The Career Path of a Chief Nursing Officer: The Impact of Nursing Leadership at the Veterans Health Administration Cathy Rick, RN PhD (h), NEA-BC,

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1 The Career Path of a Chief Nursing Officer: The Impact of Nursing Leadership at the Veterans Health Administration Cathy Rick, RN PhD (h), NEA-BC, FACHE, FAAN 1

2 Conflict of Interest Disclosure Cathy Rick, PhD (h), MSN Has no real or apparent conflicts of interest to report. 2

3 Session Objectives Describe personal characteristics/attributes of a senior executive of a national healthcare system Identify structural elements of a successful national nursing enterprise Identify key nursing initiatives resulting from strategic approaches in a national healthcare system 3

4 Department of Veterans Affairs Before you get to know me and my journey, I ll provide an introduction to VA 4

5 Today s Veterans Today, there are over 22 Million living Veterans. 8M+ Veterans are enrolled in the VA health care system 4M+ Veterans and survivors receive VA compensation and pension benefits 5

6 Today s Veterans 55% of all Veterans are 60 years old or older M M M M M Million 6

7 VA s Administrations The Veterans Health Administration (VHA) is one of the three major administrations of the Department of Veterans Affairs. Veterans Health Administration (VHA) National Cemetery Administration (NCA) Veterans Benefits Administration (VBA) 7

8 Hospital System to Health System In 1996, VA began the creation of Veterans Integrated Service Networks (VISNs) to transform VA Health Care from a Hospital System to a Health System. VHA currently has 21 VISNs. 152 Medical Centers 974 Outpatient Clinics 807 Community-Based 152 Hospital-Based 9 Mobile 6 Independent 288 Vet Centers 98 Domiciliary Residential Rehabilitation Programs 133 Community Living Centers 8 FY rd Quarter

9 Vital Statistics FY 2010 Enrollees.8.34 Million Unique Patients Treated...6 Million Outpatient Visits Million Outpatient Surgeries...298,400 Inpatient Admissions.. 679,600 Lab Tests (Inpatient & Outpatient) Million Prescriptions Dispensed (30-Day Equivalent) Million Prosthetics Services Performed Million 9

10 VA s Health Care Expertise VA is one of the largest civilian employers in the federal government and one of the largest health care employers in the world. 277,000+VHA Employees 82,000+ Veteran Employees 20,000+ Physicians 53,000+ Nurses 10

11 VA s Priceless Asset VA s volunteer program is one of the largest volunteer programs in the Federal government. In FY 2010, 139,325 volunteers contributed a total of 12.5 Million hours and an estimated $107 million in gifts and donations. 11

12 Enhancing the Way We Provide Care Patients are in control of their health care, and the system is designed around the needs of the patient. -Robert A. Petzel, M.D. Under Secretary for Health Department of Veterans Affairs 12

13 Organization of Excellence Continuously learns Continuously improves processes Continuously measures performance Empowers employees Has consistent and predictable performance Is fully integrated Is transparent 13

14 Organization of Excellence Manages its employees skills and knowledge Provides coordinated care Provides patient-centered care Works collaboratively Works in teams 14

15 New Health Care Delivery Model Patient-Centered Team Care Continuous Improvement Data-Driven, Evidence-Based Value Prevention / Population Health 15

16 VA s PACT with Veterans To help increase Veterans satisfaction with their care and improve their health outcomes, VA s health care facilities are implementing the Patient Aligned Care Team (PACT) health care model. 16 PACT emphasizes teams and coordinated care.

17 Team Care The New Health Care Work Place Work is done in teams Team members regard each other as peers Teams are empowered Teams have data about cost, quality, satisfaction and access Teams use a continuous improvement process Teams have time Teams work collaboratively 17

18 Patient-Centered Care VA is changing the way health care is delivered by shifting from a problem-based health care system, to one that is patient-centered and healing. Key Components Personalized Health Planning Whole Person; Integrative Strategies Behavior Change and Skill Building That Works 18

19 Future of VA Health Care Past VA What can I fix? Physician Case-Based Paper Medical Record We ll address your immediate concern. Present VA How can we help what is wrong with you? Clinical Team Disease-Based Electronic Medical Record You have a risky problem, please follow this plan to improve by your next visit. Future VA How can we help you live the life you want to live? Veteran, Family and Health Care Team Whole-Person Electronic Health Record We can design your personalized health plan to meet your goals. 19

20 Better Access, Better Care Before Hospital System After Health System Only Hospitals Hospitals Outpatient Clinics Mobile Clinics Vet Centers Mobile Vet Centers My HealtheVet 20

21 VHA Office of Nursing Services The Office of Nursing Services provides leadership and strategic direction for nursing practice, research, academic and emergency response initiatives that impact care and services for Veterans. 21

22 50,207 13,617 11,257 VA Nursing Workforce Registered Nurses LPN/LVNs Nursing Assistants/Health Techs 4,424 Nurse Practitioners 512 Clinical Nurse Specialist 120 Clinical Nurse Leaders 80,000+ Nursing personnel 22

23 Chief Nursing Officer Characteristics First and foremost- Patient focused Know the healthcare industry as the context for nursing Understand practice, research, education and the business aspects of nursing Open, honest and forward thinking Stay connected professionally Balance work and personal life Have FUN!!! 23

24 Nursing roles in our New Models of Care Primary Care Provider, RN Care Manager, Case Manager, Clinical Nurse Leader (CNL) Specialty Care Provider, Consultant, Direct Care, CNL Telehealth Urgent care, Coordination, Consultation Informatics The glue that holds it all together! 24

25 Background Cathy s journey to CNO Academic shapshot Core values Various settings Key opportunities Obstacles Milestones 25

26 Why me as a CNO?? 26

27 My approach to making it work Knowing your audience Setting the stage Coalition building Alignment of nursing to enterprise Articulate nursing in the context of the whole Form follows function: Shared Governance Highlights on how informatics fit 27

28 What do patient centered care and shared governance in common? Nothing about me without me 28

29 How has it worked? We have voice We are respected We are included We are colleagues We are challenged to be engaged Role expansion, increased workforce Always more to attend to 29

30 My advice to you Stay grounded Stay focused Find meaning Listen, look, learn, lean forward 30

31 National Nurse Executive Council (NNEC) Membership: Chief Nursing Officer ONS Executive Staff + Nurse Executive Representative from each VISN + Advisory Group Chairs Chair, NNEC Reps, & other VA staff members Advanced Practice Nursing Advisory Group (APNAG) Advanced Practice nursing representatives Nursing Research Advisory Group (NRAG) Nurse research representatives Nursing Clinical Practice Program (CPP) Clinical Nurse Advisors + Field Advisory Committees Office of Nursing Services (ONS) Career Developme nt & Workforce Manageme nt (CDWM): Director of CDWM Nursing Leadership Excellence : Deputy Chief Nursing Officer Nursing Practice Transform ation: Director of Clinical Practice Functional Model Advancing Nursing Practice Promoting Patient-Driven Care ONS Informatic s (ONSI): Chief Nursing Informatics Officer Evidence- Based Practice (EBP): Director of Research & Academics Clinical Executive* *Supports all program areas People-Centric + Honor and Serve Veterans and Their Families + Embrace VA Core Values of Compassion, Integrity, Respect, an d Commitment + Engage, Inspire, and Empow er Employees Results-Driven + Ensure Improved Access for All Veterans + Provide High-Quality Care and Exceptional Client Relationship Management + Leverage Technology and Adapt Business Processes with Agility + Demonstrate Leadership, Accountability, and Effective Results Forward-Looking + Communicate Widely and Effectively and Conduct Systematic Outreach and Collaboration + Anticipate Veterans Needs and Be Pro-Active in Meeting Them + Develop a VA Culture that Is Forw ard Looking, Innovative, and Veteran-Focused National Nursing Practice Council (NNPC) Facility staff nurse representatives Chief Nursing Officer Veterans Health Administration (VHA) Eight for Excellence 31

32 VA Nursing Structure/Function Monthly national nursing conference calls Interactive intranet web page Share point web connections Annual Reports Field Advisory Committees Beloved 32

33 VA Nursing Structure/Function Nursing representation on interprofessional workgroups and task forces Senior nurses as members of national leadership council committees Local, regional and national peer review Boards ONS Innovations Awards linked to strategic goals Labor/Management Forums and Council 33

34 National Nursing Strategic Plan Excellence in Patient Driven Care Caring, Collaboration, Customer Focused, Interprofessional Teamwork, and Innovation Over arching Goals are Framed by Patient Driven Care Quality and Safety Learning Environment Professional Nursing Practice 34

35 National Nursing Strategic Plan for VA Nursing Practice Transformation Career Development and Workforce Management Leadership Excellence in all Roles Evidence Based Practice Threads across all goals Advanced practice, research, informatics, nursing sensitive data 35

36 VHA Nursing Strategic Plan 36

37 VA Nursing Achievements/Accomplishments Academy for the Improvement of Microsystems (CNL Program) Healthy Work Environment Evidence Based Practice Care delivery model transformation- primary care and specialty care Transition to practice programs Elimination of Hospital Acquired Pressure Ulcers 37

38 VA Nursing Achievements/Accomplishments VA Nursing Academy Nursing Informatics Data Services Weekend Immersion in Nursing Informatics Nurse Manager Passport for Success Let s Get Certified Campaign Independent practice for APRNs Clinical Practice Program exemplars Tuition, Scholarships, Education Debt reduction 38

39 VA Nursing Achievements/Accomplishments Transformational health informatics Develop a robust informatics nursing workforce Enhance the collaborative environment for informatics personnel Standardized competencies Career development Clinical documentation systems, interdisciplinary care/charting, virtual care, simulation, patient/staff flow processes, VA/DoD joint record 39

40 More on Informatics Nurse Executive/Nurse Manager dashboards Unit specific ADT/bed days of care Unit level patient and staff satisfaction Personnel management data Pressure ulcer data at point of care Falls and injuries from falls data at point of care Informatics adds value 40

41 Strategies that have worked in VA Nursing Informatics Rocky road at the beginning Local clinical application coordinators Small team of nurses focusing on national nursing informatics needs (database, technology) Disconnect between nursing and informatics disciplines Chief Nursing Informatics Officer Integration with enterprise wide informatics and analytics Governance and priority setting are current focus keeping an eye on team care and patient centeredness 41

42 Summary Similarities and differences We re really not so different You and I VA and the rest of the healthcare industry We re here to serve: the Value proposition with high reliability 42

43 Parting words If it is to be, It is up to me 43

44 To Care for Those Who Shall Have Borne the Battle, and for Their Widow, and Their Orphan Abraham Lincoln 44

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