- Email: [email protected]
Power and Potential
Editorial
Power and Potential Lucy Bradley-Springer, PhD, RN, ACRN, FAAN* Key words: data, nurse leadership, quality care You cannot do all the good the world needs, but the world needs all the good you can do. Anonymous
D
id you see the recent blog by Sheila Davis (2016) on nurse leadership? I hope you did. If you haven’t read it yet, I would encourage you to do so. Davis is an Association of Nurses in AIDS Care colleague, a nurse practitioner, and the Chief Nursing Officer at Partners in Health, a global organization that focuses on poverty and health care. In other words, she is a global nurse who identifies herself as ‘‘a strong nursing leader’’ (Davis, 2016, { 8) and an advocate for nurses. As such, she is able to recognize and give voice to things that sometimes escape the understanding of those of us who focus more narrowly on our local or disease-specific nursing roles. I also think of myself as a nursing advocate. I have used my editorials to whine about physicians who try to prevent nurses from expanding their influence in health care (Bradley-Springer, 2012); to complain about nurses being left out of important events (Bradley-Springer, 2014); and to ask Association of Nurses in AIDS Care members and other nurses to step up and advocate for the profession (Bradley-Springer, 2010). But I never really had excellent ideas on how to address these problems, which was made clear to me in this one short statement: We can no longer insist nurses are leaders just because we are nurses—but rather we must show that we are leaders because of what we can do, because of our unique skills and because of the vital role we play in a team. (Davis, 2016, { 1)
Prove It I was thinking of that statement when I ran across a brief report from an American Medical Association meeting that listed trends important to qualityof-care measurement (Vassar, 2015). Those trends were listed as (a) transparency (i.e., patients should easily understand care options, expected outcomes, costs); (b) understand the big picture (i.e., evaluate the main goals, don’t get lost in the details); (c) focus on value (i.e., what is the real benefit of care?); (d) continuum of care (i.e., health does not take place in a vacuum, phases of the continuum are integrated); and (e) digital data (i.e., electronic health records collect data that can and should be mined to determine outcomes and improve quality; Vassar, 2015, { 5). My immediate thought was that the call to ‘‘show that we are leaders because of what we can do’’ (Davis, 2016, { 1) would require just such cutting-edge approaches to measuring what nurses do, the outcomes of those activities, and the costs/cost savings related to those activities. And, because I wondered what nursing has been doing about obtaining those measures, I did a brief search using ‘‘nurse performance measures’’ as my sole term and found about four million references, so I read a few of them. In a paper on concepts of nursing care (Dubois, D’Amour, Pomey, & Brault, 2013), I learned that, despite the critical
Lucy Bradley-Springer, PhD, RN, ACRN, FAAN, is the Editor-in-Chief of the Journal of the Association of Nurses in AIDS Care and an Associate Professor Emerita, University of Colorado, Denver, Aurora, Colorado, USA. (*Correspondence to: [email protected]).
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 27, No. 5, September/October 2016, 545-547 http://dx.doi.org/10.1016/j.jana.2016.06.007 Copyright Ó 2016 Association of Nurses in AIDS Care
546 JANAC Vol. 27, No. 5, September/October 2016
role of nurses in health care, our contributions are still mostly invisible to the people who make health policy decisions: administrators, politicians, physicians, and all of our potential consumers. This, of course, is a major problem for nurses who want to prove their key roles in health care, and further reinforces the need to have nurses at all decisionmaking tables. I also found an American Nurses Association (ANA, 2013) report of nurses’ contributions to changing patient outcomes through coordinated care. The ANA framework for measuring those contributions included guiding principles that incorporated the trends listed above, and extended those trends with additional nursing values, including care that is evidence-based, comprehensive, patientcentered, and relevant (ANA, 2013, pp. 4-5). This, and the magnitude of other references from my simple search, told me that nursing contributions, nursing quality, and nursing care improvement activities have a long history of study and implementation programming. Despite this, nurses continue to be relegated to nonleadership roles. Unfortunately, nurses don’t generally know that this wealth of research exists or, if they do know that it exists, how to use it. A quick overview from the ANA (Gallagher, 2010) can help to enlighten us. In that short document, the author reminds us that (a) nurses are the largest group of care providers in the world (i.e., we are part of the ‘‘big picture’’); (b) nurses positively influence outcomes for patients (i.e., we are valuable); (c) nursing care measures exist (i.e., we have the means to use data [and digital data] to quantify those measures); (d) the public benefits when they know the impact that nurses have on health care (i.e., transparency helps our clients, patients, consumers); (e) when the public knows about nursing quality measures, quality improves (i.e., transparency inspires quality advances); and (f) measures of the outcomes of nursing care should be integrated into health care systems (i.e., we need to demonstrate our significant contributions at all stages of the continuum of care; Gallagher, 2010; Vassar, 2015). The bottom line for me? We need to know our value; we need to prove our value; we need to lead through the power of this knowledge.
Opportunities Health care is changing, albeit slowly, and those changes have been stimulated by recent health care emergencies, such as Ebola in Africa, earthquakes in Haiti, and hurricanes in New Orleans, and health care upheavals, such as the Patient Protection and Affordable Care Act (Obama Care) and the global and increasing shortages of care providers. These and other rapidly unfolding events in health care systems around the world are opportunities for nurses, but they are opportunities only when nurses are prepared, educated, skilled in advocacy, and willing to step up to lead the way to the solutions we know we can facilitate.
Disclosures The author reports no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.
References American Nurses Association (2013). Framework for measuring nurses’ contributions to care coordination. Retrieved from http://www.nursingworld.org/Frameworkfor-Measuring-Nurses-Contributions-to-Care-Coordination Bradley-Springer, L. (2010). The audacity of nursing. (editorial). Journal of the Association of Nurses in AIDS Care, 21(4), 289-290. http://dx.doi.org/10.1016/j.jana.2010.04.004 Bradley-Springer, L. (2012). Doctor, doctor. (editorial). Journal of the Association of Nurses in AIDS Care, 23(1), 1-3. http:// dx.doi.org/10.1016/j.jana.2011.12.002 Bradley-Springer, L. (2014). A tale of two conferences. (editorial). Journal of the Association of Nurses in AIDS Care, 25(2), 103-104. http://dx.doi.org/10.1016/j.jana.2014.01.001 Davis, S. (2016). Nurse as leader: Is it time to change our strategy?. Retrieved from http://www.huffingtonpost.com/sheiladavis-dnp-anpbc-faan/nurse-as-system-leader_b_9887156.html Dubois, C.-A., D’Amour, D., Pomey, M.-P., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: A systematic and interpretive review. Retrieved from http://bmcnurs.biomedcentral.com/ articles/10.1186/1472-6955-12-7 Gallagher, R. M. (2010). The impact of nursing care on quality. Retrieved from http://www.nursingworld.org/MainMenu Categories/ThePracticeofProfessionalNursing/PatientSafety Quality/Research-Measurement/Nursing-and-Quality.pdf
Bradley-Springer / A Little Magic Vassar, L. (2015). 5 trends that will impact how quality of care is measured. Retrieved from http://www.ama-assn.org/ama/ ama-wire/post/5-trends-will-impact-quality-of-care-measured? &utm_source5BHClistID&utm_medium5BulletinHealthCare &utm_term5111915&utm_content5MorningRounds&utm_ campaign5BHCMessageID
547
Power and Potential Lucy Bradley-Springer, PhD, RN, ACRN, FAAN* Key words: data, nurse leadership, quality care You cannot do all the good the world needs, but the world needs all the good you can do. Anonymous
D
id you see the recent blog by Sheila Davis (2016) on nurse leadership? I hope you did. If you haven’t read it yet, I would encourage you to do so. Davis is an Association of Nurses in AIDS Care colleague, a nurse practitioner, and the Chief Nursing Officer at Partners in Health, a global organization that focuses on poverty and health care. In other words, she is a global nurse who identifies herself as ‘‘a strong nursing leader’’ (Davis, 2016, { 8) and an advocate for nurses. As such, she is able to recognize and give voice to things that sometimes escape the understanding of those of us who focus more narrowly on our local or disease-specific nursing roles. I also think of myself as a nursing advocate. I have used my editorials to whine about physicians who try to prevent nurses from expanding their influence in health care (Bradley-Springer, 2012); to complain about nurses being left out of important events (Bradley-Springer, 2014); and to ask Association of Nurses in AIDS Care members and other nurses to step up and advocate for the profession (Bradley-Springer, 2010). But I never really had excellent ideas on how to address these problems, which was made clear to me in this one short statement: We can no longer insist nurses are leaders just because we are nurses—but rather we must show that we are leaders because of what we can do, because of our unique skills and because of the vital role we play in a team. (Davis, 2016, { 1)
Prove It I was thinking of that statement when I ran across a brief report from an American Medical Association meeting that listed trends important to qualityof-care measurement (Vassar, 2015). Those trends were listed as (a) transparency (i.e., patients should easily understand care options, expected outcomes, costs); (b) understand the big picture (i.e., evaluate the main goals, don’t get lost in the details); (c) focus on value (i.e., what is the real benefit of care?); (d) continuum of care (i.e., health does not take place in a vacuum, phases of the continuum are integrated); and (e) digital data (i.e., electronic health records collect data that can and should be mined to determine outcomes and improve quality; Vassar, 2015, { 5). My immediate thought was that the call to ‘‘show that we are leaders because of what we can do’’ (Davis, 2016, { 1) would require just such cutting-edge approaches to measuring what nurses do, the outcomes of those activities, and the costs/cost savings related to those activities. And, because I wondered what nursing has been doing about obtaining those measures, I did a brief search using ‘‘nurse performance measures’’ as my sole term and found about four million references, so I read a few of them. In a paper on concepts of nursing care (Dubois, D’Amour, Pomey, & Brault, 2013), I learned that, despite the critical
Lucy Bradley-Springer, PhD, RN, ACRN, FAAN, is the Editor-in-Chief of the Journal of the Association of Nurses in AIDS Care and an Associate Professor Emerita, University of Colorado, Denver, Aurora, Colorado, USA. (*Correspondence to: [email protected]).
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 27, No. 5, September/October 2016, 545-547 http://dx.doi.org/10.1016/j.jana.2016.06.007 Copyright Ó 2016 Association of Nurses in AIDS Care
546 JANAC Vol. 27, No. 5, September/October 2016
role of nurses in health care, our contributions are still mostly invisible to the people who make health policy decisions: administrators, politicians, physicians, and all of our potential consumers. This, of course, is a major problem for nurses who want to prove their key roles in health care, and further reinforces the need to have nurses at all decisionmaking tables. I also found an American Nurses Association (ANA, 2013) report of nurses’ contributions to changing patient outcomes through coordinated care. The ANA framework for measuring those contributions included guiding principles that incorporated the trends listed above, and extended those trends with additional nursing values, including care that is evidence-based, comprehensive, patientcentered, and relevant (ANA, 2013, pp. 4-5). This, and the magnitude of other references from my simple search, told me that nursing contributions, nursing quality, and nursing care improvement activities have a long history of study and implementation programming. Despite this, nurses continue to be relegated to nonleadership roles. Unfortunately, nurses don’t generally know that this wealth of research exists or, if they do know that it exists, how to use it. A quick overview from the ANA (Gallagher, 2010) can help to enlighten us. In that short document, the author reminds us that (a) nurses are the largest group of care providers in the world (i.e., we are part of the ‘‘big picture’’); (b) nurses positively influence outcomes for patients (i.e., we are valuable); (c) nursing care measures exist (i.e., we have the means to use data [and digital data] to quantify those measures); (d) the public benefits when they know the impact that nurses have on health care (i.e., transparency helps our clients, patients, consumers); (e) when the public knows about nursing quality measures, quality improves (i.e., transparency inspires quality advances); and (f) measures of the outcomes of nursing care should be integrated into health care systems (i.e., we need to demonstrate our significant contributions at all stages of the continuum of care; Gallagher, 2010; Vassar, 2015). The bottom line for me? We need to know our value; we need to prove our value; we need to lead through the power of this knowledge.
Opportunities Health care is changing, albeit slowly, and those changes have been stimulated by recent health care emergencies, such as Ebola in Africa, earthquakes in Haiti, and hurricanes in New Orleans, and health care upheavals, such as the Patient Protection and Affordable Care Act (Obama Care) and the global and increasing shortages of care providers. These and other rapidly unfolding events in health care systems around the world are opportunities for nurses, but they are opportunities only when nurses are prepared, educated, skilled in advocacy, and willing to step up to lead the way to the solutions we know we can facilitate.
Disclosures The author reports no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.
References American Nurses Association (2013). Framework for measuring nurses’ contributions to care coordination. Retrieved from http://www.nursingworld.org/Frameworkfor-Measuring-Nurses-Contributions-to-Care-Coordination Bradley-Springer, L. (2010). The audacity of nursing. (editorial). Journal of the Association of Nurses in AIDS Care, 21(4), 289-290. http://dx.doi.org/10.1016/j.jana.2010.04.004 Bradley-Springer, L. (2012). Doctor, doctor. (editorial). Journal of the Association of Nurses in AIDS Care, 23(1), 1-3. http:// dx.doi.org/10.1016/j.jana.2011.12.002 Bradley-Springer, L. (2014). A tale of two conferences. (editorial). Journal of the Association of Nurses in AIDS Care, 25(2), 103-104. http://dx.doi.org/10.1016/j.jana.2014.01.001 Davis, S. (2016). Nurse as leader: Is it time to change our strategy?. Retrieved from http://www.huffingtonpost.com/sheiladavis-dnp-anpbc-faan/nurse-as-system-leader_b_9887156.html Dubois, C.-A., D’Amour, D., Pomey, M.-P., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: A systematic and interpretive review. Retrieved from http://bmcnurs.biomedcentral.com/ articles/10.1186/1472-6955-12-7 Gallagher, R. M. (2010). The impact of nursing care on quality. Retrieved from http://www.nursingworld.org/MainMenu Categories/ThePracticeofProfessionalNursing/PatientSafety Quality/Research-Measurement/Nursing-and-Quality.pdf
Bradley-Springer / A Little Magic Vassar, L. (2015). 5 trends that will impact how quality of care is measured. Retrieved from http://www.ama-assn.org/ama/ ama-wire/post/5-trends-will-impact-quality-of-care-measured? &utm_source5BHClistID&utm_medium5BulletinHealthCare &utm_term5111915&utm_content5MorningRounds&utm_ campaign5BHCMessageID
547