Emerging Nursing Roles

1. 1 Emerging Nursing Roles Pathway to the Stars Course # 192 Welcome to Course # 192, Emerging Roles: Pathway to the Stars. We�re going to go ahead and get started. We hope you enjoy this session, and hope that you have enjoyed your time here at VeHU. This is one of the last few courses of the last day of regular sessions, but we plan on keeping you interested and excited about the innovative roles that await you as nurses within our vast healthcare system. Welcome to Course # 192, Emerging Roles: Pathway to the Stars. We�re going to go ahead and get started. We hope you enjoy this session, and hope that you have enjoyed your time here at VeHU. This is one of the last few courses of the last day of regular sessions, but we plan on keeping you interested and excited about the innovative roles that await you as nurses within our vast healthcare system.

2. 2 Before we actually get started we need to take care of some Housekeeping issues. This is a 90 minute class. Please take time to turn off your cell phones, or set them to vibrate. If you must take a call, please leave the room to answer. Before we actually get started we need to take care of some Housekeeping issues. This is a 90 minute class. Please take time to turn off your cell phones, or set them to vibrate. If you must take a call, please leave the room to answer.

3. 3 Please, Hold your questions during the presentation. Questions written on the 3X5 cards provided will be answered at the conclusion of the presentation. For questions not answered, the question and the answer will be available on the web. If you have any questions please write them on the 3X5 card provided. We will answer as many of your questions as time permits, but will post the answers to all questions on the VEHU website. So please check the website when you return home.If you have any questions please write them on the 3X5 card provided. We will answer as many of your questions as time permits, but will post the answers to all questions on the VEHU website. So please check the website when you return home.

4. 4 Now, let�s move on and talk about the objectives of this session. Now, let�s move on and talk about the objectives of this session.

5. 5 Objectives To express the shift occurring in nursing practice related to Information Technology To identify future IT career opportunities within the nursing profession. To recognize the diversity of VA career pathways We hope to talk about the shift which is occurring in nursing practice related to information technology. We also want to identify future IT career opportunities within our profession. And lastly, we want to recognize the diversity of career pathways within our VA System.We hope to talk about the shift which is occurring in nursing practice related to information technology. We also want to identify future IT career opportunities within our profession. And lastly, we want to recognize the diversity of career pathways within our VA System.

6. 6 Introductions Nancy H. Prewitt, BSN, RNC, CNA VAMC Lexington Patricia Costa, MBA, BSN PI/IS Coordinator VAMC Providence Cynthia Andrus , MSN, RN VAMC Houston Paula Miller � RN, MSN, CNL TVHCS, Nashville I�d like to take just a couple of minutes to introduce your presenters for this program: -I am Nancy Prewitt, I have been with the Lexington, Kentucky VA Medical Center for 30 and one-half years now! I�ll bet you won�t be surprised that they gave me the segment of our discussion which will VERY BRIEFLY take a look at the changing roles we as nurses have held over time � see the grey hair?! I will also talk a bit about traditional versus expanded roles for nurses. -Our next presenter is Pat Costa, Pat hails from the VA Medical Center in Providence, Rhode Island. She will bring in more of the Nursing Informatics piece of our discussion. -And next is Cynthia Andrus from the VA Medical Center in Houston, Texas. Cynthia wears a number of hats at the Michael DeBakey Medical Center, and is the BCMA Coordinator and ADPAC, but for our discussion today, will bring her focus to technology and Nursing Education. -And lastly, Paula Miller, our colleague from the Tennessee Valley Health Care System, will expand on the role of the Clinical Nurse Leader. -So are you excited and ready to move on? Well here we go!I�d like to take just a couple of minutes to introduce your presenters for this program: -I am Nancy Prewitt, I have been with the Lexington, Kentucky VA Medical Center for 30 and one-half years now! I�ll bet you won�t be surprised that they gave me the segment of our discussion which will VERY BRIEFLY take a look at the changing roles we as nurses have held over time � see the grey hair?! I will also talk a bit about traditional versus expanded roles for nurses. -Our next presenter is Pat Costa, Pat hails from the VA Medical Center in Providence, Rhode Island. She will bring in more of the Nursing Informatics piece of our discussion. -And next is Cynthia Andrus from the VA Medical Center in Houston, Texas. Cynthia wears a number of hats at the Michael DeBakey Medical Center, and is the BCMA Coordinator and ADPAC, but for our discussion today, will bring her focus to technology and Nursing Education. -And lastly, Paula Miller, our colleague from the Tennessee Valley Health Care System, will expand on the role of the Clinical Nurse Leader. -So are you excited and ready to move on? Well here we go!

7. 7 Changes, Changes, Changes What changes have you seen in the past 10 years? Have those changes involved technology and information management? Have those changes improved your practice? Now, let�s talk about the rapid changes occurring in nursing practice and processes. -What changes have you seen in the past 10 years? Is there a process that you perform everyday which has NOT changed in the past 10 years? I truly can think of nothing which has remained change-free in my practice over the past 10 years. Think of documentation, medication administration, communications, procedures, equipment � I can think of nothing that has been left virtually undisturbed in this period of time. -Have those changes involved technology and information management? Well you bet they have! Information is coming at us in such a rapid way that I feel as though I must operate at light-speed myself. The amount of information at our disposal is mind-boggling, and sometimes the decision of what to use and what to let go is critical. Our brains must function faster and faster, but we have plenty of data upon which to base our decisions. -And have these changes improved your practice? I think most of us would say yes, dramatically so. We offer improved safety, improved infection control, speedier answers, faster / more accurate services, and more standardized, re-produceable results and processes associated with patient care. Now, let�s talk about the rapid changes occurring in nursing practice and processes. -What changes have you seen in the past 10 years? Is there a process that you perform everyday which has NOT changed in the past 10 years? I truly can think of nothing which has remained change-free in my practice over the past 10 years. Think of documentation, medication administration, communications, procedures, equipment � I can think of nothing that has been left virtually undisturbed in this period of time. -Have those changes involved technology and information management? Well you bet they have! Information is coming at us in such a rapid way that I feel as though I must operate at light-speed myself. The amount of information at our disposal is mind-boggling, and sometimes the decision of what to use and what to let go is critical. Our brains must function faster and faster, but we have plenty of data upon which to base our decisions. -And have these changes improved your practice? I think most of us would say yes, dramatically so. We offer improved safety, improved infection control, speedier answers, faster / more accurate services, and more standardized, re-produceable results and processes associated with patient care.

8. 8 Traditional to Expanded Roles Primarily �inpatient� nursing leading to the Expansion into many various roles Case Management � Managing smaller numbers of patients intensively Care Management � Managing large numbers of patients across the continuum Telephone Care / Triage � Assessing symptoms / changes in condition and offering education and advice by protocol So what changes in our roles have followed the shift in technology? To contrast traditional to newer roles for nurses, we�re going to take just a few moments reviewing some possible roles. I promise not to take too long, but think a mention of traditional roles is necessary because they are still extremely important. -What do we believe is a traditional role? An inpatient medical / surgical nurse, an operating room nurse, an emergency room nurse � those are the roles I think of when I think of the traditional, main-stays of our hospitals (or mother-ships as I call them) -Now how have those roles evolved with the information and technology super-highway? Nurses are managing panels or cohorts of patients rather than �units� of patients. They are managing patient outcomes based upon data and process improvement. Nurse Managers are managing work units rather than nursing units, and are managing personnel and patient care delivery through intricate dashboards, performance measures, and benchmarks. Wow, I�m impressed! As I saw in a relatively recent magazine article � this is not your Father�s VA � we are state of the art, ahead of the game, we are the benchmark, and it feels pretty good. -I want to share a quick example of how our image has changed over time, recently, we hired the nursing staff to support a new CBOC (Community Based Outreach Clinic), and they came to my work area for orientation. None of the staff had ever worked in a VA facility. While shadowing in one of our RN Assessment Clinics aimed at assuring patient recovery post hospitalization, one of the new RN Staff remarked that she now knew why our veterans loved coming to the VA for their care, and that she was very proud of the opportunities afforded to her through her new employment. She went on to actually say that this IS the BEST CARE ANYWHERE. Nowhere else is there diligent attention to preventive health practices, self care management and screening for common problems such as in our OEF/OIF (Operation Enduring Freedom and Operation Iraqi Freedom) population. This acknowledgement of the efforts made in recent years to change the VA Culture made me very proud. She was right, this is the BEST CARE ANYWHERE. -So what has some of the shifts in technology and practice made possible for nurses and role development? Case Management � managing smaller numbers of patients intensively Care Management � managing large numbers of patients across the continuum Telephone Triage � assessing symptoms and changes in condition, and offering education, advice and disposition by protocolSo what changes in our roles have followed the shift in technology? To contrast traditional to newer roles for nurses, we�re going to take just a few moments reviewing some possible roles. I promise not to take too long, but think a mention of traditional roles is necessary because they are still extremely important. -What do we believe is a traditional role? An inpatient medical / surgical nurse, an operating room nurse, an emergency room nurse � those are the roles I think of when I think of the traditional, main-stays of our hospitals (or mother-ships as I call them) -Now how have those roles evolved with the information and technology super-highway? Nurses are managing panels or cohorts of patients rather than �units� of patients. They are managing patient outcomes based upon data and process improvement. Nurse Managers are managing work units rather than nursing units, and are managing personnel and patient care delivery through intricate dashboards, performance measures, and benchmarks. Wow, I�m impressed! As I saw in a relatively recent magazine article � this is not your Father�s VA � we are state of the art, ahead of the game, we are the benchmark, and it feels pretty good. -I want to share a quick example of how our image has changed over time, recently, we hired the nursing staff to support a new CBOC (Community Based Outreach Clinic), and they came to my work area for orientation. None of the staff had ever worked in a VA facility. While shadowing in one of our RN Assessment Clinics aimed at assuring patient recovery post hospitalization, one of the new RN Staff remarked that she now knew why our veterans loved coming to the VA for their care, and that she was very proud of the opportunities afforded to her through her new employment. She went on to actually say that this IS the BEST CARE ANYWHERE. Nowhere else is there diligent attention to preventive health practices, self care management and screening for common problems such as in our OEF/OIF (Operation Enduring Freedom and Operation Iraqi Freedom) population. This acknowledgement of the efforts made in recent years to change the VA Culture made me very proud. She was right, this is the BEST CARE ANYWHERE. -So what has some of the shifts in technology and practice made possible for nurses and role development? Case Management � managing smaller numbers of patients intensively Care Management � managing large numbers of patients across the continuum Telephone Triage � assessing symptoms and changes in condition, and offering education, advice and disposition by protocol

9. 9 More Expanded Roles Patient Advocate Admissions Coordinator � �Bed Czar� Utilization Management Process Improvement Coordinator Decision Support System Safety Officer NSQUIP surgical data and trending Med � Model Consultant Performance Monitor / Measures Expert Care Coordination Home Tele-health (CCHT) Discharge Planner Home Health / Extended Care / HBPC (Home Based Primary Care) Clinical Applications Coordinator BCMA Coordinator Informatics Nurse Computer ADPAC -Many more examples of expanded roles could be discussed, but the bottom line is that anything is possible. If there is a need in a facility or from a group of patients, then nurses as natural problem-solvers get involved, and often develop roles to suit the need. Some of the examples on this slide are perfect examples of this. -(Expand on slide above as time permits)-Many more examples of expanded roles could be discussed, but the bottom line is that anything is possible. If there is a need in a facility or from a group of patients, then nurses as natural problem-solvers get involved, and often develop roles to suit the need. Some of the examples on this slide are perfect examples of this. -(Expand on slide above as time permits)

10. 10 Population Specific Roles Poly-trauma Team OEF/OIF Transition Team Suicide Prevention Coordinator Rehabilitation Coordinator -And lately, when a need arises from problems which are high risk, high volume, problem prone (remember those phrases?), then what happens, a new coordinator and case manager is often the most efficient and productive method in bringing a new program into implementation and successful existence. -Some recent examples involve our most recently returning combat veterans who have exhibited some problems that we have not be required to deal with in such large numbers before. This has been an education for us all, as those of us who have been with VA for many years have been accustomed to caring for a population of our parents� age, and now, we are dealing with a population of the age of our children. Some examples are: Poly-trauma Team OEF/OIF Transition Team Suicide Prevention Coordinator Rehab Coordinator -And lately, when a need arises from problems which are high risk, high volume, problem prone (remember those phrases?), then what happens, a new coordinator and case manager is often the most efficient and productive method in bringing a new program into implementation and successful existence. -Some recent examples involve our most recently returning combat veterans who have exhibited some problems that we have not be required to deal with in such large numbers before. This has been an education for us all, as those of us who have been with VA for many years have been accustomed to caring for a population of our parents� age, and now, we are dealing with a population of the age of our children. Some examples are: Poly-trauma Team OEF/OIF Transition Team Suicide Prevention Coordinator Rehab Coordinator

11. 11 Nurse Manager Contrast Traditional Head Nurse Role Present Day Nurse Manager Role Managing work unit and resources (human and otherwise) through data Developing staff Improving processes for staff, facility and particularly for patients Managing outcomes through data Building Teams Mentoring others Promoting stewardship through good resource management So now that we have discussed the limitless possibilities of expanded roles for nurses, I would like to talk about a couple of nurse roles in a little more depth, particularly in regard to how Information Management and Technology have changed these roles for the good of our patients, our facilities and Nursing in general. -I have been a Nurse Manager for approximately 26 of my 30 plus years with VA. In the earlier years, Nurse Managers performed mostly �Head Nurse / Charge Nurse � duties, assuring the completion of scheduling, assignments, orientation, education, growth and development, problem solving, stomping out fires, and basically assuring that staff provided excellent care to patients while becoming good employees for the VA System as a whole. Any Quality Assurance data, monitors, projects, budgets, etc., had to be collected, analyzed and displayed by hand � an extremely time consuming, arduous task. -With the advancement of technology, the electronic medical record, multiple computer assisted data collection tools, reports, queries, web sites, etc., we now have the ability to collect, analyze and display data quickly and easily, and in a fashion which is easily communicated to others. Plans can easily be made for changes in practice, process improvement, and outcome measurement which was never possible before. The one thing that I can say that is a drawback to this information explosion is that sometimes it is possible to become lost in the forest because of the trees � know what I mean?? It takes some discipline to know what is important, and what is not, what to manipulate, and what to leave alone, what to emphasize and what to wait and watch. -What would we do though without CPRS, Excel, Charts and Graphs, VANOD (VA Nursing Outcomes Database), Performance Measures and Monitors, Supporting Indicators, Whew!!! I�m tired thinking about it all, but excited for our future. -Now, Nurse Managers operate within a framework of Performance Improvement and Team Building every day. In other words, we are actually working toward the big picture through data and process improvement � we actually do see the forest despite the trees!!! We mentor and develop others, thereby promoting good stewards of our system who will carry on the Mission once the rest of us have moved into retirement. So now that we have discussed the limitless possibilities of expanded roles for nurses, I would like to talk about a couple of nurse roles in a little more depth, particularly in regard to how Information Management and Technology have changed these roles for the good of our patients, our facilities and Nursing in general. -I have been a Nurse Manager for approximately 26 of my 30 plus years with VA. In the earlier years, Nurse Managers performed mostly �Head Nurse / Charge Nurse � duties, assuring the completion of scheduling, assignments, orientation, education, growth and development, problem solving, stomping out fires, and basically assuring that staff provided excellent care to patients while becoming good employees for the VA System as a whole. Any Quality Assurance data, monitors, projects, budgets, etc., had to be collected, analyzed and displayed by hand � an extremely time consuming, arduous task. -With the advancement of technology, the electronic medical record, multiple computer assisted data collection tools, reports, queries, web sites, etc., we now have the ability to collect, analyze and display data quickly and easily, and in a fashion which is easily communicated to others. Plans can easily be made for changes in practice, process improvement, and outcome measurement which was never possible before. The one thing that I can say that is a drawback to this information explosion is that sometimes it is possible to become lost in the forest because of the trees � know what I mean?? It takes some discipline to know what is important, and what is not, what to manipulate, and what to leave alone, what to emphasize and what to wait and watch. -What would we do though without CPRS, Excel, Charts and Graphs, VANOD (VA Nursing Outcomes Database), Performance Measures and Monitors, Supporting Indicators, Whew!!! I�m tired thinking about it all, but excited for our future. -Now, Nurse Managers operate within a framework of Performance Improvement and Team Building every day. In other words, we are actually working toward the big picture through data and process improvement � we actually do see the forest despite the trees!!! We mentor and develop others, thereby promoting good stewards of our system who will carry on the Mission once the rest of us have moved into retirement.

12. 12 Nurse Practitioner (ARNP) Wise use of resources Improve efficiency and productivity Function in variety of settings Role as Primary Care Provider Another nursing role which has changed rather dramatically in recent years is that of the Nurse Practitioner. -As we work to utilize resources wisely, and to improve efficiency and productivity, guess what role has proven to be a big factor in this puzzle? THE ADVANCED NURSE PRACTITIONER ROLE (ARNP). -ARNP�s have been found to be highly effective in numerous settings. They function in specialty areas too numerous to mention, but develop expertise, and often run programs such as sleep labs, chronic pain management programs, Community Living Centers (previously known as our Nursing Home Care Units), homeless programs � you name it, and they have probably been there and done that! -I am most familiar with the ARNP role as it relates to Primary Care, as I�ve been working in Primary Care for the past 11 years, and have developed a keen awareness of the impact of this level of Provider � a mid-level Provider of Care. -ARNP�s function in many different ways, depending upon the needs of the patients, staff and the work unit as a whole. They manage a discrete panel of patients many times, providing for the care of some approximately 1000 patients under their care. They are measured as any other Provider in regard to Chronic Disease Indicators (glycos, ldl�s, systolic and diastolic blood pressure), disease management (use of ace inhibitors, thiazide diurectics, beta-blockers, aspirin therapy), and provider productivity / utilization of missed opportunities, etc. Does that sound like a bunch of mumbo-jumbo, well not really, these things are all very important to patient care. -How do you suppose we keep up with all of these requirements, measures, numbers, data ??? Well technology and information management OF COURSE. Our current computer systems and reporting mechanisms afford us methods to manage data and provide accurate and timely reports upon which to base decision making and changes in process. Rapid Cycle Improvements can occur without difficulty in today�s information age because the data is easily captured and analyzed. Another nursing role which has changed rather dramatically in recent years is that of the Nurse Practitioner. -As we work to utilize resources wisely, and to improve efficiency and productivity, guess what role has proven to be a big factor in this puzzle? THE ADVANCED NURSE PRACTITIONER ROLE (ARNP). -ARNP�s have been found to be highly effective in numerous settings. They function in specialty areas too numerous to mention, but develop expertise, and often run programs such as sleep labs, chronic pain management programs, Community Living Centers (previously known as our Nursing Home Care Units), homeless programs � you name it, and they have probably been there and done that! -I am most familiar with the ARNP role as it relates to Primary Care, as I�ve been working in Primary Care for the past 11 years, and have developed a keen awareness of the impact of this level of Provider � a mid-level Provider of Care. -ARNP�s function in many different ways, depending upon the needs of the patients, staff and the work unit as a whole. They manage a discrete panel of patients many times, providing for the care of some approximately 1000 patients under their care. They are measured as any other Provider in regard to Chronic Disease Indicators (glycos, ldl�s, systolic and diastolic blood pressure), disease management (use of ace inhibitors, thiazide diurectics, beta-blockers, aspirin therapy), and provider productivity / utilization of missed opportunities, etc. Does that sound like a bunch of mumbo-jumbo, well not really, these things are all very important to patient care. -How do you suppose we keep up with all of these requirements, measures, numbers, data ??? Well technology and information management OF COURSE. Our current computer systems and reporting mechanisms afford us methods to manage data and provide accurate and timely reports upon which to base decision making and changes in process. Rapid Cycle Improvements can occur without difficulty in today�s information age because the data is easily captured and analyzed.

13. 13 Changes in Delivery of Care -Continued Shift from Inpatient to Outpatient -Community Based Outreach Clinics (CBOC) -Telemedicine / Remote Care -Staff Education and Training -Remote training and Team Building -Group Clinics -Access, Access, Access � 30 mile access -Right Care, Right Place, Right Time -As hospitals moved toward improving utilization of their resources and reducing hospital bed days, the flood-gates opened for Outpatient Services. Traditional nursing roles quickly adapted to the change, and led the way. Nurses are flexible and adaptable, you know! -Later, the focus within our system moved closer to the patient through Community Based Outreach Clinics. Computerization has made this transition possible by creating clinics which operate exactly like those within the home facility. When working in a CBOC, it�s just like being in the �mother ship�. -Additionally, education and training for staff can be accomplished through the use of computerized independent study programs. Staff meetings, committee meetings and other conferencing is done via video teleconference. Even better, patients can receive specialty consults via telemedicine. -Computerization of the medical record has also paved the way for the increased utilization of group clinics. By the creation of templates for documentation of repetitive data, groups of patients can be assessed, evaluated, educated within a group setting. -This practice then improves provider productivity and creates improved access for patients. As we all know, access has been a very hot topic within our system of late, and the push now is to bring care closer to our veterans, within a 30 mile radius of their home in fact. Basically, the right care, in the right place, at the right time. -As hospitals moved toward improving utilization of their resources and reducing hospital bed days, the flood-gates opened for Outpatient Services. Traditional nursing roles quickly adapted to the change, and led the way. Nurses are flexible and adaptable, you know! -Later, the focus within our system moved closer to the patient through Community Based Outreach Clinics. Computerization has made this transition possible by creating clinics which operate exactly like those within the home facility. When working in a CBOC, it�s just like being in the �mother ship�. -Additionally, education and training for staff can be accomplished through the use of computerized independent study programs. Staff meetings, committee meetings and other conferencing is done via video teleconference. Even better, patients can receive specialty consults via telemedicine. -Computerization of the medical record has also paved the way for the increased utilization of group clinics. By the creation of templates for documentation of repetitive data, groups of patients can be assessed, evaluated, educated within a group setting. -This practice then improves provider productivity and creates improved access for patients. As we all know, access has been a very hot topic within our system of late, and the push now is to bring care closer to our veterans, within a 30 mile radius of their home in fact. Basically, the right care, in the right place, at the right time.

14. 14 For Those Who Served My Health e Vet For Staff and Patients Disease Management Diaries and Logs Prescriptions Lab Results Health Information And what else is out there for us all to use on the information super highway � My HealtheVet. -This is yet another electronic avenue for both patients and staff to manage medical data remotely. The possibilities for patients and staff are many. And what else is out there for us all to use on the information super highway � My HealtheVet. -This is yet another electronic avenue for both patients and staff to manage medical data remotely. The possibilities for patients and staff are many.

15. 15 One VA -Standardization / Expectations -No Veteran Left Behind -Remote Data -Cross-country Committees / Task Forces -Networking / Knowledge Sharing And what is another great benefit of all this computer technology? -Computer technology has assisted us in providing improved and more consistent care throughout the VA System, and helps us to meet our Mission and to serve our veterans as One VA. -Standardization / Expectation � Performance Measures, VANOD, Clinical Reminders, Benchmarks � now we are comparing apples to apples across our nation. -No Veteran Left Behind � access to services -Remote access to records anywhere in the country, even the Department of Defense -Cross-country committees and task forces such as those we have worked upon all year for this conference -Networking / Knowledge Sharing � Best Practices are commonly shared electronically All of this really does make us One VA. And what is another great benefit of all this computer technology? -Computer technology has assisted us in providing improved and more consistent care throughout the VA System, and helps us to meet our Mission and to serve our veterans as One VA. -Standardization / Expectation � Performance Measures, VANOD, Clinical Reminders, Benchmarks � now we are comparing apples to apples across our nation. -No Veteran Left Behind � access to services -Remote access to records anywhere in the country, even the Department of Defense -Cross-country committees and task forces such as those we have worked upon all year for this conference -Networking / Knowledge Sharing � Best Practices are commonly shared electronically All of this really does make us One VA.

16. 16 Find your pathway to the stars! -So we have talked about traditional versus expanded nursing roles, and the effect of Information Management and Technology on our practice. We have also discussed how the ease of access to information has improved practice, efficiency, productivity, and has assisted in unifying us into One VA with common expectations and standards. Further, we have explored how the VA has become the benchmark to others in many areas of practice, and is leading the way in areas such as Safety and Preventive Medicine. -In summary, there really is no limit to what nurses are capable of, so go find your pathway to the stars. -So we have talked about traditional versus expanded nursing roles, and the effect of Information Management and Technology on our practice. We have also discussed how the ease of access to information has improved practice, efficiency, productivity, and has assisted in unifying us into One VA with common expectations and standards. Further, we have explored how the VA has become the benchmark to others in many areas of practice, and is leading the way in areas such as Safety and Preventive Medicine. -In summary, there really is no limit to what nurses are capable of, so go find your pathway to the stars.

17. 17 -And now, as we transition to our next segment, I would like to show you a quick photograph of my babies � albeit that they are four-legged children, my golden retrievers, Kate and Allie. They go to work everyday with their Dad, here they are at work! -Now let me introduce our next presenter, Pat Costa. Pat?-And now, as we transition to our next segment, I would like to show you a quick photograph of my babies � albeit that they are four-legged children, my golden retrievers, Kate and Allie. They go to work everyday with their Dad, here they are at work! -Now let me introduce our next presenter, Pat Costa. Pat?

18. 18 Moving To the Dark Side??? Nursing Informatics in the VA Patricia A. Costa RN, MBA, BSN How many of you are direct care Staff Nurses ? How many of you have a Nursing Informatics role? How many of you think you have to be a geek to work in Nursing Informatics? I�m here to tell you that everyone has a a role in Nursing Informatics. I was was not born into Nursing Informatics. I came in kicking and screaming. I graduated from a Diploma school of nursing some 45 years ago and at that time our papers were either written or if we were lucky and had a typewriter we could type them. When I went on for my BSN and MBA I was typing all my papers or I paid someone to do it for me. Up until the 90�s all my documentation was on paper. I had secretaries to do all my typing. After my community hospital merged with another facility my position as Chief Nurse was eliminated which led me to an opportunity to work at another facility doing special projects like JCAHO preparation, process improvements. When the facility decided to purchase a hospital wide information system I was told that I would chair the clinical implementation process and would be part of the evaluation team to make recommendations regarding a vendor. I said to my boss are you nuts! I am just learning how to play solitaire on the computer and you want me to lead a group of clinicians. Well as they say the rest is history. I learned a lot from that experience. Nurses know how to process things, gather data make assessments, develop plans and implement them. Not that the hospital purchased the system that we liked but I learned a lot about looking at processes and automation. When that position was being eliminated my friends told me about a position at the VA that might interest me. The VA Chief Nurse knew that the VA was developing an electronic medical record and she wanted someone in nursing to help implement it. So here I am the Performance Improvement/Information Systems Coordinator for the Providence VA. Now that I�ve bored you with a little of my personal history lets discuss opportunities in Nursing Informatics at the VA. How many of you are direct care Staff Nurses ? How many of you have a Nursing Informatics role? How many of you think you have to be a geek to work in Nursing Informatics? I�m here to tell you that everyone has a a role in Nursing Informatics. I was was not born into Nursing Informatics. I came in kicking and screaming. I graduated from a Diploma school of nursing some 45 years ago and at that time our papers were either written or if we were lucky and had a typewriter we could type them. When I went on for my BSN and MBA I was typing all my papers or I paid someone to do it for me. Up until the 90�s all my documentation was on paper. I had secretaries to do all my typing. After my community hospital merged with another facility my position as Chief Nurse was eliminated which led me to an opportunity to work at another facility doing special projects like JCAHO preparation, process improvements. When the facility decided to purchase a hospital wide information system I was told that I would chair the clinical implementation process and would be part of the evaluation team to make recommendations regarding a vendor. I said to my boss are you nuts! I am just learning how to play solitaire on the computer and you want me to lead a group of clinicians. Well as they say the rest is history. I learned a lot from that experience. Nurses know how to process things, gather data make assessments, develop plans and implement them. Not that the hospital purchased the system that we liked but I learned a lot about looking at processes and automation. When that position was being eliminated my friends told me about a position at the VA that might interest me. The VA Chief Nurse knew that the VA was developing an electronic medical record and she wanted someone in nursing to help implement it. So here I am the Performance Improvement/Information Systems Coordinator for the Providence VA. Now that I�ve bored you with a little of my personal history lets discuss opportunities in Nursing Informatics at the VA.

19. 19 Digital Landscape Digital Refugees � denial Digital Voyeurs � look & wait Digital Immigrants � participants Digital Natives � live it Recently I had the pleasure of hearing Professor Diane Skiba PHD speak about preparing nurses for electronic clinical documentation. In her presentation she describes the Digital Landscape in which there are 4 types. The first is the digital refugee who do not believe in technology and are in denial. Then there are the voyeurs who know it exists but are just content to look and not touch. The third category is the digital immigrant who has crossed that bridge and is a participant. The 4th type is the Digital Native who live the digital age like my grandkids. Text messaging, video games and iPods. I�m a digital immigrant myself. How many of you are natives? Recently I had the pleasure of hearing Professor Diane Skiba PHD speak about preparing nurses for electronic clinical documentation. In her presentation she describes the Digital Landscape in which there are 4 types. The first is the digital refugee who do not believe in technology and are in denial. Then there are the voyeurs who know it exists but are just content to look and not touch. The third category is the digital immigrant who has crossed that bridge and is a participant. The 4th type is the Digital Native who live the digital age like my grandkids. Text messaging, video games and iPods. I�m a digital immigrant myself. How many of you are natives?

20. 20 Nursing Informatics Explosive Growth in Computers Combination of Nursing Skills and Computer Expertise Found in any arena related to healthcare Like any knowledge-intensive field these days, nursing is greatly impacted by the explosive growth of computers. Nursing Informatics is a broad ranging field that combines nursing skills with computer expertise. Jobs in this area might include a nurse programmer who writes or modifies programs for use by nurses; nurse communicators who work with other nurses to identify computer system needs, or assist in the training and implementation of those systems; informatics nurse managers who manage or administer information systems; or nurse vendor representatives who work for specific vendors to demonstrate systems to potential customers. There are several definitions of Nursing Informatics like this one from Hannah. Like any knowledge-intensive field these days, nursing is greatly impacted by the explosive growth of computers. Nursing Informatics is a broad ranging field that combines nursing skills with computer expertise. Jobs in this area might include a nurse programmer who writes or modifies programs for use by nurses; nurse communicators who work with other nurses to identify computer system needs, or assist in the training and implementation of those systems; informatics nurse managers who manage or administer information systems; or nurse vendor representatives who work for specific vendors to demonstrate systems to potential customers. There are several definitions of Nursing Informatics like this one from Hannah.

21. 21 What Is Nursing Informatics The use of information technologies in relation to any of the functions that are within the purview of nursing and are carried out by nurses in the performance of their duties. This comprises the care of patients, administration, education and research. (Hannah 1985) This is a 1985 definition from Hannah which I think this is astill a valid definition because it brings in the 4 realms of nursing. Pt care, Administration, education and research. Another more recent definition of Nursing Informatics This is a 1985 definition from Hannah which I think this is astill a valid definition because it brings in the 4 realms of nursing. Pt care, Administration, education and research. Another more recent definition of Nursing Informatics

22. 22 What Is Nursing Informatics Nursing informatics (NI) integrates nursing science, computer and information science, and cognitive science to manage, communicate, and expand the data, information, knowledge, and wisdom of nursing practice.ANA 2008 Another more recent definition of Nursing Informatics is from the American Nurses Association's Scope and Standards for Nursing Informatics Practice (2008):This brings in the science of nursing and technology.Nurses who are trained in Nursing Informatics support improved patient outcomes through their expertise in information processes, structures, and technologies, thereby helping nurses and other care providers to create and record the evidence of their practice. In other words Nursing Informatics nurses help to create software that enable RN�s to document their practice. It�s not automating a piece of paper. Its looking at the processes involved and analyze what or which pieces of the processes can be automated. Another more recent definition of Nursing Informatics is from the American Nurses Association's Scope and Standards for Nursing Informatics Practice (2008):This brings in the science of nursing and technology.Nurses who are trained in Nursing Informatics support improved patient outcomes through their expertise in information processes, structures, and technologies, thereby helping nurses and other care providers to create and record the evidence of their practice. In other words Nursing Informatics nurses help to create software that enable RN�s to document their practice. It�s not automating a piece of paper. Its looking at the processes involved and analyze what or which pieces of the processes can be automated.

23. 23 What Is Nursing Informatics "... use of information technologies in relation to those functions within the purview of nursing, and that are carried out by nurses when performing their duties. It�s the use of any technology that will support our decision making related to any nursing activity whether its artificial intelligence, documentation of assessments and interventions, scheduling, financial resources, education for both staff and patients, and nursing research. It manages data and integrates that data to help support nurses in any role. Now that we�ve defined Nursing Informatics, why do we need it It�s the use of any technology that will support our decision making related to any nursing activity whether its artificial intelligence, documentation of assessments and interventions, scheduling, financial resources, education for both staff and patients, and nursing research. It manages data and integrates that data to help support nurses in any role. Now that we�ve defined Nursing Informatics, why do we need it

24. 24 Why Nursing Informatics "Computers are incredibly fast, accurate and stupid. Human beings are incredibly slow, inaccurate and brilliant. Together they are powerful beyond imagination." - Albert Einstein I didn�t realize that Albert Einstein knew about computers His quote says �Computers are incredibly fast accurate and stupid. Human beings are incredibly slow, inaccurate and brilliant, Together they are powerful beyond imagination. Who better to identify, recommend, and develop processes to meld nursing practice with technology than we nurses. Informatics nurses see technology as a tool to support, rather than hinder, their love of nursing as well as impact future nursing practices.� More and more, with each passing year, "high tech and high touch" are becoming a way of life in the practice of nursing. This can only become common reality if nurses are comfortable working with computers and advanced technology while providing evidence based care for their patients. Technology can assist us in providing safer patient care and better patient outcomes. How many unidentified errors occurred prior to BCMA or illegible orders and notes prior to CPRS.I didn�t realize that Albert Einstein knew about computers His quote says �Computers are incredibly fast accurate and stupid. Human beings are incredibly slow, inaccurate and brilliant, Together they are powerful beyond imagination. Who better to identify, recommend, and develop processes to meld nursing practice with technology than we nurses. Informatics nurses see technology as a tool to support, rather than hinder, their love of nursing as well as impact future nursing practices.� More and more, with each passing year, "high tech and high touch" are becoming a way of life in the practice of nursing. This can only become common reality if nurses are comfortable working with computers and advanced technology while providing evidence based care for their patients. Technology can assist us in providing safer patient care and better patient outcomes. How many unidentified errors occurred prior to BCMA or illegible orders and notes prior to CPRS.

25. 25 Who is Nursing Informatics? So now that we've talked about the What and Why of Nursing Informatics lets� talk about the Who. According to June Kaminski " The world of the screen is fast becoming a constant reality within health care through the mediums of telenursing, e-health, hospital and nursing information systems, and advanced physiological monitoring. There is an alarming need for nurses to reflect and incubate ways to counteract the potential distancing and rupturing of relations with clients that can accompany the use of information technologies in nursing care� - June Kaminski, 2007 Each VA facility has nurses whose responsibilities relate to CPRS, BCMA, ICU Monitors, Surgical package, staffing and scheduling, QI or VANOD. Some may wear many hats and others just one. In any event they are all working with information technology and clinical data. In the following slides I will address some of these positions that are VA related. So now that we've talked about the What and Why of Nursing Informatics lets� talk about the Who. According to June Kaminski " The world of the screen is fast becoming a constant reality within health care through the mediums of telenursing, e-health, hospital and nursing information systems, and advanced physiological monitoring. There is an alarming need for nurses to reflect and incubate ways to counteract the potential distancing and rupturing of relations with clients that can accompany the use of information technologies in nursing care� - June Kaminski, 2007 Each VA facility has nurses whose responsibilities relate to CPRS, BCMA, ICU Monitors, Surgical package, staffing and scheduling, QI or VANOD. Some may wear many hats and others just one. In any event they are all working with information technology and clinical data. In the following slides I will address some of these positions that are VA related.

26. 26 ADPAC Automated Data Processing Applications Coordinator How many of you still have Nursing ADPACs. Did you know that this is what the acronym meant. Before Clinical Applications Coordinators (CAC�s ) we had ADPAC�s. This is the person that knows the VISTA system. Usually this person will set up the menus and menu keys for staff and arrange to get access codes. They trouble shoot hardware and the VISTA package. In nursing the VISTA Nursing Application which contained documentation, care plan, end of shift reports and I&O was managed by the ADPAC. With the advent of GUI CPRS soft ware the role expanded to include clinical applications. So the nursing ADPAC in some cases became the Clinical Applications Coordinator. How many of you still have Nursing ADPACs. Did you know that this is what the acronym meant. Before Clinical Applications Coordinators (CAC�s ) we had ADPAC�s. This is the person that knows the VISTA system. Usually this person will set up the menus and menu keys for staff and arrange to get access codes. They trouble shoot hardware and the VISTA package. In nursing the VISTA Nursing Application which contained documentation, care plan, end of shift reports and I&O was managed by the ADPAC. With the advent of GUI CPRS soft ware the role expanded to include clinical applications. So the nursing ADPAC in some cases became the Clinical Applications Coordinator.

27. 27 CAC Clinical Applications Coordinator Not every CAC is a nurse but the responsibilities are to oversee all the clinical applications like GUI CPRS, Clinical Reminders VISTA Imaging, or iMed Consent. When the CAC is not a nurse the responsibility for BCMA, Vitals GUI may be assigned to a clinical individual. CAC�s may work for IRM or Nursing Service depending on the facility. These individuals install and test all CPRS related patches and work closely with clinical services to implement new software, create templates for documentation and educate new clinical providers in CPRS.Not every CAC is a nurse but the responsibilities are to oversee all the clinical applications like GUI CPRS, Clinical Reminders VISTA Imaging, or iMed Consent. When the CAC is not a nurse the responsibility for BCMA, Vitals GUI may be assigned to a clinical individual. CAC�s may work for IRM or Nursing Service depending on the facility. These individuals install and test all CPRS related patches and work closely with clinical services to implement new software, create templates for documentation and educate new clinical providers in CPRS.

28. 28 PI/IS Coordinator Performance Improvement/Information Systems Coordinator Then there are the folks like me who work for Nursing Service and oversee all related nursing applications such as CPRS, BCMA and Vital Signs, and educate all nursing staff in their usage. I happen to like my hat of many colors. A large component to this position is PI data collection and analysis and the ability to present a graphical display of results to Nurse Leadership. AS such this person maybe the VANOD Coordinator as well. This means the individual needs to be knowledgeable in the use of Microsoft Office products such as Access or Excel or other types of data bases. Then there are the folks like me who work for Nursing Service and oversee all related nursing applications such as CPRS, BCMA and Vital Signs, and educate all nursing staff in their usage. I happen to like my hat of many colors. A large component to this position is PI data collection and analysis and the ability to present a graphical display of results to Nurse Leadership. AS such this person maybe the VANOD Coordinator as well. This means the individual needs to be knowledgeable in the use of Microsoft Office products such as Access or Excel or other types of data bases.

29. 29 BCMA Coordinator Bar Code Medication Administration Coordinator There are facilities that have a BCMA Coordinator without collateral duties, but these are in the minority. With advent of the Bar Code Expansion project these nurses may be responsible for implementation of that program. Managing BCMA means responsibility for hardware & software. Its important for this individual to work closely with the end user and clinical engineering to ensure that the appropriate equipment for their setting is purchased. This individual serves as the liaison between the National Bar Code Resource Office and the BCMA Medical Center Committee. This coordinator presents all national directives to the committee and recommends operational action plans.There are facilities that have a BCMA Coordinator without collateral duties, but these are in the minority. With advent of the Bar Code Expansion project these nurses may be responsible for implementation of that program. Managing BCMA means responsibility for hardware & software. Its important for this individual to work closely with the end user and clinical engineering to ensure that the appropriate equipment for their setting is purchased. This individual serves as the liaison between the National Bar Code Resource Office and the BCMA Medical Center Committee. This coordinator presents all national directives to the committee and recommends operational action plans.

30. 30 OI&T Office of Information & Technology The Office Of Information Technology has many nurses working for them. Most of whom had their beginnings as an ADPAC or CAC. For instance Russ Carlson after many years of supporting BCMA from its prototype days at the Colmery-O�Neil VAMC, Topeka, KS through the development of the current BCMA software was hired as Deputy Director for the Chief Health Informatics Office, VHA Office of Information. Joy Pasternock RN who was an ADPAC and is now an IT specialilst. There are many informatics opportunities in the VA. The Office Of Information Technology has many nurses working for them. Most of whom had their beginnings as an ADPAC or CAC. For instance Russ Carlson after many years of supporting BCMA from its prototype days at the Colmery-O�Neil VAMC, Topeka, KS through the development of the current BCMA software was hired as Deputy Director for the Chief Health Informatics Office, VHA Office of Information. Joy Pasternock RN who was an ADPAC and is now an IT specialilst. There are many informatics opportunities in the VA.

31. 31 How Do I Get Theah From Heah Become a Super User Volunteer for projects Continue education Obtain a BSN Certification Obtain a Masters in Nursing Informatics The best way to get into a nursing informatics position is to start by becoming a super user. Volunteer to help with any technology project. Show enthusiasm for looking at adapting nursing process to technology. Investigate computer classes at your community college. I was able to take 6 week courses on Microsoft office products as well basic computer courses. Go on to obtain your BSN so once in the position you can apply and take the ANCC Informatics Nurse Certification. There are several schools around the country who are offering a Masters in Nursing Informatics. Recently the NLN issued a position statement, entitled Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda, calling on faculty, deans, administrators, and the NLN itself to advocate that all students graduate with up-to-date knowledge andskills in each of three critical areas: Computer literacy � having the Knowledge & skills in using the PC Information literacy - having the knowledge & skills in validating research found on the web or in the literature Informatics-having the knowledge & skills in using the sciences of computers, technology, cognitive science & nursing to design or develop nursing software.The best way to get into a nursing informatics position is to start by becoming a super user. Volunteer to help with any technology project. Show enthusiasm for looking at adapting nursing process to technology. Investigate computer classes at your community college. I was able to take 6 week courses on Microsoft office products as well basic computer courses. Go on to obtain your BSN so once in the position you can apply and take the ANCC Informatics Nurse Certification. There are several schools around the country who are offering a Masters in Nursing Informatics. Recently the NLN issued a position statement, entitled Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda, calling on faculty, deans, administrators, and the NLN itself to advocate that all students graduate with up-to-date knowledge andskills in each of three critical areas: Computer literacy � having the Knowledge & skills in using the PC Information literacy - having the knowledge & skills in validating research found on the web or in the literature Informatics-having the knowledge & skills in using the sciences of computers, technology, cognitive science & nursing to design or develop nursing software.

32. 32 These are my super users and I hope one of them will replace me when i retire in January. The person who I think exemplified Nursing Informatics in a practice role is Sue Kinnick RN who was a nurse @ the VA in Topeka, Kansas. I call her the mother of BCMA. When returning her rental car she noticed how they scanned a bar code in the car and were able to retrieve information. As she thought about that she wondered how that process could be adopted to Medication Administration. She returned to work and began to collaborate with pharmacy and IRM and came up with the prototype that was the basis for BCMA today. One nurse One idea and a passion for innovation. Unfortunately Susan died before her idea became a national enterprise. But she did leave a legacy of changing practice for patient safety. Now that you�ve heard what nursing informatics is and the various opportunities in the VA how many of you are interested in taking that pathway? These are my super users and I hope one of them will replace me when i retire in January. The person who I think exemplified Nursing Informatics in a practice role is Sue Kinnick RN who was a nurse @ the VA in Topeka, Kansas. I call her the mother of BCMA. When returning her rental car she noticed how they scanned a bar code in the car and were able to retrieve information. As she thought about that she wondered how that process could be adopted to Medication Administration. She returned to work and began to collaborate with pharmacy and IRM and came up with the prototype that was the basis for BCMA today. One nurse One idea and a passion for innovation. Unfortunately Susan died before her idea became a national enterprise. But she did leave a legacy of changing practice for patient safety. Now that you�ve heard what nursing informatics is and the various opportunities in the VA how many of you are interested in taking that pathway?

33. 33 Our next speaker is Cynthia Andrus RN from Houston VA who will speak to us on merging role of the Clinical Practitioner and Clinical Instructor. Our next speaker is Cynthia Andrus RN from Houston VA who will speak to us on merging role of the Clinical Practitioner and Clinical Instructor.

34. 34 Merging Roles: Clinical Practitioner and Clinical Instructor Cynthia Andrus, MSN, RN, BCMA/ADPAC Coordinator Michael E. DeBakey VA Medical Center Houston, Texas July 17, 2008

35. 35 The Nursing Professional Career Challenges

36. 36 Nursing Shortages (Hospital Setting) Baby Boomer Age and the Health Care Needs Grow Increase Workload Potential Threat to Quality Care Newly Licensed RNs Changed Principal Jobs after One Year

37. 37 Limited Nursing Educators (School Of Nursing) A Wave of Faculty Retirement Increase Higher Compensation in Clinical and Private Sector Settings Limited Qualified Master and Doctoral Professors

38. 38 Competent Graduate Nurse�s Challenges Inadequate Transition from a Graduate Nurse to a Competent Practitioner

39. 39 Professional Role Model for Nurses Ability to Handle Stressful Moments Working With Limited Resources General Attitude About Nursing Profession Exemplifying Leadership

40. 40 Strategies To Address Nursing Shortage Creating a Healthy Work Environment Developing more Public-Private Partnership Using Technology as a Training Tool Designing more Flexible Roles for Advance Practice Nurses Raise the Imagine of Nursing in the Media Work together with Schools to Increase the Interest in Nursing Careers

41. 41 Continue Strategies For Nurse Shortage Provide Financial Support Education Debt Reduction (EDRP) Employee Incentive Scholarship Program (EISP) National Nursing Education Initiative (NNEI) Tuition Support Program Tuition Reimbursement Program

42. 42 Strategies to Address Faculty Shortage Develop an incentive Program for Graduate Nurses to Teach in a School of Nursing after Graduation Launched an Online Resource to Support Nurses in obtaining a Teaching Career in Nursing Develop a Partnership with Healthcare Delivery Model and Academia

43. 43 Producing a Competent, Successful and Happy Nurse Partnership between Nursing School and Healthcare Organization: Example � VA Learning Opportunities Residency (VALOR) for Senior Nursing Students Design Specific Orientation for the Graduate Nurse: Basic patient care skills development to extensive assessment and intervention skills Example � Internship Program; A Year Long Program for the Novice Nurse

44. 44 Positive Nursing Imagine Sets the Tone for Emerging Nursing Roles Increase Recruitment and Retention Creates and Maintains a Healthy Environment Open Dialogue for Collaboration with other Agencies Promotes Advance Nursing Practice Embraces Technology Positively Enhances Evidence-Based Practice

45. 45 Bridging Theory With Practicum Dr. Betty Adams, Dean, Prairie View,A&M College of Nursing Ms. Thelma Gray Becknell, Chief Nurse, Michael E. DeBakey VA Medical Center

46. 46 The Partnership Two Master Prepared Nursing Staff, VA Medical Center received Positions As Clinical Instructor for Prairie View A&M School of Nursing: Medical Surgery Adult Mental Health Medical Surgical Clinical Instructor Role � Clinical Practice Manager that provides support to the clinical units; this role serves as an education clinical leader for assigned Nursing Units

47. 47 Continue With Partnership Adult Mental Health Clinical Instructor�s Role BCMA/ADPAC Coordinator, Houston VA Medical Center BCMA Coordinator manages business and clinical operational for medication administration and ADPAC works with Nursing Application

48. 48 Benefits of Partnership Opportunities Blending theory and practice at the bedside support same school of thoughts Increase the understanding of Evidence-Based Practice Demonstrates Evidence-Based Practice at the bedside Increase the knowledge of Hospital Policy and Procedures with Nursing Practice

49. 49 Additional Benefits of Collaboration Develop Basic Skills for Patient Care Increase Recruitment and create a stronger environment for retention Increase awareness of Nursing Emerging Roles

50. 50 Projected Partnership Houston Community College School of Nursing and Michael E. DeBakey VA Medical Center Developing an Assimilation Lab for Bar Code Medication Administration First Phase � Discussing with both Agency�s IT efforts to begin and complete this project

51. 51 Emerging Roles:Pathway To The Stars Let�s invest in our future and watch how the Novice Nurse will manifest into an Expert Nurse as they float through

52. 52 Emerging Nursing Roles

53. 53 The Clinical Nurse Leader--A New Nursing Care Delivery Role By Paula Miller MSN, RN Clinical Nurse Leader This presentation is designed to describe and explain a new nursing role called the Clinical Nurse Leader (CNL) role.This presentation is designed to describe and explain a new nursing role called the Clinical Nurse Leader (CNL) role.

54. 54 Objectives Provide Historical background of CNL role development by AACN Define and identify role of the CNL Education required for CNL Role Describe CNL Outcomes I will be providing a historical background of the development of this role by the American Association of Colleges of Nursing, define and identify specifically the components of the role, explain the educational requirements for this role and present some outcomes based on current work from Clinical Nurse Leaders in the Veterans Administration health care system. I will be providing a historical background of the development of this role by the American Association of Colleges of Nursing, define and identify specifically the components of the role, explain the educational requirements for this role and present some outcomes based on current work from Clinical Nurse Leaders in the Veterans Administration health care system.

55. 55 HISTORY OF CNL 2000 � American Association of Colleges of Nursing engaged in extensive collaboration about the future of nursing e.g. Nursing education, shortages, aging workforce - Task Force on Education and Regulation or Professional Nursing Practice (TFER1) - Task Force on the Hallmarks of Professional Practice Environments (TFER2) In 2000 the American Association of Colleges of Nursing (AACN) through extensive collaboration and research identified the future needs of nursing such as seen in nursing education, nursing shortages in the work environments, and the issues of the aging nursing workforce. In an effort to meet the future demands identified in nursing two Task Forces were formed by the AACN to closely examine how to meet these future nursing needs. These task forces were identified as TFER1- the Task Force on Education and Regulation or Professional Nursing Practice and TFER2 � the Task Force on the Hallmarks of Professional Practice Environments. In 2000 the American Association of Colleges of Nursing (AACN) through extensive collaboration and research identified the future needs of nursing such as seen in nursing education, nursing shortages in the work environments, and the issues of the aging nursing workforce. In an effort to meet the future demands identified in nursing two Task Forces were formed by the AACN to closely examine how to meet these future nursing needs. These task forces were identified as TFER1- the Task Force on Education and Regulation or Professional Nursing Practice and TFER2 � the Task Force on the Hallmarks of Professional Practice Environments.

56. 56 American Association of Colleges of Nursing (AACN) Functions Recognize health organizations for nursing excellence through the Magnet recognition program Provides certification for nurses in specialty areas Accredits providers and approves continuing nursing education. Offers information and educational services and products to support credentialing programs The AACN, if you are not familiar with their work, recognizes healthcare organizations for nursing excellence through the magnet recognition program. They provide certification for nurses in specialty areas, accredits providers and approves continuing nursing education and offers information and educational services and product to support credentialing programs.The AACN, if you are not familiar with their work, recognizes healthcare organizations for nursing excellence through the magnet recognition program. They provide certification for nurses in specialty areas, accredits providers and approves continuing nursing education and offers information and educational services and product to support credentialing programs.

57. 57 TFER1 Concluded that there needed to be more nurses educated at the Master�s Level to guide practice at the point of care. Determined that the patient care delivery system needed to be redesigned to assure the skills and competencies at the point of care were maximized Final report recommended that new nursing educational models and a new nursing role needed to be developed So in an effort to meet the future nursing demands not only in the work environment but in education the AACN established 2 task forces to study the needs in nursing. TFER1 found that there needed to be more nurses educated at the Master's level to guide practice at the point of care. This task force also determined that the patient care delivery system needed to be redesigned to assure the skills and competencies at the point of care were maximized. And the final report recommended that new nursing educational models and an new nursing role was needed. So in an effort to meet the future nursing demands not only in the work environment but in education the AACN established 2 task forces to study the needs in nursing. TFER1 found that there needed to be more nurses educated at the Master's level to guide practice at the point of care. This task force also determined that the patient care delivery system needed to be redesigned to assure the skills and competencies at the point of care were maximized. And the final report recommended that new nursing educational models and an new nursing role was needed.

58. 58 TFER2 TFER2 - Created with members of both education and practice � Charged to create this new role from both education and practice to meet the current and future demands of healthcare May 2003 � The Working Paper or Working White Paper on the Role of the Clinical Nurse Leader was developed�led to creation of new role in Nursing. The second Task Force TFER2, included members of both education and practice. They were charged to create this new role from both education and practice to meet the current and future demands of healthcare. In May 2003 the Working Paper or Working White Paper was created introducing a new nursing role called the Clinical Nurse Leader. The second Task Force TFER2, included members of both education and practice. They were charged to create this new role from both education and practice to meet the current and future demands of healthcare. In May 2003 the Working Paper or Working White Paper was created introducing a new nursing role called the Clinical Nurse Leader.

59. 59 What is a Clinical Nurse Leader? Not a nursing role of Administration or Management Not an Assistant to the Nurse Manager Not a Charge Nurse Role Should not fill in for Nurse Manager in absence nor should Nurse Manager fill in for Clinical Nurse Leader The Clinical Nursing Leader role is not a role of administration or management. It is not an assistant to the nurse manager although they work very closely together. It is not a Charge Nurse role nor should it be a fill in for the Nurse Manager just as the Nurse Manager should not be a fill in for the Clinical Nurse Leader. The Clinical Nursing Leader role is not a role of administration or management. It is not an assistant to the nurse manager although they work very closely together. It is not a Charge Nurse role nor should it be a fill in for the Nurse Manager just as the Nurse Manager should not be a fill in for the Clinical Nurse Leader.

60. 60 Clinical Nurse Leader Roles Clinician Outcomes Manager Client Advocate Educator Information Manager Systems Analyst/Risk Anticipator Team Manager�workload flow Member of a Profession Lifelong Learner The roles identified in the Clinical Nurse Leader role is that of Clinician, Outcomes Manager, Client Advocate, Educator, Information Manager, System Analyst/Risk Anticipator, Team Manager of workload flow, Member of a Profession, Lifelong Learner. The roles identified in the Clinical Nurse Leader role is that of Clinician, Outcomes Manager, Client Advocate, Educator, Information Manager, System Analyst/Risk Anticipator, Team Manager of workload flow, Member of a Profession, Lifelong Learner.

61. 61 What does the CLINICAL NURSE LEADER do? Provides and manages care at the point of care Designs, Implements, and Evaluates Client Care Outcomes Coordinates, Delegates and Supervises THE CARE provided by the healthcare team Promotes Evidence Base Practice Implement and evaluate change at the micro-system level�that will greatly influence the macro-system environment. The CNL provides and manages patient care at the point of care. This is a role that designs, implements, and evaluates patient care outcomes. It coordinates delegates and supervises the care provided by the healthcare team. The CNL promotes evidence base practice and implements and evaluates change at the micro-system level that will greatly influence the macro-system environment. The CNL provides and manages patient care at the point of care. This is a role that designs, implements, and evaluates patient care outcomes. It coordinates delegates and supervises the care provided by the healthcare team. The CNL promotes evidence base practice and implements and evaluates change at the micro-system level that will greatly influence the macro-system environment.

62. 62 CNL Education and Title Requires a Master�s or Post Master�s certificate in Clinical Management Program Requires passing certification exam to carry CNL title 2007 The CNL title became a Registered trademark nursing title � by Federal Trademark Office. The CNL role requires nursing training at the Master's or Post Master's level in a Clinical Management Program at an accredited University. This role requires the nurse to pass a certification exam developed by the AACN and administered and proctored through the University. In 2007 the CNL title became a registered trademark of AACN granted by the Federal Trademark Office. The CNL role requires nursing training at the Master's or Post Master's level in a Clinical Management Program at an accredited University. This role requires the nurse to pass a certification exam developed by the AACN and administered and proctored through the University. In 2007 the CNL title became a registered trademark of AACN granted by the Federal Trademark Office.

63. 63 The CNL� Role: Growing �As of February 2008, 329 individuals have successfully achieved the CNL credential and over 1,250 students were enrolled in CNL programs across the country� (AACN, 2008) "As of February 2008, 329 individuals have successfully achieved the CNL credential and over 1,250 students were enrolled in CNL programs across the country" (AACN, 2008)"As of February 2008, 329 individuals have successfully achieved the CNL credential and over 1,250 students were enrolled in CNL programs across the country" (AACN, 2008)

64. 64 How can a CNL be used? Nursing Role Model Change Agent Unit based or facility based problem solver Collect/Analyzes and trends data Introduce Microsystem Changes Introduce Evidenced Based Practice at the bedside With the introduction of this role many questions have evolved as how is best to use this new role within an organization. The CNL is clearly a nursing role model setting examples of how best to administer nursing care for the rest of the staff to refer to. It is a Change Agent providing microsysem changes as they are needed to increase cost effectiveness and provide the most efficient nursing care available. The CNL can be unit based or can work system-wide to identify problems and provide input for problem resolution. The CNL collects, analyses and trend healthcare data which results in introducing microsystem changes at the patient care level. It introduces Evidence Based Practice at the bedside and ensures nurses are given one-on-one support as needed regarding education or changing practices. With the introduction of this role many questions have evolved as how is best to use this new role within an organization. The CNL is clearly a nursing role model setting examples of how best to administer nursing care for the rest of the staff to refer to. It is a Change Agent providing microsysem changes as they are needed to increase cost effectiveness and provide the most efficient nursing care available. The CNL can be unit based or can work system-wide to identify problems and provide input for problem resolution. The CNL collects, analyses and trend healthcare data which results in introducing microsystem changes at the patient care level. It introduces Evidence Based Practice at the bedside and ensures nurses are given one-on-one support as needed regarding education or changing practices.

65. 65 Examples of CNL Outcomes Decrease in No Show/Cancellation Rates in procedure labs and clinics Decrease in Surgery Cancellations Decrease LOS Decrease surgical infection rates Decrease ventilated assist pneumonia Decrease staff turnover rate Increase quality in delivery of care at the bedside Listed are a few of the examples of CNL outcomes that have been experienced in healthcare settings using CNL's. There have been decreases in the out-patient are in no-show cancellation rates in both procedure labs and clinics. There have been decreases in surgery cancellations due to CNL's direct involvement with the patient and surgeon. There has decrease in a patient's length of stay, surgical infection rates and ventilated assisted pneumonia. Changes seen at the staff level has been a decrease in employee turnover�with an increase in nurse retention. Finally the overall increase in the delivery of quality patient care has been noted at the bedside. Listed are a few of the examples of CNL outcomes that have been experienced in healthcare settings using CNL's. There have been decreases in the out-patient are in no-show cancellation rates in both procedure labs and clinics. There have been decreases in surgery cancellations due to CNL's direct involvement with the patient and surgeon. There has decrease in a patient's length of stay, surgical infection rates and ventilated assisted pneumonia. Changes seen at the staff level has been a decrease in employee turnover�with an increase in nurse retention. Finally the overall increase in the delivery of quality patient care has been noted at the bedside.

66. 66 Questions Does anyone have any questions for any of the panelist. Please write them on a 3x5 card and hand them to 1 of the room assistants.Does anyone have any questions for any of the panelist. Please write them on a 3x5 card and hand them to 1 of the room assistants.