Role Changes
To shift the care delivery system, role clarity needs to occur. Nurse executives must work with NMs to redefine their role and develop a system for patient engagement that ultimately impacts the role of all nurses within the healthcare system. A report from the Nursing Alliance for Quality Care outlined key distinctions between the role of direct care nurses and NMs related to patient engagement. 3 Direct care nurses are responsible for working with patients and families to most optimally manage their care or experience. 3 They can move from providing care to partnering with patients to enhance self-care management. It is critical that patients are involved in their care to achieve optimal health, foster disease prevention, and reduce acute episodic hospital admissions. 11 Conversely, NMs are responsible for managing a microsystem of care. With the support of executive leadership, they lead direct care nurses in making system-level changes that facilitate the ability of people to more actively engage in their care. Health reform offers providers incentives for initiatives that support patient engagement, but reduces reimbursement if clinical quality and satisfaction targets are not met. NMs play a critical role in monitoring, evaluating, and reporting initiatives and are held accountable for these quality measures. 12,13 NMs lead integral programs to improve health outcomes for key quality indicators including, but not limited to, fall prevention, pressure ulcer and surgical wound infection reduction, and unplanned readmissions. 12-15Crucial areas of focus for NMs include educating clinicians regarding the importance of patient engagement and determining appropriate measures to assess the effectiveness of change.