New Roles for Nursing with Health Reform

New Roles for Nursing with Health Reform

By Rose O.  Sherman, EdD, RN, FAAN

nextThere are many changes happening in health care today.  I am often asked about the potential impact that health reform will have on nursing and how to do future career planning.  Although there are many unknowns with the Affordable Care Act, one clear direction is that health care will move from being “hospital centric” back into the community.  In the transformed health care system envisioned under the ACA, building a more robust primary care model will minimize the need for expensive tertiary care.  Hospital censuses are already declining in some areas of the country and with them – positions for nurses in acute care settings.  During February 2014,  the Altarum Institute reported an overall loss of 1200 hospital positions with a growth of 8400 in Ambulatory Care.  The good news is that the changes may bring many potential opportunities for nurses to move into new and different roles in community-based settings.  In an effort to better understand what these new opportunities could be, nurse leaders from the California Institute for Nursing and Healthcare conducted a role exploration study in 2013 involving 300 nurse leaders in California to identify new nursing roles.  There findings are very interesting and important for nurse leaders everywhere.

The objective of the Nurse Role Exploration Project was to address gaps in care delivery by identifying corresponding new roles for Registered Nurses (RNs) in California’s health care system.  After an initial meeting, six consecutive meetings built cumulatively on previous discussions, resulting in an initial consensus regarding top roles for California RNs. Following the series of meetings, an online survey with participants verified outcomes of the consensus process and gathered input on critical next steps to actualize the new roles.

Five New Nursing Roles

As an outcome of the research, five new key nursing roles were identified through the consensus process as being necessary for the implementation of the ACA in California.  These role included:

Care coordinator –In every health care environment, there is a growing need for care coordination. The role of care coordinator may take many forms. It may involve providing coordination directly in complex or rapidly changing situations, supervising other team members when care is relatively predictable (tiered coordination), or advising entire communities (populations) on the best choices for the highest levels of wellness. In the latter, RNs will be involved in population health management, using population-based data and evidence-based practices to bring about large scale improvements in health.  The role of care coordinator is one that holds enormous potential for improving levels of health and wellness and ultimately reducing the cost of care. It is anticipated there will be exponential growth in this nursing role in settings across the healthcare continuum.

Faculty team leader –Nursing faculty are positioned to take the lead in creating interdisciplinary teaching teams in community practice settings. The teams would role model both interdisciplinary approaches to care and the same collaborative behaviors that would ultimately improve care outcomes.

Informatics specialist –  All too often, RNs adapt practice to accommodate technology, rather than the reverse. There is a need for a shift toward RNs playing critical roles in the development of software and its application. The roles envisioned included informatics design, application, and interpretation across settings.

Nurse/family cooperative facilitator –  The core of this role is RNs connecting with people where they live and work to understand and adjust elements that will result in healthier, more successful outcomes. Rather than a new role, this is the re-emergence of a role that has origins in the work of Lillian Wald at the turn of the twentieth century.   She clearly understood the relationship between the environment in which people lived and worked and the ability to be “healthy.” As social determinants of health are studied in more detail, it is clear RNs could be positioned for early intervention and, in many instances, prevent the development of more serious problems. In this role, RNs address both health issues and broader issues that become determinants of health, such as poverty, violence, and substance abuse.

Primary care partners – This new role identified in this Project is for RNs without advanced certification. Throughout the course of the meetings, participants expressed a strong belief that RNs could add significant value in community settings both qualitatively and by supporting increased capacity in the clinic itself. Participants described added value as ranging from intake screening to providing education, coaching, and support for people with complex illnesses. Participants described a principal value of RNs in primary care as the ability to provide individuals, families, and communities with preventative information and support to help them move to or maintain greater wellness.

It is recognized in California that further discussion is warranted regarding all dimensions of the identified roles, and their development and implementation. It will also  be essential to identify strategic partners and funding sources to develop and test the roles and identify strategies to bring them to scale as evidence warrants.  While still very new, this work is a great start to explore how nurses can contribute in this new era of health reform.

Read to Lead

Berg, J. G. & Dickow, M. (September 25th, 2013). New Nursing Roles Whitepaper.  California Institute for Nursing and Healthcare.

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