1. Future of Nursing: Planning and Progress September 16, 2015 Nebraska Rural Health Association Conference Victoria Vinton MSN, RN – Director NAC

2. Faculty Disclosure Today’s presenters have no financial interests/arrangements that would be considered a conflict of interest.

3. Objectives Describe the impact of the Institute of Medicine (IOM) 2010 The Future of Nursing: Leading Change, Advancing Health report recommendations on nursing education, leadership, and practice and the importance of the underpinnings of interprofessional practice and diversity. Discuss the role and progress of the NAC in transforming healthcare across the state.

4. National Campaign Vision All Americans have access to high- quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success.

5. High-quality, patient-centered health care for all will require a transformation of the health care delivery system Institute of Medicine Report 2010

6. Enabling nurses to practice to the full level of their training Remove scope-of- practice barriers. Implement nurse residency programs. Improving nursing education Increase proportion of nurses with a BSN degree to 80% by 2020. Double the number of nurses with a doctorate by 2020. Ensure that nurses engage in lifelong learning. Preparing and enabling nurses to lead change. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Prepare and enable nurses to lead change to advance health. Improving workforce data collection and analysis. Build an improved infrastructure to collect and analyze health care workforce data. Institute of Medicine Report 2010 Diversity Fostering Interprofessional Collaboration

7. Advancing Education Transformation Removing Barriers to Practice and Care Nursing Leadership DATA Interprofessional Collaboration Diversity

8. Triple Aim Target 2007 – 2008 Population Health Experience of Care Cost 4 th aim

9. From those… Who are most central to patient care.

10. It will take…. Leadership Vision Experience Direction

11. Nebraska Action Coalition Leading Change, Advancing Health Visiting Nurse Association, Lead Nurse Partner HDR Architecture, Inc., Lead Non-Nurse Partner

12. Executive Committee (1) L. Lazure, M. Cramer, M. Valerio, J. Lazure, N. Gondringer, D. Kozeny, A. Orduna, L. Walline, D. Straub, L. Connelly, C. Hohnholt NAC Director (2) V. Vinton Executive Consultant M. Valerio Non-Nursing Organization Lead (4) HDR Architecture, Inc. Advancing Nursing Leadership Statewide Team (7) L. Walline & D. Straub Co-Leads Open North Co-Chair C. Wahl & M. Wolf, South Co-Chair P. Agee-Lowrey & D. Ernesti, East Co-Chair C. Jones & L. Schoenholz, West Co-Chair DIVERSITY Interprofessional Collaboration Data/ NE Center for Nursing Advancing Nursing Education Statewide Team (6) M. Valerio & A. Orduna, Co-Leads Liane Connelly & K. Weidner, North Co-Chair S. Hayek, M. Mertz, & P. Bales South Chairs T. Delahoyde & A. Minster, East Co-Chairs S. Wilhelm & B. Kautz West Co-Chairs Advancing Nursing Practice Statewide Team (8) N. Gondringer & D. Kozeny, Co-Leads B. Blecher & J. Rystrom, North Co-Chair Open South & West Co-Chairs D. Conley & P. Evans East Chair Acute Care Consultant: J. Lazure Legislative Consultant: L. Lazure Nursing Organization Lead (5) Visiting Nurse Association Strategic Advisory Committee (3) J. Summerfelt—Pres/ CEO VNA C. Benjamin AARP-NE P. Lopez MSN—PHAN J. Ulrich—CEO Community Hospital McCook D. Welk-VP Immanuel; C. McCullough – HDR, Inc. Larua Redoutey—Presi. Nebraska Hospital Assc. Tom Frettee Provider Network Director-NE Medicine

13. Mission To improve healthcare access, quality, & cost-effectiveness in a manner that embraces & reflects diversity in Nebraska through collaborative partnerships with consumers, providers, policy makers, & businesses.

14. Vision Transform Leadership. Embrace Diversity. Promote Best Practices. Provide Quality Healthcare.

15. What We Are & What We Are Not Consumer partners – not just nursing Catalyst organization – not umbrella Self-sustainability essential Interprofessional collaboration a must Coalition of internal/external stakeholders

16. 1.Implement statewide initiative with all schools of nursing to streamline RN to BSN education and achieve 80% BSN by 2020 2.Support removal of practice barriers for Nebraska nurse practitioners to assure accessible primary care across the state 3.Lead statewide efforts to diversify the RN workforce in Nebraska to meet affordable, accessible healthcare for our growing minority population 4.Prepare and promote nurses for leadership on community and hospital board membership 5.Workforce data collection Click here for website Strategic Action Plan

17. 61% of Nebraska RNs now have their BSN; 9.1% increase between 2012 and 2014 14% increase in Nebraska nursing leadership on decision-making bodies/boards based on 2013 Nursing Leadership Survey. Publication of White Paper: Leadership and Education in Nebraska (2014) Working with all schools of nursing to streamline RN to BSN education and achieve 80% BSN by 2020. 20 th state to modernize practice for nurse practitioners SIP I Grant Outcomes

18. Education Team 80% BSN by 2020 Transition to Practice Double Doctorates Interprofessional Education

19. Education Evidence Studies show association between higher nurse education level & improved health care outcomes: Higher proportions of BSN-prepared nurses associated with lower rates of medication errors, mortality, and failure to rescue BSN-preparation increases diagnostic skills and better intervention evaluation Connection between baccalaureate education and lower mortality rates.

20. Silver Tsunami – graying baby boomer workforce Bureau of Labor Statistics project 526,800 more nurses needed by 2022 - 19.4% increase from 2012* Not enough faculty – retiring or gaining higher salaries in other settings Streamline advancement of nurse education Increase in BSN nurses builds pipeline *Bureau of Labor Statistics Education Evidence

23. Interprofessional Collaboration

24. What does interprofessional collaboration look like for your organizations? Interprofessional Collaboration The View

25. Practice Team LB 107 Rules & Regs Transition to Practice Workforce All nurses practice to full education/training

28. Disparities in Life Expectancy by Zip Codes Poorest Zip Code in Omaha 68111 Richest Zip Code in Omaha 68135 Zip Code of 69361 in Scottsbluff, NE Life Expectancy at Birth 70.6 years82.6 years76.9 years Median Household Income $ 23, 470$ 90,263$37,967 White (%) 21.295.575 Black (%) 70.60.3 Poverty (%) 32.41.016.8 Unemployment Rate (%) 7.50.84.1 Source: Su, Dejun (UNMC Center for Reducing Health Disparities) and NE DHHS (2015). Life expectancy estimates by three representative zip codes in Nebraska are based on vital statistics data pooled from multiple years.Vital Statistics and http://zipskinny.com/ http://www.city-data.com/zips/69361.html

29. Improve Workforce Diversity Nurses should reflect the population in terms of gender, race and ethnicity. Recruit the nursing workforce of the future. All nurses should provide culturally responsive services and care. Greater workforce diversity helps to reduce health disparities. http://campaignforaction.org/directory-of-resources/increasing- diversity

30. Nursing Diversity in Nebraska

31. Men in Nursing NE (2014)

32. Leadership Team 40 under 40 Nurses Mentors Champion Employers 10% increase nurses on boards

33. Promote Nurse Leadership Nurses bring a unique perspective to management and policy discussions. Nurses spend the most time with people receiving health services. Nurses are the largest segment of the health care work force. Nurses are vital to improving quality. Yet nurses account for only 6 percent of hospital board positions.

34. 2020: 10,000 nurses on boards NATIONAL INITIATIVE Innovate Collaborative Well honed listening/interview skills Recognize need for interprofessional roles Effective team member Patient advocate Strive for honesty, transparency, & integrity Value connection between community & healthcare

35. Agreement by 75% of NANDD members to implement the statewide seamless competency- based progression model and format for awarding credit RNs age 20-50 with a BSN will increase by 10%; diverse BSN students and RNs to increase by 2%; males 5% Add 8 mentor/mentee pairs (2 from each region) and 2 of which must be diverse Active participation in a leadership development program by 10% of the 40 under 40 honorees. SIP III Grant Deliverables

36. Held Stakeholder’s Breakfasts across state last 2 years. Culture of Health Summit statewide Oct 15 &16 in Omaha, Lincoln, Kearney, Norfolk, & Scottsbluff Collaborative legislative win for nurse practitioners Denver Rural Health Conference for RWJF grantees – July 2015 NAC & Rural Health

37. If we’re not at the table we’re on the menu … Nurses most trusted profession for over a decade. (Gallup, 2014) Opinion health leaders note barriers to nurses’ increased influence & leadership Not perceived as important decision makers Not revenue generators (directly) Don’t have single voice on national issues Solution: Nurses need to “Lean In”

38. Power of Coalitions The power of coalitions lies in their ability to bring people together from diverse perspectives around clearly defined purposes to achieve common goals. Strength lies in numbers – in working together and strategizing for success. Like us Mason, et al.

39. Robert Wood Johnson Foundation* Visiting Nurses Association* HDR Architecture, Inc* Immanuel* Saint Elizabeth Regional Medical Center* Nebraska Hospital Association Nebraska Medicine* St. Francis Medical Center – Grand Island* Good Samaritan Hospital – Kearney*NONL* and NONL District III University of Nebraska College of Nursing* Executive Committee of NAC* Creighton University College of Nursing* Alegent – Creighton Health Aureus Medical, affl of C&A Industries* NE Assembly of Nursing Deans and Directors* Great Plains Medical Center – North Platte Methodist Hospital* Nebraska Nurses Association*Columbus Community Hospital* Nebraska Association of Nurse Anesthetists* Nebraska Nurse Practitioners* Clarkson College* Community Hospital – McCook* Nebraska Emergency Nurses AssociationDonor-members of NAC* AARP-Nebraska Chapter* Equitable Bank Foundation –Grand Island* Nebraska Nurse Midwives NNA District 2 NE League for Nursing* AWHONN Heartland Gerontological Nurse Assc* Nebraska Methodist College Five Points State Bank – G.I. American Psychiatric Nurses Assc (NE) AORNNebraska School Nurse Association DHHS Office of Rural Health *Repeat donors

40. http://www.neactioncoalition.org Please join us in this important work! For more information, contact: Victoria Vinton, MSN, RN Director, Nebraska Action Coalition Call: 402.830.7769 Email: info@neactioncoalition.orginfo@neactioncoalition.org

41. References Blegen, M., Good, C., Park, S., Vaughn, T., & Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. Journal of Nursing Administration, 43(2): 89-94. Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573-576. Campaign for Action http://campaignforaction.org/directory-of-resources/increasing-diversity retrieved April 6, 2015.Campaign for Action http://campaignforaction.org/directory-of-resources/increasing-diversity Enhancing Diversity in the Workforce (2014). http://www.aacn.nche.edu/media-relations/diversityFS.pdfhttp://www.aacn.nche.edu/media-relations/diversityFS.pdf http://www.nga.org/files/live/sites/NGA/home/nga-center-for-best-practices/col2-content/list-center- bottom/top-downloads/the-role-of-nurse-practitioners@/1212NursePractitionersPaper.pdf http://www.nga.org/files/live/sites/NGA/home/nga-center-for-best-practices/col2-content/list-center- bottom/top-downloads/the-role-of-nurse-practitioners@/1212NursePractitionersPaper.pdf IOM (Institute of Medicine). 2010 The Future of Nursing: Leading Change, Advancing Health. Washington D.C. The National Academies Press. Joynt, K., Orav, E.J., & Jha, A. Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non-Critical Access Hospitals, 2002-2010. JAMA. 2013; 309(13):1379-1387. Khoury, C.M. and Blizzard, R. (2011). Nursing leadership from bedside to boardroom: A Gallup national survey of opinion leaders. JONA, 41 (7/8), 299-305. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2011). Policy & politics for nursing and health care (6th ed.). St. Louis, MO: Elsevier Saunders. (p. 626). Newhouse, R.P., et al. A Phased Cluster-randomized Trial of Rural Hospitals Testing a Quality Collaborative to Improve Heart Failure Care: Organizational Context Matters. (2013). Medical Care, 51(5): 396-403. Pribil, L. (2009). Engaging Nurses in Governing Hospital and Health Systems. Journal of Nursing Care Quality 24(1):5-9. RWJF. (2014). Building a Culture of Health http://www.rwjf.org/en/about-rwjf/annual-reports/presidents- message-2014.htmlhttp://www.rwjf.org/en/about-rwjf/annual-reports/presidents- message-2014.html Sandberg, S. (2013). Lean In: Women, Work and the Will to Lead. Alfred A. Knopf, New York.