Nursing homework

Home>Homework Answsers>Nursing homework helpCan you help me with my assignement.2 years ago02.11.202320Report issuefiles (7)NEmodule3liture1.docxNEmodule3liture.docxNEmodule3PostFriday.docxFutureofNursing2020-2030.pdfNursesparticipationintheHolocaust.pdfGraduate-QSEN-Competencies.pdfDeterminingifnursesareinvolvedinpoliticalactionorpolitics.pdfNEmodule3liture1.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3liture.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3PostFriday.docxOverviewThis week you have read about nursing organizations, political activism and advocacy, and understanding health care systems. Which are all important parts of nursing excellence. For this assignment, you need to select two of the organizations presented in the lecture (PowerPoint) and provide the following information for each organization (in your own words):· What is the purpose of the organization?· What impact does the organization have on nursing practice?· How does the organization play a role in nursing education?· How does the organization play a role in nursing research?· What part of Nursing Excellence does the organization provide? Political activism? Advocacy? Resource for Health care system?· Would you provide support to the organization as a nurse? Why or Why not?Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”Points:30Due Dates:· Initial Post: Friday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the US.· Response Post: Sunday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the USReferences:· Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.· Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.Words Limits· Initial Post: Minimum 200 words excluding references (approximately one (1) page)· Response posts: Minimum 100 words excluding references.FutureofNursing2020-2030.pdfJuly/August 2021 | Volume 39 Number 4196Nursing Economic$In May 2021, the National Academies of
Sciences, Engineering, and Medicine released
The Future of Nursing 2020-2030: Charting aPath to Achieve Health Equity. This consensus study
from the Committee on the Future of Nursing, 2020-
2030, co-chaired by Mary Wakefield and David R.
Williams, builds on earlier work conducted by the
National Academy of Medicine and its predecessor,
the Institute of Medicine, to study the potential role
of nurses in advancing health and health care and
the action needed to realize this potential. The
Future of Nursing: Leading Change, Advancing
Health (Institute of Medicine, 2011) and 2016 report
assessing progress on the 2011 goals (National
Academies of Sciences Engineering and Medicine
[National Academies], 2016) focused on identifying
expanded roles for nurses and the actions needed to
build capacity for nurses to become engaged in and
prepare for those roles.The new report asks, “to what end?” and targets
activities and roles for nurses in addressing equity in
health care and disparities in outcomes, care, and the
upstream sources of disparities. The focus on inequal-
ity and equity reflects the increasing attention the
National Academy of Medicine has given to health
equity and social determinants of health (SDOH), and
the Robert Wood Johnson Foundation’s agenda to
create a culture of health that provides everyone a
“fair and just opportunity for health and well-being,”
a plan that has equity at its center (National
Academies, 2021, p. 128).The report embraces a shift from focusing on dis-
parities as circumstances requiring downstream reme-
diation to having causes that require upstream inter-
vention. It identifies inequities in housing, employ-ment, education, and other precursors to health due
to systemic racism and discrimination. It flags
inequities associated with socioeconomic status, dis-
ability, poverty, limited access to health services, and
race, attributing all to systemic and structural causes,
not simply individual animus. The report embraces a
vision for health systems and healthcare providers to
move upstream, to consider how to intervene not just
with the patient who presents in the waiting room
and while they are in the office or facility, but outside
the traditional framework of healthcare delivery, both
to prevent illness and disease and treat patients with
full consideration of their circumstances.Tapping Nurses’ Expertise and ExperienceMuch of the report identifies and discusses pro-
grams and activities that can be part of these inter-
ventions, both generically and with specific exam-
ples. The report notes nurses’ expertise in engaging
patients with chronic conditions, coordinating the
care of chronically ill patients between the site of
care and community and neighborhood resources,
leading teams to improve care of high-need, high-
cost patients, and working with communities to cre-
ate healthy living and work environments. It calls
for greater access for populations with complex
health and social needs by expanding multiple
sources of care and expanded roles of nurses in
these settings.Among the areas for expansion are Federally
Qualified Health Centers, retail clinics (often staffed
primarily by nurse practitioners), home health and
home visiting care services, telehealth services, and
school-based health centers (National Academies,Future of Nursing 2020-2030: Increasing the Focus of Nursing
and Health Care on Equity and Discrimination
Jack NeedlemanThe Future of Nursing 2020-2030 report responds to the heightened
recognition of systemic racism and discrimination based on ethnicity, gender,
and class; the impact of these systemic problems on health and access to
health services; and the need for the nursing profession to be deeply involved
in addressing these problems.Economic$ of Health Care and NursingJuly/August 2021 | Volume 39 Number 4 197Nursing Economic$2021). The report identifies school nurses and
school nursing as an area of front-line health care,
since school nurses help manage chronic conditions
and disabilities, address injuries and urgent needs,
and provide preventive care and assessments. The
report cites the need for improved care management
and transitional care. It recognizes care should be
customized in collaboration with patients and their
families to reflect each patient’s abilities, needs, and
preferences, citing research demonstrating the value
of person-centered care. And, as in the other areas,
the report highlights the role and experience of
nurses in providing this care.Addressing Social NeedsThe new Future of Nursing report explicitly dis-
cusses how social needs might be addressed in clini-
cal and community settings. It calls for increased
screening in clinical settings for social conditions,
impact of SDOH status, and individual and communi-
ty resources that can influence choice of interventions
and treatments. It urges more active engagement to
address these circumstances through community-
based interventions. In the discussion of community-
based interventions, the report calls for increases in
community and public health nursing and active
engagement of nurses and their expertise in interpro-
fessional, multisectoral collaborations. Two specific
examples of the latter interventions, the Camden Core
Model of the Camden Coalition and the American
Academy of Nurses’ Edge Runner initiative, are pre-
sented.The Future of Nursing report also discusses the
importance of increased engagement of nurses in
policy and healthcare governance to increase nurse
involvement in effective interventions and to tap
nurse expertise in the design and implementation of
interventions. But the report is centered on expand-
ing interventions to improve equity. A core element
of this expansion is assuring these interventions can
be paid for and sustained outside of foundation and
philanthropic funding models. The issue of funding
is addressed in Chapter Six of the report and a com-
missioned paper by Needleman (2020). The pay-
ment issues discussed can be split into two related
but separate questions: What payment models sup-
port or facilitate increased health system and nurse
engagement in addressing equity and SDOH? Whatpayment models encourage or create incentives for
these interventions?Payment Systems and EquityThe main form of payment for health services in
the United States remains fee-for-service (FFS). Under
FFS, revenue is generated through billing for specific
services by providers approved to deliver those serv-
ices. Concerning the equity agenda, there are multi-
ple weaknesses in relying upon payment to support
addressing inequity or SDOH. Payment is generally
limited to physicians and advanced practice registered
nurses (APRNs); billing for services by nurses, social
workers, and others for case management and social
interventions is minimal. (While some additional
billing codes have been created for case management
and related services, these services generally cannot
be provided by non-physicians/APRNs except when
delivered under standard procedures and protocols
and when the billing physician/APRN is physically on
site.) Billing for telehealth services may similarly be
restricted to physicians/APRNs, reducing the potential
for follow-up by other care team members. Many key
providers in the system, such as school nurses, are
not eligible for payment. Community-based outreach
and public health nurses may also not be able to bill
for services.Another weakness of FFS is its incentive to
increase the volume of billable services provided.
Efforts to modify FFS created incentives to reduce
total costs per patient. These incentives may encour-
age providers to stint care, so they are often coupled
with additional incentives to deliver appropriate care.
This combination of incentives for cost containment
and improved quality form the core of value-based
payment, an essential modification of FFS.The size of the incentives compared to the rev-
enue that can be realized from increasing FFS vol-
ume will determine whether the net motivation is to
reduce cost and improve care or continue to
increase volume. The measures in these systems
shape provider behavior. There are examples of pri-
mary care practices using registered nurses and
other case managers to reduce hospital readmissions
and other acute services. But the initiatives adopted
are often specific to which incentives can be earned,
such as reduced hospital readmissions or quality
measures tied to particular diseases.July/August 2021 | Volume 39 Number 4198Nursing Economic$One program designed to create population-level
incentives within FFS is the Accountable Care
Organization (ACO) model created by the Centers for
Medicare & Medicaid. An Oregon ACO addressing
SDOH and health equity is highlighted. But ACOs
have weak incentives to promote such policies in
general. Entry into the program has not been ran-
dom. ACOs serving a higher proportion of racial and
ethnic minorities have had lower scores on quality
measures. Because the ACO accountability structure
is grafted onto the FFS payment system, internal
incentives through bonus sharing and coordination
can also limit the ability of ACO providers to address
the equity plan. The size of the bonuses themselves
is a constraint on the resources available outside of
the FFS system for program initiatives.Capitation, per-patient payments, offers robust
support for provision of non-billable services or non-
billing staff to provide services that can reduce cost
or increase quality. Capitation provides the greatest
flexibility for health systems to design care processes
that reduce high-cost care since actions that fall out-
side of traditional billable services can be implement-
ed if they will lower costs or promote other organiza-
tional goals. Capitation also offers the greatest incen-
tives to avoid enrolling high-cost or high-risk patients
and stint care, subject only to discouraging healthier
patients from enrolling due to a poor reputation. This
outcome has led to risk adjustment in setting capita-
tion rates to reduce incentives to avoid high-cost
patients and value-based payment or incentive
approaches to encourage delivering high-cost care.
But capitation will address equity and disparities only
if it also lowers net costs.Value-based payment systems, or systems with
incentives and rewards, base incentives and rewards
on specific measures. Measures define the expecta-
tions of care and determine the provider’s focus. If
the efforts focus narrowly on standard quality meas-
ures such as diabetes control or the patient care
experience, other considerations associated with
improved population health or reduced disparities in
care may not receive attention. None of the current
major initiatives encourage or create incentives for
interventions to improve equity and address social
determinants of care.Near universal features of the bonuses or pay-
ments for high-quality care among the FFS or alterna-
tive payment systems are the comparison of qualityacross providers and limited social-demographic
adjustment for risk factors, particularly community and
neighborhood effects. Missing in these systems are
adequate assessments of the social determinants of
poor health or access to health care, payment adjust-
ments to allow more intensive care to these popula-
tions, and reviews of performance or rewards based
on improvements over time in outcomes for socially
disadvantaged people or reducing disparities in care
and outcomes.Given the quality metrics used to direct and
incentivize behavior, current alternative payment
methods are not well constructed to encourage
improving population health, equity, and disparities.
While there are actions that can address these issues,
some proven, some still being trialed, a payment sys-
tem that will support implementation of programs to
address disparities and equity should be developed
from the inside out, starting with the programs and
actions that will improve equity and reduce dispari-
ties, and then designing payment methods and incen-
tives that will encourage and support implementing
these programs and activities. Such programs should
recognize the vital role nurses play in implementing
actions to respond to incentives and assure payment
for engaging nurses and other non-physicians/APRNs
in this work.The Future of Nursing report recognizes current
payment limitations and calls for including metrics on
equity and reducing disparities in payment systems. It
also highlights the importance of expanded funding
for school nurses and public health nurses and build-
ing payment and programmatic linkages between
health and social service providers.ConclusionFuture of Nursing 2020-2030: Charting a Path to
Achieve Health Equity responds to the heightened
recognition of systemic racism and systemic discrim-
ination based on ethnicity, gender, and class. The
report recognizes the impact of these systemic prob-
lems on health and access to health services and the
need for the nursing profession to be deeply
involved in addressing these problems. These prob-
lems cannot be addressed without understanding
how the economics of care delivery influence
behavior. Payment must be changed to create strong
incentives and rewards for actions and activities thatJuly/August 2021 | Volume 39 Number 4 199Nursing Economic$address disparities and promote equity in health and
health care. $Jack Needleman, PhD, FAAN
Fred W. and Pamela K. Wasserman Professor
Chair, Department of Health Policy and Management
UCLA Fielding School of Public Health
Los Angeles, CA
Nursing Economic$ Editorial Board Member

References
Institute of Medicine. (2011). The future of nursing: Leading change,advancing health. The National Academies Press. https://doi.
org/doi:10.17226/12956National Academies of Sciences, Engineering, and Medicine. (2016).
Assessing progress on the Institute of Medicine report the future
of nursing. The National Academies Press. https://doi.org/
doi:10.17226/21838National Academies of Sciences, Engineering, and Medicine (National
Academies). (2021). The future of nursing 2020-2030: Charting a
path to achieve health equity. The National Academies Press.
https://doi.org/doi:10.17226/25982Needleman, J. (2020). Paying for nursing care in fee-for-service and
value-based systems [White paper]. https://www.nap.edu/
resource/25982/Needleman%20Commissioned%20Paper.pdfCopyright of Nursing Economic$ is the property of Jannetti Publications, Inc. and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright
holder’s express written permission. However, users may print, download, or email articles for
individual use.NursesparticipationintheHolocaust.pdfThis file is too large to display.View in new windowGraduate-QSEN-Competencies.pdfThis file is too large to display.View in new windowDeterminingifnursesareinvolvedinpoliticalactionorpolitics.pdfThis file is too large to display.View in new windowDeterminingifnursesareinvolvedinpoliticalactionorpolitics.pdfThis file is too large to display.View in new windowNEmodule3liture1.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3liture.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3PostFriday.docxOverviewThis week you have read about nursing organizations, political activism and advocacy, and understanding health care systems. Which are all important parts of nursing excellence. For this assignment, you need to select two of the organizations presented in the lecture (PowerPoint) and provide the following information for each organization (in your own words):· What is the purpose of the organization?· What impact does the organization have on nursing practice?· How does the organization play a role in nursing education?· How does the organization play a role in nursing research?· What part of Nursing Excellence does the organization provide? Political activism? Advocacy? Resource for Health care system?· Would you provide support to the organization as a nurse? Why or Why not?Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”Points:30Due Dates:· Initial Post: Friday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the US.· Response Post: Sunday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the USReferences:· Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.· Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.Words Limits· Initial Post: Minimum 200 words excluding references (approximately one (1) page)· Response posts: Minimum 100 words excluding references.FutureofNursing2020-2030.pdfJuly/August 2021 | Volume 39 Number 4196Nursing Economic$In May 2021, the National Academies of
Sciences, Engineering, and Medicine released
The Future of Nursing 2020-2030: Charting aPath to Achieve Health Equity. This consensus study
from the Committee on the Future of Nursing, 2020-
2030, co-chaired by Mary Wakefield and David R.
Williams, builds on earlier work conducted by the
National Academy of Medicine and its predecessor,
the Institute of Medicine, to study the potential role
of nurses in advancing health and health care and
the action needed to realize this potential. The
Future of Nursing: Leading Change, Advancing
Health (Institute of Medicine, 2011) and 2016 report
assessing progress on the 2011 goals (National
Academies of Sciences Engineering and Medicine
[National Academies], 2016) focused on identifying
expanded roles for nurses and the actions needed to
build capacity for nurses to become engaged in and
prepare for those roles.The new report asks, “to what end?” and targets
activities and roles for nurses in addressing equity in
health care and disparities in outcomes, care, and the
upstream sources of disparities. The focus on inequal-
ity and equity reflects the increasing attention the
National Academy of Medicine has given to health
equity and social determinants of health (SDOH), and
the Robert Wood Johnson Foundation’s agenda to
create a culture of health that provides everyone a
“fair and just opportunity for health and well-being,”
a plan that has equity at its center (National
Academies, 2021, p. 128).The report embraces a shift from focusing on dis-
parities as circumstances requiring downstream reme-
diation to having causes that require upstream inter-
vention. It identifies inequities in housing, employ-ment, education, and other precursors to health due
to systemic racism and discrimination. It flags
inequities associated with socioeconomic status, dis-
ability, poverty, limited access to health services, and
race, attributing all to systemic and structural causes,
not simply individual animus. The report embraces a
vision for health systems and healthcare providers to
move upstream, to consider how to intervene not just
with the patient who presents in the waiting room
and while they are in the office or facility, but outside
the traditional framework of healthcare delivery, both
to prevent illness and disease and treat patients with
full consideration of their circumstances.Tapping Nurses’ Expertise and ExperienceMuch of the report identifies and discusses pro-
grams and activities that can be part of these inter-
ventions, both generically and with specific exam-
ples. The report notes nurses’ expertise in engaging
patients with chronic conditions, coordinating the
care of chronically ill patients between the site of
care and community and neighborhood resources,
leading teams to improve care of high-need, high-
cost patients, and working with communities to cre-
ate healthy living and work environments. It calls
for greater access for populations with complex
health and social needs by expanding multiple
sources of care and expanded roles of nurses in
these settings.Among the areas for expansion are Federally
Qualified Health Centers, retail clinics (often staffed
primarily by nurse practitioners), home health and
home visiting care services, telehealth services, and
school-based health centers (National Academies,Future of Nursing 2020-2030: Increasing the Focus of Nursing
and Health Care on Equity and Discrimination
Jack NeedlemanThe Future of Nursing 2020-2030 report responds to the heightened
recognition of systemic racism and discrimination based on ethnicity, gender,
and class; the impact of these systemic problems on health and access to
health services; and the need for the nursing profession to be deeply involved
in addressing these problems.Economic$ of Health Care and NursingJuly/August 2021 | Volume 39 Number 4 197Nursing Economic$2021). The report identifies school nurses and
school nursing as an area of front-line health care,
since school nurses help manage chronic conditions
and disabilities, address injuries and urgent needs,
and provide preventive care and assessments. The
report cites the need for improved care management
and transitional care. It recognizes care should be
customized in collaboration with patients and their
families to reflect each patient’s abilities, needs, and
preferences, citing research demonstrating the value
of person-centered care. And, as in the other areas,
the report highlights the role and experience of
nurses in providing this care.Addressing Social NeedsThe new Future of Nursing report explicitly dis-
cusses how social needs might be addressed in clini-
cal and community settings. It calls for increased
screening in clinical settings for social conditions,
impact of SDOH status, and individual and communi-
ty resources that can influence choice of interventions
and treatments. It urges more active engagement to
address these circumstances through community-
based interventions. In the discussion of community-
based interventions, the report calls for increases in
community and public health nursing and active
engagement of nurses and their expertise in interpro-
fessional, multisectoral collaborations. Two specific
examples of the latter interventions, the Camden Core
Model of the Camden Coalition and the American
Academy of Nurses’ Edge Runner initiative, are pre-
sented.The Future of Nursing report also discusses the
importance of increased engagement of nurses in
policy and healthcare governance to increase nurse
involvement in effective interventions and to tap
nurse expertise in the design and implementation of
interventions. But the report is centered on expand-
ing interventions to improve equity. A core element
of this expansion is assuring these interventions can
be paid for and sustained outside of foundation and
philanthropic funding models. The issue of funding
is addressed in Chapter Six of the report and a com-
missioned paper by Needleman (2020). The pay-
ment issues discussed can be split into two related
but separate questions: What payment models sup-
port or facilitate increased health system and nurse
engagement in addressing equity and SDOH? Whatpayment models encourage or create incentives for
these interventions?Payment Systems and EquityThe main form of payment for health services in
the United States remains fee-for-service (FFS). Under
FFS, revenue is generated through billing for specific
services by providers approved to deliver those serv-
ices. Concerning the equity agenda, there are multi-
ple weaknesses in relying upon payment to support
addressing inequity or SDOH. Payment is generally
limited to physicians and advanced practice registered
nurses (APRNs); billing for services by nurses, social
workers, and others for case management and social
interventions is minimal. (While some additional
billing codes have been created for case management
and related services, these services generally cannot
be provided by non-physicians/APRNs except when
delivered under standard procedures and protocols
and when the billing physician/APRN is physically on
site.) Billing for telehealth services may similarly be
restricted to physicians/APRNs, reducing the potential
for follow-up by other care team members. Many key
providers in the system, such as school nurses, are
not eligible for payment. Community-based outreach
and public health nurses may also not be able to bill
for services.Another weakness of FFS is its incentive to
increase the volume of billable services provided.
Efforts to modify FFS created incentives to reduce
total costs per patient. These incentives may encour-
age providers to stint care, so they are often coupled
with additional incentives to deliver appropriate care.
This combination of incentives for cost containment
and improved quality form the core of value-based
payment, an essential modification of FFS.The size of the incentives compared to the rev-
enue that can be realized from increasing FFS vol-
ume will determine whether the net motivation is to
reduce cost and improve care or continue to
increase volume. The measures in these systems
shape provider behavior. There are examples of pri-
mary care practices using registered nurses and
other case managers to reduce hospital readmissions
and other acute services. But the initiatives adopted
are often specific to which incentives can be earned,
such as reduced hospital readmissions or quality
measures tied to particular diseases.July/August 2021 | Volume 39 Number 4198Nursing Economic$One program designed to create population-level
incentives within FFS is the Accountable Care
Organization (ACO) model created by the Centers for
Medicare & Medicaid. An Oregon ACO addressing
SDOH and health equity is highlighted. But ACOs
have weak incentives to promote such policies in
general. Entry into the program has not been ran-
dom. ACOs serving a higher proportion of racial and
ethnic minorities have had lower scores on quality
measures. Because the ACO accountability structure
is grafted onto the FFS payment system, internal
incentives through bonus sharing and coordination
can also limit the ability of ACO providers to address
the equity plan. The size of the bonuses themselves
is a constraint on the resources available outside of
the FFS system for program initiatives.Capitation, per-patient payments, offers robust
support for provision of non-billable services or non-
billing staff to provide services that can reduce cost
or increase quality. Capitation provides the greatest
flexibility for health systems to design care processes
that reduce high-cost care since actions that fall out-
side of traditional billable services can be implement-
ed if they will lower costs or promote other organiza-
tional goals. Capitation also offers the greatest incen-
tives to avoid enrolling high-cost or high-risk patients
and stint care, subject only to discouraging healthier
patients from enrolling due to a poor reputation. This
outcome has led to risk adjustment in setting capita-
tion rates to reduce incentives to avoid high-cost
patients and value-based payment or incentive
approaches to encourage delivering high-cost care.
But capitation will address equity and disparities only
if it also lowers net costs.Value-based payment systems, or systems with
incentives and rewards, base incentives and rewards
on specific measures. Measures define the expecta-
tions of care and determine the provider’s focus. If
the efforts focus narrowly on standard quality meas-
ures such as diabetes control or the patient care
experience, other considerations associated with
improved population health or reduced disparities in
care may not receive attention. None of the current
major initiatives encourage or create incentives for
interventions to improve equity and address social
determinants of care.Near universal features of the bonuses or pay-
ments for high-quality care among the FFS or alterna-
tive payment systems are the comparison of qualityacross providers and limited social-demographic
adjustment for risk factors, particularly community and
neighborhood effects. Missing in these systems are
adequate assessments of the social determinants of
poor health or access to health care, payment adjust-
ments to allow more intensive care to these popula-
tions, and reviews of performance or rewards based
on improvements over time in outcomes for socially
disadvantaged people or reducing disparities in care
and outcomes.Given the quality metrics used to direct and
incentivize behavior, current alternative payment
methods are not well constructed to encourage
improving population health, equity, and disparities.
While there are actions that can address these issues,
some proven, some still being trialed, a payment sys-
tem that will support implementation of programs to
address disparities and equity should be developed
from the inside out, starting with the programs and
actions that will improve equity and reduce dispari-
ties, and then designing payment methods and incen-
tives that will encourage and support implementing
these programs and activities. Such programs should
recognize the vital role nurses play in implementing
actions to respond to incentives and assure payment
for engaging nurses and other non-physicians/APRNs
in this work.The Future of Nursing report recognizes current
payment limitations and calls for including metrics on
equity and reducing disparities in payment systems. It
also highlights the importance of expanded funding
for school nurses and public health nurses and build-
ing payment and programmatic linkages between
health and social service providers.ConclusionFuture of Nursing 2020-2030: Charting a Path to
Achieve Health Equity responds to the heightened
recognition of systemic racism and systemic discrim-
ination based on ethnicity, gender, and class. The
report recognizes the impact of these systemic prob-
lems on health and access to health services and the
need for the nursing profession to be deeply
involved in addressing these problems. These prob-
lems cannot be addressed without understanding
how the economics of care delivery influence
behavior. Payment must be changed to create strong
incentives and rewards for actions and activities thatJuly/August 2021 | Volume 39 Number 4 199Nursing Economic$address disparities and promote equity in health and
health care. $Jack Needleman, PhD, FAAN
Fred W. and Pamela K. Wasserman Professor
Chair, Department of Health Policy and Management
UCLA Fielding School of Public Health
Los Angeles, CA
Nursing Economic$ Editorial Board Member

References
Institute of Medicine. (2011). The future of nursing: Leading change,advancing health. The National Academies Press. https://doi.
org/doi:10.17226/12956National Academies of Sciences, Engineering, and Medicine. (2016).
Assessing progress on the Institute of Medicine report the future
of nursing. The National Academies Press. https://doi.org/
doi:10.17226/21838National Academies of Sciences, Engineering, and Medicine (National
Academies). (2021). The future of nursing 2020-2030: Charting a
path to achieve health equity. The National Academies Press.
https://doi.org/doi:10.17226/25982Needleman, J. (2020). Paying for nursing care in fee-for-service and
value-based systems [White paper]. https://www.nap.edu/
resource/25982/Needleman%20Commissioned%20Paper.pdfCopyright of Nursing Economic$ is the property of Jannetti Publications, Inc. and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright
holder’s express written permission. However, users may print, download, or email articles for
individual use.NursesparticipationintheHolocaust.pdfThis file is too large to display.View in new windowGraduate-QSEN-Competencies.pdfThis file is too large to display.View in new windowDeterminingifnursesareinvolvedinpoliticalactionorpolitics.pdfThis file is too large to display.View in new windowNEmodule3liture1.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3liture.docxhe Evolution of the Quality and Safety Education for Nurses (QSEN) InitiativeThe Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation (RWJF), the project had three phases between 2005 and 2012. The overall goal has been to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of healthcare.· Read Press Release I, II, III and IV (Can be found under the QSEN tab on the web page, go to project overview).Learn more from theQSEN website.· Review the Pre-Licensure and Graduate Competencies You will be using the 2012 graduate competencies for your project.2012 graduate competenciesNEmodule3PostFriday.docxOverviewThis week you have read about nursing organizations, political activism and advocacy, and understanding health care systems. Which are all important parts of nursing excellence. For this assignment, you need to select two of the organizations presented in the lecture (PowerPoint) and provide the following information for each organization (in your own words):· What is the purpose of the organization?· What impact does the organization have on nursing practice?· How does the organization play a role in nursing education?· How does the organization play a role in nursing research?· What part of Nursing Excellence does the organization provide? Political activism? Advocacy? Resource for Health care system?· Would you provide support to the organization as a nurse? Why or Why not?Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”Points:30Due Dates:· Initial Post: Friday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the US.· Response Post: Sunday of Week 3 by 11:59 p.m. Eastern Standard Time (EST) of the USReferences:· Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.· Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.Words Limits· Initial Post: Minimum 200 words excluding references (approximately one (1) page)· Response posts: Minimum 100 words excluding references.FutureofNursing2020-2030.pdfJuly/August 2021 | Volume 39 Number 4196Nursing Economic$In May 2021, the National Academies of
Sciences, Engineering, and Medicine released
The Future of Nursing 2020-2030: Charting aPath to Achieve Health Equity. This consensus study
from the Committee on the Future of Nursing, 2020-
2030, co-chaired by Mary Wakefield and David R.
Williams, builds on earlier work conducted by the
National Academy of Medicine and its predecessor,
the Institute of Medicine, to study the potential role
of nurses in advancing health and health care and
the action needed to realize this potential. The
Future of Nursing: Leading Change, Advancing
Health (Institute of Medicine, 2011) and 2016 report
assessing progress on the 2011 goals (National
Academies of Sciences Engineering and Medicine
[National Academies], 2016) focused on identifying
expanded roles for nurses and the actions needed to
build capacity for nurses to become engaged in and
prepare for those roles.The new report asks, “to what end?” and targets
activities and roles for nurses in addressing equity in
health care and disparities in outcomes, care, and the
upstream sources of disparities. The focus on inequal-
ity and equity reflects the increasing attention the
National Academy of Medicine has given to health
equity and social determinants of health (SDOH), and
the Robert Wood Johnson Foundation’s agenda to
create a culture of health that provides everyone a
“fair and just opportunity for health and well-being,”
a plan that has equity at its center (National
Academies, 2021, p. 128).The report embraces a shift from focusing on dis-
parities as circumstances requiring downstream reme-
diation to having causes that require upstream inter-
vention. It identifies inequities in housing, employ-ment, education, and other precursors to health due
to systemic racism and discrimination. It flags
inequities associated with socioeconomic status, dis-
ability, poverty, limited access to health services, and
race, attributing all to systemic and structural causes,
not simply individual animus. The report embraces a
vision for health systems and healthcare providers to
move upstream, to consider how to intervene not just
with the patient who presents in the waiting room
and while they are in the office or facility, but outside
the traditional framework of healthcare delivery, both
to prevent illness and disease and treat patients with
full consideration of their circumstances.Tapping Nurses’ Expertise and ExperienceMuch of the report identifies and discusses pro-
grams and activities that can be part of these inter-
ventions, both generically and with specific exam-
ples. The report notes nurses’ expertise in engaging
patients with chronic conditions, coordinating the
care of chronically ill patients between the site of
care and community and neighborhood resources,
leading teams to improve care of high-need, high-
cost patients, and working with communities to cre-
ate healthy living and work environments. It calls
for greater access for populations with complex
health and social needs by expanding multiple
sources of care and expanded roles of nurses in
these settings.Among the areas for expansion are Federally
Qualified Health Centers, retail clinics (often staffed
primarily by nurse practitioners), home health and
home visiting care services, telehealth services, and
school-based health centers (National Academies,Future of Nursing 2020-2030: Increasing the Focus of Nursing
and Health Care on Equity and Discrimination
Jack NeedlemanThe Future of Nursing 2020-2030 report responds to the heightened
recognition of systemic racism and discrimination based on ethnicity, gender,
and class; the impact of these systemic problems on health and access to
health services; and the need for the nursing profession to be deeply involved
in addressing these problems.Economic$ of Health Care and NursingJuly/August 2021 | Volume 39 Number 4 197Nursing Economic$2021). The report identifies school nurses and
school nursing as an area of front-line health care,
since school nurses help manage chronic conditions
and disabilities, address injuries and urgent needs,
and provide preventive care and assessments. The
report cites the need for improved care management
and transitional care. It recognizes care should be
customized in collaboration with patients and their
families to reflect each patient’s abilities, needs, and
preferences, citing research demonstrating the value
of person-centered care. And, as in the other areas,
the report highlights the role and experience of
nurses in providing this care.Addressing Social NeedsThe new Future of Nursing report explicitly dis-
cusses how social needs might be addressed in clini-
cal and community settings. It calls for increased
screening in clinical settings for social conditions,
impact of SDOH status, and individual and communi-
ty resources that can influence choice of interventions
and treatments. It urges more active engagement to
address these circumstances through community-
based interventions. In the discussion of community-
based interventions, the report calls for increases in
community and public health nursing and active
engagement of nurses and their expertise in interpro-
fessional, multisectoral collaborations. Two specific
examples of the latter interventions, the Camden Core
Model of the Camden Coalition and the American
Academy of Nurses’ Edge Runner initiative, are pre-
sented.The Future of Nursing report also discusses the
importance of increased engagement of nurses in
policy and healthcare governance to increase nurse
involvement in effective interventions and to tap
nurse expertise in the design and implementation of
interventions. But the report is centered on expand-
ing interventions to improve equity. A core element
of this expansion is assuring these interventions can
be paid for and sustained outside of foundation and
philanthropic funding models. The issue of funding
is addressed in Chapter Six of the report and a com-
missioned paper by Needleman (2020). The pay-
ment issues discussed can be split into two related
but separate questions: What payment models sup-
port or facilitate increased health system and nurse
engagement in addressing equity and SDOH? Whatpayment models encourage or create incentives for
these interventions?Payment Systems and EquityThe main form of payment for health services in
the United States remains fee-for-service (FFS). Under
FFS, revenue is generated through billing for specific
services by providers approved to deliver those serv-
ices. Concerning the equity agenda, there are multi-
ple weaknesses in relying upon payment to support
addressing inequity or SDOH. Payment is generally
limited to physicians and advanced practice registered
nurses (APRNs); billing for services by nurses, social
workers, and others for case management and social
interventions is minimal. (While some additional
billing codes have been created for case management
and related services, these services generally cannot
be provided by non-physicians/APRNs except when
delivered under standard procedures and protocols
and when the billing physician/APRN is physically on
site.) Billing for telehealth services may similarly be
restricted to physicians/APRNs, reducing the potential
for follow-up by other care team members. Many key
providers in the system, such as school nurses, are
not eligible for payment. Community-based outreach
and public health nurses may also not be able to bill
for services.Another weakness of FFS is its incentive to
increase the volume of billable services provided.
Efforts to modify FFS created incentives to reduce
total costs per patient. These incentives may encour-
age providers to stint care, so they are often coupled
with additional incentives to deliver appropriate care.
This combination of incentives for cost containment
and improved quality form the core of value-based
payment, an essential modification of FFS.The size of the incentives compared to the rev-
enue that can be realized from increasing FFS vol-
ume will determine whether the net motivation is to
reduce cost and improve care or continue to
increase volume. The measures in these systems
shape provider behavior. There are examples of pri-
mary care practices using registered nurses and
other case managers to reduce hospital readmissions
and other acute services. But the initiatives adopted
are often specific to which incentives can be earned,
such as reduced hospital readmissions or quality
measures tied to particular diseases.July/August 2021 | Volume 39 Number 4198Nursing Economic$One program designed to create population-level
incentives within FFS is the Accountable Care
Organization (ACO) model created by the Centers for
Medicare & Medicaid. An Oregon ACO addressing
SDOH and health equity is highlighted. But ACOs
have weak incentives to promote such policies in
general. Entry into the program has not been ran-
dom. ACOs serving a higher proportion of racial and
ethnic minorities have had lower scores on quality
measures. Because the ACO accountability structure
is grafted onto the FFS payment system, internal
incentives through bonus sharing and coordination
can also limit the ability of ACO providers to address
the equity plan. The size of the bonuses themselves
is a constraint on the resources available outside of
the FFS system for program initiatives.Capitation, per-patient payments, offers robust
support for provision of non-billable services or non-
billing staff to provide services that can reduce cost
or increase quality. Capitation provides the greatest
flexibility for health systems to design care processes
that reduce high-cost care since actions that fall out-
side of traditional billable services can be implement-
ed if they will lower costs or promote other organiza-
tional goals. Capitation also offers the greatest incen-
tives to avoid enrolling high-cost or high-risk patients
and stint care, subject only to discouraging healthier
patients from enrolling due to a poor reputation. This
outcome has led to risk adjustment in setting capita-
tion rates to reduce incentives to avoid high-cost
patients and value-based payment or incentive
approaches to encourage delivering high-cost care.
But capitation will address equity and disparities only
if it also lowers net costs.Value-based payment systems, or systems with
incentives and rewards, base incentives and rewards
on specific measures. Measures define the expecta-
tions of care and determine the provider’s focus. If
the efforts focus narrowly on standard quality meas-
ures such as diabetes control or the patient care
experience, other considerations associated with
improved population health or reduced disparities in
care may not receive attention. None of the current
major initiatives encourage or create incentives for
interventions to improve equity and address social
determinants of care.Near universal features of the bonuses or pay-
ments for high-quality care among the FFS or alterna-
tive payment systems are the comparison of qualityacross providers and limited social-demographic
adjustment for risk factors, particularly community and
neighborhood effects. Missing in these systems are
adequate assessments of the social determinants of
poor health or access to health care, payment adjust-
ments to allow more intensive care to these popula-
tions, and reviews of performance or rewards based
on improvements over time in outcomes for socially
disadvantaged people or reducing disparities in care
and outcomes.Given the quality metrics used to direct and
incentivize behavior, current alternative payment
methods are not well constructed to encourage
improving population health, equity, and disparities.
While there are actions that can address these issues,
some proven, some still being trialed, a payment sys-
tem that will support implementation of programs to
address disparities and equity should be developed
from the inside out, starting with the programs and
actions that will improve equity and reduce dispari-
ties, and then designing payment methods and incen-
tives that will encourage and support implementing
these programs and activities. Such programs should
recognize the vital role nurses play in implementing
actions to respond to incentives and assure payment
for engaging nurses and other non-physicians/APRNs
in this work.The Future of Nursing report recognizes current
payment limitations and calls for including metrics on
equity and reducing disparities in payment systems. It
also highlights the importance of expanded funding
for school nurses and public health nurses and build-
ing payment and programmatic linkages between
health and social service providers.ConclusionFuture of Nursing 2020-2030: Charting a Path to
Achieve Health Equity responds to the heightened
recognition of systemic racism and systemic discrim-
ination based on ethnicity, gender, and class. The
report recognizes the impact of these systemic prob-
lems on health and access to health services and the
need for the nursing profession to be deeply
involved in addressing these problems. These prob-
lems cannot be addressed without understanding
how the economics of care delivery influence
behavior. Payment must be changed to create strong
incentives and rewards for actions and activities thatJuly/August 2021 | Volume 39 Number 4 199Nursing Economic$address disparities and promote equity in health and
health care. $Jack Needleman, PhD, FAAN
Fred W. and Pamela K. Wasserman Professor
Chair, Department of Health Policy and Management
UCLA Fielding School of Public Health
Los Angeles, CA
Nursing Economic$ Editorial Board Member

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