A Registered Nurses Place in Affordable Healthcare Barbara Mayer, RN, PhD Director of Nursing Quality Stanford Health Care Stanford, California

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1 A Registered Nurses Place in Affordable Healthcare Barbara Mayer, RN, PhD Director of Nursing Quality Stanford Health Care Stanford, California People in Health Care January 29, 2015 San Diego, California

2 Stanford Health Care Level 1 Trauma Center 613 Licensed Beds 2500 Registered Nurses 49 Operating Rooms 25,100 Discharges 54,000 ED Visits 214 Clinics 520,882 Outpatient Visits

3 Nursing by the Numbers 2.8 million registered nurses are practicing in the US* 2.7% increase per year Average age is 45 years 33% are over the age of 50 14% are under the age of 30 55% hold a bachelor s degree or higher 66% work in acute care hospitals *HRSA, April 2013

4 A Changing Environment Time-based nursing care with the activities of bathing, treating, changing, feeding, intervening, drugging, and discharging are quickly becoming historic references to an age of practice that no longer exists. Now the challenge for nursing practice skills relates more to taking on the activities of accessing, informing, guiding, teaching, counseling, typing, and linking. Tim Porter-O Grady

5 Increasing Complexity Patients Higher acuity More knowledgeable about care Environment Complicated equipment/technology Regulatory oversight

6 The Affordable Care Act Implications for Nursing Financial incentives Use of technology Shift to use of outpatient resources Integration of disciplines Education

7 Value-Based Purchasing In a Nutshell Implemented in FY % of DRG payments withheld Maximum incentive payment 1.5% (FY 2015) Baseline data from used to calculate performance Incentive payment based on achievement and consistency, in each domain

8 Value-Based Purchasing FY 2013 FY 2014 FY 2015 FY % 0% 70% 25% 30% 0% 45% 30% 20% 20% 30% 25% 40% 10% 25% Clinical Process Core Measures Patient Experience Communication Responsiveness Pain Management Medication Instruction Discharge Process Environment Outcomes Mortality Safety Infection Efficiency $ per patient

9 Technology Meaningful Use and the EHR e-health/telemedicine Robotic surgery Smart pumps

10 Shift from Inpatient to Outpatient Imperative to decrease hospital length of stay: Financial incentives Patient safety Resource conservation

11 Integration of Disciplines Nurse-Physician Communication Interdisciplinary care

12 Nursing Education Increased need for nurses Some predict 250, ,000 annually IOM call for BSN Studies suggest safer practice Need for geriatric and hospice care Aging population Choosing Wisely Campaign Increased need for Advanced Practice Nurses Minimum Essential Care Provision Deficit of primary care providers

13 So Where Do You Start?

14 Smart Hiring Ensure the right fit Pre-hire survey Behavioral interviewing

15 Staff Retention Engage, create loyalty Gemba CNO forums Pride videos Career Ladder Tuition Reimbursement

16 Create Momentum Encourage collaboration, empower staff Multidisciplinary meetings Team Rounds Shared Leadership councils Kaizen workshops

17 New Nursing Roles Clinical processes Quality Consultants Data specialists Program Managers

18 New Nursing Roles Patient experience Advisory Council Patient Care Advocate Nurse Coordinator

19 New Nursing Roles Outcomes Director of Research for Patient Care Services Bedside Nurse Champions Wound Warriors Ostomy Extenders IT Super-users Project Transform

20 New Nursing Roles Efficiency Nurse Practitioners Crisis Nurses Float Nurse

21 The Nurse Leader Challenge Multigenerational work force Unpredictable environment Balancing quality care and financial boundaries Requires a new skill set Masters degree Business acumen

22 What Does the Future Hold? Increasing complexity of patients and environment Master s and Doctoral prepared nurses Increased use of Clinical Nurse Leaders Nurse Navigators Transitional Care Nurse Entry into Practice Nurses and Physicians train together

23 Thank You! Barbara Mayer, RN, PhD Director of Nursing Quality Stanford Health Care Stanford, California