nursing leadership style tends to influence the performance of nurses. Being aware of how nurse leaders are capable of influencing nurse performance is a very essential step associated with positive outcomes of the organization and patients. It is the responsibility of the healthcare institution, and the nurse scholars to continue exploring if the nursing leadership style has the potential to influence the staff motivation to perform well for positive health reforms (Kakemam, et.al, 2020).

Nurses are supposed to be in full partnership with the physicians alongside other professionals in healthcare, this is in the process of redesigning the healthcare system (Goldsberry, 2018). A strong leadership is crucial for the healthcare system transform finally occurred. However, not every single nurse starts their careers with the intentions of becoming leaders. Nursing profession is supposed to create leaders all through the system of health care, from the bedside to the boardroom; ones who can serve as full time partners with the different health professionals and become responsible for their personal contributions in the delivery of high-quality care (Goldsberry, 2018). Though the public does not have a habit of seeing the nurses in the role of leaders, in addition to the fact that not every nurse starts with desires of leading. It is necessary for every nurse been a leader in the implementation, evaluation, designing, as well as advocate for the reforms that are ongoing on the system; this will be essential for improvement of the health care (Goldsberry, 2018)

In addition, nurses need the have skills of leadership and competencies to play the role of full partners with the physicians and different health experts in reforming and redesigning efforts all over the system of healthcare (Goldsberry, 2018). Nursing research alongside practice should continue identifying and improving the evidence-based care. This improvement is supposed to be adopted and tested via change of policy all over the health care systems. The nursing leaders have the responsibility to translate new findings of research into the practice as well as into nursing education, plus from the nursing education to the policy and nurse practice (Goldsberry, 2018).

Nurses at every single level need strong leadership skills to contribute to the safety of the patient as well as the quality of the provided care. However, in the history of the nursing profession females have dominated it; making ease for the policy makers to establish nonsense rules (Heinen, et.al, 2019). Different health professionals alongside the entire public classify nurses as functional doers, meaning the ones responsible for carrying out other instructions contrary to being thoughtful strategists. Nurses should be categorized as decision makers who are informed of their independent actions that are supported on education, experience, and evidence (Heinen, et.al, 2019). Nurses are among the health information sources one of the most trusted. They are health professionals who should be having way much influence contrary to their current position within the critical sectors related to the safety and quality of patient care (Heinen, et.al, 2019).

For the nurses to become leaders who are more effective in addition to being in full partnership with the physicians, they are supposed to be in possession of two crucial sets of competencies: Being capable of playing the role of any leadership opportunity foundation and more specifically tailored to any place, time, and context (Heinen, et.al, 2019). Within the care environment, becoming a full partner mainly comprises of becoming responsible to an extent of identifying the challenges as well as the waste areas. Also, to prepare and implement an action plan for advancements, improvement, and adjustments to accomplish the goals that were established (Heinen, et.al, 2019). Nurse leaders also plays the role of patient advocates, and they should to get involved in the decision making on how the care must be delivered (Heinen, et.al, 2019).







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