Health Policy

Nurses as Partners in Redesigning the Healthcare System

Healthcare in the 21 century has had a significant shift including the nature of challenges facing the system. For instance, the American population is getting older, and by 2030, it is estimated that 20 percent of the citizens will be 65 years and above. Besides the shift in demographics, there has also been a change in the healthcare needs. Currently, more people are diagnosed with chronic diseases such as diabetes, cardiovascular diseases, hypertension, cancer, and mental health conditions. Unfortunately, despite increasing need of chronic illnesses care, the U.S. healthcare system was designed for managing acute illnesses and injuries, prevalent in the 20th century. In light of this, the healthcare system is undergoing drastic changes with a new emphasis on the transformation of the system to provide safe, quality, affordable, and patient-oriented services. As the Robert Wood Johnson Foundation (New Jersey) (2011) notes, this transformation requires comprehensive rethinking on the roles of health care professionals, and chief among them, nurses. 


Essentially, at the core of healthcare transformation, access problems, unmanageable costs, and disparities in care outcomes are some of the challenges that face the healthcare system. Costs and quality concerns present an increasing urgency for patients suffering from chronic health conditions. According to Salmond & Echevarria (2017), these problems can be eliminated through coordination of care across providers and settings to improve quality care, healthcare outcomes, minimize on spending, eliminate unnecessary hospitalization and emergencies. At the center of these concerns, nurses are better positioned to lead and contribute towards transformative changes from provider-oriented episodic care to a patient and team-based care and affordable quality care. In order to realize this vision, the Institute of Medicine recommends the inclusion of nurses in the redesigning of care delivery and payment systems by calling on payers, health organizations, employers, other care providers, and regulators in health systems should to work together with nurses. The suggestion is to encourage more nurses to serve in leadership positions in government, profit and nonprofit organizations, and health organization advisory committees.


The healthcare system is experiencing drastic changes with a new emphasis based on population health, care quality, and value of services delivered. In the United States, these changes present several opportunities and challenges to the millions of registered nurses employed in the health sector (Fraher, Spetz, & Naylor, 2015). Virtually, the number of nurses in the health workforce surpasses that of physicians, which means their participation in the transformation of healthcare is highly significant. Similarly, as Fraher et al. note, reports show that Registered Nurses shortages have abated, meaning that attention can be redirected from expanding the educational system to redesigning the system to support their professional practice in the transformed healthcare system. In light of this, and going by the IOM recommendations we address the fundamental questions: what are the models of care that can accommodate nurses in a leadership capacity, how can we create the right mix of nurses with skills and competencies for taking the lead in developing innovative and patient-oriented care models?

Current Characteristics

Nursing leadership in the transformation of the healthcare system is critical if the changes are to be realized. In the past, the nursing education curriculum did not allow nurses to begin their nursing career with thoughts of becoming a nurse leader. Rather as Robert Wood Johnson Foundation (New Jersey) (2011) notes, the educational system revolved around management of acute conditions and did not consider the intricacies of coordination and transitions necessary for nursing leadership in the healthcare system. However, nowadays a majority of nursing schools now understand the need to groom nurse students with nursing leadership skills by adding these layers of knowledge in the curriculum content. In the practical setting, the healthcare system is struggling with overcoming the hurdles that keep nurses from joining the leadership roles and are pushing for these changes.

Impact of the Recommendation

Nurses have continually played an extremely significant role in developing, implementing, and monitoring programs focused on advancing populations health through various ways among them disease prevention. Today, there is increased recognition that several health problems can be prevented through improved health programs. In light of this, promoting nursing leadership in health care systems have the potential to allow effective care management and proper coordination of roles necessary for addressing social, political, and economic factors affecting the healthcare system. As it is, several healthcare interventions fall under care coordination. By allowing nurses in leadership positions, this will enable working together with patients in the organization of services to ensure patient needs and preferences are met, exchange information across providers of health, and facilitate delivery of healthcare services (Fraher, Spetz, & Naylor, 2015). In essence, due to the skills nurses have in managing patient care, they have the potential to influence health care costs in various ways including hospital admission, readmission rates, reimbursement, and identification of resources used in the delivery of health. This is possible in that nurses understand the significance of proper patient transition to the next level of care. This knowledge helps them contribute to the board of health care systems on ways to reduce readmission rates, thus cut down on costs. Similarly, with their ability to consider implications on patients when purchasing materials and equipment will allow them to influence the purchasing policies and identification of strategic gaps that could lower health care costs.  

Current Solutions

According to the Robert Wood Johnson Foundation (New Jersey) (2011), the focus is to expand efforts and opportunities to have as many registered nurses in the boardroom as possible. In light of this, the future of nursing campaign for action recommends coming up with programs and courses in leadership, entrepreneurship, and management where nurses can be oriented with leadership skills. In addition to this, they also recommend promotion of interprofessional approach to education with a strong focus on developing leadership skills in nurses. The committee also recommends continued support of competent leadership skills in nurse professionals who are already in a leadership position. Similarly, as a focus in nurse leadership, the committee also recommends supporting inter-professional collaboration to present opportunities for nurses to invent, implement, and spread collaborative programs in delivery of quality care. 

Current Status in the Health Policy Arena

Despite their potentials to influence the transformations in the healthcare systems, the presence of nurses in the boardroom is still limited. According to a report by the American Hospital Association, nurses represent only 5 percent of hospital boards, while the percentage of physicians is as high as 20 percent (Capella University, 2016). Currently, the Nurses on Boards Coalition are spearheading efforts to implement the recommendation by the IOM of including more nurses in hospital leadership. The goal is to have at least 10,000 nurses in health systems boards by 2020. Their campaign also targets on increasing awareness on the benefits of embracing nursing leadership and the way the health system can benefit from the unique perspectives of nurses. 

The healthcare system in the United States is experiencing several transformative changes. Nurses represent the largest group of licensed health care group, and their practice is present in almost every setting of the healthcare system. Through their extensive interaction with patients, nurses recognize the needs of the populations with the ability to design, implement, and manage effective programs for the collective goods of their patients. By allowing the collaboration of nurses in redesigning the healthcare system, the sector stands to reap the benefits of nurses’ knowledge and skills, which signifies the importance of ensuring the policy is effectively implemented.


Capella University. (2016). How Nurse Leaders in the Boardroom Can Transform America’s Healthcare System. Association for Talent Development. Retrieved from:

Fraher, E., Spetz, J., & Naylor, M. D. (2015). Nursing in a Transformed Health Care System: New Roles, New Rules. Penn Libraries: University of Pennsylvania. Retrieved from:

Robert Wood Johnson Foundation (New Jersey). (2011). The future of nursing: Leading change, advancing health. Washington, D.C: The National Academies Press.

Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopaedic Nursing, 36(1), pp. 12-25.

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