title: The changing roles of registered nurses in Pioneer Accountable Care Organizations.
abstract: OBJECTIVE
  This study focuses on whether and how Pioneer Accountable Care Organization (ACO) leaders believe the deployment of the registered nurse workforce is changing in response to the shared savings incentives.
  
  
  METHODS
  Semistructured phone interviews with leaders from 18 of the original 32 Pioneer ACOs were conducted.
  
  
  RESULTS
  Narrative analysis suggests that all of the organizations are developing new and enhanced roles for registered nurses across the continuum of care. Overall, eight types of changes were reported: enhancement of roles, substitution, delegation, increased numbers of nurses, relocation of services, transfer of nurses from one setting to another, the use of liaison nurses across settings, and partnerships between nurses coordinating care in primary and acute care settings.
  
  
  CONCLUSIONS
  This exploratory study suggests that Pioneer ACO leaders believe that payment models are affecting the deployment of the health workforce and that these changes are, in turn, driving outcomes.
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, D.C.. Electronic address: ppittman@gwu.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pittman
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, D.C.
authors.forename: Emily
authors.initials: E
authors.lastname: Forrest
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration*; D019090:Case Management; D003142:Communication; D004506:Education, Nursing / Q000639:trends; D057286:Electronic Health Records; D006699:Home Care Services; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007857:Leadership; D024802:Nurse's Role; D009726:Nurses / Q000600:supply & distribution; D009732:Nursing Care / Q000458:organization & administration; D010343:Patient Admission; D032024:Personnel Delegation; D011320:Primary Health Care / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D012866:Skilled Nursing Facilities; D013647:Task Performance and Analysis; D055817:Telenursing; D014481:United States
keywords: Accountable care organization; Nurse roles; Registered nurses; Skill mix