Leading Change, Advancing Health

http://campaignforaction.org/state/virginia

Leading Change, Advancing

Health


3.2 MILLION100,00030,000

Nursing’s Voice


• To review Institute of Medicine, Future of Nursing Report

• To define the Campaign for Action• To define the Virginia Action Coalition• To describe the workgroups

Objectives


Aging and sicker population

High costs

Primary care and public health

shortages

Fragmentation

Health care disparities

Health Care System Challenges


Escalating rate of diabetes*: 193,000 in 1993 508,000 in 2010

Primary care shortage, especially acute in rural areas

Aging health care workforce

*Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System

Virginia’s Health Care Challenges


Largest segment of health care workforce

Need to enhance nurses’ skills and capabilities

Critical role in providing patient care and care coordination

Nurses and Health Care


Need to address challenges facing nursing to address challenges facing our health system

RWJF MISSION

To improve health and health care for all Americans

RWJF’s Commitment to Improving Care


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

One of the most-viewed online reports in IOM history

Institute of Medicine Report


Institute of Medicine Report

A Quote:

" achieving a successful health care system in the future rests on the future of nursing."

Harvey V Fineberg, MD, PhDPresident , Institute of Medicine.


• Committee on the RWJF Initiative on the Future of Nursing

• Membership

• Opportunity to transform health care system

IOM Future of Nursing Report

• Provide seamless, affordable, quality care

• Nursing profession is the largest segment of the health care workforce


•

High-quality patient

centeredcare

Leadership

Access to Care

Workforce Data

EducationInterprofessional Collaboration

Campaign for Action: Key Messages

Hassmiller, Susan

Should use the slide where diversity is embedded at the bottom. this slide does not even mention.


1. Nurses should practice to the full extent of their education and training

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression

3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the US

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure

Blueprint – Four Key Messages


• Remove scope of practice barriers• Expand opportunities for interprofessional collaboration• Implement nurse residency programs• Increase proportion of nurses with BSN to 80% by 2020• Double the number of nurses with doctorates• Ensure that nurses engage in lifelong learning• Prepare and enable nurses to lead change and advance

healthcare• Build an infrastructure for data collection

Future of Nursing Recommendations


Advancing Education Transformation

Removing Barriers to Practice and Care

Nursing Leadership

DATA

Interprofessional Collaboration

Diversity

Campaign for Action Pillars


Implement nurse residency programs

Increase the number of nurses with doctorates

Promote lifelong learning

Increase the proportion of nurses with BSN and higher degrees

Education


Evidence

Some association between educational level and patient outcomes

Twenty percent of BSN graduates get advanced degrees

Six percent of associate-degree graduates get advanced degrees

Aiken et al., 2003; Estabrooks et al., 2005; Friese et al., 2008;Tourangeau et al., 2007; Van den Heede et al., 2009; Aiken, 2009.

Education


All practitioners should practice to the full extent of their education and training

Physicians, nurses and other health professionals work in a 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

Studies show that APRNs permitted to practice to full extent of education and training provide equal or better care

Patient satisfaction • Length of stay • NPs: BP, glucose, lipid control • CNMs: Fewer C-sections, fewer episiotomies

Systematic review of published literature between 1990 and 2008 indicate patient outcomes of care provided by APRNs and equivalent or better than MD

Sources: Journal of Nursing Economic$, (Sept/Oct 2011), Advanced Practice Nurse Outcomes 1990 – 2008: A Systematic Review

Practice


Prepare more nurses to help

lead improvements in

health care quality, safety,

access and value

Interprofessional education,

training and practice

Integrated, collaborative,

patient-centered health

care teams

Collaboration


Nurses bring important viewpoint to management and policy discussions

Leadership


*RWJF, 2010**American Hospital Association, 2011

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

Survey of 1,000 U.S. hospitals** found:

Nurses account for only six percent of board membersPhysicians account for 20 percent of board members

Other clinicians are five percent of board members

Evidence


Research on health care workforce is fragmented

Need data on all health professions

Improved health care workforce

data collection to better assess and project workforce

requirements

Data


Nurses should reflect patient population in terms of gender, race and ethnicity

All nurses should provide culturally competent care

Diversity


• The Campaign for Action is a national initiative coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation.

• The campaign has mobilized diverse stakeholders nationally and in all states to address the nation’s most pressing health care challenges – access, quality and increasing cost – by utilizing nurses more effectively and preparing nursing for the future.

Campaign for Action


Americans have access to high quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success


Diverse Stakeholders

Policy-makers

Communications

Action Coalitions

Research, Monitoring, Evaluation

Grantmaking

RWJFAARP

Advisory Committee

Campaign Strategies


RWJF/AARP seeking support from:

Health professionals

Payers

Consumer advocates

Business

Policy-makers

Philanthropies

Educators

Hospitals and health systems

Public health agencies

Nursing Must be Considered a Societal Issue!


How will the eight IOM recommendations

translate into action?

Campaign for Actioncampaignforaction.org

State Action Coalitions

Regional Action Coalitions


AARP VirginiaVirginia Nurses Association


Virginia Action Coalition Co-leads

AARP – VirginiaDavid DeBiasi, RNAssociate State Director - Advocacy

Virginia Nurses FoundationShirley Gibson, DNP, MSHA, RN, FACHEFoundation President

Virginia Nurses Association / Virginia Nurses FoundationJanet WallChief Executive Officer


Nurses should:

• Practice to the full extent of their education and training

• Achieve higher levels of education and training through an improved educational system that promotes academic progress and explore residency programs

• Be full partners, with all members of the healthcare team in redesigning healthcare

• Develop strategies to ensure that nursing is skilled to provide leadership at all levels

• Ensure effective workforce planning and policy making require better data collection and an improved information infrastructure

Virginia Action Coalition Goals


To implement the recommendations in the Institute of Medicine report,

The Future of Nursing: Leading Change, Advancing Health

Mission


All Virginians have access to affordable, high quality care and live in

an optimal state of health

Vision


Workgroups

Virginia Action Coalition


IOM Recommendation 7Prepare and enable nurses to lead change to advance health.

ObjectiveDetermine strategic boards to which nurse could be appointed and work with stakeholders to identify, mentor, and recommend individuals for those appointments.

VAC LeadershipLindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RNCo-leads


• Continue “Nurse Leaders in the Boardroom” program piloted with Robert Wood Johnson Foundation and AARP in September 2009

• Continue to support Nurse Leadership Institute, a program of the Richmond Memorial Health Foundation

Leadership Objectives


• Nurse Leaders in the Boardroom – AARP• Nurse Leadership Institute• Partnership with Virginia Student Nurses Association• Survey of nurses for board and potential

board members • Hospital survey for nurses on boards• RWJF Boundary Spanning Leadership• CFA Breakthrough Leadership Nominees• Inaugural Leadership Symposium!

Outcomes


• Develop a video campaign re: value of nurse on boards

• Enhance the Leadership Toolkit• Develop structure for mentors and mentees serving on

boards• Publish leadership article with Campaign for Action• Blog for RWJF on Leadership• Ongoing leadership development conferences for

nurses who want to serve on boards

Next Steps


• Video: Value of Nurses on Hospital Boards

Outcomes


Local Boards

• Free Clinics• Crisis Pregnancy

Centers• AORN, VNA, Black

Nurses & other professional nursing associations

• Public Health Advisory Commissions

• Red Cross• Alzheimer’s

Association

• Church Affiliated Boards

• Performing Arts Council

• Historical Councils• County Board of

Supervisors• AARP• University &

Community College Councils

• YMCA


State Boards

• Virginia Partnership for Nursing

• Virginia Board of Nursing• Virginia Nurses Association• Virginia Nurses Foundation• Multiple professional nurses

associations• Virginia Board of Health

• Virginia Association of Counties

• VCCS Associates Degree Nursing Program Heads

• Virginia Association of Colleges of Nursing

• Health Insurance Exchange Governing Body


National Boards

• American Nurses Association & Political Action Coalition

• National eHealth Collaborative

• Nurses Organization of Veterans Affairs

• American Midwifery Certification Board

• AORN Journal Editorial Board

• National Kidney Foundation• American Academy of Nurse

Practitioners• American Organization of

Nurse Executives• Various National Nursing

Organizations


Next Steps

• Develop a video campaign value of nurse on boards• Enhance the Leadership Toolkit• Develop structure for mentors and mentees serving on

boards• Publish Leadership Article with Campaign for Action• Blog for RWJF on Leadership• Ongoing Leadership Development Conferences for

nurses who want to serve on boards


IOM Recommendation 1Remove scope-of-practice barriers

ObjectiveAll nurses should practice to the fullest extent of their training

ObjectiveEducate stakeholders, legislators and the public about APRN regulatory barriers that prevent full practice authority to continue efforts to reform outdated scope-of-practice regulations

VAC Access To CareCindy Fagan, RN, MSN, FNP-BC and Kathy Baker, RN, PhD, NE-BCCo-leads



• House Bill 346 passed and signed by Governor

– Eliminates supervisory language – emphasis on collaboration

– HB 346 manifested in 2013

• Advanced Practice Registered Nurse disciplines– Consensus Model for APRN Regulation

• Gap - Licensure, Accreditation, Certification & Education• Met with the Board of Nursing on agreement and sought advice on

titles• Met with the House and Senate Finance Committees on language in

budget amendment• Research Project

– Qualitative Descriptive Case Study rebased on Yin’s Methodology for Case Studies (In IRB status)

– Explore how policies and practices in hospitals either support or inhibit RNs from practicing to their fullest extent

Outcomes


• Video: The Advanced Practice Registered Nurse

Outcomes


Next Steps

• Consider legislation to remove the Joint Board and establish an Advisory Group for oversight

• Continue education of the public about the APRN scope of practice

• Continue to use the APRN video for education

• Conduct the Qualitative Descriptive Case Study Research


• Conduct research to explore how policies and practices in hospitals in the state of Virginia either support or inhibit RNs from practicing to their fullest extent through a Qualitative Descriptive Case Study rebased on Yin’s Methodology for Case Studies

• Participants include nurses from all hospitals in the state

• Areas include ICU, Med/Surg/Progressive Care and Emergency Department

• Include the CNOs, RNs and Advanced Practice Registered Nurses

Next Steps


VAC Academic ProgressionDeb Zimmermann, DNP, RN, NEA-BC and Amy Gillespie, RN, MSN, EdD Co-leads

IOM Recommendation 4Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020

ObjectiveConvene stakeholders on the implementation of seamless education progression


Future of Nursing Education

The Challenge51% of VA RNs BS prepared32% of AD graduates attain BSN31% of Diploma graduates attain BSN


• Regional Groups– Eastern, Central, Northwest, North and

Southwest• Inspiration to Aspiration Grant

– Interviews with nursing programs– RN-BSN Guide– Survey of RN-BSN students– Video of students– http://youtu.be/iT0ygHn4CYg

Outcomes

http://youtu.be/iT0ygHn4CYg


• Academic Progression Models– Two statewide conferences with stakeholders– Academic Progression Summit– RWJF State Implementation Grant– Met with State Council Higher Education – G. E.

requirements– Organizational policies to achieve BSN

Outcomes


• Collaborate in the design of two pilot programs with two nursing programs each, providing seamless access for nurses to achieve higher levels of education

• Develop mechanisms to track organizational progress for education progression

• Enhance and expand online Academic Progression Toolkit

Next Steps


IOM Recommendation 2Expand opportunities for nurses to lead and diffuse collaborative improvement efforts

ObjectiveDevelop and deploy an educational program that prepares nurses, physicians, and other care providers to practice in a team-based, patient-centered care model

VAC Interprofessional CollaborationPatti McCue, ScD., RN, MSN, NEA-BC Bonnie Barndt-Maglio, PhD, RNCo-leads


• Physician Foundation Grant• Developed leadership program with MSV• Recruited 20 teams of physicians, nurses and

other health professions – clinical triads• Required Capstone project on population health• Provided leadership, business and innovation

skills• Completed evolvetm Team Based Educationhttp://www.youtube.com/watch?v=M2PR2oqu66A

Outcomes

http://www.youtube.com/watch?v=M2PR2oqu66A


• In partnership with MSVF, launch phase 2 of Evolve• Track diversity (cultural, gender, rural / suburban /

urban, etc.) of program participants as well as populations served.

• Develop an educational program toolkit that can be presented in a variety of settings to promote the evolve program and to provide education on the importance of nurses practicing to the full extent of their education, training and experience in a collaborative setting

Next Steps


Diversity

• Cultivating Diversity in Academia and the Workforce – Virginia Nurses Association Roundtable held July 24, 2014– Angela Wilkes – Owens and Minor, Diversity Executive– Elizabeth Carter, PhD, Executive Director VA Board of Health

Professions Workforce Data Center– Matt Thornhill – Co-founder of Boomer Project– Panels – Perspectives on Diversity – Strategies and

Successes


Sustainability

• Campbell and Company– Technical Support– 6 State Collaborative– Sharing Best Practices– Developing Tools

• Case for Support• Prospective Relationship Building• Individual Support Base• Volunteer Engagement• Special Events• Fundraising Activities


Members of the Virginia Action Coalition honored for their contributions to the nursing profession at the 2012 VNF Gala


Engage!http://campaignforaction.org/state/virginia

Janet WallCEO, Virginia Nurses AssociationCo-lead, Virginia Action Coalition

804-212-0690 / [email protected]


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Leading Change, Advancing Health

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