Those of us who've worked in health care for any significant period of time recognize we are in time of profound transition. Consumer expectations are greater, and the complexities that have enveloped the current health care landscape are at an all-time high. There is simply no escaping it ... ready or not, change is the new constant. The speed by which these alterations are occurring almost guarantees that the next era of health care will have little resemblance to that which has been intimately familiar to us for most of our careers.
We are in the midst of a paradigm shift in the way we have historically provided care in this country. The emphasis on wellness, primary prevention, and coordinated care mandates transference of focus from our traditional hospital-centric health system to a new community-centric system. This new focus prioritizes primary care, preventive care strategies, and an integrated care delivery approach that ensures consumers receive the right level of care, at the most appropriate and least costly care delivery site, and by the right complement of care team members. To continue to do what we've always done is simply no longer an option. Our care models must adapt in sizeable and innovative ways. For those of us who are ready, we believe this new context of health care could be a "game-changing" opportunity for advanced practice registered nurses (APRNs) and the nursing profession. Let us explain....
Legislators have expended tremendous effort to bring comprehensive change to US health care, with decision makers at every level sharing a common aim of competent, efficient, and accessible care to all Americans. Among the providers gauged to help achieve this monumental goal are APRNs!
Nurse leaders are charged with identifying worthy investments that demonstrate utility in a fee-for-service and value-based payment environment ... oftentimes, with payoff from day 1. These leaders must see APRNs as a powerful nursing resource, a part of a broader community of nursing clinical leaders extending and expanding the key role of nursing in assuring and advancing the health of all people. Nurse executives/leaders must reengage advanced practice as a fundamental part of the profession and see that these APRN roles are strategically and operationally aligned with the work of nursing, not simply as another category of the so-called and pejorative "midlevel providers." Strategically deployed advanced practitioners should top the investment priority list for nurse leaders, and with good reason.
This noteworthy issue begins with Anen and McElroy illustrating the role of nurse leaders in "championing" the integration of APRNs by using APRN-specific data to drive decision making and support an effective business and care delivery strategy. It continues with Taylor and colleagues from the Carolinas HealthCare System describing their 3-state, systemwide Advanced Practice strategy for its 1750 employed advanced practice providers (APPs), an approach that began with the formation of a robust Center for Advanced Practice and resulted in the country's largest postgraduate fellowship program for APPs.
Dr Edna Cadmus and colleagues emphasize the benefits of an entrepreneurial mind-set among APRNs to better appreciate their contribution to practice operations. In addition, they share the results of a recent Needs Assessment Survey designed to better understand the business and practice management knowledge of APRNs. Along those lines, Wendy Wright, a nurse practitioner (NP) business owner in New Hampshire describes the success of the nation's first Patient Centered Shared Savings Program composed of patients managed by NPs employed within NP-owned and -operated clinics. The statistics of this inaugural accountable care organization (ACO) are quite compelling and establish a precedent to support broader inclusion of APRNs in ACOs across the board.
While the demand for advanced practitioners has skyrocketed over the past several years, a greater supply alone is insufficient to realize their full value. The key is a carefully designed approach, followed by strategic deployment. The aim of this issue is to provide nurse leaders with a collection of robust tools to accomplish just that.
It is our sincere desire that you find as much value in reading these articles as we did in putting them together. We extend our heartfelt gratitude to the talented authors for sharing their exceptional work with us and the broader health care community.
-Michelle L. Edwards, DNP, APRN, FNP, ACNP, FAANP
System Vice President
Advanced Practice
Catholic Health Initiatives
Denver, Colorado
-Tim Porter-O'Grady, DM, EdD, ScD(h), APRN, FAAN, FACCWS
Senior Partner, Health Systems
Tim Porter-O'Grady Associates, Inc
Atlanta, Georgia