Nursing Leadership: Where are we on the Journey?

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1 Nursing Leadership: Where are we on the Journey? Presented by Joan Ellis Beglinger MSN, RN, MBA, FACHE, FAAN Fall National Academy of Infusion Therapy and One Day Program November 14, 2014 Objectives Discuss the impact of The Future of Nursing report on the nursing profession Identify opportunities for the nursing profession to exert influence on quality healthcare A Time of Unprecedented Opportunity / Unparalleled Risk as Forces Converge The IOM Report on the Future of Nursing Implementation of the Affordable Care Act (ACA) Emergence of compelling evidence on the relationships among Professional Nurse staffing, professional practice environments and patient outcomes 1

2 The Affordable Care Act (ACA) Primary Goals: Expand access to health care Improve the delivery system (outcomes and experience) Control the Cost of health care It s all about outcomes. Outcomes are managed at the point of care. Nursing will have to step up. Emerging Evidence Nurse staffing and the professional practice environment directly impact patient outcomes Professional Practice Environment is measured with the Nursing Workforce Index Revised (NWI-R) Measures nurse participation in hospital affairs, control over practice, nurse-physician relationships, nurse manager ability, staffing adequacy, organizational support IOM Report The Future of Nursing: Leading Change, Advancing Health A collaboration between the IOM and the Robert Wood Johnson Foundation Report released in 2010 after 2 years of research and study 2

3 4 Key Messages of the IOM Report Nurses practice to the full extent of their education and training Nursing education redesigned to promote seamless academic progression Nurses are full partners in health care redesign Effective planning and policy design through data collection and information infrastructure 8 Specific Recommendations of the IOM Report Remove scope of practice barriers Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement nurse residency programs Increase the proportion of nurses with a BSN to 80% by 2020 Double the number of nurses with a Doctorate by 2020 Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change and advance health Build an infrastructure for the collection and analysis of workforce data The Starting Point ACA expected to increase insurance coverage to 32 million Americans Nurses are the largest sector of all health professions - >3million RNs Nurses rank #1 as most trusted profession for 11 straight years Only 10% of physicians practice in rural America; nearly 25% of the population lives there 3

4 The Starting Point The US has nearly 400,000 primary care providers. Physicians number >275,000, NPs >80,000 and PAs 20,000. There are nearly 154,000 NPs practicing in the US 45.4% of RNs in the US reported an ADN as their initial degree (2008) Approx. 50% of RNs hold a BSN or higher The Starting Point BSN and graduate programs at US nursing schools turned away 75,000 qualified applicants in 2011 due to insufficient faculty, clinical sites, classroom space, preceptors, budgets Racial and ethnic minorities make up approximately 30% of the US population but nearly 15% of RNs. <10% of RNs are men The Starting Point Nurses make up less than 3% of community health system boards. 20% of those board members are physicians 4

5 Translating the Report to Action The Campaign for Action launched in November 2010 Led by the RWJF and coordinated through the Center to Champion Nursing in America (AARP, RWJF) More than 80 health care and nursing, business and consumer organizations share the goal of working to transform health care through nursing - driven by the evidencebased recommendations from the report A State by State Strategy There are Action Coalitions in all 50 states and in Washington DC creates access to information, resources, opportunities to participate, progress by state Progress As reported by the Campaign for Action May 29,

6 Advancing Education Transformation For the first time, Medicare is paying to support the training of nurses with the Graduate Nurse Education Demonstration, a $200 million project in 5 hospital systems. This historic legislation is designed to prepare more APNs to care for people across all settings Advancing Education Transformation The Campaign has identified 4 promising models to streamline academic progression. 30 Action Coalitions have reported that they are enrolling students in one of these models From fall 2010 to fall 2013, the number of students enrolled in RN to BSN programs has grown from 77,259 to 118,176 a 53% increase Leveraging Nursing Leadership The Campaign developed a national nursing leadership strategy focused on increasing the number of nurses on hospital and health system boards, as well as other national and federal boards. To date, 23 Action Coalitions have reported getting 105 nurses on boards 6

7 Removing Barriers to Practice and Care Since the Campaign began, 7 states (Minnesota 2014, Connecticut 2014, Kentucky 2014, Nevada 2013, Rhode Island 2013, North Dakota 2011 and Vermont 2011) removed statutory barriers that prevented NPs from providing care to the full extent of their education and training 31 states impose limits on APNs Promoting Workforce Diversity 41 Action Coalitions are working on diversity initiatives; this work is threaded throughout their education and leadership work plans Fostering Interprofessional Collaboration 4 major Foundations collaborated to support the new Coordinating Center for Interprofessional Education and Collaborative Practice at the University of Minnesota. The Center s mission: accelerate teamwork and collaboration among disciplines RWJF believes interprofessional collaboration is so important they are sun setting a number of their leadership programs that are focused on one discipline 7

8 Bringing the IOM Report to Life: Every Nurse; Every Setting Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change and advance health Bringing the IOM Report to Life: Every Nurse; Every Setting The Dual Roles of the Nurse Employee of the Organization and Member of the Professional Nursing Organization The Professional Nursing Organization Governance the structure of self-regulation Cultures of Accountability ownership Lifelong Learning and continuous development the lifeblood of knowledge workers Interprofessional collaboration foundational to population health Contribution to the profession 8

9 Authentic Shared Governance an Essential Developmental Step The structure of professional selfregulation Enables fulfillment of professional accountabilities Decision-making based on expertise; not title Managers and direct care nurses have distinctly different and complementary roles - partnership Within Authentic Shared Governance Structures Obligations of membership are clearly articulated Managers and direct care nurses work in partnership to own the work of nursing and manage its outcomes Direct care nurses own clinical decisions and have meaningful voice The nursing organization is aligned with the strategic priorities of the organization Realizing the IOM Report at the Point of Care Case Example Mature shared governance direct care nurses have meaningful voice 80% BSN by 2020 Hiring strategy $1 million endowment for nursing scholarship Lifelong Learning Certification goals Certification preparation 9

10 Full Realization of the IOM Recommendations: Individual Engagement Our mental models Personal goals education, certification, ownership of practice, leadership Unprecedented Opportunity / Unparalleled Risk The Opportunity Step up to lead change and advance health The Risk Failure to seize the moment Thank you! Questions? Feedback? Joan Ellis Beglinger, MSN, RN, MBA, FACHE, FAAN 10

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