William L. Holzemer, RN, PhD, FAAN Dean and Distinguished Professor College of Nursing, Rutgers, The State University of New Jersey

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1 William L. Holzemer, RN, PhD, FAAN Dean and Distinguished Professor College of Nursing, Rutgers, The State University of New Jersey 1

2 2

3 Objectives: 1. Update on the 8 major recommendations from the IOM report on nursing s future. 2. Explore external (society) and internal (nursing & health care) topics that are NOT adequately addressed in the report. 3. Discuss a data-driven health care system and its implications for the future of nursing. 3

4 Phase I: IOM Recommendations 1. Remove barriers to scope of practice (APRN and BSN). 2. Expand opportunities for nurses to lead care teams. 3. Implement nurse residency programs. 4. Increase % of BS prepared RNs in the workforce to 80%. 5. Double the number of nurses with doctorates. 6. Ensure that nurses engage in life long learning. 7. Prepare and enable nurses to lead change to advance care. 8. Collaborate to develop better work force data, including interprofessional work force data. 4

5 IOM Recommendations 1. Remove barriers to scope of practice (APRN and BSN). Implementation Status APRN Title APRN Roles APRN & RN Licensure Education Certification Independent Practice CRNA CNM CNS CNP Independent Prescribing CRNA CNM CNS CNP NCSBN s APRN Campaign for Consensus: State Progress toward Uniformity 5

6 6

7 IOM Recommendations 2. Expand opportunities for nurses to lead care teams. AHA (2011) survey of 1000 hospital boards found 20% physician members and 6% nurses. Khoury et al (2011) in a Gallop poll for the RWJF reported that nurses were seldom viewed as leaders in the development of healthcare systems and delivery. The 1500 respondents stated that nurses were not seen as important health care decision makers compared to physicians. Is it ever going to be possible to become full partners in the delivery of health care? Hassmiller, S., Combes, J. (2012). Nurse leaders in the boardroom: A fitting choice. Journal of Healthcare Management, 57 (1) 7

8 IOM Recommendations 3. Implement nurse residency programs. Transition to practice, novice to expert Different than orientation programs, linked with academic institutions that offer credit, for example for a course on evidence-based practice. Penn Nursing (upenn.edu/careerservices) Lists over 100 state by state post-bsn residency programs 8

9 IOM Recommendations 4. Increase percent of BS prepared RNs in the workforce to 80%. HRSA (2008) estimates that there are over 3 million nurses, and 2.6 million are licensed; 84.8% of those licensed are working in nursing 50.0% of RNs hold BS/BSN degrees; 36.1% Associate degree; and 13.92% Diploma Why 80% BSN? IOM report states to respond to the demands of an evolving health care system and meet the needs of patients, nurses must achieve higher levels of education. 9

10 4. Increase percent of BS prepared RNs in the workforce to 80%. (continued) In September 2012, the Joint Statement on Academic Progression for Nursing Students and Graduates was endorsed by: American Association of Colleges of Nursing American Association of Community Colleges Association of Community Colleges Trustees National League for Nursing National Organization for Associate Degree Nursing. This historic agreement represents the first time that leaders from the major national organizations representing community college presidents, boards, and program administrators have joined with representatives from nursing education associations to promote academic progression in nursing. With the common goal of preparing a well educated and diverse nursing workforce, this statement represents the shared view that nursing students and practicing nurses should be supported in their efforts to pursue higher levels of education. Read the statement at 10

11 IOM Recommendations 5. Double the number of nurses with doctorates. Issues: Clinical Doctorate (DNP) vs. Research Doctorate (PhD) DNP as replacement of the MS degree for Advance Practice Nurses Faculty shortage Background (HRSA,2011) 355,794 MS prepared RNS 28,369 doctorally prepared RNs schools awarded 7,037 DNP degrees (in 2004 only 170 were awarded) (Fellows: Moore, Robert Wood Johnson Foundation, JONAS) 11

12 IOM Recommendations 6. Ensure that nurses engage in life long learning. Professional development (continuing education) Periodic testing of competencies? New knowledge and technologies Re-licensure 12

13 IOM Recommendations 7. Prepare and enable nurses to lead change to advance care. (RWJF Scholars, IOM/ANF, AAN Scholar) 13

14 IOM Recommendations 8. Collaborate to develop better workforce data, including interprofessional workforce data. 14

15 15

16 Phase II: Internal & External Forces Explore external (society) and internal (nursing & health care) topics that are NOT adequately addressed in the IOM report Quality --- Access --- Cost --- Delivery System 16

17 External Issues Not Well Addressed: Aging society Nature of learners (styles, relaxed career goals, IT-based) Globalization Technology 17

18 Internal Issues Not Well Addressed: Gender and ethnic imbalances in nursing workforce Reality of the structure of care (military model, top-down) Cost of care (procedures, fees, insurance commissions, etc.) Reimbursement mechanisms Interprofessional Care (IPC) and Interprofessional Education (IPE) 18

19 IPC competencies Values/Ethics Interprofessional practice Roles/Responsibilities for collaborative practice Interprofessional communication Interprofessional teamwork & team-based care 2011 (AACN, AAMC, etc., et. al) 19

20 Missing dimensions Nursing Science (PhD) Advanced Practice (DNP) Education Transformation Concept-based curriculum Competency-based curriculum Simulation and reflective learning 20

21 Phase III: A New Defining Construct Discuss a & its implications for the future of nursing. 21

22 Data-driven health care Role of evidence from Randomized Controlled Trials (RCTs) the gold standard of evidence? Collective learning Very large data sets Data mining: BD2K (big data to knowledge) 22

23 Structure of care delivery Team-based care Patient-centered care Relationship-based care Interprofessional Care (IPC)/Interprofessional Education (IPE) Context of 100% access to care 23

24 Cost/Payment Payment for outcomes Payment not based on number of procedures Value-based payment 24

25 Data-driven health care 100% access We deliver care that works We reimburse what works Care is evidence-based Care is personalized Technology and EHR pervasive NDNQI model for future Patient-center & relationship-centered care IPC/IPE required, team-based care 25

26 Update on the IOM Recommendations on: 1. Remove barriers to scope of practice (APRN and BSN). 2. Expand opportunities for nurses to lead care teams. 3. Implement nurse residency programs. 4. Increase % of BS prepared RNs in the workforce to 80%. 5. Double the number of nurses with doctorates. 6. Ensure that nurses engage in life long learning. 7. Prepare and enable nurses to lead change to advance care. 8. Collaborate to develop better work force data, including interprofessional work force data. 26

27 What is missing from the report? Nursing science & its impact on health policy Patient-centered / relationship-centered care Personalized medicine Evidence-drive health care delivery system 27

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