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Trends in Nursing, Part 1: How the shift to new care models affects nurses

Nursing is the world’s largest healthcare profession. As the industry evolves to new models (such as value-based care*), it significantly affects nurses in acute settings, home care, case management, clinics and all venues of care.

To help honor the profession during Nurses Week (May 6 – 12), we interviewed nursing leaders around the world. Here are some of the highlights of what they shared on this subject:

How is health care’s shift to value-based models affecting nurses in your organization?

“I think in a positive way. We focus on communication and on setting and sharing expectations, using value-based equations to explain why these are the right things to do. We work hard to make sure our goals tie together – from the University of California, to the department, to the individual.

“For example, about 18 months ago we held a 4-hour training for all nursing staff and leadership in the inpatient environment, focused on communication, compassion and comfort at the bedside. It was a reminder of our overall care delivery model and we re-committed to doing these things every day in our jobs. Our outcomes have improved, because we’re strengthening the infrastructure. These are the right processes for patient care.

“Through value-based models, we can tie our daily actions to goals that make sense. People here are connected to our progress.”

Karen A. Grimley, Chief Nursing Officer

University of California, Irvine Medical Center

Orange, Calif., U.S.A.


“As the Singapore government moves towards measuring patient outcomes as part of the key indicators for the industry, the impact of value-based model of healthcare will be most keenly felt when the nurses have to rely more on technology to meet these outcomes.

“Quality care has always been a part of bedside nursing but with the reliance on technology to provide efficacy, majority of nurses have felt that the value of nursing has changed from quality to quantity. Thus, this has begun to pose a challenge to them in accepting changes in the way nursing care is carried out and documented.

“However, there are the minority few nurses within the organization who shares the same goals of a value-based model to provide affordable care to patients. These are the nurses who will be able to fully appreciate the shift in healthcare model and be able to benefit both their patients and themselves.”

Annabelle Neo, Nursing Informatics

Singapore General Hospital – SingHealth



“Value-based models are causing us to look at providing care in different ways. We now have an outpatient care management team that works with the patients in our physician office practice to try and keep them out of the hospital by case managing them there in place of just the hospital. Our staff has to be more in tune to assuring we have things properly documented as well as assuring that the quality measures are met 100% of the time. We have been able to utilize the EHR to assist with this by providing care maps, discharge education forms, tracking of measures, etc.”

Jill Mason, RN, MS, Chief Nursing Officer

Blessing Hospital

Quincy, IL, U.S.A.


“About 85% of Salford Royal NHS Foundation Trust’s nursing records are now electronic, and I think staff recognize the advantages of using this system. For example standardized and structured documents. The system ensures we can standardize care and improve patient safety…More than anything it has changed our culture. With electronic documentation there is a really clear audit trail, which increases accountability and quality of care.

“You can measure outcomes much easier than you could before. As a Ward Manager, you look at those things on a regular basis. You have your objectives and can tell the electronic system what to audit — things such as drug doses, patient evaluations — at the click of a button. It definitely has improved patient safety.”

Helen Carter, Corporate Matron

Salford Royal NHS Foundation Trust

Salford, United Kingdom


“Value-based models have created an interesting phenomenon among nurses in an organization. As nurses are educated to manage the art and science of nursing — which is compassion, kindness, communication and the actual science of medicine — the art has become a greater focus than the science of nursing.  

“Senior leaders have been focusing on the science of nursing using evidence-based methodologies.  Magnet status encourages the science of nursing becoming a certified, strong evidence-based leader in the field.  

“I believe that value-based purchasing is creating an increased workload for the nurses and even decreasing the performance outcomes.   As nurses diligently work their shift they deal with factors of staffing, such as a poor working environment, operational failures, and high turnover of patients during the day. This increased workload also enhances the decrease in nursing satisfaction. In addition there is a huge burden in documentation related to the increased number Admission Assessments that the nurse has to conduct based on the volume as well as the requirements of our regulatory bodies.

“The final piece of this which is probably the most significant is that with a lower, value-based reimbursements can create budget cuts, which in turn will decrease the number of nursing and other staff. Those who remain will be required to do the same or a greater job to manage patient care. I do believe we should see nurses as customers although they are non-billing customers. They are essential to the operation of the organization, sustaining the life of the organization, and the financial reimbursement. We need to be sensitive that their words and voices must be heard.”

Jeanine Frumenti, DNP, RN, Chief Nursing Executive

Bronx-Lebanon Hospital Center

Bronx, New York, U.S.A.


How do you think the shift to new care models affects nurses? Please add your thoughts in the comments below.


Editor’s Note – “Save one life, you’re a hero. Save 100 lives, you’re a nurse.” To share this idea and wisdom from nursing leaders, click here to tweet.

Check out other posts in this Trends in Nursing series: 

*Value-based care – A healthcare payment model focused on improving quality of care and results, while reducing costs. It is different from models where providers receive payment for each service, known as “fee-for-service.”

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