In recent years, and particularly following passage of the Affordable Care Act, the concept of patient care coordination has received a renewed emphasis in the U.S. For the nursing profession, however, care coordination is nothing new, as the American Nursing Association notes nurses have long played leading roles in working with various teams of medical professionals to ensure positive patient outcomes.
The American Nurses Association has responded to the call for greater coordination by launching initiatives laying out a series of policy priorities and goals to help nurses continue to take the lead in expanding and refining care coordination across the spectrum of American healthcare.
As the ANA senior director of product development for the past four years,
Terri Gaffney, BSN, MPA, RN, has overseen the evolution of educational and professional development products to help nurses increase skills and qualities needed to achieve better care coordination for patients and other key goals. Her professional journey, spanning more than three decades, has included stops in clinical, advocacy, media and regulatory settings.
Q: How has care coordination evolved in recent years? And how is it evolving now?
A: This is something we, as nurses, have always done. But the model of care coordination is evolving along with the broader view of healthcare. Traditionally, we, as nurses, have viewed it from the perspective of the discharge planning process, often from the moment of admission. But now the conversation is about taking our view to a higher level, looking at the different environments in which a patient might receive care. Under this model, we’re looking at taking the conversation all the way back to a patient’s home environment, as well.
Q: What role does the Affordable Care Act play in
A: A key goal of the ACA is to reduce readmissions. So, for nurses and all other healthcare professionals, the question is: How do we coordinate all the services so these patients don’t have to go back to the hospital? Such goals will require us to find different ways of coordinating care than we are used to doing. We’re seeing hospitals reorganizing to make that happen, and it’s really improving the quality of care. And that process is allowing nurses the chance to step to the plate, and drive the effort forward.
The ANA has made expanding payment options for nurses its No. 1 policy priority related to care coordination. Why?
A: Nurses don’t get paid directly for the work we do. The work performed by nurses is rolled into the hospital’s charges. So a goal for the ANA is to create an opportunity for payment for services, because we believe nurses should be able to be reimbursed just as other professionals.
Historically, nurses have had trouble defining our value. And this [financial reimbursement for services] is one way society understands value.
Our challenge is to find a way to measure care coordination. Once that care has been appropriately coordinated, how do we break out a nurse’s role in it? We’re having conversations about this with multiple parties and many stakeholders. The complexity of this is amazing, but I think we can find a simple and elegant solution.
Q: How will care coordination change in the future?
A: It’s going to be so different and exciting. With all of the advancements in technology, care is going to be delivered in new and amazing ways. For the elderly, for instance, who live in a setting with remote monitoring, we’ll be able to measure things like how often they get out of bed at night, whether they’re drinking enough water, whether they’re sleeping enough, so we can monitor their needs from afar and intervene when necessary to help them live healthier, better quality lives. There is a world of possibilities that are just endless.
So our challenge, then, is to help nurses understand the future, see the possibilities and then get there.
Right now, a key area we’re working on is helping nurses practice to the full extent of their licensing and education. There is a big emphasis on APNs, but also just as fully on RNs as we have this energized, interesting conversation on what care coordination will look like in the future.