As TriStar Centennial Medical Center's relatively new chief nursing officer — brought on in March from the same position at StoneCrest Medical Center — Cyndi Stroburg has a first-hand look at how health reform affects care delivery.
For TriStar, the Affordable Care Act includes components the entity has long been focused on, she says.
"High quality, safe care — for us, it's business as usual,” Stroburg says. “But it has heightened the expectation, and they’re measuring and publicly reporting those metrics now."
Modern nursing encompasses changes in technology, coordination and a shift toward wellness, all trends affecting the health care industry at large. As responsibilities and priorities shift for all providers, nurses — and nursing students — are putting industry-wide changes into practice.
"It's an exciting time to be in health care," Stroburg says. "I'm quite happy to see the focus on safety and quality initiatives because it sends a message to our patients that we are committed to doing the right thing, [and] not just because now it's transparent. But because it's our mission and every nurse is passionate about doing the right thing for their patient."
Stroburg says technology advancements have created a "frenzy."
"Knowing there's a huge emphasis on organizations to perform more efficiently and effectively, there's an onslaught of vendors looking to put technology in our organizations," she says.
The tidal wave of health care technology could easily overwhelm providers, which forces leaders to make value judgments on what to implement and what to leave behind. At Centennial, Stroburg created a committee to assess the value of each considered implementation.
With tools like electronic health records and equipment trackers, technology is changing the work flow of nursing. Some disruptions are acceptable, Stroburg says, when they clearly add value to efficiency, quality or safety. But other systems can cause more problems than they solve, and it's crucial to make those judgments alongside the nurses who would be impacted. Additionally, Stroburg advocates for retaining the critical thinking skills and intuition that are central to healing, even when technology increasingly affects the practices of care.
"I think that's one of our biggest learning curves as we adopt technology," she says. "When EHRs were introduced, we had to relearn our work flow. I have to figure out how to assess my patient, enter that information into a computer and still connect with my patient. We've got to make sure technology is improving work flow, not hindering it or creating distance between us and the patient."
A major operational focus for providers nationwide is managing the full continuum of a health care procedure, and Centennial is no different.
"There's the expectation both internally and externally that the patient does not have any breaks in their transitions of care," Stroburg says. "Everyone is responsible for making sure that patient passes safely through each level of care and knows what the long-term plan is."
At the bedside, it means thorough discharge orders with an educational focus so that patients have the tools to take care of themselves at home. The two-week hospital stay for patients — from the point of being severely ill to being fully healed — is a thing of the past, meaning nurses have to do more in a shorter period of time to prepare patients for their post-acute care. Internally, it means solid communication between all providers and post-acute partners.
"There's a lot more post-acute services available now, and their world has changed at the same time," Stroburg says. "This whole shift has affected everybody in the continuum, which is why we have to have a good relationship with our post-acute providers to make sure they're ready to continue what we've started."
With medical and technological advances, patients are living longer, surviving diseases that previously yielded high mortality rates. But those patients are not truly well, Stroburg says, and the acuity of patients has risen.
"We've made so many advancements that these patients are surviving, but they have chronic diseases," she says. "Traditionally, the health care industry in the United States has been focused on disease and illness, and now we're moving toward wellness and prevention."
But nurses have to live in both worlds — treating the urgently sick while advocating prevention. It becomes a collaboration between physicians, nurses and post-acute partners, Stroburg says.
"It's educating the patients on how to stay well, what things are preventable. That's where the hand-off of care becomes very important," she says. "Post-acute needs to pick up the education that I started in that next level of care. It's a partnership all the way through."
Stroburg engages frequently with higher education partners in the Nashville area to communicate the today’s needs with tomorrow's nurses.
"There's a heavier emphasis on evidence-based medicine to drive care, and more standardization in the delivery of care," she says. "I think we're doing things better now than how we used to do them because we're approaching them in a more structured and systematic way. But it's more that the nurses have to learn."
Martha Buckner, associate dean of nursing at Belmont University, knows that excellent nurses are integral to the success of health reform goals — better care, better health and lower costs. But in a rapidly changing industry, the curriculum has to keep up.
"The nursing curriculum at Belmont is constantly undergoing review and revision," she says. "We've launched a major emphasis on quality, safety and patient centeredness."
In the coming years, Buckner expects the BU nursing program to additionally focus on community and population care, health promotion, preventive care and leadership training.
"Nurses are taking on new roles as health navigators and care managers," Buckner says. "As health reform continues to unfold, we will need a more highly educated and active nursing workforce to the full extent of licensure and scope of practice. We think we are well positioned to prepare future students to lead the way in high- quality, coordinated, team-based care."