Transcript Navy Nurses - American Academy of Ambulatory Care Nursing
Navy Nursing Update
CAPT Sarah Martin
Deputy Director, Navy Nurse Corps Active Component 30 April 2012
What We Know About Nurses
• • • • • • Knowledge of frontline nurses and their interactions with patients are critical to improving patient outcomes Nurses at every level across the continuum strengthens the health care system in general Increasing the time nurses have with the patient to educate is essential to the goal of patient-centered care Integrated systems that leverage assets (people, technology) are key to increasing efficiency and allowing nurses to spend time with the patients.
Multi-disciplinary care teams improve the quality, safety and effectiveness of care NURSES MAKE A DIFFERENCE!!!!!
What We Also Know
• • • • •
More than 3 million registered nurses in the United States Nurses have a steadfast commitment to patient care, improved safety and quality, and better outcomes Nurses can fill multiple roles Nurses are lifelong learners Nurses are leaders in advancing health
NAVY NURSING Nurse Corps Force Data
Nurse Corps Force Structure
Flag 1
Actual Force (Inventory)
12% 21% 5% CAPT 146/146 CDR 338/357 LCDR 589/648
DOPMA Force Structure (OPA)
5% 12% 22% 63% LT & Below 1806/1815 61% TOTAL = 2875 96.9% manned Data Source: OPA to Inventory FEB 2012 TOTAL =2966
FY -2012
– Navy Nurse Corps Strategic Plan
CLINICAL & INFORMATION RESEARCH STRATEGIC WORKFORCE PROFESSIONAL MANAGEMENT PARTNERSHIPS EXCELLENCE
Maximize Clinical and Professional Excellence Promote Communication Across the Enterprise Cultivate a Culture of Scientific Inquiry Foster a Culture of Collaboration Optimize Human Capital Resources
• Build , strengthen and advance clinical, operational and professional skills and knowledge • Sustain, advance and evaluate communication across the enterprise • Increase interest, submission and selection of evidence based practice research projects to improve the health of our patients and add to the body of nursing knowledge • Develop joint and strategic partnerships to strengthen the profession of nursing and maximize utilization of limited resources • Focus on maintaining the right workforce to provide nursing care across the full range of military operations
Vision For Navy Nursing
Provide exceptional patient & family centered, interdisciplinary, and evidence-based care. We place quality-caring relationships at the center of our practice resulting in a safe, compassionate and healing environment.
The Navy Nurse Corps Strategic Plan is aligned with Navy Medicine ‘s Strategic Plan relative to Quality of Care, Agile Capabilities, Deployment Readiness, Total Force and Research & Development.
GOALS CLINICAL AND PROFESSIONAL EXCELLENCE
Goal: Maximize Clinical and Professional Excellence.
Goal Team Purpose:
Build, strengthen and advance clinical, operational and professional skills and knowledge.
FY-12 ACTIVE COMPONENT (AC) OBJECTIVES
Develop standardized guidance for career development boards (CDB) building on existing tools for use across the enterprise.
Develop a standardized Director of Nursing (DNS) dashboard to measure and track key elements across the leadership and professional continuum.
INFORMATION MANAGEMENT
Goal: Promote communication across the enterprise.
Goal Team Purpose:
Sustain, advance and evaluate communication across the enterprise (up, down, across the chain, internal and external).
RESEARCH
Goal: Cultivate a Culture of Scientific Inquiry.
Goal Team Purpose: Increase interest, submission and selection of Evidence Based Practice (EBP) research projects to improve the health of our patients and/or add to the body of nursing knowledge.
STRATEGIC PARTNERSHIPS
Goal: Foster a culture of collaboration Goal Team Purpose: Develop joint and strategic partnership across Federal (Military, VA and Active Reserve Component) and civilian healthcare systems. These partnerships will strengthen the profession of nursing and maximize utilization of limited resources.
WORKFORCE
Goal: Optimize human capital resources.
Goal Team Purpose: Focus on maintaining the right workforce to provide nursing care across the full range of military operations.
Publish and market the Communication Playbook via NKO and other media for enterprise access.
Implement the most effective substitute for List Serve.
Targeted communication action group members attend Executive Development Strategic Communication Program at Monterey Postgraduate School to structure the enduring Strategic Communication plan.
Repeat the original environmental scan and analyze results.
Market and launch the annual Navy Nurse Corps recognition program that promotes and acknowledges excellence in EBP.
Develop a two – three day regional EBP Course.
Facilitate the initiation of three multi-site, regional Evidence Based Practice (EBP) project.
Establish research “knowledge broker” at each command.
Establish and electronically publish a joint service Senior Nurse Executive (SNE) directory. Establish a forum to foster joint collaboration and explore best practices and networking opportunities among uniformed service regional SNE, specialty leaders and consultants.
• Perform a comprehensive review of the 1960 critical care community and provide recommendations to the Office of the Nurse Corps (MOOC3). Define and optimize the role of the Clinical Nurse Specialist (CNS).
CHAMPION/TEAM LEADER Champion(s) CAPT Vince Starks
Email: [email protected]
CAPT Lisa Houser
Email: [email protected]
Team Leader(s) CDR Pat Taylor
Email: [email protected]
CDR Janine Allen
Email: [email protected]
Champion (s) CDR Julie McNally
Email: [email protected]
Team Leader LCDR Guidry
Email: [email protected]
Champion CAPT Mary Greenwood
Email: [email protected]
Team Leader: CDR Michele Kane
Email: [email protected]
Champion(s) CAPT Denise Johnson
Email: [email protected]
Team Leader(s): CAPT Anna Hurt
Email: [email protected]
CDR Cindy Baggott
Email: [email protected]
Champion(s) CAPT Brenda Davis
Email: [email protected]
Team Leader (s): CDR Amy McBride
Email: [email protected]
CDR Erin Robertson
Email: [email protected]
MEDICAL HOMEPORT AND NAVY NURSING
Nearly 40 sites applied for NCQA recognition last year, and 130 are currently applying
Navy Medicine East Navy Medicine West Navy Medicine National Capital Area Army Air Force JTF
TOTAL 2008 Standards
10 2 3 17 6 1*
39 2011 Standards Round 1
7 8 0 20 15 0
50
* This site was a Navy site during the application process and has since realigned to JTF
2011 Standards Round 2
14 24 0 30 10 2
80
Typical Navy Medical Home Port primary care team
Example: Panel size = 4,400 patients Provider c-FTE Equivalent of 4 full-time providers (not bodies) 0.5 RN per provider c-FTE 2 nurses 2.5 CMA per provider c-FTE 10 medical assistants 0.75 clerk per provider c-FTE 3 clerks
Behavioral Health is the first specialty to embed its specialists in the MHP team
Behavioral Health
1 Integrated Behavioral Health Consultant (IBHC) per 7,500 enrollees Depending on population, could include psychiatrists, clinical psychologists, licensed clinical social workers, licensed professional counselors Practice model has been re-conceptualized to meet the needs of primary care populations Shorter (15-20 minute) appointments Fewer encounters per patient (typically 1-2 visits per patient) Care is co-managed with the Primary Care Manager (PCM) Brief, focused interventions in which patient drives problem identification, commits to short-term behavioral change, and sets a goal to accomplish by the next visit Fully-integrated provider provides consultative services and training to MHP Team Goal: improve early recognition, treatment, and management of psychosocial conditions
Additional specialties, based on patients’ needs, will gradually integrate into MHP
Pharmacy Case Management Case Management
1 per 7,200 enrollees Need-based assessment of case mix/enrollee complexity Registered Nurses or Licensed Social Workers Care management/coordination for high-risk patients, including • • • • • Chronic illness or disabled Complex care needs, At risk for hospitalization Hospitalized enrollees High-risk and high utilizers
Pharmacy
Based on population Assist with medication education, reconciliation, other clinic needs • Anticoagulation • Anti-lipidemic • Medication management and patient education • • Prescription renewal Over the Counter (OTC) • Medication reconciliation
Nutrition Nutrition
Based on population Dieticians, Nutritionists, or SMEs in nutrition management Advise patients on • Health promotion and Illness prevention • Nutrition; administering • • nutrition therapy Teaching, monitoring, advising the public, Improve quality of life through healthy behaviors
What is Navy/GS Nurse Role in Ambulatory Care Role?
•
Advanced Practice Nurses
– Experts at primary care with a focus on wellness and preventive care at every encounter; fastest group of primary care providers in the country – Medical Home Port Team Leaders and command champions – Integral to team in delivering timely, easily accessible quality care
Navy Nurses (GS/Active Duty) in Role in Medical Homeport?
– Clinic Managers – Case Manager – Patient Educators – Team Leaders – Disease Management/Wellness Promotion
Ambulatory Nursing Challenges in the Navy
• • • • • • Continuity for Medical Home with deployment cycles Capturing Workload – no defined workload management system that captures ambulatory care Budget Constraints Competency Development – Experts in the Field Billet Alignment
MISSION OF NAVY MEDICINE?
Unanswered Questions
• • •
Do we need an Ambulatory/Medical Homeport Subspecialty Code? How does that fit into Navy’s billet structure?
If assets are shifted, how do we maintain wartime requirement and clinical sustainment?
QUESTIONS?
BACK-UP
NCQA PCMH Levels and Scoring 6 standards = 100 points, including passing score on all 6 Must Pass Elements NOTE: Must Pass elements require a ≥ 50% performance level to pass
Level of Recognition
Level 3 Level 2 Level 1 Not Recognized
Total Score
85 - 100 60 - 84 35 - 59 0 - 34
Must Pass Elements Passed
6 of 6 6 of 6 6 of 6 < 6 Although NCQA recognizes practices with a score greater than 34 as a Patient Centered Medical Home, Navy Medicine requires a score of 60 or greater (Level 2 or 3) for acknowledgement as a Medical Home Port.
Each element under the 6 NCQA standards is scored based on how fully the element is met
Standard 1: Enhance Access and Continuity A.
B.
C.
D.
E.
F.
G.
Access During Office Hours**
After-Hours Access Electronic Access Continuity Medical Home Responsibilities Culturally and Linguistically Appropriate Services Practice Team
Pts 4
4 2 2 2 2 4 20
Pts Standard 2: Identify and Manage Patient Populations
A.
B.
C.
D.
Patient Information Clinical Data Comprehensive Health Assessment
Use Data for Population Management**
3 4 4
5
16
Pts Standard 3: Plan and Manage Care
A.
B.
C.
D.
E.
Implement Evidence-Based Guidelines Identify High-Risk Patients
Care Management**
Medication Management Use Electronic Prescribing 4 3
4
3 3 17
Standard 4: Provide Self-Care Support and Community Resources A.
B.
Support Self-Care Process**
Provide Referrals to Community Resources
Standard 5: Track and Coordinate Care
A.
B.
C.
Test Tracking and Follow-Up
Referral Tracking and Follow-Up**
Coordinate with Facilities/Care Transitions
Standard 6: Measure and Improve Performance
A.
B.
C.
D.
E.
F.
G.
Measure Performance Measure Patient/Family Experience
Implement Continuously Quality Improvement**
Demonstrate Continuous Quality Improvement Report Performance Report Data Externally Use of Certified EHR Technology
** Must Pass Elements Pts
3 3 2 0 20 4 4
4 6
3 9
Pts
6
6
6 18
Pts