Health Care History

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

The Institute of Medicine’s 2010 report on The Future of Nursing: Leading Change, Advancing Health acknowledges the changing healthcare sector in the US and describes future vision of healthcare and the role of nurses to fulfill that vision. The United States always strives to provide affordable and quality healthcare to the entire population of the country. In order to achieve this goal an overall restructuring of the healthcare system was necessitated. Nurses are considered to be the central part of the healthcare system to provide high quality and safe patient care. Nursing in the US is the single largest segment of the healthcare workforce with almost 3 million nurses working in different areas across the county. The changing

Nursing guidance is a complex but essential part of the nursing workforce. Guidance can come in the form of management and in the form of leadership. The two terms are often used interchangeably, but do not always mean the same thing. The nurse manager is often someone who has authority from the facility to be in management. The nursing leader may not have authority over other nurses, but may be a strong guide in the workplace for other nurses and nursing staff. Nursing as a profession is ever-changing and increasingly challenging. Nurse managers are tasked with an enormous variety of functions in their respective workplaces, budgeting, scheduling, hiring, disciplinary actions, implementing facility policies and procedures, and the

There are four evolutionary phases in healthcare. The first phase was the preindustrial era, which started in the middle 18th century to the beginning of the 19th century. At this time, American medicine was not developing as fast as other countries; in Britain, France, and Germany, medical science and research was much more advanced than America. The postindustrial era began in the late 19th century, physicians in America were becoming more successful than others in the world. The third phase was the corporate era, which was marked by the growth of managed care, organizational integration, the information revolution and globalization. Finally, the fourth phase is the one in which we are in today, it is still fairly new and is characterized by the health care reform, which was brought about by the Affordable Care Act.

Affordable Care Act (ACA) shift American health care system.The Institue of Medicine (IOM) report recommends the future of nursing are one of the important workforces leading the change. The Robert Wood Johnson Foundation (RWJF) sponsored the Initiative on the Future of Nursing (IFN) research in America (Robert Wood Johnson Foundation Initiative on the Future of... n.d.). In this essay, the student will discuss the IOM report on the IFN leading healthcare system reform. And Acknowledge the significance of nursing workforce development related to the nursing shortage, nursing education, leadership and nursing practice. Also, interduce the goals of State of Arizona action coalitions on future of nursing campaigns and how to overcome the

The timeline of U.S. healthcare history began with Early American medicine with Native Americans and common folk practices performed by settlers. Practices included herbal remedies, procedures such as “bleeding, blistering, and purging (Batnitzky, Hayes, & Vinall, (2014). Practices were based on theory and environmental contributors rather than diagnosis of treatment. The First Marine Hospital fund was signed into law in 1789,creating the beginning of organized medicine and facilities. The First Marine Hospital fund ensured military members and individuals with federal eligibility were provided medical treatment and preventive care. Funds in maintaining treatment facilities was acquired though payroll deductions. This treatment was provided at various hospitals and facilities. Through growth and expansion, treatment facilities were operated and maintained by military operations. In 1847, the American Medical Association (AMA) was founded by Dr. Nathan Davis. Standards and guidelines were determined for the education requirements for medical professionals, drug manufacturing, preventing disease, sanitation, and in providing higher standards of treatment and care (American Medical Association [AMA], 2015). In 1872, the American Public Health Association [APA] was formed in promoting prevention of communicable diseases. This was the next major breakthrough in reducing diseases such as smallpox, whooping cough, and other common diseases that highly spread. As advances in

Malloch, T. P.-O. (2013). Leadership in Nursing Practice: Changing the Landscape of Health Care. Burlington MA: Jones &

In the 1990 census, there were 77 million baby boomers (born between 1946 and 1964) compared with the 44 million in the subsequent generation (Fox & Abrahamson, 2009, p. 237). This population imbalance creates quite the challenge for the future of nursing. It is anticipated that the United States will need a 35 percent increase in formal health care providers by 2030 in order to meet the needs of the growing population (Houde & Melillo, 2009).

Healthcare changes occurring today along with shrinking budgets and reimbursement rates for hospitals has forced institution CEOs to do more with less. Changes and restructuring of various health facilities require nursing leaders with flexibility and adaptability. Nurse leaders must also consider budgetary constraints, cost effectiveness, patient safety, and quality care while maintaining focus on improved patient outcome. The responsibility of ensuring patients receive safe and high quality care belongs to every employee in the hospital, including support staff such as IV therapy. In this hospital, this led to the development of a nurse director position to oversee the

Healthcare Reform has been and still is a highly debated controversial political issue in this country. It has been a hot topic of past presidential campaigns, with many proposed solutions, none of which were enacted upon by Congress. The Affordable Care Act (ACA) was passed in 2010. This law or Obamacare, as it is commonly called, was designed to cover the 48 million Americans, including about 1 million in New Jersey who did not have health insurance. It is envisioned to provide seamless, affordable, quality care that is accessible to all. Great emphasis will be placed on transforming our current “sick care” hospital system into a community “health care” system of prevention and health promotion. This paper discusses the evolving and future roles of nurses under the new system. It also examines the proposals of a joint committee made up of members of the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), as an initiative to help nurses in their new leadership roles to a healthier nation.

Leadership traits associated with nurse executives are honesty, credibility, supportiveness, visibility, and flexibility. Nurse executives analyze nursing functions and empower nurses through participatory decision making, shared governance, and employee involvement. Nurse executives share the vision and goals of the hospital and promote application of a nursing theory into the nursing care delivery system. They anticipate the future of health care and nursing and serve as monitor, role model, and preceptor to lower level management (Upeniecks, 2003). Nurse executives in the Magnet program are required to have advance practice degrees with certification in their specialty (ANCC). Understanding evidence-based management and enabling the use of evidence-based knowledge provides the nurse executive with the tools to improve patient outcomes. The transformational leader will remove barriers to improvement and encourage outcome based thinking. While nurse leaders are charged with questioning the status quo, nurse managers in the transformational approach to leadership are charged with maintaining the status quo.

“On March 23, 2010, President Obama signed the Affordable Care Act. The law put in place comprehensive health insurance reforms that put consumers back in charge of their health care. A new wave of powerful evidence points to one clear conclusion: The Affordable Care Act is working to make health care more affordable, accessible and of a higher quality, for families, seniors, businesses, and taxpayers alike”. “By creating incentives for integrated care delivery models and paying for coordination and quality of care, the law seeks to rebalance the system’s resource allocation and reward the value of care over volume of care” (Secretary, 2013). Some of the ways that the Affordable Care Act will be successful is by implementing the concepts of continuity of care with the introduction of accountable care organizations, medical homes, and nurse managed health clinics. Due to these new organizations, this means there will be significant changes and growth in the nursing field. “Registered nurses are fundamental to the critical shift needed in health services delivery, with the goal of transforming the current “sick care” system into a true “health care” system” (Key provisions related to nursing, 2010). There will be an increased need for nursing in these new areas and a decrease in the number of nurses needed in the acute care settings.

In November of 2010, the Institute of Medicine (IOM) released “The Future of Nursing: Leading Change, Advancing Health”. This special report examined the current state of nursing and changing landscape of the American healthcare system and offered recommendations for the future role nurses should play. The committee that released the report, Committee on the Robert Wood Johnson Foundation, divided it into three parts. Part II of the study, focused on transforming the nursing profession in order to improve America’s healthcare system. In order to achieve this transformation, the committee recommended that nurses attain higher levels of education and training, practice to the full extent of that education and training, and assume more

In the healthcare field, nursing leaders and managers face consistent issues in their respective practices that force them to alter the way they work and the way they think. In taking on a role as a leader within the field, nursing leaders and managers also take on the role of ensuring that work within an organization runs smoothly regardless of new issues that may arise in the healthcare arena. For instance, in today's healthcare environment, the issues of nurse shortage and nurse turnover have the capacity to alter the healthcare field and many of its respective branches and organizations should these problems not be managed properly by the leaders in the field. In viewing the issue at hand and in discovering how nursing leaders and managers are expected to act, and do act, in order to approach this issues, along with pinpointing the best approach possible to aid this issue, one can better understand which leadership styles are necessary for leaders to function.

The following paper discusses the nurse manager’s/leader’s role in healthcare financial management and budgeting. The definition of a budget is a detailed financial plan. The nurse manager/leader is responsible in knowing and understanding the different types and budgets within the healthcare organization: operating, capital expenditure, and cash. The operating budget is the main budget the nurse manager/leader maintains an active role in for the healthcare organization by controlling personnel and supply costs. Collaboration with the nursing staff on the unit as well as other