To understand the initial challenges, we need to look back over 50 years ago, in 1966, Avedis Donabedian articulated the structure-process-outcomes theory and supported and underpinned the relationship between patient outcomes such as falls, morbidity, and mortality rates. Fast forward to 2008, Berwick, Nolan, and Whittingham correlated obstacles in healthcare policy, healthcare culture, and payment systems as natural deterrents to nursing to achieve the Triple Aim and, later, the Quadruple Aim(Adams, 2018). Furthermore, the meaningful use stage 1(MU-1) went into effect in 2011, thus creating the foundation for implementing Information Technology (IT) to ensure eligible professionals and hospitals participate in programs that record and store data on health outcomes, clinical processes, patient safety, care coordination, population, and evidence-based medicine. Altogether, 15 core and affiliated objectives supported key healthcare outcome measures and priorities determined by the 2010 Medicare & Medicaid HER Incentive programs (Bindra, 2018).
While researching the history and reimbursement mechanisms, nurse staffing is clearly linked to bottom-line revenue. Reflecting on my experiences with nursing and frontline clinician shortages and my professional work, I deeply understand the severity and consequences of inadequate bedside nurses to support quality patient care. This heightened awareness shows that Chief Nurse Executives (CNEs) must make a strong business case to support increased staffing budgets and ratios to improve patient care, outcomes, and experiences and bolster nurse and overall employee satisfaction.
Comparatively, to strengthen this position, The Joint Commission accredits about 19,000 HCOs and programs across the United States with programs and goals to positively influence quality outcomes and patient safety initiatives. Among these programs, in 2002, the Joint Commission published a groundbreaking report, Health Care at the Crossroads, Strategies for Addressing the Evolving Nursing Crisis. The publication linked the shortage of nurses to patient safety and quality risks, along with a call to action to improve nursing practice environments, education, and advancement. In addition, the report identified strategies and specific financial incentives to increase quality, quality, and nursing working environments (Jones et al.,.2019).
Finally, the increasing financial pressures of Healthcare Organizations (HCOs) are also causing unprecedented mergers, acquisitions, and reorganizations. These transactions can disrupt nurse staffing, frontline clinicians, communities, and patient care, and cause panic along with healthcare worker displacement (Sampson & Fried, 2021).To this point, the nursing profession is in a highly fragile and vulnerable phase. Instead of viewing nursing as a cost center, HCOs, nurses, and frontline clinicians must stand together and advocate with a unified voice for public policy changes linking nursing services to optimal patient outcomes equaling healthy communities and bottom lines.
Adams, J. M., Mensik, J., Reid Ponte, P., & Somerville, J. (2018). Leadership in Every Healthcare Setting Lead Like a NURSE (pp 20-24). Silver Spring, MD: American Nurses Association.
Bindra, P. S. (2018). The Core Elements of Value in Healthcare (pp. 314-347). : The Foundation of the American College of Healthcare Executives.
Jones, C. B., Finkler, S. A., Kovner, C. T., & Mose, J. N. (2019). Financial Management for Nurse Managers and Executives (5th ed., pp. 1-15). St Louis, MO: Elsevier.
Sampson, C. J., & Fried, B. J. (Eds.). (2021). Human Resources in Healthcare Managing for Success (fifth ed., pp. 132–133). Chicago, IL: Health Administration Press.