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The Future of Nursing: Leading Change, Advancing Health
BSN students should be placed for clinical training in new models of integrated care that require care coordination, such as accountable care organizations within universities or medical homes.
MSN students should study the research cited above that shows the effectiveness of APN transitional care. Components of MSN clinical training should include the care coordination role.
Across education levels of nursing education, care coordination should be structured around knowledge, skills and competencies to include: advanced assessment skills appropriate for senior baccalaureate and master’s/DNP students; interpersonal and communication skills necessary for the ability to communicate with patients and families with a high degree of sensitivity and cultural competence, as well as the science-based skills necessary to communicate effectively with physicians and others on the health care team; competencies in care planning that integrate the biological, social, and psychological needs of patients; understanding of and ability to seek and apply evidence-based protocols and national standards for patient conditions; and payment and social services systems to better address the full range of patients’ and families’ needs.
HEALTH POLICY EDUCATION
In large measure nursing education must remain patient focused. This makes sense for an applied discipline whose goal is the prevention or amelioration of illness and the improvement in the wellbeing of patients, families, and communities. However, a major lesson of the past 20 years is the degree to which health systems and policy shape the health both of populations and individual patients. Yet nursing students gain only a glimmer that health policy at multiple levels, from the hospital unit to the federal government, affects not only their practice but ultimately the fate of patients. Few educational programs include more than a token course on health policy, typically only at the graduate level. Since nursing education curricula generally treat health policy as extra rather than core, the naiveté of graduates, is no surprise. With few exceptions, nurses generally view themselves as being shaped by, not shaping, policy.
Since nurses largely take a back seat to policy processes, the profession’s input has been relatively invisible, certainly compared to that of medicine (Mechanic and Reinhard, 2002). Few nurses, when asked “What is nursing?” include health policy as a component of what nurses do (Gebbie et al., 2000). Missed opportunities for nursing to shape legislation or wade into legislative debates are all too common. One example is the recent Centers for Medicare and Medicaid Services (CMS) rule that restricts reimbursement for such “never events” as pressure ulcers, certain catheter-related infections and injuries, and certain surgical site