Nur4060- Chapter 1

Introducing Nursing Management

Learning Objectives
1. Explain changes to healthcare over the past decade, including those resulting from implementation
of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving
medical and communication technology.
2. Describe how nursing management is influenced by changes in society
3. Identify the changes and challenges that nurses face now and in the future.

Changes in Health Care

Strong nursing leadership is critical to fully transform the health care system and to act in positions of
leadership to work collaboratively with leaders from other health professions. Nurse leaders need to be full
partners at all levels of the system—from bedside to boardroom—who can contribute actively to policy
making by serving on committees, commissions, and boards.( Institute of Medicine, 2016, p. 24)

Affordable Care Act (ACA), signed into law in 2010

a. Provided health coverage to millions of Americans
b. Access to health care for the uninsured
c. Development of Health Insurance Marketplace
d. Establish accountable care organizations (ACO),.
e Changes in Primary care providers role - Health Home
Establish accountable care organizations (ACO), consisting of healthcare providers and hospitals who agree
to provide care to a designated population.
Changes in Primary care providers role as facilitators of access to coordinated, specialized care
Cost of Medical Errors
The Institute of Medicine (IOM) published a report in 1999 reporting that
a. 98,000 Americans die each year from preventable medical mistakes.
b. The report focused attention on eliminating errors.
c. As a result, the Centers for Medicare and Medicaid Services have linked payment to quality of
care. If mistakes occur, hospitals must absorb those costs.
d. CDC - no coverage for medical mistakes, pay for performance and quality of care

Medical Errors Continue to Climb

Life Loss
Diminished Quality of Life
Estimated costs over 17.1 billion annually
( Dem Bos et al, 2011)

Demand for Quality

Quality Management
Leapfrog
Benchmarking
Magnet Recognition
Evidence Based Practice
Quality and Safety Education for Nurses

Quality Management
Prevent the problem before they occur
Leapfrog Group
A consortium of public and private purchasers, uses its mammoth purchasing power to leverage quality care
for its consumers by rewarding healthcare organizations that demonstrate quality outcome measures.
 Benchmarking
Compares an organization’s data with similar organizations.
Outcome indicators are used to compare performance across disciplines or organizations.
Identifies healthcare organizations weaknesses and enhance strengths.

Evidence Based Practice

Uses Evidence-based practice (EBP) to improve quality:
a. with clinical experience
b. In patient’s values and preferences
Five steps in EBP:
1. Identify the clinical question.
2. Acquire the evidence to answer the question.
3. Evaluate the evidence.
4. Apply the evidence.
5. Assess the outcome.

Application of Evidence
a. Anecdotal
b. Testimonial
c. Statistical ( Most Rigorous)
d. Case study
e. Nonexperimental design research
f. Quasi-experimental design research
g. Randomized control trial ( Most Rigorous)

Magnet Recognition Program

Certification to healthcare organizations for nursing excellence
Focus on the following outcome measures
• Transformational leadership
• Structural components
• Exemplary professional practice
• New knowledge, innovations, and improvement
• Empirical outcomes
Most Demonstrate
• Promoting quality in a setting that supports professional practice
• Identifying excellence in the delivery of nursing services to patients/residents
• Disseminating “best practices” in nursing services.

Quality and Safety Education for Nurses or QSEN

Quality and safety competencies focusing on knowledge, skills, and attitudes (KSAs) for nursing education
• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement
• Safety
• Informatics
National advisory board of experts developed quality and safety competencies, designating targets of
knowledge, skills, and attitudes (KSAs) for nursing education
 Demand for Quality Continued
Evolving Technology
Electronic health records (EHRs)
Telehealth
Robotics
Communication Technology

Demand for Quality

Quality Management
Leapfrog
Benchmarking
Magnet Recognition
Evidence Based Practice
Quality and Safety Education for Nurses
Changes in Society
Gender, culture and generational in Nursing
Demands in Health Care
Increased Violence
Threats from pandemics
Challenges in potential disasters
Cultural Differences
Gender Differences
Generational Differences
Violence, Pandemics, and Disasters
Emergency Plans
• Minority population in the United States is projected to rise to 56% of the total in 2060, with fastest
growing minority being those who identify as two or more races.
• Lesbian, gay, bisexual, and transgender (LGBT) populations challenge healthcare providers to offer
appropriate care and services.
• A 2013 survey of registered nurses demonstrates that the nursing profession doesn’t represent the
diversity in the general population.

Changes in Nursing
Aging population
Shortages in Nursing
More nurses retiring
Institute of Medicine’s Recommendations for Nursing
The Future of Nursing 2020-2030
https://nam.edu/publications/the-future-of-nursing-2020-2030/