Power to the Patient:The Medical Strategist

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The wide range of effective leadership programs now available for nurses is illustrated by the examples described below.

The challenge is to better utilize these opportunities to develop a greater number of nursing leaders. The Integrated Nurse Leadership Program INLP , 6 funded by the Gordon and Betty Moore Foundation, works with hospitals in the San Francisco Bay area that wish to remodel their professional culture and systems of care to improve care while dealing more effectively with continual change. INLP has found that the development of stable, effective leadership in nursing-related care is associated with better-than-expected patient care outcomes and improvements in nurse recruitment and retention.

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The impact of the program will be evaluated to produce models that can be replicated in other parts of the country. The Wharton Fellows program has changed in many ways since then in response to the evolving health care environment, according to a review Shea, The program also aims to improve such leadership competencies as systems thinking, negotiation, communications, strategy, analysis, and the development of learning communities.

Its offerings will likely undergo yet more changes as hospital chief executive and chief operating officers increasingly come from the ranks of the nursing profession. The Robert Wood Johnson Foundation Executive Nurse Fellows Program 8 is an advanced leadership program for nurses in senior executive roles who wish to lead improvements in health care from local to national levels.

It provides a 3-year in-depth, comprehensive leadership development experience for nurses who are already serving in senior leadership positions. The fellowship program includes curriculum and program activities that provide opportunities for executive coaching and mentoring, team-based and individual leadership projects, professional development that incorporates best practices in leadership, as well as access to online communities and leadership networks.

Best on Board 9 is an education, testing, and certification program that helps prepare current and prospective leaders to serve on the governing board of a health care organization. Its CEO, Connie Curran, is a registered nurse RN who chaired a hospital nursing department, was the dean of a medical college, and founded her own national management and consulting services firm.

A review cites the growing recognition by blue ribbon panels and management researchers that nurses are an untapped resource for the governing bodies of health care organizations. Fellows work on Capitol Hill with elected officials and congressional staff. The goal is for fellows to use their academic and practice experience to inform the policy process and to improve the quality of policies enacted.

Investigators are funded to complete innovative studies of topics relevant to current and future health policy. Participants in both programs receive intensive training to improve the content and delivery of messages intended to improve health policy and practice. This training is critical, as investigators are often called upon to testify to Congress about the issues they have explored. The health policy fellows bring their more detailed understanding of how policies are formed back to their home organizations.

In this way, they are more effective leaders as they strive to bring about policy changes that lead to improvements in patient care. Although not an individual leadership program, the American Nurses Credentialing Center ANCC Magnet Recognition Program 11 recognizes health care organizations that advance nursing excellence and leadership. In this regard, achieving Magnet status indicates that the nursing workforce within the institution has attained a number of high standards relating to quality and standards of nursing practice. Some of these Forces include quality of nursing leadership, management style, quality of care, autonomous nursing care, nurses as teachers, interprofessional relationships, and professional development.

Leadership is also fostered through effective mentorship opportunities with leaders in nursing, other health professions, policy, and business. All nurses have a responsibility to mentor those who come after them, whether by helping a new nurse become oriented or by taking on more formal responsibilities as a teacher of nursing students or a preceptor. Nursing organizations membership associations also have a responsibility to provide mentoring and leadership guidance, as well as opportunities to share expertise and best practices, for those who join.

Fortunately, a number of nursing associations have organized networks to support their membership and facilitate such opportunities:. Nurses may articulate what they want to happen in health care to make it more truly patient centered and to improve quality, access, and value. They may even have the evidence to support their conclusions. As with any worthy cause, however, they must engage in the policy-making process to ensure that the changes they believe in are realized.

To this end, they must be able to envision themselves as leaders in that process and seek out new partners who share their goals. The challenge now is to motivate all nurses to pursue leadership roles in the policy-making process. Political engagement is one avenue they can take to that end. For example, engaging school board candidates about the fundamental role of school nurses in the management of chronic conditions among students can make a difference at budget time.

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And if the goal is broader, perhaps to locate more community health clinics within schools, achieving buy-in from the local school board is absolutely vital. Political engagement can be a natural outgrowth of nursing experience. In February , Ms. Tavenner was named deputy administrator for the federal Centers for Medicare and Medicaid Services. Like many nurses, she had never envisioned working in government. But she realized that she wanted to have an impact on health care and health care reform. She wanted to help the uninsured find resources and access to care.

For her, that meant building on relationships and finding opportunities to work in government.

Power to the Patient: The Medical Strategist

Other notable nurses who have answered the call to serve in government include Sheila Burke, who served as chief of staff to former Senate Majority Leader Robert Dole, has been a member of the Medicare Payment Advisory Commission, and now teaches at Georgetown and Harvard Universities; and Mary Wakefield, who was named administrator of HRSA in and is the highest-ranking nurse in the Obama Administration. The fellowship rotates among three branches of service Army, Navy, and Air Force annually.

Shirley Chater led the reorganization of the Social Security Administration in the s. Carolyne Davis served as head of the Health Care Finance Administration predecessor of the Centers for Medicare and Medicaid Services in the s during the implementation of a new coding system that classifies hospital cases into diagnosis-related groups.

From to , Rhetaugh Dumas was the first nurse, the first woman, and the first African American to serve as a deputy director of the National Institute of Mental Health Sullivan, Lois Capps organized and co-chairs the Congressional Nursing Caucus which also includes members who are not nurses.

The group focuses on mobilizing congressional support for health-related issues. None of these nurses waited to be asked; they pursued their positions, both elected and appointed, because they knew they had the expertise and experience to make changes in health care. Very little in politics is accomplished without preparation or allies. Health professionals point with pride to multiple aspects of the Prescription for Pennsylvania initiative, a state health care reform initiative that preceded the ACA and is also described in Box As is clear from a detailed review, success was not achieved overnight; smaller legislative and regulatory victories set the stage starting in the late s.

Even some apparent legislative failures built the foundation for future successes because they caused nurses to spend more time meeting face to face with physicians who had organized opposition to various measures. As a result, nursing leaders developed a better sense of where they could achieve compromises with their opponents. They also found a new ally in the Chamber of Commerce to counter opposition from some sections of organized medicine Hansen-Turton et al.

Case Study: Prescription for Pennsylvania.

2. Kevin M.D.

Hansen-Turton and colleagues draw three major lessons from this experience. First, nurses must build strong alliances within their own professional community, an important lesson alluded to earlier in this chapter. Second, nurses must build relationships with key policy makers. Third, nurses must find allies outside the nursing profession, particularly in business and other influential communities. Perhaps the most important lesson to draw from the Pennsylvania experience lies in the way the campaign was framed.

The focus of attention was on achieving quality care and cost reductions. A closer examination of the issues showed that achieving those goals required, among other things, expanding the roles and responsibilities of nurses. What drew the greatest amount of political support for the Prescription for Pennsylvania campaign was the shared goal of getting more value out of the health care system—quality care at a sustainable price. The fact that the campaign also expanded nursing practice was secondary. Those expansions are likely to continue as long as the emphasis is on quality care and cost reduction.

Similarly, the committee believes that the goal in any transformation of the health care system should be achieving innovative, patient-centered, highvalue care. If all stakeholders—from legislators, to regulators, to hospital executives, to insurance companies—act from a patient-centered point of reference, they will see that many of the solutions they are seeking require a transformation of the nursing profession. Having enough nurses and having nurses with the right skills and competencies to care for the population is an important societal issue.

Having allies from outside the profession is important to achieving this goal. More nurses need to reach out to new partners in arenas ranging from business, government, and philanthropy to state and national medical associations to consumer groups. Additionally, nurses need to fortify alliances that are made through personal connections and relationships. Just as important, society needs to understand its stake in ensuring that nurses are effective full partners and leaders in the quest to deliver quality, high-value care that is accessible to diverse populations.

The full potential of the nursing profession in care, leadership, and research must be tapped to deal with the wide range of health care challenges the nation will face in the coming years. Eventually, to transform the way health care is delivered in the United States, nurses will have to move not just out of the hospital, but also out of health care organizations entirely. For example, nurses are underrepresented on the boards of private nonprofit and philanthropic organizations, which do not provide health care services but often have a large impact on health care decisions.

The Commonwealth Fund and the Kaiser Family Foundation, for instance, have no nurses on their boards, although they do have physicians. Without nurses, vital ground-level perspectives on quality improvement, care coordination, and health promotion are likely missing. On the other hand, AARP provides a positive example.

At least two nurses at AARP have served in the top leadership and governance roles president and chair in the past 3 years. Nurses serve on the health and long-term services policy committee, and the senior vice president of the Public Policy Institute is also a nurse. Enactment of the ACA will provide unprecedented opportunities for change in the U.

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Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care.

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Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment. Gallup research staff—Richard Blizzard, Christopher Khoury, and Coleen McMurray—conducted telephone surveys with 1, individuals, including university faculty, insurance executives, corporate executives, health services leaders, government leaders, and industry thought leaders.

It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented.