The Future of Nursing Report Implications for Iowa Ann Williamson, PhD, RN, NEA-BC Associate VP for Nursing & Chief Nursing Officer Rita Frantz, PhD, RN, FAAN Dean, College of Nursing April 21, 2011

The Report Commissioned by the Robert Wood Johnson (RWJ) Foundation’s initiative on the future of nursing at the Institute of Medicine Released in hard copy January 2011

The Commission 18 members (5 intergenerational nurses) with expertise in: Public health Nursing Federal & state administration Hospital & health plan administration Business administration Health information & technology Health services research Health policy Workforce research & policy Economics Health care consumer perspective

Background and Context The committee was tasked with producing a report that was: an action-oriented blueprint for the future of nursing including changes needed in public and institutional policies at the national, state, and local levels Study process 5 committee meetings 3 public workshops 3 public forums Literature review 5 commissioned papers RWJF Nursing research network Interviews with nurses for case studies and nurse profiles

Background and Context With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act. Legislation enacted will provide insurance coverage to health care for 32 million more Americans; the implications of this new demand on the nation’s health care system are significant.

Vision The committee envisioned a future system that makes quality care accessible to the diverse populations of the United States, intentionally promotes wellness and disease prevention, reliably improves health outcomes, and provides compassionate care across the lifespan. In this envisioned future, primary care and prevention are central drivers of the health care system.

Vision

Inter-professional collaboration and coordination are the norm. Vision Inter-professional collaboration and coordination are the norm. Payment for health care services rewards value, not volume of services, and quality care is provided at a price that is affordable for both individuals and society. The rate of growth of health care expenditures slows. In all these areas, the health care system consistently demonstrates that it is responsive to individuals’ needs and desires through the delivery of truly patient- centered care.

Nurse’s Role in this Vision Nurses are at the front lines in ensuring that care is delivered safely, effectively, and compassionately. Because of their regular, close proximity to patients and their scientific understanding of care processes, nurses have a considerable opportunity to act as full partners with other health professionals and to lead in the improvement and redesign of the health care system and its practice environment. Nurses across the continuum of care have made significant contributions to improving the health of our nation... …We can do more!

Key Messages Recommendations The Report Key Messages Recommendations

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Implementation Strategy Regional Access Coalitions Must be co-led Five lead states named, but more to follow and not to deter other actions from moving ahead:  

Implementation Strategy

Education of Nurses in Iowa UIHC Demographics Compared to Magnet Hospitals and AMCs Education of Nurses in Iowa 2008 2010 UIHC Magnet Academic Mean Age 43 42 % Female 92% 93% 91% % White 97% 96% 79% 84% 71% BS 53% 54% 50% 51% 55% 52% MS/PhD 4% 6% 5% 7% Certification 16% 17% 24% 21% 22%

Nurse Residency We participate in: The University HealthSystem Consortium (UHC) and American Association of Colleges of Nursing (AACN) Nurse Residency program. Developed by representatives of the nation's leading academic medical centers and their affiliated schools of nursing, is a one year post-baccalaureate program designed to ease the transition to practice for new graduate nurses. In the first 3 years, UHC/AACN Nurse Residency Program™ hospitals experienced an aggregate turnover rate of only 5.6%, compared to the national average of 27.1%.

Future of Nursing To ensure the delivery of safe, patient-centered care across settings, an improved nursing education system is critical. To respond to changing patient needs and an evolving health care systems, nurses must achieve higher levels of education and training. Education should include opportunities for seamless transition into higher degree programs. 24

Education of Nurses in Iowa Educational Level* BSN 25% in Iowa 50% nationally Masters in Nursing 4.3% Doctoral Degree 0.6% * IBON, 2008-2009

Education of Nurses in Iowa New Graduates* BSN = 31% ADN = 69% RN to BSN† 21% (nationally) * IBON, 2008-2009 † HRSA, 2006

Strategies to Achieve Goal Seamless transition to advancing education of RNs Partnerships between community colleges and 4-year colleges/universities to share standard, competency-based curriculum for BSN Curricular models for BSN to doctorate to enhance efficiency of graduate preparation Increased access to education through distance technologies & simulation Build the case for advanced education among RNs Transformed roles for nurses in 21st century Increased complexity of patients Broader range of competencies required for practice

Build partnerships with key stakeholders Action Steps at Iowa Build partnerships with key stakeholders Nurse educators across all program levels Build collaborative programs Schools of nursing & practice partners Create dedicated education units Experienced clinicians become clinical instructors Focus on competencies rather than subspecialties Build the case with consumers Media campaign focused on outcomes for patients

Health Care Transformed 21st Century = “new world” in health care Unparalleled opportunity for nursing to play strategic role in designing & implementing a more effective & efficient health care system Time is NOW to innovate, change, transform nursing

Questions to ponder – strategies to imagine: What are the barriers/impediments to progression from RN to BSN? What are the difficulties that you see new graduates have in transition into practice? What are the impediments that RNs have to being full-partners in health care at UI?

Questions? Other alternatives?