Collaboration and resourcefulness:
thinking outside the box
Christine Grady RN PhD
Department of Bioethics
NIH Clinical Center
2013 PHS Nursing Recognition Day
Embracing Diversity: Limitless Possibilities in Nursing
May 3, 2013
• These views are mine and do not necessarily
represent those of the Department of
Bioethics, Clinical Center, National Institutes of
Health, or the Department of Health and
Human Services.
• I have no conflicts of interest to declare
The Future of Nursing
• Enactment of the ACA will provide unprecedented opportunities for change
in the U.S. health care system for the foreseeable future. Strong leadership
on the part of nurses, physicians, and others will be required to devise and
implement the changes necessary to increase quality, access, and value and
deliver patient-centered care. If these efforts are to be successful, all
nurses, from students, to bedside and community nurses, to CNOs and
members of nursing organizations, to researchers, must develop leadership
competencies and serve as full partners with physicians and other health
professionals in efforts to improve the health care system and the delivery
of care. Nurses must exercise these competencies in a collaborative
environment in all settings, including hospitals, communities, schools,
boards, and political and business arenas. In doing so, they must not only
mentor others along the way, but develop partnerships and gain allies both
within and beyond the health care environment.
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The Future of Nursing, Leading Change, Advancing Health, IOM 2011
Overview
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Leadership
Partnership
Collaboration
Resourcefulness
Nurse Leaders in Health Care
Top 25 Women in Healthcare – 2013
• … program honors exceptional female healthcare
executives who are making a positive difference
in the industry. The honorees represent all
sectors of healthcare, including hospitals, health
systems, insurance, government, trade and
professional organizations, and labor.
Nurses and Nurse Champions Included in Modern Healthcare's Top 25 Women in Health Care
Top 25 Women in Healthcare – Modern Health Care 2013
Honorees with Nursing Background
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Maureen Bisognano is president and CEO of the Institute for Healthcare Improvement, a patient-safety
organization. She began her career in health care in 1973 as a staff nurse at Quincy City Hospital.
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Karen Daley is president of the American Nurses Association, a professional organization representing the interests
of the nation’s 3.1 million registered nurses.
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Patricia Hemingway Hall is president and CEO of Health Care Service Corp. Hall began her career as an intensivecare nurse in the 1970s, but since 2008, has led HCSC, which covers more than 13 million members in Illinois, New
Mexico, Oklahoma and Texas.
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Sister Carol Keehan is president and CEO of the Catholic Health Association, representing the nation’s Roman
Catholic health systems and the largest group of not-for-profit health providers in the nation.
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Judith Persichilli is president and CEO of Catholic Health East, a health system that includes 39 acute-care hospitals,
26 long-term-care facilities and other operations in 11 Eastern states.
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Shirley Weis is chief administrative officer and vice president of the Mayo Clinic, one of the most well-known brand
names in health care and a system that treats more than 1 million people annually in Arizona, Florida, Georgia,
Iowa, Minnesota and Wisconsin.
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Sharon O’Keefe is president of the University of Chicago Medical Center and has more than 30 years of health care
experience, initially as a critical-care nurse and then in hospital leadership.
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Marilyn Tavener is acting administrator for the CMS and oversees the $757 billion federal agency that provides
health care coverage to 100 million Americans through Medicare, Medicaid and other programs.
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Mary Wakefield is administrator of the Health Resources and Services Administration and leads efforts to work
with providers and community programs to improve access to health care services for the needy, uninsured and
isolated.
Nurses in Congress
Congresswoman Karen Bass (D-CA-33)
Congresswoman Diane Black (R-TN-06)
Congresswoman Lois Capps (D-CA-23)
Congresswoman Renee Ellmers (R-NC-02)
Congresswoman Eddie Bernice Johnson (D-TX-30)
Congresswoman Carolyn McCarthy (D-NY-04)
http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Federal/Nurses-in-Congress
Nurse Leaders- Uniformed Services
• Lieutenant General Patricia D. Horoho, Surgeon
General and Commanding General of the United
States Army Medical Command . (first female and
first Nurse Corps officer to be SG & CG in the
Army).
• Rear Admiral Kerry Paige Nesseler, Assistant
Surgeon General, Chief Nurse Officer, USPHS and
Director of the Office of Global Health Affairs,
HRSA US DHHS
• “…all nurses, from students, to bedside and
community nurses, to CNOs and members of
nursing organizations, to researchers, must
develop leadership competencies…”
Developing Leaders
• Recommendation 7: Prepare and enable nurses to lead change to advance
health. Nurses, nursing education programs, and nursing associations
should prepare the nursing workforce to assume leadership positions across
all levels, while public, private, and governmental health care decision
makers should ensure that leadership positions are available to and filled by
nurses.
– Nurses should take responsibility for their personal and professional growth by
continuing their education and seeking opportunities to develop and exercise
their leadership skills.
– Nursing associations should provide leadership development, mentoring
programs, and opportunities to lead for all their members.
– Nursing education programs should integrate leadership theory and business
practices across the curriculum, including clinical practice.
– Public, private, and governmental health care decision makers at every level
should include representation from nursing on boards, on executive
management teams, and in other key leadership positions.
The Future of Nursing, Leading Change, Advancing Health, IOM 2011
Leadership
1.
2.
3.
4.
“Sit at the table”
Seek Challenges and take
Risks
Make your partner a real
partner
Pursue goals with gusto
“Studies also show
that compared to men,
women underestimate their performance. If
you ask men and women questions about
completely objective criteria such as GPAs or
sales goals, men get it wrong slightly high;
women get it wrong slightly low. More
importantly, if you ask men why they
succeeded, men attribute that success to
themselves; and women, they attribute it to
other factors like working harder, help from
others. Ask a woman why she did well on
something, and she’ll say, “I got lucky. All of
these great people helped me. I worked really
hard.” Ask a man and he’ll say or think, “What
a dumb question. I’m awesome.” So women
need to take a page from men and own their
own success”
S. Sandberg
CELEBRATING NURSES: Nurses are strong,
nurturing and selfless
Laura Raines, Atlanta Journal Constitution April 26, 2013
• “Woven within our communities are strong, nurturing
and selfless people. We call them nurses. They are the
trusted professionals we turn to when we’re sick and
hurting. But nurses don’t just practice at the bedside.
They bring their caring, thinking, teaching, problemsolving, get-it-done qualities into our families, schools,
churches, businesses, legislatures and neighborhoods —
and we’re all the richer for it. “
And yet…
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Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion
Leaders’ Perceptions” (RWJF, 2010, Box 5.1)
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Opinion leaders rate doctors and nurses first and second among a list of options
for trusted information about health and health care.
Opinion leaders perceive patients and nurses as having the least amount of
influence on health care reform in the next 5–1 years.
Reducing medical errors, increasing quality of care, and promoting wellness top
the list of areas in which large majorities of opinion leaders would like nurses to
have more influence.
Relatively few opinion leaders say nurses currently have a great deal of influence
on increasing access to care, including primary care.
Opinion leaders identified top barriers to nurses’ increased influence and
leadership as not being perceived as important decision makers or revenue
generators compared with doctors, having a focus on acute rather than preventive
care, and not having a single voice on national issues.
Opinion leaders’ suggestions for nurses to take on more of a leadership role were
making their voices heard and having higher expectations.
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Leadership
BOX 7-3: Research Priorities for Transforming Nursing Leadership
Identification of the:
–personal and professional characteristics most critical to leadership of
health care organizations, such as accountable care organizations, health
care homes, medical homes, and clinics.
– skills and knowledge most critical to leaders of health care
organizations, such as accountable care organizations, health care homes,
medical homes, and clinics.
–personal and professional characteristics most important to leaders of
quality improvement initiatives in hospitals and other settings.
–characteristics of mentors that have been (or could be) most successful
in recruiting and training diverse nurses and nurse faculty.
–influence of nursing on important health care decisions at all levels.
–unique contributions of nurses to health care committees or boards.
ANA Leadership Institute
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Webinar 1. Strategic Thinking
Webinar 2: Results Orientation
Webinar 3: Leading People
Webinar 4: Personal Leadership
Webinar 5: Unleashing Innovation and Creativity
http://anawebinarseries.eventbrite.com/#
Partnership and Collaboration
• “Make your partner a real partner”
• Lean In and Lean On
• Health care is a team sport
• Patient as Partner
The Power of Collaboration
Lord Shiva led the Swami to two doors.
Behind the first door, he saw a large round table with a large delicious smelling pot of stew.
The people sitting around the table were thin and sickly and appeared to be famished. They were
holding spoons with long handles that were strapped to their arms. They could reach into the
pot with the spoon and take a spoonful of stew, but since the handle was longer than their arms,
they could not get the spoons back into their mouths.
The Swami shuddered at their misery and suffering.
Behind the second door, things looked similar. A delicious smelling pot of stew sat in the middle
of a large round table. The people were equipped with the same long-handled spoons. But here
the people were well nourished and plump, laughing and talking.
The Swami said, “I don’t understand”.
“It is simple”, said Lord Shiva, “It requires but one skill. You see they have learned to feed each
other. They have learned to work together”.
SUFI PARABLE: Author Unknown
Figure 1. Possible skills, knowledge, traits and motives influencing
teamwork, from Leggat S.
Effective healthcare teams require effective team members: defining
teamwork competencies. BMC Health Services Research 2008
• Key Message #3: Nurses should be full partners, with
physicians and other health professionals, in
redesigning health care in the United States.
• Strong leadership is critical if the vision of a
transformed health care system is to be realized. Yet
not all nurses begin their career with thoughts of
becoming a leader. The nursing profession must
produce leaders throughout the health care system,
from the bedside to the boardroom, who can serve as
full partners with other health professionals and be
accountable for their own contributions to delivering
high-quality care while working collaboratively with
leaders from other health professions
Leadership and Collaboration
• Leadership from nurses is needed at every level
and across all settings. Although collaboration is
generally a laudable goal, there are many times
when nurses, for the sake of delivering
exceptional patient and family care, must step
into an advocate role with a singular voice. At the
same time, effective leadership also requires
recognition of situations in which it is more
important to mediate, collaborate, or follow
others who are acting in leadership roles.
Healthcare Changes:
Need for innovation, collaboration, and leadership
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Affordable Care Act
Workforce changes
Shifting Demographics
Globalization
Genomics and personalized medicine
Learning health systems
Technologic advances
Affordable Care Act
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IV.
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VI.
VII.
VIII.
IX.
X.
Quality Affordable Healthcare for All
Role of Public Programs
Improving quality and efficiency
Prevention of chronic disease
Health Care Workforce
Transparency and professional integrity
Improving access to innovative therapies
Community Living Assistive and Supportive
Revenue provisions
Reauthorize Indian Healthcare Improvement Act
NEJM April 18, 2013
Figure 7. Growth in the U.S. Nursing Workforce
The U.S. Nursing Workforce: Trends in Supply and Education (2013 HRSA)
http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/index.html
Figure 8. Highest Degree Held by RNs, Census 2000 and ACS 2008 to 2010
Figure 18. NCLEX-RN Passers, 2001 to 2011
150,000
107.7%
Growth,
2001-2011
140,000
130,000
137,834
134,027
120,000
Passers
116,045
109,726
110,000
142,390
127,592
100,000
85,824
90,000
80,000
70,474
98,365
75,821
70,000
60,000
68,561
50,000
2001
2002
2003
2004
2005
2006
Year
2007
2008
2009
2010
2011
Figure 24. Licensed RNs Graduating With BSN Qualification, 2007 to 2011
Figure 25. Master’s and Doctoral Graduates, 2007 to 2011
Figure 9. The Changing Age Distribution of RNs, in Five-Year Increments
Figure 11. Race/Ethnicity in the RN Workforce and Total Working-Age Population
• The national spotlight on the nursing shortage has raised
awareness of the pivotal role nurses play in health care
delivery as well as the many career opportunities available
in the field. In addition to providing direct patient care,
nurses today can conduct research, teach in universities,
advise public policymakers, lead healthcare organizations,
establish independent practices, and share their expertise
in many other ways. This dynamic profession is attracting
an increasing number of highly skilled individuals from
other disciplines who are seeking new careers in nursing.
• RWJ- New Careers in Nursing,
http://www.newcareersinnursing.org/aboutncin/background
Demographic Shifts
Globalization
Why Nurses Are the Unsung Heroes of Global Health
Sheila Davis, Huffington Post 2012
Table 1: The human resource crisis: health personnel (nurses
and doctors) per 100,000 population
country
Nurses
Doctors
Malawi
25.5
1.1
Tanzania
36.6
2.3
Ghana
64
9
Zambia
113
6.9
Botswana
241
28,7
South Africa
388
69.2
UK
937
256
USA
1212
230
(Source: WHO 2007 HIV/AIDS Programme. Task shifting to tackle health
worker shortages. Table 1 p.2)
• “…although nurses deliver ~90 percent of all
healthcare services worldwide, they remain
largely invisible at decision-making tables in
national capitals and international agencies.
Their absence constitutes a global health
crisis.” Davis S 2012
Genomics and personalized medicine
Changes in research:
Learning Health Care Systems
Technological Advances
Resourcefulness and Innovation
Ten Innovations That Will
Transform Healthcare
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Checklists
Behavioral economics
Patient portals
Payment innovations
Evidence based decision making
Accountable Care Organizations
Regenerative Medicine
Virtual Visits
Genetics enters practice
Surgical Robotics
http://hbr.org/web/extras/insightcenter/health-care/10innovations/1checklists
Throughout the years, PHS nurses have demonstrated
their innovative flexibility and willingness to adapt to new
opportunities, and they continue to bridge the gaps today.
http://phs-nurse.org/usphs-nurses/slider-3
The Future of Nursing
• Enactment of the ACA will provide unprecedented opportunities for change
in the U.S. health care system for the foreseeable future. Strong leadership
on the part of nurses, physicians, and others will be required to devise and
implement the changes necessary to increase quality, access, and value and
deliver patient-centered care. If these efforts are to be successful, all nurses,
from students, to bedside and community nurses, to CNOs and members of
nursing organizations, to researchers, must develop leadership
competencies and serve as full partners with physicians and other health
professionals in efforts to improve the health care system and the delivery of
care. Nurses must exercise these competencies in a collaborative
environment in all settings, including hospitals, communities, schools,
boards, and political and business arenas. In doing so, they must not only
mentor others along the way, but develop partnerships and gain allies both
within and beyond the health care environment.
•
The Future of Nursing, Leading Change, Advancing Health, IOM 2011
LEAN IN, LEAN ON, AND THINK OUTSIDE
THE BOX