Better Care, Better Health, Reduced Cost A Commitment to Advance the Health of Texans

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2 Better Care, Better Health, Reduced Cost A Commitment to Advance the Health of Texans

1) Remove scope-of-practice barriers 2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3) Implement nurse residency programs 4) Increase the proportion of

3 1) Remove scope-of-practice barriers 2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3) Implement nurse residency programs 4) Increase the proportion of nurses with a BSN degree to 80% by ) Double the number of nurses with a doctorates by ) Ensure that nurses engage in lifelong learning 7) Prepare and enable nurses to lead change to advance health 8) Build an infrastructure for the collection and analysis of interprofessional health care workforce data

number of nurses with a doctorates by 2020 6) Ensure that nurses engage in lifelong learning 7) Prepare and enable nurses to

4 Campaign for Action Education Practice Collaboration Leadership Data Diversity

5 Ellarene Sanders Executive Director Freda Hanley VP Clinical Services

6 Texas Team StAC Co-Chairs Dr. Pat Yoder-Wise Dr. Ray Perryman

7 Strategic Advisory Committee Strategic Advisory Committee Executive Committee Executive Committee Texas Nurses Association Texas Nurses Association Advancing Nursing Practice Advancing Nursing Practice Regional Leaders Regional Leaders Tactical Support and Operations Tactical Support and Operations Advancing Nursing Education Advancing Nursing Education Blue Cross/Blue Shield of Texas Blue Cross/Blue Shield of Texas

Regional Leaders Regional Leaders Tactical Support and Operations Tactical Support and Operations

8 Alexis Green, RN, PhD, FAAN Co-Chair Cindy Johnson Co-Chair Patricia Allen, RN, EdD, CNE, ANEF, FAAN Joyce Batcheller, DNP, RN, NEA-BC, FAAN Paulette Burns, RN, PhD Sondra Flemming, RN, MS Cole Edmonson, DNP, RN, FACHE, NEA-BC Freda Hanly, BSN, RN, CCM Mary Elizabeth Mancini, RN, PhD, NE-BC, FAHA, FAAN Ellarene Duis Sanders, PhD, RN, NEA-BC Elizabeth Sjoberg, RN, JD Susan Sportsman, RN, PhD, FAAN

Edmonson, DNP, RN, FACHE, NEA-BC Freda Hanly, BSN, RN, CCM Mary Elizabeth Mancini, RN, PhD, NE-BC,

9 National Evidence Multiple studies find association between educational level and patient outcomes Twenty percent of BSN graduates get advanced degrees Six percent of associate-degree graduates get advanced degrees

percent of BSN graduates get advanced degrees Six

10 In 2005, the TCNWS projected Texas would need 293,000 RNs in order to meet its needs in That is 51% more than Texas has today (194k RNs) Texas Team s Current Assumption: Texas will need this number of RNs by 2020 & possibly more. Meeting 80% goal will require 234,000 BSN RNs (80% of 293%K)

That is 51% more than Texas has today (194k RNs) Texas Team s Current

11 Demonstrate alignment & collaboration between practice & education to achieve the 80/20 education goals. Implement APIN grant, actualizing the CABNET project to promote the for RN to BSN completion. Develop policy strategies that support the goal of 80% BSN workforce by Plan & operationalize regional faculty forums on the IOM goal of 80% BSN by 2020

Implement APIN grant, actualizing the CABNET project to promote the 1+1+1 for RN to BSN

12 Provide leadership for the achievement of the overall RN production goals for 2020 established by original Texas Team Create & deploy a toolbox for faculty to utilize in educating nursing students regarding the IOM Future of Nursing report especially the importance of achieving higher levels of education.

faculty to utilize in educating nursing students regarding the IOM Future of

13 Goal: Advance 80/20 $4.3 M for two years Use proven models to get nurses to earn BSN/higher degree Two states funded per model

14 Recruit twenty Texas nursing programs to adopt the standardized general education courses & prerequisites established by CABNET & forty programs to implement the concept based curriculum at the AD and BSN level as well as recommended standardized education courses. Using a focus group methodology, assess Texas employers perceptions of behaviors demonstrating the competence of the nurse of the future, specifically related to concepts of leadership, cultural competency/diversity, interprofessional collaboration, quality and safety.

15 Increase the percentage of minority graduates of RN to BSN programs from 45 to 50% of the graduates by Document employment policies used by partnering clinical sites to support academic progress for nurses. Develop and provide faculty development programs to increase faculty expertise in clinical and didactic teaching in a concept based curriculum.

Document employment policies used by partnering clinical sites to support academic

16 Analyze the current production & current & future utilization of doctoral prepared nurses & set production goals for Texas DNP & PhD programs, based upon IOM goals. Assess the current production and utilization of doctoral prepared nurses and establish production goals. Identify and raise awareness of the value of the doctoral prepared nurse in the practice and regulatory environments.

Assess the current production and utilization of doctoral prepared nurses and establish

17 All practitioners should practice to the full extent of their education and training Physicians, nurses and other health professionals work in a team-based model of care delivery Models of care maximize time that providers can spend on their respective roles and responsibilities to patients

team-based model of care delivery Models of care maximize time that

18 Texas would enhance efficiency, increasing state economic output by $8 billion annually and creating 97,205 permanent jobs if APRNs were better utilized in the state. The economic stimulus would spark additional yearly tax receipts of $483.9 million to the State of Texas & $233.2 million to local governments. By 2040, the total impact would reach 177,220 permanent jobs with $23.6 billion in economic output and almost $46.9 billion in total expenditures each year. The State of Texas would see its annual tax receipts boosted by $1.432 billion, with another $538.1 million going to local government coffers. Perryman, R. (2012)

By 2040, the total impact would reach 177,220 permanent jobs with $23.6 billion in economic output and almost $46.9 billion in total expenditures each year.

19 National Governor s Association issued The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (Dec, 2012) None of the studies in NGA s literature review raise concerns about the quality of care offered by NPs. Most studies showed that NP-provided care is comparable to physician-provided care on several process and outcome measures. Moreover, the studies suggest that NPs may provide improved access to care. p states might consider changing scope of practice restrictions and assuring adequate reimbursement for their services as a way of encouraging and incentivizing greater NP involvement in the provision of primary health care pg 11

Most studies showed that NP-provided care is comparable to physician-provided care on several process and outcome measures.

20 AHA Workforce Roles In ARedesigned Primary Care Model (Jan, 2013) Trust and respect among the health care team members and an environment that allows them to practice to the full scope of their license, respectfully share differing views and collaborating in order to deliver the highest quality care to the patient.

to practice to the full scope of their license, respectfully share differing

21 National Evidence Studies show that APRNs permitted to practice to full extent of education and training provide equal or better care Systematic review of published literature between 1990 and 2008 indicate patient outcomes of care provided by APRNs and equivalent or better than MD Patient satisfaction Length of stay NPs, BP, glucose, lipid control CNMs: Fewer C-sections, fewer episiotomies

22 Nursing first legislative success in 2013 session: Prescriptive Authority Agreement

23 Prepare and enable nurses to lead change to advance health care

24 1. Facilitate increased nurse involvement on boards. 2. Facilitate nurse involvement in innovation designed to improve the care environment. 3. Facilitate nurse leader mentorship and internships.

25 Team #3 Advancing Nursing Leadership Sub-Committee #1 Board Involvement Sub-Committee #2 Innovation Sub-Committee #3 Mentorship

26 Nurses bring important viewpoint to management and policy discussions

27 THA Appoints first CNO to Board in 2013 Caryn Iverson RN, MSN Presbyterian Dallas appoints first nurse to Board in 2013 Dr. Stephanie Woods Governor Appointments to Boards in 2012 Janell Shepard RN to THECB Dr. Alexia Green to TIHCQE

28 Gallup survey of 1,500 opinion leaders* said nurses should have more: Influence in reducing medical errors, increasing quality of care, promoting wellness Input and impact in planning, policy development and management Survey of 1,000 U.S. hospitals** found: Nurses account for only 6 percent of board members Physicians account for 20 of board members Other clinicians are 5 percent of board members *RWJF, 2010 **American Hospital Association, 2011

29 Research on health care workforce is fragmented Improved health care workforce data collection to better assess and project workforce requirements Need data on all health professions

30 Texas Ahead Texas Has: Texas Center for Nursing Workforce Studies Created by legislature in 2004 Provides nursing workforce information to Texas policy maker, legislators and Governor

31 Nurses should reflect patient population in terms of gender, race and ethnicity All nurses should provide culturally competent care 19

32 Percent of Population Un-insured 1 st Percent of Non- Elderly Un-insured 1 st Percent of Low Income Population Covered by Medicaid 49 th Percent of Population with Employer Based Health Insurance 48 th Total State Government Health Expenditures as percent of the Gross State Product 43 rd Per Capita State Spending on Mental Health 50 th Per Capita State Sending on Medicaid 49 th Percent of Population Physically Active 36 th Health Care Expenditures per Capita 44 th Hospital Beds per 1,000 Population 27th Texas on the Brink A Report to the Texas Legislature 2011

33 Questions Contact Ellarene Duis Sanders, PhD, RN, NEA-BC

34 Discussion/Comments/Group Work

Highlights from the Texas Team Central Texas Region Coalition LEGISLATIVE SUMMIT AT THE TEXAS CAPITOL. September 23, 2014

Highlights from the Texas Team Central Texas Region Coalition LEGISLATIVE SUMMIT AT THE TEXAS CAPITOL September 23, 2014 The Texas Team Central Texas Region Coalition presented the Legislative Summit at