Essentials of Nursing Leadership and Management, 5th Edition

chapter 10 | Quality and Safety 151

patient care. As a practicing professional, you can use
the competencies to guide future professional devel-
opment and ensure positive impact on health-care
reform while improving quality and safety.

Role of Nursing in System Reform

The ANA’s Agenda

In 1989, taking a leadership position regarding
health-care reform, the ANA began to address
concerns regarding quality, safety, and cost of care
as well as the potential health-care reform within
the United States Working with more than 60
nursing and health-care organizations, the ANA
published Nursing’s Agenda for Health Care Reform
(ANA, 1991). This document was positioned as its
blueprint for reform.
Building on the ANA’s report from 1991, the
ANA’sHealth Care Agenda(ANA, 2005) describes
the organization’s policy on health system reform.
This policy includes four basic principles:

1.Health care is a basic human right. A restruc-
tured health-care system should include univer-
sal access to essential services.
2.The development of health policies that incor-
porate the IOM’s six aims of health care will
save money.
3.The health-care system must be reshaped and
redirected away from the overuse of expensive,
technology-driven, acute, hospital-based
services in the model we now have to one
in which a balance is struck between high-
technology treatment and community-based
and preventive services, with emphasis on
the latter.

4.The ANA supports a single-payer health-care

system (ANA, 2005, p. 2).

Although updated in 2008, the ANA’s policy still

maintains the same four principles.

Influence of Nursing

Nurses are empowered through self-determination,

meaning, competence, and impact (Whitehead,

Weiss, & Tappen, 2007, p. 71). Additionally, nurses

play vital roles in collective bargaining and decision

making within their organizations, empowered

through professional organization such as the

ANA (see Chapter 5).

Nurses are respected and trusted health-care

professionals. To influence change in the health-

care system, professional nurses must first acknowl-

edge power within the profession and recognize

their central role in health care. To be effective,

nurses must leverage their professional expertise

and the trust and respect they have garnered. It is

critical that nurses speak up and seek an active role

in shaping health-care reform:

■Become informed.Research topics of interest

to youand your practice. Rely on the Internet

and your professional organizations as resources

for current policy and legislative topics.

■Plan.After selecting a topic, prepare your plan:

gather facts and figures that will support your

ideas and position. Outline them, and address

your audience in person, on paper, or via the

Web. The most influential people are prepared

and believe in their topic.

■Take action.Shape public opinion by the

method of your choice. Start small, and build

box 10-10

Core Competencies for Health Professionals (IOM, 2003a, p. 4)

Provide patient-centered care.Identify, respect, and care about patients; differences, values, preferences, and expressed

needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate

patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion

of healthy lifestyles, including a focus on population health.

Work in interdisciplinary teams.Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is

continuous and reliable.

Employ evidence-based practice. Integrate best research with clinical expertise and patient values for optimum care, and

participate in learning and research activities to the extent feasible.

Apply quality improvement.Identify errors and hazards in care; understand and implement basic safety design principles,

such as standardization and simplification; continually understand and measure quality of care in terms of structure, process,

and outcomes in relation to patient and community needs; and design and test interventions to change processes and

systems of care with the objective of improving quality.

Utilize informatics. Communicate, manage knowledge, mitigate error, and support decision making using information

technology.