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Objectives Explain changes in healthcare that are redefining
our nursing practice Describe roles that can evolve into meaningful
work Discuss barriers and benefits to successful role
transitions
Slide 3
Lets begin with Optimism! I see nursings glass as full- full of
potential, if we are going to pick ourselves up, dust ourselves
off, and start all over again From: Ziggy Cartoon by
Wilson,1995
Slide 4
Affordable Care Act- 2010 Aims at advancing the roles and
responsibilities of nurses Presents new options for patients to
choose: health over disease, wellness over illness, prevention over
cure, opportunity to lead productive lives and avoid more costly
care Wellness and prevention services will be more accessible and
affordable as health plans are required to cover them Eliminates
cost-sharing; services at no added cost Pay- for -performance
replaces pay-for-services
Slide 5
ACA Affects Nursing Work outside hospitals will grow Nurses
will be in short supply Providers are welcoming older patients New
standards mean a new specialty Advanced practice nurses are in
demand
Slide 6
ACA Purpose & Demands Reforms health care industry in 4
ways improved quality added consumer protection decreased cost
increased access to healthcare Predicted job openings: 250, 000 to
400, 000 annually over next 10 years By 2020, as NPs fill in more
for doctors, projected jobs for RNs and LPNs= 1.2 million!
Slide 7
But Wait Everything which succeeds, is not the production of a
scheme, of rules and of regulations made beforehand, but of a mind
observing and adapting itself to wants and needs Florence
Nightingale
Slide 8
Significant Changes Shift to ambulatory care Decreased length
of stays Growth in managed care Soaring healthcare expenditures
Emphasis on cost containment Emphasis on quality (outcomes)
Emphasis on service (outcomes) Emphasis on prevention, wellness and
rehab Technological advances Challenges regarding workforce needs
(shortage)
Slide 9
The List Goes On. Care for aging population as well as
pediatric services Shifting values: over live and death Lack of
access: maternity & newborn care De-jobbing: occurs in
hospitals as services expand in communities New infectious diseases
needing management Increased substance abuse: need for treatment
Increased violence: need for behavioral health Chronic disease
management Need to renovate & expand school-based health
centers
Slide 10
Back to the Future! Welcome to the year 2036. A lot has changed
since the old days in nursing, especially throughout the healthcare
field. There is still death, of course, but not from illness; that
was taken care of long ago. Technology has made surgery obsolete
and you may be surprised to learn that the government is picking up
most of the healthcare tab these days. As for hospitals, well,
whats a hospital? Farley, 2012
Slide 11
The Future has Become the Present In the book, Pulling Together
to Make a Difference, The following quote hits the mark: Constant
training, re-training, job hopping, and even career hopping, will
become the norm. Bob Johansen
Slide 12
Rewarding, Relevant Roles Advanced role requiring advanced
education (i.e. Nurse Practitioner) Disciplines: primary care,
nurse midwives, psychiatric nurse specialists, geriatrics
Vacancies: 1,700 at hundreds of locations nation wide including
health centers Critical care nurses: greater need in hospitals
Patient-centered medical homes: settings in which tech-savvy nurses
function as Care Managers and Data Analysts
Slide 13
Population Health Care Managers: advise on evidence-based
diagnoses, treatments and interventions measure progress in
real-time Data analysts: generate and analyze disease registries
interpret data and track clinical measures determine if population
health management works Roles are in Medicare Advantage &
Insurance Programs
Slide 14
National Health Service Corps Looking for a new work setting,
role or specialty? NHSC supports health care providers dedicated to
working in areas of U.S. with limited access to care Scholarships
are awarded in exchange for service in these underserved
communities Administered by Health Resources & Service
Administration 75% of professionals continue to practice where they
are after their contracts expire choose to make a career out of the
experience!
Slide 15
More Rewarding Roles Hospice nurses Geriatric practitioners
Pediatrician office nurse: well-baby visits, developmental
screenings to increase Experts in Clinical Performance measures
Experts in new billing and reporting mechanisms Experts in
digitizing medical records (I.T.) Potential: hospital/patient
liaison: post-discharge, nurse assures that patient fills
prescriptions, goes for follow-up visit, follows prescribed
regimen
Slide 16
Expand Your Current Role Preceptor/mentor Patient/family
advocate Care coordinator: for patients with multiple chronic
conditions Enhanced role in health coaching, transitional care,
prevention activities and quality improvement Change agent: lead
change in healthcare that the populations around you need
Slide 17
Become a Nursing Leader If you see yourself moving into this
role: You will help lead improvements in health care quality,
safety, access, and value You will become a decision-maker You will
be able to influence health outcomes You will participate on public
policy and health care organization boards
Slide 18
How About a Nurse Educator? Everybody has to get more
education: nurses, patients, families, communities, partners in
care Nurse undergrads are already participating in courses with
medical students (i.e. doing patient safety together) Chronic care
management, palliative care and public health are topics that allow
nurses to play a bigger role upfront! Nurses need to learn now how
to use their voices more effectively to improve quality and
access
Slide 19
From Novice to Expert Some roles that never change: The helping
role: comfort, being present The teaching-coaching function:
readiness to learn Effective management of rapidly changing
situations: reacting to early warning signals Administering and
monitoring therapeutic interventions and regimens: medications,
skin care Monitoring and ensuring quality of healthcare practices:
back up system to ensure safe care Organizational and work-role:
how nurse fits in
Slide 20
Facilities with Critical Nursing Shortages Home health agencies
Rural health clinics Outpatient clinics, extension clinics Hospice
programs Skilled nursing facilities Ambulatory surgical centers
Federally qualified health centers Health Service Health Centers:
esp. Indian & Hawaiian State or local Public Health
departments
Slide 21
Examples Community Health Centers: Deliver primary and
preventive care Many specialize ( i.e. oral and behavioral health)
Currently, about 16,000 nurses- including 4,300 advanced practice
nurses are employed there Home Visiting: Nurses, social workers
visit pregnant women and children Offer intervention services and
counseling to improve outcomes
Slide 22
Barriers to Role Transitions Unclear perspective about roles
Unsure about skills preference Inability to match up interests with
roles Negative attitude toward transitions Unfocused about
possibilities
Slide 23
Timely Advice I think ones feelings waste themselves in words;
they ought all to be distilled into actions which bring results.
Florence Nightingale
Slide 24
Successful Role Transitions Depends on your perspective o Is it
just a job? Low on self-fulfillment, negligible rewards o Is it
your chosen career? High public acceptance and prestige; but with
external environment changes, comes diminished self-fulfillment o
Is it driven by a mission? High on dedication to a cause but low on
financial reward or successes o Is it a true calling? Higher level
of awareness that skills, passions and experiences result in joy
and contributions to the common good!
Slide 25
Caring For Your Nursing Career CALLING MISSION CAREER JOB
Slide 26
5 Constructs of a Healthy Nurse Calling to care: compassionate
offering of self; nurse builds relationships with patient and
family Opportunity to role model: nurse confidently identifies
personal health challenges in self and patients; enables patients
and self to overcome them Priority to self-care: nurse effectively
manages emotional and physical stressors Authority to advocate:
nurse empowered to advocate at all levels within work environment
and community
Slide 27
Follow This Advice I attribute my success to this- I never gave
or took any excuse Florence Nightingale
Slide 28
Know Your Skill Preferences Totally Satisfying Skills Very
Satisfying Skills Somewhat Satisfying Skills Prefer Not To Use
These Skills Strongly Dislike These Skills
Slide 29
Career Interests Leading to New Roles Investigative: evaluate,
analyze, systemize, observe Research, informatics, academic
faculty, consultant, computer analyst, infection control, H.R.
resource, work process design, systems development Artistic:
perform, write, design, draw Education/training development,
art/music therapy, computer graphics, promotional displays
Enterprising: plan, supervise, lead; persuade, innovate
Project/committee management, self-employment Legislative work,
patient advocacy, recruitment, marketing, fund-raising
Slide 30
More Career Interests Social: instruct, guide, communicate,
help P.R., health education advocacy, rehab, ethicist, direct
patient care Conventional: financial, clerical, detail and
data-driven Staff coordinator, regulatory compliance officer, cost
analyst, equipment manager, policy resource Realistic: manual
dexterity, motor-coordination, athletic Equipment demonstrator,
technical product vendor, hands- on trainer, staff in dialysis,
surgery or rehab
Slide 31
Surrounded by Negativity? Conquer it by: Practicing
appreciative inquiry: explore what is right with a group or
organization ( value, strengths, potential) Build healthy
relationships Laugh and engage humor Live open-ended questions:
What is my calling? Move ever forward and remain open to inner and
outer voices of wisdom~ active-receptive stance
Slide 32
Be Positive The single most important employee trait in the 21
st century is attitude- with regard to change, adventure and risk.
Farley, 2012
Slide 33
Unfocused About Possibilities? Switch the paradigm by asking:
What assumptions am I making that Im not aware Im making? What
might I invent that I havent yet invented that would give me other
choices? Explore expectations of others & what they can expect
of you Be intentional in life and career: helps inform actions and
choices Place an anchor in the present
Slide 34
Wise Advice Alice in Wonderland said to the Cheshire Cat Would
you please tell me which way I ought to go from here? and the
Cheshire Cat said, That depends on where you want to go. Lewis
Carroll, 1865
Slide 35
Toolkit To Successful Role Transitions On your journey, dont
forget to bring: Helmet for the knocks Cushion for the falls Mop
for the tears Earplugs for the gossip Good shoes for running twice
as fast as others to get to the same place at the same time Hammer
to nail down promises Key to open closed minds Hatchet to open
closed doors
Slide 36
Might as Well Pack Gavel to command attention Microphone so you
will be heard Box to pick up the pieces Certificate of merit Medal
of honor Badge of Courage Friend for good times and especially for
bad times Natasha Josefowitz, 2012
Slide 37
Manage Career Transitions Through o Self-assessment: skills,
knowledge, attitude o Goal setting and priorities o Alignment of
assessment with goals o Market assessment for what is best for YOU
o Skill strengthening o Action plan o Implementation o Reflection
and feedback o Adjust as necessary to reach successful outcome
Slide 38
AH HA: Illumination Listen to yourself Trust your hunches Stop
questioning your qualifications Be a risk taker: failure is not
fatal Give up fearing the unknown Heed your dreams and your mentors
Turn things around: interpret trends so you see things differently
Be prepared: so timing will be on your side
Slide 39
Benefits of Successful Role Transitions Achievement of outcomes
(personal and patient) Increased productivity Sense of
accomplishment ( making a difference) Appreciation of adaptability
Freedom and adventure Commitment to a purpose Power to deliver
results Economic security Control of future career
Slide 40
Make a Difference by Managing All 3 Quality Cost Service
Slide 41
Follow the Leader Just like Florence Nightingale, we must be
tough, canny, powerful, autonomous and even heroic. Farley,
2012
Slide 42
Imagineering Vivid imagination according to Walt Disney Combine
it with repetition and you will be a Winner imagination
repetition
Slide 43
All Roles Become One Gentle gestures drift from one to another,
(listening, gazing, touching, holding); Feelings rendered in,
around and through, (warmth, interest, concern, caring); Shared
memories converge, (I and you become we); Actions offered, regard
given, love bestowed, create a trickle of compassion, that feels
like a river of kindness, that courses to the sea of humanity, and
in mingling with the vastness, purifies all Farley, 2012
Slide 44
Final Words: What is Life? Life is a gift accept it Life is an
adventuredare it Life is a mystery unfold it Life is a game play it
Life is a struggle face it Life is beauty praise it Life is a
puzzle solve it Life is an opportunity take it Life is sorrowful
experience it
Slide 45
Life is a song sing it Life is a goal achieve it Life is a
mission fulfill it Author Unknown This sums up my advice to you, so
I will only add: Life in both your personal and professional lives
is a journey, not a destination never stop taking it! Thank
You