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April 11, 2017

How the nurse leader's job is changing under value-based care

Daily Briefing

Nurse leaders and executives are playing an increasingly important role in the transition to value-based and patient-centered care—which means they must master a diverse new set of skills, Laurie Larson writes for Hospitals & Health Networks.

A valuable perspective

Nurse leaders' experience on the front lines of care uniquely positions them to champion changes toward value-based care, Larson writes. As Maureen Swick, CEO of the American Organization of Nurse Executives (AONE), put it, "[Nurses] are the most trusted profession, responsible for the total care of the patient." And as such, the system chief nursing executive (CNE) "must look at all required competencies across the care continuum, particularly in ambulatory settings, to manage population health," Swick said.

Separately, Maggie Hansen, the first CNE at Memorial Healthcare System, said, "When you realize that three-quarters of all employees in the (health) system are nurses or on the nursing team, that their voice affects so many people, it's important to have the CNE voice at the executive table." She added that nurses "have a vantage point that health care leadership needs."

For nurse leaders, a new set of skills

But in order to succeed in this new environment, nursing executives need new skills and an AONE task force is working to define what those skills are, from systemwide data integration to developing a more advanced understanding of value-based payment models, Swick said.

Separately, Bonnie Clipper—chief clinical officer of Cornerstone Hospital Austin and a Robert Wood Johnson Foundation (RWJF) executive nurse fellow—said she sees five key competencies for nurse leaders:

  1. Influencing innovation;
  2. Spanning boundaries;
  3. Collaboration;
  4. Expanding the accessibility and use of technology; and
  5. Courage.

Clipper said nursing leaders can promote innovation by modeling new ideas for their subordinates and "educating their staff, physicians, and patients on what (innovation) means." For instance, she said the growing use of tablet computers among nursing leaders is a good example not only of innovation, but also of spanning boundaries—by using tablets, nursing leaders can interact with the staff on the floor rather than from behind their desks.

According to Clipper, innovation also requires collaboration, she said, noting that nurse leaders should work closely with CMOs in a "dyad" leadership model to achieve organizational goals. Jane Englebright, SVP and CNE at HCA, said, "The CMO and CNE have to be partners to address the clinical agenda—and they need to be role models for how physicians and nurses should work together."

The role of data and technology

It is increasingly important for nurse leaders to understand and use the power of data, Larson continues. "A good portion of the data that go into EHRs comes from nurses," Englebright said, which means that it's important for nurses to know how to leverage that data to improve patient care and coordination.

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Clipper said emerging nurse leaders who grew up using technology will help accelerate the adoption of new technologies. "Many [high-tech] tasks will become very mainstream," she said. "We'll have to speed up our adoption rate of technologies" and automation.

The role of higher education and networking   

Heather O'Sullivan, CNO for Cardinal Health's affiliate naviHealth, said the need for collaboration across the continuum of care is pushing more nurse leaders into executive roles—but getting there and succeeding means being prepared, such as by getting an economics degree or an MBA.

"I look for that key talent; these will be critical roles going forward," she said, adding, "Nurses with MBAs or other analytical experience will be sure to find positions in the coming years."

And O'Sullivan recommends that nurses who want to move into the business side of health care let others know. "Nurses should go to the COO or the CFO and ask them about their perspective, maybe even what keeps them up at night," she advises. CEOs can help build those types of relationships by creating a supportive, collaborative environment Englebright said, adding that technology—such as communal Facebook groups—can help increases transparency.

"Nurses have to understand how to lead across the continuum of care, including in both pre- and post-hospitalization roles," Clipper added. "We are no longer siloed; we've been forced to learn how to expand our boundaries" (Larson, Hospitals & Health Networks, 3/20).

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