The CCNR Addresses Needs at a Pivotal Point in Nursing History
In today’s acute-care environment, new RNs are being called on increasingly to (1) fill primary-care roles in preventing acute-care episodes and disease progression, (2) master technological tools and complex information-management systems in improving quality of care, (3) coordinate care and collaborate with a variety of health professionals, (4) expand leadership opportunities, and (5) engage in collaborative improvement efforts (IOM, 2010). How well are nurses doing in meeting these expectations? Do we know? If not, how can we know?
The keys to answering these questions are (1) possession of robust, timely nursing data and (2) expertise in using those data to maximize nursing-specific outcomes. And possessing those keys is a new nurse-empowerment vehicle called the Colorado Collaborative for Nursing Research (CCNR).
Passage of the Patient Protection and Affordable Care Act (PPACA, 2010) has shifted the scope and nature of US healthcare delivery in ways we cannot yet fully comprehend. Moreover, the Institute of Medicine (IOM, 2010) has recently issued four recommendations intended to shape the future of nursing, with the last two being the most pertinent to this topic. IOM recommendation number three is that nurses form partnerships with physicians and other healthcare professionals to improve health care; the fourth IOM recommendation is that nurses use data far more effectively. In sum, then, at the same time as the PPACA throws open the chance to redesign the US healthcare system, the IOM advocates that nurses exercise data-use mastery and proactivity in crafting the as-yet-determined future of American health care.
Yes, to be sure, this is a pivotal time!
Need #1: The Need for a Fresh Perspective
Making a sea change in nursing practice means making a sea change in nursing viewpoint, which means making a change from living in the actual to living in the potential. The profession of nursing has been for too long “living in the actual” (Porter-O’Grady, 2003, pg. 44): basing actions mainly on awareness of the present; planning for the future by extrapolating from current conditions; and focusing primarily on one’s own work rather than system-level work. Instead, we need to shift to “living in the potential” (Porter-O’Grady, 2003, pg. 44): being aware of a reality that is not-yet-existent but inevitable; emphasizing outcomes, change, and teamwork. We need to develop nursing-care systems that are efficient, effective, productive, data-driven, and value-driven (Welton, 2013). Shared funding resources and pooled, large data sets are essential.
Shifting from living in the actual to living in the potential is part of the CCNR mission.
Need #2: The Need for Partnerships between the Academic and Delivery Sides of Health Care
The CCNR makes the CU College of Nursing’s (CON’s) research facilities, research-support personnel, and research faculty available to external stakeholders who have innovative research ideas but lack research experience and/or infrastructure.
The goal of increasing the number of patients who have access to and receive evidence-based care seems to have two distinct approaches. The first is a bottom-up approach (“The evidence-based care is out there, but more people need access to it”); the second is a top-down approach (“The amount of evidence on which to base nursing best practices is insufficient because not nearly enough nursing research is being conducted and applied”). The CCNR takes the top-down approach to expanding the availability of evidence-based care, merging academic and clinical sides to generate more top-quality nursing research and get it translated to practice.
Need #3: The Need to Isolate and Quantify the Discrete Value of Nursing
The Patient Protection and Affordable Care Act (PPACA) Funding Squeeze. The PPACA pegs healthcare-facility incentive payments to quality-care metrics. As a result, to function in the new PPACA healthcare environment, healthcare facilities must (a) document and track mandated metrics and (b) understand those metrics’ responsiveness to specific patient-care practices.
The Challenge of Nursing Valuation. Nurses practice “in the in-between social spaces of medical diagnosis and treatment and the patient’s lived experience of illness or prevention of illness” (Benner et al., 2010, pg. 31). Clearly, putting a dollar figure on this concept is hard; thus, monetizing nursing practice is a challenge. But both access to patients and occupation of social spaces put nurses in optimal surveillance positions: assessing patients, delivering therapeutic intervention, and coordinating/integrating care (IOM, 2004). Therefore, plotting points on the patient health trajectory and anticipating/projecting future points on that trajectory fall within nursing’s purview. And knowing the future points on a patient’s health trajectory is of substantial value to healthcare providers.
Pinpointing the Value of Nursing. The following is an optimal acute-care sequence: (a) effective patient assessment (derived from quality nursing care), followed by (b) effective patient surveillance (derived from quality nursing care), followed by (c) effective patient-status management (derived from quality nursing care), followed by (d) effective projection of patient-health trajectory (derived from quality nursing care), leads to (e) desired patient outcomes (e.g., lower 30-day readmission rates) and (f) more effective cost-management strategies (which is an existential healthcare necessity). The key to codifying and replicating this sequence is the identification of best nursing practices, those practices that lead directly to desired patient outcomes.