november 2012 Focus on New Roles for Nurses in Today s Health Care Climate

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1 VOICE of nursing leadership In this issue: PAGE 4 Innovative Careers in Nursing and Health Care Reform: What Nurse Leaders Need to Know PAGE 8 The Nurse Navigator: Charting the Course to Quality Outcomes PAGE 12 Education for Nurses in Community-Based Care Settings PAGE 15 Nine States Receive Grants to Build a More Highly-Educated Nursing Workforce PAGE 16 AONE Members in the News november 2012 Focus on New Roles for Nurses in Today s Health Care Climate Voice of the President Laura Caramanica, RN, PhD, CENP, FACHE 2012 president, AONE Board of Directors New Roles for Nursing the Future of Health Care and Care Delivery Systems As AONE president over this past year, I helped bring your attention to important required changes that will need to be made for the future of health care and care delivery systems. Many of these issues were addressed during the year through articles published in Voice of Nursing Leadership. The March issue reported on the growing evidence of these new systems of care that will be characterized by vast complexity due to the use of sophisticated technology, the aging and diversity of patient populations and the associated growth in chronic health issues. The articles provided the rationale as to why registered nurses (RNs) need to be prepared at the baccalaureate (BSN) level or higher and the importance of all caregivers making the commitment to continuous learning. The practice environment will require engaging patients and families as partners who own their care goals. It will be their goals that will be addressed and met by interdisciplinary teams who must collaborate effectively and will be held accountable for both clinical and financial outcomes. Connecting patient outcomes to the work of nurses enables others to see and measure the impact that quality nursing care has on patient outcomes. In the May issue of Voice, we explored the trajectory of nurse leaders who advanced their careers from bedside nursing to becoming the chief executive officer. These leaders are keenly able to uphold the voice of the patient while possessing necessary competencies in finance, strategic planning, seeding market growth, cultivating philanthropic donations and crafting arguments for reasonable and necessary health care policies. These nurse leaders understand that it is necessary to leverage technology and human resource capital to achieve desired outcomes. They also know how to champion the types of change that has providers using evidenced-based protocols to meet the six aims of health care as defined by the Institute of Medicine (IOM) that health care be safe, efficient, effective, equitable, timely and patient-centered/driven. Continued on page 18 Connecting patient outcomes to the work of nurses enables others to see and measure the impact that quality nursing care has on patient outcomes.

2 REACHING NEW HEIGHTS Join us in scenic Denver, Colorado for the AONE 46th Annual meeting and Exposition, march 20-23, Education themes include: Care Delivery Communication & Business Strategies Leadership Patient Safety & Quality Technology Plenary Sessions Chesley B. (Sully) Sullenberger, III Miracle on the Hudson Hero Pilot; Contributor, CBS News and Best- Selling Author Liz Wiseman Executive Strategy and Leadership Consultant, Advisor and Best-Selling Author of Multipliers Steve Uzzell Renowned National Geographic Photographer and Authority on Creative Problem Solving AONE Foundation Lecture Cokie Roberts Political Analyst for ABC News, NPR Senior News Analyst, Former Co-Anchor, This Week with Sam Donaldson & Cokie Roberts REGISTRATION OpENS NOvEmBER 5, 2012

3 Volume 10, Number 6 November 2012 Voice of Nursing Leadership TM is published bi-monthly by the American Organization of Nurse Executives, a subsidiary of the American Hospital Association. Postage paid at Chicago, Illinois. Voice of Nursing Leadership TM is published for AONE members only and is not available for subscription. All opinions expressed in Voice of Nursing Leadership TM are those of the authors and not necessarily those of AONE or the institution with which the authors are affiliated, unless expressly stated. Naming of products or services does not constitute an endorsement by AONE AONE. All rights reserved. Voice of Nursing Leadership TM may be reproduced only by permission. Send reprint requests and all other inquiries to the editor. Executive Editor Susan Gergely Managing Editor Kimberly Cavaliero American Organization of Nurse Executives Executive Office Liberty Place 325 Seventh Street, NW, Washington, DC Phone (202) Fax (202) Operations/ Membership 155 N. Wacker Drive, Suite 400, Chicago, IL Phone (312) Fax (312) AONE Officers President Laura Caramanica, RN, PhD, CENP, FACHE Chief Nursing Officer WellStar Kennestone Hospital Marietta, GA President-Elect Michelle Janney, PhD, RN, NEA-BC Senior Vice President and Wood-Prince Family Chief Nurse Executive Northwestern Memorial Hospital Chicago, IL Immediate Cheryl Hoying, RN, PHD, NEA-BC, FACHE Past President Senior Vice President, Patient Services Cincinnati Children s Hospital Medical Center Cincinnati, OH Treasurer Brenda Gail Summers, MBA/MHA, MSN, RN, NEA-BC Senior Consultant The Greeley Company Charlotte, NC Secretary Pamela A. Thompson MS, RN, CENP, FAAN Chief Executive Officer AONE Senior Vice President for Nursing American Hospital Association Washington, DC 2012 AONE Directors Region 1 Sharon A. Gale, MSN, RN Chief Executive Officer Organization of Nurse Leaders, Massachusetts-Rhode Island Burlington, MA Region 2 Mary T. Kinneman, RN, BSN, MSN, NE-BC Senior Consultant IMA Consulting Lansdale, PA Region 3 Mary Crabtree Tonges, PhD, RN, FAAN Senior Vice President, Nursing Administration The University of North Carolina Hospitals Chapel Hill, NC Region 4 Lori L. Knarr, DNP, RN, NEA-BC, FACHE Vice President and Chief Nursing Officer Indiana University Health University Hospital Indianapolis, IN Region 5 Mary-Anne Ponti, MS, RN, MBA, CNAA-BC Chief Operating Officer/Chief Nurse Executive Northern Michigan Regional Hospital Petoskey, MI Region 6 Dawn A. Straub, MSN, RN, NEA-BC Director, Nursing Professional Practice and Development The Nebraska Medical Center Omaha, NE Region 7 Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN Senior Vice President and System Chief Nurse Executive Texas Health Resources Arlington, TX Region 8 Donna Poduska MS, RN NE-BC, NEA-BC Vice President, Chief Nursing Officer Poudre Valley Hospital Fort Collins, CO Region 9 Linda Burnes Bolton, DrPH, RN, FAAN Vice President, Nursing and Chief Nursing Officer Cedar Sinai Medical Center Los Angeles, CA Member at Large Elaine L. Cohen, EdD, RN, FAAN Associate Chief, Nursing Quality Improvement James A. Haley Veterans Hospital Tampa, FL AONE education calendar November Proposals due for 2013 AONE Foundation Research Seed Grants AONE Emerging Nurse Leader Week AONE Emerging Nurse Leader Institute (ENLI) November 1 November November 5-7 Online Nationwide Chicago, IL March 2013 AONE 46th Annual Meeting and Exposition March 20-23, 2013 Denver, CO Ongoing AONE Essentials of Nurse Manager Orientation (ENMO) Letter to the Editor Dear Editor, I commend AONE for publishing the article AONE s CCIT: One Unit s Trial by Fire. It inspires nurses by showing nursing leaders tried and true ways to combat turnover on units. I can truly state that if the Care Innovation and Transformation (CIT) program was used on this unit, the results would have been astonishing. Turnover rates have plagued units with poor staffing and increased risk of errors for patients. One thing I learned quickly was that it was no fun working extra shifts short staffed because of a high turnover rate. In a previous facility where I worked, the psychiatric unit hired seven newlygraduated nurses to fill in holes in the schedule. They marched on the unit bright eyed and bushy tailed only to all quit within the next month. This particular hospital lost 25 nurses and techs in a three-month period. Researchers have reported that the high nursing turnover rate nationwide Now available for individual purchase Online does not exclude turnover at the nurse manager and nurse leader levels. This particular department also lost three directors in a period of a year. Instead of working to find a solution, new people were hired onto the units causing a painful revolving door. Involving staff to create an atmosphere of change is the only way for turnover rates to decrease. Now, rather than expecting leadership to solve problems and create new processes, nurses are able to find their own solutions and establish best practices. Hopefully more hospitals will pick up on the ingenuity of this program to save their units from the dreaded high turnover rates. This is such an easy solution to a big problem. Thanks again for featuring this article as it will change lives and units for the better. Thank you, Tyra Fizer, BSN, RN Voice of Nursing Leadership November

4 Cheri Clancy, RN, MSN, MS, NE-BC, BSN, instructor and nurse recruitment department, University of Medicine and Dentistry of New Jersey, Stratford, NJ Innovative Careers in Nursing and Health Care Reform: What Nurse Leaders Need to Know It has been well publicized that the provisions to U.S. health care reform will increase the demand for experienced registered nurses. One of the major initiatives of the Patient Protection and Affordable Care Act (ACA) is to have enough primary care providers to meet the needs of approximately 44 million newly-insured patients who enter the U.S. health care system carrying government-subsidized insurance plans. This is in addition to more than one million citizens age 65 and older who will need nursing care, home care, lab work and additional services. In alignment with the Future of Nursing Campaign initiatives, the ACA supports and expands the nation s health care workforce by funding scholarships and loan repayment programs. The legislation would inaugurate new programs to address projected nursing shortages and utilize a comprehensive approach to focus on nurse retention, enhanced educational opportunities and other forward-thinking initiatives geared toward fostering and building the nursing workforce of the future. In an effort to meet the evolving changes in third party reimbursements, many health care organizations are creating new nursing positions or expanding nursing roles. For example, programs such as Accountable Care Organizations (ACOs), bundled payment, value-based purchasing and patient-centered medical home (PCMH) provide nurses ample career opportunities since nurses are skilled in knowing how to expand access to care and improve quality at lower costs. Many health care organizations are hiring and/or training nurses to acquire roles under the case management sector such as nurse navigators, case managers, health coaches and disease management coordinators to enrich and enhance these programs services and outcomes. Although there is some overlap on the various roles and responsibilities of these positions, it can be summarized that interdisciplinary care coordination, patient advocacy, referrals, access to care, patient education and identifying barriers to care are some of the many responsibilities being undertaken by nurses in health care today. One may argue that an analysis of the provisions and regulations of the legislation impacting nursing will enhance the profession, but some people are concerned about the endless career possibilities this will allow nurses to embark upon. Why would skepticism be equated with endless career possibilities? As with many of the well-publicized work place barriers that cause workplace dissatisfaction and attrition (such as doing more with less, poor compensation, bureaucratic road blocks), many savvy nurses are stepping outside of the traditional career trajectory and are exploring entrepreneurship opportunities. Nurse entrepreneurs are bridging critical and innovative nursing roles either stemmed from health care organizations or through creating innovative care models that include nurse-managed health clinics, home visiting programs for low-income mothers and various other nurse consultant businesses. Other nurse entrepreneur businesses have been developed, including: Design of health care facilities Health and wellness Nurse career consulting Health research IT and software programming in the health care setting Legal nurse consulting Life care planning Marketing health related products Pharmaceutical and medical device sales and education Let s explore some of these new roles and meet some nurses who have utilized their nursing skills in these emerging jobs. Nurse case management /health coach Nurse navigators and care coordinators are integral parts of coordinated care models because they have thorough knowledge of disease processes, barriers to care and treatment compliance. Nurses are uniquely positioned to apply a patient-centered care model and are adept in human behavior and cultural competence. Although the concept was in the field of oncology, Stacey Smith, RN, an after-hours pediatric phone triage coordinator for Advocare Pediatrics, Marlton, NJ, posited there was recent discussion in hiring disease management nurses to oversee disease specific cohorts such as asthmatics and diabetics. Smith explained that this was a new role for the company a role created to meet the requirements of the PCMH. As it turned out, some applicants were not interested in full-time employment, but rather in consultant work. Elizabeth Scala, MSN, MBA, is a health coach and reiki practitioner who runs her own company. This business focuses on guiding nurses to create space for balance and self-care in their lives. Scala stated, I decided to start my own business because I have always wanted to be an entrepreneur. I always knew I wanted to Elizabeth Scala own something but was never sure what that something was. I had a very rough experience with burnout and compassion fatigue. I felt I really had no choice but to leave my job at the hospital. When I did that, I worked part-time and continued my education. I found health and wellness coaching and loved the idea of helping people come to their own vision of themselves at their best. Instead of me trying to fix them or do for them, this was a chance to empower and guide people to wellness. To me, part of the trouble with our current health care model is we think we can cure, fix or do for the patient. Instead, from my perspective, each patient knows their own bodies best and can heal and help themselves with our guidance. That is more in line with the health coaching model. So the next steps were to create my business, choose a target market and get out there. Because I had experienced severe burnout first hand, I decided to market my business to nurses who were stressed, overwhelmed or fatigued. I decided this was a way to still work indirectly with the patients that I so loved working with as an in-patient psychiatric nurse. I coach nurses to be healthy so that their work is optimal and they are role-models and 4 Voice of Nursing Leadership November 2012

5 examples of well-being for the patients they touch each day. To me, having my own business is a ton of fun because I get to use my creativity imagination and organizational skills. Nursing education The ACA includes funding provisions to increase the number of master s prepared nursing graduates to become advanced practice nurses and nursing faculty. Nurses who complete a master s level informatics program can work as consultants and are integral in assisting with research, development and completion of special projects. They can also contract to assist with the implementation and support of electronic medical records and other patient record applications. In alignment with the mission to retain and recruit more nursing faculty, Dr. Shelley Johnson, nurse educator, created a website to support nurse educators in their quest to stay current, find creative methods to aid learning and to network with other nurse educators. Dr. Johnson says, I have found peace in knowing that nursing education is where my life s work will be devoted. However, nursing education is a vast area and includes all nursing specialties. I find comfort in knowing that my options are endless and that my education and practical experiences had prepared me for employment and entrepreneurship. Nurse practitioners Nurse practitioners (NPs) are some of the fastest-growing primary care professionals in the country. The ACA calls for new programs to support nurse-managed health centers that provide comprehensive primary care and wellness services to underserved or vulnerable populations. Although NPs will help meet the needs of the influx of patients needing primary care, it also leaves the NPs old clinical positions vacant, adding to the RN shortage. Although NP entrepreneurs are governed by factors such as legal obligations, ethical obligations and social obligations, they can increase access to health care in any community they serve and have autonomy and accountability. Legal nurse consultant Victoria Powell, RN, CCM, LNCC, CNLCP, CLCP, MSCC, CEAS, has been providing nursing education and consulting services for more than 18 years. She is an RN and holds specialty certifications in case management, legal nurse consulting, life care planning and ergonomic assessments. Powell has a special Victoria Powell interest in caring for amputation injuries and complex orthopedic problems. She explained, After nursing school, I was working for a local hospital when I was diagnosed with a latex allergy. In the mid 90 s, this was not yet commonplace and we did not have all of the latex-free options that we have today, so I went looking for a job away from the bedside that would have less exposure to latex. I went to work for a neurologist and soon I became the clinical manager of the group and later worked as an office manager and nurse for the group. With the management experience I acquired, I moved to a large orthopedic group and worked as the manager. After a while, I realized I missed nursing and sought new employment, but I had been away from the bedside for so long, I was not sure that the hospital was the right place for me. I found a job in medical sales. While working in this capacity I was approached by a friend who asked me to work with her as a case manager. I did not even really know what all that entailed. I called the supervisor at the company who offered me the job, sight unseen. Powell continues, I worked for a national case management company and obtained my certification in case management. However, I did not like the corporate environment and policies and found that many of the business practices conflicted with my personal nursing philosophy. With a push from my husband, I started my own nurse case management company. I also trained as a legal nurse consultant (LNC) in hopes that if my case management business did not sustain me, my LNC work would. My case management work came through so I just dabbled in LNC work for the time being. In LNC, I found that most attorneys retained nurses as expert witnesses when they were litigating a medical malpractice case. Some also employed nurses to review their records and make recommendations, but none seemed to understand my value behind the scenes. In sharing my frustration with a former manager she shared information with me about nurse life care planning. When the company downsized and she was laid off, my former manager had gone to work providing nurse life care planning services. She explained how a nurse with case management experience was well suited for this position. The job included acting as an expert witness which the attorneys knew and understood. I looked into training and soon became certified. As an add-on to my training in nurse life care planning, I could pick up new courses to add to my credentials. One of the advantages of having your own business is that you can design it anyway you like. By having different service offerings I never get bored I can work on something different everyday. The disadvantage is that you can be spread too thin. Never offer so many services that you try to be everything to everyone. Instead, find others who are great at providing services and refer business out when necessary. In turn, these other experts will remember you when they need to refer others outside of their business. Supporting entrepreneurship and encouraging professional growth Should nurse leaders be cautious or unsupportive of RN staff looking to extend their talent beyond the organization s walls? No, nurse leaders should be cognizant of the myriad opportunities available for all nurses. Nurse leaders should not take for granted that employment is limited to established businesses, but that breaking out of the glass ceiling is a possibility for anyone. Entrepreneurial spirit should be supported. There are, however, some key points that nurse leaders can consider to ensure smooth transitions for all staff members whether someone leaves for another health care job, or to start their own business. These include: 1. Succession planning Consider how many staff are continuing their education and in what specialty? Are they moving up in the organization or are their plans to potentially move out? Find ways to incorporate their skill set to add to the organization s success. 2. Workplace satisfaction Round with staff often and address workplace wins and opportunities. Move from the traditional model of the way it has always been done to innovation and creativity. Continued on page 6 Voice of Nursing Leadership November

6 Innovative Careers in Nursing and Health Care Reform: What Nurse Leaders Need to Know continued from page 5 3. Tough questions Ask staff about any issues they may be facing at work. If as a nurse leader you feel a high performer is not happy, ask what you can do to improve conditions. Support innovative or entrepreneurial staff by trying to encourage them to consider continuing employment within the organization even if it is not in your department. Consider the costs to the organization as a whole. 4. Educate Inform staff at all levels about what the new health care legislation and Future of Nursing campaign means for nurses. Provide information, address questions, solicit questions and be visionary. 5. Empower Support staff in trying new ways to deliver care efficiently and effectively. Welcome creative ideas and strategies. Provide guidance, direction, feedback and support. Although set hours, benefit packages and hourly/salary pay from health care organizations can provide fiscal comfort, many nurses may still opt for entrepreneurship as the economy and stock market fluctuations continue to affect reduction in earnings from retirement accounts and other investments. Often, the lack of benefits such as an alternative source of health insurance creates a job lock and staff members who are interested in branching out in their own businesses will not do so due to lack or cost of benefits. Small businesses however, may benefit from the new health care legislation. Some small businesses are now eligible for tax credits for a portion of their health insurance premium contributions. In addition, insurance marketplaces, administered by state governments or nonprofit institutions, will offer qualified health insurance options for individuals and small businesses with up to 100 employees by Build relationships with nurses Serious entrepreneurs see large benefits in branching out and starting their own businesses. Benefits such as health insurance and other corporate perks may not be enough to keep these people working in traditional work environments. They have entrepreneurial spirits and will find a way to build their businesses despite initial roadblocks. As nurse leaders, it s important for us to be supportive and encourage all staff members in their professional endeavors, whether it entails furthering their education or starting their own business. We may someday work again with that person on a project or through a service they offer. Good entrepreneurs learn to build bridges and great nurse leaders do the same. ABOUT THE AUTHOR Cheri Clancy, RN, MSN, MS, NE-BC, BSN, instructor and nurse recruitment department, University of Medicine and Dentistry of New Jersey, Stratford, NJ. She is also a New Jersey regional coalition member for the Institute of Medicine/Future of Nursing initiative. AONE delegation travels to Vietnam and Cambodia AONE president Laura Caramanica, RN, PhD, CENP, FACHE, and AONE chief executive officer Pamela A. Thompson, MS, RN, CENP, FAAN, this summer co-led a People to People Nurse Executive Delegation to Vietnam and Cambodia. While traveling, the delegates convened with esteemed health care colleagues from Nhi Dong Children s Hospital, Angkor Hospital for Children, National Pediatric Hospital of Cambodia, Chenla University and a special meeting with Kingdom of Cambodia Ministry of Health, His Excellency Professor Dr. Thir Kruy, Secretary of State. The delegation participated in facility walk-throughs, informal social events and roundtable discussions with their professional counterparts in the nursing leadership field. A feature article as well as photos from the trip will be published in the December issue of Nurse Leader magazine. You can also learn more by reading the delegation blog authored by Caramanica and delegation member David Marshall, JD, MSN, RN at 6 Voice of Nursing Leadership November 2012

7 The two-day Just Culture Public Course is the entry point to start your organization on the transformational journey towards better outcomes. The course will introduce you to the concepts, language and skills of the Just Culture framework. Through an introduction to the Five Skills, you will identify the techniques necessary to create a values-supportive culture within your organization. Just Culture balances the need for an open reporting environment and quality learning culture, with the need to appropriately hold all employees accountable for the quality of their choices. You will learn how to harness these concepts and apply them to improve outcomes across all of your organizational values safety, privacy, finance, security, and service. December Frisco, TX Westin stonebriar TAUGHT by David marx The Just Culture Community is pleased to announce the launch of the all-new Just Culture website, Space is limited; reserve your seat today: or call us at

8 By Diane Brady Schwartz, PhD, RN, NEA- BC, president and chief executive officer, DC Brady Associates, LLC, Fort Myers, FL, and contributing faculty member, Walden University School of Nursing, Minneapolis, MN Cheri Clancy, RN, MSN, MS, NE-BC, BSN, instructor and nurse recruitment department, University of Medicine and Dentistry of New Jersey, Stratford, NJ The Nurse Navigator: Charting the Course to Quality Outcomes Current emphasis on the evolving concepts of continuity of care and care coordination can arguably be stemmed from the passing of the Patient Protection and Affordable Care Act (ACA) legislation in March, The intent of the ACA is to lower the spiraling costs of health care while preserving and enhancing the delivery of quality health care services. Although the focus on quality is not new to health care, reimbursement based on the level of quality of care provided is a new phenomenon. The era of determining inpatient length of stay (LOS) has been replaced with measuring LOS along with readmission rates and other variables. In an effort to reach quality benchmarks set forth by the Center for Medicare and Medicaid Services (CMS), many registered nurses (RNs) are now adopting an expanded role in case management and acquiring the title of nurse navigator. A nurse navigator s role can be viewed not only as a patient and family satisfier, but also as the coordinator of the interdisciplinary team, ensuring quality outcomes and efficient care processes. The role takes on a personal, concierge-type approach to coordination of care, ensuring patients are compliant with follow-up to appropriate resources, have access to care and adhere to professional recommendations all of which help promote quality care and lower health care costs. Dr. Harold Freeman and colleagues at the Harold P. Freeman Patient Navigation Institute coined the title of patient navigators in the field of oncology back in the 1990s. He identified that a significant impact in breast cancer diagnosis and survival rates resulted when timely access, treatment and resources were implemented. Similar to case management models, nurse navigators play an integral role in care coordination. Today s nurse navigator roles (formerly patient navigators) have since expanded into various specialties including emergency departments (ED), pediatrics, cardiology and obstetrics. Interviews with nurse navigators working in breast health, high risk obstetrics and the emergency department demonstrate the value of these roles in addressing the complexity of health care delivery and ensuring continuity of care that are so vital in meeting the needs of high-quality, patient-centered care delivery. We will profile a variety of nurse navigators and examine the important work they are performing. Breast health navigation program/flagler Hospital, St. Augustine, FL Cathy Conner, RN, BSN, BA, CBCN, is the breast health nurse navigator at Flagler Hospital. Flagler is a 335-bed, acute care, Magnet hospital that has been ranked among the top five percent of hospitals in the nation for both clinical excellence and patient safety for the past eight consecutive years. The navigator role was established by the facility s Cancer Institute, with the goal to ensure coordination of care for patients with a diagnosis of breast cancer. Conner s first contact with patients is when breast cancer is suspected, usually during a biopsy. She works to establish a trusting relationship with the patient before a cancer diagnosis is given and makes sure the patient has Conner s contact information. If a breast cancer diagnosis is confirmed, Conner meets with the patient as soon as possible to offer assurance, provide specific information related to their pathology, and discuss available resources and options. Cathy Conner She often hears the relief patients express in knowing they have a competent team approach in the provision of their care. Conner feels privileged to watch a patient s anxiety level decrease and their confidence level increase as she follows them throughout their breast care treatments. She holds their hand when they come for surgery, joins them for appointments to discuss possible chemotherapy, is with them as they start their radiation, assisting with plastic surgery decisions and connecting them with resources as they begin survivorship. As a nurse navigator, Conner feels she is able to fulfill a unique role that is desperately needed by breast cancer patients. Conner was instrumental in establishing and coordinating an Interdisciplinary Breast Cancer Conference, which meets bi-weekly. All newly-diagnosed patients attend the panel where they can address concerns about their diagnosis before a panel of medical oncologists, radiation oncologists, surgeons, radiologists and pathologists. This conference allows patients to receive collaborative care recommendations based on National Cancer Care Standards from panel members and gives assurance to patients that they are receiving excellent care. As a nurse navigator, Conner is the connection between the patient, referring physician, radiologist, surgeon, pathologist, medical oncologist, radiation oncologist, genetic counselor, support groups and patient assistance programs. She thinks of herself as a patient s GPS system, guiding them through one the most difficult times in their lives, offering hope and assurance with confidence and compassion. Barbara Drummond-Huth, RN, DNP, NEA-BC, Flagler s chief nursing officer (CNO), has identified not only an increase in patient satisfaction and retention due to the nurse navigator program, but also an increase in patient volume. Drummond-Huth s vision is for every patient to be cared for as if they were a member of her family. She knows the nurse navigator program aligns with the hospital s patient-centered care professional practice model. The outcomes demonstrated through the nurse navigator program far offset any costs involved in sustaining the program and additional nurse navigator positions are currently under consideration. 8 Voice of Nursing Leadership November 2012

9 High risk obstetrical nurse navigator program/caromont Health, Gastonia, NC Sandy Langheld, BSN, RN, RNC-OB, serves as the high risk obstetrical nurse navigator in the birthplace at CaroMont Health s Gaston Memorial Hospital, a Magnet-designated hospital. North Carolina has experienced a rising number of high risk obstetrical patients, which triggered implementation of the nurse navigator program. High risk obstetrical patients need specialized education, followup, support and coordination of care to Sandy Langheld avoid complications associated with pregnancy. Dr. Ramada Smith, an OB/ GYN maternal fetal medicine specialist collaborated with Langheld to design and implement the high risk obstetrical nurse navigation program which started in In only one year, more than 500 patients, or 20 percent, of all new mothers have had their care coordinated through the program. Langheld serves as a liaison between patients and health care providers. She is consulted through pre-delivery high risk screening criteria and works closely with patients and families, unit nurses and patient s physicians to offset complications due to high risk pregnancies. Patients at risk for pre-term birth and severe pre-eclampsia are a particular focus, as pre-term birth is the leading cause of newborn death in the United States. As the navigator, Langheld is able to have a plan of care in place before the patient enters the birth center. She establishes strong nurse-patientfamily relationships. Patients and families receive detailed information about what to expect, and plans are made for what the family wishes in many cases this is defined as comfort care and precious time with a life-limiting fetal diagnosis. Langheld is closely involved in educating postpartum patients regarding the need to live healthy lifestyles to avoid high risk pregnancies in the future. Langheld is currently conducting a research study to determine if the high risk obstetrical nurse navigation program affects patient perceptions of their overall satisfaction, preparation, education, access to care, advocacy and timeliness of information received. The study will also determine if the nurse navigation program affects staff perception of overall satisfaction, barriers to care, education, preparedness and value in the navigation service. ED nurse navigator program/ Kennedy Health System, Turnersville, NJ Pat Madden, RN, BSN, is the nurse navigator at Kennedy Health System (KHS) where the ED nurse navigation role was established in The overarching concept of this nurse navigation program is to assist the uninsured in obtaining comprehensive follow-up care post discharge, which in turn, allows the system to reduce hospital readmissions through timely follow-up care. The effectiveness of the role is measured through readmission rates, referrals within the Kennedy network, and patient length of stay (LOS) in the ED. Nurse navigators are instrumental in coordinating transfers to long-term care, sub-acute care or home care, as well as assisting veterans with benefits and assisting the homeless with alternate living arrangements. Nurse navigation is a leadership position within the Kennedy Health System. A bachelor of science in nursing (BSN) is required, as well as knowledge of critical care, emergency nursing or case management. Knowledge in community nursing is also a requirement. Nurse navigators need to be familiar with medical billing and available county and state programs and resources. Nurse navigators work closely with the physicians and nurses within the ED and other nursing units. Madden believes that ED nurse navigators are resources not only for ED patients, but also employees and the community. Physicians and hospital staff provide business cards for the nurse navigators to patients and families. In addition to ED services, Kennedy Health System also employs six nurse navigators in the oncology, ambulatory care and bariatric medicine departments. All nurse navigators collaborate with one another and each one brings something different to the table. The end result is excellent patient care. Madden knows that communication is the key to a successful program, so nurse navigators have monthly meetings to share ideas and review individual complex cases. Madden is most proud of being able to develop this program for the ED and take it to new heights as new changes in health care continue to evolve. In one difficult case, Madden was able to ensure coordination of care for a 24-year-old uninsured man who arrived in the ED after experiencing a seizure. His CT scan revealed a brain tumor. As the system did not have a neurosurgical program at the time, Madden arranged care for the patient in another facility. She then received ongoing reports on the patient s status from physicians and the patient s family. The patient had a successful outcome and Madden was able to secure health care insurance for the man following his surgery. Madden realizes that this patient would not have been able to navigate this process alone. She credits the success in this case to her many community connections, as well as working well with other institutions. The system has also developed an ED naviteer program (navigator/ volunteer) in which volunteer navigators are responsible to call 100 percent of all discharged ED patients within three days of discharge. A scripted tool was developed for use by the naviteers. Naviteers are also utilized to alert the nurse navigators when patients are experiencing problems postdischarge, allowing for early intervention prior to readmission. Madden acknowledges that the nurse navigator program has allowed her to blossom in her professional role and credits the health system for supporting the program. Nurse navigators continue to evolve across the system and will help to support Kennedy Health System to face the many challenges in the complex and sometimes fragmented health care environment. Continued on page 10 Voice of Nursing Leadership November

10 The Nurse Navigator: Charting the Course to Quality Outcomes continued from page 9 Navigating the future Nurse navigator roles have great potential to support efficient and effective care delivery systems. Nurse leaders who are focused on improving patient satisfaction, recruitment and increased volume should weigh the advantages of implementing nurse navigator roles in supporting quality patient outcomes. References Freeman, H. P The Harold P. Freeman Patient Navigation Institute. Internet file accessed 7/28/2012. Internet file available at Healthcare Benchmarks & Quality Improvement Final ACO rule includes several changes favorable to hospitals.18 (12), D.B. Gardner The future of the affordable care act: Will we abandon health care reform? Nursing Economics, 30 (1), L. Shockney Evolution of patient navigation. Clinical Journal Of Oncology Nursing, 14 (4), doi: /10.cjon ABOUT THE AUTHORs Diane Brady Schwartz PhD, RN, NEA- BC, is president and chief executive officer, DC Brady Associates, LLC, Fort Myers, FL. She is also a contributing faculty member at Walden University College of Health Sciences, School of Nursing, Minneapolis, MN. Cheri Clancy, RN, MSN, MS, NE-BC, BSN, instructor and nurse recruitment department, University of Medicine and Dentistry of New Jersey, Stratford, NJ. She is also a New Jersey regional coalition member for the Institute of Medicine/Future of Nursing Initiative. Both are members of the 2012 AONE Publications Committee. Resources for Nurse Leaders Available in the AONE Online Store AONE Nurse Executive Competencies AONE recognizes that excellent leadership is essential to ensure excellent patient care. The AONE Nurse Executive Competencies describe skills common to nurses in executive practice regardless of educational level or titles in different organizations and are presented as information for nurse leaders as well as those who employ or work with them. The competencies include: Communication and relationship building Knowledge of the health care environment Leadership Professionalism Business skills These competencies can be used by nurse executives, nurse leaders and nurse educators as a self-assessment tool, useful in the identification of career growth areas. They may also be used by health care organizations as guidelines to assist in the creation of job descriptions, expectations and evaluations of nurse leaders. They can also be used by nurse educators as a curriculum guideline for the educational preparation of nurses seeking expertise and knowledge in executive practice. Available in 5 and 10 packs. 5 pack Product Code: ; member price: $35.00; non-member price: $ pack Product Code: ; member price: $65.00; non-member price: $75.00 AONE Nurse Executive Competencies Assessment Tool The AONE Nurse Executive Competencies Assessment Tool is a companion guide to the AONE Nurse Executive Competencies booklet. This tool is designed to assist the user in assessing their level of preparation on each of the competencies included in the booklet. Competencies are ranked on a five-point scale from novice to expert. Using this tool, nurses can identify strategies they need to implement to raise their competency to the next level. Available in 5 and 10 packs. 5 pack Product Code: ; member price: $35.00; non-member price: $ pack Product Code: ; member price: $65.00; non-member price: $75.00 Products available for sale in the AONE Online Store. Visit for more information. 10 Voice of Nursing Leadership November 2012


12 By Rebecca A. Jones, PhD, RN, NEA-BC, CNE, national director of nursing, Career Education Corporation, Schaumburg, IL Education for Nurses in Community-Based Care Settings The health care provision landscape has changed dramatically over the past decade. In the past, patients would visit an acute care hospital or a medical center for invasive diagnostic tests or minor surgical procedures. Today, these services are being provided in free-standing laboratories, doctors offices and outpatient surgical centers. Because it is less expensive to have these procedures performed at an outpatient setting, these types of provisions of care are helping to recreate the health care landscape as government and third party payors are continually looking for ways to reduce costs. As new care models continue to focus on cost-cutting, changing the standard hospital model of care and moving toward more community-based care models, nurses will be expected to play an even larger role in health care than they do today. What is community-based care? Community-based care occurs outside a health care institution and consists of services provided to individuals and families in a community. This care may occur in community agencies, home, work or school. Nurses provide community-based nursing care when acute care and care for chronic health problems are provided to individuals and families in the community. However, community-based care is different from public or community health nursing because the focus is not on the health care of the community or populations. Setting All nurses in a given community including those working in hospitals, physicians offices and health clinics contribute positively to the overall health of the community in which they work. Community-based settings for the provision of nursing care include caring for individuals and families in ambulatory surgery clinics, outpatient clinics, physician and advanced-practice nursing offices and clinics, employment settings, school sites, preschool programs, housing projects and migrant camps. These sites often also provide acute and chronic individual-focused health care services which is in contrast to population-focused services provided by public and community health nurses. Practice The practice of community-based nursing care is setting-specific and pertains to the care of the individual and family. This care is provided to acute and chronically ill clients where they live, work or attend school in community-based settings. This type of care is comprehensive, coordinated and continuous. Nurses providing the care may be generalists or specialists in maternal infant, pediatric, adult or psychiatric mental health nursing. This is in contrast to public or community health nursing which occurs in the community, organizations and government, and includes the health of individuals, families, communities and the population at large. Medical interventions are geared toward the health of the larger community. Education With the movement of health care delivery toward the community, it should come as no surprise that the education of nursing students has also moved into the community. Many associate degree nursing programs have added a community health introductory course for nursing students. Other nursing programs have altered curricula to include community-based settings and are providing clinical rotations throughout the teaching of the various nursing clinical specialties to accompany the didactic coursework. The table below depicts a few of these experiences by setting and clinical specialty. Other community-based care settings may be available in various communities throughout the United States. Clinical Nursing Specialty Theory Course Fundamentals Medical-Surgical Maternal Newborn Pediatrics Geriatrics Psychiatric Mental Health Community Leadership Community-Based Clinical Rotation Setting Ambulatory Clinics Home Health, Outpatient Surgical Centers, Physicians Clinics and Offices, Rehabilitation Centers Day Cares, Physicians Clinics and Offices, Home Health Day Cares, Physicians Clinics and Offices, Home Health, Schools Adult Day Care Centers, Senior Centers, Assisted Living Facilities, Retirement Homes Adult Day Care Centers, Assisted Living Facilities, Retirement Homes, Ambulatory Outpatient Treatment Centers for Alcoholism and Drug Addiction YMCAs, Home Care, Public Health Agencies, Community-Based Treatment Facilities, Soup Kitchens, Churches, Parish Nursing Programs, Homeless Shelters, Assisted Living Facilities for the Elderly, Senior Centers and Mentally Challenged Any of the above Settings with Practicing Nurses 12 Voice of Nursing Leadership November 2012

13 Collaboration Opportunities exist for nurse leaders and educators to collaborate on the provision of nursing education in the clinical setting. Educators can provide preceptor courses for staff nurses who want to work with students in community-based settings. These courses can be offered for continuing education units to assist the staff nurse with personal development and obtaining continuing education for licensure renewal. These types of courses also provide an opportunity to formally introduce the staff nurse to the goals of clinical education. Orientation programs for students and faculty can be provided by clinical facilities to introduce both students and faculty to the types of patients they will be caring for, as well as teaching them about the types of problems and diseases these people might have. Additionally, faculty and students can be oriented to infection control, safety and other institutional policies required for the clinical setting s continued accreditation. Faculty and nursing leaders can share nurse staffing, faculty staffing and teaching schedules in advance in order to better plan for student clinical experiences. Carefully crafted affiliation agreements that reduce risk and liability, provide for coverage of potential student injury, maximize quality patient care and address the roles for the clinical facility and nursing program need to be executed. All of the agreements must be reviewed and considered by all relevant legal parties and administrators. Last, staff nurses and clinical settings need to be carefully matched with students and clinical rotations to assure that student clinical competencies are achieved and future nurses are adequately prepared for the work setting. Outcomes Fruitful collaborative strategies introduced between nursing leaders and educators can produce positive outcomes for all parties involved. Extra attention and care can be provided for patients by nursing faculty and staff. An extra hand for the staff nurse during low staffing periods can be planned for. Students and faculty can contribute to enhance patient education, both one-on-one and through student projects. With proper planning, the safety of the patient is maintained. Finally, quality patient care can be delivered through the academic-service partnership. Nurse managers are in key positions to identify community-based settings where nursing education could take place. They need to work with educators to create these types of student experiences in their health care systems. Often times educators are made aware of community-based care delivery sites and will need to work with health care institutions to set up student clinical rotations. Academic health service partnerships can produce positive outcomes for the health care institution, staff nurse, student nurse and patient. ABOUT THE AUTHOR Rebecca A. Jones, PhD, RN, NEA-BC, CNE, is national director of nursing, Career Education Corporation, Schaumburg, IL. She is also a member of the AONE 2012 Publications Committee. Special Projects and Methods to Introduce Students to Community- Based Nursing Nurse educators are moving to a health promotion, prevention and healthy habits model with community-based interventions and experiences for nursing students from the time they begin their programs of study. Nurse executives can facilitate those experiences through collaboration with the placement of students within community-based settings that also fall along the continuum of care. Kathy Harris, MS, RN, CENP, FACHE Regional Vice President, Clinical Services Banner Health Banner Health System, Greeley, CO Health care is shifting to accountable care by moving a large volume of patient care from hospitals to community-based and home care locations. In my job with Banner Health, we have discussed community-based nursing. Banner Health Network will be the overriding model for a Health Home so we are focusing on treating acute care as an episode of care and focusing everything else on the patient. We are exploring different models about what nurses and nurse leaders need to know in order to assure the best professional practice along a continuum. Historically, 99 percent of nursing care focused on acute care but that is changing. One of our nurse managers job-shadowed while working in a nursing home. She discovered that the majority of discharge information coming from acute care hospitals was of little use to a long-term care facility (LTC). This is because the discharge criteria are focused on acute care rather than providing information that the LTC nurse needs to know. I have no doubt that this same type of situation may also be true in community health settings. Historically, community health nursing was a setting of care, but not a continuum of care. Today, we deliver care in a variety of settings including through incorporating new technology such as remote monitoring. Today s nurses need to look at the larger health care continuum as we move through each health care episode and into community-based nursing. Karen Given, MS, RN Program Chair, Nursing Sanford-Brown College, Dallas, TX With the move toward community-based nursing, there is a need for all levels of nursing students, not just the baccalaureateprepared nursing students, to learn more about community-based nursing. In my role as founding chair for the Sanford-Brown Dallas nursing program, I plan to place students who are beginning clinical courses into fundamentals of nursing courses. I will also place the first year medical-surgical nursing students continued on page 14 Voice of Nursing Leadership November

14 Special Projects and Methods to Introduce Students to Community-Based Nursing continued into a course in the rehabilitation setting. Students will be asked to identify patients that they can follow later through their community health nursing and geriatrics courses. The overall course objectives are designed to provide students an opportunity to learn about community services and resources, home safety, fall prevention, complications encountered in transferring patients from sub-acute care to home settings and how follow-up after discharge to home might be improved. Students also need an opportunity to learn how the home care environment needs to be altered to accommodate a patient s current mobility and health status. For example, how might a total joint replacement patient modify their home? Josie Lu O Quinn, EdD, RN Retired Associate Dean University of Texas, Arlington, TX My personal philosophy of nursing is that everyone should adopt a healthy lifestyle. In the past, nursing has dealt with the acute care setting and illness side of the health care continuum. As we move from the traditional public health nursing to community-based nursing, we need to focus on health promotion and prevention and healthy behaviors to impact the health of individuals in the community. Dolores Aguilar, RN, APRN Clinical Instructor University of Texas, Arlington, TX As educators move to teaching about community-based nursing, they need to be patient-centered which is the foundation of community-based nursing. The Institute of Medicine s report, The Future of Nursing: Leading Change, Advancing Health, reiterated a high need to reconfirm community-based nursing. At our college we offer community-based nursing using a preceptored model. We developed relationships with public health nurses across the patients life-span throughout the Dallas-Fort Worth community and then fostered students finding of community-based sites where they could make a difference. For example, some students went to homeless shelters and taught about foot care. Working in community-based settings helps the student to see the world differently, especially the RN to BSN completion students who have been working in acute care. Sometimes it is not the patient in need, but the patient s caregiver. Students also have the opportunity to use assessment skills and teach healthy behaviors. This is how we offer community-based nursing experiences to our students. of 500 new members from July - September! 14 Voice of Nursing Leadership November 2012

15 Nine States Receive Grants to Build a More Highly-Educated Nursing Workforce AONE has announced that nine states were chosen to receive two-year, $300,000 grants to advance state and regional strategies to create a more highly-educated, diverse nursing workforce through the new program Academic Progression in Nursing (APIN.) Administering APIN on behalf of the Tri-Council for Nursing and the Robert Wood Johnson Foundation (RWJF), AONE has begun implementation of the Phase I two-year initiative that will provide $4.3 million in support to nine state Action Coalitions as they enact innovative strategies with academic institutions and employers to better prepare nurses to achieve higher degrees, improve patient care and fill faculty and advanced practice roles. The states chosen for the new grants are California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas and Washington State. RWJF will support an additional two years of work at the close of Phase I, to allow states that have met or exceeded their benchmarks to continue to make progress. Susan B. Hassmiller Our state Action Coalitions are bringing nursing and other key leaders together to ensure that nurses have critical competencies, including leadership, cultural competence, interprofessional collaboration, and quality and safety, and to increase the diversity of the nursing workforce, said RWJF senior adviser for nursing Susan B. Hassmiller, PhD, RN, FAAN. We are pleased to be able to provide financial support to nine of the Action Coalitions that are doing highly effective work on academic progression. Advancing a more highly-educated, diverse workforce where nurses are able to practice to the top of their education and training is essential to achieving the Robert Wood Johnson Foundation s mission to improve health and health care in this country. Pamela A. Thompson The nation needs a welleducated nursing workforce to ensure an adequate supply of public health and primary care providers, improve care for patients living with chronic illness, and in other ways meet the needs of our aging and increasingly diverse population, said Pamela A. Thompson, MS, RN, CENP, FAAN, national program director for APIN and chief executive officer of AONE. We have great confidence in the nine states that will receive these grants to implement bold and effective strategies that will work in their states and create models that other states can utilize. Thompson and her counterparts on the Tri-Council for Nursing (an alliance of four autonomous nursing organizations each focused on leadership for education, practice and research) consisting of the American Association of Colleges of Nursing (AACN), the National League for Nursing (NLN), the American Nurses Association (ANA), and AONE, have worked for years to improve pathways for academic progression that ultimately lead to improved patient care. Releasing their position statement on academic progression in May 2010, the Tri-Council noted that current health care reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation s health will be further at risk. Driving the APIN program is the recommendation from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, that 80 percent of the nursing Polly Bednash workforce be prepared at the baccalaureate level or higher by the year 2020, said Polly Bednash, PhD, RN, FAAN, chief executive officer of AACN. Currently, less than half of nurses in the United States have baccalaureate or higher degrees, and too few associate degree-prepared nurses are seeking to advance their education. Developing new strategies for academic progression will help to ensure that the nursing workforce is well-prepared to provide high-quality, patientcentered care to our nation s population. APIN will help to build strong partnerships between community colleges and universities to make it easier for nurses to transition to baccalaureate and advanced degrees, added Beverly Beverly Malone Malone, PhD, RN, FAAN, chief executive officer of the NLN. Nurses who advance their educations are better equipped with the critical competencies necessary to deliver outstanding patient care, including leadership, cultural competence, interprofessional collaboration and quality and safety. The Tri-Council is uniquely positioned to spearhead the APIN initiative, said ANA chief executive officer Marla Weston, PhD, RN. Through bringing together our respective constituencies in practice, Marla Weston leadership and education, we re able to facilitate the necessary partnerships at the state and national level to advance academic progression and develop the sustainable infrastructure that will prepare the nurse of the future. Look for future information and updates on APIN in AONE publications and on the AONE website at Voice of Nursing Leadership November

16 AONE Members in the News AONE CEO appointed to National Patient Safety Foundation board of governors AONE chief executive officer Pamela A. Thompson, MS, RN, CENP, FAAN, has been appointed to the National Patient Safety Foundation (NPSF) board of governors. The board of governors offers direction and insight on NPSF program development, in keeping with the Foundation s mission of improving the safety of care provided to patients. Thompson was most recently immediate past chair of the NPSF board of directors. Waxman elected chair of the DNP department at University of San Francisco AONE member KT Waxman, DNP, MBA, RN, CNL, CENP, has been elected chair of the doctor of nursing practice (DNP) department at the University of San Francisco (USF). Dr. Waxman will be responsible for the traditional DNP program, Executive Leader DNP (EL-DNP) program, and the DNP-FNP program. She was formerly the EL-DNP coordinator and taught in the program as a full-time faculty member. Dr. Waxman also leads the California Simulation Alliance through the California Institute for Nursing and Health Care. Dr. Waxman is a multi-published author, whose book Financial and Business Management for the Doctor of Nursing Practice (Springer Publishing) comes out this month. An international speaker on nursing leadership and clinical simulation, Dr. Waxman will be a keynote speaker at the Leadership and Practice Development in Health in Tasmania, Australia this month. Dr. Waxman is a member of the AONE International Committee. Nevidjon receives 2012 ANA honorary recognition award AONE member Brenda Nevidjon, MSN, RN, FAAN, has been awarded the 2012 ANA Honorary Recognition Award for her distinguished service to the nursing profession by the American Nurses Association (ANA) board of directors. Over her 12 years as a faculty member, Brenda Nevidjon has prepared 70 nurses for key positions in nursing and health care leadership, many of whom are now in key leadership roles, said dean Catherine L. Gilliss, DNSc, RN, FAAN, Helene Fuld Health Trust professor of nursing and vice chancellor for Nursing Affairs. Brenda, herself, has taken on significant leadership roles over her career as chief operating officer of Duke University Hospital, president of the Oncology Nursing Society, and chair of the school s Faculty Governance Association. Her leadership contributions are well known. Nevidjon is currently the faculty coordinator of the Health Care Systems Instructional Area in the MSN program and lead faculty for the Nursing and Healthcare Leadership specialty at Duke University School of Nursing, Durham, NC. Porter named endowed chair of nursing at Mount Sinai Hospital AONE member Carol Porter, DNP, RN, chief nursing officer and senior vice president for nursing, Mount Sinai Hospital, New York, NY has been named as the inaugural chair holder of the Edgar M. Cullman Sr., chair of the department of nursing. The chair is named in honor of Edgar M. Cullman, Sr. who had a longstanding and deep admiration for nurses and a keen understanding of the dynamics of patient care. Washington graduates from Boston College Connell School of Nursing AONE member Deborah Washington, PhD, RN, recently graduated from Boston College Connell School of Nursing. Washington has worked at Massachusetts General Hospital for the past 25 years and currently serves as director of diversity. Washington is also national co-chair of the Diversity Steering Committee for the Future of Nursing State Action Coalitions and serves on the Diversity Advisory Committee of five local schools of nursing. Washington serves on the board of Medically Induced Trauma Support Services (MITSS) an organization that provides emotional support to clinicians, patients and families who have been involved in an adverse event. The Joint Commission taps Ann Scott Blouin as EVP of Customer Relations The Joint Commission announced the appointment of AONE member Ann Scott Blouin, PhD, RN, FACHE, to the newly created position of executive vice president (EVP) of customer relations. Dr. Blouin, who previously held the title executive vice president of accreditation and certification operations, will focus on building and strengthening external customer and stakeholder relationships. Ann has demonstrated remarkable leadership in actively engaging with The Joint Commission s customers to help guide our strategic planning process, as well as our operational improvements, says Mark R. Chassin, MD, FACP, MPP, MPH, president, The Joint Commission. In this new role, Ann will build on The Joint Commission s many achievements over the past few years that have resulted in our success in increasing the benefit our customers receive from our surveys and other services. Dr. Blouin joined The Joint Commission in 2008 after more than 30 years of health care administration, consulting and clinical nursing experience. Over her career, she has worked with multiple constituents ranging from nursing and medical staff to senior client executives and boards. AONE member becomes board certified in health care management with FACHE Christine Hamill, RN, MSN, CNL, NEA-BC, director of outpatient services and Magnet coordinator Wentworth-Douglass Hospital Dover, NH recently became board certified in health care management as a Fellow with the American College of Healthcare Executives (FACHE). 16 Voice of Nursing Leadership November 2012

17 AONE members chosen as National League for Nursing award winners AONE members Marion E. Broome, PhD, RN, FAAN, professor and dean of the Indiana University School of Nursing in Indianapolis, and Patricia S. Yoder-Wise, EdD, RN, NEA-BC, FAAN, ANEF, dean emerita and professor emerita of the Health Sciences Center School of Nursing at Texas Tech University in Lubbock, have been chosen as winners of the National League for Nursing (NLN) Award for Outstanding Leadership in Nursing Education. Dr. Broome assumed her current role as dean of the Indiana University School of Nursing (IUSON) in July In addition, she is a professor in the school s department of family health nursing. Dr. Broome is also a member of the Indiana University Graduate School, affiliate faculty of the Indiana University School of Bioethics, and serves as associate vice president for academic affairs at IU (formerly Clarian) Health. Dr. Yoder-Wise has demonstrated leadership through every facet of nursing education: scholarship, administration, in the classroom and on the lecture circuit, and through her extensive impact on nursing education policy, specifically advocating for and implementing programs to increase diversity and cultural competence among students and nurse faculty. Dr. Yoder-Wise is the editor-inchief of the Journal of Continuing Education in Nursing: Continuing Competence for the Future and Nursing Forum. AACN selects AONE member as 2013 Distinguished Research Lecturer The American Association of Critical-Care Nurses (AACN) selected AONE member Nancy M. Albert, RN, PhD, CCNS, CCRN, NE-BC, FAHA, FCCM, as its 2013 Distinguished Research Lecturer. The award recognizes nurses whose program of research significantly influences high acuity and critical care. Albert is senior director of nursing research and innovation for Cleveland Clinic and its Nursing Institute, which oversees the practice and education of more than 11,000 nurses throughout Cleveland Clinic s health system. In this role, she mentors fellow nurses in conducting, translating and disseminating research to increase nursing knowledge of clinical and administrative practices and facilitate evidence-based nursing practices that improve patient outcomes. She remains active as a clinical nurse specialist in Cleveland Clinic s Kaufman Center for Heart Failure and is also an adjunct associate professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland and an adjunct faculty member in the nursing school at Kent State University. Her personal program of research focuses on improving clinical outcomes for patients hospitalized with heart failure and improving evidence-based delivery of acute and critical care. be a nursing leader For patients, their family members, friends and caregivers, nurses are a compassionate and prominent touch point at Centra. Our Nurse Managers are a key to Centra s ability to drive the best possible outcomes for our patients. Their professional contributions have resulted in Centra being recognized as one of the safest hospitals in America by Forbes Magazine, receiving the National Premier Care Science Quality Award and earning top patient satisfaction scores in the nation. we invite you to be a part of nursing excellence at centra Voice of Nursing Leadership November

18 Voice of the President continued from page 1 Global nursing issues Health care is a global concern and AONE continues to promote its international presence because the delivery of the best health care in any country depends on exemplary nursing leadership. In July s issue of Voice we outlined our plan to collaborate with the People to People Ambassador program and visit Vietnam and Cambodia as a delegation of nurse leaders. The People to People program mission is to bridge cultural and political borders through education and exchange, creating global citizens and making the world a better place for future generations. While on our trip in August, our delegation learned that most countries are facing the same type of transformations in health care that we are facing in the U.S. Other countries are also looking to advances in nursing education and practice to help better health care. Our delegation met with global nurse leaders and discussed the growing need for nurses who hold advanced nursing education and skills. We also talked about the need for qualified nursing faculty to educate future generations of nurses who would hold new competencies. These competencies include leadership and the ability to easily navigate information systems to access information and deploy standardized protocols based on evidence. We agreed that nurses are well-positioned to take on new roles and provide leadership for the changes ahead. We also shared concerns for a future that is coming fast and holds fiscal and resource constraints. But amidst these discussions of future uncertainty and challenges, our group of engaged nurse leaders both from the U.S. and abroad, held no doubt that medical science and technology advances along with a committed group of transformational nurse leaders, would ensure success in shaping our profession s new roles and responsibilities. We agreed that nurses are well-positioned to design and serve in key roles in these future care delivery systems. Nursing innovation is key to a healthy future The September issue of Voice focused on the work of AONE s Center for Care Innovation and Transformation (CCIT). With health care moving in a new direction, frontline nurses who utilize appropriate tools are transforming the patient s experience and revitalizing the clinician s work environment. The Care Innovation and Transformation (CIT) initiative however, goes further to provide additional support and leadership training for bedside nurses, nurse managers and other nurse leaders who must learn to successfully manage change. Developing new and innovative approaches to make patient care safer and more efficient is one of the hallmarks of CIT. Empowering patients to own their health and deal effectively with illness as they partner with providers in new and different roles will provide care across the continuum. This new concept is foundational for the emerging world of health care and its delivery. This will be successful because of dedicated groups of people coming together to assist each other. As new roles and responsibilities for nursing emerge as a result of these needed changes in the health care landscape, they will be sponsored by transformational nursing leadership. In this issue of Voice, the authors share information and stories that address these new and evolving roles. Their writings underscore the importance of nurse leaders embracing and interpreting the manner in which these new nursing roles will meet or exceed patient/family needs. These innovative nursing roles include the advancement of more nurse-run and managed clinics as all providers practice to the full extent of their education and license. This issue also illustrates the advancing role of nurse navigators who prepare and guide patients during their health care journey throughout the care continuum while paying close attention to the overall patient experience as well as the patient s physical and emotional needs. It also addresses the role of nurses as designers of new health care facilities (including alternative sites for patient care located in retail and other community-based centers) that will make care more accessible and cost effective. These are all examples of the work of the present and future that is needed to better meet patient care needs. This work redefines nurse leaders who are and will be, well-positioned to provide leadership to nurses caring for patients across the continuum. Highlighting the year s accomplishments As I finish my year as AONE president and prepare my 2012 report summarizing the year s achievements and all of your contributions, it is noteworthy to highlight what has been achieved together. AONE through its members and formal committees continues to advance the IOM report on the Future of Nursing s agenda and goals with bold steps being taken to increase the number of RNs at the bedside to hold a BSN degree; creating workplaces in which nurses and other health care providers want to practice; continuing with dialogue and creation of statements on mandating staffing standards and addressing fatigue in the work place. In collaboration with the American Nurses Association (ANA), AONE developed Principles for Collaborative Relationships between Clinical Nurses and Nurse Managers to be shared for implementation in clinical settings. In March, AONE began its work as the National Program Office (NPO) for the Academic Progression in Nursing (APIN) program that will advance state and regional strategies to create a more highlyeducated nursing workforce. The Robert Wood Johnson Foundation (RWJF) awarded funding to the Tri-Council for Nursing consisting of AONE, the American Association of Colleges of Nursing (AACN), the National League for Nursing (NLN) and the American Nurses Association (ANA) to lead this $4.3 million initiative. In its first phase, this program will support funding of up to $300,000 over two years to nine state action coalitions that are working to advance academic progression and to ensure demand for baccalaureate-educated nurses. More information about the APIN program is available in this issue of Voice. In April, I was invited along with representatives of other national nursing organizations to attend a reception at the White House to celebrate the launch of Joining Forces, a national campaign sponsored by the U.S. Department of Veterans Affairs. The goal of the initiative is to help educate nurses to meet the unique health needs of service members and their families and to raise awareness of the specific health issues facing the more than one million service members who are projected to leave the military within the next five years. 18 Voice of Nursing Leadership November 2012

19 In late 2010, AONE adapted a new mission statement: To shape health care through innovative and expert nursing leadership. Prior to this adaption, the organization s mission statement had remained consistent for the prior 10 years. During this time, the health care environment and AONE as an organization had changed significantly. The new mission was strongly grounded in the existing vision statement. It was a wonderful moment of reflection when we realized our vision had now become our mission. What we had aspired to do 10 years prior, we were accomplishing. This year, the AONE Board was charged with formulating our new vision statement for the organization. We were inspired to craft a vision that was forward thinking and imagined the possibilities ahead. This fall, the Board approved the new vision statement for AONE: Global Nursing Leadership One Voice Advancing Health. AONE members are at work designing future health care delivery systems that hold opportunities for nurses in new roles, working in alternative settings to achieve greater access, quality and financing of health care for global citizens. We believe our new vision reflects these goals. During the year, I had the opportunity to share and teach the use of the Nurse Manager Inventory Tool and the AONE Nurse Executive Competencies to inform two graduate nursing programs. As I mentioned earlier in this column, during the People to People delegation in Vietnam and Cambodia, our team shared some of these initiatives with both leaders in service and in practice so that they may also advance their academic and service goals for nursing. In return, these international leaders taught us what true perseverance is as they work to rebuild their countries, health care systems, educational programs and practice expectations/settings while facing many barriers. Thank you I would like to thank the group of dedicated professionals on AONE s staff, the leaders, and members of all our committees and taskforces, our officers and regional directors on the board of directors and most importantly, Pamela Thompson, AONE s chief executive officer. Thank you for all of your hard work and commitment to provide leadership for this truly great professional organization whose mission is to shape health care through innovative and expert nursing leadership. And of course, I want to thank all of the AONE members whose skill and dedication continues to help patients every day. You are the reason this great organization exists. We couldn t do this meaningful work without you. Last but not least, I would like to extend my sincere thanks to my organization, Wellstar/ Kennestone Hospital, and especially to Candice Saunders, chief executive officer; Dan Woods, chief operations officer; and MaryLou Wesley, chief nurse executive, for their support in enabling me to serve AONE and its members. A special thanks to my directors Sandra Lucius, Kathy Young, Beth Chapman, Scott Schug, Joyce McMurran, Philadeh Seda and Carole Harman for ensuring that things continued on (and very well I might add!) in my absence. No one does this work alone and for all those I did not mention, I extend my sincere thanks as well. ABOUT THE AUTHOR Laura Caramanica, RN, PhD, CENP, FACHE, is president, 2012 AONE Board of Directors. She is also vice president/chief nursing officer at WellStar/Kennestone Hospital, Marietta, GA. Photo Highlights of Laura Caramanica s Year as 2012 AONE President Voice of Nursing Leadership November

20 The Future of Nursing Starts with You. The Institute of Medicine s Report on the Future of Nursing calls for 80% of RNs to have their BSN by the year As a nursing leader, you are the catalyst to implement these recommendations and can start by providing seamless pathways to education through a partnership with Drexel University Online. Here are just a few ways a partnership can assist: Tuition Reductions Save Your Employees Money Reduced tuition rates of up to 25% off help nurses maximize their tuition reimbursement benefits, translating to substantial savings. 24/7 Online Convenience Means Greater Flexibility Nurses can log-on anytime, from anywhere, to complete assignments without interrupting their career. Top-Ranked Programs Offer Nurses an Unparalleled Education As one of America s Best Colleges 2012, Drexel offers your nurses a way to earn a reputable degree conveniently online. Learn more about partnership opportunities with Drexel: Current Drexel University Online Student Drexel Online. A Better U. Questions? Please contact: Hayden Carpien

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