The role that nurses play in providing health care has been becoming bigger and bigger within recent decades. Nurses are no longer viewed as physicians’ assistants who accomplish tasks for which doctors may not have enough time. A special value of nurses’ work consists in the special connection that nurses have with patients and in a wide range of opportunities for a nurse to make a positive contribution to a patient’s treatment.
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Various theories and concepts have been developed in the academic community to address this changing role of nurses, and many studies have been conducted to reveal how nursing care can be more effective and how certain methods can help improve the quality of care nurses deliver.
One of the most influential concepts in this regard is continuity of care. Uijen, Schers, Schellevis, and van den Bosch (2012) note that the concept is closely related to other modern nursing concepts, such as coordination of care, integration of care, and patient-centered care; the meanings often overlap. However, the main idea that can be learned from all these theoretical frameworks is that care is not only meeting the most vital needs of a patient and ensuring that he or she receives treatment properly.
Instead, it is suggested by researchers and health care providers that the notion of care encompasses a wide range of patient needs and necessities. Nurses are not only there to give a shot or fix a pillow; nurses can significantly improve health outcomes by developing personal relationships with patients, creating physical environments that facilitate recovery, engaging patients’ families in care, enhancing patient comfort, ensuring patient safety, and doing many other things that emphasize the importance of nurses’ work.
For example, accountable care organizations (ACO) demonstrate a new model of providing care in which health care professionals come together voluntarily to coordinate treatment efforts and ensure that patients receive treatment they need, and services are not duplicated (Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012). In this model, the role of nurses is explicitly important, as nurses get to connect the efforts of other health care team members and maintain the network of cooperation needed to address the needs of patients effectively.
Also, medical homes and nurse-managed health clinics present a model in which the number of nurses compared to the number of physicians is higher than in traditional models, and the scope of work done by nurses is larger. According to Auerbach et al. (2013), the model is promising because it can help mitigate the negative effects of physician shortage. To promote mitigation, it is suggested to change laws and expand the roles of nurses to an extent that face-to-face visits with physicians are no longer the main components of care.
The main thing for nurses to learn about the upcoming change in the profession is that nurses can offer much more to care than they do now in most facilities. What is particularly important to the process of role expansion is communication. Uijen et al. (2012) argue that integrated care can be developed through making the communication between nurses and patients, among nurses, and with other members of health care teams more effective. It means that, in the nearest future, nurses will be expected to build more willingly close relationships with patients, coordinate their work more efficiently (e.g. by applying modern technologies), and work more closely with physicians, e.g. by engaging in advocacy, i.e. serving as a bridge between patients and doctors.
Three practicing nurses were asked to familiarize themselves with the presentation and provide their feedback. For convenience and anonymity, the nurses will be referred to as A, B, and C. A general theme in their feedbacks is that the profession is changing indeed, and all three agreed that further evolution of care models should be expected.
However, nurse C expressed their skepticism about the scope of change, as they said, “There is more talking about nursing changing than there is changing.” Nurse C thinks that the essence of the profession has remained the same over the last hundreds of years. However, they too acknowledged that the role of a nurse in health care would be expanding in the nearest future.
In their feedback, nurse A paid attention to the explanation of different terms provided in the presentation. Nurse A confessed that they had never really understood the difference between continuity of care and integration of care and suspected that the two meant virtually the same. The presentation does not state that the two concepts are the same; it does, however, state that the meanings of the two, as well as some other concepts, such as coordination of care and patient-centered care, may overlap.
Nurse A suggests that, with all these concepts, different theorists and practitioners are trying to say the same thing. Nurse A wrote, “You keep hearing about new theories in nursing. The practice changes, too. Nurses today have to do more things than we used to, I think. We have to make better use of technologies, be closer with patients, more attentive to their environments, more cooperative, and more responsible.”
It should be noted that, while the presentation described the recognition that nurses, in what they do, can make larger contributions to care provided to patients, nurse A, in their feedback, stresses the necessity, not the opportunity; instead of “can,” they use “have to.” Therefore, the first respondent emphasized the changing requirements of the profession, not the changing conceptual understanding. Nurse A provides an example of a new electronic patient record system that their facility adopted; instead of describing how the new system make their work easier and perhaps more efficient, nurse A again stresses that mastering the new technology was a challenge that took a lot of time, while the nurse still had to perform all the regular duties, too.
Nurse B paid more attention to the models of medical homes and nurse-managed health clinics, i.e. models in which the role of nurses is significantly more important than in traditional models. Nurse B wrote, “It is not as much a shift in responsibilities because nurses always got to do more for the process of care delivery than it was acknowledged, so it is more of a shift in recognition.” Further, nurse B argues that nursing theories that encourage nurses to be more cooperative are not something new, either; they simply describe the actual process of nurses’ work in which nurses always had to cooperate extensively within medical facilities and health care teams before there were any theories to describe it.
Concerning the presentation, nurse B expressed their doubt as to the fact that nurse-managed facilities will help mitigate the negative effects of physician shortage. The presentation states that such models can expand the roles of nurses to an extent that face-to-face visits with physicians are no longer the main components of care; nurse B argues that “nurses do not do treatment but only ensure that it is properly delivered.” Therefore, according to the respondent, models in which patients are deprived of direct physician attention and only communicate with their doctors through nurses are harmful models. A theme in nurse B’s feedback is that nurses cannot and should not do everything in delivering care, and they should strive for more extensive cooperation with physicians, not assumption of physicians’ functions.
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As it was mentioned, nurse C was the most skeptical toward the content of the presentation. They claimed that the variety of nursing theories emerging today “say nothing new” about nursing care or nursing practice; according to nurse C, those theories merely state what nurses already know. The respondent was particularly critical about the part of the presentation that addressed the issue of communication; the presentation stated that, in the concept of continuity of care, effective communication between nurses and patients, among nurses, and between nurses and physicians is a key factor. Nurse C wrote, “We are told…that we need to communicate more effectively. It is almost like nurses today do not talk to patients and silently obey doctors.
This is not the case. Nurses are always there for each other and for patients, they are the glue of any treatment process.” However, nurse C expressed their satisfaction with the fact that actual practices of nursing care, i.e. something nurses usually do, e.g. communicating effectively for promoting continuity of care, become more recognized and receive more attention from the academic community.
Auerbach, D. I., Chen, P. G., Friedberg, M. W., Reid, R., Lau, C., Buerhaus, P. I., & Mehrotra, A. (2013). Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage. Health Affairs, 32(11), 1933-1941.
Fisher, E. S., Shortell, S. M., Kreindler, S. A., Van Citters, A. D., & Larson, B. K. (2012). A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Affairs, 31(11), 2368-2378.
Uijen, A. A., Schers, H. J., Schellevis, F. G., & van den Bosch, W. J. (2012). How unique is continuity of care? A review of continuity and related concepts. Family Practice, 29(3), 264-271.