IOM Report on the Future of Nursing: Our Value on the Frontline

1. IOM Report on the Future of Nursing: Our Value on the Frontline Caryl Goodyear-Bruch, RN, PhD, NEA-BC Director Professional Resources & Leadership Development Children’s Mercy Hospitals & Clinics Kansas City, MO AACN CSI Faculty American Association of Critical-Care Nurses AlisoViejo, CA

2. No Conflict of Interest

3. We are NOT victims.We are the champions of our future.Caryl Goodyear-Bruch

4. Objectives • Describe the key messages of the 2010 The Future of Nursing. Leading Change, Advancing Health IOM report. • Discuss the challenges and opportunities of this report in relation to the profession of nursing. • Analyze personal reactions to the report and develop strategies to address the opportunities as evolved with the discussion of this report.

5. Case Study #1 Your MICU unit council decided to implement a progressive ambulation activity program to include patients on ventilators. Overall, how will you help the nurses show the value of instituting this practice? a. review the progressive ambulation literature to show decreased length of stay. b. brainstorm ways to decrease time and energy cost of ambulating ventilated patients. c. break the process of instituting this practice into component parts for analysis. d. analyze the performance of this practice in relation to it’s cost.

6. Case Study #2 As a Nurse Manager, you are responsible in leading and managing a 22 bed ICU. How would you go about proving your performance is of value to the hospital? a. Choose patient-centered goals and utilize benchmarks to analyze performance. b. Assume your boss knows your performance and how it impacts patient outcomes. c. Show the financial savings and cost diversion of your staffing matrix. d. Present to the hospital board of directors the unit’s clinical outcomes.

7. Health Care System Challenges

8. Being the calm in the storm

9. IOM Report: What’s It About? • Report on the future of meeting the needs of the people who live in the US. • RWJF with IOM • Committee structure with focus groups • Donna E. Shalala (Chair) President, University of Miami

10. Future of Nursing Campaign for Action • RWJF and AARP • Each state with action coalitions • Diverse group of stakeholders creating and implementing actions based on report recommendations.

12. Education

13. Education • Higher levels of education • Academic preparation • Meeting the needs of demand for BSNs • Life long learning • Academic • Hospital based

14. 1. What are the barriers and creative solutions to meeting the goal of 80% of nurses having their BSN by 2020? What are the creative solutions in your own city, institution, unit, personal life?

15. Practice

16. Practice • Practice to full extent of education: APRNS & BSN direct care nurses • Full partners to redesign healthcare • Models of care • Quality and safety change agents • HWE • EBP • Healthcare workforce data • What are the numbers? • What will we need to meet patients needs?

17. 1. What are the barriers and creative solutions to meeting the goal of 80% of nurses having their BSN by 2020? What are the creative solutions in your own city, institution, unit, personal life? 2. What opportunities do we all have in creating the environment in which we practice to the full extent of our education and are full partners in healthcare and healthcare redesign?

18. Leadership

19. Leadership • Lead collaborative improvement efforts • All nurses to lead change • Every nurse….a leader • TCAB, CSI, EBP Fellows

20. 1. What are the barriers and creative solutions to meeting the goal of 80% of nurses having their BSN by 2020? What are the creative solutions in your own city, institution, unit, personal life? 2. What opportunities do we all have in creating the environment in which we practice to the full extent of our education and are full partners in healthcare and healthcare redesign? 3. What are some of the ways we can engage nurses to become leaders of change?

21. Top Actions for Profession

22. Top Actions for Profession

23. Top Actions for Profession

24. What We’ve Always Known To Be True • Research: more patients = worse outcomes • Economic Value of Professional Nursing (Dall, et al.) • 133,000 MORE nurses save ~ 6,000 lives each year! • productivity value of $1.3 billion per year!

25. Our Value

26. What is Our Value? Value = Performance/Quality Cost • Cost • Decreased cost • Performance or quality • Increased quality

27. Nurse Value • Individual performance • We are the sum of our parts - competency • How do we personally increase quality/decrease cost? • Group performance (unit; interdisciplinary groups; nursing committees/groups)

28. Frontline Leadership • The Nurse • What do we need? • Time to • Think • Plan • Do • Technology MUST help not hinder

29. Frontline Leadership • How? • Project work • Value – increase performance, decrease cost • The Leader at the bedside • Quality knowledge • Data, data, data • Evidence

30. Frontline Leadership • QI professionals • Mentor, coach techniques • Researchers • Support the need for Evidence

31. Frontline Leadership • Educators • Academia – fluid to change curriculum • Service – strategize various delivery modes, follow trends • The C Suite • Support for innovation • Shared decision making

32. Frontline Leadership • What is Innovation?

33. Frontline Leadership • Leading at the bedside • Skills needed • The leaders of change • Change management – personal and unit • Education • Back to school? • Quality safety • Finance

34. Case Study #1 Your MICU unit council decided to implement a progressive ambulation activity program to include patients on ventilators. Overall, how will you help the nurses show the value of instituting this practice? a. review the progressive ambulation literature to show decreased length of stay. b. brainstorm ways to decrease time and energy cost of ambulating ventilated patients. c. break the process of instituting this practice into component parts for analysis. d. analyze the performance of this practice in relation to it’s cost.

35. Case Study #2 As a Nurse Manager, you are responsible in leading and managing a 22 bed ICU. How would you go about proving your performance is of value to the hospital? a. Choose patient-centered goals and utilize benchmarks to analyze performance. b. Assume your boss knows your performance and how it impacts patient outcomes. c. Show the financial savings and cost diversion of your staffing matrix. d. Present to the hospital board of directors the unit’s clinical outcomes.

36. “The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” — John Maxwell

37. Personal Actions Get Out of the Comfort Zone

38. Letters to Editors August2, 2011 Dear Cori Ast, Thank you for your recent article in the Spring/Summer 2011 Kansas Medicine + Science entitled An Expanding Role. It is vitally important for all of us to be informed about the efficiency and effectiveness of nurse practitioners and other advanced practices nurses including the Certified Registered Nurse Anesthetist (CRNA). In addition to the safe efficient care provided by nurse practitioners, the CRNA provides quality anesthesia services to the residents of Kansas as the only provider in a majority of the counties (See attached pfd map of Kansas). Further, in a current review of quality and safety research to be published in the September/October issue of Nursing Economics, Robin Newhouse and colleagues found that advanced practice registered nurses (APRNs), including nurse practitioners and CRNAs, provide safe, high-quality, effective care indicating that APRNs have an important role in providing healthcare services to the residents of our country. Addressing the concerns of Dr. Michael Kennedy and other physicians, this landmark evidence supports that APRNs can safely augment the physician supply in efforts to meet the healthcare needs. As nurses, we encourage and promote a collaborative model of healthcare with our physician colleagues and all healthcare team members in order to best serve our patients. Thank you again for bringing this important information to our KU community. Caryl Goodyear-Bruch, RN PhD KU School of Nursing PhD graduate, 2005

40. “Nurses sustain excellence when they dare to push themselves beyond boundaries. As individuals and as strong, bold teams, they step beyond their comfort zones to achieve new heights in clinical practice, professional development and personal growth.”

41. References • Boyd, T. (March 7, 2011). It’s academic: Studies spur push to BSN-in-10. Accessed at www.nurse.com; http://news.nurse.com/apps/pbcs.dll/article?AID=2011103070046 • Brooks, K. (Spring, 2011). The future of nursing. Johns Hopkins Nursing Magazine. Accessed April 19, 2011 at http://magazine.nursing.jhu.edu/2011/04/future-of-nursing/ • Committee of the RWJ Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The Future of Nursing. Leading Change, Advancing Health. Washington, DC.: The National Academies Press. • Future of Nursing, Campaign for Action. (Feb 1, 2011). Regional action coalitions: An overview. Accessed June 1, 2011 at www.thefutureofnursing.org • Kovner, C. T. (2011). The future of nursing: An interview with Susan B. Hassmiller. Nursing Economics, 29(1), 32-34. • Munro, C.L., & Savel, R. H. (2011). Critical care and the future of nursing. AJCC, 20(3), 188-190. • Website: The Future of Nursing, Campaign for Action website is www.thefutureofnursing.org • Add the TCAB article and the new cost article