CBSPAN Annual Seminar Chris Price, MSN,RN, CPAN, CAPA ASPAN President 2011-2012 [email protected]

The IOM/RWJ Report

 Landmark report  2 Year Investigation  October 2008 – a 2 year initiative was launched  Bold assessment of nursing to transform the nursing profession  October 5, 2010 – End result  The Future of Nursing: Leading Change, Advancing Health

The Future of Nursing: Leading Change, Advancing Health

Institute of Medicine of the National Academies

The Future of Nursing RWJ/IOM Report

 Director Susan Hassmiller, RN, PhD, FAAN  Campaign for Action  State Coalitions  Implementing Solutions and Leading Change  What the initiative means for Nurses

Making Nursing Work Successful

 “The key to making nursing work successful in a physician-oriented environment was aligning it with the quality mission of the foundation. So, it’s not just about nursing, but about the greater good in health care – and the nurse’s role in achieving the greater good. You can’t be afraid to say that nurses count, and count in a big way. Nurses are the lynchpin when it comes to quality and safety. You have to make the link between the nurses’ roles and their contributions to addressing cost, quality, and access.” Susan Hassmiller, RN, PhD, FAAN

Health Care Reform Demands

 Nurses play a vital role in the 2010 Affordable Care Act  Broadest healthcare overhaul since 1965 which introduced the Medicare and Medicaid programs  Nurses need to overcome barriers that prevent them from leading the charge for change!

 All State Laws unique  Federal government could promote reforming states’ practice acts to be less restrictive

The Committee

 Donna Shalala  Worked with Presidents Bill Clinton and George W Bush  1997 was the Secretary of Health & Human Services  Committee Chairperson  Currently President of the University of Miami 18 Committee members 10 Study Staff 2 Consultants

Committee Charge

 Examine and produce recommendations:  Reconceptualize the role of nurses  Entire workforce  The Nursing Shortage  Societal issues  Current and future technology

Advance Education Transformation

 Expand Nursing faculty  Increase capacity of Nursing Schools  Redesign nursing education to assure that adequate number of well prepared nurses  Meet current and future health care demands  Innovative solutions to health professional education

Committee Charged to

 Expand technology  Focus on Nursing and the delivery of Nursing services  Attract and retain well prepared nurses in multiple care settings  Include acute, ambulatory, primary care, long term care, community and public health

How They Did It…….

 5 Meetings/ 3 technical workshops  Gathered information and data  3 Public forums on the future of nursing  Literature review – Commissioned a series of papers  Focused on acute care, care in the community, public health, primary care, long term care, and nursing education  Site visits in conjunction with each public forum  Collected testimony and input  www.iom.edu/nursing

4 Key Messages

 Nurses should practice to the full extent of their education and training  Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression  Nurses should be full partners with physicians and other health professionals, in redesigning healthcare in the US  Effective workforce planning and policy require better data collection and an improved infrastructure

Eight Recommendations

1.

2.

Remove scope of practice barriers Expand opportunities to lead 3.

4.

5.

6.

7.

8.

Implement nurse residency programs Increase baccalaureate degrees – 80% by 2020 Double doctorates in nursing Ensure lifelong learning Enable nurses to lead change Build an infrastructure for the collection and analysis of inter-professional workforce data

Remove Practice Barriers – What They Found………

 Numerous Regulatory and policy barriers  Fragmentation of the current healthcare system  High turnover rates for nurses  Transitioning from school to practice  Aging workforce  Demographic barriers – state to state differences  Scope of practice variations by state  Majority of state laws/boards do not allow prescriptive authority to APNs w/o MD supervision and oversight

What Can Be Done? Re: Scope

 Federal support  Collect and disseminate best practices  Incentivize adopting them  Promote and assure access to wide choice of competent, cost effective health care providers  Provide policies that ensure availability of full EBP regardless of geography  Access to appropriate care  Rules and policies that reflect evolving practice abilities of licensed providers

What Can Be Done?Re:Turnover

 Manage transition from school to practice  Nurse residency programs for new grads  Structured, planned, comprehensive periods for GNs to acquire knowledge and skills to deliver safe, quality care that meets defined standards of practice  In acute care hospitals and the outside arenas

The Registered Nurse Population

 Findings from National Sample Survey of RNs, 2008  US Department of Health and Human Services Health Resources and Services Administration  Bureau of Health Professions Divisions of Nursing

The Registered Nurse Population

 3 Million strong  Largest workforce in healthcare  Take the lead in meeting future demands  By 2030 – 20% of all Americans will be over 65 years of age

Increasing Numbers of Nurses…

 Increased number of younger nurses  More diversity is evident  444,668 RNs – 1 st license  50% were BSN  404,163 MSN/doctorates degrees  45% were over the age of 50

2008 Report

3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 1980

Registered Nurse Population in the United States

3,063,162 1,661,590

Year

2008

Employed Registered Nurses

86% 84% 82% 80% 78% 76% 74% 72% 76,6% RN Population by Employment Status 84,8% 83,2% 82,7% 82,7% 81,7% 80,0% 78,7% 1980 1984 1988 1992 Year 1996 2000 2004 2008

The Aging Work Force

RNs under 30 from 25% to years old decreased 10.6% of the RN population.

The average age of RNs increased from 40 to 46 years.

Average age at graduation from a basic nursing program increased from 24 to 31 years.

Action Coalitions

 State & Hospital Led – 50 states and District of Columbia  Collaborative – Nursing & Non Nursing  Groups of stakeholders at the state level  To affect long term sustainable change  Educate policy makers and other decision makers  Reach out to philanthropic/funders for support  Gain visibility - Advance key IOM recommendations

So Where are we in 2014?

 Medicare – Graduate Nurse Education Demonstration $ 200 million demonstration project in 5 hospital systems – preparing more APNs caring for patients  APIN – 4 promising models to streamline academic progression  Number of students enrolled in RN to BSN programs increased to 53%  268 nurses have been appointed to boards  MN, ND, VT,CT,NV, RI removed statutory barriers that prevented NPs from providing care to their full extent of education and training

Leveraging Leadership Initiative

Removing Practice Barriers

Nursing’s Commitment

 Patient care - Improved safety - Improved quality  All nurses must take responsibility for their own professional and personal growth  “An important message from the campaign is that all nurses can and should be leaders because leadership at every level is what is needed to ensure safe and high quality care.” ~ Susan Hassmiller  Lifelong learning

Designing YOUR Future & YOUR Practice

 Practice to Your Own Potential – Real Life Examples  Geissinger – Shifted to Primary Care - Used NPs higher quality – lower cost care  Kaiser – Nurse led Discharge Process – Discharge Nurse role  Recognize – Embrace opportunities – Anesthesia Extender – Pain Management Coordinator  Look at YOUR Workplace  Build a Blue Print for your own practice and education goals

Designing YOUR Future & Practice

 Plan - Strategize- Evaluate  Where will you be in 6 years? (by 2020)  Where do you want to be?

 Where do you want your practice and specialty to be?

 Find a mentor – Get a study buddy  BE a mentor – Share successes AND pitfalls  Stay on track – Check off your accomplishments  Celebrate your milestones  Idealistic versus Realistic

Getting Started – Getting Ready

    Have a broad – and CURRENT knowledge base -FACTS Health care, politics, the economy, business, finance Develop your potential – make it your MISSION and your PASSION      Clinical expertise & Credibility - get certified – pursue education Supports clinical care Information Technology Administration of care Quality improvement Get involved AND visible – Community and municipal organizations – other influences value YOUR expertise

Being Prepared – Being Ready

 Identify areas in your organization where you can be useful and CONTRIBUTE  Do your ‘homework’ – read reports and question all  Committee work – local, regional, national  Start small, joining committees within your organizations or local organizations  Use your influence, and contacts, to become involved on a board  Make it professional and PERSONAL – this is YOUR future, too

Take The Next Step

 Going from the bedside to the Board Room  Create a personal leadership plan  Develop an area of expertise – write about it – speak about it – this is how prospective members are noticed  SPEAK up – don’t wait to get noticed – let others see what YOU can bring to the table  Build connections – within and outside your profession – Find a mentor – mentor others  Seek ongoing education  Hassmiller, S. (November 2012).Taking the first steps to serving on a board, American Nurse Today,

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Be Someone’s SPARK – Every Day

Choose to be so! Take care of and Nurture OUR Own Promote and support diversity – it takes all of us and multicultural views and contributions Network – Network – Network Seminars, Conferences, Regional, National, International You are a product of the company you keep – Surround yourself with greatness and pay it forward!

 “A candle never diminishes its’ own flame in the lighting of another~ John Maxwell  “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the fire within us.” ~ Albert Schweitzer