January 2012 Focus on the Future of Nursing

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1 VOICE of nursing leadership In this issue: PAGE 6 LewisGale Regional Health System Already Taking Strides that Meet the IOM Recommendations Head-On PAGE 8 Linking the Institute of Medicine s Future of Nursing Report Recommendations to the Veterans Hospital Administration National Nursing Strategic Plan PAGE 11 AONE Announces 2012 President-Elect PAGE 12 Inova Health System Refines the Role of Nursing and Focuses Resources on Education January 2012 Focus on the Future of Nursing Letter from the Leadership AONE Survey: Gauging Hospitals Use of Preferential Hiring Policies for BSN-Prepared Nurses In the 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that leaders at the federal level, in nursing schools and in health care systems work to increase the proportion of nurses with a baccalaureate degree in nursing (BSN) from 50 to 80 percent of all registered nurses (RNs) by More Laura Caramanica, RN, PhD, CENP, FACHE 2012 president, AONE specifically, it recommended that health care Board of Directors organizations offer support and incentives for nurses with associate s and diploma degrees to enter baccalaureate programs within five years of graduation. According to that report: Although a BSN education is not a panacea for all that is expected of nurses in the future, it does, relative to other pathways, introduce students to a wider range of competencies Pamela A. Thompson,.... Care within the hospital continues to MS, RN, CENP, FAAN grow more complex, with nurses having to AONE chief make critical decisions associated with care for executive officer sicker, frailer patients and having to use more sophisticated, lifesaving technology coupled with information management systems that require skills in analysis and synthesis. AONE has long advocated that RNs advance their educations to include baccalaureate and graduate degrees. In 2005, AONE was recognized with the BSN Champion Award from the American Association of Colleges of Nursing (AACN) for releasing a statement advocating the baccalaureate degree as the appropriate preparation for RNs, and urging nurse leaders to work with educators to help create paths A well-educated nurse is better prepared for changes in technology, advanced treatments and protocols and most important, can offer better and safer patient care. Continued on page 17

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3 Volume 10, Number 1 January 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, RN, PhD, NEA-BC Vice President/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, MS, RN, NEA-BC, FACHE Executive Director, Nursing Operations Tallahassee Memorial Hospital Tallahassee, FL 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 D. Poduska, MS, RN, CNAA Director, Resource Services 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 calendar ONGOING Essentials of Nurse Manager Orientation Now available for individual purchase! March 21-24, 2012 AONE 45th Annual Meeting and Exposition, Boston, MA. meeting Continuing education events of interest to nurse leaders and sponsored by AONE and its chapters will be included in this calendar. Send event information to AONE Index A quick look at interesting informational tidbits for AONE and its members. Number of pages in the full IOM Future of Nursing (FON) report: 586 Future of Nursing report publication date: October 5, 2010 Date AONE released position statement on the educational preparation of nurse leaders: December 10, 2010 As referenced by IOM, number of nursing professionals: 3 million Number of states participating in Regional Action Coalitions (RACs): 36 Deadline for the Campaign for Action application to be deemed official Action Coalitions: January 25, 2012 IOM recommendation of nurses with a baccalaureate degree in nursing (BSN) by 2020: 80 percent Voice of Nursing Leadership January

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5 Map your adventure for four days of illuminating sessions, networking opportunities, and discovery with fellow AONE members and friends, new and old, in the historic city of Boston. Don t miss this illustrious array of general session speakers! Daniel H. Pink New York Times bestselling author Drive: What the Science of Motivation Can Teach You About High Performance Susan B. Hassmiller, PhD, RN, FAAN Robert Wood Johnson Foundation Senior Advisor for Nursing Call to Duty: Serving as a Volunteer in Time of Disaster John Welton, PhD, RN Dean, School of Nursing, Florida Southern College AONE Foundation Lecture: Value-Based Nursing Care Thomas Goetz Executive Editor, Wired Magazine The Future of Personalized Medicine Join us for a special evening event honoring John Welton, PhD, RN, 2012 AONE Foundation Nurse Researcher Award recipient Cocktail reception Friday, March 23, from 5:45 to 7:30 p.m. Enjoy a captivating one-woman show: Saints, Soldiers & Spies: Women and War performed by Pippa White Tickets: $150 Proceeds from this event will benefit The AONE Foundation for Nursing Leadership Research and Education Dee Dee Myers Former White House Press Secretary In the Belly of the Beast Light tomorrow with today. Elizabeth Barrett Browning AONE 45th Annual Meeting & Exposition Registration Fees Register by: Before February 24 February 25 March 16 March Member Full Conference $845 $925 $945 Non-Member Full Conference* $1090 $1170 $1190 Member Speaker $425 Non-member Speaker $550 Single Day Member $475 $550 $570 Single Day Non-Member $575 $650 $670 CENP/CNML Review Session^ $300 $300 Pre-Conference Session $200 $200 $200 Guest $100 $100 $100 *The non-member full conference fee includes a one year AONE membership ^The CENP and CNML review sessions will be held from 8:00 a.m. 4:30 p.m. and will include lunch. No onsite registrations will be accepted for these classes. Register Today American Organization of Nurse Executives (AONE) 155 North Wacker Drive, Suite 400 Chicago, Illinois

6 By Pamela Hardesty, PhD, RN, CENP, NEA-BC, chief nursing officer LewisGale Medical Center, Salem, VA LewisGale Regional Health System Already Taking Strides that Meet the IOM Recommendations Head-On The Institute of Medicine (IOM) Future of Nursing report released by the Robert Wood Johnson Foundation (RWJF) offers recommendations that align the nursing profession s goals with the current and future health care needs of our country. The report is a must-read for every nurse leader as well as everyone in the C-suite. Hospital patient care continues to become more complex and compressed into a shorter time span with nurses and patients at the epicenter. The chief nursing officer (CNO), nurse leaders and staff members must be willing to make the often difficult, but necessary changes required for a successful future. Many of the recommendations in the report have been in our knowledge base for years so they should not surprise anyone. We have known the right course to take and have discussed and processed it for decades, but current and future circumstances in health care now make following these recommendations an imperative. At LewisGale Regional Health System (a four-hospital HCA-affiliated health care system located in southwest Virginia), nursing leadership has taken steps to begin implementing the report s recommendations. All four hospitals have either received Magnet recognition (LewisGale Hospital Montgomery), are officially on the journey (LewisGale Medical Center), or are planning to apply for designation (LewisGale Hospital Alleghany and LewisGale Hospital Pulaski). Each hospital has a strong shared governance model that promotes nurses at the table leading and participating in health care decisions. In addition, all four hospitals participate in the National Database for Nursing Quality Indicators (NDNQI) a nursing database that provides quarterly and annual reporting of structure, process and outcome indicators to evaluate nursing care at the unit level for national benchmarking. The IOM report and the Magnet components are congruent, so using the IOM recommendations are important as we journey towards creating and sustaining a culture of nursing excellence. Our system works to assure that our nurses are working to the fullest extent of their education and training as recommended in the IOM report. For example, all four facilities have created expanded roles for advanced practice registered nurses (APRNs). LewisGale Hospital Montgomery has a clinical specialist palliative care nurse and a cardiology nurse practitioner who works from case management to follow cardiovascular patients. Additionally, the facility uses a nurse practitioner to lead their research council. LewisGale Medical Center and LewisGale Hospital Montgomery utilize certified registered nurse anesthetists (CRNAs) in the operating room and nurse practitioners in their emergency department. All four facilities also have an extensive forensic nursing program that has received accolades from the community and is recognized as one of the best in the state. LewisGale Medical Center has created roles for APRNs in both oncology and cardiovascular services. Our hospitals have long been providing opportunities for nurses to lead and diffuse collaborative methods, another of the IOM recommendations. Our nursing staff and nurse leaders act as change agents for the community and the market we serve. This occurs through participation in research and evidence-based projects including the formation of ST segment elevation myocardial infarction (STEMI) networks, development of a hypothermia program, palliative care programs, congestive heart failure clinics, work with the local high school sports teams around the prevention of concussions in athletes, and the development of stroke services. Many nurses and nurse leaders also serve on local boards and participate in community activities that promote health care initiatives. Addressing nursing education For the past four years, the CNOs have worked together to develop consistent programs for the four hospitals and have formed system staffnurse-led councils in addition to individual hospital councils. There is one market-wide policy and council for our clinical ladder, one for certification bonus and the development of one professional practice model and schematic. In the future, we are looking at forming a marketwide nursing practice council. One year ago, LewisGale Regional Health System CNOs realized the need for a nurse residency program. After seeing the success of the all the other market-wide councils, the development of one nurse residency program was the natural next step. In 2010, the system received a $50,000 HCA grant to begin a nurse residency program with the purpose of increasing the retention of two-year registered nurses (RNs). The southwest area of Virginia is fortunate to have numerous nursing programs including several baccalaureate (BSN) programs as well as a doctor of nursing practice (DNP) program. New graduate nurses are available and are welcomed to work at our facilities. Through the work of the Nurse Residency Market Council (consisting of staff nurses, nurse leaders and nurse educators from the colleges and our system), a nurse residency program for all four hospitals was developed and began in August There are currently more than 40 nurse graduates in the year-long program. It is important to the system s hospitals that nurses are afforded opportunities and encouraged to take advantage of educational advancement. We provide tuition reimbursement that fully funds RNs to attain a BSN and/ or a master s degree. We also support education through flexible scheduling. All four hospital CNOs have collaborated with area schools and sit on their 6 Voice of Nursing Leadership January 2012

7 advisory boards to help develop creative and assessable curriculum designed for the full-time practicing nurse. All of our nursing directors are required, at the minimum, to have a BSN degree. Through our clinical ladder program, the BSN is also required to achieve the highest level. Our senior management leads by example with three of our CNOs either possessing or working toward a doctorate degree in nursing. In 2009, a market wide nursing research conference was developed and opened up to the entire region to include all schools of nursing. At the conference, our staff had the opportunity to present their research which has encouraged further exploration in the possibilities around attainment of higher education. Each of our facilities has also had the privilege of area schools of nursing sitting on our research councils and assisting our RNs in their evidence-based projects and studies. This relationship has been priceless and has encouraged the need for further education and life-long learning among our staff. In January of 2012, the four hospitals are again joining forces through the development of a market-wide charge nurse course for our staff leaders. Included in the course will be summits where issues directly affecting charge nurses can be discussed, as well as opportunities for continued education on the issues facing the profession regionally and nationally. Included in the course will be ongoing education around the IOM s recommendations and how they can be translated into everyday practice. Throughout our market-wide, unit-based councils, staff nurses have developed staffing models and acuity-based assignment models for each of their units. This has been developed through the evidence-based projects of our staff-led nursing research councils and nursing directors. Teaching the fine art of nursing leadership LewisGale Regional Health System also provides a monthly Leadership University for all leaders in our system. Other leadership opportunities include HCA s CNO development program and the participation of our nurse leaders in the Virginia Nursing Leadership Institute. Our nurse leaders also attend other local and regional programs such as Leadership Roanoke a year-long program also attended by executives from other businesses within the community. In addition, our nurses have the opportunity to partner with the area universities on LEAN projects and research studies. LEAN projects consist of the development of people systems that include a shared vision and way of thinking that all participants can engage in, while aligning problem-solving and improvement activities. The end result is a framework for observing, discussing and changing the way in which work is done. For example, two of our hospitals work in conjunction with Virginia Tech University on operational efficiencies around workflow and supply management. We also have a partnership with the Radford University nursing department on several joint research projects, poster presentations and our nurse residency program. In addition to the work that has been started to implement the IOM recommendations, the system s CNOs have participated in both state and local workforce and planning meetings centered around the recommendations. Virginia has been selected as a Campaign for Action state with the Center to Champion Nursing in America, an initiative of AARP and RWJF, whose primary purpose is to implement the IOM blueprint for action. Loressa Cole, MSN, RN, FACHE, the CNO of LewisGale Montgomery, leads Virginia s State Leadership Action Coalition, whose primary goal is to ensure that nurses are skilled and able to provide leadership from the bedside to the boardroom. As CNO of LewisGale Medical Center, I have participated on the IOM Future of Nursing Taskforce within AONE during the past year. Regionally, the CNOs, educators and other nurse leaders from around the southwest Virginia market have met to discuss how this area of Virginia can best address the IOM recommendations. Both CNOs at LewisGale Hospital Pulaski (Sandra Emeott, BSN, RN) and LewisGale Hospital Alleghany (Robin Broughman, PhD, RN), along with our nurse educators and leaders, have been the lead representatives of our system at the regional discussions. I am excited at the possibilities and the role our profession will take in the 21 st century to create a health system in the United States that continues to meet the health care needs of our nation. Throughout our history, nurses have led the way in health care and through innovation and knowledge have met the challenges of the time. We can be assured that it will be no different this time around. ABOUT THE AUTHOR Pamela Hardesty, PhD, RN, CENP, NEA-BC, is chief nursing officer, LewisGale Medical Center, Salem, VA. She was also a member of the AONE 2011 IOM Future of Nursing Task Force. Do We Have Your Updated Information? Have you moved, changed jobs or have a new address? Visit MyAONE at to explore your profile, member resources and publications available from AONE. It s fast, convenient and easy! Voice of Nursing Leadership January

8 An Interview with Cathy Rick, RN NEA-BC, FAAN FACHE, chief nursing officer, Department of Veterans Affairs By Elaine Cohen, EdD, RN, FAAN, associate chief, Nursing Quality Improvement, James A. Haley Veterans Hospital, Tampa, FL Linking the Institute of Medicine s Future of Nursing Report Recommendations to the Veterans Hospital Administration National Nursing Strategic Plan As the nation s largest health care system, the Veterans Health Care Administration (VHA) remains at the forefront of caring for our country s heroes. The Department of Cathy Rick, RN NEA-BC, FAAN FACHE, Veterans Affairs (VA) chief nursing officer, strategic mission and Department of Veterans strong commitment Affairs to provide the highest standard of care, services and support to veterans and their families, is deeply rooted in its culture of excellence. Continuous improvement and agility to current challenges is reflective of the VA s commitment to transformation and is demonstrated through the leadership and oversight provided by its nursing practice environments. Advancing nursing practice and promoting patient-driven care represent the core of the Office of Nursing Services (ONS) Functional Model. The VA s National Nursing Strategic Plan truly exemplifies the recommendations of the Institute of Medicine s (IOM) Future of Nursing report. What follows are highlights of an extensive summary of VA nursing activities as provided by Cathy Rick, RN, NEA-BC, FAAN, FACHE, chief nursing officer for the Department of Veterans Affairs and their alignment with the IOM s eight recommendations. IOM Recommendation 1: Remove Scopeof-Practice Barriers The Advanced Practice Nursing Advisory Group serves the ONS in an advisory capacity for all issues related to the advanced practice registered nurse (APRN) in the implementation and evaluation of the national nursing strategic plan. One of its major accomplishments includes the development and submission of a position paper to ONS supporting implementation of federal supremacy for independent APRN practice in VHA in an effort to remove scope of barriers for APRNs and allow them to work to the full extent of their education and training. This group also assisted with the development of frequently asked questions (FAQs) for APRNs regarding independent practice. In addition, a VHA Nursing Handbook was written to provide guidance for the delivery of nursing care and to articulate patient-centered nursing practice within the VHA. The handbook provides direction to assist in decision-making and program development related to nursing practice and guidance inclusive of all nursing practice environments, populations, technologies and workforce designs. Professional nursing practice concepts are described to reflect evidence-based practice for current and further future efforts. Another initiative involves a collaborative partnership between the ONS and the Midwest Mountain Veterans Engineering Resource Centers to form the Academy for the Improvement of Microsystems (AIM). This entity will foster the development of the clinical nurse leader (CNL) role through an inter-professional approach emphasizing systems redesign and flow improvement. The Academy will serve as the foundation to guide medical centers toward implementation and sustainment of the CNL role, and evaluate practice outcomes. IOM Recommendation 2: Expand Opportunities for Nurses to Lead and Diffuse Collaborative Improvement Efforts The Evidence-Based Practice Committee of the National Nurse Executive Council has expanded opportunities for VA nurses to lead and diffuse collaborative improvement efforts in inter-professional teams. Trainings have included pressure ulcer prevention, catheter-associated urinary tract infections, fall prevention and bedside shift handoffs. Another initiative involves the Clinical Practice Program which is composed of seven field advisory committees and three workgroups who advise ONS about the assessment and design of a broad range of specialty nursing practice initiatives and evaluation of nursing-sensitive clinical outcomes across all care settings. Nursing efforts in the Patient Aligned Care Teams (PACT) is significant. PACTs are a patient-driven, team-based approach that delivers efficient, comprehensive and continuous care through active communication and coordination of health care services. Additional efforts are focused on creating healthy work environments and implementing nursing initiatives to support health care practices and employment conditions that promote quality patient outcomes, optimal system performance and support of professional growth from a Veteran-centric and team-based perspective. IOM Recommendation 3: Implement Nurse Residency Programs VA nursing is taking a broad approach with respect to transitions to practice. ONS launched a Nurse Residency Program that focuses on refinement of graduate nurse clinical competencies, and development of professional nursing roles and leadership characteristics. This program resulted in 100 percent RN retention rates. Additionally, ONS is adapting principles of the Nurse Residency Program to 8 Voice of Nursing Leadership January 2012

9 meet the needs of experienced nurses who are transitioning to new roles such as the clinical nurse leader (CNL), nurse practitioner (NP), clinical nurse specialist (CNS), nurse scientist, nurse manager and even chief nurse executives (CNEs). These transitions to practice encompass a mentor matching process along with programs to prepare appropriate preceptors and options for mini residencies to learn new skills or procedures. IOM Recommendation 4: Increase the Proportion of Nurses with a Baccalaureate Degree to 80 Percent by 2020 The VA Nursing Academy (the academy) is a partnership with accredited nursing schools to provide compassionate, highly-educated nurses to look after the health care needs of the nation s veterans. Individual VA facilities partner with schools of nursing to address shortages by expanding faculty and professional development, increasing nursing student enrollment, primarily in baccalaureate programs, providing opportunities for educational and practice innovations, and increasing recruitment and retention of VA nurses as a result of enhanced roles in nursing education. In addition, the creation of the National Nursing Education Initiative (NNEI) supports the opportunities for the VA s registered nurses to complete or expand their formal education by providing funding and other assistance for their academic pursuits. Since inception of the NNEI program in 2000, 257 scholarships have been awarded to RNs pursuing doctorate degrees and 4,795 have been awarded for baccalaureate degrees through IOM Recommendation 5: Double the Number of Nurses with a Doctorate by 2010 The Office of Academic Affiliations sponsors nursing pre- and post-doctoral fellowships to assist in the education and research development of doctoral-level nurses for the VA and the nation. Fellows benefit from rigorous research methodology training under the direction of VA field-based investigators and apply their knowledge and skills through a doctoral research dissertation on a topic of relevance to veteran care involving a veteran population. Fellows may seek VA employment upon completion of the fellowship. The VA National Quality Scholars Fellowship Program is a two-year post residency fellowship program for nurses and physician scholars that provide opportunities for learning and working together to advance the science and practice of health care improvement. Fellows apply their knowledge to projects in quality improvement system design, conducting quality improvement research, integrated systems technology, and health care informatics development. Another effort involves a Memorandum of Understanding between the VHA and the Uniformed Services University of the Health Sciences to allow VA nurses to attend the PhD program in nursing science. Clinical research includes studying the effects of blast traumatic brain injury and toxic effects of embedded metals. IOM Recommendation 6: Ensure that Nurses Engage in Lifelong Learning The Career Development Workforce Management (CDWM) portfolio is engaged in developing programs to facilitate nursing students achieving the transition to early novice nurse in the beginning phases of their professional careers. To meet the challenges issued by IOM, CDWM is continuing long-term collaborations with Healthcare Recruitment Retention Office/Workforce Management and Consulting Office on national educational scholarship and debt reduction programs. ONS collaborated with external stakeholders to further nursing practice, education and professional development to contribute content to and address recommendations from the Future of Nursing report. Contributions included features on the PACTs/Patient-Centered Medical Home, and the VA Nursing Academy. ONS continues to partner with the IOM, the American Association of Colleges of Nursing, the Association of Military Surgeons United States, the Society of Federal Health Agencies and other national nursing organizations through a number of initiatives. As VA nursing continues to participate in transforming health care and contributing to the creation of a learning organization, one key component is leadership development through coaching and mentoring. The National Nurse Executive Mentoring Program that began in 2004 remains an active and viable component of nurse executive development. Since the program s inception, 98 matches of newly appointed and certified nurse executives have occurred. Of the matches, 91.8 percent of participants have remained in the role. IOM Recommendation 7: Prepare and Enable Nurses to Lead Change to Advance Health ONS is partnering with the Central Texas Veterans Health Care System to provide consultation and assistance to VA medical centers, academic affiliates offering a CNL curriculum, and to individual CNL students and preceptors, regarding CNL practice, clinical immersion, and program initiation and sustainment to transition and sustain the CNL role. As VHA transforms to become peoplecentric, forward-thinking and results-oriented, shared governance and staff involvement will be the foundation to move the organization forward. There is a need to revise the processes currently utilized to appoint and promote registered nurse staff. ONS has convened a task force to develop a framework and process whereby nurses are active participants in the promotion process. In addition, the VHA National Nurse Executive Council chartered a workgroup to design and implement a national VHA Magnet/Pathway to Excellence Nursing Consultative Service. Services offered Continued on page 10 Voice of Nursing Leadership January

10 Linking the Institute of Medicine s Future of Nursing Report Recommendations to the Veterans Hospital Administration National Nursing Strategic Plan continued from page 9 include facility consultations, a web-based resource center, small group workshops and pre-submission reviews of Magnet/Pathway to Excellence documents. IOM Recommendation 8: Build an Infrastructure for the Collection and Analysis of Inter-Professional Health Care Workforce Data The goal of the VA Transformational Health Informatics Initiative (Hi2) is to develop the informatics workforce in the VA by increasing the number of education and training opportunities, developing career tracks and recruitment and retention plans and enhancing collaborative environments for health informatics personnel. Other efforts include the development of a Clinical Applications Development Team. This team works collaboratively with numerous departments and disciplines on activities and decision-making on solutions such as clinical documentation systems coordination and standardization, interdisciplinary care and charting promotion and adoption, virtual provision of health care, simulation training and product testing, patient/staff flow processes and joint VA/ Department of Defense electronic health records. VA nurses charging ahead to advance the nursing practice In closing, from the perspective of CNO Cathy Rick, the work of VA nursing has had a significant impact on leading change and advancing health for the Veterans Health Administration. She notes that the outstanding achievements are a result of the unbelievable talent in the VA nursing community. Rick remarks that their focus is on understanding and improving the patient experience from a patient-driven perspective. She believes that it is a true partnership between VA nursing and the interprofessional team as they approach a comprehensive plan of care that is coordinated across the continuum of services. Exemplary achievements are realized through the exceptional performance of nurse leaders, nurse clinicians, nurse scientists and nurse faculty within the context of a robust practice/academic partnership. VA nurses are some of the best and brightest this country has to offer. This makes them a perfect match to act as caregivers and health care champions for the veterans for whom they care. Those men and women deserve the best care available and they are in the best of hands with VA nurses. ABOUT THE AUTHOR Elaine Cohen, EdD, RN, FAAN, is associate chief, Nursing Quality Improvement, James A. Haley Veterans Hospital, Tampa, FL. She is also At-large director, AONE 2012 Board of Directors. 10 Voice of Nursing Leadership January 2012

11 AONE Announces 2012 President-Elect Michelle Janney, PhD, RN, NEA-BC, has been elected 2012 president-elect of the AONE Board of Directors. Janney is the senior vice president and Wood-Prince Family chief nurse executive at Northwestern Memorial Hospital in Chicago where she has worked since Selected through a voting process of AONE s 8,100 members, Janney will serve as president-elect for a one-year term beginning January 1, She will become AONE president and serve a one-year term beginning January 1, I am honored to serve as president-elect and look forward to partnering with our members to further the AONE agenda, said Janney. Health care reform, along with the Institute of Medicine s report on the Future of Nursing, presents unique opportunities to influence health care policy and the nursing profession. Janney has been a registered nurse for more than 30 years, serving as a bedside nurse, faculty, researcher, administrator and board member. She has been an AONE member for 18 years and has served on the AONE Strategic Planning Committee and the AONE Board of Directors in In addition, she has served in national leadership capacities for the Hospital Advisory Committee of the Joint Commission and the Regional Policy Board of the American Hospital Association. Under Janney s leadership, Northwestern Memorial received Magnet designation in 2006 and re-designation in Magnet designation recognizes health care organizations for superior patient care, nursing excellence and innovations in professional nursing practice. Janney received the Power of Nursing Leadership Pinnacle Leader Award in 2007 and the Nursing Spectrum Excellence Award for Advancing and Leading the Profession in Also elected to the 2012 AONE Board of Directors by the AONE membership are the following: Region 1 Sharon Gale, MSN, RN chief executive officer Organization of Nurse Leaders, Massachusetts-Rhode Island Burlington, MA Region 3 Mary Tonges, PhD, RN, NEA-BC, FAAN senior vice president and chief nursing officer The University of North Carolina Hospitals Chapel Hill, NC At-Large Elaine Cohen, EdD, RN, FAAN associate chief nursing quality improvement The James A. Haley Veterans Hospital Tampa, FL Point, Click and Connect with the AONE Online Career Center The AONE Online Career Center is a members-only benefit featuring more than 250 open positions, with new ones added every day. Employers seek out AONE members for their high level of expertise and prominence in the field of nursing leadership. Visit to find the best jobs for nurse leaders nationwide. Voice of Nursing Leadership January

12 By Maureen Swick, RN, PhD, NEA-BC, senior vice president, chief nurse executive Inova Health System, Falls Church, VA Inova Health System Refines the Role of Nursing and Focuses Resources on Education Inova Health System is the largest not-forprofit health care system in Northern Virginia. As the system s senior vice president and chief nurse executive, I have been given the responsibility to oversee the redesign of the system s model of care in order to meet the challenges of health care reform legislation. In addition, Inova hospital-based chief nurse executives (CNEs) and other system nurse leaders have incorporated several tactics that will assist us in meeting the Institute of Medicine s (IOM s) recommendations for the Future of Nursing into the system s nursing strategic plan. Changing the culture of nursing at Inova Inova has redesigned and improved the practice environment and in so doing, we have shaped a culture that gives nurses the opportunity to be an integral part of this improvement effort. Through the use of Lean methodology and computer simulation technology, nurses and other care givers sought to redefine how patient care is delivered on a busy, 52-bed, adult medical/surgical unit. In our planning, we used the AONE Guiding Principles for the Role of the Nurse in Future Care Delivery as a framework. This prototype unit now serves as a model for the redesign of the patient care delivery model across our entire system. Our trans-professional initiative included a system-wide, nurse-led team. As a result of its efforts, the role of the professional nurse as the integrator of coordinating patient care has been solidified. Also created was the opportunity to clarify and enhance the roles of both the professional nurse and the unlicensed assistive personnel (UAP). The project team redefined and redesigned role responsibilities which included delegation, communication and trust. Consequently, the organization refined its care delivery model staffing and skill mix to create an environment where registered nurses (RNs) can focus on RN-specific, valueadded professional interventions. To ensure our RNs success in adopting this new model, nursing leadership partnered with Inova s Organization and Talent Development staff to create a two-day experiential training course that will be required for all RNs in direct patient care roles. In addition to internal professional development opportunities, Inova has also established a corporate partnership with the University of Phoenix. This partnership provides a series of courses aimed at developing and improving RN leadership and communication skills. The success of the new model of patient care delivery requires a UAP workforce that, in addition to technical skills, understands the basic tenets of communication, delegation and teamwork. Current UAPs receive substantive education to support their adoption of newly identified roles and responsibilities. To ensure UAPs are well-positioned to be successful, Inova established a hiring pathway that includes a three week academy. The comprehensive academy provides improved orientation to our patient care delivery model and is comprised of clinical, didactic and supervised practice modules. Simulation proved to be a useful aid that allowed decision-makers to predict the impact of alternative care delivery model changes, to select a model that allows RNs to spend their time in a manner that best utilizes their professional training and to reduce waste in the system. The program is still in the pilot phase although some components have proven so successful that they have already been implemented across the system. Another Inova initiative is the strategic decision to migrate to a new enterprise-wide core clinical software platform. Our team viewed this as a monumental effort that will substantially affect the clinical practice environment. The nursing-centric focus of this project has been apparent from inception and nurses have been involved at every level of the development process to include senior project leadership and sponsorship. Nurses play a key leadership role in project design and will continue to be part of the strategy for longterm system sustainment and support. Promoting advanced nursing education through incentives As an organization, Inova has a slightly greater than 58 percent proportion of RNs who have achieved at least a baccalaureate of nursing in science (BSN) degree. We are taking steps to increase the rate of BSN-prepared nurses to meet the IOM target goal of 80 percent by Through these efforts, Inova offers full- and part-time nursing staff members up to $3,000 per year in tuition reimbursement for coursework leading to an advanced degree. Online RN-to-BSN programs have proliferated and Inova affiliates with several nationally accredited programs. These programs are increasingly popular with nurses who for reasons of shift work or family obligations prefer the flexibility that online study offers. In addition, due to our major metropolitan locations, nurses also have easy access to a number of brick and mortar universities if they prefer to take classes in a traditional classroom environment. Inova has affiliation agreements with over 90 academic institutions allowing our employee nurses, who are also students, to have their clinical rotation experiences and practicums at local hospitals within our system. The nursing leadership team supports the educational endeavors of staff by making every effort to adapt work schedules to the nurses academic schedules. The Inova culture encourages and facilitates the achievement of further education for all nurses, at every degree level. 12 Voice of Nursing Leadership January 2012

13 The organization fosters a culture that facilitates and rewards continuing education and ongoing professional development. The achievements demonstrating versatile accomplishments in nursing clinical excellence (ADVANCE) clinical ladder program which provides career development and enhancement for nurses has been recently revised to require a baccalaureate degree in nursing for direct care nurses who achieve the RN4, or expert, level. After initial resistance, nurses have enthusiastically endorsed this requirement and a salary differential is awarded to nurses who achieve the RN4. Additionally, relevant specialty certification from a nationally-recognized nursing body is necessary to achieve the RN3, or proficient level, of the ladder. These are tough economic times and nurses can be hampered in their pursuit of higher education by the cost of going back to school. We are truly blessed at Inova by our cadre of generous benefactors. These donors designate funds specifically for nursing education, so we are able to offer a variety of scholarship opportunities to our employees who are considering going back to school. In collaboration with the nursing foundation team, I have directed funds to be specifically devoted to RN-to-BSN education for our nurses. Previously, scholarships were awarded just to students attending local universities, but these funds are now available to our employed nursing students attending any accredited program that confers a baccalaureate or higher degree. Commitment to nursing improvement Inova has made a sincere commitment to implement the IOM recommendations. To that end, we have made the decision to prioritize the use of our hospitals for clinical rotations of nursing students on the baccalaureate track. The organization has a long and valued relationship with a local community college and this decision will significantly restrict the clinical rotation opportunities for students in that program. However, we are unapologetic and transparent in our deliberate approach to improving the education level of our nurses. I started in my position at Inova Health System approximately 18 months ago and immediately seized the opportunity at a staff nurse conference to review the recommendations from the IOM report. I was surprised and disappointed with the initial response I received from some of the associate-degreed nurses who voiced extreme displeasure with the recommendations related to returning to school to obtain their BSN degree. However, during these 18 months, I am happy to say that we have increased the number of BSN enrollments. We have brought more affordable BSN programs to our facilities by supporting our nurses enrollment in online programs and by working collaboratively with our local academic partners to develop and implement leadership classes for key nurse leaders. Our goal is to support their efforts in furthering employee engagement on vital issues such as advanced education. This is definitely a journey of many paths. Ultimately, I believe it will all lead to our success in meeting the recommendations our profession so desperately needs in order to be credible leaders in the redesign of health care in the United States. ABOUT THE AUTHOR Maureen Swick, RN, PhD, NEA-BC, is senior vice president, chief nurse executive, Inova Health System, Falls Church, VA. She is also a member of the board of trustees for the American Hospital Association (AHA). Swick is the current AHA/AONE Political Action Committee (PAC) chair and has previously served as region two director for the AONE Board of Directors. Requests for Research Participation For a nominal fee, AONE assists nurse leaders in accessing participants for research studies. In order to qualify for access to the AONE membership, all research must be consistent with the AONE mission and vision and reviewed by AONE. In addition to the option of purchasing a mailing list rental, AONE now offers the opportunity to announce approved research studies in our weekly e-newsletters: AONE Working for You and AONE enews Update. For more information on this service, contact M.T. Meadows, AONE director of professional practice, at (312) Shop Smart with the AONE The AONE Online Marketplace is an invaluable resource dedicated to providing a collection of suppliers of goods and services for nurse leaders. So pull up your virtual shopping cart and log on at aoneonlinemarketplace.com. Voice of Nursing Leadership January

14 My Leadership Story Sharon Gale As chief executive officer (CEO) for the Organization of Nurse Leaders, Massachusetts-Rhode Island (ONL, MA-RI), Sharon Gale, MS, RN, works daily to connect nurse leaders on a broad scale and oversees the operations of a robust state chapter of AONE whose mission includes supporting the strategic plan that is focused on shaping the future practice environment, advancing the profession through practice and education integration and developing nurse leaders. Sharon has been an AONE member since 1990, holding a variety of roles, including the post of regional board member and past president. She is also Region 1 director of the 2012 AONE Board of Directors. Sharon has a passion for advancing health care policies and AONE recently interviewed her to hear her story of being a nurse leader. Explain your job as CEO for the Organization of Nurse Leaders, MA-RI The Organization of Nurse Leaders, MA-RI has 650 members and an annual budget of half a million dollars. I started as the executive director in 2003 and my title was changed to CEO in I am responsible for overseeing the operations and growth of the organization and making sure the board and committee members have the information and resources they need to provide strategic direction. How does what you do affect and benefit nurse leaders? My organization provides nurse leaders the opportunity to network, attend development workshops and be active in a variety of statewide activities and task forces. We have strong partnerships with the Massachusetts Hospital Association and with the Department of Higher Education. How were you involved in the Future of Nursing (FON) report? The Massachusetts Action Coalition, led by the Organization of Nurse Leaders, MA-RI, along with the Department of Higher Education, were selected as an Action Coalition by the Future of Nursing (FON): Campaign for Action initiative. We realized a lot of statewide initiatives with established partners were already underway and fit the FON recommendations. In addition, ONL has a strong commitment to nurse leadership development and for the last eight years presented a program for new and emerging nurse leaders. This year, after three years of planning, ONL offered a four-day executive-style program for experienced nurse leaders looking to continue their leadership development. The organization also strongly supports the concept of academic progression and will be working with our partners to develop pathways for nurses to advance their education. What is an important idea to come from the Institute of Medicine s FON report? Nurses need to be at the table, not waiting to be asked, but discussing and contributing to ideas that will promote change. We have to create an opportunity to communicate. The best way to get things done is to have a committed group to do the work that s how you can advance change in a positive way. How do you think AONE members will be affected by the FON report? I think the information outlined in the report gives us an important and strong platform to look at academic progression when it comes to the profession. Nurses enter the profession in a variety of academic programs and nurse leaders should be looking for opportunities to provide programs for nurses to pursue baccalaureate or higher degrees. Part of that equation is making academic advancement affordable and accessible, including offering programs through the workplace, not just on college campuses. What is your biggest challenge at your job and how does AONE help you with this challenge? Every week is different and my priorities constantly need to be evaluated. I support a 22-member board, which is very committed, and I need to be sure they have the resources to accomplish their goals that align with the organization s strategic plan. The resources provided by AONE and chapter leaders have been very valuable. I know I can always pick up the phone or send an and instantly get a response to any issue. Who inspired you to become a nurse leader? When I started my leadership journey I had a mentor who believed education and empowerment lead to great care for patients. She believed if something wasn t done before, that didn t mean it couldn t be done now. I learned from her that if you believe in something, be courageous, lead and take on issues. Do you have any advice for aspiring nurse leaders? Take every opportunity to find people and experiences to enhance your leadership skills. That includes joining organizations, committees and becoming involved in various projects. Also, seek out a mentor to help with dilemmas as they arise. And always be willing to listen to different perspectives. Continued on page Voice of Nursing Leadership January 2012

15 By Eileen Kingston RN, BSN, MPA, associate director, Patient Care VA Nebraska Western Iowa Healthcare System, Omaha, NE Future Patient Care Delivery Committee: Disruptive Innovation Editor s Note: This is a new column based on blog entries from members of AONE s Future Patient Care Delivery Committee. Committee members blog about issues facing nurse leaders as they continue to confront challenges to providing safe and reliable patient care today and in the future. This column and corresponding blog entries highlight topics included in the AONE Guiding Principles for Future Care Delivery and Toolkit. To read the blogs visit wordpress.com. Have you ever heard or thought about the business concept of disruptive innovation? This concept was developed by Clayton Christensen, a professor at Harvard Business School. A disruptive innovation is a product or service that is created before the public knows that they need it or want it. Usually when the innovation is first developed it is so new that it may cost more or be inconvenient for many consumers. Eventually, improvements to the innovation are made and the demand for it increases. It becomes more accessible and less expensive, therefore, displacing the previous methods or competition. The innovation becomes disruptive because of the dramatic changes that it makes to an entire population of customers and the way business is done. Some of the most important innovations disrupted entire industries by creating less costly alternatives in more convenient settings. An example is the use of the personal computer as opposed to a mainframe computer. Cell phones are disruptive to land line technology. Diabetic glucose monitors are a less expensive and more convenient form of tracking blood sugars than a physician s office visit. Nurse leaders are well-situated to drive and implement disruptive innovation. Creating an environment to generate and implement new innovative ideas, supporting education in informatics and other innovative practices, creating new nursing roles, and eliminating barriers to piloting new ways of caring for patients are skills that nurse leaders possess to improve health care. Nurses have been extensively involved and have led the implementation of more recent disruptive innovations such as the advent of retail clinics, the medical home model of care management, and home tele-health. These all allow patients access to care, with more convenience, and at less cost. There is a belief that the field of health care needs more disruptive innovation to address the expense and inaccessibility of health care. For example, more technology should be utilized to allow patients to do for themselves what professionals do. Increasing innovations in diagnostic testing could allow nurse practitioners the ability to diagnose and treat more uncomplicated illnesses. How can we continue to develop new disruptive innovations? Are resources funding technology that can help patients care for themselves or are we funding more of the same technology? One belief is that we are investing in outdated organizational structures. Should investments be made in new organizational structures with the main intent to create health care innovations? Are there political factors and resistance that hold back innovation? Nurse leaders have the skills and an opportunity to respond to the need for disruptive innovation and participate in transforming the current health care delivery system. The future is now! To read additional blogs, visit the link at ABOUT THE AUTHOR Eileen Kingston, RN, BSN, MPA, is associate director, Patient Care, VA Nebraska Western Iowa Healthcare System, Omaha, NE. She was also a member of the 2011 AONE Future Patient Care Delivery Committee. need a color photo My Leadership Story continued from page 14 What do you like to do in your spare time? I am a cheerleader for my grandchildren, who are involved in everything from soccer to dancing. I also enjoy power boating with my husband, playing golf and I ve recently taken up zumba. What drives you or gives you passion? I think what drives me is the commitment of the people around me. One person can t do it all alone and every day is a new challenge. What fuels my fire is the caliber of people in the state with whom I work. Sharon Gale, MS, RN, is chief executive officer for the Organization of Nurse Leaders, Massachusetts-Rhode Island, Burlington, MA. She is also Region 1 director of the AONE 2012 Board of Directors. Voice of Nursing Leadership January

16 AONE Members in the News AONE past president Joyce C. Clifford, PhD, RN, FAAN remembered AONE past president Joyce C. Clifford, PhD, RN, FAAN, passed away Friday, October 21. A true nursing champion, Joyce was respected internationally for creating practice models that are considered a benchmark for professionalism in nursing. Joyce also inspired thousands to become primary nurses, keeping the focus on the patient and family in an increasingly complex health care environment. Joyce served as senior vice president and nurse-in-chief at Beth Israel Hospital in Boston, MA for more than 25 years before founding and becoming president and CEO of the Institute of Nursing Healthcare Leadership. Throughout her career, Joyce received numerous awards including the Living Legend in Massachusetts Nursing by the Massachusetts Association of Registered Nurses in 2007, a Living Legend by the American Academy of Nursing in 2005, and the AONE Lifetime Achievement Award in Joyce also served as AONE president in Joyce will be remembered for her compassion, wisdom and love for nursing. She served as mentor, colleague and friend to so many of us. A memorial service was held in October in West Roxbury, MA. Briggs becomes senior consultant AONE member Bill Briggs, RN, MSN, CEN, FAEN, has been appointed senior consultant at Blue Jay Consulting, a provider of interim leadership and process improvement solutions for emergency and surgical departments. Briggs also serves on the American Nurses Association s Congress on Nursing Practice and Economics. He has also held office as a board member and president of the Emergency Nurses Association. Hansen named nursing leadership award winner Marcia Hansen, MS, BSN, RN, CENP, has been named the recipient of the 2011 Award of Excellence in Nursing Leadership, presented by the New Hampshire Organization of Nurse Leaders (NHONL). The award is given to a nurse leader who demonstrates excellence in nursing leadership through advocacy, innovation and practice. Hansen is the vice president of Patient Care and Laboratory Services, and chief nursing officer of Franklin Regional Hospital (FRH), Laconia, NH. Hansen has worked in nursing leadership for 30 years since joining FRH in 1978 as a nursing supervisor. She received her award at the 77th Annual New Hampshire Hospital Association meeting in September. Halstead named president of National League for Nursing Judith A. Halstead, PhD, RN, ANEF, has been named president of the National League for Nursing (NLN). Dr. Halstead is a professor and executive associate dean for academic affairs at Indiana University school of nursing in Indianapolis, IN. She is also editor of the book Nurse Educator Competencies: Creating an Evidence-Based Practice for Nurse Educators. Dr. Halstead will serve as NLN president in AONE members receive awards from Washingtonian magazine AONE members Ann Marie Madden RN, MS, and Susan D. Ohnmacht, MSN, MS, NEA-BC, were both named as honorable mentions in Washingtonian magazine s first Excellence in Nursing Awards. The awards honor nurses who go above and beyond the call of duty in hospitals, rehabilitation and long-term-care centers, and community facilities offering wellness services, medical care or health education. Madden is assistant vice president, Nursing Operations, MedStar Heart Institute, Washington Hospital Center, Washington DC and Ohnmacht is director, Critical Care, VIP and Special Care Services, Sibley Memorial Hospital, Washington, DC. Both women will be honored at the First Annual Excellence in Nursing Awards dinner in December. Ratcliffe inducted into Alabama Nursing Hall of Fame AONE member Dr. Carol Jefferson Ratcliffe, RN, CNOR, FACHE, has been recognized as an influential nursing leader through her induction into the 2011 Alabama Nursing Hall of Fame. The Hall was established in 2001 by the board of visitors at the University of Alabama s Capstone college of nursing. It pays tribute to nurses and others who, through their work and accomplishments, have brought honor and fame to the profession of nursing and to the state of Alabama. Dr. Ratcliffe is vice president of patient care services and chief nursing executive for St. Vincent s East, Birmingham, AL. New AONE resource: sample job descriptions AONE is happy to announce a new resource available exclusively to members sample job descriptions. AONE members have submitted job descriptions for a wide range of positions from administrative assistant to vice president. Over 100 descriptions are now posted. These samples are a great starting place when hiring new positions and reviewing your own. Visit for more information. 16 Voice of Nursing Leadership January 2012

17 Letter from the Leadership continued from page 1 for RNs to attain BSNs. In 2010, AONE, as part of the Tri-Council for Nursing, released a statement urging stakeholders to take actions that would help create a more educated nurse workforce, with employers providing financial and professional incentives for nurses. AONE surveys the nursing education landscape in hospitals Because the educational preparation of RNs has garnered so much attention recently, a number of authorities have asserted that the best educational preparation for a RN is a BSN degree and have encouraged hospitals to create practices and policies to assist and incent nurses to attain that educational level. To gauge how health care organizations were progressing with such policies, in the fall of 2011, AONE ed a survey to all of its members, resulting in nearly 300 responses. Survey Respondent Profile Nearly all of the respondents were full members of AONE and slightly more than half of the respondents listed their organization as a hospital or medical center. Thirty-nine respondents said their organization was a health system, and another 39 listed their organization as acute care, making a majority of the respondents nearly 80 percent involved with acute care. Nearly half of the respondents, 47 percent, said their facilities operated in an urban area, while 32 percent operated in suburban areas and a smaller group, 21 percent, said they operated in rural areas. The facilities were evenly split among bed size, with 35 percent of the respondents representing facilities with less than 201 beds, 33 percent with facilities with a range of 201 to 500 beds, and 32 percent with 500 beds or greater. Implementing policies can be complex While nurse leaders in health care settings are encouraged to foster further education for RNs, it s clear from the AONE survey that these same nurse leaders face a host of issues as they implement such policies. Of the nearly 300 respondents, only 51 percent said their organization had a policy to preferentially hire BSN-prepared nurses. This response may contrast with the real number of facilities that preferentially hire BSN nurses. Respondents were able to add comments to this question, with a dozen of them noting that they do not have a policy in place, but are preferentially hiring BSNs. Others said their organizations plan to institute such a policy. Additionally, some respondents without a policy said they do require nurses with an associate s degree (ADNs) to attain a BSN within five or six years. Respondents at organizations without such policies indicate a number of reasons why this type of policy is difficult to implement, including a short supply of BSN nurses in their locale, and/or strong ties with ADN- or diploma-granting institutions. In the survey, the top reason listed for not having such a policy was a lack of access to BSN nurses, an issue that was clearly voiced in the comments. One respondent said, Critical access hospitals often have very few applicants that have a BSN. Another respondent added, We are a large system and many of our rural facilities have ADN programs in their vicinity and have no choice but to hire ADNs.... Many nursing students in ADN programs have a degree in another field and seek the ADN program for financial reasons. Most plan to get their BSN. Reasons Organizations Do Not Have Preferential Hire Policies for BSNs*»» Limited access to BSNs 34%»» Lack of support from other leadership members 22%»» Union does not support 10%»» Cost concerns 10%»» Lack of evidence related to improved patient safety 7%»» Unfair to general nursing staff 4% *Respondents could check as many reasons as applied, so percentages do not add up to 100. Another respondent pointed out that her organization has sensitivity to ADN schools whose students have clinical rotations at its facility, while another noted a diploma nursing school was affiliated with her hospital. The second most frequent reason listed by respondents without a policy was a lack of support from other leaders in the organization. Noted one respondent, I personally choose to hire BSN nurses and my chief nursing officer (CNO) supports me, but the rest of administration does not really care. Reasons behind a preferential policy When respondents were asked to list the top three reasons their organizations instituted a preferential policy, data revealed that quality and safety were the chief concerns. About half of the respondents included reasons such as improved patient outcomes, patient safety, or referenced clinical studies showing that patients cared for by BSN nurses had better outcomes. Said one respondent, We embrace the evidence that supports that patient outcomes are better in organizations with a high number of BSN nurses. We also rely on our nurses to lead improvement efforts and bedside care, which requires them to be qualified to do so. However, it s also evident that many organizations don t yet have their own data to show that the policy has made a difference. More than one-third of the respondents who answered the question asking for the evidence that your organization s preferential hiring policy is making a difference in nursing care said their policies were too new to have results, or that they simply didn t have that data. Noted one respondent, [That s the] $64,000 question. We need a business case for BSN. Others mentioned that their organization s improved indicators could be attributed to various ongoing initiatives not just BSN hires. One respondent said, It s hard to make the case for cause and effect when you are changing other variables at the same time. Continued on page 18 Voice of Nursing Leadership January

18 Letter from the Leadership continued from page 17 Snapshot of organizations with preferential policies Survey results show that of the organizations with a preferential policy, 32 percent pay BSN hires more at the time of hire regardless of their years of experience. Even if organizations do not pay more at the time of hire, they can use other ways to reward BSN nurses. For instance, one respondent s organization has a clinical ladder in which BSN nurses are paid more, while another organization requires BSNs for certain job classifications that carry higher salaries. Ninety-three percent of the respondents with a policy have tuition benefits for associate s degree-educated nurses to attain a BSN or higher degree. Of that 93 percent, nearly onethird offer $2,000 to $3,999 annually toward tuition costs, and one-fifth offer between $4,000 and $5,999. Another 19 percent offer $500 to $1,999. Several respondents noted that this assistance had been reduced recently due to budget constraints. Organizations with Preferential Policies»» Pay BSN nurses more at time of hire regardless of experience 32 percent»» Have tuition benefits for nurses with ADNs to attain higher degrees 93 percent»» Have time period by which ADN nurses must attain BSN degree 27 percent Although these organizations are likely to offer tuition benefits to ADN nurses, there isn t a widespread time requirement for getting a BSN, indicating these health care organizations are more likely to use enticements, rather than penalties, to encourage nurses to further their education. Only 27 percent have a mandatory deadline for nurses to achieve their BSN. Of those, 44 percent require the nurses to obtain the degrees in three to six years. When asked to name the institutional goal for their percentage of RNs with a BSN or higher degree, nearly half of these organizations appear to be in line with the IOM s report recommendation #4 Increase the proportion of nurses with a baccalaureate degree to 80 percent by Forty-seven percent indicated their goal was to have 80 to 90 percent of their nurses educated at a BSN or higher level while another one-fifth of the respondents said the goal was 60 to 75 percent. Added one respondent, The goal is 80 to 90 percent within the next three years, and [we] continue to work toward 100 percent. My position is that if we hire only BSN nurses, the message will soon be recognized in the community and education programs can begin to re-think practices. Education and strategic partnerships drive success for nursing profession AONE has long supported advanced education for nurses; a key driver of AONE s strategic plan is nursing workforce supply and competency. Through organizational work, AONE has developed and implemented strategies in partnership with academic organizations, community leaders, foundations and other relevant organizations to increase the number of qualified nurse faculty and the capacity of nursing schools for both baccalaureate and advanced nursing degrees. AONE will continue to collaborate and partner with academia and provide professional development and certification opportunities to create robust educational programs that focus on the AONE leadership competencies. A well-educated nurse is better prepared for changes in technology, advanced treatments and protocols and most important, can offer better and safer patient care. As we work through the challenges of health care reform and advancing technology, it s in everyone s best interest to support advanced nursing education. AONE will continue be there with new innovations and support, and we encourage all of you to join us. ABOUT THE AUTHORs Laura Caramanica, RN, PhD, CENP, FACHE, is 2012 president, AONE Board of Directors. She is also vice president/chief nursing officer at WellStar Kennestone Hospital, Marietta, GA. Pamela A. Thompson, MS, RN, CENP, FAAN, is AONE chief executive officer. She is also senior vice president for nursing at the American Hospital Association, Washington, DC and Chicago, IL. AONE Workplace Environment Assessment Survey Tool sign up now during introductory period AONE has developed the Workplace Environment Assessment Survey Tool, based on the nine principles of a healthful work/practice environment. This survey tool will enable you to: assess executive and nursing staff perceptions of the key elements of a healthful practice environment; engage in dialogue between executive and nursing staff as to what is working and where your challenges are; develop processes and systems that will effectively orient new nurses and retain them; and establish baselines to measure future performance and set improvement targets. As an introductory offer, hospitals who sign up before March 1, 2012 will receive a discounted rate of $1,500. Visit to learn more, read FAQs and register. 18 Voice of Nursing Leadership January 2012

19 AONE CENP Certified in Executive Nursing Practice Certifying nurse leaders Become certified through the organization with the most Validate your expertise and take the exam created for nurse leaders by nurse leaders. expertise and credibility in the field of executive nursing leadership. The CENP examination is based on the AONE Nurse Executive Competencies, a hallmark compendium of skills necessary for successful nurse executive practice. For additional information, a candidate handbook and to apply, visit the AONE Credentialing Center at

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