An accomplished nurse leader is working to increase the number of nurses available to work where they will be most needed in the future—in patients’ homes and within the community.

pg20_profile_bolton-burnesThroughout her childhood, Linda Burnes Bolton admired the nurses who cared for her during regular hospital visits to treat her asthma. Their compassionate care and belief in her ability to achieve great things in spite of her illness inspired Burnes Bolton to become a nurse.

Needless to say, those nurses guessed right about Burnes Bolton’s potential. She has achieved some of the highest accomplishments in her profession as CNO and director of nursing research at Cedars-Sinai Medical Center, Los Angeles, and as president-elect of the American Organization of Nurse Executives.

Burnes Bolton is leading a transition in nursing from providing inpatient care to delivering care outside of hospital walls. “The footprint of the healthcare delivery system is widening, and nurses need to expand their reach to the places where people live, work, play, and go to school. Nurses will be involved in home care and health prevention programs brought to local residents in schools and community centers,” says Burnes Bolton.

Listen to a short audio clip of Burnes Bolton describing Cedars-Sinai’s population management approach.

Shifting to Community-Based Care

Currently, 65 percent of the 3.1 million nurses in the United States work inside acute-care settings, while 35 percent work outside of acute care, according to the Institute of Medicine’s Report on the Future of Nursing, which summarizes the work of a committee that Burnes Bolton co-chaired. The healthcare system must flip those numbers to achieve the Institute for Healthcare Improvement’s Triple Aim—improving the quality of the patient experience, improving the health of populations, and reducing the per capita cost of health care, says Burnes Bolton.

“This is home care and community care on steroids. It’s the intense monitoring of patients in their homes and in skilled nursing facilities as well as outreach through community organizations,” says Burnes Bolton.

For example, nurses at Cedars-Sinai are starting to make the transition outside the walls of the hospital by performing “tuck-in calls” within 24-48 hours after patients are discharged. Nurses call the patients they cared for in the hospital to ensure that patients are following physicians’ post-care directions, such as scheduling follow-up visits, adhering to dietary recommendations, and taking their medications properly.

“Nurses conduct a review of patient’s medications based on the after-visit summary provided at time of discharge. If there are any discrepancies or patient concerns about their medications—such as side effects that could cause an emergency department visit or readmission—the patient is encouraged to speak with the prescribing physician. Nurses also notify the prescriber to ensure that patients concerns have been addressed,” says Burnes Bolton.

For patients at high risk for readmissions, nurses make another call at seven days. If the staff nurse determines that a home visit is necessary, a clinical nurse specialist or nurse practitioner visits the patient to review post-discharge instructions on medications and self-care.

Acquiring New Skills

Treating patients in settings outside the hospital will require nurses to gain additional skills and education, says Burnes Bolton. For example, nurses caring for patients in their homes will need to learn how to use medical products specifically designed for home health care. In addition, not all healthcare plans cover home care, so nurses will have to gain an understanding of what services typically are covered by patients’ insurance plans before delivering care.

The nursing profession’s shift to providing more care in patient homes and the community coincides with broader changes in health care, such as advancing population health management and expanding access to health care. “The core of nursing is to provide human caring at the individual, population, and societal levels. When nurses can accomplish this, they become leaders who perform at their very best,” says Burnes Bolton.

Linda Burnes Bolton, DrPH, RN, FAAN, is vice president, nursing and CNO, Cedars-Sinai Medical Center, Los Angeles.

Publication Date: Wednesday, August 20, 2014