Leadership for Advanced Practice Nursing 1

Staffing is not the main issue in elevating or containing costs: the main issue is retention. High turnover rates in nursing can drive costs up, but proper staffing with an appropriate ratio of nurses to patients can actually reduce costs over the long-term so long as turnover is not an issue. The reason is that appropriate staffing leads to improvements in quality care delivery (Martin, 2015). And as Rothberg, Abraham, Lindenauer and Rose (2005) point out, improving nurse-to-patient staffing ratios is a cost-effective intervention that—far from being detrimental to cost control—reduces costs because it enables patients to receive better care and reduces the risk of nursing errors being committed as a result of burnout.

Everhart, Neff, Al-Amin, Nogle and Weech-Maldonado (2013) show that in highly competitive markets, the better the nurse-to-patient ratios, the better the reputation of the hospital. The only markets in which increases in staffing has not been found to be impactful has been in non-competitive rural markets. In short, the law of diminishing returns only appears to kick in, both cost-wise and care-wise, in markets where nurses and facilities are not challenged to out-perform their competition. In markets where hospitals and health care facilities are required to be competitive, staffing does help to contain costs and increase the quality of care that patients receive.

2

Health care leaders can determine appropriate nursing and care delivery models to address rapidly changing populations by focusing on the models that will best serve the needs of the community. For instance, the transcultural model of nursing focuses on emphasizing cultural understanding and requires nurses to learn how different cultures create different expectations in populations (Maier-Lorentz & Leininger, 2008). In a rapidly changing population, there is bound to be an influx of cultures, whether because the population is aging, more ethnicities are arriving in the area, or for whatever reason; these various populations have to be understood as having unique needs, wants, desires and expectations. Therefore, by exercising some innovative leadership (Gliddon, 2006) and emphasizing the importance of recognizing cultural values among patients, health care leaders can determine the appropriate nursing and care delivery models to help their nurses address the needs of this population.

It is also important to look at the needs of health care providers: the nurses themselves may require some training and instruction and, as a result, could benefit from the implementation of specific models that would provide them with the right kind of guidance. Leaders must be able to communicate with their workers, listen, and identify issues and potential barriers to change. By creating a vision of what the organization is trying to achieve and getting all stakeholders on board, the right models will begin to fall into place as resistance to change is melted away.

3

As Lathrop and Hadnicki (2014) point out, the Affordable Care Act (ACA) helped to bring reform to the health care industry by focusing on “a preventive healthcare model that emphasizes primary care, funds community health initiatives, and promotes quality care.” This reform has created a demand for doctorally prepared APRNs who can deliver the kind of quality care in a primary care setting that is needed according to the ACA. Doctorally prepared nurses can provide leadership, guidance for interdisciplinary teams, and advocacy for future nursing reforms.

Another issue that has been introduced in recent years in states’ legislatures is the issue of who has the right to be called a doctor. As Zittel (2012) notes, “in January 2011, two U.S. representatives introduced H.R. 451, the Healthcare Truth and Transparency Act of 2011, designed to empower patients by increasing transparency in healthcare provider-related advertisements and marketing.” The goal of this bill is to make it clear to patients which care providers a medical doctors—aka physicians—and which are doctors of nursing. The bill aims at reducing confusion about who is a doctor—but the bill is actually only adding to the confusion. Doctor is an academic term, not a medical one. Doctors of nursing have just as much right to advertise themselves as doctors traditionally associated with the concept of medical doctor. This bill would make it so that nurses with doctoral training are viewed as less equipped and knowledgeable than medical doctors. That would be disadvantageous for APRNs because as the Institute of Medicine has pointed out, there is a need for more APRNs in primary care and doctoral nurses should be respected in the industry—not further marginalized...

Advocacy is about listening and supporting the rights of patients and professionals. By advocating for both, the doctorally prepared APRN establishes a symbiotic relationship between the two goals because ultimately what benefits the care provider will benefit the patient, and what benefits the patient is what the care provider should seek to achieve. By protecting through advocay the patient and the care provider, the APRN creates a union between the two that should exist naturally.
Advocacy is advanced effectively by adhering to a “complex process that requires skillful use of problem solving, communication, influence, and collaboration to achieve a solution to an issue. Often, advocacy is an incremental process of achieving change through a series of efforts that may take months or years to accomplish” (Tomajan, 2012, p. 4). By collaborating with colleagues and other leaders, communicating, raising awareness through publications and conferences, and engaging in problem solving, the nurse advocate engages in a process of advocacy that can be very helpful in resolving issues that are important to patients and nurses. Advocacy is most effectively advanced when it is promoted via an organized process united groups and individuals with community and organizational leaders with the goal being to produce a solution to a specific issue.

5.1

The reason behind the need for doctorally prepared advanced practice nurses to be politically active is that they are the leaders for other nurses: they have the training, knowledge, skill, expertise and contacts that enable them to use their voices in a positive and effective manner. Political leaders listen to the leaders of the public for guidance and ideas. Political leaders are representatives of the people and doctorally prepared advanced practice nurses are leaders of nurses—so it is natural for the two to get together to promote legislative changes that will positively impact the health care industry, help nurses and help patients. The Affordable Care Act is one example of a piece of legislation that benefited from APRNs being politically active. They served as one group of constituents advocating for the need for preventive care in medicine, and their voice helped shape the outcome of the ACA policy. When bills like the ones being passed in various states to clarify who is a doctor and who isn’t a doctor, it is important for APRNs to again be assertive and highlight the right of doctors in nursing to be able to use that title. So the doctorally prepared advanced practice nurse should be politically active because so much happens in the political arena that impacts nurses directly—and they are the leaders in the nursing industry so it is up to them to take charge. They can take charge by organizing groups or committees, meeting directly with legislators and representatives, hosting fund raisers, and holding conferences, seminars, work groups, and discussion panels to share ideas and raise awareness. Ethical and other considerations that must be taken into account as a nurse becomes politically active are the facts that the nurse is not there to represent herself but rather there to represent other nurses and patients so that the best practices can be promoted at the legislative level.

5.2

It is meaningful to have doctorally prepared advanced practice nurses as members of health care boards because they help to provide guidance, leadership and representation on those boards to ensure that nurses are protected, supported and empowered and that patients’ rights and privileges are also supported in line with the guidelines of nursing professional codes. The role of the nurse on these boards is to facilitate the development of relationships with other organizations, help to create policies that are effective for patients and health care providers and to strengthen orientation programs that use the boards for assistance (Walton, Lake, Mullinix, Allen & Mooney, 2015).

The nurse helps to make sure that nurses have their needs met by sitting on boards, as they represent their interests. For instance, with staffing needs, the doctorally prepared advanced practice nurse can provide information to help shape policies; the nurse can present the experiences of other nurses as anecdotal evidence to support promoting a…