NUR 514 Week 1 DQ1 Discuss the shift to value-based health care and its impact on the roles and responsibilities of advanced registered nurses.

NUR 514 Week 1 DQ1 Discuss the shift to value-based health care and its impact on the roles and responsibilities of advanced registered nurses.

NUR 514 Week 1 DQ1 Discuss the shift to value-based health care and its impact on the roles and responsibilities of advanced registered nurses.

NUR 514 Organizational Leadership and Informatics

Week 1 Discussion

DQ1 Discuss the shift to value-based health care and its impact on the roles and responsibilities of advanced registered nurses. What major evolving trends in the health care delivery system will affect your practice in the next 3-5 years, and how do you think advanced registered nurses will continue to influence the direction of health care?

Behavior can be changed in a sustainable way by inviting people to change, most of the time, particularly when a supportive structure is a priority. A few years ago, I was able to take a Motivational Interviewing (MI) class. This is an evidence-based technique of interaction that was designed to assist patients explore and resolve ambivalence regarding behavioral change (Levensky, et al., 2007). The process involves exploring suggested change, the patient’s underlying values related to initiating change and issues that hinder aligning personal values with the suggested change. While this process was designed in relation to patient treatment, this is a useful technique when undertaking change extending beyond an individual. When inviting people to change, regardless of whether it is an individual or organization, it is important to evaluate issues that may obstruct forward progress. Structure can play a large part in affecting motivation to change. Organizational structure that supports efficiency and satisfaction is more likely to result in sustainable change by inviting people to change (Weberg, et al., 2019). This is ultimately a very similar process to MI in evaluating and aligning values related to the proposed change. Engaging others in aligning their values with organizational structure increases the chance that change will be sustained.



Levensky, E., Forcehimes, A., O’Donohue, W., Beitz, K. (2007). Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations. The American journal of nursing, 107(10), 50–59.


Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning. ISBN-13: 9781284146530

The concept of Advanced Practice Nurse (APN) is acknowledged by many countries; however, the presents of active APNs is not as prevalent in these countries. Most countries are supposable to the APN role because of the need for qualified healthcare workers in rural areas and the shortage of physicians (Schober, 2018). However, this concept has not been fully utilized by many countries because of the role confusion and the lack of appropriated policies to govern the profession. Countries like New Zealand and Singapore, where APNs are prevalent, there are policies and procedures in place to govern the profession. Nurses are required to meet certain educational milestones and work within specified role guidelines.


Schober, M. (2018). Global emergence of nurse practitioner/advanced practice nursing roles. Journal of the American Association of Nurse Practitioners, 30 (4), 182-184. doi: 10.1097/JXX.0000000000000029.




As a country and as health care providers, we can no longer support ever-escalating health care costs and too-slow (despite our best efforts) progress in improving patient safety, patient satisfaction and clinical outcomes. It is also clear that reimbursement is increasingly being tied to quality and cost outcomes, and patient assessments of their care experiences. The Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS), developed by the Agency for Healthcare Quality at the request of the Centers for Medicare & Medicaid services (CMS), has been collecting and disseminating a great deal of information in this regard for years!

To be competitive in the evolving health care world, the need to shift from volume-driven to value-driven practice has been evidenced. In order to do this, we need to understand the meaning of value, how to measure and achieve it, and how volume will continue to play a critical role in achieving excellent outcomes but will not be the driving strategic imperative nor the driving reimbursement metric.

To do so, more emphasis will be on the clinical leader. Professional shared governance, shared decision making, and shared interaction will then become the framework for structuring delivery of the healthcare services in a much different way. The nurse leader must put value at the center of practice. Why? Please share your thoughts!

Take care,

Dr. B



Frank’s team should consist of himself, the medical doctor following this patient, a social worker, a nurse, possibly PT or OT therapy, a home health agency liaison, the patient, and if necessary a responsible party (caregiver / decision maker)

The services needed post hospital discharge may be a nurse to come into the home to show the patient / pt. family how to use a glucometer, PT/OT to evaluate safety measures in the home and guidelines for the MD orders to be continued. A nurse from a home health agency to go into the patient’s home and do a physical assessment, see if they are managing their diabetes within the range for this patient.

The nurse if the patient’s closest advocate and she sees more than the MD, social worker or discharge planner. She is an integral part of this team because she has spent the most time performing direct patient care.



When I was reviewing our reading, this quote really stood out to me:

Although U.S. health care is often called a system because it has various features, components, and services, it may be misleading to talk about the American healthcare delivery system because a true, cohesive system does not exist. Indeed, a major feature of the U.S. healthcare system is its fragmented nature, as different people obtain health care through different means (DeNisco & Barker, 2019, p.178).


This observation emphasizes the importance of moving from a volume-based practice to a value-based practice model. To accomplish the goal of a more cohesive, and collaborative healthcare delivery system, shared decision making, governance and interaction must be considered key elements of the system. While overall patient volume is considered when developing collaborative strategies to improve patient outcomes, it should no longer be the sole consideration. In U.S. health care, reimbursement often drives initiative to improve patient care outcomes by impacting financial returns. Major insurance providers, such as Medicare and Medicaid, drive organizational innovation to improve care delivery and patient outcomes. These government program models strongly influence other major insurance carrier policies, and healthcare delivery organizations, as a result. While not required to align with these governmental organizations, many do under the principle that the studies leading to these policies will result in reduced expenditure by improving outcomes. Through these financially driven changes, advanced practice nurses are positioned to provide high quality reduce cost care. By viewing patients wholistically and developing systems thinking nurse leaders can innovate to improve patient safety, satisfaction, and outcomes.




DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

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