1. Baker, Kathy A. PhD, RN, ACNS-BC, FAAN

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I have been pleasantly surprised that the discussions for reform and change related to healthcare have continued despite early and persistent arguments that change will never happen. The Patient Protection and Accountable Care Act (ACA) signed into law by U.S. President Barack Obama in 2010 has caused numerous organizations and their leaders to seriously address the opportunity for redesign and innovation. The recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health (2010) is one example of visionary leaders moving to advance our discipline so that the needs of American citizens are met in a timely and appropriate manner.

Kathy A. Baker, PhD,... - Click to enlarge in new windowKathy A. Baker, PhD, RN, ACNS-BC, FAAN

The American Hospital Association (AHA) has also taken seriously the upcoming changes mandated by the ACA, and more than 1 year ago, organized a roundtable of experts to examine the future primary workforce. Their white paper the roundtable produced, Workforce Roles in a Redesigned Primary Care Model (AHA, 2013) was just released and adds to the body of work highlighted in nursing's report (IOM, 2010).


The AHA (2013) recommendations related to workforce state that all healthcare professionals should be educated within the context of interdisciplinary (i.e., interprofessional) clinical learning teams. Academia has already embraced this concept and numerous institutions of higher learning and practice partners have moved to explore and develop opportunities for interdisciplinary learning. However, barriers to this approach include difficulty finding times congruent with students' schedules across the disciplines, lack of faculty knowledge about how members of the interdisciplinary team function outside their own discipline, physical logistics, and communication challenges. My own institution has discovered challenges across the different levels of education among interprofessional students. For instance, third year medical students are not as familiar with clinical care during a mock resuscitation at this stage of their education compared with senior baccalaureate nursing students. This led to a disruptive interdisciplinary learning experience until these challenges were addressed before the learning experience commenced in subsequent learning experiences. Fortunately, much work is being funded nationally in the area of interprofessional education, and progress is being made so that interprofessional education is becoming a "standard" of healthcare education.


The AHA (2013) also supports redesign of the primary care model and offers the following recommendations:


1. Primary healthcare should be centered around the patient and family in a user-driven design in all aspects of practice.


2. Hospitals should evolve from traditional "hospitals" to "health systems," partnering with community organizations and patients to advance the community's wellness and health needs.


3. Hospitals (or health systems) can serve as catalysts for linking and integrating the various components of health and wellness together for patients in a way that provides a sustainable infrastructure of healthcare for patient and the community.


4. To mitigate rising healthcare costs, a fundamental shift in reimbursement will need to occur. This means patients and organizations alike will need to transition from the episodic, fee-for-service model of reimbursement to a new model that will reimburse for and encourage wellness and care across the health service continuum.



The AHA (2013) further emphasized that the primary healthcare team should be guided by what is best, needed, and helpful to the patient and family. Healthcare team members must deliver role-based care, not task-based care and the team must be empowered to create effective approaches for delivering care. Finally, hospitals/systems should work with communities and patients to provide the infrastructure for primary care teams to deliver quality care.


The gastroenterology care team has another opportunity to actively participate in implementing these national recommendations. It is important for gastrointestinal (GI) nurses and associates to be conversant in all of the national recommendations coming forward as a result of the recent ACA white paper. Because many GI practices transverse both acute and community care, GI nurses and associates are already familiar with community needs and opportunities for enhancing health in our patient population. We can easily be a voice for efficient, effective ways to reform care delivery and meet patient and community needs related to health care access and care.


As an organization, our Society of Gastroenterology Nurses and Associates leadership is actively engaged in monitoring and impacting health policy through the ongoing appointment of a legislative activity director (currently Kimberly Foley, BSN, RN, CGRN) who attends numerous interprofessional committees and meetings (often on Capitol Hill) to assure that GI patients and providers have a voice in shaping healthcare delivery.


All indications as we move into this new year are that we will finally have a new way of doing things in healthcare. Let's make sure GI nurses and associates are actively engaged in shaping this "new way." Our patients, communities, and discipline need our leadership.




American Hospital Association (AHA). (2013). Workforce roles in a redesigned primary care model. Retrieved from[Context Link]


Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health. Washington DC: National Academies Press. [Context Link]