Population Health Policy Analysis

In October 2005 the Quality and Safety Education for Nursing program was established. This program is funded by the Robert Wood Johnson Foundation. QSEN was developed specifically for future nurses to understand and be aware of key challenges such as the knowledge, skills, and attitudes that are essential to constantly advance the quality and safety of the way healthcare systems work. The goal for QSEN is to reshape the identity of nursing so it includes the recommendations by the Institute of Medicine so there is a commitment to the quality and safety proficiency (Dycus, 2009).

Since 1980, the United States has taken on 10-year plans that outline certain key national health objectives set to be accomplished during a 10-year timeframe (Shi & Singh, 2015). These initiatives are founded on medical care with prevention services, health promotion, education, community health care, and increased access to integrated services. The initiative, Healthy People 2010: Healthy People in Healthy Communities, launched in 2000. The initiative emphasizes the role of community partners such as

Quality and Safety Education in Nursing (QSEN) was started around 2005 by the Robert Wood Johnson Foundation. QSEN's main goal is to “prepare future nurses with knowledge, skills and attitudes (or KSAs) necessary to continuously improve the quality and safety of the healthcare system,” (QSEN, 2017). “Integration of clinical skills with the intellectual capacity to safely manage the complexity of nursing work in key to quality care in a time of diminishing resources,” ( Dolansky, 2013). “It is vital for schools of nursing to meet the needs of today's complex health care systems by including principles of quality and safety throughout the curriculum,” (Lewis, 2016). Within the KSAs are six main categories; patient-centered care, teamwork

In the article “What Do Nurses Really Do?”, Suzanne Gordon explores what nurses truly do. She concludes that nurses “save lives, prevent complications, prevent suffering, and save money” (Gordon 2006). Nurses provide care for their patients in the physical and emotional sense. Emotionally caring for a patient and being sensitive to his or her needs result from interacting with patients while performing the skills and using the knowledge that nurses learned in school. Nurses grow in their skills, knowledge, and attitudes through practice. Quality and safety education for nursing incorporates competencies that all nurses must use in their practice. These nursing competencies include evidence-based nursing practice, quality improvement, safety, teamwork and collaboration, patient-centered care, and informatics.

The overall goal through all phases of The Quality and Safety Education for Nurses (QSEN) is to address the challenge of preparing future nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they work. In order to accomplish this goal, six competencies were defined. These competencies from the Institute of Medicine (IOM) are patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics and safety. Over a decade has passed since the Institute of Medicine’s reports on the need to improve the American healthcare system. The Quality and Safety Education for Nurses

Over time the health care industry has become more complex. Health care is rapidly evolving and continuing to complicate our delivery of care, which in turn has the same effect on quality of care. This steady evolution and change results in nursing shortages and an increase in the prevalence of errors being made. In hopes of preventing these errors and creating safe and high quality patient care, with the focus on new and improved ways of thinking, The Quality and Safety Education for Nurses (QSEN) initiative was developed. The QSEN focuses on the following competencies: patient-centered care, quality improvement, safety, and teamwork and collaboration. Their initiatives work to prepare and develop the knowledge, skills, and attitudes that are necessary to make improvements in the quality and safety of health care systems (Qsen.org, 2014).

The American Nurses Association (ANA) Code of Ethics provides many professional traits that can be incorporated to an interdisciplinary team of healthcare professionals such as compassion and respect, advocacy, accountability for nursing practice and participation in advancement of the nursing career (Cherry, 2011). Compassion is a very important aspect of the nursing profession. It would be very difficult to be a nurse without being compassionate. Nurses demonstrate compassion and respect daily in their work by actively listening to patients’ and family members’ problems and concerns and by empathy when appropriate. Advocacy is a nursing trait constantly used by the entire interdisciplinary team. Nurses advocate for patients’ right of autonomy for decision making in regards to their care, treatments and procedures. Also, nurses are in the best position to serve as a bridge between the patient and the interdisciplinary team. Accountability is so essential in the nursing profession. Nurses are accountable for their own nursing practices and for our patients.

Dolansky and Moore (2013) argued that the development and integration of QSEN competencies into nursing education had not have the outcomes intended. They stated "over a decade has passed since the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System" and national initiatives to improve quality, especially QSEN, have been futile in significantly improving quality and safety. "QSEN is a national movement that guides nurses to redesign the "what and how ' they deliver nursing care so that they can ensure high-quality, safe care" (Dolansky & More 2013).

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

Patients want and expect to receive high quality care. Nurses want to provide the best care possible to their patients and like everybody else; want a pleasing job environment. Hospitals, on the other hand, are expected to provide a safe environment to patients, have enough nursing staff and remain profitable (Keller, Dulle, Kwiecinski, Altimier & Owens, 2013). The ultimate goal is to improve quality of care and patient safety across the United States; therefore, all the different interests of these major stakeholders should be taken into

American Nurses Association (ANA) Standards of Professional Performance explains how all registered nurses do their work and activities consistently according to their professions that promote the wellbeing of their patients and communities (ANA, 2010a). The standards provide a mechanism to patients that they are been taken good care of and that the nurses know exactly what to do so as to provide high-quality care and the measures are in place to determine whether nursing care meets the standards. These activities are related to performance like ethics, quality of practice, education, communication, resources, leadership, environmental health, professional practice evaluation, and evidence-based practice and research. Registered nurses are responsible for their professional actions to themselves, their patients, their peers, and the community at large.

In 2010, the Affordable Care Act invoked a $75 millon dollar demonstration project known as the Medicad Emergency Psychiatric Demonstration that was amended in section 2707 of the Affordable Care Act (ACA). The change seemed to be just what the nation needed, however, there was fine print added to the amendment that changed the interpretation. The fine print stated, patients who are on Medicaid from the ages of 21-65 seeking inpatient mental health care can receive treatment under the law. However, the inpatient facility will receive no

Following the appropriate ethics is of extreme importance in the nursing profession. “Ethics are of universal concern and crucial in all professional healthcare” (Gustafsson & Stenberg, 2017, p.420). The leading goal in nursing is to achieve patient-centered care. According to Arnold and Boggs (2016), “Patient centered care focuses on fully partnering with the client to provide care that incorporates his or her values and preferences to give safe, caring, compassionate and effective care” (p.25). In order to provide a well-grounded, caring environment, nurses need to be able to balance their personal differences with the ethical care standards they are obligated to provide patients (Gustafsson & Stenberg, 2017). Nurses spend the most time with patients; therefore, they eventually will develop a “sense of rightness” (Gustfasson & Stenberg, 2017, p.420).

The passage of the ACA addresses population health in several ways, including expanded insurance coverage while improving quality of care and promoting community and population-based activities (Stoto, M.A). First, provisions to expand insurance coverage are targeted to improve population health by improving access to healthcare. A number of expanded programs include individual mandates, Medicaid expansion, state insurance exchanges, and support for community health center. Secondly, the establishment of the National Prevention, Health Promotion, and Public Health Council are aimed at the promotion and access to community- and population-based activities (Stoto, M.A) The ACA provides incentives, such as small grants, for workplace wellness programs to develop well programs and insurance discounts to employees for participating (Stoto, M.A).

These competencies consist of Patient-Centered Care, Teamwork and Collaboration, Evidence-based Practice (EBP), Quality Improvement (QI), Safety, and Informatics. The overall goal of QSEN is to continuously guide nurses who have the knowledge, skills, and attitudes (KSAs) to improve the quality and safety of the healthcare systems within which they work. During this sentinel event four of the QSEN competencies (Patient-Centered Care, Safety, EBP, and Informatics) were compromised, reflecting poor teamwork and