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Leading Change, Advancing Health

Leading Change, Advancing Health. Nursing’s Voice. 3.2 million 100,000 30,000. Objectives. To review Institute of Medicine, Future of Nursing Report To define the Campaign for Action To define the Virginia Action Coalition To describe the workgroups. Health Care System Challenges.

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Leading Change, Advancing Health

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  1. Leading Change, Advancing Health

  2. Nursing’s Voice 3.2 million100,00030,000

  3. Objectives • To review Institute of Medicine, Future of Nursing Report • To define the Campaign for Action • To define the Virginia Action Coalition • To describe the workgroups

  4. Health Care System Challenges Fragmentation High costs Health care disparities Primary care and public health shortages Aging and sicker population

  5. Virginia’s Health Care Challenges • Escalating rate of diabetes*: • 193,000 in 1993 • 508,000 in 2010 Aging health care workforce Primary care shortage, especially acute in rural areas *Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System

  6. Nurses and Health Care Largest segment of health care workforce Critical role in providing patient care and care coordination Need to enhance nurses’ skills and capabilities

  7. RWJF’s Commitment to Improving Care Need to address challenges facing nursing to address challenges facing our health system RWJF MISSION To improve health and health care for all Americans

  8. Institute of Medicine Report High-quality, patient-centered health care for all will require a transformation of the health care delivery system One of the most-viewed online reports in IOM history

  9. Institute of Medicine Report A Quote: " achieving a successful health care system in the future rests on the future of nursing." Harvey V Fineberg, MD, PhD President , Institute of Medicine.

  10. IOM Future of Nursing Report • Committee on the RWJF Initiative on the Future of Nursing • Membership • Opportunity to transform health care system • Provide seamless, affordable, quality care • Nursing profession is the largest segment of the health care workforce

  11. Campaign for Action: Key Messages Education Leadership High-quality patient centered care Interprofessional Collaboration Access to Care Workforce Data

  12. Blueprint – Four 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 health care in the US • Effective workforce planning and policy making require better data collection and an improved information infrastructure

  13. Future of Nursing Recommendations • Remove scope of practice barriers • Expand opportunities for interprofessional collaboration • Implement nurse residency programs • Increase proportion of nurses with BSN to 80% by 2020 • Double the number of nurses with doctorates • Ensure that nurses engage in lifelong learning • Prepare and enable nurses to lead change and advance healthcare • Build an infrastructure for data collection

  14. Campaign for Action Pillars Interprofessional Collaboration Diversity DATA

  15. Education Increase the proportion of nurses with BSN and higher degrees Increase the number of nurses with doctorates Implement nurse residency programs Promote lifelong learning

  16. Evidence Some association between educational level and patient outcomes Twenty percent of BSN graduates get advanced degrees Six percent of associate-degree graduates get advanced degrees Education Aiken et al., 2003; Estabrooks et al., 2005; Friese et al., 2008;Tourangeau et al., 2007; Van den Heede et al., 2009; Aiken, 2009.

  17. Practice All practitioners should practice to the full extent of their education and training Physicians, nurses and other health professionals work in a team-based model of care delivery Models of care maximize time that providers can spend on their respective roles and responsibilities to patients

  18. Evidence Studies show that APRNs permitted to practice to full extent of education and training provide equal or better care Patient satisfaction • Length of stay • NPs: BP, glucose, lipid control • CNMs: Fewer C-sections, fewer episiotomies Practice Systematic review of published literature between 1990 and 2008 indicate patient outcomes of care provided by APRNs and equivalent or better than MD Sources: Journal of Nursing Economic$, (Sept/Oct 2011), Advanced Practice Nurse Outcomes 1990 – 2008: A Systematic Review

  19. Collaboration

  20. Leadership Nurses bring important viewpoint to management and policy discussions

  21. Survey of 1,000 U.S. hospitals** found: Nurses account for only six percent of board members Physicians account for 20 percent of board members Other clinicians are five percent of board members Gallup survey of 1,500 opinion leaders* said nurses should have more: Influence in reducing medical errors, increasing quality of care, promoting wellness Input and impact in planning, policy development and management Evidence *RWJF, 2010 **American Hospital Association, 2011

  22. Need data on all health professions Improved health care workforce data collection to better assess and project workforce requirements Research on health care workforce is fragmented Data

  23. Diversity Nurses should reflect patient population in terms of gender, race and ethnicity All nurses should provide culturally competent care

  24. Campaign for Action • The Campaign for Action is a national initiative coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. • The campaign has mobilized diverse stakeholders nationally and in all states to address the nation’s most pressing health care challenges – access, quality and increasing cost – by utilizing nurses more effectively and preparing nursing for the future.

  25. Campaign Strategies Diverse Stakeholders Action Coalitions Policy-makers RWJF AARP Advisory Committee Research, Monitoring, Evaluation Communications Grantmaking

  26. Nursing Must be Considered a Societal Issue! RWJF/AARP seeking support from: Health professionals Philanthropies Payers Educators Consumer advocates Hospitals and health systems Business Public health agencies Policy-makers

  27. Campaign for Action campaignforaction.org How will the eight IOM recommendations translate into action? State Action Coalitions Regional Action Coalitions

  28. AARP Virginia Virginia Nurses Association

  29. Virginia Action Coalition Co-leads AARP – Virginia David DeBiasi, RN Associate State Director - Advocacy Virginia Nurses Foundation Shirley Gibson, DNP, MSHA, RN, FACHEFoundation President Virginia Nurses Association / Virginia Nurses FoundationJanet Wall Chief Executive Officer

  30. Virginia Action Coalition Goals • Nurses should practice to the full extent of their education and training • Nurses should achieve higher levels of education and training through an improved educational system that promotes academic progress and explore residency programs • Nurses should be full partners, with all members of the healthcare team in redesigning healthcare • Nurses should develop strategies to ensure that nursing is skilled to provide leadership at all levels • Nurses should ensure effective workforce planning and policy making require better data collection and an improved information infrastructure

  31. Mission To implement the recommendations in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health

  32. Vision All Virginians have access to affordable, high quality care and live in an optimal state of health

  33. Virginia Action Coalition Workgroups

  34. VAC LeadershipLindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RNCo-leads IOM Recommendation 7 Prepare and enable nurses to lead change to advance health. Objective Determine strategic boards to which nurse could be appointed and work with stakeholders to identify, mentor, and recommend individuals for those appointments.

  35. Leadership Objectives • Continue “Nurse Leaders in the Boardroom” program piloted with Robert Wood Johnson and AARP in September, 2009 • Continue to support Nurse Leadership Institute, a program of the Richmond Memorial Health

  36. Outcomes • Networking and educational event for the nurses identified as 40 under 40 • Recognized at VNF Gala - 2011 • Mentoring event – May 31, 2012 • Collaboration with: • VONEL • VNA • VNF

  37. Outcomes • Survey to determine boards nurses are serving – regional, state and national • Survey also identified those wanting to serve on boards • 334 Surveys completed • 118 Experienced Nurse Board Leaders • 181 Virginia Registered Nurses are future board leaders! • Video : Value of having a nurse serve on hospital board

  38. Outcomes • Video: Value of Nurses on Hospital Boards

  39. Local Boards Free Clinics Crisis Pregnancy Centers AORN, VNA, Black Nurses & other professional nursing associations Public Health Advisory Commissions Red Cross Alzheimer’s Association Church Affiliated Boards Performing Arts Council Historical Councils County Board of Supervisors AARP University & Community College Councils YMCA

  40. State Boards Virginia Partnership for Nursing Virginia Board of Nursing Virginia Nurses Association Virginia Nurses Foundation Multiple professional nurses associations Virginia Board of Health Virginia Association of Counties VCCS Associates Degree Nursing Program Heads Virginia Association of Colleges of Nursing Health Insurance Exchange Governing Body

  41. National Boards American Nurses Association & Political Action Coalition National eHealth Collaborative Nurses Organization of Veterans Affairs American Midwifery Certification Board AORN Journal Editorial Board National Kidney Foundation American Academy of Nurse Practitioners American Organization of Nurse Executives Various National Nursing Organizations

  42. Next Steps • Survey hospitals to find boards where nurses serve • Develop a video campaign value of nurse on boards • Enhance the Leadership Toolkit • Develop structure for mentors and mentees serving on boards • Publish Leadership Article with Campaign for Action • Blog for RWJF on Leadership • Leadership Development Conference for nurses who want to serve on boards

  43. VAC Access To CareCindy Fagan, RN, MSN, FNP-BC and Kathy Baker, RN, PhD, NE-BCCo-leads IOM Recommendation 1 Remove scope-of-practice barriers Objective All nurses should practice to the fullest extent of their training ObjectiveEducate stakeholders, legislators and the public about APRN regulatory barriers that prevent full practice authority to continue efforts to  reform outdated scope-of-practice regulations

  44. Outcomes • House Bill 346 passed and signed by Governor • Eliminates supervisory language • Emphasized collaboration and consultation between NPs (LNP & CNMs) and physicians to practice in teams • Increased from 4 to 6 number of APRNs physicians can collaborate with • Joint Boards of Nursing and Medicine have 280 days from July 1 to develop regulations • HB 346 manifested in 2013

  45. Outcomes • Video: The Advanced Practice Registered Nurse

  46. Continue education of the public about the APRN scope of practice Conduct a gap analysis with all nurse practitioner roles in respect to the National Council of State Boards of Nursing Consensus Model Meet with the Board of Nursing to review the NCSBN Consensus Model Consider legislation to remove the Joint Board and establish an Advisory Group for oversight Next Steps

  47. Next Steps • Conduct research to explore how policies and practices in hospitals in the state of Virginia either support or inhibit RNs from practicing to their fullest extent through a Qualitative Descriptive Case Study rebased on Yin’s Methodology for Case Studies • Participants include nurses from all hospitals in the state • Areas include ICU, Med/Surg/Progressive Care and Emergency Department • Include the CNOs, RNs and Advanced Practice Registered Nurses

  48. VAC Academic ProgressionDeb Zimmermann, DNP, RN, NEA-BC and Amy Gillespie, RN, MSN, EdD Co-leads IOM Recommendation 4 Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020 Objective Convene stakeholders on the implementation of seamless education progression

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