Editor's Note: Transforming healthcare is a formidable challenge that can only be met through a coordinated response from academic and practice leaders across the health professions. Nursing plays an important role in steering this critical work.
In a new white paper prepared for the American Association of Colleges of Nursing (AACN), Manatt Health examines the potential for an enhanced partnership between academic nursing and academic health centers around the imperative to advance integrated systems of healthcare, achieve improved health outcomes and foster new models for innovation. Based on research with a variety of stakeholders in academic health center (AHC) and non-AHC-affiliated institutions, the final report identifies best practices and effective models for fully integrating nursing schools into the operation of AHCs. In the first in a series of articles based on the white paper, we summarize below key findings and recommendations. To download the full white paper, click here.
Academic health centers have long been at the apex of American healthcare. Health reform imperatives are compelling AHCs to broaden their focus to community settings and deliver care across the continuum of patient needs. Along with changing economics, market consolidation, generational changes in the healthcare workforce, and an increasing focus on chronic disease prevention and management, these market dynamics are requiring AHCs to transform their operating models and evolve into more integrated and efficient systems of care.
In addition to providing the largest professional workforce in the health system, nurses play a central role in the management of AHCs' patients and their families. Nurses are often the primary interface point and advocate for patients. Patients want to get well—and nurses play a central role in making healthcare better.
As academic health systems develop and increasingly implement value-based reimbursement programs, as well as assume responsibilities for patient populations, health system leaders should look to nurses to lead and support prevention and wellness programs, new models of care delivery, continuity across transitions in care settings, and integration with home- and community-based services. At the same time, academic nursing is advancing higher levels of preparation and developing pathways for deeper specialization, which can help AHCs expand access to care and address the primary care shortages in many communities.
Summary of Findings
To date, the potential for academic nursing to be a driving force in the transformation of AHCs into health systems has not been realized. Manatt Health's findings regarding the current state of alignment between academic nursing and AHCs are sobering.
- Finding 1: Academic nursing is not positioned as a partner in transformation.
Significant organizational limitations prevent academic nursing from functioning as a true partner in AHC transformation. These include minimal meaningful participation in health system governance, lack of integration of nursing faculty into health system leadership roles, marginal integration of nursing faculty into clinical services, and siloed nurse-scientist research.
- Finding 2: Institutional leaders recognize the missed opportunity from lack of alignment with academic nursing and are seeking a new approach.
Preparation of Manatt Health's report involved numerous interviews and surveys with deans of nursing and university presidents, as well as a summit that brought together institutional leaders for candid dialogue. A theme that ran consistently throughout these discussions was one of missed opportunity for partnership and a strong desire to reset relationships around a dynamic vision for academic nursing.
- Finding 3: Insufficient resources are a barrier to supporting a significantly enhanced role for academic nursing.
The tuition-dependent funding structure of academic nursing severely limits the ability of schools of nursing to participate in healthcare transformation initiatives and to provide the institutional leadership of which they are capable. Most schools of nursing do not have faculty practices. Therefore, they have no clinical income, nor do they generally receive funding from their affiliated health systems. Despite unique research capacity (particularly related to patient-oriented research), schools of nursing received just 1% ($133 million) in National Institutes of Health (NIH) funding from a total budget of approximately $30 billion.
Summary of Recommendations
An enhanced partnership between AHCs and academic nursing will enhance the ability of academic health systems to transform healthcare. Achieving a new partnership requires that nursing faculty have a deeper involvement in clinical practice and greater opportunity to engage in clinical innovation. Stronger partnerships also entail fostering enhanced nurse-scientist-based patient- and community-oriented research. There are six recommended actions for institutional leaders:
1. Embrace a new vision for academic nursing.
The recommended vision for institutions is the following: Academic nursing is a full partner in healthcare delivery, education and research that is integrated and funded across all professions and missions in the academic health system. The elements of the vision include:
- Nursing participation in health system governance.
- Expanded academic nursing leadership in clinical practice and care delivery.
- Growth and evolution of academic nursing research programs in partnership with the medical school, health system and other professional schools.
- Collaborative workforce plans and training programs in partnership with the health system.
- Integration of academic nursing into population health initiatives.
- Systemwide commitment to leadership development to prepare and support future nurse leaders.
2. Enhance the clinical practice of academic nursing.
Initiatives should be implemented that more fully bring nursing faculty into the clinical practice of the health system and connect the clinical service more closely to the academic mission of the school of nursing.
3. Partner in preparing the nurses of the future.
Build a pipeline of nurses at all levels—from undergraduate to post-graduate—to meet the clinical requirements of the extended AHC system. Create nursing leadership development programs for faculty and practicing nurses that are jointly managed by the school of nursing and clinical practice.
4. Partner in the implementation of accountable care.
Strategies include joint clinical planning, leadership from academic nursing in developing linkages between acute and post-acute care, home-based and long-term care services, and expansion of nurse-led community programs under the leadership of academic nursing faculty in partnership with health system leaders and clinicians.
5. Invest in nursing research programs and better integrate research into clinical practice.
A research-grounded and evidence-based nursing service will enrich the AHC and benefit the community. Strategies for achieving this goal include:
- Creating mechanisms to coordinate research projects and activities across academic nursing and AHCs,
- Developing joint research programs between academic nursing and health system nurse-scientists,
- Integrating nurse researchers into developing informatics programs,
- Strengthening the training programs for nurse clinical trial coordinators and clinical research nurses,
- Providing leadership in establishing linkages to other professional schools, and
- Expanding nursing faculty development and recruitment to include PhD investigators across multiple disciplines in targeted research areas.
6. Implement an advocacy agenda in support of a new era for academic nursing.
Planks of the recommended agenda include:
- Seeking growth in the NIH budget to support nursing-led research, especially at the National Institute of Nursing Research (NINR);
- Increasing funding support for the training of nurse-scientists;
- Advancing a national nursing agenda that links to the Triple Aim, including expansion of the Graduate Nurse Education (GNE) Demonstration;
- Heightening advocacy for scope of practice changes to enable nurses to take on the clinical roles that they are trained to perform; and
- Supporting academic nursing leadership in clinical care delivery.
Achieving the potential for academic nursing requires a change in culture that can only be accomplished through the collaborative leadership of university presidents, deans of nursing and medicine, and health system chief executives. All parties must embrace a new vision for academic nursing and challenge the status quo, seeking to unharness the potential of their nursing colleagues.
Participatory governance structures that cross-populate, as appropriate, leaders of the academic and clinical practices will help ensure mission integration and diverse insights across a range of constituencies. Participatory governance will be enhanced by collaborative strategic and financial decision making around academic, clinical and research programs, as well as workforce development. Further alignment of medicine, nursing and health system organizations may also prove beneficial for some institutions.