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Julie Thomas, DNP, RN, CPHQ, NEA-BCCo-Chair North Texas Regional Coalition-Texas Team
Texas Team: Advancing Health through Nursing
Objectives
• Describe how to become involved in efforts to advance the Future of Nursing
• Develop grassroots methods for spreading the Campaign for Action at participant’s organization
• Demonstrate increased awareness of current and planned initiatives to support the nursing and its impact on the Health of Texans
The Time is Right !
• IOM Reports• Health Care Reform-Affordable Care Act• Primary Care Shortages• Value-Based Purchasing• Increased focus on Research and Evidence-based
Care• National Initiatives on Quality and Safety• Care Coordination
The 8 Recommendations1. Remove scope of practice barriers.2. Expand opportunities to lead collaborative improvement
efforts.3. Implement nurse residency programs.4. Increase the proportion of nurses with BSN to 80% by 2020.5. Double the number of nurses with doctorate degrees by
2020.6. Ensure that nurses engage in life-long learning.7. Prepare nurses to lead change.8. Build an infrastructure for the collection and analysis of
workforce data.
First Things First: Getting Out the Message
• Frontline Staff-What’s in it for me?– Over 500 page report from nurses-over 2 years of work– Transform Care Delivery– Platform that supports nursing’s commitment to Patient
Care• Coalition Efforts-Website updates• Staff Newsletters • Ties to Strategic Initiatives-Vision • Staff Forums and Community Presentations
Vision 2015-A Sample
Engage and support recommendations for RWJF/IOM Future of Nursing
Remove Scope of Practice Barriers
• Advance use of CNS-driven, population-focused programs, e.g. Stroke and Trauma Certifications
• Expand role of Unit Secretaries to Health Unit Coordinators
Nurses to lead and diffuse collaborative improvement efforts
• Continue to improve nurse-to-physician relations as evidenced by increased
collaboration/participation of physicians on key house wide initiatives
• Open and sustain advances in throughput with a Clinical Decision Unit
Bridge the gap from academia and practice
• Build and sustain a mentoring program for new graduates based on Professional Practice
Model and Magnet® Model
Increase BSN rate to 80% house wide by 2015
Vision 2015-A Sample
Engage and support recommendations for RWJF/IOM Future of Nursing
Prepare nurses to lead change• Advance number of certified nurses to 50%
Double the number of doctorate prepared nurse
Embrace Evidence-Based Practice and Research
Each unit will engage in 1 EBP/Research Study
Enhance a culture of excellence by achieving key performance milestones that
affect quality and safety
Nurse sensitive metrics will continually improve and outperform national
benchmarks:• Fall prevention program promoting efforts to exceed NDNQI 25th percentile for number of falls per
1000 patient days
• Sustain and/decrease current rate of HAPU, CAUTI, CLBSI
Removing Scope of Practice Barriers
• Advanced Practice Nurses– Perryman Report fully supports the IOM stance that APN increase
access, safety and continuity of care– Average cost of NP visit is 20-35% lower than the average cost of
a physician office visit (MEPS)– No difference in malpractice rates among states
• National Council of State Boards of Nursing
Removing Barriers
• Examining Our Practice-Remember it’s not just APNs…– What you or your colleagues doing that does not require
your RN skill set?– What you or your colleagues not doing that we are great at
doing?• Care Coordination
• Working with State and Federal Regulatory bodies– National Council of State Boards of Nursing
• Transition to Practice
– Texas Medical Association– Peers In Practice
Removing Barriers
• Great Work Being Done!– California Study of Regulations– RWJF-Transforming Care at the Bedside
• Ways to Expand– Health Care Policy-Duty– Informatics– Customer Service-Advocacy– Certification– Education or Academic Partnerships
Collaboration
• Meeting the Challenge to Improve the Care– Our ethical code requires it-Provision 8 “the nurse collaborates…”– Engaging those with similar goals
• Transforming Care at the Bedside• Community Transition Programs• Medical Services/Ambulances• Geriatric
– NICHE
Interprofessional Collaboration
• IHI Triple AIM – Decrease Cost– Increase Satisfaction or the “patient experience”– Improve the overall health of the population
• Community partnerships-Community Health Action Team• HCAHPS questions
• Care Coordination/Transition of Care– Clinical Nurse Leader
• Partnership-Avoid “acute care centric”– Social Services, Pharmacists, Physicians, Home Care, LTC
Nurse Residency Programs
• Not just a “product you purchase”– Advantages of formalized program
• Data/recruiting
• Not Just About Student Placement– Henry Street Project-Public Health
• It’s a Partnership!– AACN/AONE Guiding Principles for Practice-Academic Partnerships
1. Develop Formal Relationships – Advisory committees– Fellowship programs to advance EBP
2. Shared Visions/Mutual Goals– Dedicated Education Units– Externships
Nurse Residency Programs
• Why We Need– Increase recruitment and retention– Decrease cost for orientation and training
• Internships- “not just 15 weeks”– Mentorships– Journey to Professionalism– Teaching to ANA Standards of Care– ANA Code of Ethics
• Get Involved– Preceptor/Clinical Coach
Increase the Number of BSN Nurses
• What does this mean and why?– Managing complexity– Advancing EBP/Research– Lower mortality and failure to rescue rates
• Doesn’t mean forget about the ADNs– Pipeline for BSN enrollees– Often best option for minorities or low-income
• Student Experience– Clinical Placement software– Other opportunities/Other industries
Ways to Communicate
• Presbyterian Hospital of Dallas– Strategic Vision
• Academic Partnerships• Recruitment and Retention• Funding and Encouragement
= Success! An increase of 12% in 1 year to 67% rate of BSNs
• Seton– Long-term strategy with Leadership Established Guiding
Principles• Increase BSN hire rate• Increase Nursing retention rates• Increase number of non-BSN nurses returning to school
Call to Action to Universities, Colleges and Hospital Systems• The Doctor of Philosophy
– Leads Research Efforts
• The Doctor of Nursing Practice– Translation and Promotion of Research into Practices– Clinical Specialist
Double Doctoral Prepared Nurses
• Advance Education• Certification in area of Specialty• Attend Conferences• Share locally
Life-long Learning
Prepare Nurses to Lead Change
• TONE/TNA-Improving EHR Education-HIT• Nurses Members of Boards-Not just hospitals• Boardroom presentations on Micro-level changes
– Opinion Polls conducted by RWJF show many believe nurses should have more influence on improving quality of care and preventing errors
• Lean Methodology• Support Shared Decision-Making
Summary
• Keep Texans First• Know your power but more importantly your responsibility• Use Your Resources• Know the Issues• Get Involved
– Are you the Carrot, the egg or the coffee??