Discussion: Policy Brief

This is a call for nurses to lead at every level to have a seat at the table when critical decisions are being made. Those decisions extend from clinical care to national policy, and all require the voice of nurses (Institute of Medicine, 2010). Based on my analysis of the policy proposal, the Institute of Medicine get it right. A perfect example of how this works can be seen when the nursing staff members of the Veterans Health Administration (VHA) healthcare team voiced confidence and interest in assisting patients to achieve blood glucose level goals. They heard patients’ voices of frustration in their inability to attain more frequent access to the clinic provider above the usual three-month follow-up visits. This resulted in management inertia about insulin dosage adjustments based on their home and laboratory glucose values. Patients knew that they needed to change their medications but had no power to do so. The Veterans Health Administration (VHA) metabolic and diabetes nursing field advisory committee created a vision, recognizing that together with Veteran stakeholder input and partners in nutrition, behavioral health, pharmacy, and medicine. They created a diabetes program to provide state-of-the-art evidence-based interventions that are timely and Veteran-centric (U.S. Department of Veterans Affairs, 2015).

This article reviews patients’ actions reflected by carrying out medication lists to diminish information loss from health care settings and identifying support for patient safety. The study reveals priorities for improving medication safety in primary care by addressing incomplete medication reconciliation. The strength of the study is reflected by the empowerment and confidentiality inspired to patients by involvement in medication management, increasing their dignity and self-esteem level, evidencing a form of resilience in nursing practice. Patient-held medication lists may be helpful for information transfer in emergency situations when communication is altered. Patient-held medication lists assist with taking medications, reordering, monitoring health care conditions, or tracking the efficiency of medications. The weakness of the study is reflected by possible disconnections between the information needs by health care professionals and the information being kept by patients who carried medication lists. Another limitation of the study is interviewing more females than males who carried a medication list, and the procedure suggests that more females carry a medication list than males and may reflect an inaccurate practice (Garfield et al., 2020).

The Office of Nursing Service (ONS) diabetes experts collaborated with the VA national home telehealth department and nutrition field advisors to compile daily prompts, knowledge, and affirmations on diabetes safety and self-care. The program was field-tested with patients and continues to teach diabetes self-management skills on a daily basis through short mobile telephone messages that meet the patient’s learning needs in short bursts of learning. Members of the medical and nursing field advisory committees worked together to create an insulin titration protocol to be piloted at five VHA facilities. They brought together an interprofessional team of field-based diabetes experts including physicians, clinical psychologists, pharmacists, and nurses, and created a training program based upon the Project ECHO model from New Mexico. Project ECHO (Extension for Community Health Outcomes) is a telehealth program started in 2009 (Brown et al., 2016). Weekly videoconferences were held by specialists for rural clinicians. Theoretical didactic content was presented by a panel of experts who then mentored the learners in utilizing theory by talking them through actual patient case presentations. Best practices were taught by theory and then integrated into practice (U.S. Department of Veterans Affairs, 2015).

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References

Brown, N. N., Carrara, B. E., Watts, S. A., & Lucatorto, M. A. (2016). RN Diabetes Virtual Case Management: A New Model for

Providing Chronic Care Management. Nursing administration quarterly, 40(1), 60–67. https://doi.org/10.1097/NAQ.0000000000000147

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

U.S. Department of Veterans Affairs. (2015). Realizing the Future of Nursing: VA Nurses Tell Their Story. Washington, D. C.: United States Government Printing Office

Thank you for your insightful post! Reflecting on the start of my career, nurses have played a significant role in the positive transformation of the healthcare environment. Nurses have answered the call to action to be healthcare leaders, breaking some of the longstanding barriers impacting nurses to meet the healthcare system’s needs. A fantastic attribute of nurses is defending the right of our patients to receive that is, advocating for safe, appropriate, and quality care. Hence, nurses have gained public respect for their work and can influence health policy development for healthcare reform. Subsequently,  nurses have a unique opportunity to fill the gap in the healthcare arena due to the general decline in trusting politicians and policymakers (Anders 2021).

Furthermore, the nurse care continuum provides nurses with a broad understanding of environmental factors affecting the health outcomes of patients and communities and an understanding of healthcare requirements (Shariff, 2015). Nurse leaders need to address outdated regulations, policies, and practice habits that restrict nursing practice innovation impeding the future of nursing practice transformation (England & Improvement, 2020). So, nurses must attract political support by taking ownership of IOM recommendations and forming allies with those internally (patients, physicians, employers, nurse, organizational leaders) and externally (insurance companies, pharmaceutical firms, and government)  healthcare to implement these recommendations (Altman, 2016). At any rate, nurses need to support each other in leadership to influence healthcare reform policies and nursing innovation to  create and design a  safe, accessible, and affordable healthcare system.

References

Altman, S. H. (2016). Assessing progress on the Institute of Medicine report the future of nursing. Washington, DC: National Academies of Sciences, Engineering. Medicine

Anders, R. L. (2021) Engaging nurses in health policy in the era of COVID‐19. In Nursing forum (Vol. 56, No. 1, pp. 89-94).

England, N. H. S., & Improvement, N. H. S. (2020). Leading the acceleration of evidence into practice: a guide for executive nurses. London: NHS England and NHS Improvement, www. england. nhs. uk/wp-content/uploads/2020/03/leading-theacceleration-of-evidence-intopractice-guide. pdf.

Shariff, N. J. (2015). Empowerment model for nurse leaders’ participation in health policy development: an east African perspective. BMC nursing, 14(1), 1-11.

The Institute of Medicine (IOM) Future of Nursing Report Brief addresses four very important elements of nursing practice that are in need of change. According to Kershaw (2011), the four areas of needed change include nurses practicing to the fullest scope of their license, nurses engaging in seeking and attaining higher levels of education, nurses being considered as equals with their physician colleagues when taking the initiative to redesign health care, and nurses creating a foundation of data through research and evidence-based practice to support policies and procedures in nursing practice.

The area of specific interest to me is item number three. This initiative focuses on nurses becoming full partners with physicians when redesigning healthcare in the United States (Kershawm 2011). The reason this initiative is important to me is that I work in an acute care setting where physicians are still revered as gods by the hospital leadership and nurses are considered the handmaiden to the physician. It is a large hospital but set in a rural community and the founding fathers who opened the community hospital 16 years ago (Now part of a larger system) were very physician-focused. The bylaws do not promote employing mid-level practitioners, they do not recognize that certified nurse-midwives can practice independently, and have a strong working relationship with a Kaiser Permanente group that feels very threatened by the thought of utilizing mid-level providers and advance practice nurses (APNs). According to Abraham et al. (2019), APNs are far more cost-effective than physicians, and they increase patient experience scores and clinical outcomes. Constable et al. (2022) describe an increase in provider communications scores from 69% to 85% when APRNs were used in the acute care setting. This specific article also outlined a reduction in endotracheal tube-associated pressure injuries by 50% because of the care the APN provided to this population. The reason for this is that APNs are trained to treat patients holistically and not be solely focused on a diagnosis or disease. Physicians are trained with a primary focus on disease. Collaboration between these two groups is essential when health care reform is being considered.

The IOM report brief nailed this issue on the head. There is a need to include APNs in health care reform and the recommendation in the article suggests this will happen through leadership training and the attainment of leadership competencies by all APNs. The American Organization of Nurse Executives (AONE) offers leadership training for all levels of nurse leaders. The sole focus of the AONE is to promote leadership excellence among nurses, advance the practice, increase the engagement of research by nurses, and facilitate the preparation of nurses who will influence legislation and public policy (www.aha.org). For far too long the shape of health care has been formed by only a select portion of the population who provides it. Now is the time to think globally about healthcare reform and invite all of the contributors to the table.

References:

Abraham, C. M., Norful, A. A., Stone, P. W., &Poghosyan, L. (2019). Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review. Nursing Economic$, 37(6), 293–305.

American Organization of Nurse Executives. (February, 2022). AHA releases 2022-2024 strategic plan and updates to vision and mission statements. Retrieved: https://www.aha.org/special-bulletin/2022-02-08-aha-releases-2022-2024-strategic-plan-and-updates-vision-and-mission

Constable, M., Mulkey, M., &Aucoin, J. (2022). Hospital value–based purchasing: How acute care advanced practice nurses demonstrate value. Journal of the American Association of Nurse Practitioners, 34(1), 12–17. https://doi.org/10.1097/JXX.0000000000000606

Kershaw, B. (2011). The future of nursing – leading change, advancing health. Nursing Standard, 26(7), 31–31. https://doi.org/10.7748/ns2011.10.26.7.31.b1274

Hello Edwige, it is true that the current shortage in primary care provision may be bridged by advancing knowledge; which varies for different states in the united states. The provision that allows for advanced Practice Registered Nurses (APRNs) to exercise their skills and training in healthcare may be more efficient through nurse’s pursuit for further education on the healthcare areas of interest (White et al., 2021). Optimization of contribution of nurses to the healthcare teams require advanced skills acquired through education and training, other than practice.

Barriers to the application of skills and knowledge gained by nurses include restrictions by some institutional cultures, federal and state control as well as insurance models. Recommendations on the utilization of the potential of nurses to bridge the primary care provision gap should be advanced to both federal and state authorities (Davis et al., 2021). Evolving needs in healthcare systems and the increased advocacy for patient best outcome require collaborative approach that includes the utilization of skills amassed by nurses.

References

Davis, D., Maughan, E. D., White, K. A., & Slota, M. (2021). School Nursing for the 21st Century: Assessing Scope of Practice in the Current Workforce. The Journal of school nursing : the official publication of the National Association of School Nurses, 37(5), 374–386. https://doi.org/10.1177/1059840519880605

White, K. A., Davis, D., & Maughan, E. D. (2021). Development and validation of an instrument to measure scope of practice in school nurses. Journal of advanced nursing, 77(7), 3226–3237. https://doi.org/10.1111/jan.14867