Role of Nurse in Health Care

This research will examine the phenomenon of change in the design or redesign of health care, focusing on the role of the nurse. If there is any single issue on which health-care theorists, practitioners, policy makers, and consumers agree in the current period, it is that health care in general and the profession of nursing in particular have been permanently marked by change. Lancaster (1999) cites nursing literature that cautions nurses to seize the initiative in managing change in health-care venues, so that they will have a voice in the shape that change assumes in institutional systems.

Structural change in health-care delivery systems has occurred since the 1950s in part because of the success of medical interventions and the increase in life expectancy. These factors, together with the increase in medical insurance coverage, funded by private underwriters and government entities alike, help explain the rise in the number of patients seeking access to care. By the 1960s, the care-delivery system had been well institutionalized: "Hospitals were the focus of care; physicians were in charge; providers told patients what to do; patients were dependent" (Healthcare, 1999). The effect of this entrenched, subsidized system, particularly after Medicare and Medicaid were instituted as a government-subsidized health-insurance systems for the elderly and the indigent, respectively, in the mid-1960s (General, 1997), was to conceal the costs of health care, which rose so dramatical

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et forces, but the back end of responding to cost pressures can be discerned in the effects on day-to-day administration of hospital and health-care administrators. In the case of the VA, for example, the intent of decentralization, which includes site-specific management responsibility and authority for budgets and resource allocations, was to increase both systemic efficiency and executive-administrator accountability. Restructuring is specifically and programmatically embedded into that strategy, for medical center directors are accountable for both efficiency and improving the range of access to care for hitherto underserved veterans who are eligible for care. One aspect of this was a policy change that lifted historical restrictions on coverage for outpatient care. Another, more bureaucratic, change flowed from the Government Performance and Results Act of 1993, which, in line with accountability policy, requires all government agencies to address structural organization and change, i.e., to "set goals, measure performance, and report on their accomplishments. The intent is . . . to define what desired results [the agency] wishes to achieve, identify the strategy to achieve the desired results, and then determine how well it

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