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Leading Change, Advancing Health.

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Presentation on theme: "Leading Change, Advancing Health."— Presentation transcript:

1 Leading Change, Advancing Health

2 3.2 MILLION 100,000 30,000 Nursing’s Voice

3 To review Institute of Medicine, Future of Nursing Report To define the Campaign for Action To define the Virginia Action Coalition To describe the workgroups Objectives

4 Aging and sicker population High costs Primary care and public health shortages FragmentationFragmentation Health care disparities Health Care System Challenges

5 Escalating rate of diabetes*:  193,000 in 1993  508,000 in 2010 Primary care shortage, especially acute in rural areas Aging health care workforce *Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System Virginia’s Health Care Challenges

6 Largest segment of health care workforce Need to enhance nurses’ skills and capabilities Critical role in providing patient care and care coordination Nurses and Health Care

7 Need to address challenges facing nursing to address challenges facing our health system RWJF MISSION To improve health and health care for all Americans RWJF’s Commitment to Improving Care

8 High-quality, patient- centered health care for all will require a transformation of the health care delivery system One of the most-viewed online reports in IOM history Institute of Medicine Report

9 A Quote: " achieving a successful health care system in the future rests on the future of nursing." Harvey V Fineberg, MD, PhD President, Institute of Medicine.

10 Committee on the RWJF Initiative on the Future of Nursing Membership Opportunity to transform health care system IOM Future of Nursing Report Provide seamless, affordable, quality care Nursing profession is the largest segment of the health care workforce

11 High-quality patient centered care Leadership Access to Care Workforce Data Education Interprofessional Collaboration Campaign for Action: Key Messages

12 1.Nurses should practice to the full extent of their education and training 2.Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression 3.Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the US 4.Effective workforce planning and policy making require better data collection and an improved information infrastructure Blueprint – Four Key Messages

13 Remove scope of practice barriers Expand opportunities for interprofessional collaboration Implement nurse residency programs Increase proportion of nurses with BSN to 80% by 2020 Double the number of nurses with doctorates Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change and advance healthcare Build an infrastructure for data collection Future of Nursing Recommendations

14 Advancing Education Transformation Removing Barriers to Practice and Care Nursing Leadership DATA Interprofessional Collaboration Diversity Campaign for Action Pillars

15 Implement nurse residency programs Increase the number of nurses with doctorates Promote lifelong learning Increase the proportion of nurses with BSN and higher degrees Education

16 Evidence Some association between educational level and patient outcomes Twenty percent of BSN graduates get advanced degrees Six percent of associate-degree graduates get advanced degrees Aiken et al., 2003; Estabrooks et al., 2005; Friese et al., 2008;Tourangeau et al., 2007; Van den Heede et al., 2009; Aiken, 2009. Education

17 All practitioners should practice to the full extent of their education and training Physicians, nurses and other health professionals work in a team-based model of care delivery Models of care maximize time that providers can spend on their respective roles and responsibilities to patients Practice

18 Evidence Studies show that APRNs permitted to practice to full extent of education and training provide equal or better care Patient satisfaction Length of stay NPs: BP, glucose, lipid control CNMs: Fewer C-sections, fewer episiotomies Systematic review of published literature between 1990 and 2008 indicate patient outcomes of care provided by APRNs and equivalent or better than MD Sources: Journal of Nursing Economic$, (Sept/Oct 2011), Advanced Practice Nurse Outcomes 1990 – 2008: A Systematic Review Practice

19 Prepare more nurses to help lead improvements in health care quality, safety, access and value Interprofessional education, training and practice Integrated, collaborative, patient- centered health care teams Collaboration

20 Nurses bring important viewpoint to management and policy discussions Leadership

21 *RWJF, 2010 **American Hospital Association, 2011 Gallup survey of 1,500 opinion leaders* said nurses should have more: Influence in reducing medical errors, increasing quality of care, promoting wellness Input and impact in planning, policy development and management Survey of 1,000 U.S. hospitals** found: Nurses account for only six percent of board members Physicians account for 20 percent of board members Other clinicians are five percent of board members Evidence

22 Research on health care workforce is fragmented Need data on all health professions Improved health care workforce data collection to better assess and project workforce requirements Data

23 Nurses should reflect patient population in terms of gender, race and ethnicity All nurses should provide culturally competent care Diversity

24 The Campaign for Action is a national initiative coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. The campaign has mobilized diverse stakeholders nationally and in all states to address the nation’s most pressing health care challenges – access, quality and increasing cost – by utilizing nurses more effectively and preparing nursing for the future. Campaign for Action

25 Americans have access to high quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success

26 Diverse Stakeholders Policy-makersPolicy-makers CommunicationsCommunications Action Coalitions Research, Monitoring, Evaluation GrantmakingGrantmaking RWJFAARP Advisory Committee RWJFAARP Campaign Strategies

27 RWJF/AARP seeking support from: Health professionals Payers Consumer advocates Business Policy-makers Philanthropies Educators Hospitals and health systems Public health agencies Nursing Must be Considered a Societal Issue!

28 How will the eight IOM recommendations translate into action? Campaign for Action State Action Coalitions Regional Action Coalitions

29 AARP Virginia Virginia Nurses Association

30 Virginia Action Coalition Co-leads AARP – Virginia David DeBiasi, RN Associate State Director - Advocacy Virginia Nurses Foundation Shirley Gibson, DNP, MSHA, RN, FACHE Foundation President Virginia Nurses Association / Virginia Nurses Foundation Janet Wall Chief Executive Officer

31 Nurses should: Practice to the full extent of their education and training Achieve higher levels of education and training through an improved educational system that promotes academic progress and explore residency programs Be full partners, with all members of the healthcare team in redesigning healthcare Develop strategies to ensure that nursing is skilled to provide leadership at all levels Ensure effective workforce planning and policy making require better data collection and an improved information infrastructure Virginia Action Coalition Goals

32 To implement the recommendations in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Mission

33 All Virginians have access to affordable, high quality care and live in an optimal state of health Vision

34 Workgroups Virginia Action Coalition

35 IOM Recommendation 7 Prepare and enable nurses to lead change to advance health. Objective Determine strategic boards to which nurse could be appointed and work with stakeholders to identify, mentor, and recommend individuals for those appointments. VAC Leadership Lindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RN Co-leads

36 Continue “Nurse Leaders in the Boardroom” program piloted with Robert Wood Johnson Foundation and AARP in September 2009 Continue to support Nurse Leadership Institute, a program of the Richmond Memorial Health Foundation Leadership Objectives

37 Nurse Leaders in the Boardroom – AARP Nurse Leadership Institute Partnership with Virginia Student Nurses Association Survey of nurses for board and potential board members Hospital survey for nurses on boards RWJF Boundary Spanning Leadership CFA Breakthrough Leadership Nominees Inaugural Leadership Symposium! Outcomes

38 Develop a video campaign re: value of nurse on boards Enhance the Leadership Toolkit Develop structure for mentors and mentees serving on boards Publish leadership article with Campaign for Action Blog for RWJF on Leadership Ongoing leadership development conferences for nurses who want to serve on boards Next Steps

39 Video: Value of Nurses on Hospital Boards Outcomes

40 Local Boards Free Clinics Crisis Pregnancy Centers AORN, VNA, Black Nurses & other professional nursing associations Public Health Advisory Commissions Red Cross Alzheimer’s Association Church Affiliated Boards Performing Arts Council Historical Councils County Board of Supervisors AARP University & Community College Councils YMCA

41 State Boards Virginia Partnership for Nursing Virginia Board of Nursing Virginia Nurses Association Virginia Nurses Foundation Multiple professional nurses associations Virginia Board of Health Virginia Association of Counties VCCS Associates Degree Nursing Program Heads Virginia Association of Colleges of Nursing Health Insurance Exchange Governing Body

42 National Boards American Nurses Association & Political Action Coalition National eHealth Collaborative Nurses Organization of Veterans Affairs American Midwifery Certification Board AORN Journal Editorial Board National Kidney Foundation American Academy of Nurse Practitioners American Organization of Nurse Executives Various National Nursing Organizations

43 Next Steps Develop a video campaign value of nurse on boards Enhance the Leadership Toolkit Develop structure for mentors and mentees serving on boards Publish Leadership Article with Campaign for Action Blog for RWJF on Leadership Ongoing Leadership Development Conferences for nurses who want to serve on boards

44 IOM Recommendation 1 Remove scope-of-practice barriers Objective All nurses should practice to the fullest extent of their training Objective Educate stakeholders, legislators and the public about APRN regulatory barriers that prevent full practice authority to continue efforts to reform outdated scope- of-practice regulations VAC Access To Care Cindy Fagan, RN, MSN, FNP-BC and Kathy Baker, RN, PhD, NE-BC Co-leads


46 House Bill 346 passed and signed by Governor –Eliminates supervisory language – emphasis on collaboration –HB 346 manifested in 2013 Advanced Practice Registered Nurse disciplines –Consensus Model for APRN Regulation Gap - Licensure, Accreditation, Certification & Education Met with the Board of Nursing on agreement and sought advice on titles Met with the House and Senate Finance Committees on language in budget amendment Research Project –Qualitative Descriptive Case Study rebased on Yin’s Methodology for Case Studies (In IRB status) –Explore how policies and practices in hospitals either support or inhibit RNs from practicing to their fullest extent Outcomes

47 Video: The Advanced Practice Registered Nurse Outcomes

48 Next Steps Consider legislation to remove the Joint Board and establish an Advisory Group for oversight Continue education of the public about the APRN scope of practice Continue to use the APRN video for education Conduct the Qualitative Descriptive Case Study Research

49 Conduct research to explore how policies and practices in hospitals in the state of Virginia either support or inhibit RNs from practicing to their fullest extent through a Qualitative Descriptive Case Study rebased on Yin’s Methodology for Case Studies Participants include nurses from all hospitals in the state Areas include ICU, Med/Surg/Progressive Care and Emergency Department Include the CNOs, RNs and Advanced Practice Registered Nurses Next Steps

50 VAC Academic Progression Deb Zimmermann, DNP, RN, NEA-BC and Amy Gillespie, RN, MSN, EdD Co-leads IOM Recommendation 4 Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020 Objective Convene stakeholders on the implementation of seamless education progression

51 Future of Nursing Education The Challenge 51% of VA RNs BS prepared 32% of AD graduates attain BSN 31% of Diploma graduates attain BSN

52 Regional Groups –Eastern, Central, Northwest, North and Southwest Inspiration to Aspiration Grant –Interviews with nursing programs –RN-BSN Guide –Survey of RN-BSN students –Video of students – Outcomes

53 Academic Progression Models –Two statewide conferences with stakeholders –Academic Progression Summit –RWJF State Implementation Grant –Met with State Council Higher Education – G. E. requirements –Organizational policies to achieve BSN Outcomes

54 Collaborate in the design of two pilot programs with two nursing programs each, providing seamless access for nurses to achieve higher levels of education Develop mechanisms to track organizational progress for education progression Enhance and expand online Academic Progression Toolkit Next Steps

55 IOM Recommendation 2 Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Objective Develop and deploy an educational program that prepares nurses, physicians, and other care providers to practice in a team-based, patient-centered care model VAC Interprofessional Collaboration Patti McCue, ScD., RN, MSN, NEA-BC Bonnie Barndt-Maglio, PhD, RN Co-leads

56 Physician Foundation Grant Developed leadership program with MSV Recruited 20 teams of physicians, nurses and other health professions – clinical triads Required Capstone project on population health Provided leadership, business and innovation skills Completed evolve tm Team Based Education Outcomes

57 In partnership with MSVF, launch phase 2 of Evolve Track diversity (cultural, gender, rural / suburban / urban, etc.) of program participants as well as populations served. Develop an educational program toolkit that can be presented in a variety of settings to promote the evolve program and to provide education on the importance of nurses practicing to the full extent of their education, training and experience in a collaborative setting Next Steps

58 Diversity Cultivating Diversity in Academia and the Workforce – Virginia Nurses Association Roundtable held July 24, 2014 –Angela Wilkes – Owens and Minor, Diversity Executive –Elizabeth Carter, PhD, Executive Director VA Board of Health Professions Workforce Data Center –Matt Thornhill – Co-founder of Boomer Project –Panels – Perspectives on Diversity – Strategies and Successes

59 Sustainability Campbell and Company –Technical Support –6 State Collaborative –Sharing Best Practices –Developing Tools Case for Support Prospective Relationship Building Individual Support Base Volunteer Engagement Special Events Fundraising Activities

60 Members of the Virginia Action Coalition honored for their contributions to the nursing profession at the 2012 VNF Gala

61 Engage! Janet Wall CEO, Virginia Nurses Association Co-lead, Virginia Action Coalition 804-212-0690 /

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