Future of Nursing Leading Change, Advancing Health Title of Slide has a box to insert the appropriate aduience

3.2 million 100,000 30,000 This is used to hook the audience. There are 3.2 million nurses in the US. If we could all have a collective voice can you imagine what we could do. We are the largest profession in the healthcare field. There are 100,000 nurses in VA There will be a shortage of 30,000 nurses by 2020 if we continue to prepare at the rate that we do today based on increased demand with the greying (aging) tsunami and the increased number of insured by the Affordable Care Act.

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

IOM Future of Nursing Campaign for Action The Institute of medicine Future of Nursing was released in October of 2010. It is the best body of evidence that we have on nursing and the future. It is 500 pages but has a very good executive summary that is 13 pages. It can also be downloaded from the IOM site or the RWJF site.

IOM Future of Nursing Committee on The Robert Wood Johnson Foundation Initiative on the Future of Nursing Membership Opportunity to transform health care system Provide seamless, affordable, quality care Nursing profession is the largest segment of the health care workforce How did it all get started. The RWJF spearheaded by Dr. Susan Hasmiller partnered with the Institute of Medicine to form a committee to investigate and make recommendations about the future of nursing. The membership consisted of Chair Dr. Donna Shalala former Secretary of Health and Human Services who is not Dean at the University of Florida. Dr. Linda-Burnes Bolton CNO of Cedar Sinai was the nurse who was most influential on the committee. There were only 3 nurses and all other members were physicians, economist, lawyers and other business representatives. The committee looked at this as an opportunity to transform healthcare and provide seamless affordable quality care since nursing as has been said is the largest segment of the health care workforce and we have been voted by the Gallup Poll on the most ethical and honest professions in the top for 13 consecutive years except for 911 when the Firefighters were number 1 and we were number 2.

Campaign for Action: Key Messages Leadership Access to Care Workforce Data Education Interprofessional Collaboration High-quality patient centered care There are 4 key messages in the IOM FON report and one thread that runs through. The four key messages are education, leadership, access to care and workforce data. The thread is interprofessional collaboration. And what we all know it takes a team to care for patients not just one profession can do it all.

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

Future of Nursing Recommendations 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 These are the 8 recommendations and they are defined under each as to what can be done at the federal level, the state level and the regional or local level…review

Campaign for Action 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.

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

AARP Virginia Virginia Nurses Association

Virginia Action Coalition Co-Leads AARP Virginia David DeBiasi , RN, Associate State Director – Advocacy VNA Shirley Gibson, DNP, MSHA, RN, FACHE, President Janet Wall, CEO Each AC has to have a nursing lead and a non nursing lead. We had a great partnership and relationship with AARP and when they agreed to partner with us on the AC we were thrilled. David DeBiasi is wonderful to work with and he just happens to also be a BSN prepared nurse.

Virginia Action Coalition Goals Nurses should practice to the full extent of their education and training Nurses should achieve higher levels of education and training through an improved educational system that promotes academic progress and explore residency programs Nurses should be full partners, with all members of the healthcare team in redesigning healthcare Nurses should develop strategies to ensure that nursing is skilled to provide leadership at all levels Nurses should ensure effective workforce planning and policy making require better data collection and an improved information infrastructure When we wrote our grant to become an AC these were the 5 goals we set out. Review.

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

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

Virginia Action Coalition Workgroups In order to get our work done we have developed workgroups who meet on a monthly basis generally by conference calls.

VAC Leadership Lindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RN Co-Leads 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

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

Outcomes Networking and educational event for the nurses identified as 40 under 40 Recognized at VNF Gala - 2011 Mentoring event – May 31, 2012 Collaboration with: VONEL VNA VNF

Outcomes Survey to determine boards nurses are serving – regional, state and national Survey also identified those wanting to serve on boards 334 Surveys completed 118 Experienced Nurse Board Leaders 181 Virginia Registered Nurses are future board leaders! Video : Value of having a nurse serve on hospital board http://www.youtube.com/watch?v=MXwo0m8MLa0

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

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

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

Next Steps Survey hospitals to find boards where nurses serve Develop a video campaign value of nurse on 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 Leadership Development Conference for nurses who want to serve on boards

VAC Access To Care Cindy Fagan, RN, MSN, FNP-BC Kathy Baker, RN, PhD, NE-BC Co-Leads 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

Outcomes House Bill 346 passed and signed by Governor Eliminates supervisory language Emphasized collaboration and consultation between NPs (LNP & CNMs) and physicians to practice in teams Increased from 4 to 6 number of APRNs physicians can collaborate with Joint Boards of Nursing and Medicine have 280 days from July 1 to develop regulations HB 346 manifested in 2013

Outcomes APRN Video has been completed

Next Steps Continue education of the public about the APRN scope of practice Conduct a gap analysis with all nurse practitioner roles in respect to the National Council of State Boards of Nursing Consensus Model Meet with the Board of Nursing to review the NCSBN Consensus Model Consider legislation to remove the Joint Board and establish an Advisory Group for oversight

Next Steps 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 Nurses from select hospitals in the state of Virginia will be invited to participate. Nurses will purposively be selected to participate in a one hour focus. The nurses selected to participate should have worked on their current unit for the period of at least one year. The staff nurses selected should consist of at least one nurse from critical care, one from the general and/or intermediate care areas, and one from the Emergency Department. In addition, the staff nurses chosen should consist of at least one nurse who primarily works day shift and one nurse who primarily works night shift. If possible, the staff nurses chosen should represent a range of experience levels. In addition Nurse Practitioners from select hospital in the state of Virginia will be invited to participate in a separate one hour focus group. Each staff RN, each NP and each CNO from participating hospitals will be asked to complete a demographic questionnaire in order to provide descriptive statistics for all of the participating hospitals and participants. The study investigators will conduct independent focus groups at each hospital using a semi-structured interview technique (See appendix A for interview questions). Informed consent will be obtained from each study participant prior to the initiation of the interviews.

Deb Zimmermann, DNP, RN, NEA-BC, Amy Gillespie, RN, MSN, EdD Co-leads Education Progression Deb Zimmermann, DNP, RN, NEA-BC, Amy Gillespie, RN, MSN, EdD Co-leads

VAC Education Progression 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

Future of Nursing Education The Challenge 50% of VA RNs BS prepared 32% of AD graduates attain BSN 31% of Diploma graduates attain BSN

Outcomes Regional Groups Eastern, Central, Northwest, North and Southwest Inspiration to Aspiration Interviews with nursing programs RN-BSN Guide Survey of RN-BSN students Video of students http://youtu.be/iT0ygHn4CYg Academic Progression Models Two statewide conferences with stakeholders Shared models

Outcomes Community College statewide forum Vice Chancellor of the Community College System Forecasting Model Policies regarding returning to school 2 years to enroll, 5 years to complete Hiring BSN CNO Survey Tuition Assistance and scholarships Flexible schedules and weekend programs

Outcomes Virginia Association Colleges of Nursing Meeting held Awarded SIP Grant from RWJF Supported Community Colleges continuing the work of collaboration for curriculum development Provide support in policy development for education progression Held Academic Progression Summit – March 28, 2014

Workforce Data Objective Nina Beaman, PhD, MS, RN-BC (PMH), RNC-AWHC and Richardean Benjamin, PhD, MSN, MPH, RN Co-Leads Improve data collection and information infrastructure Develop and implement specific geographical demand models for nursing and other health professionals

Next Steps Identify pilots for academic progression Models from Campaign for Action Develop mechanisms to track organizational progress for education progression

Outcomes WHITE PAPER Completed comprehensive white paper- Addressing Nursing Workforce Issues in the Commonwealth of Virginia Finalized Distributed

Outcomes Continue participation on DHP Healthcare Workforce Data Center Participation and dissemination of information from the VA Workforce Development Authority to inform AC workgroups VHHA Workforce Development

Next Steps Serve as data experts to other workgroups Assist VAC with compiling necessary statistics for any grant proposals

VAC Interdisciplinary Team-Based Care Patti McCue, ScD VAC Interdisciplinary Team-Based Care Patti McCue, ScD., RN, MSN, NEA-BC Bonnie Barndt-Maglio, PhD, RN Co-Leads 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 Sallie/Patti

Outcomes Physician Foundation Grant Expanded leadership program with MSV Recruited 20 teams of physicians, nurses and other health professions Completed Evolve Team Based Education New partnership with VHHA/MSV/VAC

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

Engage! www.virginianurses.com sgibson@mcvh-vcu.edu