What Nurses Need to Know About Care Coordination

There is a reason that RN to BSN programs place an emphasis on care coordination. Care coordination is linked to improved patient outcomes as well as lower costs. Nurses are being called on to take the lead in this essential role.

Bachelor’s-level nursing programs are designed to help RNs advance their nursing practice in a changing healthcare environment. The online RN to BSN program at the University of Southern Indiana (USI) includes a focus on care coordination to prepare RNs for success in this core competency.

What Is Care Coordination?

Patients often see more than one healthcare provider. Patients with complex needs, such as diabetes and other chronic illnesses, may have many people on their healthcare team. Care coordination is about how healthcare professionals work together to meet their patients’ needs — providing the right care, in the right place, at the right time.

Most healthcare providers agree that care coordination is essential for high-quality care. In the case of chronic illnesses, care coordination reduces the risk of medical errors that can occur when patients see multiple providers.

Care coordination does not happen on its own. As the Agency for Healthcare Research and Quality (AHRQ) explains, coordinating care involves intentional actions that “guide the delivery of safe, appropriate, and effective care.” Teamwork, care management and health informatics (such as electronic health records) are important aspects of care coordination.

Nurses coordinate care in the following ways:

  • Sharing knowledge related to patient care with other members of a care team
  • Working to ensure seamless transitions of care
  • Collaborating with multiple providers on a healthcare team to develop a personalized, proactive care plan to manage a patient’s healthcare needs
  • Support patients in managing their healthcare goals, including by connecting them with community resources

How Does Care Coordination Help Patients?

Care coordination is seen as the basis for achieving the “triple aim” of health reform:

  • Improved patient experience of care (quality and satisfaction)
  • Improved population health
  • Reduced per capita costs 

It may be overwhelming to think about transforming the entire healthcare system. Instead, consider a patient with diabetes, one of the most common and costly chronic diseases. The patient’s care team probably includes a primary care provider and an endocrinologist.

The healthcare team may also include a dietitian, pharmacist, eye doctor, dentist, podiatrist, nurse educator and social worker. It is easy to see how care fragmentation could happen. Nurses working with diabetic patients can improve outcomes by coordinating care. Identifying gaps in care, such as annual diabetic eye exams, is crucial.

According to the American Nurses Association, documented results of nursing care coordination include:

  • Fewer emergency department visits
  • Greater patient confidence in self-managing care
  • Reduced overall charges
  • Significant increases in survival

How Can a BSN Prepare Nurses for Care Coordination?

Studies promoted by the AACN show that a BSN makes a difference. BSN-prepared RNs have better patient outcomes than RNs with two-year degrees. Coursework that develops care coordination skills can only help.

USI’s RN to BSN program provides a foundation in care coordination, including collaborative care models. Additional coursework in nursing informatics also helps nurses improve care coordination. RNs who stay up to date on informatics, such as electronic health records (EHRs), will be better equipped to make the most of these tools.

As healthcare needs become increasingly complex, BSN-prepared RNs can lead the way in coordinating care and improving outcomes.

Learn more about the University of Southern Indiana’s online RN to BSN program.


AHRQ: Care Coordination Measure Atlas Update

Institute for Healthcare Improvement: IHI Triple Aim Initiative

American Nursing Association: The Value of Nursing Care Coordination

American Association of Colleges of Nursing: The Impact of Education on Nursing Practice

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