Diane Gilworth, MPH, APRN, BC, Vice President Nursing, Harvard Vanguard
The future for nurses and nurse practitioners in the ambulatory setting is not just about surviving the next round of health care reform, it is about thriving. As accountable care organizations (ACO) align financial incentives to improve health outcomes, nurses and nurse practitioners should stand at the forefront. The strength in ACOs lies in the development of new teams which leverage the talent and expertise of all clinicians from hospital to the office practice.
Nurses and nurse practitioners have played the role of care giver and coach for years. It is common for patients to develop close bonds with nurses, and in the process nurses develop a unique understanding of the patient’s needs. Understanding the true needs of patients will be foundational for ACO teams to develop alternatives of care beyond the hospital for high risk elderly patients, develop new types of office visits for patients who routinely seek care in emergency rooms, and ultimately develop new community based outreach programs to combat the rising pediatric and adolescent obesity and type II diabetes rates.
ACOs cannot achieve the triple aim outlined in the IHI’s goals – to improve population health, improve individual health and decrease per capita costs - without actively engaging the nursing workforce. Nurses and nurse practitioners must step beyond the silent assistant role to physicians and actively pursue solutions to our most vexing health care problems. The solutions will not be highly technical. Rather, the solutions will be about developing continuous healing relationships with patients, and nurses are best positioned to do this. Patients will need help deciphering complex medication regimens and in some cases nurse practitioners may help to simplify regimens. Nurses will need to spend more time with patients and their care givers, coaching them during all transitions, easing the process from hospital to discharge, assessing them in their homes, and helping to coordinate home based services. Specialized case management programs are already beginning to realize the importance of providing horizontal care across the entire continuum of care.
As the shortage of PCPs worsens, there will be a need for more nurse practitioners to see patients in clinic settings and at home. Reducing the high Medicare readmission rate will require that patients have urgent and semi-urgent medical issues taken care of in the comfort of their own home. This is not only more cost effective health care, it is also better care which encompasses a holistic understanding of the patient’s life and health care needs. During hospitalization, nurses and nurse practitioners will bridge the communication gap that commonly occurs between the hospitalist, patient, care givers and the primary care physicians.
It is probably too early to fully understand the effects of health care reform for nurses. ACOs have created new opportunities within the team, and there are new funding opportunities for nursing education and reimbursement changes for nurse practitioners. Most importantly, health care reform will move nurses out of the shadows, and nurses who seize upon this opportunity will most assuredly transform health care.
Diane Gilworth has served as Vice President of Nursing at Harvard Vanguard since June 2009. Prior to returning to Harvard Vanguard, Diane was most recently director of ambulatory operations for Beth Israel Deaconess Medical Center where she had responsibility for the Breast Surgery Clinic, medical and surgical programs for breast care, and multidisciplinary clinics for breast care and medical specialties. From January 1997 through March of 2008, Diane held a number of positions at Harvard Vanguard, beginning as clinical manager of the Congestive Heart Failure program. She was instrumental in creating an interdisciplinary care delivery team for patients with chronic disease as Director of Complex Chronic Care. In 2005, Diane assumed the role of Director of Nursing, where she strengthened the responsibility of nursing leadership and established a strong vision for the role of nursing in the organization. Diane was also a Trustee on the Harvard Vanguard Board from 2003-2006. Prior to joining Harvard Vanguard in 1997, Diane spent 15 years in a variety of nursing roles. She has a Master of Nursing, Adult Nurse Practitioner degree from Simmons College, a Masters of Public Health from Boston University and a Bachelor of Nursing degree from Montana State University. Diane sees patients at our Medford location as part of Harvard Vanguard’s Complex Chronic Care Program.