Editor's Note: In the March issue of "Health Update," Manatt Health introduced a new report prepared for the American Association of Colleges of Nursing (AACN) that 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. In the March article, we summarized key findings and recommendations from our research with a variety of stakeholders in academic health center (AHC) and non-AHC-affiliated institutions. We continue our series based on the white paper with a summary of the major takeaways from the Academic Nursing Leadership Summit, which provided important input into our final report. To download the full white paper, click here.
The Academic Nursing Leadership Summit, held August 2015, brought together deans from academic nursing and medicine; health system CEOs and CNOs; and leaders from AACN, Association of American Medical Colleges, universities, and the Veterans Health Administration nursing team. Participants engaged in a thorough discussion of the challenges of health reform, the imperative for health system transformation, and the opportunity for academic nursing leadership. Manatt Health facilitated the session, which yielded 10 major themes, each of which was developed and included in the final report:
- The traditional ways of doing business within AHCs must evolve, which will necessitate cultural change. Of particular importance will be enhanced communication, a focus on "we," and a commitment to mutual support among all the players. This will be a difficult cultural change, given that the schools of nursing, other professional schools and schools of medicine have become increasingly siloed.
- New organizational structures that more closely couple academic nursing with health systems will be important to facilitate the kind of successful integration that is a precursor to effective collaboration. The broad principle of alignment of interests along strategic, cultural, programmatic and governance dimensions should be pursued.
- The financial model of tuition driving academic nursing inhibits the strategic and aspirational role participants believe is possible. Nursing faculty typically focuses on teaching and is reluctant to take on positions of clinical responsibility, particularly without a financial support model. If academic nursing is to serve a transformative role, then the economic model must be put in place to provide resources—through clinical, research and educational support—to do so.
- Within academic nursing, there is a strong perception that physicians are overly dominant and that independence is necessary for nurses to achieve their full potential. Contemplating the pivotal role for nursing in the future, the issues of cultural and organizational bias that persist in our organizations must be addressed.
- Nursing needs to be at the table as AHCs develop their population health strategies and accountable care organizations. Leaders should be seeking new opportunities to connect their deans of nursing to other initiatives in their enterprise.
- Leadership development is a key long-term success factor for AHCs given trends in inter-professional, team-based clinical care and in multi-professional research programs that seek to translate discovery and innovation into practice. Approaches that identify and foster the development of future leaders—both through informal mentorship and formal educational programs—in the clinical, research and administrative realms are essential.
- Workforce planning efforts within AHCs through partnerships with the health system and its affiliated schools represent a major opportunity for collaboration:
a. Significant opportunity exists within AHCs to link clinical enterprise workforce needs and planning to various academic programs to create a robust pipeline of clinicians prepared for the future of care delivery.
b. There is a shortage of clinicians to support clinical trials and data integrity/analytic roles in AHCs, as well as a shortage of researchers in data science and implementation science.
- Research program capacity-building within academic nursing presents an important opportunity for alignment. Academic nursing should consider recruiting PhD investigators in emerging areas, including informatics, implementation science, health services research and patient safety/quality, which can increase the amount of grant dollars.
- The recommendations set forth are not without risk to those schools of nursing that operate in silos—strategically, programmatically and financially. With integration, shared leadership and shared governance comes shared accountability for success and failure.
- Policy issues at the federal and state levels, and possibly within professional societies that oversee the various stakeholder groups, are limiting. Specifically, we need to consider:
a. Scope of practice,
b. Reimbursement for advanced practice registered nurse (APRN) services, and
c. National Institutes of Health (NIH) and other public programs to support nursing-focused and multi-professional research.
Building a Strong Partnership
The participants in this first summit agreed that an enhanced partnership between academic nursing and academic health centers will yield tremendous benefits across all three missions of academic health centers—clinical care delivery, research and teaching. AHCs are in the midst of a significant transformation in clinical care delivery and in the evolution and integration of research and education programs. Academic nursing can contribute materially to the success of this transformation. Similarly, academic nursing has unrealized potential to grow as a center for research and clinical innovation, contributing to the ultimate goal of advancing health.
The following challenges must be met to achieve a new partnership:
- Academic nursing faculty must have a deeper involvement in clinical practice and more opportunity to engage in the clinical innovation that evolving academic health systems need.
- Research programs across academic nursing, health systems, academic medicine and other professional schools must be fostered, particularly around patient- and community-oriented research.
Overcoming these challenges will require a paradigm shift in how academic and clinical programs across health sciences schools and the clinical enterprise organize and align themselves. Academic nursing needs to reflect on its aspirations and reorient to these themes, and make a compelling business case for investment, both nationally and within each institution.