Being a change agent is a major function for nurses. Nurses are on the floor seeing the effects medicine and the health care system is having on the patient. We know that some things are getting better for the patient and other things are not. We must be vocal about the changes that are working and those that aren’t, and about what still needs to change.
Nurses comprise the largest sector of the health care workforce in the United States and in most other countries. There are more than 3 million nurses in the United States alone. We can play a critical role in shaping the health care system of the future.
There are barriers keeping nurses from being effective change agents in the ever evolving health care system. These barriers need to be fully identified, recognized, and overcome for nurses to be in the position to lead change and demonstrate the ability to be change agents.
Some of the barriers for nurses to be a major leader in change is that nurses need to be allowed to practice to the full level of their education and training. Nurses also need to be recognized as a fully functioning discipline in health care delivery and be a full partner in health care decision making.
One example of nurses being involved in facilitating change is in decreasing hospital readmissions. When nurses are assigned to elderly, high risk patients that are likely to relapse, readmissions go down. This was demonstrated at the University of Pennsylvania in Philadelphia with the Transitional Care Model program. In this program the nurse follows the patient up to three months after discharge, attending their medical appointments, and collaborating with physicians, caregivers, and family. This program demonstrated a significant reduction in the number of hospital readmission and costs dropped by as much as $5,000 per patient. Unfortunately, many third-party-payers and institutions are not willing or not structured in a way to pay for nurse-directed programs.
Nurses must continue to look for ways to impact change within the health care system. You don’t have to be a nurse manager to be a change agent. Any nurse can have a significant impact on needed change within nursing. If you see a change that could occur that you think would have an impact, discuss it with someone who can help to champion your idea and get it implemented. It will need to be tested to see if it does result in a positive outcome and is cost effective. Nurses have what is needed to be successful in identifying and implementing change.
The United States has an opportunity to dramatically change its health care system. The current system won’t function very well into the future due to both a shortage of physicians and nurses. It is critical for nursing to play a significant role in how our health care system is shaped and changed going forward.
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