- Email: [email protected]
If Not Now, When?
Editor ial Roxane Spitzer, PhD, RN, MBA, MA, FAAN
If Not Now, When? T his week was an exciting one for me as I attended the annual AONE meeting. We are at a very unusual place in the history of nursing, or perhaps we are back to the roots of the practice of nursing: the community! The changes resulting from the initial implementation of the Affordable Care Act vary throughout the United States, but one thing is sure: the changes impacting both patients and the profession of nursing are profound. For more than 100 years, our focus has been hospital-based care. We have made great progress in both the delivery of patient care and the practice of nursing, but it is a new era with different and new challenges. It should be no surprise to anyone that inpatient hospitalization is at a new low in many areas, whereas ambulatory care is advancing at a rapid pace. We have been talking and procrastinating about the importance of implementation of a seamless continuum for at least a decade. We have recognized that a hospital is not a healthy place to be. This transition to a more community-based delivery system, although not a mandate, must be implemented to improve quality, affordability, and access to care in the appropriate setting. The motto has been the “right care in the right place at the right time and at the right price.” This obviously was not going to happen without massive changes in the financing system. This was finally triggered by the Affordable Care Act. Unfortunately, many of the nursing staff do not seem prepared to acknowledge and accept the changing healthcare scene. As an example, at one institution, where inpatient volume was decreasing steadily, nursing staff were offered opportunities to transfer into various ambulatory care settings. Much to the chagrin of the chief nursing officer, an often heard comment was that they would not give up 12-hour shifts to do a 5-day 40-hour work week. One wonders whether they are meeting their professional obligation to recognize the changes are real and necessary to build a viable healthcare system, even through the current chaos. Notwithstanding the problems, there are also opportunities afforded in this new environment. It appears that we may well have created our own nightmare by not planning to change work shifts in response to
8
Nurse Leader
research studies that have shown numerous times that 12-hour shifts are not only unhealthy for the staff, the quality and safety of care is adversely affected. As a former chief executive officer and chief nursing executive, I realize that it is easy to say and far from easy to do. Nevertheless, it is essential that nurse leaders actually lead the way in the preparation as well as implementation of this massive change. In light of that, on the advice of our very creative and innovative advisory board, we intend to feature at least 1 article per issue on changes being made by our colleagues to both prepare for and proactively implement to meet societies’ needs. We recently featured an article by Linda Everett at the University of Indiana hospital system on the implementation of an accountable care organization in that setting. I want to encourage more articles on the successful, as well as unsuccessful, attempts at meeting this tremendous challenge. We can learn as much from what doesn’t work and why, as we can from what does work. At the same time, I am seeking articles from those affected on the frontline. Workforce transitions are a reality. Let’s help each other through it by sharing our experiences. This is truly a remarkable time for professional nursing; although uncomfortable and frightening, it is in the best interest of the patient and the community. I believe that is what we are all about. Editor-in-Chief Roxane Spitzer, PhD, RN, MBA, MA, FAAN, can be reached at [email protected].
1541-4612/2014 Copyright 2014 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2014.03.006
June 2014
If Not Now, When? T his week was an exciting one for me as I attended the annual AONE meeting. We are at a very unusual place in the history of nursing, or perhaps we are back to the roots of the practice of nursing: the community! The changes resulting from the initial implementation of the Affordable Care Act vary throughout the United States, but one thing is sure: the changes impacting both patients and the profession of nursing are profound. For more than 100 years, our focus has been hospital-based care. We have made great progress in both the delivery of patient care and the practice of nursing, but it is a new era with different and new challenges. It should be no surprise to anyone that inpatient hospitalization is at a new low in many areas, whereas ambulatory care is advancing at a rapid pace. We have been talking and procrastinating about the importance of implementation of a seamless continuum for at least a decade. We have recognized that a hospital is not a healthy place to be. This transition to a more community-based delivery system, although not a mandate, must be implemented to improve quality, affordability, and access to care in the appropriate setting. The motto has been the “right care in the right place at the right time and at the right price.” This obviously was not going to happen without massive changes in the financing system. This was finally triggered by the Affordable Care Act. Unfortunately, many of the nursing staff do not seem prepared to acknowledge and accept the changing healthcare scene. As an example, at one institution, where inpatient volume was decreasing steadily, nursing staff were offered opportunities to transfer into various ambulatory care settings. Much to the chagrin of the chief nursing officer, an often heard comment was that they would not give up 12-hour shifts to do a 5-day 40-hour work week. One wonders whether they are meeting their professional obligation to recognize the changes are real and necessary to build a viable healthcare system, even through the current chaos. Notwithstanding the problems, there are also opportunities afforded in this new environment. It appears that we may well have created our own nightmare by not planning to change work shifts in response to
8
Nurse Leader
research studies that have shown numerous times that 12-hour shifts are not only unhealthy for the staff, the quality and safety of care is adversely affected. As a former chief executive officer and chief nursing executive, I realize that it is easy to say and far from easy to do. Nevertheless, it is essential that nurse leaders actually lead the way in the preparation as well as implementation of this massive change. In light of that, on the advice of our very creative and innovative advisory board, we intend to feature at least 1 article per issue on changes being made by our colleagues to both prepare for and proactively implement to meet societies’ needs. We recently featured an article by Linda Everett at the University of Indiana hospital system on the implementation of an accountable care organization in that setting. I want to encourage more articles on the successful, as well as unsuccessful, attempts at meeting this tremendous challenge. We can learn as much from what doesn’t work and why, as we can from what does work. At the same time, I am seeking articles from those affected on the frontline. Workforce transitions are a reality. Let’s help each other through it by sharing our experiences. This is truly a remarkable time for professional nursing; although uncomfortable and frightening, it is in the best interest of the patient and the community. I believe that is what we are all about. Editor-in-Chief Roxane Spitzer, PhD, RN, MBA, MA, FAAN, can be reached at [email protected].
1541-4612/2014 Copyright 2014 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mnl.2014.03.006
June 2014