In October 2009, the American Nurses Association (ANA) and the National Quality Forum (NQF) held a historic meeting attended by a broad array of healthcare stakeholders. For 2 days, nurses from all sectors of clinical practice, education, administration, and research—as well as consumers, government officials, and experts in healthcare delivery and information technology—came together to advise the National Priorities Partnership (NPP) on nursing’s current and future contributions to transforming health care. NPP is a collaboration among a large and influential group of public and private organizations convened by NQF to address major healthcare challenges. NPP members share a vision for a world-class, affordable healthcare system and are working together to achieve it.
The meeting, Nursing and the National Priorities Partnership: Aligning Our Efforts to Transform America’s Healthcare, was the first in-depth look at a single profession’s contributions to NPP’s goals. Funded by the Robert Wood Johnson Foundation, it was conducted as a workshop that created an opportunity for the nursing community to devise an action plan to work with NPP on shared goals for transforming health care. American Academy of Nursing members helped plan the event, in which NQF Nursing Organizational Members and the ANA Organizational Affiliates participated. In this article, we share highlights of the workshop recommendations. (The full meeting report is available at www.ncnq.org.)
Workshop goals were to:
- analyze nursing’s current and future contributions to the NPP agenda
- identify critical opportunities for nursing to advance and accelerate the achievement of NPP goals
- gather ideas for a nursing strategy and action plan to advance the NPP agenda.
The workshop was organized around six priority areas that NPP had previously identified as having the greatest potential to improve health care in America—patient and family engagement, population health, safety, care coordination, palliative and end-of-life care, and overuse of services. For a more complete discussion of NPP’s vision and goals in each of these priority areas, visit www.nationalprioritiespartnership.org/uploadedFiles/NPP/08-253-NQF%20ReportLo.pdf.
Panels of experts were invited to examine each priority area and highlight ways in which nursing already contributes to achieving NPP goals. Panel members proposed strategies for advancing these contributions by leveraging major drivers of change in today’s healthcare system, such as performance measurement, public reporting of performance measures, payment reform, dissemination of research findings, and professional education. The potential for information technology to enhance each driver was examined in detail.
Panel presentations were followed by small group discussions, during which participants developed recommendations for a nursing strategy and an action plan for each priority area. Below are examples of the broad array of recommendations that emerged from the workshop. They illustrate the scope of action steps participants believed are needed to optimize nursing’s contributions to NPP goals.
Nursing’s contributions to NPP patient and family engagement goals
According to workshop participants, patient and family engagement is a pivotal area for the nursing community to join efforts with NPP and other professional groups. Nurses share NPP’s vision of a patient- and family-centered healthcare system. NPP themes of informed decision making, honoring patient choices, and providing tools for patients and families to manage their care are time-honored in the nursing profession.
Participants identified many strategies to accelerate nursing’s contributions in this priority area. Here are examples of proposed strategies for performance measurement, payment reform, research, and education:
- Develop performance measures to assess how patient and family engagement affects health outcomes and service use, including self-management of chronic diseases and healthy lifestyle behaviors.
- Create financial incentives for providers to engage with patients and families.
- Collect and disseminate best practices in nurse-led interventions to engage patients and families in their care.
- Design tools and toolkits to support patient and family engagement in care; develop educational programs for health professionals to build the knowledge and skills required to fully engage patients and families in care.
Nursing’s contributions to NPP population health goals
Nurses have been deeply involved in community-based initiatives to improve and enhance health promotion, wellness, and prevention services. According to workshop participants outside the nursing profession, nurses’ presence in these initiatives isn’t well known to the public and key stakeholders in healthcare reform.
Nurse-led clinics and retail-based nurse practitioner practices were cited as examples of nursing models whose goals align closely with NPP goals for population health. Expanding access to these models and others, according to expert panelists, will require regulatory and payment reform as well as research to demonstrate their effectiveness. Population health was seen as a key area for nurses to partner with consumers to accelerate the shift from our current disease-oriented system to one that emphasizes healthy lifestyles and prevention.
Workshop participants made several recommendations for actions needed for NPP to capitalize on nursing’s contributions to population health goals. They included:
- Refine and develop performance measures that reflect health rather than disease, including measures that capture nursing’s contributions to population outcomes.
- Advocate for legislation to pay for patient-centered, community-based care models, including community nursing centers.
- Advocate for a consistent scope of practice for advanced practice registered nurses across all states.
Nursing’s contributions to NPP safety goals
The NPP safety agenda emphasizes evidence-based practice and rigorous attention and commitment to continuous improvement. Workshop participants gave many examples of the major roles nurses currently play in advancing NPP safety goals across the care continuum. The nursing community already has embraced performance measurement and quality and safety education and is engaged in research programs to establish the link between nursing interventions and safety outcomes.
According to participants, advancing nursing’s contribution in this area will require changes in public reporting and payment. Specific recommendations were to:
- expand the set of nurse-sensitive measures that capture nursing’s impact on safety outcomes and advocate for their inclusion in public reporting and payment systems.
- fund research to accelerate development and testing of performance measures that link nursing interventions to safety outcomes.
- advocate for the appointment of nurses to major national committees and task forces on performance measurement, quality, and safety.
- initiate local and national education campaigns to prepare frontline nurses to use nurse-sensitive quality measures to improve quality and patient safety.
Nursing’s contributions to NPP care coordination goals
Care coordination is seen as the area with the greatest opportunity for nursing to advance and accelerate the achievement of NPP goals. Nursing has a long history of designing and implementing effective care coordination models, especially in the areas of care transition and coordinating care for high-risk vulnerable populations. Nurse researchers studying care coordination focus on outcomes central to NPP goals, such as hospital readmission.
Specific recommendations to capitalize on and accelerate nursing’s current contributions in this area included:
- Raise awareness among policymakers and the public about nurse-led care coordination programs.
- Garner research funding to advance the development of performance measures that capture nursing’s contribution to care coordination; these measures also need to be included in public reporting.
- Reform payment structures to include reimbursement for effective and efficient nurse-led care coordination programs.
Nursing’s contributions to NPP palliative and end-of-life care goals
Workshop participants noted that nurses have played a significant role in the evolution of palliative care. Consistent with NPP goals in this area, nursing has emphasized the importance of dignity and support for patients with advanced illness (and their families) and improving access to information about treatment options and symptom relief. Consequently, most recommendations related to accelerating nursing’s contributions to NPP palliative care goals focused on the need for professional development and education in this area. They included:
- Modify nursing curricula to include content on palliative care.
- Add questions about palliative care to the licensure examination.
- Require certification for nurses practicing in palliative care.
Nursing’s contributions to NPP goals for reducing healthcare overuse
NPP goals in this area focus on improving the delivery of appropriate care and “reducing the burden of unscientific, inappropriate, and excessive care” (NPP, 2008, page 42). Nurses are very involved in care and decisions associated with reducing overuse. Workshop participants cited examples of nurse-led services and interventions that have already demonstrated benefit or potential value for reducing overuse.
Recommendations in this area emphasized the importance of expanding research on the effectiveness of these models and reducing barriers to the use of nurse-led models with demonstrated effectiveness. Specific recommendations included:
- Fund research to demonstrate the impact of nurse-led home- and community-based interventions in reducing overuse of costly healthcare treatments and services.
- Advocate for reimbursement of nursing services that assess and monitor effective use of treatments and services.
Opportunities for nursing and NPP
Nursing and the NPP workshop highlighted the many contributions nurses currently are making to NPP goals. Participants identified a wide array of opportunities for the nursing community to accelerate NPP’s agenda. They noted that capitalizing on these opportunities will require a united effort among nurses and support from public and private stakeholders. It will take concerted action to leverage the needed changes in payment, performance measurement, consumer and professional education, and research.
Since this workshop took place, a new Nursing Alliance for Quality Care has formed and the Institute of Medicine’s new report, The Future of Nursing: Leading Change, Advancing Health, has been released. These developments are further evidence of the intensive efforts underway to ensure that nursing’s current and potential contributions to transforming our healthcare system are realized.
Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010.
National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008. www.nationalprioritiespartnership.org/uploadedFiles/NPP/08-253-NQF%20ReportLo.pdf. Accessed December 8, 2010.
National Priorities Partnership. Nursing and the National Priorities Partnership: Aligning Efforts to Transform America’s Healthcare. One Vision, One Voice. Invitational Workshop Summary. Washington, DC: National Quality Forum; 2010. www.nursingworld.org/DocumentVault/NursingPractice/NCNQ/NNPP-Summary.aspx. Accessed December 8, 2010.
Gerri Lamb is an associate professor at Arizona State University College of Nursing and Health Innovation in Phoenix. Bonnie Mowinski Jennings is an independent healthcare consultant in Evans, Georgia. The authors wrote the Nursing and the NPP Invitational Workshop Summary.