DOCSLIB.ORG

Increasing Primary Care Capacity Through Academic Preparation and Effective Utilization of Registered Nurses in Team-Based Delivery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Increasing Primary Care Capacity Through Academic Preparation and Effective Utilization of Registered Nurses in Team-Based Delivery Increasing Primary Care Capacity Through Academic Preparation and Effective Utilization of Registered Nurses in Team-Based Delivery PREPARED BY Judith G. Berg, MS, RN, FACHE Former President and Chief Executive Officer Carolyn Orlowski, MSN, RN Program Director AUGUST 2019 ACKNOWLEDGMENTS Contents This project was conducted with the support and col- 1 Introduction: laboration of the California Health Care Foundation, Escalating Need for Primary Care which sponsored the work, and consultative assistance of an advisory team of academic and practice leaders 2 Trends and Driving Forces across California. (See Appendix A.) The knowledge, Value-Based Payment and Care vision, professional commitment to primary care, and diverse experience and expertise of the advisory The RN Workforce team members contributed significantly to the project Assumptions Underlying design, key areas for exploration, and the synthesis of This Project findings in developing actionable recommendations. 3 Summary of Findings Their leadership representing key statewide organiza- tions also strengthened important connections with 4 Recommendations for Change: leaders, organizations, and communities in California, Five Key Domains ensuring that the findings would be representative, Domain 1: Transforming the Practice Environment to relevant, and evidence based. Effectively Utilize RNs In particular, the project team is grateful for the time Domain 2: Supporting the Primary Care Career and contributions that Laurie Bauer, MPH, PhD(c), RN, Development of RNs from the UC San Francisco School of Nursing, pro- Domain 3: Educating Nursing Students in Primary Care vided in supporting the development and testing of Domain 4: Developing Nursing Program Faculty with the survey questions, assisting with facilitation of focus Primary Care Expertise groups, and analyzing key findings. Domain 5: Increasing Opportunities for Interprofessional Education and Development of Collaborative Team- The project team also acknowledges the importance Based Practice Models of many primary care leaders, nurses working in these settings, and academic nursing program leaders, who 13 Conclusions: dedicated time to participate in the various surveys Timely and Reachable Opportunities and focus group sessions; they provided valued infor- mation, shared their experiences, and provided ideas 14 Appendices to strengthen the preparation and development of A. Advisory Team the future primary care nursing workforce. B. Recommendations and Strategies Sorted by Stakeholder Group 20 Endnotes HealthImpact 663 13th Street, Suite 300 Oakland, CA 94612 www.healthimpact.org Suggested citation: Increasing Primary Care Capacity Through Academic Preparation and Effective Utilization of Registered Nurses in Team-Based Delivery (Oakland, CA: HealthImpact, 2019). Introduction: Escalating “ My role is unique in that I work with Need for Primary Care people who may have no one else in their California will face a shortage of 4,100 primary care providers in the next 10 years, according to a 2019 lives, often being the primary liaison report by the California Future Health Workforce when they interact with different health Commission.1 At the same time, the demand for pri- mary care services will continue to accelerate due care systems. ” to the state’s growing and aging population, as well — PRIMARY CARE RN as payment models requiring value-based care and strong patient-centered focus on health maintenance and illness prevention. The trends point to an urgent need to expand and About This Project more efficiently deploy California’s primary care work- An advisory team of experts in primary care, nursing, force. Effective utilization of registered nurses will be and academia guided development of the project, including design of survey instruments and focus a crucial factor in addressing this need as part of inter- group processes. The team also recommended the 2 – 5 professional team-based care models. recruitment of participants and codeveloped recom- mendations for action. See Appendix A for a list of There are more than 430,000 registered nurses (RNs) advisors. in California, the state’s largest group of licensed A statewide primary care survey and series of focus 6 health care professionals. The size and skill of this groups conducted in fall 2018 invited broad partici- potential workforce—currently underutilized in ambu- pation. Responses were received from 112 primary latory care—represents an opportunity to strategically care site leaders in various types of health care address the growing demand for lower-cost, more organizations, 199 RNs working in primary care set- tings, and 58 academic leaders of RN pre-licensure effective primary care through new care delivery nursing programs. The survey was designed to: models that use RNs to their maximum effectiveness. Team-based care can help address rising costs and $$Obtain information about the current primary care RN workforce, including the utilization of increasing demand as well. RNs and their roles. $$Consider the academic preparation and However, realizing this potential will require addressing readiness of nursing students for RN roles in the academic-practice gap with significant changes in primary care. the way nursing schools prepare students for practice $$Explore strategies supporting the preparation as well as the way primary care settings enhance and of the future nursing workforce in these deploy RNs’ knowledge, skills, and experience. practice settings. Focus groups were conducted in four geographical To acquire information to serve as a basis for specific regions of California. Participants were leaders in recommendations, an 18-month project, Improving organizations providing primary care, RNs practicing Capacity for Team-Based Care: The Registered in primary care settings in various roles, and RN pre- Nursing Workforce in Primary Care, was launched in licensure nursing program leaders and faculty. The focus groups were designed to validate and build January 2018. (See sidebar, About This Project.) The on the survey findings, providing opportunities to project investigated current nursing roles in primary explore issues in detail. These discussions informed care, academic preparation of RNs for work in ambula- the development of recommendations and strate- tory settings, and gaps between current practices and gies detailed in this paper. See Summary of Findings what will be needed in the primary care workforce of (page 3). the near future. Increasing Primary Care Capacity Through Academic Preparation and Effective Utilization of Registered Nurses in Team-Based Delivery 1 Trends and Driving The RN Workforce Traditionally, RNs have not had an extensive role in Forces the primary care workforce.13 However, as care models The health care environment is changing dramatically evolve to include prevention, wellness, management due to rising costs, increasing demand for services, of chronic conditions, and population health, RNs are shifting consumer expectations, workforce shortages, well positioned to assume roles and provide patient- payment restructuring, and policy changes.7,8 Two of focused care in all these areas.14,15 (See sidebar.16,17) the most notable trends impacting primary care and Baccalaureate-level nurses particularly have a ground- RNs are discussed below. ing in leadership, research, and public health that enables them to address complex health and commu- nity-based needs.18,19 The Institute of Medicine (IOM)’s Value-Based Payment and Care landmark report Crossing the Quality Chasm: A New Health care is transitioning away from hospital-centric Health System for the 21st Century identified nursing models of care delivery to those that address social as the largest component of the health care workforce determinants of health and are community based, in a key position to improve client safety and influence prevention and wellness oriented, and focused on the health care system.20 Evidence supports the impor- optimizing client health independence. This shift tance of RN roles working within interprofessional elevates the importance of primary care in improving teams in achieving better outcomes.21 Many of the client and population health (whether defined by geo- Affordable Care Act regulatory measures and Centers graphical boundaries or specific characteristics) and for Medicare & Medicaid Services (CMS) quality met- reducing cost.9–11 rics link to functions and competencies that are carried out through nursing roles and responsibilities.22 Changing payment models that tie payment to out- comes are setting new expectations for efficiency and effectiveness. Combined with growing demand and provider shortages, this is driving organizations Definitions providing primary care to develop new skill sets and Nursing is the protection, promotion, and optimiza- reconfigure their resources.12 Many are expanding tion of health and abilities, prevention of illness and capacity by implementing team-based, client-centered injury, alleviation of suffering through the diagnosis care models in which providers work collaboratively and treatment of human response, and advocacy in the care of individuals, families, communities, and with other team members to allow for larger patient populations. panels and additional services. — AMERICAN NURSES ASSOCIATION Professional ambulatory care nursing is a com- plex, multifaceted specialty that encompasses independent and collaborative practice. The com- prehensive practice of ambulatory care nursing is one
Load more

Recommended publications
  • Measuring Nurse Workload in Ambulatory Care
    Thomas Jefferson University Jefferson Digital Commons College of Nursing Faculty Papers & Presentations Jefferson College of Nursing September 2005 Measuring nurse workload in ambulatory care Beth Ann Swan PhD, CRNP Thomas Jefferson University Karen F. Griffin MSN, RN, CNAA South Texas Veterans Healthcare System Follow this and additional works at: https://jdc.jefferson.edu/nursfp Part of the Nursing Commons Let us know how access to this document benefits ouy Recommended Citation Swan, Beth Ann PhD, CRNP and Griffin, Karen F. MSN, RN, CNAA, "Measuring nurse workload in ambulatory care" (2005). College of Nursing Faculty Papers & Presentations. Paper 6. https://jdc.jefferson.edu/nursfp/6 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in College of Nursing Faculty Papers & Presentations by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Beth Ann Swan Perspectives in Ambulatory Care Karen F. Griffin Measuring Nursing Workload in Ambulatory Care nursing time required to care for patients. However, Executive Summary time is not the only factor to consider when measur- ᮣ Nurses and adequate nurse staffing are critical to ing nursing workload, a prerequisite for developing the delivery of safe, cost-effective, and quality ambulatory care nurse staffing models.
    [Show full text]
  • AAACN Core 06
    Contents SECTION ONE The Organizational/Systems Role of the Ambulatory Care Nurse 1 Ambulatory Care Nursing Specialty Practice . 3 2 The Ambulatory Care Practice Arena . 15 3 The Context of Ambulatory Care Nursing . 29 4 The Ambulatory Care Team. 49 5 Practice/Office Support . 59 6 Health Care Fiscal Management . 73 7 Informatics . 85 8 Legal Aspects of Ambulatory Care Nursing . 99 9 Patient Advocacy . 117 10 Staffing and Workload . 127 11 Telehealth Nursing Practice. 137 SECTION TWO The Professional Nursing Role in Ambulatory Care 12 Leadership . 153 13 Evidence-Based Practice . 165 14 Ethics . 183 15 Regulatory Compliance and Patient Safety. 191 16 Professional Development . 201 SECTION THREE The Clinical Nursing Role in Ambulatory Care 17 Application of the Nursing Process in Ambulatory Care. 215 18 MulticulturalAmerican Nursing Care in the Ambulatory Academy Care Setting. of. 237 19 Patient© Education and Counseling . 253 20 Care of the Well Patient: Screening and Preventive Care. 267 21 Care of the Acutely Ill Patient . 289 22 Care of theAmbulatory Chronically Ill Patient. .Care . .Nursing . 321 23 Care of the Terminally Ill Patient . 385 Glossary. 415 Index . 427 This file is provided as a sample only and may not be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, or via any information storage or retrieval system. XV Chapter 1 Ambulatory Care Nursing Specialty Practice Sheila A. Haas, PhD, RN, FAAN Objectives Key Points Study of the information presented in this chapter will 1. The definition of ambulatory care nursing must enable the learner to: delineate the scope and unique dimensions of 1.
    [Show full text]
  • A Primary Care Nursing Perspective on Chronic Disease Prevention and Management Cynthia D
    DOI: 10.32481/djph.2017.03.011 A Primary Care Nursing Perspective on Chronic Disease Prevention and Management Cynthia D. Griffin, MS, BSN, RN, CPHQ, CCM Director of Nursing Services EXECUTIVE SUMMARY Today, there is growing interest in advancing health care outcomes through the utilization of registered nurses in ambulatory settings such as primary care facilities. Western medicine exist a longstanding ethos that promulgates the treatment of acute illnesses and injuries, but as the field progresses, so should our focus. There is a need today to focus on and grow the fields of preventative care and chronic disease management.1 In America today we have an aging population. According to the most recent consensus projections, the proportion of the US population aged 65 or older is expected to rise from 12.7 percent to 19.3 percent in 2030.2 As the population continues to age a dramatic growth in demand for health care services will be seen.1 Historically, physicians cared for patients individually in their private practices. Due in large part to their smaller size, many of these physician practices, do not utilize RNs and in where RNs are used their primary role is to triage telephone calls. As we move into the 21st century and demands on healthcare systems, physicians, and accountable care organizations are to meet and manage the health care needs of the communities where they are located in the most optimal way possible.3 This article will explore the importance of the role of the RN in the Primary Care setting and their role in managing and preventing chronic diseases in the population they serve.
    [Show full text]
  • Nursing Telehealth Practice – RN, LPN, NT, and NA
    Advisory Opinion: NCAO 25.00 Nursing Telehealth Practice – RN, LPN, NT, and NA Department of Health Nursing Care Quality Assurance Commission Advisory Opinion An advisory opinion adopted by the Nursing Care Quality Assurance Commission (NCQAC) is an official opinion about safe nursing practice (WAC 246-840-800). The opinion is not legally binding and does not have the force and effect of a duly promulgated regulation or a declaratory ruling by the NCQAC. Institutional policies may restrict practice further in their setting and require different expectations to assure their patients’ safety and decrease risk. Title: Nursing Telehealth Practice: Registered Nurse, Number: NCAO 25.00 Licensed Practical Nurse, Nursing Technician, and Nursing Assistant References: See References and Resources (Page 5-6) Contact: Deborah Carlson, MSN, RN, Director of Nursing Practice Phone: 360-236-4703 Email: [email protected] [email protected] Effective Date: March 12, 2021 Supersedes: Telehealth/Telenursing for Nurses (Undated) Approved By: Nursing Care Quality Assurance Commission (NCQAC) Conclusion Statement The appropriately trained and competent registered nurse (RN), licensed practical nurse (LPN), nursing technician (NT), and nursing assistant-certified/nursing assisted-registered (NA-C/NA- R) may perform telehealth nursing care using telehealth technologies within their legal scope of practice, regulatory requirements, and practice standards. The individual must be credentialed in Washington State to provide telehealth nursing services to individuals/patients located in Washington unless a qualified exception applies. The individual providing telehealth services to patients located in other states, U.S. territories, or countries must comply with licensing, practice requirements, and laws and rules for that jurisdiction.
    [Show full text]
  • American Academy of Ambulatory Care Nursing
    The Role of the Registered Nurse in Ambulatory Care Position Statement Background Health care is in the midst of unprecedented change. Improving the health of our nation will require reframing our health care system from one that emphasizes acute, episodic, interventional care to one that engages patients and providers together, in health promotion, disease prevention and early intervention. (Bodenheimer, Bauer, Syer, & Olayiwola, 2015). As a result, this enhancement of the Role of the Registered Nurse in Ambulatory Care position statement (AAACN, 2011) reflects current trends and changes to the RN role in response to the changing healthcare environment. Across the continuum of care, ambulatory care registered nurses (RNs) work independently and collaboratively, partnering with patients, caregivers, providers, and other health care professionals in the design and provision of care in an ever expanding array of settings. The context of the ambulatory care environment is complex, rapidly changing, and often difficult to navigate. Care delivery design and implementation is directly influenced by social determinants, environmental factors, and access to care issues that impact the patient’s ability to adhere to a prescribed plan of care and obtain needed services (Fraher, Spetz & Naylor, 2015; Lamb, 2014; Smolowitz, et. al., 2014). Concurrently, health care is rapidly evolving to meet the needs of an increasingly diverse and aging population. At the same time health care costs are driving value-based reimbursement and innovative models of care. Ambulatory care RNs are well-prepared to assume an expanded role in the design and delivery of high quality care, defying traditional boundaries, and working in redefined interprofessional relationships, expanded community partnerships, and non-traditional health care settings.
    [Show full text]
  • Telehealth Nursing Practice Resource Directory Sample Pages
    TELEHEALTH NURSING PRACTICE of Resource Directory 2011 Edition Nursing Academy Copyright 2011 American Academy of AmbulatoryCare Care Nursing East Holly Avenue/Box 56 Pitman, NJ 08071-0056 800-AMB-NURS (262-6877) FAX: 856-589-7463 E-mail: [email protected] Web site: aaacn.org ©American Ambulatory All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without the permission of the American Academy of Ambulatory Care Nursing. TELEHEALTH NURSING PRACTICE RESOURCE DIRECTORY T A B L E O F C O N T E N T S Professional Standards .......................................................................... 4 Decision Support Tools ...........................................................................5 Textbooks ...............................................................................................12of Nursing Journals ....................................................................................25 Articles ...................................................................................................34 Standard Reference Works ....................................................................42 Web sites ................................................................................................51Nursing Academy Listservs, Electronic Newsletters & Publications ...............................64 Health & Wellness Newsletters .............................................................68Care
    [Show full text]
  • Leveraging National Reports to Transform Ambulatory Care Practice
    Thomas Jefferson University Jefferson Digital Commons College of Nursing Faculty Papers & Presentations Jefferson College of Nursing 4-2017 Leveraging National Reports to Transform Ambulatory Care Practice Anne T. Jessie Evolent Health, Roanoke, VA Beth Ann Swan Thomas Jefferson University Follow this and additional works at: https://jdc.jefferson.edu/nursfp Part of the Nursing Commons Let us know how access to this document benefits ouy Recommended Citation Jessie, Anne T. and Swan, Beth Ann, "Leveraging National Reports to Transform Ambulatory Care Practice" (2017). College of Nursing Faculty Papers & Presentations. Paper 89. https://jdc.jefferson.edu/nursfp/89 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in College of Nursing Faculty Papers & Presentations by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Anne T. Jessie Perspectives in Ambulatory Care Beth Ann Swan Leveraging National Reports to Transform Ambulatory Care Practice EXECUTIVE SUMMARY Multiple national reports identify actionable recom - mendations to transform education and practice to meet the needs of health care and healthcare deliv - ery beyond the hospital walls. S HEALTHCARE REFORM con - The Josiah Macy Jr.
    [Show full text]
  • Standards of Practice for Professional Ambulatory Care Nursing
    Table of Contents Scope and Standards Revision Team . .2 Introduction . 5 Overview of the AAACN Standards 9th Edition . 5 Scope of Practice for Professional Ambulatory Care Nursing . 6 I. Definition of Professional Ambulatory Care Nursing . 6 II. Conceptual Framework . 7 III. Evolution of Modern Ambulatory Care and Nursing Practice . 9 IV. Practice Environment . of. 10 V. The Science and Art of Ambulatory Care Nursing Practice . 12 VI. Ambulatory Care Nursing Roles . .13 VII. Professional Trends and Issues . 14 Standards of Practice for Professional Ambulatory Care Nursing . 17 Standards of Professional Clinical Practice . .19 Standard 1: Assessment . 21 Standard 2: Diagnoses . 22 Standard 3: Outcomes Identification . Nursing. 23 Standard 4: Planning . 24 Standard 5: Implementation . 25 5a: Coordination of Care . 26 5b: Health Teaching and Health PromotionAcademy . 27 5c: Telehealth Services . 28 5d: Consultation . 29 Standard 6: Evaluation . Care. 30 Standards of Nursing Organizational and Professional Performance . 31 Standard 7: Ethics . .33 Standard 8: Education . 34 Standard 9: Research and Evidence-Based Practice . .35 Standard 10: Performance Improvement . 36 Standard 11: Communication . 37 Standard 12: Leadership . .38 Standard 13: Collaboration . 40 Standard 14: Professional Practice Evaluation . .41 StandardAmerican 15: Resource Utilization . .42 Standard 16: Environment . .43 © Glossary . 44 References . 46 AmbulatoryAdditional Readings . 47 Scope and Standards of Practice for Professional Ambulatory Care Nursing – 9th Edition – 2017 3 Introduction he American Academy of Ambulatory Care Overview of the AAACN Standards 9th TNursing (AAACN) is the specialty nursing organ- Edition ization for nurses practicing in ambulatory care set- In 1987, AAACN published the first edition of the tings. AAACN is responsible for establishing and standards.
    [Show full text]
  • Telehealth Nursing Practice Special Interest Group a Telehealth Manager’S Toolkit
    Telehealth Nursing Practice Special Interest Group A Telehealth Manager’s Toolkit Editors: Rocquel Crawley, MBA, BSN, RNC-OB, NEA-BC and Pam Kuchta, MBA, BSN, RNC Introduction R. Crawley, MBA, BSN, RNC-OB, NEA-BC & P. Kuchta, MBA, BSN, RNC-TNP 2011-2012 AAACN TNP SIG Co-Chairs Telehealth is the delivery, management, and coordination of health services that integrate electronic information and telecommunications technologies to increase access, improve outcomes, and contain or reduce costs of health care. Telehealth is an umbrella term used to describe the wide range of services delivered across distances by all health-related disciplines (AAACN, 2011). Telehealth Nursing Practice is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of ambulatory care nursing. Telehealth nursing is a broad term encompassing practices that incorporate a vast array of telecommunications technologies (e.g., telephone, fax, email, Internet, video monitoring, and interactive videos) to remove time and distance barriers for the delivery of nursing care (Espensen, 2009). Telehealth Nursing Practice (TNP) is recognized as a nursing subspecialty of ambulatory care nursing by the American Academy of Ambulatory Care Nursing (AAACN). AAACN has worked to formalize the practice of Telehealth Nursing by developing a Telehealth Nursing Practice Core Course (TNPCC), the Scope and Standards of Practice for Professional Telehealth Nursing , the Telehealth Nursing Practice Essentials (TNPE) textbook, competencies, and included a chapter on Telehealth Nursing Practice in the C ore Curriculum for Ambulatory Care Nursing . AAACN also offers a TNP track at their annual conference and includes many Telehealth articles in ViewPoint , AAACN’s bi-monthly newsletter.
    [Show full text]
  • Comprehensive Health Care Program for American Indians & Alaska Natives
    DOCUMENT RESUME ED 414 114 RC 021 231 TITLE Comprehensive Health Care Program for American Indians & Alaska Natives. INSTITUTION Indian Health Service (PHS/HSA), Rockville, MD. PUB DATE 1994-00-00 NOTE 55p.; Photographs may not reproduce adequately. PUB TYPE Reports Descriptive (141) EDRS PRICE MF01/PC03 Plus Postage. DESCRIPTORS *Alaska Natives; *Allied Health Occupations Education; American Indian Reservations; *American Indians; Delivery Systems; Elementary Secondary Education; Federal Indian Relationship; Health Education; Health Occupations; *Health Programs; Health Services; Medical Education; Postsecondary Education; *Public Health; Special Health Problems; Technical Education; Tribes IDENTIFIERS *Indian Health Service ABSTRACT This booklet summarizes programs of the Indian Health Service (IHS). The IHS was created in 1954 as part of the Public Health Service when responsibility for American Indian and Alaska Native health care was transferred from the Department of the Interior's Bureau of Indian Affairs to the Department of Health, Education, and Welfare. The goal of the IHS is to raise the health status of American Indians and Alaska Natives to the highest possible level. Since 1955 the average life expectancy for American Indians and Alaska Natives has risen 19%; mortality rate among Indians with tuberculosis has decreased 96%; and infant mortality rates have decreased 85%. These improved health numbers are the result of stronger central program supervision, more qualified staff, and an accelerated public health program, including
    [Show full text]
  • 2002 Subject & Author Index
    2002 SUBJECT INDEX Academic Nursing In Memory Quality Indicators for Academic Nursing Primary Care Centers, 62 In Memory of Margaret D. Sovie, 234 Advance Practice Nurses Leadership Roundtable The Role of Advance Practice Nurses in Community Settings, Responses to the Nursing Shortage: Policy, Press, Pipeline, and 102 Perks, 287 Case Management Legal Issues Case Management: An Evaluation at Childrens Hospital in Los Legal Issues in Performing Patient Safety Work, 118 Angeles, 22 Letters (Department) Editorial (Department) Recent Events Highlight Importance of Mental Health Services, 39 First, Do No Harm, 5 Technology and Patient Safety, 194 Dare to Care, 57 Comments Regarding Nursing Program Completion Time, 206 A Question About Leadership, 101 Commitment vs. Compliance: The Key to Sustainable Change, Nursing Administration/Management 153 Nurse Practitioners and Physician Assistants in Hospital Your Greatest Business Asset Is Masterful, Middle-Aged, Mad, Outpatient Departments, 1997-1999, 174 and Mobile, 205 Your Greatest Business Asset Is Masterful, Middle-Aged, Mad, Culture Eats Strategy for Lunch Every Time, 257 and Mobile, 205 Failure: Lessons for Health Care Leaders, 225 ExecuSearch (Department) Patient-Focused Redesign and Employee Perception of Work Faculty Position Available, 144 Environment, 163 Nurses, Long-Term Care, and Eldercare: An Impact on Work Gender Earnings Gap Performance, 266 The Gender Earnings Gap in the RN Labor Market, 155 Unlicensed Assistive Personnel Retention and Realistic Job Previews, 279 Health Literacy
    [Show full text]
  • Nurses and Clinical Technology: Sources of Resistance and Strategies for Acceptance
    Information Systems & Technology Debra Kirkley Maribeth Stein Nurses and Clinical Technology: Sources of Resistance And Strategies for Acceptance To explore the specific reasons behind this resis- Executive Summary tance, an electronic roundtable was conducted fol- ᮣ Many organizations in the process of introducing lowed by phone interviews with nurse leaders at four online clinical documentation and other nursing health care organizations: three in the United States functionality have experienced resistance — at and one in the United Kingdom. The goal was to elic- least initially — from the nursing staff. it candid opinions and anecdotes from nurse execu- ᮣ Rather than meeting these objections individual- tives on the front lines of technology initiatives. ly, implementing clinical information systems (CIS) requires organization-wide change manage- These individuals are nurse leaders in organizations ment initiatives that put the need for automated that have successfully made the leap to automated processes in a global perspective. systems, and their experiences provide insight into ᮣ A roundtable discussion with nurse leaders identifying and circumventing the obstacles that can revealed that cultural and societal factors may arise during technology rollouts. play a larger role in nurses’ willingness to The respondents focused on three fundamental embrace the CIS than attitudes toward computers questions: themselves. •Why are some nurses reluctant to adopt CIS? •Can you identify the types of nurses who are more SMOREHEALTHCAREorganizations
    [Show full text]