Nebraska Hospital Association May 15, 2013 Linda Lazure Rosanna Morris Marilyn Valerio Victoria Vinton

Committee Charge: To examine the capacity of the nursing workforce to meet the demands of a reformed health care and public health system I ns titute of Medicine Report

IOM Recommendations: A Blue Print for Action Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Recommendation 3: Implement nurse residency programs. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.

IOM Recommendations (cont.) Recommendation 5: Double the number of nurses with a doctorate by 2020 Recommendation 6: Ensure that nurses engage in lifelong learning Recommendation 7: Prepare and enable nurses to lead change to advance health. Recommendation 8: Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

Action Coalitions (ACs) are the driving force of the Future of Nursing: Campaign for Action (CFA), national effort to implement the Institute of Medicine’s (IOM) recommendations. The Campaign is a collaboration created by the Robert Wood Johnson Foundation (RWJF) and the AARP Foundation. The Campaign is building action at the local, state, and regional levels, to support a transformed health care workforce in which nurses contribute as essential partners in system-wide transformation. ACs will capture best practices, determine research needs, track lessons learned and identify replicable models. With assistance from the Center to Champion Nursing in America (CCNA) and RWJF, RACs are developing and implementing unique sets of regional goals and campaigns within the framework of the IOM recommendations.

Advancing Education Transformation Removing Barriers to Practice and Care Nursing Leadership DATA INTERPROFESSIONAL COLLABORATION DIVERSITY

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

Steering Committee formed November 2010 Identified lead partners: VNA/HDR Formal application submitted to the RWJF/ AARP to become a Regional Action Coalition Solicited up to $90, in funding Hired Director to coordinate & facilitate action plans NAC Formation

NAC Strategic Focus Preparation of nurses for the future Manage Care Transitions Improve access to care Improve patient outcomes Operationalize interdisciplinary team approach to care Formed three state-wide teams using IOM framework to develop tactics to achieve outcomes: Education, Practice, and Leadership

Prepare nurses to meet new challenges in health & health care. Increase the proportion of nurses with BSN and higher degrees. Increase the number of nurses with doctorates. Implement nurse residency programs. Advancing Education

IOM Action Steps NAC Update…. 1.Define academic pathways, promote seamless access for nurses to higher education. 2.Enable ADN and diploma RNs to obtain BSN by removing barriers. 3.Encourage health care organizations to identify and support incentives for advancing education.  Data collected from all 20 Nebraska schools of nursing in collaboration with NANDD.  Developing competency –based approach for seamless articulation – pilot fall 2013  SIP Grant awarded for $150K – focuses on seamless articulation, leadership development, & diversity.

Education Evidence Studies show association between higher nurse education level and improved health care outcomes. Evidence that higher proportions of BSN-prepared nurses associated with lower rates of medication errors, mortality, and failure to rescue. Research also shows that BSN-prepared nurses have stronger diagnostic skills and are better at evaluating interventions. A growing body of research shows a connection between baccalaureate education and lower mortality rates. Advancing Education

Enhance access to care through use of RNs, APRNs in primary, chronic & transitional care Utilize nurses to practice to full education & training Redesign the role of nursing specific to care coordination Advancing Nursing Practice

Build a diverse workforce to better reflect population served Utilize nurses in education and leadership to participate in healthcare redesign Prepare and enable nurses to lead change Coach and mentor nurses at all levels Prepare nurses to be active decision makers Advancing Leadership

Visiting Nurses Association HDR Architecture, Inc. Immanuel Communities Saint Elizabeth Regional Medical Center Nebraska Medical Center Alegent Health Great Plains Med Center – North Platte Good Samaritan Hospital – Kearney St. Francis Med Center – Grand Island Executive Committee of NAC NE Assembly of Nursing Deans & Directors Creighton University School of Nursing University of Nebraska College of Nursing Donor-members of NAC Nebraska Association of Nurse Anesthetists Nebraska Emergency Nurses Association Nebraska Nurses Association Nebraska Nurse Midwives Nebraska Nurse Practitioners NONL Community Hospital - McCook Methodist Hospital AWHONN NNA District 2 Nebraska Methodist College Clarkson College AARP-Nebraska Chapter Equitable Bank Foundation –Grand Island Five Points State Bank – Grand Island Heartland Gerontological Nurse Association NE School Nurse Association NE American Psychiatric Nurse Association Contributors

Endorsement –Partner with you and others to redesign healthcare in the state of Nebraska –Focus on access to care –Facilitate Care Transitions –Improve patient outcomes & the health of the public Financial Support The NAC- Future of Nursing Requests your Support

Please join us in this important work! For more information, contact: Victoria Vinton, MSN, RN Director, Nebraska Action Coalition Call:

References Aiken, L. et al., (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care 49: Benner, P. et al Educating Nurses: A Call for Radical Transformation. Jossey-Bass. Blegen, M., Good, C., Park, S., Vaughn, T., & Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. Journal of Nursing Administration, 43(2): Chen, L., Nguyen, A., Shaw-Sutherland, K. The Economic Impact of the Health Care Sector on Nebraska’s Economy, UNMC NE Center for Rural Health Research & NE Office of Rural Health, March, Cramer, M., Jones, K. J.(2011). Nurse Staffing in Critical Access Hospitals. Journal of Nursing Quality Care, DOI: /NCQ.0b013e318219d30a. IOM (Institute of Medicine) The Future of Nursing: Leading Change, Advancing Health. Washington D.C. The National Academies Press.

References Kutney-Lee, A., Sloane, D., & Aiken, L. H. An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Postsurgery Mortality. Health Affairs. 2013; 32 (3): Joynt, K., Orav, E.J., & Jha, A. Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non-Critical Access Hospitals, JAMA. 2013; 309(13): 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): Pew Research Center The Data Bank, retrieved September 3 pessimism pessimism