Name of Sponsoring Organization
presents
The Future of Nursing:
Leading Change, Advancing Health
Casey R. Shillam, PhD, RN-BC
Nurse Co-Lead
CA Action Coalition
Mary Dickow, MPA
Statewide Director
CA Action Coalition
Objectives
At the conclusion of the presentation participants will be able to:
1.
Identify the 4 key messages and 8 recommendations of
Institute of Medicine (IOM) study on the future of nursing.
2.
Determine how INSERT THE AUDIENCE POPULATION
DESCRIPTION in California can contribute to the California
Action Coalition (CA AC) workgroups and the statewide
effort.
3.
Demonstrate understanding of nursing’s contributions that
positively impact the health of the population.
Institute of Medicine
High-quality,
person-centered
health care for all
will require
remodeling many
aspects of health
care system,
especially nursing
Why Now?
Initiative on the
Future of Nursing
access
quality
Health reform
Chance to
transform system
to improve care
Add value
while
slowing
costs
Health System Challenges
Fragmentation
Health care
disparities
Aging and
sicker
population
Primary care
shortage
Medical errors
High costs
*World Health Statistics 2009. World Health Organization, 2009.
Available at: http:/www.who.int/whosis/whostat/EN_WHS09_Full.pdf
IOM Committee for the RWJF
Initiative on the Future of Nursing
18 members with expertise in:
– Public health
– Nursing
– Federal and state
administration
– Hospital and health plan
administration
– Business administration
– Health information and
technology
– Health services research
– Health policy
– Workforce research and policy
– Economics
– Health care consumer
perspective
Our Current Health System
Wellness
Primary care
Home care
Long-term care
Acute care
Committee’s Vision
Wellness
Primary care
Home care
Long-term care
Acute care
A Transformed Health System
Acute care
Long-term care
Home care
Management of chronic illness
Wellness & Primary Care
IOM Recommendations
Enabling nurses
to practice to the
full level of their
training
• Remove scope-ofpractice barriers.
• Implement nurse
residency programs.
Improving nursing
education
• Increase proportion of
nurses with a BSN
degree to 80% by
2020.
• Double the number of
nurses with a
doctorate by 2020.
• Ensure that nurses
engage in lifelong
learning.
Preparing and
enabling nurses
to lead change
• Expand opportunities
for nurses to lead and
diffuse collaborative
improvement efforts.
• Prepare and enable
nurses to lead change
to advance health.
Improving
workforce data
collection and
analysis
• Build an improved
infrastructure to
collect and analyze
health care workforce
data.
Fostering Inter-professional Collaboration
Diversity
Future of Nursing:
Campaign for Action
Collaboration created by the Robert Wood
Johnson and AARP Foundations to ensure
that all Americans have access to high
quality, person-centered care
Campaign for Action
Inter-professional Collaboration
Education
Leadership
Access to Care
Workforce Data
Highquality
patient
centered
care
AARP: CFA Technical Assistance
Provide states with
technical assistance
48 Action Coalitions as of
March 7, 2012
Goal: Action Coalition in all
50 states by end of 2012
Key Message #1: Nurses should practice to the full extent
of their education and training.
Nurse leaders must:
– work with state boards of nursing, state policy makers,
consumers and other health care professional
organizations to remove restrictive scopes of practice.
– participate in efforts to assure appropriate use of
advanced practice nurses and optimal roles for RNs in
chronic disease and transitional care management.
Improve Access to Care
Team-based model of care delivery
APRNs can help alleviate primary
care shortage
MDs should provide care in cases
requiring their expertise
APRNs should refer patients to
specialty providers when care is
beyond their education and skill set
The Evidence
Over 10 studies show equivalent patient outcomes when
care is provided by APRN or MD:
– Two Cochrane reviews (Hatem et al, 2008 and Laurant
et al, 2004)
– RCT published in JAMA (Mundinger et al., 2000)
– No studies suggest care is better in states with tighter
scope-of-practice restrictions
Role of the Registered Nurse
Refocus the role of the Registered Nurse to provide:
– Prevention and wellness care rather than acute care
– Community education and wellness
– Chronic disease case management
– Prevention of functional decline and need for
hospitalization / placement in facility
Key Message #2: Nurses should achieve higher levels of
education and training through an improved education
system that promotes seamless academic progression.
Nurse leaders must:
– support academic progression of the nursing
workforce.
– collaborate in developing and implementing
transitional programs.
– identify, promote and support colleagues in
pursuing doctorates.
Improve Education
More BSN nurses as care moves
into community
Residencies & continuing education
to help nurses retain clinical skills
and develop leadership abilities
More nurses with advanced
degrees to teach next generation
and work in primary care
More nurses to study / evaluate the
profession of nursing and
contribute to nursing science
The Evidence
– Lowered patient mortality
– Every 10% increase in BSN nurses results in 4% decrease in
risk of death
– Lower number of medication errors and procedural
violations
– Stronger critical thinking and leadership skills of BSN nurses
– 6% of nurses who graduate with AD get advanced degree,
compared to 20% of BSN graduates
*Aiken et al., 2003; Aiken et al., 2009; Estabrooks et
al., 2005; Friese et al., 2008;Tourangeau et al., 2007;
Van den Heede et al., 2009
Key Message #3: Nurses should be full partners, with
physicians and other health care professionals, in
redesigning health care in the United States
Nurse leaders must:
– act as full partners with other health care providers, being
accountable for their responsibility to deliver high-quality care.
– work collaboratively with leaders from other health
professions.
– identify and propose solutions to problems in care
environments.
– devise and implement plans for improvement.
– participate in health policy decision-making.
Promote Interprofessional Collaboration
Models of Care to Follow:
Arkansas Aging Initiative and
Health Care Teams
Team follows patients across
settings including home, hospitals,
clinics, and LTC
Effective chronic care management,
care coordination and focus on
prevention and wellness
The Evidence
Greater levels of collaboration between health professionals,
especially between nurses and physicians, improves quality
of care and patient outcomes
Barr, 2002; Barnsteiner et al, 2007
Prepare and Enable Nurses to Lead
In collaborative, patient-centered
care environments, team leadership
is based on patient need and
provider expertise
Nurses can bring patient
perspective to leadership tables
Nurses can become a greater part
of decision-making process across
health care settings
Must identify specific places where
nurses can take the lead in policy
development and implementation
The Evidence
Gallup survey of 1,500 opinion leaders:
– Predicted nurses will have little influence on health care
reform over next 5-10 years
– Wanted nurses to have more influence in reducing medical
errors, increasing quality of care and promoting wellness
– Believed nurses should have more input and impact in
planning, policy development and management
*RWJF, 2010
Key Message #4: Effective workforce planning and
policy making require better data collection and an
improved information infrastructure
Nurse leaders must:
– assist in the collection of data regarding both the
workforce and the demand for care from the
populations we serve.
– determine the type of data to collect to accurately
assess the demand for nursing services, particularly the
specialties and geographic areas of nursing shortages.
Build Workforce Data
Build an improved infrastructure
for collection and analysis of
interprofessional workforce data
Research on health care
workforce is fragmented
Data need to look at supply of and
demand for combination of health
care professionals in a region,
instead of single professions
The Evidence
Move from evaluating simply “number” of hours to the
content and quality of those hours
– CA BRN survey
• No nursing shortage!?!?
– Evaluating hours of nursing care across settings
• Can create methods of comparing quantitatively
long term care vs.
primary care vs.
home health care
Spetz et al., 2011;
Van Cleave et al., 2011
The Evidence
Only with the right “mix” of data can we ensure the
populations in most need will have the services and
health care that they need.
The Evidence
The IOM Recommendations
1) Remove scope-of-practice barriers
2) Expand opportunities for nurses to lead and diffuse
collaborative improvement efforts
3) Implement nurse residency programs
4) Increase proportion of nurses with B.S.N. degree to 80%
by 2020
The IOM Recommendations
5) Double the number of nurses with a doctorate by 2020
6) Ensure that nurses engage in lifelong learning
7) Prepare and enable nurses to lead change to advance
health
8) Build an infrastructure to collect and analyze health care
workforce data
How Nursing Will Contribute
to Improved Healthcare
Communications Committee engaged nurses and
other partners from across the state to develop a
brand for the Coalition.
Vision
A healthy California through
nursing leadership and service
Mission
Implement the recommendations of
the IOM Future of Nursing report
through strategic partnerships for a
healthy California
Core Values
•
•
•
•
Engaging broad and diverse perspectives
Increasing and using influence
Strategic and efficient use of resources
Improving health outcomes
Goals
• Develop action steps to achieve the Recommendations
• Engage a broad-base of stakeholders in the Campaign
• Create statewide structures that support the work
• Ensure regional engagement
• Influence national-level healthcare policy decisions
Organizational Structure
Executive
Committee
Leadership
Council
Working
Group #1
Working
Group #8
Working
Group #2
Working
Group #3
Working
Group #7
Working
Group #4
Working
Group #5
Regional Groups
Stakeholders
Working
Group #6
Recommendation #1: Remove scope-ofpractice barriers
Conduct gap analyses to:
• compare California regulatory language with NCSBN
Consensus Model for advanced-practice registered
nurse regulation
• compare for the four advanced-practice registered
nurse and RN roles to the IOM Future of Nursing
Report with the laws and statues of California
Co-Leads: Garrett Chan and Susanne Phillips
Recommendation #2: Lead and diffuse
new practice model efforts
• Convene a statewide symposium in September 2012 to
explore opportunities to transform health care delivery,
share innovative models, and assess gaps in current
models of care delivery
Lead: BJ Bartleson
Recommendation #3: Transition-topractice through nurse residencies
• Promote transition to practice programs and residencies
as expectation of nursing education
• Expand programs for new graduates to include more
community-based opportunities
• Create a statewide evaluation of current programs to
inform next steps
Co-Leads: Dorel Harms and Nikki West
Recommendation #4: Increase
number of nurses with BSN
• Establish baseline percentage of RN’s with minimum
educational level of BSN
• Inventory and analyze data from existing ADN-BSN
projects to establish best practices
• Continue to facilitate progress AB1295 with
consultation and support to CCC and CSU Chancellor’s
Offices
Co-Leads: Liz Close and Stephanie Robinson
Recommendation #5: Double number
of nurses with a doctorate by 2020
• Work with Recommendation #8 to establish baseline
number of nurse with a doctorate
• Establish outcome measures and methods of
collecting data for reaching goal of a 10% increase of
BSN grads matriculating into Master’s programs within
5 years
Co-Leads: Holli DeVon and Robyn Nelson
Recommendation #6: Ensure that
nurses engage in life-long learning
• Establish priorities and communications plans for
messaging the need for culture change to expectations
of life long learning in the profession of nursing
• Create repository on the Action Coalition website
showcasing service and academic partnerships that
demonstrate and support lifelong learning
Co-Leads: Jan Boller and Martha Dispoto
Recommendation #7: Prepare and
enable nurses in leadership positions
• Conduct gap analysis of 2011 survey to identify needs
for developing new leadership programs for nurses
• Expand nursing leadership opportunities for
participation by nurses in board rooms, policy
discussions and on management teams
• Develop a systematic plan for involving students in the
Action Coalition work
Co-Leads: Pat McFarland and Peggy Hodge
Recommendation #8: Build data
infrastructure for workforce planning
• Upload all public-access web links and resources for
data to Action Coalition website
• Disseminate a seamless inventory of CA data for
analysis and workforce planning
• Work closely with other recommendation groups to
assess data needs to implement strategies
Co-Leads: Joanne Spetz and Louise Bailey
Regional Approach
• Change will happen locally
• Regional champions serve on Leadership Council
• Hold regional forums to build engagement and deliver
the message locally
• Ensure regional members serving on work groups
and/or coordinate with regional subgroups to link into
statewide effort
Progress to Date
•
•
•
•
•
•
Planning Year completed
Workgroups established for all 8 Recommendations
Regional Champions identified in all 8 regions
Statewide Director appointed
Communication Plan and website
Secured initial funding for creating sustainable
structure
Successes to Date
Town Hall Events:
• Sacramento in August 2011
• Los Angeles in February 2012
• Fresno in April 2012
• Humboldt in May 2012
Funders Round Table meetings held
• Sacramento in August 2011
• Los Angeles in December 2011
Successes to Date
Legislative Meeting with future discussions in the works
High Stakeholder Engagement due to successful outreach
CA is Role Model for Action Coalitions in other states
It Will
Take
All
of Us!
Get Involved!
Workgroups / Regional activity
Speaker’s Bureau Trainings
Development Campaign
Communications Committee
Exercise for your Organizations
1) With your colleagues, discuss examples of how your
organization is already engaged in work around the IOM
Future of Nursing Recommendations.
2) Brainstorm to develop ideas that your organization should
be or could be engaged in around the recommendations
and connect with workgroup co-leads.
For More Information
Mary Dickow, MPA
California Action Coalition
Statewide Director
marydickow@me.com
415-307-9476
Future of Nursing Campaign for Action
www.thefutureofnursing.org
California Action Coalition
www.CAactioncoalition.org