58% of nurses currently work in an acute care setting. But, as providers start to manage health rather than treat illness, we expect inpatient days to decline. The number of hospital-based nursing jobs also may shrink.
A couple of years ago at an AONE conference, leaders shared their research on new nursing roles. These roles correspond to the ways hospitals will transform to encompass the full continuum of care. Different roles contribute to varying strategic models for managing the health of a population.
Emerging (or newly paramount) roles for nurses
New non-acute-care roles are not organized in a traditional framework. Instead, nursing practice reinvents itself along longitudinal rather than hierarchical structures. This offers better outcomes for patients and families.
Whether at the individual, family or community level, Care Coordinators work across the continuum of care to manage gaps between providers. RN Care Coordinators work in partnership with patients, families, nurses, and other disciplines. This improves outcomes, assists collaboration among caregivers, and decreases cost and risk to patients.
By focusing on patient population coordination, the RN Care Coordinator assures that needs are met across people, functions, and sites. For example, a Congestive Heart Failure (CHF) patient may be under medical care of more than one provider. They may risk redundant testing, have multiple prescriptions, need dietary counseling, and participate in a therapeutic exercise program. Due to its complexity, managing CHF across the continuum can become a fragmented effort, risking communication failures and errors. A misstep could result in a hospital readmission.
The RN Care Coordinator helps to connect the dots of the treatment plan. They identify gaps and redundancy and verify the patient’s comprehension and willingness to comply. This ensures optimal outcomes and keeps the patient out of the hospital.
Nurses who work as informatics specialists develop technological applications and products. Sometimes they devise digital ways to help consumers track and manage their health with instant feedback. In other cases, they make systems and interfaces easier for nurses and patients to use, reducing the potential for errors.
Community-based facilitators are like “public nurses on steroids.” They know the kids in the gangs, teachers, families, students, church leaders, agency staff, and the police. They have the ability to address social determinants of health such as violence and substance abuse before major health problems develop. They bring health and wellness resources to individuals where they live and work.
Primary Care Partner
In this scenario, an RN without Advanced Practice certification teams with a provider to expand the capacity of primary care. Primary care partners provide intake screening and preventative care, and manage stable chronic conditions via protocols. In a school-based community clinic, they may serve as an adjunct to a school nurse by caring for family members of the students. Currently, few RNs work in community health clinics due to existing reimbursement models. An innovative preceptor model may need to support RNs moving into this new practice environment. Nurses are in a unique position to partner with other leaders. They are sophisticated about networking with various disciplines, the community, patients, and families.
How new nursing roles link to a hospital’s population health strategy
Based upon their circumstances, hospitals gravitate towards one of the following prototypes for managing a population at risk.
The Aggregator hospital system accentuates improving cost efficiency with a low tolerance for variation. Standardization and economies of scale drive down unit costs. This method is common in for-profit hospitals. Requires nursing role: Care Coordinator.
Health Manager Model
Health Managers integrate care across the continuum to manage utilization and prevent the onset or progression of disease. They use demographic data to identify high risk populations. Like Kaiser, these organizations emphasize physician alignment and preventative/ primary care to contain costs. Requires nursing roles: Care Coordinators, Informatics Specialists, Community-Based Facilitators, Primary Care Partners.
Connector organizations deliver a narrow set of facility-based services. They frequently transfer high-acuity patients to affiliated providers. Rural hospitals often fall into this category. Requires nursing roles: Care Coordinators, Informatics Specialists, Community-Based Facilitators, Primary Care Partners.
Innovator organizations maximize reimbursements through premium contracts and reimbursement rates. Academic medical centers typify this model. Rather than managing costs, they focus on improving revenue performance. Requires nursing roles : Informatics Specialists, Care Coordinators.
Differentiators improve revenue performance by offering enhanced conveniences and amenities at a premium. More consumer-oriented than the other types, these boutique organizations capture a greater “share of the wallet.” Requires nursing roles: Informatics Specialists, Primary Care Partners.
As “Early Adopter” organizations reinvent themselves, Catalyst helps them measure:
- Efficiency and standardization
- Care transition
- Directed outmigration of patients
- Quality outcomes and patients experience
- Costs per episode of care.
The model establishes themes of nursing practice integration in a challenging new environment of healthcare. Nurses can lead the charge in capitalizing upon new opportunities in prevention, wellness, and managing chronic illness.