Name of Sponsoring Organizationpresents 

The Future of Nursing:

Leading Change, Advancing Health

Casey R. Shillam, PhD, RN-BC Mary Dickow, MPANurse Co-Lead Statewide Director CA Action Coalition CA Action Coalition

ObjectivesAt the conclusion of the presentation participants will be able to:

1. Identify the 4 key messages and 8 recommendations of Institute of Medicine (IOM) study on the future of nursing.

2. Determine how INSERT THE AUDIENCE POPULATION DESCRIPTION in California can contribute to the California Action Coalition (CA AC) workgroups and the statewide effort.

3. Demonstrate understanding of nursing’s contributions that positively impact the health of the population.

Institute of Medicine

Why Now?

Health System Challenges

*World Health Statistics 2009. World Health Organization, 2009.Available at: http:/www.who.int/whosis/whostat/EN_WHS09_Full.pdf

IOM Committee for the RWJF Initiative on the Future of Nursing

18 members with expertise in:

– Health information and technology

– Health services research– Health policy– Workforce research and policy– Economics– Health care consumer

perspective

– Public health– Nursing – Federal and state

administration– Hospital and health plan

administration– Business administration

Our Current Health System

Committee’s Vision

A Transformed Health System

Diversity

Fostering Inter-professional Collaboration

Future of Nursing: Campaign for Action

Collaboration created by the Robert Wood Johnson and AARP Foundations to ensure

that all Americans have access to high quality, person-centered care

Leadership

Access to Care

Workforce Data

Education

High-quality patient

centeredcare

Inter-professional Collaboration Inter-professional Collaboration

Key Message #1: Nurses should practice to the full extent of their education and training.

Nurse leaders must:– work with state boards of nursing, state policy makers,

consumers and other health care professional organizations to remove restrictive scopes of practice.

– participate in efforts to assure appropriate use of advanced practice nurses and optimal roles for RNs in chronic disease and transitional care management.

Improve Access to Care

The Evidence

Over 10 studies show equivalent patient outcomes when care is provided by APRN or MD:

– Two Cochrane reviews (Hatem et al, 2008 and Laurant et al, 2004)

– RCT published in JAMA (Mundinger et al., 2000)

– No studies suggest care is better in states with tighter scope-of-practice restrictions

Role of the Registered Nurse

Refocus the role of the Registered Nurse to provide:

– Prevention and wellness care rather than acute care

– Community education and wellness

– Chronic disease case management

– Prevention of functional decline and need for hospitalization / placement in facility

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

Nurse leaders must:

– support academic progression of the nursing workforce.

– collaborate in developing and implementing transitional programs.

– identify, promote and support colleagues in pursuing doctorates.

Improve Education

– Lowered patient mortality

– Every 10% increase in BSN nurses results in 4% decrease in risk of death

– Lower number of medication errors and procedural violations

– Stronger critical thinking and leadership skills of BSN nurses

– 6% of nurses who graduate with AD get advanced degree, compared to 20% of BSN graduates

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

The Evidence

Key Message #3: Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States

Nurse leaders must:– act as full partners with other health care providers, being

accountable for their responsibility to deliver high-quality care.– work collaboratively with leaders from other health

professions.– identify and propose solutions to problems in care

environments.– devise and implement plans for improvement. – participate in health policy decision-making.

Promote Interprofessional Collaboration

Greater levels of collaboration between health professionals, especially between nurses and physicians, improves quality of care and patient outcomes

Barr, 2002; Barnsteiner et al, 2007

The Evidence

Prepare and Enable Nurses to Lead

Gallup survey of 1,500 opinion leaders:

– Predicted nurses will have little influence on health care reform over next 5-10 years

– Wanted nurses to have more influence in reducing medical errors, increasing quality of care and promoting wellness

– Believed nurses should have more input and impact in planning, policy development and management

*RWJF, 2010

The Evidence

Key Message #4: Effective workforce planning and policy making require better data collection and an improved information infrastructure

Nurse leaders must:– assist in the collection of data regarding both the

workforce and the demand for care from the populations we serve.

– determine the type of data to collect to accurately assess the demand for nursing services, particularly the specialties and geographic areas of nursing shortages.

Build Workforce Data

Move from evaluating simply “number” of hours to the content and quality of those hours

– CA BRN survey

• No nursing shortage!?!?

– Evaluating hours of nursing care across settings

• Can create methods of comparing quantitatively

long term care vs.

primary care vs.

home health care

Spetz et al., 2011; Van Cleave et al., 2011

The Evidence

Only with the right “mix” of data can we ensure the populations in most need will have the services and

health care that they need.

The Evidence

The Evidence

The IOM Recommendations

The IOM Recommendations

How Nursing Will Contribute to Improved Healthcare

Communications Committee engaged nurses and other partners from across the state to develop a 

brand for the Coalition.

VisionA healthy California through nursing leadership and service

MissionImplement the recommendations of the IOM Future of Nursing report 

through strategic partnerships for a healthy California

Core Values• Engaging broad and diverse perspectives• Increasing and using influence• Strategic and efficient use of resources• Improving health outcomes

Goals• Develop action steps to achieve the Recommendations

• Engage a broad-base of stakeholders in the Campaign 

• Create statewide structures that support the work

• Ensure regional engagement

• Influence national-level healthcare policy decisions

Organizational Structure

Executive Committee

Leadership Council

Working Group #5

Working Group #4

Regional Groups

Stakeholders

Working Group #1

Working Group #2

Working Group #3

Working Group #6

Working Group #7

Working Group #8

         Co-Leads: Garrett Chan and Susanne Phillips 

Conduct gap analyses to:• compare California regulatory language with NCSBN Consensus Model for advanced-practice registered nurse regulation

• compare for the four advanced-practice registered nurse and RN roles to the IOM Future of Nursing Report with the laws and statues of California 

Recommendation #1: Remove scope-of- practice barriers

Recommendation #2: Lead and diffuse new practice model efforts

•  Convene a statewide symposium in September 2012 to explore opportunities to transform health care delivery, share innovative models, and assess gaps in current models of care delivery

        Lead: BJ Bartleson

Recommendation #3: Transition-to-practice through nurse residencies• Promote transition to practice programs and residencies as expectation of nursing education

• Expand programs for new graduates to include more community-based opportunities 

• Create a statewide evaluation of current programs to inform next steps

         Co-Leads: Dorel Harms and Nikki West

• Establish baseline percentage of RN’s with minimum educational level of BSN 

• Inventory and analyze data from existing ADN-BSN projects to establish best practices

• Continue to facilitate progress AB1295 with consultation and support to CCC and CSU Chancellor’s Offices

Recommendation #4: Increase number of nurses with BSN

         Co-Leads: Liz Close and Stephanie Robinson

• Work with Recommendation #8 to establish baseline number of nurse with a doctorate

• Establish outcome measures and methods of collecting data for reaching goal of a 10% increase of BSN grads matriculating into Master’s programs within 5 years

Recommendation #5: Double number of nurses with a doctorate by 2020

         Co-Leads: Holli DeVon and Robyn Nelson

• Establish priorities and communications plans for messaging the need for culture change to expectations of life long learning in the profession of nursing

• Create repository on the Action Coalition website showcasing service and academic partnerships that demonstrate and support lifelong learning

Recommendation #6: Ensure that nurses engage in life-long learning

         Co-Leads: Jan Boller and Martha Dispoto

Recommendation #7: Prepare and enable nurses in leadership positions• Conduct gap analysis of 2011 survey to identify needs for developing new leadership programs for nurses

• Expand nursing leadership opportunities for participation by nurses in board rooms, policy discussions and on management teams 

• Develop a systematic plan for involving students in the Action Coalition work

         Co-Leads: Pat McFarland and Peggy Hodge

• Upload all public-access web links and resources for data to Action Coalition website

• Disseminate a seamless inventory of CA data for analysis and workforce planning

• Work closely with other recommendation groups to assess data needs to implement strategies

Recommendation #8: Build data infrastructure for workforce planning

         Co-Leads: Joanne Spetz and Louise Bailey

Regional Approach

• Change will happen locally

• Regional champions serve on Leadership Council

• Hold regional forums to build engagement and deliver the message locally

• Ensure regional members serving on work groups and/or coordinate with regional subgroups to link into statewide effort  

Progress to Date

• Planning Year completed• Workgroups established for all 8 Recommendations• Regional Champions identified in all 8 regions • Statewide Director appointed • Communication Plan and website• Secured initial funding for creating sustainable

structure

Successes to DateTown Hall Events: • Sacramento in August 2011• Los Angeles in February 2012• Fresno in April 2012• Humboldt in May 2012

Funders Round Table meetings held• Sacramento in August 2011• Los Angeles in December 2011

Successes to Date

Legislative Meeting with future discussions in the works

High Stakeholder Engagement due to successful outreach

CA is Role Model for Action Coalitions in other states

It Will Take All

of Us!

Government

Business

Health Care

Institutions

All Health Professionals

Insurance

Industry

Academia

Patients

Get Involved!

Workgroups / Regional activity

Speaker’s Bureau Trainings

Development Campaign

Communications Committee

Exercise for your Organizations

1) With your colleagues, discuss examples of how your organization is already engaged in work around the IOM Future of Nursing Recommendations.

2) Brainstorm to develop ideas that your organization should be or could be engaged in around the recommendations and connect with workgroup co-leads.

Mary Dickow, MPACalifornia Action CoalitionStatewide Directormarydickow@me.com415-307-9476

For More Information

Future of Nursing Campaign for Action          California Action Coalitionwww.thefutureofnursing.org            www.CAactioncoalition.org