1. Landing the Flight: Bringing the 30,000 Foot View to the Bedside
Teresa L. Anderson
EdD, MSN, RNC-OB, NE-BC
President, Nebraska Nurses Association

2. Disclaimer
The speaker acknowledges the following affiliations but has no financial conflicts of interest related to the contents of this program:
President of the Nebraska Nurses Association
ANCC Magnet Program Consultant, the American Nurses Association, Silver Spring, Maryland
Chief Nursing Officer of Voalte, Inc., Sarasota, Florida

3. Objectives
Identify the trends affecting patient care in the United States today.
Discuss the potential impact of these programs on nursing policy and practice.
Describe the nursing
skill set of the future.

4. Trends and Manifestations
Affordable Care Act
Guaranteed issue and community rating (premiums/pre-existing)
Individual mandate (federal subsidies sliding scale)
Minimum health insurance policy standards
Health insurance exchanges
Medicaid expansion option
Employer shared responsibility
Elimination of the “co’s”
(co-pay, co-insurance, deductibles)
Fee-4-Service to “bundles” and
ACOs
President Obama signing the bill

5. Trends and Manifestations
Pay 4 Performance (aka P4P or Value- Based Purchasing)
Rewards for meeting pre-established targets for care delivery (quality and patient satisfaction (HCAHPS scores)
Disincentives - removal of payments for adverse “never” events
Foreign object unintentionally retained after surgery
Surgical site infection after bariatric, orthopedic, and bypass surgery
Vascular-catheter associated infection
Catheter-associated urinary tract infection
Administration of incompatible blood
Pressure ulcer stages III and IV
Falls with injury
Air embolism
Readmission within 30 days

6. Trends and Manifestations
Meaningful Use
Stage 1 Objective domains:
Improve Quality, Safety, Efficiency
Engage Patients & Families
Improve Care Coordination
Improve Public and Population Health
Ensure Privacy and Security for Personal Health Information
Stage 2 Objectives
Increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information

7. Meaningful Use Improve Quality, Safety, Efficiency
CPOE, Problem List, Patient List, Patient Reminders, Clinical Lab Test Results
e-Prescribing, Formulary Checks, Drug Interaction Checks, Active Medication & Medication Allergy List
Record demographics, VS, Smoking
CQMs & Clinical Decision Support
Engage Patients & Families
Clinical Summaries
Electronic Copy of Health Information
Patient Electronic Access
Pt- Specific Education Resources

8. Meaningful Use Improve Care Coordination
Electronic Exchange of Clinical Information
Medication Reconciliation
Transition of Care Summary
Improve Public and Population Health
Immunization Registries Data Submission
Syndromic Surveillance Data Submission
Ensure Privacy and Security for Personal Health Information
Protect Electronic Health Information

9. Trends and Manifestations
IOM, Future of Nursing
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 United States
Effective workforce planning and policy making require better data collection and an improved information infrastructure

10. Trends and Manifestations Magnet Recognition Program®
Transformational Leadership
Structural Empowerment
Exemplary Professional Practice
New Knowledge, Innovations, and Improvements
Empirical Outcomes
Global Issues in Nursing and Healthcare

11. Potential Impact
Financial
Provider
Consumer

12. Potential Impact Technical Costs in financial and human capital
Extension of the healthcare continuum
Chasing innovation

13. Potential Impact Social Communication
Confidentiality (includes social media)
Portability

14. Professional (includes advocacy)
Potential Impact
Professional (includes advocacy)
Policy and Practice

15. Professional Nursing Skill Set
BSN, MSN, and Beyond
Specialty certifications
Cross-training to a minimum of three areas
Multiple home-unit mind set

16. Professional Nursing Skill Set
Quality, EBP, and Research
Performance improvement methodologies
Quality toolkit
Global access to information

17. Professional Nursing Skill Set
Communication and Collaboration
Interprofessional collaborative education and training
Strong professional communication

18. Professional Nursing Skill Set
Professional involvement and advocacy
Professional organization membership and leadership
Partnerships and affiliations to support healthy communities
Understanding public policy from multiple viewpoints
Legislative advocacy

19. Professional Nursing Skill Set
Strategic and Tactical Management
Networking?
Social media?
Project management?

20. Excellence… begins AND ends with YOU!

21. Teresa (Terry) Anderson, EdD, MSN, RNC-OB, NE-BC
(home)
(cell)