IOM Future of Nursing:Leading Change, Improving Health

Ready or Not?

Lucy Marion, PhD, RNDean, GRU College of Nursing

MIF Meeting June 18. 2013

Lee Auditorium

Unity

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

2005 2006 2007 2008 2009 2010 2011 2012 2013*0

100

200

300

400

500

600

700

800

335 339 338 330 290236

183

162

361

104 134197 230

301375 404 396

427

Undergraduate Graduate

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 areas.

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 2020.

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 2020.

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 EnrollmentsDNP & PhD Programs 2003-2011

2003 2004 2005 2006 2007 2008 2009 2010 20110

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

70 170 329 862

1874

3415

5165

7037

9094

3,229 3,439 3,718 3,927 3,982 3,976 4,161 4,611

4,907

Doctorate of Nursing Practice (DNP) Research Focused Doctorate (PhD)

Source: AACN databases, 1997-2011©

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 40th in nation in 2000

– Estimates indicated pending shortages approaching 40,000 RNs by 2020

– Shortages equaled:• 3,400 as of 2000• 37,700 by 20202000 2005 2010 2015 2020

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Projected Demand

Projected Supply

26,30016,400

8,9003,400

37,700

How the USG Responded• Georgia’s new RN programs have increased productivity

– 2006 - GA programs graduated 2,206 pre-licensure RNs– 2011 - 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

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 20120

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

1,713

2,811

2,206

3,634

USGTCSGPrivates*Total

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?

Unity

Community

EngagementEducation

Thank you.

Questions and comments to lumarion@GRU.edu