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.
The 1990s saw a broad paradigm shift in health care delivery throughout the country - from a focus on illness to health and wellness; from the provision of health services to individuals to population-based services; from institutional care to communitybased care; and from professional, provider-centered decisionmaking to decision-making by patients and payers based on information about cost and quality. The interdependence of providers and organizations was recognized as essential for the advancement of health care. The integration of services, the management of costs and care, evidence-based accountability, and collaboration among multiple providers became major strategies within the emerging health care delivery system.
Another trend during this period was the proliferation of the nurse practitioner role in the delivery of care to individuals of all ages across the continuum of care. The nature of advanced practice nursing and educational preparation for this role were examined in depth (3,4). However, despite a call for creative and effective leadership by communities and health care organizations, the emphasis was primarily on advanced practice roles that addressed the health needs of individuals. …