Transcript Creating a 21st Century Nurse Workforce: What will it take?

What do we need to know to
Create a 21st Century Nurse
Workforce
ENRS, March 2010
Lori Melichar, Ph.D.
Senior Economist
Robert Wood Johnson Foundation
Initiative on the Future of Nursing
Susan Hassmiller, Director
Lori Melichar, Research Director
Funding Opportunities
Health Reform
Payment Reform
Quality and Safety
Workforce Planning
Value of healthcare
Implementation
The opportunity of health reform
Nurses will have to play a key role
Expanding access
 Improving quality
 Reducing costs
 adding value
The challenge of health reform
How can nurses reduce
Burden of more aging sick patients
Expensive, wasteful care
Health care disparities
Primary care shortage
Unacceptable medical errors
We need research that explores nurses’ contributions to these
goals and how nursing’s ability to contribute can be enhanced
The opportunity of payment reform
Transparency and P4P
Bundled payments to ACOs
Equal pay for equal work
Rewards for wellness
The challenge of payment reform
P4P for nurses?
Impact of Bundled payments to ACOs
which episodes for payment?
Equal pay for equal work
Incentives for Wellness
The opportunity to improve quality
Curbing infections in hospitals
Improving hospital discharge
Preventing medication errors
RWJF’s answer to the challenge of
improving quality :INQRI
Mission of the Interdisciplinary Nursing
Quality Research Initiative:
To generate, disseminate and translate research to
understand how nurses contribute to and can
improve the quality of patient care.
Strategy:
Support interdisciplinary teams to address the gaps
in knowledge about the relationship between
nursing and health care quality.
July 20, 2015
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The opportunity to reduce Blood Stream Infection
Rates in Intensive Care”
• First RCT to reduce CLABSI for ICU patients
• Reductions in infections can be achieved by:
• Using an ICU Safety Program
• Adopting a safety improvement environment
with nurses involved
• Higher nurse turnover related to higher
infection rates
Johns Hopkins University
July 20, 2015
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“A Quality & Cost Analysis of Predictors of Readiness for
Hospital Discharge & Post-Discharge Outcomes”
• Studied nurses' contributions re:
discharge
• Post-discharge utilization of readmission &
ER visits were lower when units had
•More RN hours per patient day
•Less overtime hours
•Fewer vacancies
Marquette University
July 20, 2015
11
“Nursing-Pharmacy Collaboration on Med Reconciliation:
A Novel Approach to Information Management”
• Evaluated effectiveness of nurse-pharma
team to improve medication
reconciliation
• Reconciliation at admission &
discharge:
•Helps avoid ADEs
•Improves patient safety
•Reduces healthcare costs
Johns Hopkins University
July 20, 2015
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INQRI.org
Research Findings
Grantee Updates
Webinar Schedule
July 20, 2015
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The opportunity to build the workforce
Adequate numbers
High priority competencies
Relevant Experience
WorkplaceSupport
The challenge of workforce planning
Data
Education/Testing
Residencies
Work environment
The opportunity for nursing to add value
 Largest component of health care workforce
 Spend most time with patients
 Most likely to catch medical errors*
 Work in many care settings
Advanced practice RNs
 Technology design and use
Nurses leading innovation and QI
The challenge of assessing the value
added by nurses
Lots of studies
Is there enough evidence?
for spread
For policy
What does the evidence mean?
Initiative on the Future of Nursing
IOM committee
Public Forums
Implementation
Research
National forum in Houston
RWJF Nursing Research Network
Quick strike projects
Commentaries/Reviews
•Overlap in scope of practice for
health professionals
•Policy Implications of work
•Physician perspectives on
nursing work and workforce
•Consumers’ acceptance of
nurses evolving roles
•Trends in nursing education
•Assessment of data available to
study nursing and other health
professions
Doing quick projects with
existing data, drawing on existing
expertise
•Seeking all (evidence based) sides
of an issue
•Starting and encouraging an
ongoing conversation
•Linking evidence to implementation
•Identification of cross cutting
themes
Engaging experts and researchers
from a wide range of disciplines
and experiences
Do your part to ensure that
opportunities aren’t missed
•Engage in rigorous research on policy relevant topics
• engage scholars of other disciplines
• Conduct implementaition research
• Publish in non-nursing journals
•Make sure your voice is heard (read)
• Stay on top of policy discussions
• Policy/research briefs
• Social media
• Worry more about impact, less about impact journal
Share your thoughts, analysis and
findings
Visit us on the Web at:
www.thefutureofnursing.org
Follow us on twitter at:
www.twitter.com/futureofnursing
Leave a comment on the Initiative blog at:
www.blog.thefutureofnursing.org
Join us on Facebook at:
http://facebook.com/futureofnursing
 Blog about quality at INQRI.org
Nurses Lack Influence
Nurses hold about 2% of
all board positions
Gallup Poll suggests
policy makers think they
should have more
influence on policy
How will things change when more nurses
are at the table?
What are the benefits of fostering
Inter-professional Collaboration ?
Health students
(nursing, medical, others)
Build collaboration during their education
Classes
Clinicals
To foster collaboration later in their careers
Improve patient-centered care
This is hard. Is it worth the effort?
What is the impact of Innovating?
Do
Plan
Study
Act
Engage!
What can we learn from consumers?
Over 1,200 retail clinics use
NPs for common acute
problems.
 ERs and urgent care clinics
freed up for more severe
aliments
Retail clinic*
 Patients enjoy convenience
 NP-staffed clinics are more
affordable
 No known reports of quality
deficiencies
*Photo by Jim Amon, The Denver
Post, September 30, 2009.
What can we learn from consumers?
Shoshanna Sofaer and Colleagues found:
• Nurses and NPs seen as providing more
compassionate care, and spending more time with
patients, than MDs
• Little known about education/training/current scope
of practice of RNs, NPs, MDs and PAs
• Fear that if NPs get more independence, they might
also become more rushed and financially motivated
• Negative feelings about FFS payment v. salary
• Consumer perception that MDs should just specialize