Creating a 21 st Century Nurse Workforce: What will it take? The Soule Lecture, University of Washington Susan Hassmiller, R.N., Ph.D., F.A.A.N.
Mar 31, 2015
Creating a 21st Century Nurse Workforce: What will it take?The Soule Lecture, University of Washington
Susan Hassmiller, R.N., Ph.D., F.A.A.N.
Health Reform
Reform must:
expand access
improve quality
reduce costs
add value
Nursing workforce goals must be the same
My Objectives:
1. Discuss health care system’s needs
2. Explain how nurses can help
3. Share 8 goals for creating a 21st century workforce
Health System’s Needs:
Aging, sicker population:
85 and older fastest growing segment*
20% of Medicare beneficiaries have 5 or more chronic conditions**
75 cents out of every health care $ treats chronic conditions**
5% of beneficiaries who die each year take up 30% of Medicare budget***
*The Aging Population in the Twenty-First Century: Statistics for Health Policy (1988) Commission on Behavioral and Social Science Education.**Medicare Standard Analytic File, 1999.***Lubitz J.D., Riley G.F. Trends in Medicare payments in the last year of life. N Engl J Med 1993;328:1092-1096.
Health System’s Needs
We’re plagued by:
health care disparities
high infant mortality rate (ranked 37th)*
lagging life expectancy (ranked 31st)*
primary care shortage
unacceptable medical errors
*World Health Statistics 2009. World Health Organization, 2009.Available at: http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf
Creating a 21st Century Health System:
Our health system will need:
chronic care management
care coordination
end-of-life care
preventionPerfect role for nurses
Why Nurses?
Largest component of health care workforce
Spend most time with patients
Most likely to catch medical errors*
Work in many care settings
*Preventing Medication Errors. Washington, D.C.: Institute of Medicine, 2006.
Goal #1: Develop Nurse-Led Innovations
New models of care:
expand access
improve quality
reduce costs
enhance value
Example: 11th Street Family Health Center
Nurse-managed clinic at Drexel University:
addresses health care disparities
coordinates care
provides health promotion and disease prevention services
serves as clinical training site
11th Street Family Health Center
Example: 11th Street Family Health Center*
7,837 primary care visits in ’06, up 19%
20% reduction in hemoglobin A1C
68% of clients have controlled hypertension
14% increase in adult immunization rates
Fewer low-birth weight babies
Decreased depression rates in vulnerable adults with chronic illness
Increased rate of breast cancer screening
*http://www.aannet.org/files/public/11thStreetFamilyHelthSvcs_template.pdf
Example: Community and Retail Clinics
Over 1,200 retail clinics use NPs for common acute problems.
ERs and urgent care clinics freed up for more severe aliments
Patients enjoy convenience
NP-staffed clinics are more affordable
Retail clinic*
*Photo by Jim Amon, The Denver Post, September 30, 2009.
Example: Community and Retail Clinics
Compared to physician practices, NP practices show equivalent or better:
health status, patient adherence and symptom relief*
care management*
patient satisfaction*
NP practices also decrease health utilization and costs**
* Horrocks, S., et al. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ; 324:819-23.* *American Academy of Nurse Practitioners. Nurse Practitioner Cost-Effectiveness, 2007.
Example: TCAB
RWJF and IHI program. AONE on board.
Goal:Goal: to empower nurses and others to redesign work processes on med/surg floors to achieve better clinical outcomes
Goal:Goal: to improve patient quality
Goal:Goal: to ensure a high-quality work environment and retain nurses
Example: TCAB
Example: TCAB
Promising findings:
Falls with harm declined by 45% from 2005-2007*
“Code blue” calls declined 30% from 2005-2007*
30-day re-admissions declined 25% between 2006-2007*
Nurses’ time at the bedside increased from 47% to 49%**, (with some hospitals up to 70%)
*Needleman, Jack and Susan Hassmiller. “The Role of Nurses in Improved Hospital Quality and Efficiency: Real-World Results” Health Affairs 28 no. 4, 2009 (published online 12 June 2009). **Needleman, Jack, et al. “Overall Effect of TCAB on Initial Participating Hospitals” American Journal of Nursing, 109(11) November 2009.
Example TCAB
Improvements Cost Savings
Reduction in nurse turnover $5.6 million
Reduction in patient falls $7.9 million
Reduction in pressure ulcers $59.3 million
TCAB Savings at Cedars-Sinai Medical Center 2007-2008*
Bolton, Linda Burnes, et. al. “The Business Case for TCAB” American Journal of Nursing109(11) November, 2009.
Transitional Care Model
Goals:
avoid repeat hospitalizations
attain longer-term positive health outcomes
TCM Improves Quality of Care*
*Source: Transitional Care Model Web site:
http://transitionalcare.info/ToolQual-1801.html.
Transitional Care Model Savings*
*Source: Transitional Care Model Web site:http://transitionalcare.info/ToolQual-1801.html.
Nearly $5,000 in savings at one year.
Nurse-Led Innovations
AAN has designated these examples:
Go to: http://www.aannet.org
Goal #2: Engage in Research
Build evidence base:
collect data and evaluate outcomes
publish
translate research to action
show link between nursing and high-quality patient outcomes
invest in faculty who will conduct the research needed for new solutions
Goal #3: Redesign Education
Make curriculum relevant and current
Teach students to think, make critical judgments, create solutions
“Today’s nurses are undereducated for demands of practice”
-- Carnegie Foundation report*
*Benner, Patricia, et al. Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey-Bass, 2009.
Goal #3: Redesign Education
Curriculum must teach students to:
prevent disease
coordinate and manage chronic illness
offer solutions for and use new technologies
provide palliative and end-of-life care
work in every setting where society needs us
lead and advocate
Goal #3: Redesign Education
Residency program for nurses:
on-the-job learning and clinical preparation
safer patient care
Lifelong learning:
remain competent in practice area
keep pace with new technology
Goal #4: Embrace Medical Technology
Medical devices
E-records
Virtual patient visits
Simulation labs
Online classes
Social mediaNursing simulation lab
Goal #5: Foster Inter-professional Collaboration
Example: INQRI
Interprofessional teams conduct research showing how nurses can improve quality
Ex) Nurse and engineer team reducing pressure ulcers
Goal #6: Pursue Academic Service Partnerships
Engage:
1. hospitals
2. clinics
3. public health offices
4. area health education centers
Provide right clinical training to meet community’s needs
We must know what’s going on in the real world!
Goal #7: Develop Leadership at Every Level
Speak up to improve patient care
Serve on a board
Run for public office
Know your area of expertise
Develop your skill set
Goal #7: Develop Leadership at Every Level
Nurses hold about 2% of all board positions
Goal #7: Develop Leadership at Every Level
RWJF/Gallup survey of 1,500 health opinion leaders:
insurance
corporate
health services
government
university faculty
thought leaders
See significant barriers that prevent nurses from fully participating as health reform leaders
Who Will Influence Health Reform in the United States in the Next 5-10 Years
Question Wording: Thinking about the next five to ten years, how much influence do you think each of the following professions or groups of people will have in health reform in the United States?
Nurses Should Have More Influence in Planning, Developing Policy, and Management
Question Wording: Would you like nurses to have more influence, about the same influence, or less influence than they do now in planning, developing policy, and management of the following health systems and services?
Medical Errors
Quality Care
Access to Care
Goal #8: Be at the Table
Join boards
Enter policy debates
Communicate clearly
Show supporting data
Volunteer
Explain how nurses improve patient care
8 Goals to Create a 21st Century Nursing Workforce:
1. Develop nurse-led innovations
2. Generate evidence
3. Redesign education
4. Embrace medical technology
5. Foster inter-professional education
6. Pursue academic service partnerships
7. Develop leadership at every level
8. Be at the table
Creating a 21st Century Workforce
Nurses must take a leadership role in influencing:
policy
health planning
management
Creating a 21st Century Workforce
“Be the change you want to see.”
--- Gandhi
Thank You