ABSTRACT Health care delivery systems are challenged to provide and demonstrate accountability for cost-effective, high quality, and integrated interdisciplinary services to increasingly diverse populations across the care continuum. Nurses with advanced knowledge and skills in systems thinking, collaborative practices, and a population focus are needed to provide leadership to these emerging systems. The Health Systems Nurse Specialist (HSNS) program at the University of Nebraska is an innovative master's curriculum that prepares nurses in three distinct specialties: community health nursing, nursing administration, and nursing informatics. All build on a set of core courses that integrate foundational knowledge and skills from each specialty that are needed by any nurse working at the systems level in health care. HSNS students develop specific skills to work collaboratively to determine priority health and organizational needs; develop and implement interventions, programs, and supportive information infrastructures; and monitor and improve program and population outcomes. The background and vision for formation of the program and its curriculum are presented in this article.
GRADUATES OF COMMUNITY HEALTH NURSING AND NURSING ADMINISTRATION MASTER'S PROGRAMS have traditionally served as leaders in the development, implementation, and evaluation of health care programs and health policy for communities and organizations. In the past decade, however, enrollments in programs focused on population-level health and organizational administration have decreased significantly. Thus, throughout the country, there is a need for nurse leaders who will shape and strengthen systems of health care delivery for multiple and diverse populations. * Challenges confronting health care delivery systems providing integrated, interdisciplinary services have led to a heightened need for nurses with backgrounds in both Community Health Nursing and Nursing Administration, as well as the emerging specialty of Nursing Informatics. Some of these trends include an increased need to demonstrate accountability for cost, quality, and access to services to consumers and to the community, a heightened recognition of the interdependence of public and private health sectors, and a growing diversity among populations that require care across the continuum. * A faculty work group at the University of Nebraska designed an innovative master's curriculum, the Health Systems Nurse Specialist (HSNS) program, to respond to these needs. The program consists of three distinct specialties--Community Health Nursing, Nursing Administration, and Nursing Informatics. All build on a set of core courses that integrate the foundational knowledge and skills unique to the specialty that are needed by any nurse working at the systems level in health care. A systems perspective with a population-level focus and socialization as a leader, knowledge worker, and continuous learner are hallmarks of the program. * The creation and ongoing development of the HSNS program challenged nurse faculty from different specialties to practice the collaborative skills viewed as essential for leaders in emerging health care delivery systems.
THIS ARTICLE DESCRIBES THE BACKGROUND AND VISION FOR THE HSNS PROGRAM, ITS INNOVATIVE CURRICULUM, AND THE STRATEGIES USED TO CREATE AN INTEGRATED PROGRAM ACROSS SPECIALTIES.
The Need for an Integrated Program It became clear during the 1990s that to provide leadership, nurses would need more than a solid grounding in nursing knowledge and practice. They would also need advanced skills in systems thinking and functioning, interdisciplinary collaboration, and information and communication technologies.
This was a decade of major transformation in the organization, delivery, and financing of health care in the United States (1,2). Driving forces for change included rapidly escalating costs, disparate health status indicators across populations, and consumer concerns about quality of care.