Patient Safety / Quality

Viewpoint: Disrupting and disrupted—nursing’s response to the inevitable

Editor’s note: Viewpoint highlights the thoughts, opinions, and expertise of well-known nurse leaders. We welcome your comments about these thought-provoking articles.

Disruptive innovation is described as an “innovation that transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo.” Within the healthcare arena, as more is known about causality, treatment, and predicted outcomes, care can be provided in less specialized venues by generalists and community-based clinicians, thus disrupting the status quo.

As an example, little was known about HIV when it emerged 30 years ago, and care was primarily delivered by infectious disease specialists. As research, drug therapy, and treatments emerged and were incorporated into standardized practice, patients with HIV received care from both specialists and primary care providers.

Other examples include: Autonomous practice by advanced practice registered nurses (APRNs) is a disruptive innovation to the traditional medical model. “Minute clinics” are disruptive to community practices and health centers as well as to hospitals.

Both the Affordable Care Act (ACA) and the Institute of Medicine’s “Future of Nursing Report: Leading Change, Advancing Health” call on all nurses to practice to the full extent of their education and training. Nurses from across the spectrum of practice, from staff nurses to advanced practice nurses, from generalists to specialists, must incorporate emerging knowledge, evidence, skills, and technology in order to ensure that the profession capitalizes on the strength of its members to meet the health care needs of the future.

As we strive to expand our practice to the fullest, the status quo changes, resulting in both higher quality patient care and more advanced nursing practice. This creates the opportunity for disruption within the profession and the entire health care system. For nurses to believe that expanding the scope of practice will only happen for APRNs is simply not reasonable. The nursing profession as a whole will be pushed, pulled, and redefined as new science, skills, and technology emerge and as other disciplines such as physical therapy, occupational therapy, speech and language, pharmacy, and social work strive to practice at their fullest extent as well. This in turn will create both challenges and opportunities for nurses. What new health care models and nursing roles will emerge as health policy, science, predictive modeling, and technology enable ever more advancements in care and care delivery models?


What should nurses do?

We have a tremendous opportunity to explore our preparation for, and reaction to the inevitable disruptions that will occur in the future by looking at our response to other disruptive innovations. Organized medicine responded to the “disruption” caused by APRNs by trying to protect their turf or territory, creating barriers and challenging outcomes of care provided by APRNs. What lessons can nurses learn from this as well as the possible changes in the practice of other disciplines and the advances in science and technology?

I suggest that nursing has the opportunity to do better than medicine at responding to disruption. In order to respond effectively, we must be grounded in our discipline; we must cherish and practice to the fullest extent of our education and training; and we must improve the outcomes for patients, families, clinicians, and the health care system. By keeping the patient and family at the center of the system of care, our planned response and resulting professional practice changes will be designed to improve patient care.

We know we will be disrupted. What will our tolerance be? What values will frame our response? Do we know and agree on those values? What role should our professional nursing associations take in defining and framing the profession’s response? What current roles will be redefined and what new roles will emerge? The interplay of disruptions will add to the opportunity to fully establish our professional impact on care and for increased collaboration.

Ultimately, it is in our own, as well as in the public’s best interests to not only manage but to seek out opportunities for disruption, to take on emerging new roles and responsibilities and to support the appropriate shifting of some aspects of care to other educated providers. We are well poised to begin the work that lies ahead. Let us look critically at the past as we shift our own focus to practicing to the full extent of our education and training to identify opportunities for disruption that will best serve patients, the health care system, and the nursing profession in the years to come.

Disruption need not be painful as long as we use it to advance and evolve the practice of nursing and enhance patient care. By letting go of some practices, we have the ability to embrace change and expand our practice. In order to accomplish this we must, as both a profession and as individual practitioners, be nimble and committed to the values that have defined us as a profession. We must recognize that change will only come faster and faster. With each turn of the evolutionary wheel, we further define, refine, and advance the practice of nursing.

The evidence and data from over 30 years of research regarding the role and impact of APRNs has helped the nursing profession respond to challenges and barriers created by the medical status quo. As APRNs continue to disrupt medicine, it is disingenuous of the rest of us to resist others who are pushing their own disciplinary envelopes using evidence-based and data-driven rationales.

Perhaps the most important lessons to learn from the past are what not to do. Perhaps we should consider embracing change and disrupting ourselves.

Barbara A. Blakeney is the innovations specialist for The Center for Innovations in Care Delivery at Massachusetts General Hospital, Boston.

Selected references

Christensen C. Disruptive innovation. Clayton Christensen Institute. http://www.christenseninstitute.org/key-concepts/disruptive-innovation-2/ Accessed August 1, 2013

Christensen C, Grossman J, Hwang J. The Innovator’s Prescription: A Disruptive Solution for Health Care. McGraw Hill; New York: 2009.

The Institute of Medicine of the National Academies.
The Future of Nursing: Leading Change, Advancing Health. The National Academies Press; Washington, DC: 2011.

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