Future of Nursing: Campaign for Action Kansas Public Health Association September 21, 2011 Shirley Orr, MHS, ARNP, NEA-BC

Health Care System Challenges Fragmentation Health care disparities Aging and sicker population Primary care shortage High costs

Fragmentation Lack of integration among providers System rewards volume, not value Result: lower-quality care and higher costs

Health Care Disparities Get fewer routine procedures Receive poorer care Die younger Racial and ethnic minorities

Aging and Sicker Population Life expectancy rising Baby boomers aging Chronic diseases increasing

Primary Care Shortage Rural and low-income areas particularly affected Fewer physicians entering primary care 32 million more people to get health insurance in 2014

High Costs Health care costs unsustainable Federal budget deficits affected Wages stagnating

RWJFs Commitment to Improving Care RWJF mission: to improve health and health care for all Americans Need to address challenges facing nursing to address challenges facing our health system

IOM Report High-quality, patient- centered health care for all will require a transformation of the health care delivery system

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

Campaign for Action EducationPractice Collaboration LeadershipData Campaign for Action

Education Increase to 80 percent the proportion of nurses with BSN by 2020 Double number of nurses with doctorate by 2020 Implement nurse residency programsPromote lifelong learning

Education Evidence –Significant association between educational level and patient outcomes –6 percent of AD grads get advanced degree, enabling them to teach and serve as PCPs, compared to 20 percent of BSN grads

Practice All practitioners should practice to full extent of their education and training Optimal care –Physicians, nurses and other health professionals work in team-based model of care delivery –Models of care maximize time that providers can spend on their respective roles and responsibilities to patients

Practice Evidence: More than 10 studies show equivalent patient outcomes when care is provided by APRN or MD for certain services –Includes two Cochrane reviews –Randomized clinical trial published in JAMA –Office of Technology Assessment No studies show care is better in states that do not allow APRNs to practice to full extent of education and training

Practice

Collaboration Integrated, collaborative, patient-centered health care teams Foster interprofessional education, training and practice

Leadership Nurses bring important viewpoint to management and policy discussions Prepare more nurses to help lead improvements in health care quality, safety, access and value

Leadership Gallup survey of 1,500 opinion leaders* said nurses should have more: –Influence in reducing medical errors, increasing quality of care, promoting wellness –Input and impact in planning, policy development and management * RWJF, 2010

Nurse Leaders in the Boardroom Survey of 1,000 U.S. hospitals* found: –Nurses account for only 6 percent of board members –Physicians are 20 percent of board members –Other clinicians are 5 percent of board members * American Hospital Association, 2011

Data Improve health care workforce data collection to better assess and project workforce requirements –Research on health care workforce is fragmented –Need data on all health professions

Diversity Nurses should reflect patient population in terms of gender, race and ethnicity All nurses should provide culturally competent care Increase workforce diversity

RWJF AARP Advisory Committee Diverse Stakeholders Policy-makersAction CoalitionsCommunicationsGrantmaking Research, Monitoring, Evaluation Campaign Strategies

Strategic Advisory Committee Members Judy Ann Bigby, MD, Massachusetts Secretary of HHS Sheila Burke, RN, (Chair), Harvard Kennedy School of Government Linda Burnes Bolton, RN, CNO, Cedars Sinai Medical Center Lloyd Dean, CEO, Catholic Healthcare West Christina Esperat, RN, Associate Dean, Texas Tech University Chip Kahn, President, Federation of American Hospitals Darrell Kirch, MD, CEO, American Association of Medical Colleges Alan Morgan, CEO, National Rural Health Association Debra Ness, President, National Partnership for Women and Families Bill Novelli, Professor, Georgetown University School of Business Jack Rowe, MD, Professor, Columbia University Antonia Villarruel, RN, Associate Dean, University of Michigan School of Nursing Phyllis Wise, PhD, Interim President, University of Washington

Campaign for Action RWJF/AARP seeking support from: health professions payers consumers business policy-makers philanthropies educators hospitals and health systems public health agencies Nursing must be considered societal issue!

Examples OrganizationCommitment National Hispanic Medical Association Working with members on initiative to improve interdisciplinary education Consumers Advancing Patient Safety Challenged nursing members to identify and place a nurse on their board Convenient Care Association Working with national members who have community partners to increase Coalition involvement Leapfrog Group Encouraging hospitals to achieve magnet status Target Promised to engage its clinical nurses in leadership positions and opportunities

RWJF Grantmaking Examples Leadership Executive Nurse Fellows Nurse Faculty Scholars Education New Careers in Nursing Evaluating Innovations in Nursing Collaboration Alumni Network Summer Medical, Dental Education Program

New Investment Area The Future of Public Health Nursing PHN Workforce Enumeration State of Public Health Nursing Summit Exploration of New Models for Education--Pilots LinksScope and Standards of PHN Practice; PHN Core Competencies

Campaign for Action Long-term alliances Field strategy to move key nursing issues forward at local, state and national levels Expect to be in all states by end of 2012 Capture best practices, networking Action Coalitions To become part of a coalition, go to:

Map Legend Action Coalition State State Involvement Campaign for Action State Involvement OR WA ID MT WY NV CA UT AZ CO NM ND SD NE KS OK TX MN IA MO AR LA WI IL IN MI OH KY TN MSAL FL GA SC NC VAWV PA MD DE NY DC CT RI MA VT NH ME AK HI NJ UPDATED:

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