Introduction
The 2010 Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, offers a blue print for transforming health care through changes in nursing education, practice, and leadership. With 2020 rapidly approaching, the lessons from that landmark report continue to inform how nurses can drive efforts to improve health and health care. Today, 51 state Action Coalitions are working to implement the Future of Nursing recommendations as part of the Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation, AARP, and the AARP Foundation.
As the largest segment of the health care workforce, and the providers with the most direct connection to patients and their families, nurses are well positioned to identify innovative solutions to problems. Nurses often bridge the divide between the system and the person, and work strategically with partners to implement and scale solutions in profound ways. Across the country, nurses are building a Culture of Health, by supporting positive patient experiences through a health care system that is easy to access and navigate; and by ensuring patient needs are met and patients are being heard, respected, and can contribute to decisions related to their own care.
At its core, the Pennsylvania Action Coalition (PA-AC) embraces innovation, because innovation is key to change. While definitions of innovation vary, all descriptions reflect the power of thinking differently -- whether it is a new product or idea or a different application or understanding of an existing idea -- and the potential impact of systems change.
The articles in this edition demonstrate how nurses are not only developing innovative ideas but also implementing these ideas creatively, effectively, and in collaboration with cross-sector and interprofessional partners.
The Pennsylvania Action Coalition
The PA-AC works with diverse stakeholders across sectors and disciplines and recognizes that the strength of a coalition comes as much from our differences as from our aligned goals. The two organizations leading the PA-AC appear quite different at first glance. Masimo is an international corporation that develops non-invasive technological solutions throughout the health care continuum from acute care through first responders and EMS settings. While, the National Nurse-Led Care Consortium (NNCC), a nonprofit affiliate of Public Health Management Corporation, advances nurse-led models of care to address health and wellbeing, typically in community-based settings. Yet, the organizations share a commitment to leveraging the power of nursing. As the Chief Nursing Executive at Masimo, Mike Becker’s role underlines the fact that technology will not improve care without insight and buy-in from the nurses charged with delivering that care. Meanwhile, programming at NNCC ranges from environmental health home visiting to value-based payment reform to federally-qualified health centers that serve public housing residents. With a public health focus, NNCC pushes expectations for how nurses lead and redefine health care delivery, quality, and wellbeing. For example, the Nursing-Legal Partnership, a public health home visiting program, integrates legal services attorneys into the health care team of nurses and their families and also builds relationships with local community organizations to address systemic problems impacting the communities they serve. Masimo and NNCC are joined by 22 other PA-AC Advisory Board Member Organizations, each offering substantial contributions to efforts to increase access to high quality, safe health care. On the PA-AC’s various committees, nearly 100 volunteers contribute to a vision shared by hundreds of thousands throughout the state -- a healthier Pennsylvania. This edition’s leadership profile on Amy Ricords, MEd, BSN, RN-BC is one example among many of PA-AC champions with a passion for transforming health care.
The Future of Nursing Innovation
When assessing health care challenges in the United States, the Institute of Medicine (now the National Academies of Medicine) identified nursing as key to the solution. There are many reasons why nursing was highlighted: the enormity of the nursing workforce, the abundance of nursing-sensitivity patient outcome measures, the unrealized potential for nurses to inform policy decisions, and more. However, the most compelling reason stems in large part from the foundations of nursing -- the humanistic core of the nursing discipline, which places the people first and emphasizes caring in health care. The future of nursing innovation will benefit from person-based solutions to quality and safety challenges.
In 2017, the PA-AC Coalition launched the inaugural Nursing Innovation Corps, through which interprofessional teams proposed innovative solutions to common health care problems facing the elderly. Winning teams shared ideas for better communicating fall risks through smart whiteboards and enhancing discharge education through a mobile game that tests understanding of medication instructions among patients and their caregivers. They also addressed the need to better support innovation and entrepreneurship by prioritizing interprofessional partnerships and recognizing that professional development is not only good for the professional and patients, but also impacts employers’ bottom lines. These types of programs are only beginning to receive the attention in nursing that they have in other disciplines. Some nursing schools are now offering majors and degrees in innovation, design thinking, and systems engineering. Other organizations like the IBC Foundation are investing in the nursing workforce of the future through evidence-based internships and mentorship.
Caring Across Disciplines
When we begin with the person, we may look differently at existing resources to meet important needs. At Fox Chase Cancer Center, innovation spawned efforts to better support family members and friends as caregivers. We also are now placing value on traditionally underappreciated skills stemming from emotional intelligence, as a priority across disciplines. At Robert Morris University, “standardized patients,” commonly employed for nursing simulations to develop interpersonal communication skills, are now being utilized to prepare teachers working on Individualized Education Plans and business executives cultivating strong workforce environments. Nurses also partner across disciplines and sectors to tackle seemingly impossible systemic challenges like homelessness and incarceration. Within this edition, nurses describe the creative partnerships taking place with partners including community health workers, prisons, and community members.
Changing Systems to Improve Quality and Safety
Many nursing innovations utilize technology, and we can expect technological advancements to continue to change how, and how well, health care is delivered. However, the theme that stands out across innovations, like the use of virtual reality to increase lay bystander CPR, wireless pulse oximetry monitoring for patients on opioids, and telemedicine intensive care units, is not the sophisticated technology, but rather the systems approach to quality improvement.
Looking ahead
In December 2017, the PA-AC made a formal commitment to the Patient Safety Movement Foundation and the mission to eliminate preventable deaths by 2020 (ox2020). Like many of our 2020 goals, we are motivated by a vision but will not be stopped by a deadline. The work laid out in The Future of Nursing: Leading Change, Advancing Health report, by the Patient Safety Movement and in other health transformation initiatives, will continue past 2020. However, it is the spirit of innovation, and the commitment to transformation, that will ultimate improve health and health care in Pennsylvania and beyond.