1. Creating a 21 st Century Nurse Workforce: What will it take? The Soule Lecture, University of Washington Susan Hassmiller, R.N., Ph.D., F.A.A.N.

2. Health Reform Reform must: expand access improve quality reduce costs add value Nursing workforce goals must be the same

3. My Objectives: 1.Discuss health care systems needs 2.Explain how nurses can help 3.Share 8 goals for creating a 21 st century workforce

4. Health Systems Needs: Aging, sicker population: 85 and older fastest growing segment* 20% of Medicare beneficiaries have 5 or more chronic conditions** 75 cents out of every health care $ treats chronic conditions** 5% of beneficiaries who die each year take up 30% of Medicare budget*** *The Aging Population in the Twenty-First Century: Statistics for Health Policy (1988) Commission on Behavioral and Social Science Education. **Medicare Standard Analytic File, 1999. ***Lubitz J.D., Riley G.F. Trends in Medicare payments in the last year of life. N Engl J Med 1993;328:1092-1096.

5. Health Systems Needs Were plagued by: health care disparities high infant mortality rate (ranked 37 th )* lagging life expectancy (ranked 31 st )* primary care shortage unacceptable medical errors *World Health Statistics 2009. World Health Organization, 2009. Available at: http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf

6. Creating a 21 st Century Health System: Our health system will need: chronic care management care coordination end-of-life care prevention Perfect role for nurses

7. Why Nurses? Largest component of health care workforce Spend most time with patients Most likely to catch medical errors* Work in many care settings *Preventing Medication Errors. Washington, D.C.: Institute of Medicine, 2006.

8. Goal #1: Develop Nurse-Led Innovations New models of care: expand access improve quality reduce costs enhance value

9. Example: 11th Street Family Health Center Nurse-managed clinic at Drexel University: addresses health care disparities coordinates care provides health promotion and disease prevention services serves as clinical training site 11 th Street Family Health Center

10. Example: 11th Street Family Health Center* 7,837 primary care visits in 06, up 19% 20% reduction in hemoglobin A1C 68% of clients have controlled hypertension 14% increase in adult immunization rates Fewer low-birth weight babies Decreased depression rates in vulnerable adults with chronic illness Increased rate of breast cancer screening *http://www.aannet.org/files/public/11thStreetFamilyHelthSvcs_template.pdf

11. Example: Community and Retail Clinics Over 1,200 retail clinics use NPs for common acute problems. ERs and urgent care clinics freed up for more severe aliments Patients enjoy convenience NP-staffed clinics are more affordable Retail clinic* *Photo by Jim Amon, The Denver Post, September 30, 2009.

12. Example: Community and Retail Clinics Compared to physician practices, NP practices show equivalent or better: health status, patient adherence and symptom relief* care management* patient satisfaction* NP practices also decrease health utilization and costs** * Horrocks, S., et al. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ; 324:819-23. * *American Academy of Nurse Practitioners. Nurse Practitioner Cost-Effectiveness, 2007.

13. Example: TCAB RWJF and IHI program. AONE on board. Goal: Goal: to empower nurses and others to redesign work processes on med/surg floors to achieve better clinical outcomes Goal: Goal: to improve patient quality Goal: Goal: to ensure a high-quality work environment and retain nurses

14. Example: TCAB BrainstormTestSpread

15. Example: TCAB Promising findings: Falls with harm declined by 45% from 2005-2007* Code blue calls declined 30% from 2005-2007* 30-day re-admissions declined 25% between 2006- 2007* Nurses time at the bedside increased from 47% to 49%**, (with some hospitals up to 70%) *Needleman, Jack and Susan Hassmiller. The Role of Nurses in Improved Hospital Quality and Efficiency: Real-World Results Health Affairs 28 no. 4, 2009 (published online 12 June 2009). **Needleman, Jack, et al. Overall Effect of TCAB on Initial Participating Hospitals American Journal of Nursing, 109(11) November 2009.

16. Example TCAB Improvements Cost Savings Reduction in nurse turnover$5.6 million Reduction in patient falls$7.9 million Reduction in pressure ulcers$59.3 million TCAB Savings at Cedars-Sinai Medical Center 2007-2008* Bolton, Linda Burnes, et. al. The Business Case for TCAB American Journal of Nursing 109(11) November, 2009.

17. Transitional Care Model Goals: avoid repeat hospitalizations attain longer-term positive health outcomes Nurse assigned to hospitalized patient with chronic conditions Nurse coordinates care with patient and family members Nurse provides regular home visits

18. TCM Improves Quality of Care* *Source: Transitional Care Model Web site: http://transitionalcare.info/ToolQual-1801.html.

19. Transitional Care Model Savings* *Source: Transitional Care Model Web site: http://transitionalcare.info/ToolQual-1801.html. Nearly $5,000 in savings at one year.

20. Nurse-Led Innovations AAN has designated these examples: Go to: http://www.aannet.org

21. Goal #2: Engage in Research Build evidence base: collect data and evaluate outcomes publish translate research to action show link between nursing and high- quality patient outcomes invest in faculty who will conduct the research needed for new solutions

22. Goal #3: Redesign Education Make curriculum relevant and current Teach students to think, make critical judgments, create solutions Todays nurses are undereducated for demands of practice -- Carnegie Foundation report* *Benner, Patricia, et al. Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey-Bass, 2009.

23. Goal #3: Redesign Education Curriculum must teach students to: prevent disease coordinate and manage chronic illness offer solutions for and use new technologies provide palliative and end-of-life care work in every setting where society needs us lead and advocate

24. Goal #3: Redesign Education Residency program for nurses: on-the-job learning and clinical preparation safer patient care Lifelong learning: remain competent in practice area keep pace with new technology

25. Goal #4: Embrace Medical Technology Medical devices E-records Virtual patient visits Simulation labs Online classes Social media Nursing simulation lab

26. Goal #5: Foster Inter-professional Collaboration To foster collaboration later in their careers Improve patient-centered care Build collaboration during their education ClassesClinicals Health students (nursing, medical, others)

27. Example: INQRI Interprofessional teams conduct research showing how nurses can improve quality Ex) Nurse and engineer team reducing pressure ulcers

28. Goal #6: Pursue Academic Service Partnerships Engage: 1. hospitals 2. clinics 3. public health offices 4. area health education centers Provide right clinical training to meet communitys needs We must know whats going on in the real world!

29. Goal #7: Develop Leadership at Every Level Speak up to improve patient care Serve on a board Run for public office Know your area of expertise Develop your skill set

30. Goal #7: Develop Leadership at Every Level Nurses hold about 2% of all board positions

31. Goal #7: Develop Leadership at Every Level RWJF/Gallup survey of 1,500 health opinion leaders: insurance corporate health services government university faculty thought leaders See significant barriers that prevent nurses from fully participating as health reform leaders

32. Who Will Influence Health Reform in the United States in the Next 5-10 Years Question Wording: Thinking about the next five to ten years, how much influence do you think each of the following professions or groups of people will have in health reform in the United States?

33. Nurses Should Have More Influence in Planning, Developing Policy, and Management Question Wording: Would you like nurses to have more influence, about the same influence, or less influence than they do now in planning, developing policy, and management of the following health systems and services? Medical Errors Quality Care Access to Care

34. Goal #8: Be at the Table Join boards Enter policy debates Communicate clearly Show supporting data Volunteer Explain how nurses improve patient care

35. 8 Goals to Create a 21 st Century Nursing Workforce: 1.Develop nurse-led innovations 2.Generate evidence 3.Redesign education 4.Embrace medical technology 5.Foster inter-professional education 6.Pursue academic service partnerships 7.Develop leadership at every level 8.Be at the table

36. Creating a 21 st Century Workforce Nurses must take a leadership role in influencing: policy health planning management

37. Creating a 21 st Century Workforce Be the change you want to see. --- Gandhi

38. Thank You