IOM Future of Nursing:
Leading Change, Improving Health
Ready or Not?
Lucy Marion, PhD, RN
Dean, GRU College of Nursing
MIF Meeting
June 18. 2013
Lee Auditorium
Unity
GRU College of Nursing
• Consolidated GHSU and ASU faculty, students and
staff associates in January
• Teaching out 2 BSN curricula; starting a new one
• Maintaining total new BSN enrollment numbers
(~190 new students/year, including 40 in Athens)
• Educational Programs: BSN, MSN/CNL, DNP, PhD
• Clinical Specialties: FNP, PNP, NAP, MHNP, ACNP
• Faculty practice: primary care, occupational health,
mental health, and clinical/health systems research
• Research: basic science, translational, and
community participatory interventions
Academic-Practice Partnership
 GRMC provides to the CON: (THANK YOU!)
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Clinical learning experiences for our students
Clinical faculty (donated and contracted)
Research facilitation, support, collaboration
Scholarships; preceptors; mentoring
 CON provides GRMC

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Student impacts and new graduates: all levels
Educational programs for employed nurses
Consultants: research, continuity of care models
Community contacts and benefits
CON Growth: Student Enrollment
800
700
600
427
500
400
104
134
230
197
301
375
404
396
300
200
335
339
338
330
290
236
361
183
100
162
0
2005
2006
2007
2008
2009
Undergraduate
2010
Graduate
*Projected Fall 2013, 788 students
2011
2012
2013*
The Future of Nursing:
Leading Change, Advancing Health
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Prepared by the Institute of Medicine in 2010
Funded by Robert Wood Johnson Foundation
Advocated by AARP
Future of Nursing Summit in ATL
– President Azziz presented: leadership
• Georgia Nursing Leadership Coalition formed
• GRMC featured for nurse residency program
IOM Report Key Messages
• Nurses should practice to the full
extent of their education and
training.
• Nurses should achieve higher
levels of education and training
through an improved education
system that promotes seamless
academic progression.
IOM Report Key Messages
• Nurses should be full
partners, with physicians
and other health care
professionals, in redesigning
health care in the United
States.
• Effective workforce planning
and policy making require
better data collection and an
improved information
infrastructure.
1. Remove scope-of-practice barriers.
Why?
 Increase productivity of healthcare delivery
GRU College of Nursing (CON) response:
 All CON students prepared to practice to the boundaries of
legal scope of practice
 Advanced Practice Nurses prepared at national scope and
standards; informed of state and institutional restrictions
 DNP APRNs increasingly prepared as independent
clinicians, i.e., competent to practice in solo sites with
telemed and other tech and specialty supports
 Faculty and students educated to advocate for full scope
for all professionals.
2. Expand opportunities for nurses to lead and
diffuse collaborative improvement efforts.
Why?
 Innovations for better patient and cost outcomes
 Interprofessional collaboration for
broad perspectives, including nursing
CON response:
 Practice change projects required
for each student in clinical programs
 Interprofessional teams for all
current CON research
 Service on non-CON research and practice teams
Leading into the Future
Healthcare Coordination: Essence of Quality
• Community mobilization: Maximize health
information exchanges (HIE)
• Self care centers – advancing people capacity
• Health Tracking – using smart phone apps
• Monitoring and coaching – chronic conditions
• Mobile Health Care - linking rural communities
to essential care: use of eICU model of support
3. Implement nurse residency programs.
Why?
 Relatively short nursing programs. Need
transition-to-practice program (nurse
residency) for new prelicensure or advanced
practice nurses and experienced nurses
when entering new clinical areas.
 Safety, quality in patient care
CON response
 Support GRMC residency as academic
partner
 Provide statewide plan and consultation
4. Increase the proportion of nurses with a
baccalaureate degree to 80 percent by 2020.
Why?
 Better patient outcomes, community health
and continuing care perspective, leadership
development
College of Nursing response:
 Completion programs for RNs
 RN to BSN
 RN to Clinical Nurse Leader (CNL)
 Contract with health systems to create
tailored, hybrid on-line and mentoring
program for groups
 Foster use of statewide articulation plan
5. Double the number of nurses
with a doctorate by 2020.
Why?
 Need for higher level knowledge and skills for leading
complex, changing patient care and health systems
 Demand for faculty, advanced practice nurse
providers, administrators, and researchers
CON response:
 Opened Doctorate of Nursing Practice Program
in 2005; 110 graduates, ½ faculty
 Transitioning PhD program to be hybrid on-line
National Enrollments
DNP & PhD Programs 2003-2011
10000
9,094
9000
8000
7,037
7000
6000
5,165
5000
4000
3,229
3,439
3,718
3,927
3,982
3000
2000
1000
0
3,976
3,415
4,907
4,161
4,611
1,874
70
170
329
2003
2004
2005
862
2006
Doctorate of Nursing Practice (DNP)
2007
2008
2009
2010
2011
Research Focused Doctorate (PhD)
Source: AACN databases, 1997-2011©
6. Ensure that nurses engage
in lifelong learning.
Why?
 Maintain relevance in rapidly-changing evidencebased care and systems to improve patient outcomes
CON response:
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Advanced practice post master’s certificates
Planning CE initiative
RN to BSN and CNL programs
BSN to DNP and PhD
On line programs
7. Prepare and enable nurses to lead
change to advance health.
Why?
 To capitalize on high-knowledge technologists
with leadership education and experience for
best outcomes
 Nurses proven as effective CEO, COO,
as well as CNO
College of Nursing response:
 Leadership training and practice for all degree
students, faculty, and staff associates
 Considering Executive DNP in partnership with
Hull College of Business
DNP/CNL Evidence-based Projects
 DNP Projects
 Validating a Re-Admission Risk Assessment Tool
 Nurse Residency Program Outcomes: The New
Graduate Nurse Experience
 Impact of an Affordable Care Clinic on Emergent
Transports to Local Emergency Departments
 CNL Projects
 Guided Family Presence During a Code Blue
 Establishment of a Retention & Recruitment Policy for
Emory 2D-ICU
 Communication Between Staff Nurses, Respiratory
Therapists and Techniquest
8. Build an infrastructure for the collection
and analysis of inter-professional
health care workforce data
 Data sources are woefully
inadequate
 No statewide master planning
for nursing workforce
 CON sustains the CSRA
Nursing Workforce Task
Force—very difficult to collect
data across employers (GRMC
one of best!).
Historic Concerns with RN workforce
90,000
Projected
Demand
80,000
70,000
37,700
60,000
16,400
– Georgia RN workforce
ranked 40th in nation in
2000
– Estimates indicated
pending shortages
approaching 40,000 RNs by
2020
– Shortages equaled:
26,300
8,900
3,400
50,000
40,000
Projected
Supply
30,000
20,000
10,000
0
2000
2005
2010
2015
• By early 2000s federal
estimates indicated
existing and growing
shortages of RNs
2020
• 3,400 as of 2000
• 37,700 by 2020
How the USG Responded
• Georgia’s new RN programs have increased productivity
–
–
–
–
2006 - GA programs graduated 2,206 pre-licensure RNs
2011 - GA programs graduated 3,366 pre-licensure RNs
This represents an increase of over 1,100 (50%) in six year period
Note - data on graduates from private sector programs is
estimated for 2012 based on productivity in previous years
4,000
3,634
3,500
3,000
2,811
2,500
USG
2,206
TCSG
2,000
Privates*
1,713
1,500
Total
1,000
500
0
FY 2006
FY 2007
FY 2008
FY 2009
FY 2010
FY 2011
FY 2012
Has the USG Met GA Need?
• Based on Georgia DOL
data, Georgia is now
educating sufficient
numbers of new RNs
– Georgia RN programs
graduated approx. 3,700
new RNs in FY12
– Georgia must fill 3,330
openings per year
• Are Georgia RN programs
overproducing? Probably not.
– DOL estimates are somewhat
conservative – Measure
employer demand for labor not
population needs
– Not all graduates will secure
needed licensing and not all will
work full time
– Aging of current RN workforce
– Impacts of graduates of private
sector programs may be
overstated – RN-BSN count is
mixed with new RNs
Ready, or Not?
Does the CON prepare/provide and does GRMC
promote
 Full scope of practice for all levels of nurses/other
professionals?
 Higher levels of functioning by nurses through
quality, seamless education and positioning?
 Full partnerships with other health care
professionals in healthcare redesign?
 Effective nursing workforce planning for the MC
and beyond to the larger HS?
Community
Engagement
Education
Unity
Thank you.
Questions and comments to
lumarion@GRU.edu