Academic journal article Creative Nursing

Building Economic Value for Professional Nurses at the Gateway to the Health Care System

Academic journal article Creative Nursing

Building Economic Value for Professional Nurses at the Gateway to the Health Care System

Article excerpt

An enhanced role for professional nurses as directed care practitioners will lead to improved effectiveness of the health care system, establish independent economic value for nursing activities, and use the full range of nurses' expertise.

Keywords: ambulatory care nursing; care management; care coordination; nursing economic value; professional nurse expertise; nurse practitioners

Health care reform has become a reality as components of the Affordable Care Act are implemented. Workforce use is an open area for redesign to improve effectiveness and efficiency of the health care system. The Institute of Medicine (IOM, 2011) report, The Future of Nursing: Leading Change, Advancing Health, resonates in many areas marked for change, including placing more nurse practitioners in ambulatory care for better consumer access to health care. This article provides a different vision, using professional nurses, both nurse practitioners and their registered nurse colleagues, in enhanced roles that create a higher level of visibility and value as well as the opportunity to practice to their highest level of expertise. This vision goes beyond merely increasing the number of nurse practitioners in their existing roles.

The IOM report (2011) envisions a health care system that promotes wellness and disease prevention and improves health care outcomes throughout the lifespan. Giving professional nurses the responsibility to direct care in these areas is a natural fit for their traditional and current strengths. Professional nursing leadership and management skills should be engaged routinely to influence individual personal health behaviors toward optimal wellness and to guide consumers to more effective and efficient use of health care resources.


Adding nurse practitioners addresses the supply side of services in the health care system. This article focuses on consumer demand. It proposes a new workflow to decrease requests for illness and injury services, and to improve the evaluation of consumer needs (the magnitude of illness or injury, immediate or long term).

Demand factors that are within a consumer 's control are personal health habits, self-efficacy, and attitudes about health care (Willis Insights, 2011). These factors are crucial because they often impact risks of chronic disease, which is the leading cause of death and a major source of health care use and cost (Centers for Disease Control and Prevention [CDC], 2009). Demand management can be addressed prospectively, with integrated planning for individual preventive and chronic care needs, and retrospectively, by reviewing an individual's use of health care resources relative to the integrated plan. Professional nurses sharing credible information and helping individuals develop health care consumer skills and confidence in managing health issues can lead to better choices.


Starfield (1998), a highly regarded advocate for primary health care, states that "primary care is that level of a health service system that provides entry into the system for all needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care provided elsewhere by others" (p. 8). A health care system based on primary health care principles has demonstrated improved health outcomes and greater equity than systems with a medical specialty orientation (Starfield, 1998).

A New Focus for Ambulatory Primary Care

The importance of preventive care in keeping people healthy, in lieu of treating them when they become ill or injured, is becoming apparent. Ambulatory primary care needs to be proactive in decreasing the likelihood of an incident or illness occurring, or diminishing the severity if it does occur, with emphasis on preventive care. …

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