Navy Nurse Corps…Navy Nurse Corps…Outstanding Care….Outstanding Care….Anytime, Anywhere!Anytime, Anywhere!

LCDR Denise M. Gechas, NC, USNLCDR Denise M. Gechas, NC, USNSpecialty Leader, Community/Public HealthSpecialty Leader, Community/Public Health

AAACN ConferenceAAACN Conference16 April 200816 April 2008

Navy Nurse Corps…Navy Nurse Corps…Outstanding Care….Outstanding Care….Anytime, Anywhere!Anytime, Anywhere!

LCDR Denise M. Gechas, NC, USNLCDR Denise M. Gechas, NC, USNSpecialty Leader, Community/Public HealthSpecialty Leader, Community/Public Health

AAACN ConferenceAAACN Conference16 April 200816 April 2008

Navy Nursing

1908 - 1908 - 20082008

Presentation Objectives:

• At the end of this presentation the participant will be able to:– List and describe Navy Medicine and Navy

Nursing’s priorities– Discuss current and projected Navy Nurse

Corps manning and demographics– Review current 1940 subspecialty code

practice issues– Discuss methods to increase promotion

potential

Navy Surgeon General’s Priorities:

• Maintain a fully ready force by recruiting and retaining outstanding healthcare personnel

• Excellence in clinical care, graduate education and research, the foundation stones of Navy Medicine

• Responsive and compassionate care to all our beneficiaries, focusing on the health of our service members and their families while providing

FY 08 Nurse Corps Strategic Priorities

• LeadershipLeadership– Competencies identified for senior & mid-level leaders; Gap analysis

completed for leadership training. Creation of a new and fluid leadership continuum, and implement recommendations of this team.

• Force ShapingForce Shaping– Recruiting & Retention Force Shaping. Focus will be on wartime

relevance of maintaining adequate numbers in each specialty. Understand migration patterns and values of Active Duty, Reserves and Civilian Nurses as it relates to retention.

• Education Policies and ProgramsEducation Policies and Programs– DUINS Utilization Policy for APN and CNS dual degree, Mentorship

programs for students in NC Pipeline programs (MECP, NCP, ROTC, STA-21)

• Readiness & Clinical ProficiencyReadiness & Clinical Proficiency– Clinical skills sustainment for operational assignments; Tri-Service

competencies; Pilot Competency assessment and orientation/ skill assessment. Standardize competency-based orientation among RC.

• ProductivityProductivity– Pursuing selection and funding for commercially available products

to streamline workload capture and scheduling across health care and the three Services.

• CommunicationCommunication– Communication to the Deckplate - Overhaul of NC Website, VTCs

with new accessions, Newsletter, NC News, Semiannual VTCs, Bimonthly meetings with Regional SNEs, Semiannual VTC with DNS & Admiral by Region

Regional SNEsSNEs

Policy andPractice

CAPT Raimondo

Career PlannerCAPT Scott

CommunityManager

CDR Bateman

CNRCNurse Programs

LCDR Hunt

AssignmentOfficers

CAPT Mitchell

SpecialtyLeaders

NMETC Educ. Programs

CAPT Biggs

StrengthPlanner

CDR Morrison

Reserve AffairsOfficer

CAPT Shannon

Deputy DirectorRC-RDML FlahertyAC-CAPT Pierce

Office of theCorps Chief

“Virtual Office”

Recruitment/Retention

LiaisonLCDR Lopez

Updates• Clinical Sustainment

Policy• 13 Deployment Health

Clinics • Comprehensive Combat

Casualty Care Center, NMC San Diego

• Mental Health Nursing and Practitioners

• 28 Military Treatment Facilities

• 135 Medical Clinics and Branch Clinics

Navy Nurse CorpsMTFs and Clinics

• 242 (13%) Navy NC currently deployed as of FY ‘07

• Assigned to Marine Corps and Navy Operational around the world.

Navy Nurse Corps Operational & Humanitarian

Data as of 30SEP06

Nurse Corps OfficerCurrent Manning Profile

Years of Commissioned Service

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30+

FY10 OPA CAPT CDR LCDR LT LTJG ENS

Data as of Aug 2007

Missed recruiting goals in FY04/05 and increased losses have caused these gaps.

HPLRP Retention tool

CSRB proposal

RN ISP/ DUINS/ War College

Nurse Accession Bonus; HPLRP Accession tool

Nurse Corps Force Structure FY98 - FY08 (Projected)

0

100

200

300

400

500

FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08PROJ

Gains Losses

*FY08 Gains Projected at 260; Losses at 290Source: BUMIS, PERS, 31DEC07

27722802

2500

2600

2700

2800

2900

3000

3100

3200

3300

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Actual EOY INV Projected EOY INVBillets E/S Target (OPA)

Nurse Corps Force StructureBillet Authorizations vs Inventory

126

7

356

11

637

-20

1083

-236

545

-184

230

235

-400

-200

0

200

400

600

800

1000

1200

CAPT CDR LCDR LT LTJG ENS

Billets

Inventory

Delta

Source: BUMIS, 31DEC07

Nurse Corps Force Structure

Losses by Rank FY03 - FY07

0

50

100

150

200C

AP

T

CD

R

LC

DR

LT

LT

JG

EN

S

FY03 FY04 FY05 FY06 FY07

Source: BUMIS, PERS, 31OCT07 (*Includes Plan Adjusts)

Nurse Corps Force Structure by Specialty

0

100

200

300

400

500

600

BILLETS 447 134 42 44 42 162 274 326 29 139 6 28 68 13 26

INVENTORY 517 225 61 52 21 177 245 198 16 142 3 20 57 14 26

% MANNED 116% 168% 145% 118% 50% 109% 89% 61% 55% 102% 50% 71% 84% 108% 100%

Med-Surg 1910

Mat-Infant 1920

Peds 1922

MH 1930

Com Hlth 1940

ER 1945

OR 1950

Crit Care 1960

NICU 1964

CRNA

1972

MHNP

1973

PNP 1974

FNP 1976

WH NP

1980

MW 1981

*Based on Primary Subspecialty Code*In Trng not included*1900 – Inventory = 802; Billets =812

Source: BUMIS, 31DEC07

Nurse Corps Force Structure by Specialty

0

10

20

30

40

50

60

BILLETS 11 32 51 36

INVENTORY 12 20 13 14

% MANNED 109% 63% 26% 39%

MPTE 3130E & T MGMT

3150NRSG ADMIN

1901NRSG ED

1903

*Based on Primary Subspecialty Code*In Trng not included

Source: BUMIS, 31DEC07

Phasing out community

Phasing out community

1901 and 1903 communities will become 1900

Nurse Corps Force Structure FY04 - FY07 Projected

0

100

200

300

400

500

600

700

2004 2005 2006 2007

2600

2700

2800

2900

3000

3100

3200

3300

Total Gains Total Losses Billets Authorized EOY Inventory

Actual Inventory Source - BUMIS, PERSBillet Source - TFMMS extract 30 SEP of Applicable Year.

Nurse Corps Force Structureby Education

*Based on highest level of educationSource: BUMIS, 31DEC07

BACHELORS67%

MASTERS32%

DOCTORATE1%

Nurse Corps Force Structureby Gender

Source: BUMIS, 31DEC07

FEMALE63%

MALE37%

Nurse Corps Force Structure Grade Distribution by Gender

Source: BUMIS, 31DEC07

114

280

352

456

234

317

19

87

265

391

127148

0

50

100

150

200

250

300

350

400

450

500

CAPT CDR LCDR LT LTJG ENS

FEMALE MALE

Nurse Corps Force Structure by Race/Ethnicity

Source: BUMIS, 31DEC07 Hispanic = 5.8%

White74.5%

Amer Indian or AK Native0.5%

Asian5.1%

Native HI or OPI0.4%

Black or African Amer13.9% Decline to

Respond4.1%

Multiple Race Code1.5%

Specialty BA Inventory%

Manned

#

Loss

Loss

Rate

Professional Nursing 868 924 107% 44 6%

Operating Room 281 250 89% 23 9%

Critical Care 333 188 57% 25 13%

Anesthetist 140 137 98% 14 8%

Family Nurse Practitioner

68 54 79% 4 6%

High Demand SpecialtiesHigh Demand Specialties

• Losses exceeded gains for 7 of last 10 years – most losses from LT• Cannot continue LTs• Direct accessions difficult due to National nursing shortage• Loss of CRNAs – highly remunerative specialty in civilian sector• Will continue to monitor loss rates post RN-ISP

FY 08 New Initiatives:FY 08 New Initiatives:• Accession Bonus rate: $20K/3 yrs; $30K/4 yrs

• May accept $20K/3yr and up to $38,300 in HPLRP = 5 yr

• Continue Health Profession Loan Repayment (HPLRP) as accession (20 slots) and retention incentive (Board to be held 1st Qtr 08 and 26 Slots)

• Continue Nurse Anesthetist Incentive Special Pay (ISP)

• Critical Skills Retention Bonus (CSRB) proposed for FY04 & 05 for nurses at first decision point

• RN ISP implementation, focus on clinical practice, for critically manned wartime specialties <90%

• Tiered bonus: 5K/1 yr; 10K/2 yr; 15K/3yr; 20K/4yr. Requires working in specialty full-time, certification, and SG approved Course or MS. Requires active mentoring and long range career planning.

• Critical Care, Perioperative, FNP, PNP

Nurse Corps Officer Incentives

Nurse Corps 1940 Stats

Nurse Corps:

Inventory: 2774

Training: 149

Billets: 2942

Manning: 94.3%

Public/Community Health:

Inventory: 20

Training: 4

Billets: 42

Manning: 38.1%**Billets authorized may not be correct; current billets based upon historical need for Ambulatory Nurses. If BA is decreased, then manning will improve.

Data source: BUMIS ao 29FEB08NAVMED MPT&E

Community Status – Active ComponentBillet Authorizations to Inventory Strength

0

10

20

30

40

50

60

70

80

Billets 68 54 54 45 42

Inventory 37 34 22 26 16

FY04 FY05 FY06 FY07 FY08*

Data Source: BUMIS, 30JUN06

*Does not include # in training or training billets; FY08 is as of 29FEB08

Public/Community HealthPublic/Community Health Subspecialty 1940Subspecialty 1940

0

2

4

6

8

10

12

14

16

18

20

LTJG LT LCDR CDR CAPT

BA

Inventory

BA 42*

Inventory 20

38.1%

Data source: BUMIS ao 29FEB08

Community Health Needs During San Diego Wildfires

Director Branch Clinics Role at Emergency Operations Center

• Initial exposure of DBC to the EOC function• Facilitated communication between branch

clinics, base EOC’s and NMCSD EOC• Provided direct report to NMCSD Commander• Collaborated with the Director of Public health to

educate community regarding “after-fire clean-up”

Community Health Needs

• BMC staff served as medical representative to base EOC

• 4,000 evacuees – Housed in tent cities at NAB and BOQ – Housed military members, retirees, families, pets – Provided on-site medical care 24/7 – Provided flu shots– Monitored air quality and provided masks– Coordinate with Marine Corps recruit training impact

of air quality – Assisted Preventive Medicine staff to ensure proper

sanitation at evacuation

Transition from Ambulatory Care to Public Health

• Operational Relevance: – OIF/OEF & Humanitarian

• Utilization in MTF Mission:– Public Health Directorate– HEDIS measures– Health Promotion– Emergency/Disaster Response Team– Pandemic Influenza

Career & PromotionPlanning

• Emphasis on Clinical Expertise (translate to outcomes) Leadership & Mission Accomplishment

• Diversity of Assignments/Commands• Stretch yourself, don’t stay in your professional

“comfort zone”• Expand your leadership ability and influence

– Leadership position, # led, $ budget, scope & command impact

– Interdisciplinary involvement and leadership

• Large commands allow large competitive comparison groups

~100% ~100% ~80% ~70% ~50% ~12% (2007)

6

Staff Nurse/Div Off/Instructor/Duty Under Instruction/Dept Head/Advanced Practice/ Research/HQ Staff

Exec. Med. /SNEAPN/HQ Staff/Research

CO

Nurse Corps Typical Career PathNurse Corps Typical Career Path

Staff Nurse/Division Officer/Instructor/Duty Under Instruction/ Advanced Practice

Dept Head/Advanced Practice/HQ Staff / OIC/Research/Senior Nurse Executive

Years of Commissioned Service

O-1 O-2 O-3 O-4 O-5 O-6 CO/CO Equiv

Staff Nurse

Career TracksClinical Administration Education Research Operational

Clinical Proficiency & Leadership

Clinical Proficiency, Admin. Acumen, and Leadershipthroughout the career continuum

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30