From the Editor's Perspective…

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• Cindy Lewis, MSN, RN, ACNS-BC

As I reflect back over this year, I am amazed at the numerous care initiatives that we as nurses have led and implemented. Such evidence-based best practice initiatives include VTE protocols, surgical-care improvement programs, elder-care principles, pressure-ulcer programs, catheter-associated urinary tract infection programs, vascular catheter-associated infection programs, patient-safety programs and fall-prevention programs, to name just a few. These initiatives have demonstrated positive effects on patient outcomes. Such initiatives have improved quality of care and have helped our patients lead healthier lives. Certainly, they play a major role in transforming our healthcare system. Nurses have created model programs in acute care, primary care and public health settings that have improved and are continuing to improve the health status of our patients and communities. These initiatives are expanding access, improving quality, promoting prevention, and driving down costs. They have gained recognition from consumer groups, insurers, physicians, states and the federal government.

The key goals of healthcare reform are to expand access to care, especially primary care; improve quality by delivering safe, evidence-based care; reduce costs for patients and payers; and promote prevention through public health programs. Nursing initiatives embody promising policies that address these reform agendas. Offering comprehensive community-based care for the elderly as in all-inclusive care for the elderly (PACE) and acute care for the elderly (ACE) programs have positively affected the health status and quality of life, and they have prolonged survival and reduced costs. Nurse-developed models using services of advanced practice nurses to plan hospital discharges and provide follow-up care have resulted in shortened hospital stays and reduced readmissions. Nurse home-visiting has helped lower costs in primary care, community and acute care settings. Studies show that improving the size and composition of nurse staffing reduces the incidence of adverse hospital-acquired conditions and saves lives. The decision by Medicare to stop reimbursing for preventable hospital-acquired conditions has strengthened the call for appropriate nurse staffing. Programs that engage nurses in redesigning their work environments have improved patient outcomes and led to better retention of nursing staff. As the users of most health-information technologies, nurses play a leading role in their development.

In addition, public-health nursing expenditures have produced outstanding results and significant financial returns. School nurses are screening for common problems and providing vital access to health services. Nurse practitioners have demonstrated their capacity to provide high-quality care in private medical practices and community-based health centers. Nurse-led practices provide excellent care coordination in keeping with nursing-home initiatives. Nurses are successfully coordinating care in all settings for patients with chronic conditions as vital members of the interdisciplinary healthcare team.

Challenges and change will always occur in healthcare. Today, we are in a current state of flux. With so many variables involved in the delivery of care, such as third-party payments, federal and state regulations, healthcare reform, escalating overhead costs, declining reimbursements, and increasing administrative burdens, constant change is one certainty we will continue to face. Continued emphasis on quality of care and clinical outcomes will be of utmost importance. As nurses we must continue to drive and implement quality initiatives and evidence-based practice guidelines. Our Journal provides the avenue for you to share your best-practice initiatives, success stories and challenges. As we move forward into this new year, let's work together and help each other. Share your knowledge with your colleagues. Submit your knowledge and expertise for publication in our Journal! We can help mentor you through the process from idea to writing your manuscript. Call me. E-mail me. Let's start the New Year ready to collaborate and grow our professional practice! I look forward to hearing from you!!!