How Best to Prepare Nurses for the Future?

Transcription

1 Page 3 Page 5 Quarterly circulation approximately 293,000 to all RNs, LVNs, and Student Nurses in Texas. How Best to Prepare Nurses for the Future? by J. Cunningham, TEXAS NURSING VOICE Staff For what by now seems like forever, nursing has been debating how best to prepare nurses for the future. The discussions often labeled as entry into practice or preparedness of future nurse leaders have lacked consensus, so nursing continues to grapple with the question: what is the right preparation the right levels of education and training that nurses need when they enter the profession and when they continue on with their careers? Just into the 21st century, the discussions took an interesting turn. Those outside of nursing joined in. Business, legislators, researchers, educators, other health care providers and the general public brought about a rediscovery for nursing of something it really had always known: nurses are at the very core of quality patient care. They are present at the bedside; in touch with the patient like no other health care provider. With such a unique focus, why then, many asked, does nursing not achieve more influence in key areas of health care? One Join the Texas Nurses Association Today! current resident or Presort Standard US Postage PAID Permit #14 Princeton, MN group asking was the polling division of the Gallup organization. On behalf of the Robert Wood Johnson Foundation, Gallup surveyed U.S. opinion leaders in 2009 about their views of nursing and nursing leadership, particularly the role America s nurses can and should have in improving access and quality of care, and containing costs. When findings of that Gallup survey titled, Nursing Leadership from Bedside to Boardroom: Opinion Leaders Perceptions were revealed at a news conference in Washington, D.C., Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said, Expanding the leadership of nurses is critical to health care reform. Opinion leaders recognize that we are squandering opportunities to learn from nurses and implement their ideas. While nurses are perceived as having a lot to offer, they are resources relatively untapped. Survey results identified the problem as one of structural issues there isn t a structure in place for people to listen and nurses to say. Or as Dr. Frank Newport, editor-in-chief of the Gallup Application on page 14. Poll, put it at the news conference: nurses lack a single voice on national issues, no leadership opportunities, no strategic vision, and different levels of education. In 2010, huge outside influences continued to press the discussion. The Patient Protection and Affordable Care Act was signed into law with an underlying promise of health care reform of high quality, safe, more affordable and accessible care for millions of Americans. In order to achieve that, however, a transformation of the entire health care system is required. And it puts nursing at the very core of the change. Also in 2010, an action-oriented blueprint for achieving a similar promise seamless, affordable, quality care that is accessible to all, patient centered, and evidence based and leads to improved health outcomes was put forth by the Institute of Medicine in its milestone report, The Future of Nursing: Leading Change, Advancing Health. Eight recommendations are outlined in the report; four key messages frame the discussion of how it is nursing that will lead How Best to Prepare continued on page 8 Inside this Issue Why the Push for Increasing the Number of BSN Nurses by 2020?....3 How Will Future of Health Care Look with the Affordable Care Act and Health Care Reform?. 6 Nurses: Are You Ready for Your New Role in Health Information Technology?....7 The Growth of Complex Patients....8 RN Green Among Board of Director Appointments to Texas Institute of Health Care Quality and Efficiency....9 Nursing Practice Question: Is Unsecured Texting/Receiving of Patient Information via Smartphone a Potential Weak Link in Health Care? Membership Application

2 Page 2 Texas Nursing Voice April, May, June 2012 Texas Nurses Association Districts and Presidents Presidents of the 28 state-wide Districts of Texas Nurses Association, as well as some District offices, are listed below. They invite you to contact them with questions or comments about TNA District membership and involvement in your local areas. For specific District locations, please refer to the TNA Tri-Level Membership District map on page 14. TEXAS NURSING Voice A publication of Texas Nurses Association April, May, June 2012 Volume 6, Number 2 District 1: Laura Sarmiento Phone: laurasarmiento01@aol.com District 2: Beth Terry Phone: bterry@amarillo heartgroup.com District 3: Dennis Cheek Phone: d.cheek@tcu.edu District Address: Renee James P.O. Box Ft. Worth, TX Office: tna3@usapathway.com Website: District 4: Frances (Frankie) Phillips Phone: frances.phillips@va.gov District Address: Pat Pollock P.O. Box Dallas, TX Office: d4tna@flash.net Website: District 5: Gail Acuna Phone: gail.acuna@st.davids.com Website: District 6: Paula Stangeland Phone: pstangeland9@gmail.com Website: District 7: Linda Pehl Phone: lpehl@umhb.edu District Address: P.O. Box 3041 Temple, TX District 8: Sarah Williams Phone: williajs@uiwtx.edu Website: org/districts/08/ District 9: Dana Bjarnason Phone: dana_bjarnason@hchd. tmc.edu District Office: Melanie Truong 2370 Rice Blvd., #109 Houston, TX Office: tna9@tnadistrict9.org Website: District 10: Joyce Sims Phone: jsims@mclennan.edu District 11: Marcy Beck Phone: marcy.beck@mwsu.edu District 12: Alicia Boaze Phone: alicia.boaze@bhset.net District 13: Vacant District 14: Joe Lacher Phone: joe.lacher@utb.edu District 15: Andrea Kerley Phone: akerley@ hendrickhealth.org Website: org/districts/15/ District 16: Wilma Powell Stuart Phone: wilmastuart@ shannonhealth.org Board Investigation Peer Review Legal Problem Don t go it alone Before You Respond Call Joe Perdue for a free consultation Your license, your reputation is on the line. You have worked hard to earn them. Don t let them be tarnished. They may represent a governmental agency or your employer but you have rights that you should protect. Contact us today Mr. Perdue and Mr. Plummer are proud to announce that they were selected for inclusion in Super Lawyers Rising Stars Edition 2012 for their legal work. We will be by your side from day one to the end. Our principal office is located in downtown Houston just minutes from the Texas Medical Center at 1314 Texas Ave., Ste We will make time for you. For more go to: Perdueplummer.com District 17: Eve Layman Phone: evelayman@yahoo.com Web site: org/districts/17/ District 18: Jeff Watson Phone: jeff.watson@ umchealthsystem.com Website: org/districts/18/ District 19: Tara Patton Phone: power4nurses@gmail.com Website: org/districts/19/ District 20: Debbie Pena Phone: Debbie.pena@ victoriacollege.edu District 21: Rebekah Powers Phone: Rebekah.powers@ midland-memorial.com District 22: Toni McDonald 3tmcdonald@ windstream.net District 25: Inger Zerucha Phone: zinger65@sbcglobal.net District 26: Vacant District 28: Jenny Wilder Phone: jennyrwilder@gmail.com District 29: Beverly Howard Phone: bhoward@alvincollege.edu District 35: Kim Gatlin Phone: kgatlin@ntcc.edu District 40: Contact TNA Phone ext brichey@texasnurses.org Published by: Arthur L. Davis Publishing Agency, Inc. Editor-in-Chief Clair B. Jordan, MSN, RN Managing Editor Joyce Cunningham Creative Communications Deborah Taylor Circulation Manager Belinda Richey Editorial Contributors Therese Clinch, MSN, RN; Stan Harmon, MSN, RN, FNP; Joyce Cunningham; Christy Meriwether; Angelica Ybarra, BSN, RN Editorial Advisory Board Stephanie Woods, PhD, RN, Dallas Jose Alejandro, MSN, RN, MBA, CCM, Dallas Patricia Allen, EdD, RN, CNE, ANEF, Lubbock Sandra Kay Cesario, PhD, RN, C, Pearland Jennifer D.M. Cook, PhD, MSN, RN, San Antonio Anita J. Coyle, PhD, RN, CHES, Sanger Thelma L. Davis, LVN, Giddings Anita T. Farrish, RN, MHSM, NE-BC, Waco Patricia Goodpastor, RN, The Woodlands Patricia Holden-Huchton, RN, DSN, Denton Tara A. Patton, BSN, RN, Palestine Dianna Lipp Rivers, RN, CNAA, BC, Beaumont Executive Officers Margie Dorman-O Donnell, MSN, RN, President Victoria England, RN, MBA, Vice President Claudia Turner, MSN, RN, Secretary-Treasurer Regional Directors of Texas Nurses Association June Marshall, DNP, RN, NEA-BC North Region Eve Layman, PhD, RN, NEA-BC South Region Kim Belcik, BSN, RN-BC Central Region Viola Hebert, MA, BSN, RN East Region Jo Rake, MSN, RN, CNAA West Region Executive Director Clair B. Jordan, MSN, RN TEXAS NURSING Voice is published quarterly January, February, March; April, May, June; July, August, September; and October, November, December by Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX Editorial Office TEXAS NURSING Voice, 7600 Burnet Road, Suite 440, Austin, TX , tnveditorial@texasnurses.org Address Changes Send address changes to Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX , tnvcirculation@texasnurses.org Advertising Arthur L. Davis Publishing Agency, Inc., 517 Washington St. P.O. Box 216, Cedar Falls, Iowa , sales@aldpub.com Texas Nurses Association and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. Acceptance of advertising does not imply endorsement or approval by Texas Nurses Association (TNA) of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. TNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect the views of the staff, board, or membership of TNA or those of the national or local associations. Copyright 2012 by Texas Nurses Association, a constituent member of the American Nurses Association.

3 April, May, June 2012 Texas Nursing Voice Page 3 Why the Push for Increasing the Number of BSN Nurses by 2020? by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association Staff nurses and some nurse leaders keep asking the question, why the push for increasing the number of nurses with BSN degrees by 2020? Some nurses would argue that by successfully passing a National Council Licensure Examination (NCLEX), they have demonstrated the minimal competencies needed to safely care for patients and they will continue to increase their nursing knowledge and experience as they work in clinical settings with patients. Taking the NCLEX-PN or the NCLEX-RN is a capstone experience to your studies and so much more. Passing the exam demonstrates your competence so that you can launch your nursing career. That is true for current and seasoned nurses however, with the changes occurring in health care due to advancements in medicine and technology which are leading to people living longer, the ability to provide a higher level of care for patients with chronic illnesses creates a greater demand on nurses in coordinating care in clinical settings. Now, it s no longer simply about having the skill set to care for chronically ill patients. Rather it s having the in-depth knowledge and ability to utilize evidence-based practice from research and nursing theory, team work, and wellness and prevention concepts in caring for the complex patient of the future alongside highly functioning, interdisciplinary care teams that include physicians, pharmacists, social workers and physical therapists, many of whom have earned doctoral degrees. Nurses, as care coordinators, will need to see the whole picture when it comes to patients with chronic illnesses. Nurses must have good communication skills in order to communicate patient problems to the care team that are related to medications, treatment modalities, and procedures that are ineffective and/or causing more side effects or adverse effects. Now is the time for nurses to drive change in their practice and work environments. Gone Board Issues? Medicare and Medicaid Questions? Joe Flores is a fellow RN, FNP and an Attorney! Joe is a nationwide lecturer on nursing and the law. He represents registered nurses and other healthcare providers in matters concerning Nursing Board Licensure Hospital Law Home Health Law Nursing Home Law Health Care Fraud Civil and Criminal R Trial Lawyer Call Today and Program His Number in Your Cell Phone joe@floreslawfirm.com are the days of this is how it s always been done and why change it? Why? Because the landscape has changed for nurses and patients due to an aging population with multiple, simultaneous chronic illnesses accessing health care. Nursing programs of the future will need to have nursing theory, nursing research, wellness, safety and prevention, care coordination and patient-centered care, health informatics, and teamwork concepts in their curriculum in order to prepare the nurses to care for complex patients with chronic illness(es) including the increasing geriatric population. Nursing programs include key competencies in their curriculum in preparing future nurses for the workforce and care of complex patients resulting in positive patient outcomes. Key competencies in a nursing program curriculum would include nursing practice, research, communication, leadership, professionalism, cultural competency, teaching and critical thinking (Nursing 2012). Nurses will need to elevate their critical thinking skills in making clinical decisions in a systematic and logical manner with an openness to questions and a reflection on the reasoning process used to ensure safe nursing practice and quality care. (Critical Thinking in Nursing, 2008) Here are some nurses statements on their BSN education: (Nursing 2012) Nursing is more than administering medications and performing tasks Nursing practice has changed from taskoriented delivery of care to theory-driven care based on standards of care of the profession Learning to consider both patient and the health system working on a team better team player Learning how to utilize resources including standards of practice, professional websites, and evidenced-based research when considering nursing interventions Full and Part-Time Faculty Positions Fall 2012 Concordia University Texas is currently recruiting for full-time faculty in Adult Health, Pediatrics, OB, Mental Health and Community Health for Fall Also, we are recruiting Adjunct (part-time) Instructors as follows: Mental Health Lecture and Practicum, Pediatrics Lecture and Practicum, Maternal/Newborn Practicum, Advanced Adult Health Capstone Practicum, Interdisciplinary Team Communications Lecture, Community Health Nursing Lecture and Practicum For more information or to apply, please visit our website Member, Texas Tech University System Position announcement PROGRAM DIRECTOR FOR NURSING/ BUDDY DAVIDSON ENDOWED CHAIR Angelo State University is seeking a Nursing Program Director to join the Physical Therapy and Athletic Training Program Directors in the Department of Nursing and Rehabilitation Sciences with an anticipated start date of Fall Qualifications Earned doctorate from a regionally accredited institution and a Master of Science in Nursing. Current unrestricted RN license in the state of Texas (or eligible) To view and apply visit EOE Ability to communicate my ideas better due to the greater understanding of health care policy, organizational structure and nursing practice Some health care leaders and educators have suggested that health care professional education programs require and support interprofessional education. Interprofessional education brings together members of the health care team to learn and work together in providing patientcentered care especially in the health care education programs (Linda Cronenwett s presentation at Texas Nurses Association s 10th Annual Nursing Leadership Conference, 2010). References Nursing 2012, (March, 2012). Magnet hospitals are attracted to the BSN but what s in it for the nurses? Retrieved on 3/9/2012 from Critical Thinking (2008). Critical Thinking and Nursing. Retrieved on 3/5/2012 from Texas Nurses Association Annual Nursing Leadership Conference (September, 2010). Linda Cronenwett s presentation on Education Preparation of Primary Care Providers of the Future. Stethoscope Skills! Back By Popular Demand! Are you certain of what you hear through your stethoscope? This one day class covers everything you always wanted to know about using the stethoscope: the basics and way beyond!! Covers Heart, Breath, & Abdominal Sounds and much more! Everything you need to know about the sounds you hear! Choose from these locations: Apr 11 Texarkana Apr 12 Marshall Apr 13 Nacogdoches Apr 18 Arlington Apr 19 Austin Apr 25 Galveston Apr 26 Houston Apr 27 San Antonio May 1 San Angelo May 2 Odessa May 15 Amarillo May 16 Sweetwater May18 Abilene May 23 Dallas May 24 San Marcos July 11 Houston July 12 Victoria July 13 Kerrville July 25 Wichita Falls July 26 Fort Worth July 27 Austin 9am - 4:30pm each day. Approved for 6 CEU s. Fee $79; Group & Student Discounts Available Call or visit: LICENSING BOARD, PEER REVIEW, EMPLOYMENT PROBLEMS? DO NOT WAIT!!! Call before you respond to a letter or notice. Toll Free: Initial Consultation is Free Friend & Associates Nurse Health Care Attorneys Practice Throughout Texas Aug 7 Corpus Christi Aug 8 San Antonio Aug 15 El Paso Aug 16 Fort Stockton Aug 17 Del Rio SAN marcos treatment center, in continuous operation for more than half a century, is recruiting Texas Licensed Registered Nurses to become part of an experienced and effective treatment team. Our highly specialized residential programs provide 24 hour care to a broad spectrum of adolescent boys and girls ages 8-17 with psychiatric, neuropsychiatric, and developmental disturbances. Apply in Person, Call, or Mail/Fax resume to: san marcos treatment center 120 Bert Brown Road San Marcos, TX robin.cunningham@uhsinc.com Phone: (512) Fax: (512) Attn: Human Resources Pre-employment Drug Screen, Health Assessment & Criminal History Check required An Equal Opportunity Employer

4 Page 4 Texas Nursing Voice April, May, June 2012 Spring into New Adventure Enjoy going to work each day without the hassle of heavy traffic. Have an uncomplicated drive in the country and come to a facility that cares enough to make a difference in the lives of our residents. Cypress Woods Care Center 135 ½ Hospital Dr. Angleton, TX RNs, LVNs Seeking RNs ICU Nights and ED Nights (7pm-7am) Active Texas license or ability to obtain Equal Opportunity Employer To learn more visit Are You a Nursing Professional with a Passion for Education? Teach for the DCCCD! Dallas County Community College District, the largest undergraduate institution in the state of Texas, is a leading educator for Nursing and Allied Health! DCCCD offers excellent benefits, a great work environment and state-of-the-art educational facilities! We are currently seeking a Director, Nursing/Allied Health Skills Lab III and 2 Nursing Faculty Positions. Give us a shot, visit our web site at for more information! Wishing upon a star? IRAM, 31, BRAIN CANCER, WITH HIS DAUGHTER LIVESTRONG can help your patients with emotional support. We also provide services and resources that may help your patients preserve their fertility, manage their finances and understand a cancer diagnosis, and we can help them navigate a complex system. Learn how LIVESTRONG supports health care professionals and their patients toll-free at For more information visit LIVESTRONG.org/yourpatients Find a nursing career where you can become a star! nursingald.com Registration is free, fast, confidential and easy! You will receive an when a new job posting matches your job search.

5 April, May, June 2012 Texas Nursing Voice Page 5 The Need for High-Level Care Coordination by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association What would the high-level care coordination model for complex patients including geriatric patients look like in health care of the future for nurses who focus on value-based care of patients? Care coordination has always been part of the nurse s role so how will it be different in the future? Care coordination is a set of activities encompassing patient engagement, assessment, care planning, monitoring, support for family caregivers and coordination with all providers especially during the patient transitions from one level of care to the other. The care coordination process consists of: Initial, comprehensive assessment of the patient and patient s circumstances including family Development of a comprehensive care plan that addresses the patient s medical and social and family needs Designated individual to take the lead communicating and coordinating with the patient s medical and social service providers Including the family and the patient in the patient s plan of care Care coordination models that have been developed are being considered to improve quality, efficiently or health-related outcomes of care for the chronically ill adults and older adults. Two models being considered are the primary care-based model which would reside in primary care and/or physician office settings and community-based models which would reside in hospital and/or community settings (The Gerontological Society of America Scientific Summit, September 2010). RNs would be the best choice as care coordinators, functioning in one or both of the care coordination models above. Organizations would need to provide adequate staffing ratios to ensure the nurse is able to function in the care coordinator role, provide education and training of nurses on the higher level care coordinator s role and process with ongoing evaluation by supervisors. RN care coordinators would ensure ongoing focus on patientrelated outcomes and be the team leader on the care team. RN care coordinators would need to elevate their expertise and knowledge of chronic illnesses, disease process, and treatment protocols to achieve the desired outcomes set by the patient s plan of care as developed by the interdisciplinary team of physician, pharmacist, nurse and other health care providers due to the complexity of the patient. Nurses will need to possess expert leadership skills to manage the complex patients with chronic illnesses and be able to recognize incompatibility of treatment protocols and communicate to the team with the goal of reaching the desired outcomes (The Gerontological Society of America Scientific Summit, September 2010). For complex patients in the Medicare system, the Centers for Medicare & Medicaid Services (CMS) is promoting the voluntary development of Accountable Care Organizations (ACO) to include the RN s role as care coordinator. The ACO model focuses on addressing the need for proactive and effective coordination across all levels and types of health care services. ACOs consist of groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated, high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. New clinical workflows and business processes will need to be designed and nurses should be an active part in the development of these entities within ACOs. Some potentially new nursing roles as care coordinators in ACOs are: Care outreach Health and wellness Coaching and coordinating medical, social and psychosocial needs Care management strategies The Need for High-Level Care continued on page 6

6 Page 6 Texas Nursing Voice April, May, June 2012 The Need for High-Level Care continued from page 5 (Milliman Health Care Reform Briefing Paper, April 2011). In Texas, an example of a communitycoordinated model has started with the goal of reducing adult potentially-preventable hospitalizations in 16 eligible counties with a population rate of less than 100,000 residents that has a high rate of adult hospitalizations of people with preventable hospitalization illnesses over the rate of the state. This community-coordinated approach initiative was a result of the 82nd Texas Legislature allocating funding to Texas Department of State Health Services (TDSHS) to implement an initiative to reduce potentially preventable hospitalizations in fiscal year 2012/2013. Targeted adult potentially-preventable hospitalizations are: Bacterial Pneumonia Dehydration UTI Congestive Heart Failure (CHF) Hypertension Asthma COPD Chronic Obstructive Pulmonary Disease Diabetes complications Community-coordinated approach initiative included the implementation of one or more evidence-based interventions including immunizations, patient education, community education, smoking cessation, health care provider education, diabetes self-management education, patient case management, nutrition and physical activity, weight management, glycemic control and blood pressure control. A coalition was formed of community health stakeholders including hospitals, DSHS, home health agencies and elected officials to assist in implementing the evidencedbased interventions in the county. Each county identified a Project Contact to lead the community coordinated approach interventions. (TDSHS, January 2012) This initiative and the formation of ACOs in Texas are the beginning of what health care may look like in the future due to the Affordable Care Act. RNs will face a variety of new challenges in the coming years as they are asked to play a greater role in patient care coordination due to their commitment to ongoing education and training and the trust that patients have for them. References The Gerontological Soicety of America Scientific Summit (September 2010). Diffusing Care Coordination Models: Translating Research into Policy & Practice. Retrieved on 3/5/2012 from Models-Summit%20Summary.pdf How Will Future of Health Care Look With the Affordable Care Act and Health Care Reform? Milliman Health Care Reform Briefing Paper (April 2011). The Nurse s Role in Accountable Care. Retrieved on 3/8/2012 from healthreform/pdfs/acos-beyond-medicare.pdf Texas Department of State Health Services (January 2012). Stakeholder Update: Reducing Adult Potentially Preventable Hospitalizations Initiative 01/29/2012. Retrieved on 3/8/2012 from the Assessment & Benchmarking Specialist Office of State Epidemiologist at Texas Department of State Health Services electronic message system. As coordinators of care in the future, nurses will take the lead in delivering and coordinating care for patients, safeguarding them against medical errors and acting as their advocate as they move from clinical settings to other settings within the health care system. There has been much written on the changes coming in health care because of the Patient Protection and Affordable Care Act of So, what is the current delivery system and what is the suggestive delivery system of the future? The current delivery system has been about volume of services and pay for reporting services by health care organizations and providers, and not as much around the value for patients. Movement toward restructuring the care delivery system to offset the rising costs of an aging population and new medical advances is the thinking surrounding where health care is moving in the future. (NEJM, 2009) What is the goal of the movement toward an increasing value for patients? It is health outcomes achieved per dollar spent and the accomplishment through a value-based system of achieving and maintaining good health (preventive care). To achieve a value-based delivery system of the future, the following would need to be implemented: Outcomes are measured over the full cycle of care for a medical condition, not separately for each intervention. Measurement of true health outcomes and not process measures/outcomes. Move to integrated practice units that require full cycle of care for each medical condition including common coexisting conditions and complications with use of EMR (electronic medical records) to support integrated care and outcome measurement. Consumers become much more involved in their health and health care. Outcome measurement will drive the restructuring of care delivery. Electronic medical records will facilitate both delivery restructuring and outcome measurement. Value-based system leads to patient-centered care for the older adults by providers. Patientcentered care includes the patients as active participants in their own care and receives services designed to focus on their individual needs and preferences (AHRQ, 2002). Valuebased system and shift to patient-centered care could support the development and expansion of Accountable Care Organizations (ACOs), which are collaborations between physicians, hospitals, and all providers that provide health care delivery in their communities. (CMS, 2010) Health care strategy will involve a sequence of steps over time rather than changing all at once. What does it mean for nurses and how they care for patients in the clinical setting? It means that nurses will take the lead in the care coordination of the complex patients through the use of their high level critical thinking, indepth disease knowledge, expert leadership skills, and comprehensive nursing skills and assessment to ensure positive patient outcomes. This is the time for nurses to step up and take the lead in the care of older and complex patients and ensure quality patient care. References New England Journal of Medicine (July 2009). Perspective: A strategy for Health Care Reform Toward a Value-based System. New England Journal of Medicine 2009, 341: retrieved on 3/5/2012 from full/ /nejmp Agency for Healthcare Research and Quality (AHRQ), (May 2002). Research in Action: Expanding Patient-Centered To Empower Patients and Assist Providers. Retrieved on 3/5/2012 from Center for Medicaid and Medicare Services (CMS), (January 2010). Roadmap for Implementing Value Driven healthcare in the Traditional Medicare Fee-For-Service program. Retrieved on 3/6/2012 from QualityInitiativesGenInfo/downloads/VBPRoadmap_OEA_1-16_508.pdf RN: CAMP NURSE GENEVA GLEN CAMP in INDIAN HILLS, Colorado, needs a CAMP NURSE for the 2012 Summer: June 3-August 11. GENEVA GLEN has an excellent reputation and rich heritage. ACA accredited. Compensation includes $6,000 salary, travel allowance of $300, insurance, room and board, beautiful new health center facility, participation in camp life including horseback riding, swimming, hiking ideal Colorado climate, healthful working environment (Indian Hills is near Red Rocks). Nurse graduates welcome! Contact: Ken or Nancy Atkinson, Directors, P.O. Box 248, Indian Hills, CO 80454, (303) ken@genevaglen.org. Apply online at Navy Nursing. Truly an Honor. There are opportunities for nurses to gain extraordinary experience serving part-time in America s Navy Reserve. And all while maintaining a civilian career. 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7 April, May, June 2012 Texas Nursing Voice Page 7 Nurses: Are You ready for Your New role in HeAltH information technology? When health information technology (HIT) is fully integrated into direct patient care at every hospital, there will be new expectations of nurses. For every nurse, the time is now to get ready for your new role in HIT and its impact on patient safety and quality. To help nurses prepare, Texas Nurses Association and Texas Organization of Nurse Executives have teamed up to deliver two continuing nursing education opportunities on the topic: May 23, 2012 FREE CNE WEbiNaR UNiNtENdEd CoNsEqUENCEs of UsiNg ElECtRoNiC HEaltH RECoRds. 12:30-1:30 p.m. Webinar presenters are Mari Tietze, PhD, RN-BC, FHIMSS and Mary Beth Mitchell, MSN, RN, BC. Get more information and REgistER today at texasnurses.org > Events. 1.0 contact hours will be awarded for successful completion. JUNE 1, 2012 CNE activity informatics and technology: supporting professional NURsiNg, improving the quality of CaRE. 11 a.m. to 4 p.m., Houston. This interactive, critical thinking, scenario activity will provide practical approaches for solving common HIT implementation challenges, including workflow redesign for the optimization of patient safety and quality. The activity, provided by Texas Nurses Association and Texas Organization of Nurse Executives and hosted by TNA District 9 in conjunction with the Houston Organization of Nurse Executives, is a must-attend for nursing leaders, clinical directors, middle- and first-line managers. Get more information and REgistER today at texasnurses.org>events. Early bird registration (prior to May 18) is $60 per person (includes lunch and all materials); registration until May 30 is $75 per person. Parking is FREE. 4.0 contact hours will be awarded for successfully completing the activity. Provided by texas Nurses Association and texas organization of Nurse executives The CNE activity planning committee reserves the right to cancel this activity or substitute faculty in the event of unforeseen or extenuating circumstances. Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation.

8 Page 8 Texas Nursing Voice April, May, June 2012 The Growth of Complex Patients by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association The day of nurses caring for patients with only one chronic condition is becoming less common and less seen in the clinical setting (AHRQ, 2011). Instead, what s becoming more common is people who are suffering with one or more chronic illness having multiple providers treating them. The reason could be that people are living longer due to the advancement in medicine and technology, and accessing the Medicare system for coverage. The following is a breakdown of chronic health conditions including chronic conditions and/or functional problems of people in the Medicare system: (Gerontology Society Summit 2010) 88 percent of persons 65 years or older have at least one chronic health condition 65 percent have at least two chronic health conditions 24 percent have four or more chronic health conditions These numbers could rise as a large number of Baby Boomers retire and access health care and Medicare. Due to the anticipated rise in the number of people with multiple, chronic conditions who will seek health care, researchers are looking at how to prioritize treatment and preventive care for those patients, such as deciding which medications should be prescribed in the treatment of patients with multiple conditions when the medicines may have dangerous interactions. And they are also determining the harm and/or benefit of preventive tests that may unnecessarily burden patients with multiple chronic conditions who might already be juggling numerous drugs, doctors and office visits. This will result in the move from caring for each of a patient s conditions to caring for the patient as a whole. (AHRQ, 2011) Health care of older adults extends beyond the traditional medical management of illness. Health care providers will evaluate all issues WE DEFEND NURSES! (throughout the State of Texas) BON Defense TPAPN Assistance Peer Review Assistance RN and LVN Reinstatements Hearings and Appeals Nurse Malpractice Defense Are you under investigation or received a complaint letter? Call our law firm NOW! Austin: (Located six blocks from Texas Board of Nursing) Houston: San Antonio: belolaw.com that contribute to or impact the health of older adults including physical, cognitive, affective, social, financial, environmental and spiritual. Basic components of an older adult s or a geriatric client s assessment need to include (Medscape): Medical problem list, medication and treatments reviews, and nutritional status Psychological mental status (cognitive), depression/mood Social support network, financial support Environmental home safety, transportation and telehealth Functional components ability to perform activities necessary or desirable in daily life such as activity of daily living (ADLs) This assessment and evaluation of older adults or geriatric clients will involve an interdisciplinary team that consists of a physician, nurse, social worker or case manager, and pharmacist in developing patient-centered care plans on older adults or geriatric patients who move from clinical setting to clinical setting. (Up-To-Date 2012). Nurses will need to have astute assessment skills in caring for the older adults, have the ability through clinical reasoning skills to recognize problems, and communicate potential or actual problems to the interdisciplinary team for possible changes in the care plan if needed. Teamwork among the interdisciplinary team is essential in the care for older adults or geriatric clients, and nurses will be expected to take the lead of the team. They therefore must rely on their in-depth knowledge of the disease process or chronic illness, comprehensive nursing process skills, high level critical thinking or clinical reasoning and leadership skills. References Agency for Healthcare Research and Quality (AHRQ) September The challenge of prioritizing care of complex patients. U.S. Department of Health and Human Services, No 3l73, September 2011). Medscape (2012), Components of Comprehensive Geriatric Assessment. Retrieved on 3/8/2012 from com/viewarticle/465308_4 Up-To-Date (2012), Comprehensive geriatric assessment. Retrieved on 3/5/2012 from comphrehensivie-geriatic-assessment The Gerontological Soicety of America Scientific Summit (September 2010). Diffusing Care Coordination Models: Translating Research into Policy & Practice. Retrieved on 3/5/2012. Baylor College of Medicine, located in the heart of the Texas Medical Center in Houston, Texas, currently has openings for Registered Nurses (Clinic), Nurse Practitioners, and Research Nurses. Baylor College of Medicine, the only private medical school in the Greater Southwest, is recognized as a premier academic health science center and is known for excellence in education, research and patient care. To apply, please visit Baylor College of Medicine is an Equal Opportunity/ Affirmative Action/Equal Access Employer. How Best to Prepare continued from page 1 the change to advance health. Again, nursing is placed by others at the core of this monumental realignment of our health care system. But, the report points out, if nursing is to lead the change that advances health, nursing education must be fundamentally improved both before and after nurses receive their licenses. Why? Because nurses must be better prepared; nursing care must be strengthened. In the future, chronic conditions will replace acute illnesses in patients, care environments will shift and needed competencies will expand to include leadership, research, evidence-based practice, health policy, and interprofessional collaboration. Health care environments will be more complex, technology and health information systems will be implemented more widely, and nurses will be called upon to coordinate care across the continuum and collaborate in a new way. Now, the 2012 discussion of how best to prepare nurses for the future is being framed by the Initiative on the Future of Nursing as 80 by 20 increasing to 80 percent by 2020 the proportion of nurses with a bachelor of science in nursing degree (BSN) or higher, and doubling the number of nurses with doctorates. Whether that goal can be achieved in Texas and exactly how it might be is the question being considered by the Texas Nurses Association Education Committee and the Advancing Nursing Education Committee of Texas Team Action Coalition. In this issue of TEXAS NURSING VOICE, we take a look at some of the factors of preparing nurses to lead in the transformation of health care in the state: Why the Push for Increasing the Number of BSN Nurses by 2020? page 3 The Need for High-Level Care Coordination page 5 How Will the Future of Health Care Look? page 6 The Growth of Complex Patients page 8 And we take a look at the personal explanation of one nurse/nursing student who decided to continue on and further her education page 13. Ultimately, stakeholders are valuable and can weigh in with unique and encouraging perspective but it is nursing who must prepare itself for the future. The DeTar Healthcare System has delivered high quality and compassionate healthcare to the residents of our community for more than 80 years. Position Openings: Staff RN Nurse Requirements: 2 years nurse work experience in an acute level hospital ER TICU ICU Med/Surg PACU Pediatrics Cath Lab Services NURSE MANAGEMENT Requirements: 2 years management/charge experience in field preferred. 3-5 years recent nurse experience in specialty required. ER Manager Please visit to view and apply DeTar Healthcare System DeTar Navarro 506 E. San Antonio St. Victoria, TX DeTar North 101 Medical Drive or EOE Employer

9 April, May, June 2012 Texas Nursing Voice Page 9 RN Green Among Board of Director Appointments to Texas Institute of Health Care Quality and Efficiency In early March, Gov. Rick Perry announced the Board of Directors appointments to the newly created Texas Institute of Health Care Quality and Efficiency. Alexia Green, PhD, RN, FAAN, is among those appointed and is the only nurse. She will serve the citizens of Texas alongside seven physicians and six business leaders from across the state. Ben Raimer, MD of Galveston will serve as Board chairman. The Texas Institute of Health Care Quality and Efficiency resulted from Senate Bill 7 of the 82nd Legislative Session. According to the governor s office, the institute will improve health care quality, accountability, education and cost to the state by encouraging health care provider collaboration, effective health care delivery models and coordination of health care services. It is also intended to provide a cost savings to Texas of approximately $467 million by expanding managed care and streamlining efficiencies in the Medicaid program. Dr. Green is professor and dean emeritus of the Texas Tech University Health Sciences Center School of Nursing, past president of Texas Nurses Association a co-lead organization of Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action, and a member of the American Nurses Association. She currently serves as a co-leader representing nursing on the Texas Team Action Coalition, a diverse group of stakeholders interested in effecting sustainable change at the state level by capturing best practices, determining research needs, tracking lessons learned and identifying replicable models that can then accelerate improvements nationally. Through this newly appointed Board seat, Dr. Green can help nurses in Texas better realize the vision of a transformed health care system as put forth by the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. The report outlines the need for a fundamental transformation of the nursing profession. Part of that transformation requires nurses to be full partners with other health professionals, in redesigning health care in the U.S. Dr. Green s leadership for nursing on this Board presents her with the privilege and opportunity to represent nursing, and to be a thoughtful strategist as Texas sets about to improve health care in the state. Dr. Green s appointed term of office will expire January 31, Simplify your nursing research... with access to over 10 years of nursing publications at your fingertips. nursingald.com Simply click on the Newsletter tab on the far right and enter your search term. WE DEFEND NURSES AGAINST BOARD OF NURSING COMPLAINTS HIRE AN AFFORDABLE, EXPERIENCED FORMER MEDICAL BOARD PROSECUTOR TO AGGRESSIVELY DEFEND YOU! ATTORNEY OSCAR SAN MIGUEL IS A FORMER P.A., O.R. TECHNICIAN AND MEDICAL BOARD PROSECUTOR. HE HAS HANDLED HUNDREDS OF CASES BEFORE LICENSING BOARDS AND COMMISSIONS. OSCAR SAN MIGUEL S OFFICE IS IN AUSTIN WHERE ALL BOARD OF NURSING HEARINGS ARE HELD. YOU DON T HAVE TO PAY TRAVEL EXPENSES WHEN YOU HIRE OSCAR SAN MIGUEL. REASONABLE RATES. PAYMENT PLANS AVAILABLE ON ALL CASES. Mr. San Miguel s fees were very reasonable and he worked diligently on my case. He is the type of attorney that thinks out of the box. He literally saved my stellar career and because of his persistence, and intellect, I am continuing to practice nursing doing what I do best. Thank you Oscar! T.H. RN OSCAR SAN MIGUEL Of Counsel Bargas Law Firm OSCAR@OSMMEDLAW.COM fax

10 Page 10 Texas Nursing Voice April, May, June 2012 Happy Nurses' Week In recognition of the heartfelt passion you display this week and all year long, Select Specialty Hospitals and Regency Hospitals wish you a Happy Nurses' Week. Select Specialty HoSpitalS Dallas Houston Heights Houston Medical Center Houston West Midland San Antonio South Dallas Regency HoSpitalS Fort Worth Odessa offering Full time and prn opportunities for experienced telemetry and icu Rn s Contact Tricia Cogdell, Divisional Recruiter tcogdell@selectmedical.com selectmedical.com Across the United States, Select Medical s knowledge network includes 111 long-term acute care hospitals. Education is a journey. Discover yours... Online. Adventure awaits. Imagine the possibilities. Skiing, hiking, camping and fishing make Alaska a pleasure-seeker s dream. Fairbanks Memorial Hospital, located in the Golden Heart of Alaska, in the second largest city in Alaska, is the perfect jumping off point for exploring the state. We at Fairbanks put the patients first and remain steadfast in our commitment to providing the highest quality healthcare to our friends and family. Opportunities available for Nurse Practitioners & Staff Nurses various departments If you re looking for a career with great benefits that makes your future a priority, look to Banner Health. Visit or call Please reference keyword Alaska Careers when applying. Take care of your patients AND your career with a CCNE-accredited nursing degree from WGU Texas! Relevant and Accredited CCNE-accredited degree programs designed to produce highly qualified, caring nurses, educators, and administrators. Flexible Log in and learn anytime, anywhere you can find the time before, during, and after rigorous nursing shifts. Affordable One of the best values in higher education, WGU Texas tuition is among the most affordable in the entire country. Competency-based Challenging programs that measure your learning rather than your time spent in class. Programs begin the first of every month. Your future can start right now! *RN Prelicensure programs available in select areas! Texas.WGU.edu/texasnurse WGU.edu/StudyWGU EOE/AA. We support a tobacco-free and drug-free workplace. Connect with Banner Health Careers:

11 April, May, June 2012 Texas Nursing Voice Page 11 Nursing Practice Question: Is Unsecured Texting/Receiving of Patient Information via Smartphone a Potential Weak Link in Health Care? by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association In the last issue of TEXAS NURSING VOICE (January, February, March 2012), my nursing practice question had to do with the appropriateness and liability of texting patient information. I asked: Is Texting/Receiving Patient Information a HIPAA Rules Violation? The question was posed as a way to bring awareness to this growing and misdirected trend in health care and believe me, it did. It stirred up conversation among nurses and some of them phoned me with additional responses and reactions. In light of the interest in that question, I now offer a follow up from the health informatics industry. Health informatics leaders are working at a fast pace to become compliant with the American Recovery and Reinvestment Act of 2009, and the implementation of Meaningful Use of Electronic Health Records. One common practice that is growing is the sharing of patient information between physicians and independent practitioners, as well as between patients and families via hospital portals and/or smartphones.¹ Although this sharing via portals and smartphones is becoming a best practice in coordination of patient care and improving communication among health care workers and practitioners, it brings challenges to the health care workplace in the way of privacy concerns, workflow issues, and the task of integrating new technologies in already existing IT systems, and brings potential liability to nurses and organizations if portals and smartphones are not secured with encrypted software. As mentioned in the first article on this question, a Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation is a concern with this growing practice of sending and receiving texted patient information/ orders between physicians and independent practitioners. Violations can lead to criminal and/ or civil law suits resulting in fines of up to $50,000 and up to one-year imprisonment for any person who knowingly obtains or discloses individually identifiable patient health information.² In a Fall 2011 survey of 72 health care organizations conducted by Ponemon Institute LLC, Traverse City, MI, it was determined that the estimated cost of data breaches in these health care organizations was more than $2.2 million per year. In the survey, 80 percent of the respondents stated that they use mobile devices to collect, store and transmit protected patient health information, yet only 23 percent of those respondents use an encryption software or application for security purposes on their mobile devices. The top causes of data breaches were either lost or stolen computing devices and/ or unsecured mobile devices. Use of HIPAAcompliant encryption software or applications on mobile or computing devices is a small cost and can prevent theft or potential HIPAA violations.³ Again, it s the responsibility of all health care practitioners and workers to ensure that patient health information is secure and not breached. If a practice of unsecured data transmission is occurring in your workplace, it s your duty to report it immediately to your supervisor or to the IT department. Comments and questions are welcomed at practice@texasnursing.org. References 1. Healthcare Informatics (February 2012, Vol. 29/No.2), Getting the Message, Securely. 2. US Department of Health and Human Services (2011), HIPAA rules accessed on 12/ 6/2011 from hipaa. 3. Healthcare Informatics (February 2012, Vol. 29/No.2), Unsecured Mobile Devices: The Weak Link. Editor s Note: A reproduction of the original article, Nursing Practice Question: Is Texting/Receiving Patient Information a HIPAA Rules Violation?, can be found at texasnursing. org>resources. REGISTERED NURSES WYOMING IS CALLING! $5,000 RN Recruitment Bonus $6,000 Manager Recruitment Bonus Apply online today:

12 Page 12 Texas Nursing Voice April, May, June 2012 Nurses Taking Action in Texas: A Series Nurse Practitioner Harmon Chooses the Future of Nursing Mantra by Stan Harmon, MSN, RN, FNP with Christy Meriwether My name is Stan Harmon and I am a member of the Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action. The Campaign envisions a nation where every American has access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success. I joined the Campaign for Action to change the future of nursing in Texas. I believe it is unequivocally the right thing to do! I live and work in El Paso, Tex., and as a family nurse practitioner, I provide care to active duty military soldiers and their family members at Fort Bliss. It is rewarding to know I am helping my country and I am proud of the care we provide although it is difficult for me to comprehend that our level of care is not equally available to all Texans. Texas leads the nation in the percentage of uninsured residents. Federal legislation passed in 2010 (Patient Protection and Affordable Care Act) promises to add millions to the Texas Medicaid roles. At one point in my nursing career I provided primary care in an emergency room setting at a county hospital. It was clear to me that the primary care in an Doctors Hospital of Laredo Looking for the Best We are currently seeking qualified experienced acute care RNs for the following units: Medical/Surgical/Telemetry/Oncology Labor & Delivery, NICU & ICU Sign-on bonus (up to $10,000) Relocation (up to $3,000) *Competitive benefits package* Application may be submitted through: Doctors Hospital of Laredo McPherson Rd; Laredo, Texas Phone: The Federal Bureau of Prisons Federal Correctional Institution in Fort Worth, Texas is seeking to fill open positions for RNs, LVNs & Nurse Practitioners. We offer competitive salaries including extra pay for working nights, Sundays, and federal holidays. We also offer great law enforcement retirement benefits including Health/Life insurances, a Thrift Saving Plan, and a possible recruitment bonus. We are an EOE. For Immediate Consideration, FTW/Recruiter@bop.gov acute care facility was far more costly than treating certain conditions in an ambulatory primary care environment consequently, underserved patients waited greater than a year to see a provider for management of diabetes, hypertension or other chronic conditions. I believe provision of quality, primary health care in a community setting would provide positive outcomes while maintaining affordability. The current health care system is based on a disease process model which tends to spend the greatest amount of financial resources treating diseases and very little on health promotion. Providers receive financial rewards for ordering costly tests and procedures. For example, treating patients in primary care for obesity is far more cost efficient and safer than expensive bariatric surgeries. I m convinced it will take legislative action to change the mindset of the patient and provider to one of education and smart, healthy choices. In the military setting, I am free to provide patients the care they need without the cumbersome, site-based, delegated model used in Texas. Currently, advanced practice registered nurses (APRN) must meet the education and national certification requirements to be able to prescribe medications and have a physician to delegate prescriptive authority. Texas cumbersome process is further complicated by the four types of practice sites: primary, alternate, medically underserved and facility based. By removing the statutory requirement of delegation from physicians, APRNs would be able to choose practice sites more freely and move to underserved rural areas across the state. Nurses should be full partners in redesigning the health care system as they collectively provide the largest professional contribution of direct patient care time. It would be far more efficient for hospital RNs to order drugs or x-rays for conditions in the emergency room than to have the patients wait to see providers. Upon completion of studies, RNs trained in laboratory and radiology could evaluate the results and manage conditions. ONLINE APPLICATION AVAILABLE or call (830) Visit us online: Texas laws which govern the practice of nursing need to change to allow nurses at all levels to practice to the full extent of their education and training. In my role with the Texas Team Action Coalition, I am actively working with the Texas Nurse Practitioners, Coalition of Nurses in Advanced Practice, and Texas Nurses Association the lead organization representing nursing in the Texas Team Action Coalition to find common ground in an effort to advance the role of nursing in improving rural health and increased access to APRN care. I also spend many hours speaking to legislators, local and state groups about the patient care that APRNs provide so they can better understand APRNs valuable contributions. I firmly believe in the Campaign for Action in Texas goals of appointing nurses to leadership positions involving health policy, advocating for a better educated nursing workforce and for nurses being able to practice to the full scope of their education. The ideal picture is for the whole health care team from physicians to nurses to assistive staff to be able to contribute fully to the care of all Texans with a focus on the provision of quality care. About the Authors Stan Harmon has been practicing nursing in Texas for more than 17 years. With certification as a family nurse practitioner, Harmon has provided high-level health care in both acute and primary care settings. For the Texas Team Action Coalition, he serves as a member of its Advancing Nursing Practice team representing the Upper Rio Grande Region. Among other involvement for nursing, Harmon is the Texas Nurses Association representative to the Texas Board of Nursing s APRN Advisory Committee and president-elect of Texas Nurse Practitioners. Christy Meriwether is the director for Customer Support in Education Support Services at Texas Tech University Health Sciences Center School of Nursing. For the Texas Team Action Coalition, she serves as a member of its Tactical Support and Operations Committee. About Texas Team Action Coalition: Texas Team Advancing Health through Nursing Action Coalition, convened to advance the Future of Nursing: Campaign for Action, is a diverse, statewide group of nurses, nursing organizations, hospitals, schools/universities, consumer businesses and advocacy groups interested in addressing future demand for high quality, cost-effective and accessible health care in Texas. Explore the opportunities to participate and follow the news of Texas Team at texasnurses.org. Cut Your Stress! Become a Clinical Trainer! Hospital Communications Technology Integrator has immediate opening for a Clinical Systems Educator. Responsibilities include: Develop and conduct in-service education for clinical staff Act as project clinical coordinator through the duration of projects Measure ongoing customer satisfaction Candidate requirements: RN, BSN minimal education Staff Education and/or Nursing Management experience Group presentation experience Proficient in Microsoft Office and Publisher 7+ years clinical and management experience desired To apply, please send resumes to jobs@intercominc.com Houston Community College is currently recruiting Nursing Instructors! The following positions are now open: Instructor, Associate Degree Nursing (Job#002130) Instructor, Occupational Therapy Assistant (Job#003349) How to Apply: Interested applicants must complete an online application. Go to To learn more about HCC visit us at Thank you for your interest in employment opportunities with Houston Community College! Houston Community College seeks to provide equal employment opportunities without regard to race, color, religion, national origin, gender, age, disability, sexual orientation or veteran status.

13 April, May, June 2012 Texas Nursing Voice Page 13 Nurse Ybarra Takes Action to Support the 80 by 20 Initiative by Angelica Ybarra, BSN, RN Every nurse regardless of initial academic preparation is an asset to the nursing profession. Collectively, we nurses stand 3 million strong in the U.S. and approximately 200,000 RNs and 90,000 LVNs are licensed in Texas. The Institute of Medicine s report, The Future of Nursing: Leading Change, Advancing Health, recommended that the profession increase the proportion of nurses with a baccalaureate degree to 80 percent by However, only 50 percent of the Texas nursing workforce currently holds a BSN. It is my opinion that supporting the 80 by 20 initiative is a step in the right direction for moving the nursing profession forward. Although returning to school can appear challenging, I can assure you it is attainable. My nursing career started in 1998 when I began a hospital-based RN diploma program at the Baptist School of Professional Nursing in San Antonio, Texas. Throughout my clinical rotations, I was inspired by the nurses who provided care to patients and their families. It amazed me that one person could make such a difference in the lives of so many and do so with compassion, competence and professionalism. I graduated in 2000, and it was a grand achievement; I was proud of my RN diploma. There was nothing more rewarding than providing care to patients in need and being the nurse entrusted with such an important responsibility. I married soon after graduation and settled into my new roles as wife and nurse. I temporarily relocated to Savannah, Georgia due to my husband s military service in the Army. As I practiced in a hospital setting, I kept pondering what my baccalaureate-prepared RN colleagues knew that I didn t and this bothered me. During the course of my first year of practice, I reflected on what my nursing professors had said. They told us that the roles of nurses were evolving, that the health care environment was changing, and that the future of nursing would require a broader education than an RN diploma program could provide. I contemplated going back to school and because I still had decades to devote to the nursing profession, I felt my patients would best be served by my being a more educated nurse. After my first year of nursing practice, while living in Georgia, I enrolled in an RN-to-BSN program at Armstrong Atlantic State University. Although I was married and already working full time, I made the commitment to attend classes in the evening. I knew it wouldn t be easy. During my academic endeavor, I was thrilled to learn that I was expecting my first child, but then saddened to have my husband deployed overseas to go to war. Yet, I was determined to complete the program. I must acknowledge that once I started my classes, I quickly understood the indepth knowledge I was lacking to provide comprehensive nursing care. Knowledge in areas such as nursing research and evidencebased practice, leadership and management, health policy, and population-focused nursing really expanded my view beyond disease processes, care plans, and nursing skills. I was able to understand the broader context of nursing practice and the importance of ensuring safe, high quality, patient-centered and costeffective care in a health care delivery system that is dependent upon the nursing profession for its success. After I graduated with my BSN, my husband came home safely from the war and completed his Army service. We welcomed our first child into our lives, and moved back to Texas. I continued to practice for several years, supported my husband while he worked towards his undergraduate and graduate degrees, and had a second child. My nursing journey has taken me through a variety of health care settings that lead to a position in management. It was my management experience that sparked my desire to next pursue an MSN degree in nursing administration. After years of nursing, I felt compelled to return to school and obtain academic preparation in an advanced practice role consistent with the high-caliber nursing standard that I wanted to promote and ensure through nursing administration and leadership. After researching nursing schools, I learned that BSN and graduate nursing programs had also evolved. They were more flexible and were now offering new and innovative methods of teaching in traditional face-to-face classes, as well as innovative hybrid and online classes that could be taken from remote locations. I started the MSN degree program at the University of Houston-Victoria in While in the MSN program, I learned of the IOM s Future of Nursing report. When I first read the report, I was quite moved and impressed. I felt as if somebody had finally and officially acknowledged the true worth and importance nurses play in our nation s health care delivery system. After all, nurses are at the forefront of patient care delivery and far outnumber any other profession within our U.S. health care workforce. I encourage all nurses to read the report, reflect on your own nursing journey, and envision what a BSN and/or advanced degree can do for your career and the profession. I truly believe that encouraging more nurses to obtain their BSN degree will prepare them for a broader nursing practice arena and support nurses professional role synthesis within a rapidly changing health care environment. The 80 by 20 movement will strengthen the profession, position nurses as key members of the health care team, and contribute towards better patient outcomes. Overall, a more educated workforce will be instrumental in redesigning our nation s health care delivery system and will propel the profession to new heights in the 21st century. Let us move together and join the Future of Nursing: Campaign for Action. Let us encourage one another, and actualize the 80 by 20 initiative. About the Author: Angelica Ybarra, BSN, RN is conducting her Leadership Practicum at the Texas Nurses Association. She is attending the University of Houston-Victoria, School of Nursing and will graduate with an MSN degree in nursing administration in December of PERSONAL BEST. ANCC Board-Certified. I m proud and in charge of my nursing career. And I trust ANCC certification to help me maintain and validate the professional skills I need to remain a confident and accomplished nurse for years to come. Find out how to be the best at American Nurses Credentialing Center. All Rights Reserved. The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA).

14 Page 14 Texas Nursing Voice April, May, June 2012

15 April, May, June 2012 Texas Nursing Voice Page 15 PATIENT CARE IS YOUR PRIORITY. PROTECTING YOUR FUTURE IS OURS. You think of others first. Now it s time to think about yourself. The ANA recommends that you protect your career and your financial future by setting up your personal malpractice safety net. You need malpractice insurance because... - you have recently started, or may soon start a new job. - you are giving care outside of your primary work setting. - it provides access to attorney representation with your best interests in mind. - claims will not be settled without your permission. ANA recommends personal malpractice coverage for every practicing nurse. As an ANA member, you may qualify for one of four ways to save 10% on your premium. Earn a Credential That s in Demand Nationwide Top 15 ranked nursing school Practice specialties for all interests State-of-the-art nursing informatics and facilities Community of scholars with broad faculty expertise Distance learning opportunities New BSN to DNP option Vanderbilt is an equal opportunity affirmative action university. Master of Science in Nursing (MSN) Doctor of Nursing Practice (DNP) PhD in Nursing Science clinical interventions, health services research Learn more. Apply today. Everyday you make a difference in someone s life. Personal malpractice insurance helps protect your financial future so you can go on making a difference. Set up your malpractice safety net because you care for more information proliability.com Administered by Marsh U.S. Consumer, a service of Seabury & Smith, Inc. Underwritten by Liberty Insurance Underwriters, Inc., a member company of Liberty Mutual Group, 55 Water Street, New York, New York May not be available in all states. Pending underwriter approval. CA Ins Lic # AR Ins Lic # d/b/a in CA Seabury & Smith Insurance Program Management 56702, 55915, 55903, 55862, 55900, 58005, 56716, 56715, (4/12) Seabury & Smith, Inc ALL PROGRAMS 100% online doctor of nursing practice-dnp Post-Masters to DNP Post-BSN to DNP (504) doctor-nursing-practice Application Deadlines: February 1st and November 1st HEALTH CARE SYSTEMS MANAGEMENT MSN (504) Bachelor OF Science in Nursing Program RN-BSN RN-MSN Blend to MSN (504) bachelor-science-nursing Ranked in the Top USNWR Best Graduate Nursing Online Programs! potential faculty Create your future with us! School of Nursing Faculty Positions: Loyola University New Orleans, a progressive Jesuit University, is seeking to hire outstanding faculty for newly created tenure track positions at the ranks of Associate and Full Professor. Responsibilities include teaching online; community engagement; student supervision; curriculum development, revision and evaluation; program development funding; research translation for practice and a progressive record of scholarship and community service. Faculty must hold regular office hours and have same on campus availability. If working in a place where you can blossom is of interest to you, please submit a letter of interest, vitae and three letters of reference for these positions to: Dr. Ann Cary, Director and Professor Robert Wood Johnson Executive Nurse Fellow School of Nursing, Loyola University New Orleans 6363 St Charles Avenue, Campus Box 45, New Orleans, La Attn: Debbie Smith, Executive Assistant (504) dhsmith@loyno.edu Candidates will have a doctoral degree and national certification as a Family/Adult Nurse Practitioner or Nurse Administrator. Experience in education and practice is desired. Rank and salary are commensurate with qualifications. Loyola is an EO/AA employer. Educating Nurses for over 30 years!

16 Page 16 Texas Nursing Voice April, May, June 2012 Free CE credits. Available 24/7. Now you can choose the time and place to take the courses you need and want. We ve made it easy to take free CE courses online. We offer 24/7 access to more than 40 courses, including when to refer to a pediatric specialist. And even when you re not taking a course, you can access the latest references and resources you need. The CE courses were developed by the Texas Department of State Health Services and the Texas Health and Human Services Commission. All courses are comprehensive and accredited. * To view courses online, visit CE Courses Include: When to Refer to a Geneticist Children with Diabetes Children with Asthma Newborn Screening Case Management Developmental Screening Many others Referral Guidelines Pediatric Depression High Blood Pressures in the Office Atopic Dermatitis Gastroesophageal Reflux in Infants Exercise-Induced Dyspnea Referral Guidelines Overview Taking New Steps *Accredited by the American Nurses Credentialing Center, Texas Medical Association, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Dietetic Association, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for these events. Advanced nursing education today for advanced healthcare tomorrow. On the front lines of patient care, nurses serve a critical role in shaping the future of healthcare delivery. For over 120 years, Chamberlain College of Nursing has been preparing compassionate and clinically proficient nurses by increasing access to quality nursing education nationwide and training aspiring nurses, nurse leaders and nurse educators. For nurse advancers, Chamberlain offers accelerated, flexible online options: RN to BSN Option RN-BSN to MSN Option Master of Science in Nursing Degree Program Lead. Achieve. Inspire. Now enrolling for spring, summer and fall semesters For more information, please visit chamberlain.edu or call CCN (8226) Comprehensive consumer information is available at: chamberlain.edu/studentconsumerinfo National Management Offices 3005 Highland Parkway Downers Grove, IL CCN (8226) 2012 Chamberlain College of Nursing, LLC. All rights reserved.