Several years ago, my friend Elise Foreman-Carter, RN, BSN, became board-certified as a Nurse Coach. The conditions of her work environment at the time prompted her to look at large structural issues and the impact they had on nurses’ interpersonal relationships, communities, and politics and how we could ultimately approach our patients with safe and effective nursing care.

Elise was a traveling psychiatric nurse and social determinants played a big part in her nursing discipline. No matter what state or location Elise was in, the common theme was an overriding powerlessness and frustration. Patients did not seem to be getting better and would return for inpatient psychiatric services multiple times even in the short span of her 13-week contracts. At that time, structural changes were only being hinted or buzzed at - and literature on values-based care was non-existent. Patients were experiencing shorter hospital stays, and EPIC was just getting established.

By 2012, the Affordable Care Act had been around for a couple of years. The word “value” was being used in regards to healthcare. Elise had studied Nurse Coaching and holistic/integrative nursing practice. The very term "Values Based Healthcare" was curious to her. It seemed ambiguous. Her first thought was of empowering her clients within a system where they experience repeated defeat and powerlessness. Elise applied the holistic Nurse Coach lens and the early questions that she asked herself looked like this:

• Who is determining the value? In other words, who is determining what is important?
• Is it implicit or explicit?
• What is their perception of health value? (Not everyone cares about health as a motivator.)
• When would they be willing to consider opportunities for development - if ever?
• Why would they want to?

As a Nurse Coach, Elise noticed that client values are not a constant - they are subject to change and influence in perspective. So why and how was this equivocal idea determining health care policy? Those questions have proven key in her assessment and implementation of coaching values.

The values conversation offers a powerful and useful understanding to serve our interests as Nurse Influencers for health partnerships and alliances. The values conversation is the elemental piece of a broad conversation that occurs each time a Nurse Influencer asserts human-centered values in any number of interactions. It can happen with clients dealing with specific health concerns, in community organizations tending to specific geographic concerns, in organizations, and in the politics.

The nature of the values-based approach is to transform U.S. healthcare strategy with continual refinements and quality improvement (Ballard, 2019). That being said, there are a few key assumptions to apply as a Nurse Influencer approaching healthcare value:

• Quality is not the same thing as value
• Value is governed by perception
• Perception is not static, but ever-changing
• Negotiation is merely a way of reconciling values

(Carter, Davis, & Schaub, 2015)

When the nursing vision is opened to greater possibilities for participation, then we see that Nurse Influencers stand in their power to practice at full scope and in full partnership with their colleagues. The values conversation occurs as we perform our due diligence in nursing practice, networking, and job or other contract negotiations. It doesn't come without its challenges, such as being heard regarding day-to-day processes and tasks.

Nurse Influencers take an expansive approach. If population health is to improve as directed by initiatives like Healthy People 2020 and The Nightingale Initiative on Global Health, then Nurse Influencers must have more of these “values conversations”. The integrity of our communities depends on nurses asserting their place as advocates, coaches, community leaders... etc. (Barker & Barker, 2011) Nurse Influencers come with purpose and a clear mind that paves a way for sacred service and human centered care as a core value.

Elise has written an excellent CE course "Coming into Your Nursing Influence and Impact: Aligning with Purpose in a Values-Based Healthcare Economy (5 CE)".