HLM: What other important take-aways do you have to offer?
Watland: Nurses get in leadership roles, at least traditionally, when they're good clinically. So you have to have this clinical expertise, and then you rise to the awareness of someone that maybe you could be a leader. But today's leaders have to be so much more than that.
I really think with healthcare reform we have to have new skill sets and we have to be making sure that we have not only the clinical awareness...and make sure that we're providing quality care, but we have to have business knowledge, we have to understand financial principles and how to do productivity management.
We have to know how to sit at the board…and speak for nursing and have nursing have a voice, to get the things that we need to get to help provide better patient care. And I think we really need to be innovative thinkers and inventive thinkers. Now that healthcare reform is coming in it's a whole new world; we have to think and do things differently.
We have to be risk-takers; we have to support each other. I think nursing has to be very collaborative and cohesive in that we share what's working and what's not working, and that we're not competitive about it. And really take on some new challenges and deal with them in different ways than we have in the past because healthcare reform is going to demand that of us.
Davis: I would add to that...we're an integrated delivery system. Because of that, I really have the opportunity to look at and to work within our leadership organization with nursing colleagues about what does that mean for a patient when you're in a total prepaid environment. You're the insurer as well as the delivery system for care—and how does that change how we think about our accountability for managing the patient across the continuum?
[There are] some of the innovations in our care model...we have a program that we call Hospital at Home where we bring higher acuity patients into the home and provide more intense nursing care, higher acuity nursing care, and physician visits for patients who would ordinarily be in the hospital setting.
And for us, we can do that at less cost and with great outcomes for the patient. But really [we're] looking across our whole system, not just as a deliverer of services, but also as the financer of the care. And I think that is really the future and the sooner we can think more systematically, and prepare for that we'll be better positioned to be prepared for change.
Watland: We can also take a leadership role in how do we expand the scope of, well maximize is the better way to put it...
Davis: Work to the highest level of the licensure...
Watland: Right, the licensure and the level of education, and especially advance practice nurses and nurse practitioners. In fact I was in a meeting this morning, a medical staff meeting...and I was really pleased to hear the physicians comment about being able to use [APRNs] to their fullest potential in the acute care setting. And [they were] really supporting that, and I think we need to be really promoting that and helping that to happen.
[Not only] advance practice nurses, but also our general trained nurses: How do we maximize that resource? And I don't mean overwork, but [let's] maximize their ability to function to the highest level of their licensure.