Navy Nursing Update
CAPT Sarah Martin
Deputy Director,
Navy Nurse Corps
Active Component
30 April 2012
What We Know About Nurses
• Knowledge of frontline nurses and their interactions with
patients are critical to improving patient outcomes
• Nurses at every level across the continuum strengthens the
health care system in general
• Increasing the time nurses have with the patient to educate
is essential to the goal of patient-centered care
• Integrated systems that leverage assets (people,
technology) are key to increasing efficiency and allowing
nurses to spend time with the patients.
• Multi-disciplinary care teams improve the quality, safety
and effectiveness of care
• NURSES MAKE A DIFFERENCE!!!!!
What We Also Know
• More than 3 million registered nurses in the
United States
• Nurses have a steadfast commitment to
patient care, improved safety and quality, and
better outcomes
• Nurses can fill multiple roles
• Nurses are lifelong learners
• Nurses are leaders in advancing health
NAVY NURSING
Nurse
Corps
Force
Data
Nurse Corps Force Structure
Flag
1
Actual Force
(Inventory)
CAPT
146/146
5%
CDR
338/357
12%
21%
LCDR
589/648
63%
TOTAL = 2875
LT & Below
1806/1815
96.9% manned
Data Source: OPA to Inventory FEB 2012
DOPMA Force Structure
(OPA)
5%
12%
22%
61%
TOTAL =2966
FY-2012
CLINICAL &
PROFESSIONAL
EXCELLENCE
– Navy Nurse Corps Strategic Plan
INFORMATION
MANAGEMENT
RESEARCH
STRATEGIC
PARTNERSHIPS
WORKFORCE
Foster a Culture of
Collaboration
Optimize Human
Capital Resources
• Develop joint and
strategic partnerships
to strengthen the
profession of nursing
and maximize
utilization of limited
resources
• Focus on
maintaining the right
workforce to provide
nursing care across
the full range of
military operations
Maximize Clinical and
Professional Excellence
Promote
Communication Across
the Enterprise
Cultivate a Culture of
Scientific Inquiry
• Build , strengthen and
advance clinical,
operational and
professional skills and
knowledge
• Sustain, advance and
evaluate
communication across
the enterprise
• Increase interest,
submission and
selection of evidence
based practice research
projects to improve the
health of our patients
and add to the body of
nursing knowledge
Vision For Navy Nursing
Provide exceptional patient & family centered, interdisciplinary, and evidence-based care.
We place quality-caring relationships at the center of our practice resulting in a safe,
compassionate and healing environment.
The Navy Nurse Corps Strategic Plan is aligned with Navy Medicine ‘s Strategic Plan
relative to Quality of Care, Agile Capabilities, Deployment Readiness, Total Force and
Research & Development.
GOALS
CLINICAL AND PROFESSIONAL EXCELLENCE
Goal: Maximize Clinical and Professional Excellence.
Goal Team Purpose: Build, strengthen and advance
clinical, operational and professional skills and knowledge.
INFORMATION MANAGEMENT
Goal: Promote communication across the enterprise.
Goal Team Purpose: Sustain, advance and evaluate
communication across the enterprise (up, down, across the
chain, internal and external).
FY-12 ACTIVE COMPONENT (AC) OBJECTIVES






RESEARCH
Goal: Cultivate a Culture of Scientific Inquiry.
Goal Team Purpose: Increase interest, submission and
selection of Evidence Based Practice (EBP) research
projects to improve the health of our patients and/or add
to the body of nursing knowledge.
STRATEGIC PARTNERSHIPS
Goal: Foster a culture of collaboration
Goal Team Purpose: Develop joint and strategic
partnership across Federal (Military, VA and Active Reserve
Component) and civilian healthcare systems. These
partnerships will strengthen the profession of nursing and
maximize utilization of limited resources.
WORKFORCE
Goal: Optimize human capital resources.
Goal Team Purpose: Focus on maintaining the right
workforce to provide nursing care across the full range of
military operations.






•
Develop standardized guidance for career development boards (CDB) building
on existing tools for use across the enterprise.
Develop a standardized Director of Nursing (DNS) dashboard to measure and
track key elements across the leadership and professional continuum.
Publish and market the Communication Playbook via NKO and other media
for enterprise access.
Implement the most effective substitute for List Serve.
Targeted communication action group members attend Executive
Development Strategic Communication Program at Monterey Postgraduate
School to structure the enduring Strategic Communication plan.
Repeat the original environmental scan and analyze results.
CHAMPION/TEAM LEADER
Champion(s)
CAPT Vince Starks
Email: lavencion.starks@navy.mil
CAPT Lisa Houser
Email: lisa.houser@med.navy.mil
Team Leader(s)
CDR Pat Taylor
Email: patricia.taylor2@med.navy.mil
CDR Janine Allen
Email: janine.allen@med.navy.mil
Champion (s)
CDR Julie McNally
Email: julie.mcnally@navy.mil
Team Leader
LCDR Guidry
Email: stephen.guidry@med.navy.mil
Market and launch the annual Navy Nurse Corps recognition program that
promotes and acknowledges excellence in EBP.
Develop a two – three day regional EBP Course.
Facilitate the initiation of three multi-site, regional Evidence Based Practice
(EBP) project.
Establish research “knowledge broker” at each command.
Champion
CAPT Mary Greenwood
Email: mary.greenwood@med.navy.mil
Team Leader:
CDR Michele Kane
Email: michele.kane@med.navy.mil
Establish and electronically publish a joint service Senior Nurse Executive
(SNE) directory.
Establish a forum to foster joint collaboration and explore best practices and
networking opportunities among uniformed service regional SNE, specialty
leaders and consultants.
Champion(s)
CAPT Denise Johnson
Email: denise.johnson@med.navy.mil
Team Leader(s):
CAPT Anna Hurt
Email: anna.hurt@med.navy.mil
CDR Cindy Baggott
Email: cindy.baggot@navy.mil
Champion(s)
CAPT Brenda Davis
Email: brenda.davis@med.navy.mil
Team Leader (s):
CDR Amy McBride
Email: amy.mcbride2@med.navy.mil
CDR Erin Robertson
Email: erin.robertson@med.navy.mil
Perform a comprehensive review of the 1960 critical care community
and provide recommendations to the Office of the Nurse Corps
(MOOC3).
Define and optimize the role of the Clinical Nurse Specialist (CNS).
MEDICAL HOMEPORT AND
NAVY NURSING
Nearly 40 sites applied for NCQA recognition last
year, and 130 are currently applying
2008
Standards
2011
Standards
Round 1
2011
Standards
Round 2
Navy Medicine East
10
7
14
Navy Medicine West
2
8
24
Navy Medicine National
Capital Area
3
0
0
Army
17
20
30
Air Force
6
15
10
JTF
1*
0
2
TOTAL
39
50
80
* This site was a Navy site during the application process and has since realigned to JTF
Typical Navy Medical Home Port primary
care team
Example: Panel size =
4,400 patients
Provider c-FTE
Equivalent of 4
full-time providers
(not bodies)
0.5 RN per
provider c-FTE
2 nurses
2.5 CMA per
provider c-FTE
10 medical
assistants
0.75 clerk per
provider c-FTE
3 clerks
Behavioral Health is the first specialty to
embed its specialists in the MHP team
Behavioral Health
 1 Integrated Behavioral Health Consultant (IBHC) per 7,500 enrollees
 Depending on population, could include psychiatrists, clinical psychologists, licensed
clinical social workers, licensed professional counselors
 Practice model has been re-conceptualized to meet the needs of primary care populations
 Shorter (15-20 minute) appointments
 Fewer encounters per patient (typically 1-2 visits per patient)
 Care is co-managed with the Primary Care Manager (PCM)
 Brief, focused interventions in which patient drives problem identification, commits
to short-term behavioral change, and sets a goal to accomplish by the next visit
 Fully-integrated provider provides consultative services and training to MHP Team
 Goal: improve early recognition, treatment, and management of psychosocial
conditions
Additional specialties, based on patients’ needs,
will gradually integrate into MHP
Pharmacy
Case Management
Case Management
Nutrition
Pharmacy
 1 per 7,200 enrollees
 Based on population
 Need-based assessment of case
mix/enrollee complexity
 Assist with medication
education, reconciliation,
other clinic needs
 Registered Nurses or Licensed
Social Workers
 Care management/coordination
for high-risk patients, including
•
•
•
•
•
Chronic illness or disabled
Complex care needs,
At risk for hospitalization
Hospitalized enrollees
High-risk and high utilizers
•
Anticoagulation
•
Anti-lipidemic
•
Medication management and
patient education
•
Prescription renewal
•
Over the Counter (OTC)
•
Medication reconciliation
Nutrition
 Based on population
 Dieticians, Nutritionists, or
SMEs in nutrition
management
 Advise patients on
• Health promotion and
Illness prevention
• Nutrition; administering
nutrition therapy
• Teaching, monitoring,
advising the public,
• Improve quality of life
through healthy behaviors
What is Navy/GS Nurse Role in
Ambulatory Care Role?
• Advanced Practice Nurses
– Experts at primary care with a focus on wellness
and preventive care at every encounter; fastest
group of primary care providers in the country
– Medical Home Port Team Leaders and command
champions
– Integral to team in delivering timely, easily
accessible quality care
Navy Nurses (GS/Active Duty) in Role
in Medical Homeport?
– Clinic Managers
– Case Manager
– Patient Educators
– Team Leaders
– Disease Management/Wellness Promotion
Ambulatory Nursing Challenges in
the Navy
• Continuity for Medical Home with deployment
cycles
• Capturing Workload – no defined workload
management system that captures ambulatory
care
• Budget Constraints
• Competency Development – Experts in the Field
• Billet Alignment
• MISSION OF NAVY MEDICINE?
Unanswered Questions
• Do we need an Ambulatory/Medical
Homeport Subspecialty Code?
• How does that fit into Navy’s billet structure?
• If assets are shifted, how do we maintain
wartime requirement and clinical
sustainment?
QUESTIONS?
BACK-UP
NCQA PCMH Levels and Scoring
6 standards = 100 points, including passing score on all 6 Must Pass Elements
NOTE: Must Pass elements require a ≥ 50% performance level to pass
Level of Recognition
Total Score
Must Pass Elements
Passed
Level 3
85 - 100
6 of 6
Level 2
60 - 84
6 of 6
Level 1
35 - 59
6 of 6
Not Recognized
0 - 34
<6
Although NCQA recognizes practices with a score greater than 34 as a PatientCentered Medical Home, Navy Medicine requires a score of 60 or greater (Level 2 or 3)
for acknowledgement as a Medical Home Port.
Each element under the 6 NCQA standards is
scored based on how fully the element is met
Standard 1: Enhance Access and Continuity
Pts
A.
B.
C.
D.
E.
F.
4
4
2
2
2
2
G.
Access During Office Hours**
After-Hours Access
Electronic Access
Continuity
Medical Home Responsibilities
Culturally and Linguistically Appropriate
Services
Practice Team
4
20
Standard 2: Identify and Manage Patient
Populations
Pts
A.
B.
C.
D.
3
4
4
5
Patient Information
Clinical Data
Comprehensive Health Assessment
Use Data for Population Management**
16
Standard 3: Plan and Manage Care
Pts
A.
B.
C.
D.
E.
4
3
4
3
3
Implement Evidence-Based Guidelines
Identify High-Risk Patients
Care Management**
Medication Management
Use Electronic Prescribing
17
Standard 4: Provide Self-Care Support and
Community Resources
Pts
A.
B.
6
3
Support Self-Care Process**
Provide Referrals to Community Resources
9
Standard 5: Track and Coordinate Care
Pts
A.
B.
C.
6
6
6
Test Tracking and Follow-Up
Referral Tracking and Follow-Up**
Coordinate with Facilities/Care Transitions
18
Standard 6: Measure and Improve Performance
Pts
A.
B.
C.
4
4
4
D.
E.
F.
G.
Measure Performance
Measure Patient/Family Experience
Implement Continuously Quality
Improvement**
Demonstrate Continuous Quality
Improvement
Report Performance
Report Data Externally
Use of Certified EHR Technology
3
3
2
0
20
**Must Pass Elements