NURS FPX 6210 Assessment 4: Leading the Future of HealthCare

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Introduction

NURS FPX 6210 Assessment 4 As health systems develop to address the needs of populations with varying health conditions, nurse leaders have a critical role to play in forging the future. This evaluation considers ways to guide transformational change, enhance the delivery of care, and drive health policy. It targets a strategic leadership solution to solving a contemporary healthcare problem—reducing hospital readmissions through optimizing care transitions.

Identifying the Healthcare Challenge

Problem Focus: Hospital Readmissions

Unnecessary readmissions to the hospital strain resources, are costly, and negatively affect patient outcomes. The Centers for Medicare & Medicaid Services (CMS) indicates that almost 1 in 5 Medicare patients are readmitted in 30 days.

CMS Readmissions Reduction Program

Key Contributing Factors:

  • Inadequate discharge planning
  • Poor medication reconciliation
  • Lack of follow-up care
  • Low health literacy

Strategic Leadership Approach

Transformational leadership is critical to solving complex problems, Nursing managers need:

  • Inspire a shared vision
  • Empower interdisciplinary team
  • Encourage innovation and accountability
  • Use date -driven decisions

AONE Leadership Competencies

Proposed Evidence-Based Change Strategy

Change Initiative: Transitional Care Program (TCP)

A transitional care program with a nursing -led model supports patients to read after discharge and support after discharge to increase satisfaction.

Key Components:

  • Assign a nurse for transitional care (TCN) to patients at high risk
  • Conduct home visits or check -in in the telecommunications neck within 48 hours after discharge
  • Strengthen drug farming and self -management education
  • Coordinate follow-up appointments

Conscious support: According to Niler et al, nurse -TCP can reduce reduction by up to 30% in older adults. (2017).

🔗 Naylor Transitional Care Model

Interprofessional Collaboration Strategy

Nurse leaders need to lead across disciplines to enhance outcomes.

Collaboration Includes:

  • Physicians and pharmacists for medication management
  • Case managers for social support referrals
  • Home health providers for continuity of care
  • Health IT teams to facilitate electronic transitions

Benefits:

  • Decreased care fragmentation
  • Enhanced communication
  • Improved patient and caregiver engagement

Outcome Metrics and Evaluation

Success of the TCP will be measured through:

Metric Target Outcome
30-day readmission rates ↓ by 25% in 6 months
Patient satisfaction (HCAHPS) ↑ by 15%
Medication reconciliation compliance 100% within 48 hours
Post-discharge follow-up attendance ↑ to 90% compliance

Ethical Considerations

  • Equity: Make sure the TCP is accessible to underserved populations
  • Autonomy: Honor patient choices and consent
  • Confidentiality: Protect sharing of patient information using HIPAA-compliant systems

Conclusion

Visionary nurse leadership is needed to lead the future of healthcare. Through the implementation of evidence-based transitional care practices and interprofessional collaboration, nurse leaders can best decrease hospital readmissions and enhance quality of care. This leadership model is not only sustainable but also patient-focused and outcomes-driven

References

  1. Centers for Medicare & Medicaid Services (CMS). (2023). Readmissions Reduction Program.https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program
  2. Naylor, M. D., et al. (2017). Transitional Care Model: Translating Research Into Practice. https://www.nursing.upenn.edu/ncth/transitional-care-model/
  3. American Organization for Nursing Leadership (AONL). (2022). Nurse Executive Competencies.https://www.aonl.org/resources/nurse-leader-competencies
  4. Agency for Healthcare Research and Quality (AHRQ). (2020). Care Coordination Interventions.https://www.ahrq.gov/ncepcr/care/coordination.html

FAQs

❓ What is the purpose of a Transitional Care Program?

It maintains continuity of care following discharge and reduces readmissions through follow-up, education, and coordination by nurses.

❓ How do nurse leaders shape the future of healthcare?

They exercise strategic leadership, guide change efforts, and facilitate interprofessional collaboration to address healthcare problems.

❓ Why prioritize hospital readmissions?

High readmission rates are a sign of inadequate transitions of care and lead to financial penalties and lower quality scores.

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