Future of Nursing: Planning and Progress

September 16, 2015

Nebraska Rural Health Association Conference

Victoria Vinton MSN, RN – Director NAC

Faculty Disclosure

Today’s presenters have no financial interests/arrangements

that would be considered a conflict of interest.

Objectives

• Describe the impact of the Institute of Medicine (IOM) 2010 The Future of Nursing: Leading Change, Advancing Health report recommendations on nursing education, leadership, and practice and the importance of the underpinnings of interprofessional practice and diversity.

• Discuss the role and progress of the NAC in transforming healthcare across the state.

National Campaign Vision

All Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success.

High-quality, patient-centered health care for all will require a transformation of the health care delivery system

Institute of Medicine Report 2010

Enabling nurses to practice to the full level of their

training

Remove scope-of-practice barriers.

Implement nurse residency programs.

Improving nursing education Increase proportion of nurses with a BSN degree to 80% by 2020.

Double the number of nurses with a doctorate by 2020.

Ensure that nurses engage in lifelong learning.

Preparing and enabling nurses to lead change.Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.

Prepare and enable nurses to lead change to advance health.

Improving workforce data collection and analysis.

Build an improved infrastructure to collect and analyze health care workforce data.

Institute of Medicine Report 2010

Diversity

Fostering Interprofessional Collaboration

Campaign for Action Pillars

Advancing Education

Transformation

Removing Barriers to Practice and Care

Nursing Leadership

DATA

Interprofessional Collaboration

Diversity

Triple Aim Target2007 – 2008

• Population Health

• Experience of Care

• Cost

• 4th aim

From those…

Who are most central to patient care.

It will take….

• Leadership• Vision• Experience• Direction

Nebraska Action CoalitionLeading Change, Advancing Health

Visiting Nurse Association, Lead Nurse Partner HDR Architecture, Inc., Lead Non-Nurse Partner

Executive Committee (1)L. Lazure, M. Cramer, M. Valerio, J. Lazure,

N. Gondringer, D. Kozeny, A. Orduna, L. Walline,

D. Straub, L. Connelly, C. Hohnholt

NAC Director (2) V. Vinton

Executive Consultant M. Valerio

Non-Nursing Organization Lead (4)

HDR Architecture, Inc.

Advancing Nursing Leadership Statewide Team (7)

L. Walline & D. Straub Co-LeadsOpen North Co-Chair

C. Wahl & M. Wolf, South Co-ChairP. Agee-Lowrey & D. Ernesti, East Co-ChairC. Jones & L. Schoenholz, West Co-Chair

DIVERSITY

Interprofessional Collaboration

Data/ NE Center for Nursing

Advancing Nursing Education Statewide Team (6)

M. Valerio & A. Orduna, Co-Leads Liane Connelly & K. Weidner, North Co-ChairS. Hayek, M. Mertz, & P. Bales South ChairsT. Delahoyde & A. Minster, East Co-Chairs

S. Wilhelm & B. Kautz West Co-Chairs

Advancing Nursing Practice Statewide Team (8)N. Gondringer & D. Kozeny, Co-Leads

B. Blecher & J. Rystrom, North Co-ChairOpen South & West Co-Chairs

D. Conley & P. Evans East ChairAcute Care Consultant: J. LazureLegislative Consultant: L. LazureLegislative Consultant: L. Lazure

Nursing Organization Lead (5)

Visiting Nurse Association

Strategic Advisory Committee (3)J. Summerfelt—Pres/ CEO VNA

C. Benjamin AARP-NE P. Lopez MSN—PHAN

J. Ulrich—CEO Community Hospital McCookD. Welk-VP Immanuel; C. McCullough – HDR, Inc.Larua Redoutey—Presi. Nebraska Hospital Assc.

Tom Frettee Provider Network Director-NE Medicine

Mission

To improve healthcare access, quality, & cost-effectiveness in a manner that embraces & reflects diversity in Nebraska through collaborative partnerships with consumers, providers, policy makers, & businesses.

VisionTransform Leadership.

Embrace Diversity. Promote Best Practices.

Provide Quality Healthcare.

What We Are & What We Are Not

• Consumer partners – not just nursing• Catalyst organization – not umbrella• Self-sustainability essential• Interprofessional collaboration a must• Coalition of internal/external stakeholders

1. Implement statewide initiative with all schools of nursing to streamline RN to BSN education and achieve 80% BSN by 2020

2. Support removal of practice barriers for Nebraska nurse practitioners to assure accessible primary care across the state

3. Lead statewide efforts to diversify the RN workforce in Nebraska to meet affordable, accessible healthcare for our growing minority population

4. Prepare and promote nurses for leadership on community and hospital board membership

5. Workforce data collection

Click here for website

Strategic Action Plan

• 61% of Nebraska RNs now have their BSN; 9.1% increase between 2012 and 2014

• 14% increase in Nebraska nursing leadership on decision-making bodies/boards based on 2013 Nursing Leadership Survey.

• Publication of White Paper: Leadership and Education in Nebraska (2014)

• Working with all schools of nursing to streamline RN to BSN education and achieve 80% BSN by 2020.

• 20th state to modernize practice for nurse practitioners

SIP I Grant Outcomes

Education Team

Double Doctorates

Interprofessional Education

Education EvidenceStudies show association between higher nurse education level & improved health care outcomes:

• Higher proportions of BSN-prepared nurses associated with lower rates of medication errors, mortality, and failure to rescue

• BSN-preparation increases diagnostic skills and better intervention evaluation

• Connection between baccalaureate education and lower mortality rates.

• Silver Tsunami – graying baby boomer workforce

• Bureau of Labor Statistics project 526,800 more nurses needed by 2022 - 19.4% increase from 2012*

• Not enough faculty – retiring or gaining higher salaries in other settings

• Streamline advancement of nurse education• Increase in BSN nurses builds pipeline *Bureau of Labor Statistics

Education Evidence

Interprofessional Collaboration

What does interprofessional collaboration look like for your organizations?

Interprofessional Collaboration

The View

Practice Team

Transition to Practice

Workforce All nurses practice to full education/training

Disparities in Life Expectancy by Zip Codes

Poorest Zip Code in Omaha 68111

Richest Zip Code in Omaha 68135

Zip Code of 69361 in Scottsbluff, NE

Life Expectancy at Birth

70.6 years 82.6 years 76.9 years

Median Household Income

$ 23, 470 $ 90,263 $37,967

White (%) 21.2 95.5 75

Black (%) 70.6 0.3 0.3

Poverty (%) 32.4 1.0 16.8

Unemployment Rate (%)

7.5 0.8 4.1

Source: Su, Dejun (UNMC Center for Reducing Health Disparities) and NE DHHS (2015). Life expectancy estimates by three

representative zip codes in Nebraska are based on vital statistics data pooled from multiple years.Vital Statistics and http://zipskinny.com/ http://www.city-data.com/zips/69361.html

Improve Workforce Diversity

Nurses should reflect the population in terms of gender, race and ethnicity.•Recruit the nursing workforce

of the future.

•All nurses should provide culturally

responsive services and care.

•Greater workforce diversity helps

to reduce health disparities.

http://campaignforaction.org/directory-of-resources/increasing-diversity

Nursing Diversity in Nebraska

94.00%

6.00%

Female Male

Men in Nursing NE (2014)

Leadership Team

40 under 40 Nurses

Mentors

Champion Employers

10% increase nurses on boards

Promote Nurse Leadership

Nurses bring a unique perspective to management and policy discussions.•Nurses spend the most time with people receiving health services.

•Nurses are the largest segment of the health care work force.

•Nurses are vital to improving quality.

•Yet nurses account for only 6 percent of hospital board positions.

2020: 10,000 nurses on boards

NATIONAL INITIATIVE

• Innovate• Collaborative• Well honed listening/interview skills• Recognize need for interprofessional

roles • Effective team member• Patient advocate• Strive for honesty, transparency, &

integrity• Value connection between community

& healthcare

• Agreement by 75% of NANDD members to implement the statewide seamless competency-based progression model and format for awarding credit

• RNs age 20-50 with a BSN will increase by 10%; diverse BSN students and RNs to increase by 2%; males 5%

• Add 8 mentor/mentee pairs (2 from each region) and 2 of which must be diverse

• Active participation in a leadership development program by 10% of the 40 under 40 honorees.

SIP III Grant Deliverables

• Held Stakeholder’s Breakfasts across state last 2 years. Culture of Health Summit statewide Oct 15 &16 in Omaha, Lincoln, Kearney, Norfolk, & Scottsbluff

• Collaborative legislative win for nurse practitioners

• Denver Rural Health Conference for RWJF grantees – July 2015

NAC & Rural Health

If we’re not at the table

we’re on the menu…Nurses most trusted profession for

over a decade. (Gallup, 2014)Opinion health leaders note barriers to

nurses’ increased influence & leadership

• Not perceived as important decision makers • Not revenue generators (directly)• Don’t have single voice on national issues

Solution: Nurses need to “Lean In”

Power of Coalitions The power of coalitions lies in their ability to bring people together from diverse perspectives around clearly defined purposes to achieve common goals.

Strength lies in numbers – in working together and strategizing for success.

Like us Mason, et

al.

Robert Wood Johnson Foundation* Visiting Nurses Association*HDR Architecture, Inc* Immanuel*Saint Elizabeth Regional Medical Center* Nebraska Hospital AssociationNebraska Medicine* St. Francis Medical Center – Grand Island* Good Samaritan Hospital – Kearney* NONL* and NONL District III

University of Nebraska College of Nursing* Executive Committee of NAC* Creighton University College of Nursing* Alegent – Creighton HealthAureus Medical, affl of C&A Industries* NE Assembly of Nursing Deans and Directors*Great Plains Medical Center – North Platte Methodist Hospital*

Nebraska Nurses Association* Columbus Community Hospital*Nebraska Association of Nurse Anesthetists* Nebraska Nurse Practitioners* Clarkson College* Community Hospital – McCook*

Nebraska Emergency Nurses Association Donor-members of NAC*AARP-Nebraska Chapter* Equitable Bank Foundation –Grand Island*Nebraska Nurse Midwives NNA District 2 NE League for Nursing* AWHONNHeartland Gerontological Nurse Assc* Nebraska Methodist CollegeFive Points State Bank – G.I. American Psychiatric Nurses Assc (NE)

AORN Nebraska School Nurse AssociationDHHS Office of Rural Health

*Repeat donors

http://www.neactioncoalition.org

Please join us in this important work!

For more information, contact:Victoria Vinton, MSN, RN

Director, Nebraska Action CoalitionCall: 402.830.7769

Email: info@neactioncoalition.org

References

• Blegen, M., Good, C., Park, S., Vaughn, T., & Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. Journal of Nursing Administration, 43(2): 89-94.

• Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573-576.

• Campaign for Action http://campaignforaction.org/directory-of-resources/increasing-diversity retrieved April 6, 2015.

• Enhancing Diversity in the Workforce (2014). http://www.aacn.nche.edu/media-relations/diversityFS.pdf• http://www.nga.org/files/live/sites/NGA/home/nga-center-for-best-practices/col2-content/list-center-bott

om/top-downloads/the-role-of-nurse-practitioners@/1212NursePractitionersPaper.pdf 

• IOM (Institute of Medicine). 2010 The Future of Nursing: Leading Change, Advancing Health. Washington D.C. The National Academies Press.

• Joynt, K., Orav, E.J., & Jha, A. Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non-Critical Access Hospitals, 2002-2010. JAMA. 2013; 309(13):1379-1387.

• Khoury, C.M. and Blizzard, R. (2011). Nursing leadership from bedside to boardroom: A Gallup national survey of opinion leaders. JONA, 41 (7/8), 299-305.

• Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2011). Policy & politics for nursing and health care (6th ed.). St. Louis, MO: Elsevier Saunders. (p. 626).

• Newhouse, R.P., et al. A Phased Cluster-randomized Trial of Rural Hospitals Testing a Quality Collaborative to Improve Heart Failure Care: Organizational Context Matters. (2013). Medical Care, 51(5): 396-403.

• Pribil, L. (2009). Engaging Nurses in Governing Hospital and Health Systems. Journal of Nursing Care Quality 24(1):5-9.

• RWJF. (2014). Building a Culture of Health http://www.rwjf.org/en/about-rwjf/annual-reports/presidents-message-2014.html

• Sandberg, S. (2013). Lean In: Women, Work and the Will to Lead. Alfred A. Knopf, New York.