Name of Sponsoring Organization presents The Future of Nursing: Leading Change, Advancing Health Casey R. Shillam, PhD, RN-BC Mary Dickow, MPA Nurse Co-Lead Statewide Director CA Action Coalition CA Action Coalition
Jan 11, 2016
Name of Sponsoring Organizationpresents
The Future of Nursing:
Leading Change, Advancing Health
Casey R. Shillam, PhD, RN-BC Mary Dickow, MPANurse Co-Lead Statewide Director CA Action Coalition CA Action Coalition
ObjectivesAt the conclusion of the presentation participants will be able to:
1. Identify the 4 key messages and 8 recommendations of Institute of Medicine (IOM) study on the future of nursing.
2. Determine how INSERT THE AUDIENCE POPULATION DESCRIPTION in California can contribute to the California Action Coalition (CA AC) workgroups and the statewide effort.
3. Demonstrate understanding of nursing’s contributions that positively impact the health of the population.
Institute of Medicine
Why Now?
Health System Challenges
*World Health Statistics 2009. World Health Organization, 2009.Available at: http:/www.who.int/whosis/whostat/EN_WHS09_Full.pdf
IOM Committee for the RWJF Initiative on the Future of Nursing
18 members with expertise in:
– Health information and technology
– Health services research– Health policy– Workforce research and policy– Economics– Health care consumer
perspective
– Public health– Nursing – Federal and state
administration– Hospital and health plan
administration– Business administration
Our Current Health System
Committee’s Vision
A Transformed Health System
Diversity
Fostering Inter-professional Collaboration
Future of Nursing: Campaign for Action
Collaboration created by the Robert Wood Johnson and AARP Foundations to ensure
that all Americans have access to high quality, person-centered care
Leadership
Access to Care
Workforce Data
Education
High-quality patient
centeredcare
Inter-professional Collaboration Inter-professional Collaboration
Key Message #1: Nurses should practice to the full extent of their education and training.
Nurse leaders must:– work with state boards of nursing, state policy makers,
consumers and other health care professional organizations to remove restrictive scopes of practice.
– participate in efforts to assure appropriate use of advanced practice nurses and optimal roles for RNs in chronic disease and transitional care management.
Improve Access to Care
The Evidence
Over 10 studies show equivalent patient outcomes when care is provided by APRN or MD:
– Two Cochrane reviews (Hatem et al, 2008 and Laurant et al, 2004)
– RCT published in JAMA (Mundinger et al., 2000)
– No studies suggest care is better in states with tighter scope-of-practice restrictions
Role of the Registered Nurse
Refocus the role of the Registered Nurse to provide:
– Prevention and wellness care rather than acute care
– Community education and wellness
– Chronic disease case management
– Prevention of functional decline and need for hospitalization / placement in facility
Key Message #2: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Nurse leaders must:
– support academic progression of the nursing workforce.
– collaborate in developing and implementing transitional programs.
– identify, promote and support colleagues in pursuing doctorates.
Improve Education
– Lowered patient mortality
– Every 10% increase in BSN nurses results in 4% decrease in risk of death
– Lower number of medication errors and procedural violations
– Stronger critical thinking and leadership skills of BSN nurses
– 6% of nurses who graduate with AD get advanced degree, compared to 20% of BSN graduates
*Aiken et al., 2003; Aiken et al., 2009; Estabrooks et al., 2005; Friese et al., 2008;Tourangeau et al., 2007; Van den Heede et al., 2009
The Evidence
Key Message #3: Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States
Nurse leaders must:– act as full partners with other health care providers, being
accountable for their responsibility to deliver high-quality care.– work collaboratively with leaders from other health
professions.– identify and propose solutions to problems in care
environments.– devise and implement plans for improvement. – participate in health policy decision-making.
Promote Interprofessional Collaboration
Greater levels of collaboration between health professionals, especially between nurses and physicians, improves quality of care and patient outcomes
Barr, 2002; Barnsteiner et al, 2007
The Evidence
Prepare and Enable Nurses to Lead
Gallup survey of 1,500 opinion leaders:
– Predicted nurses will have little influence on health care reform over next 5-10 years
– Wanted nurses to have more influence in reducing medical errors, increasing quality of care and promoting wellness
– Believed nurses should have more input and impact in planning, policy development and management
*RWJF, 2010
The Evidence
Key Message #4: Effective workforce planning and policy making require better data collection and an improved information infrastructure
Nurse leaders must:– assist in the collection of data regarding both the
workforce and the demand for care from the populations we serve.
– determine the type of data to collect to accurately assess the demand for nursing services, particularly the specialties and geographic areas of nursing shortages.
Build Workforce Data
Move from evaluating simply “number” of hours to the content and quality of those hours
– CA BRN survey
• No nursing shortage!?!?
– Evaluating hours of nursing care across settings
• Can create methods of comparing quantitatively
long term care vs.
primary care vs.
home health care
Spetz et al., 2011; Van Cleave et al., 2011
The Evidence
Only with the right “mix” of data can we ensure the populations in most need will have the services and
health care that they need.
The Evidence
The Evidence
The IOM Recommendations
The IOM Recommendations
How Nursing Will Contribute to Improved Healthcare
Communications Committee engaged nurses and other partners from across the state to develop a
brand for the Coalition.
VisionA healthy California through nursing leadership and service
MissionImplement the recommendations of the IOM Future of Nursing report
through strategic partnerships for a healthy California
Core Values• Engaging broad and diverse perspectives• Increasing and using influence• Strategic and efficient use of resources• Improving health outcomes
Goals• Develop action steps to achieve the Recommendations
• Engage a broad-base of stakeholders in the Campaign
• Create statewide structures that support the work
• Ensure regional engagement
• Influence national-level healthcare policy decisions
Organizational Structure
Executive Committee
Leadership Council
Working Group #5
Working Group #4
Regional Groups
Stakeholders
Working Group #1
Working Group #2
Working Group #3
Working Group #6
Working Group #7
Working Group #8
Co-Leads: Garrett Chan and Susanne Phillips
Conduct gap analyses to:• compare California regulatory language with NCSBN Consensus Model for advanced-practice registered nurse regulation
• compare for the four advanced-practice registered nurse and RN roles to the IOM Future of Nursing Report with the laws and statues of California
Recommendation #1: Remove scope-of- practice barriers
Recommendation #2: Lead and diffuse new practice model efforts
• Convene a statewide symposium in September 2012 to explore opportunities to transform health care delivery, share innovative models, and assess gaps in current models of care delivery
Lead: BJ Bartleson
Recommendation #3: Transition-to-practice through nurse residencies• Promote transition to practice programs and residencies as expectation of nursing education
• Expand programs for new graduates to include more community-based opportunities
• Create a statewide evaluation of current programs to inform next steps
Co-Leads: Dorel Harms and Nikki West
• Establish baseline percentage of RN’s with minimum educational level of BSN
• Inventory and analyze data from existing ADN-BSN projects to establish best practices
• Continue to facilitate progress AB1295 with consultation and support to CCC and CSU Chancellor’s Offices
Recommendation #4: Increase number of nurses with BSN
Co-Leads: Liz Close and Stephanie Robinson
• Work with Recommendation #8 to establish baseline number of nurse with a doctorate
• Establish outcome measures and methods of collecting data for reaching goal of a 10% increase of BSN grads matriculating into Master’s programs within 5 years
Recommendation #5: Double number of nurses with a doctorate by 2020
Co-Leads: Holli DeVon and Robyn Nelson
• Establish priorities and communications plans for messaging the need for culture change to expectations of life long learning in the profession of nursing
• Create repository on the Action Coalition website showcasing service and academic partnerships that demonstrate and support lifelong learning
Recommendation #6: Ensure that nurses engage in life-long learning
Co-Leads: Jan Boller and Martha Dispoto
Recommendation #7: Prepare and enable nurses in leadership positions• Conduct gap analysis of 2011 survey to identify needs for developing new leadership programs for nurses
• Expand nursing leadership opportunities for participation by nurses in board rooms, policy discussions and on management teams
• Develop a systematic plan for involving students in the Action Coalition work
Co-Leads: Pat McFarland and Peggy Hodge
• Upload all public-access web links and resources for data to Action Coalition website
• Disseminate a seamless inventory of CA data for analysis and workforce planning
• Work closely with other recommendation groups to assess data needs to implement strategies
Recommendation #8: Build data infrastructure for workforce planning
Co-Leads: Joanne Spetz and Louise Bailey
Regional Approach
• Change will happen locally
• Regional champions serve on Leadership Council
• Hold regional forums to build engagement and deliver the message locally
• Ensure regional members serving on work groups and/or coordinate with regional subgroups to link into statewide effort
Progress to Date
• Planning Year completed• Workgroups established for all 8 Recommendations• Regional Champions identified in all 8 regions • Statewide Director appointed • Communication Plan and website• Secured initial funding for creating sustainable
structure
Successes to DateTown Hall Events: • Sacramento in August 2011• Los Angeles in February 2012• Fresno in April 2012• Humboldt in May 2012
Funders Round Table meetings held• Sacramento in August 2011• Los Angeles in December 2011
Successes to Date
Legislative Meeting with future discussions in the works
High Stakeholder Engagement due to successful outreach
CA is Role Model for Action Coalitions in other states
It Will Take All
of Us!
Government
Business
Health Care
Institutions
All Health Professionals
Insurance
Industry
Academia
Patients
Get Involved!
Workgroups / Regional activity
Speaker’s Bureau Trainings
Development Campaign
Communications Committee
Exercise for your Organizations
1) With your colleagues, discuss examples of how your organization is already engaged in work around the IOM Future of Nursing Recommendations.
2) Brainstorm to develop ideas that your organization should be or could be engaged in around the recommendations and connect with workgroup co-leads.
Mary Dickow, MPACalifornia Action CoalitionStatewide [email protected]
For More Information
Future of Nursing Campaign for Action California Action Coalitionwww.thefutureofnursing.org www.CAactioncoalition.org