IOM Future of Nursing: Leading Change, Improving Health Ready or Not? Lucy Marion, PhD, RN Dean, GRU College of Nursing MIF Meeting June Lee Auditorium

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GRU College of Nursing Consolidated GHSU and ASU faculty, students and staff associates in January Teaching out 2 BSN curricula; starting a new one Maintaining total new BSN enrollment numbers (~190 new students/year, including 40 in Athens) Educational Programs: BSN, MSN/CNL, DNP, PhD Clinical Specialties: FNP, PNP, NAP, MHNP, ACNP Faculty practice: primary care, occupational health, mental health, and clinical/health systems research Research: basic science, translational, and community participatory interventions

Academic-Practice Partnership  GRMC provides to the CON: (THANK YOU!)  Clinical learning experiences for our students  Clinical faculty (donated and contracted)  Research facilitation, support, collaboration  Scholarships; preceptors; mentoring  CON provides GRMC  Student impacts and new graduates: all levels  Educational programs for employed nurses  Consultants: research, continuity of care models  Community contacts and benefits

CON Growth: Student Enrollment *Projected Fall 2013, 788 students

The Future of Nursing: Leading Change, Advancing Health Prepared by the Institute of Medicine in 2010 Funded by Robert Wood Johnson Foundation Advocated by AARP Future of Nursing Summit in ATL – President Azziz presented: leadership Georgia Nursing Leadership Coalition formed GRMC featured for nurse residency program

IOM Report 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.

IOM Report Key Messages Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

1. Remove scope-of-practice barriers. Why?  Increase productivity of healthcare delivery GRU College of Nursing (CON) response:  All CON students prepared to practice to the boundaries of legal scope of practice  Advanced Practice Nurses prepared at national scope and standards; informed of state and institutional restrictions  DNP APRNs increasingly prepared as independent clinicians, i.e., competent to practice in solo sites with telemed and other tech and specialty supports  Faculty and students educated to advocate for full scope for all professionals.

2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Why?  Innovations for better patient and cost outcomes  Interprofessional collaboration for broad perspectives, including nursing CON response:  Practice change projects required for each student in clinical programs  Interprofessional teams for all current CON research  Service on non-CON research and practice teams

Leading into the Future Healthcare Coordination: Essence of Quality Community mobilization: Maximize health information exchanges (HIE) Self care centers – advancing people capacity Health Tracking – using smart phone apps Monitoring and coaching – chronic conditions Mobile Health Care - linking rural communities to essential care: use of eICU model of support

3. Implement nurse residency programs. Why?  Relatively short nursing programs. Need transition-to-practice program (nurse residency) for new prelicensure or advanced practice nurses and experienced nurses when entering new clinical area s.  Safety, quality in patient care CON response  Support GRMC residency as academic partner  Provide statewide plan and consultation

4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by Why?  Better patient outcomes, community health and continuing care perspective, leadership development College of Nursing response:  Completion programs for RNs  RN to BSN  RN to Clinical Nurse Leader (CNL)  Contract with health systems to create tailored, hybrid on-line and mentoring program for groups  Foster use of statewide articulation plan

5. Double the number of nurses with a doctorate by Why?  Need for higher level knowledge and skills for leading complex, changing patient care and health systems  Demand for faculty, advanced practice nurse providers, administrators, and researchers CON response:  Opened Doctorate of Nursing Practice Program in 2005; 110 graduates, ½ faculty  Transitioning PhD program to be hybrid on-line

National Enrollments DNP & PhD Programs Source: AACN databases, ©

6. Ensure that nurses engage in lifelong learning. Why?  Maintain relevance in rapidly-changing evidence- based care and systems to improve patient outcomes CON response:  Advanced practice post master’s certificates  Planning CE initiative  RN to BSN and CNL programs  BSN to DNP and PhD  On line programs

7. Prepare and enable nurses to lead change to advance health. Why?  To capitalize on high-knowledge technologists with leadership education and experience for best outcomes  Nurses proven as effective CEO, COO, as well as CNO College of Nursing response:  Leadership training and practice for all degree students, faculty, and staff associates  Considering Executive DNP in partnership with Hull College of Business

DNP/CNL Evidence-based Projects  DNP Projects  Validating a Re-Admission Risk Assessment Tool  Nurse Residency Program Outcomes: The New Graduate Nurse Experience  Impact of an Affordable Care Clinic on Emergent Transports to Local Emergency Departments  CNL Projects  Guided Family Presence During a Code Blue  Establishment of a Retention & Recruitment Policy for Emory 2D-ICU  Communication Between Staff Nurses, Respiratory Therapists and Techniquest

8. Build an infrastructure for the collection and analysis of inter-professional health care workforce data  Data sources are woefully inadequate  No statewide master planning for nursing workforce  CON sustains the CSRA Nursing Workforce Task Force—very difficult to collect data across employers (GRMC one of best!).

Historic Concerns with RN workforce By early 2000s federal estimates indicated existing and growing shortages of RNs – Georgia RN workforce ranked 40 th in nation in 2000 – Estimates indicated pending shortages approaching 40,000 RNs by 2020 – Shortages equaled: 3,400 as of ,700 by 2020

How the USG Responded Georgia’s new RN programs have increased productivity – GA programs graduated 2,206 pre-licensure RNs – GA programs graduated 3,366 pre-licensure RNs – This represents an increase of over 1,100 (50%) in six year period – Note - data on graduates from private sector programs is estimated for 2012 based on productivity in previous years

Has the USG Met GA Need? Based on Georgia DOL data, Georgia is now educating sufficient numbers of new RNs – Georgia RN programs graduated approx. 3,700 new RNs in FY12 – Georgia must fill 3,330 openings per year Are Georgia RN programs overproducing? Probably not. – DOL estimates are somewhat conservative – Measure employer demand for labor not population needs – Not all graduates will secure needed licensing and not all will work full time – Aging of current RN workforce – Impacts of graduates of private sector programs may be overstated – RN-BSN count is mixed with new RNs

Ready, or Not? Does the CON prepare/provide and does GRMC promote  Full scope of practice for all levels of nurses/other professionals?  Higher levels of functioning by nurses through quality, seamless education and positioning?  Full partnerships with other health care professionals in healthcare redesign?  Effective nursing workforce planning for the MC and beyond to the larger HS?

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Thank you. Questions and comments to