Welcome

1. Welcome Group Discussion on Changes Needed in Healthcare November 1st, 2013

2. This evening we are webcasting from The University Medical Center which lies in an undisclosed location! • We have four professionals that are going to present topics that are very important to each of them. • After their presentations, they will be asked a series of questions by a multidisciplinary panel that has been chosen by a secrete admirer.

3. The panel members are….. Pat Georgia Tina VP of Nursing MSW Unit Nurse Educator

4. Dan The CFO (His pockets are too big to put on one slide)

5. After the four participants have explained their dilemma, the group will make a decision. • That decision will determine the topic that will be discussed at a much deeper level, later in the year. • Once again, thank you for your time and lets get started!

6. Advanced Practice Nurses – One position = multiple answers Daniel Powell BSN RN

7. “An Ounce of prevention is worth a pound of cure” - Ben Franklin • Very true in healthcare for our patients and their families. • Also true when allocating resources for those taking care of those patients. • It is the intent of this presentation to explain how this holds true for healthcare in many different facets and how an investment in Advanced Practice Nurse Educators will have positive impact on more than the bottom line!

8. 5 areas that will see an early impact by Apn educators are: • HCAPS Scores • Hospital Readmissions • Quality Indicators • Nurse Retention • Risk\Liability

9. 1st - HCAPS Scores • In October 2012, Medicare began rewarding and penalizing hospitals based upon their patient satisfaction scores. The higher the satisfaction scores, the better the reimbursements. • Patients reported that the overall involvement of their nurse and their perception of the nurse’s competence dramatically impacted their overall satisfaction. (Nelson, Cortez, Curtis, Lustlader, Mosenthal, Mulkerin& Puntillo2011) The range is between 1.5% to – 1.0% Competence = Satisfied Patients

10. 2nd – Reduction in readmissions • In 2012, Medicare and Medicaid told hospitals that they would not pay for patients readmitted to the hospital if they returned for the same diagnosis within 30 days of discharge. • Hospitals scrambled to find ways to keep patient this from happening! • Green (2012) found that patients who were satisfied and comfortable with their hospital stay were much more likely to follow through with discharge instructions and follow up care. Thus leading to more compliance and fewer readmissions. Thousands of readmissions = NO PAY Competent Nurses = Fewer Readmissions

11. 3rd - Quality Indicators • In 2011, Medicare and Medicaid began rewarding hospitals for following recommendations in treating patients with certain disease processes or conditions. Major insurance carriers followed suit. • These Quality Indicators\Core Measures are complex and ever-changing. Some examples include: • Timely Antibiotics for patients with Pneumonia. • Administering DVT prophylaxis daily for inpatients. • CHF care and meeting educational requirements. Meeting Indicators = 1%-2% Bonus Great, Timely Care to Patients

12. 3rd - Quality Indicators Cont. • All of these Quality Measures and Core Measures are evolving and require a constant, trained eye to evaluate, interpret and educate those responsible for adhering to these standards. Involves Best Practices Constant Evolution of Requirements

13. 4th - Nurse Retention • Retaining qualified, well trained nurses is a top goal of any organization. • Replacing one RN can cost an organization well over $30,000! • Outside of the obvious, (pay & benefits) what else matters to employees? • According to Halfer (2011) newer nurses were more likely to be retained if educators were used for staff and career development. • Nurses were more likely to stay in their jobs if they were satisfied with professional development and learning assistance. (Graf & Halfer 2006) Some Estimates are over $50,000 Professional Staff want a Developmental Plan

14. Well Educated – Great Direction No Educator – No Direction

15. 5th - Risk management - Liability • Marshall (2011) states, “risk is the other side of safety and quality.” • Much attention is given to this area in all hospitals to reduce the risk of bad patient outcomes and fines from regulatory agencies. • Regulations are complex and need a trained eye to interpret! Patient Safety = Top Priority APN = Qualified Interpreter

16. Let’s Stop & do a little math(based on a small, rural hospital – 50 million dollar budget) • Best Case Scenario: • HCAP Scores are Awesome = Additional $450,000 • No Readmissions = No Free Care • All Quality Indicators are Met = Additional $300,000 - $600,000 • Most RNs are Retained = Low Cost • Risk is Minimized = No Costly Lawsuits\Fines • Worst Case Scenario: • HCAP Scores are Awful = $300,000 decrease in Reimbursement. • Multiple Readmissions = $250,000 in Free Care • No Quality Indicators Met = No Bonus • High Turnover Rate = $250,000 more for training. • Risk is not Minimized = Costly Law Suits and $150,000 Fines!

17. The Differences are astounding! • Best Case Scenario • Operating Budget now at $51,050,000! • Patients Kept Safe • Staff are Happy • Best Practices Utilized • Worst Case Scenario • Operating Budget now at $49,050,000. • Several Patient Injuries • Staff Not Happy • JCO and CMS Visit! • Several Lawsuits • One Large Fine • Patients not Satisfied! Growth of Services, Raises for Staff! Staff Layoffs, Reduction in Services!

18. How do we get there?(to the - Best case scenario) • Unfortunately, you have to be a rocket scientist to figure it out!

19. Not Really, Just Hire advanced practice nurse educators! • APN Educators have the knowledge and ability to connect with all four generations in the work place. • APN Educators have the ability to collect, interpret, advise, and educate on all aspects of the evolving healthcare landscape. Including Quality Indicators, Core Measures, and HCAP Criteria! • APN Educators mentor and coach both young and old staff for career and professional development, thus enhancing staff satisfaction and retention.

20. More reasons to hire advanced practice nurse educators • APN Educators, ultimately make staff feel more confident and competent at the patient’s bedside, thus improving the patient’s perception of the nurse and the believability of what is being told to them, raising their satisfaction levels. • Patients are more likely to follow their discharge instructions and participate in follow-up care if their nurses are well educated, thus reducing the rate of readmissions! • APN Educators reduce the overall risk to the organization by ensuring employees are compliant in knowing new equipment, policies, procedures, etc.

21. Your APN Nurse Educators • Should incorporate qualities of both a Servant Leader and of a Transformational Leader. • As a Servant Leader, will motivate and inspire change by setting a positive example and always being willing to work and to listen. • As a Transformational Leader, will inspire quality improvements as a way to enhance both the employee’s role and the patient’s experience. • Utilizing these leadership qualities, will: • Establish Relationships Quickly • Bring Professionalism and Order to Education • Gain Respect and Compliance from Staff • Instill Pride and Accomplishment to those Around Them • Empower Staff to be Active Participation • Provide Guidance for Quality Improvement Processes

22. Your APN Nurse Educators • Should always keep spare change with them to play poker with the staff! • Just Checking!!!

23. Your APN Nurse Educators, utilizing their leadership skills… • Must get involved and be an active participant in multiple areas, meeting with: • Risk Management • Utilization Review • Quality and Patient Safety • Customer Service • Nursing Units • Physician Practices • Individual Employees Once started, establishing transparency, setting goals based and priorities and designing and implementing plans of action are key.

24. Once the apn educator starts, how should we monitor progress? • If time allows, survey staff before the APN Educator position is filled, including job satisfaction. • Give the APN Educator 6 months to get acclimated to your institution and begin comparing prior data to the most current. • Include: • Patient Satisfaction Scores • Core Measures • Quality Indicators • Staff Satisfaction\Retention • Sentinel Events\Poor Patient Outcomes

25. Once comparisons are complete, the APN Educator will revise and adapt to whatever is needed. The numbers will speak for themselves! • The APN Educator is never done! Healthcare is evolving and every individual is their own complex adaptive system. Having your Advanced Practice Nurse Educator in place gives your organization the best opportunity to adapt and evolve as a whole, while maintain financial stability and compliance with regulations! • Thanks for your time, any questions?

26. References • Green, J. (2012, December 12). Better care, bigger share; Hospitals prepare for Medicare changes that link quality to reimbursement. In www.crain.com. Retrieved October 1, 2013, from Popular Magazines ( GALE|A312067922). • Halfer, MSN, RN, NEA-BC, D. (2012, October 1). Job EmbeddednessFactors and Retention of Nurses with 1 to 3 Years of Experience [Electronic version]. Journal of Continuing Education in Nursing, 42(10), 468-476. doi:http://0-doi.org.libcat.ferris.edu/10.3929/00220124- 20110601-02. • Halfer, D., and E. Graf. "Graduate Nurse Perceptions of the Work Experience." Nursing Economics24.3 (2006): 150-55. EBSCOhost. Web. 1 Oct. 2013. • Nelson, J. E., Cortez, T. B., Curtis, J., Lustbader, D. R., Mosenthal, A. C., Mulkerin, C., & Puntillo, K. A. (2011). Integrating palliative care in the ICU: the nurse in a leading role. Journal of Hospice & Palliative Nursing, 13(2), 89-96. doi:10.1097/NJH.0b013e318203d9ff. • Marshall, E. (2011). Transforming leadership in nursing: From expert clinician to influential leader. Ney York, NY: Springer Puplishing Company.

27. Nurse Retention

28. The Challenge • The continuously changing and rising demands for healthcare services due to an ageing population, technological advances and higher patient expectations requires a larger and more skilled nursing workforce.

29. Unfortunately our organization as is the nursing profession as a whole challenged by an ageing workforce, difficulties with recruitment of young, motivated people and the retention of existing nursing personnel.

30. There “is an expected nursing shortage between now and 2025 of more than 260,000 RN’s”(Blake, Leach, Robbins, Pike& Needleman,2013,p.356). • “This is projected to be a shortage twice as large as any other shortage seen in the United States since the early 1960’s(Blake et al.,2013).

31. This trend implies that in the near future sicker patients will be cared for by fewer nurses. • This presents a sense of urgency to all of us today as the leaders of our organization to answer the question, “How can we provide an environment that promotes nurse retention?”

32. It is imperative for us to understand the complexity of this issue. • In 2013, a study by Blake, Leach, Robbins, Pike and Needleman, stated that, “one reason that registered nurses leave jobs is because they are looking to find better leadership”(p.356).

33. Another point discussed in this study was that novice nurses or new graduate RN’s were leaving their current jobs within their first 2 years in alarmingly high rates.

34. This study concluded that when authentic leadership is present which included strong leadership skills of communication and collaboration this showed a significant effect on nurses decisions to stay in their current jobs ( Blake, Leach, Robbins, Pike &Needleman,2013,p.367).

35. Another very important piece of literature from Sanders, Krugman and Schloffman (2013), linked healthy work environments to improved patient outcomes. And also pointed to the link between strong unit level leadership and improved nurse retention levels.

36. Healthcare struggles financially on a daily basis. Reimbursement guidelines and expectations to meet patient outcomes are becoming more rigid as each day passes and our organization must keep pace with these standards.

37. So from a purely financial standpoint, keeping our nurses in our organization is good business. According to Bland Jones & Gates(2007), “costs of nurse turnover can range anywhere from $22,000 to $64,000 per nurse turnover” (para. 3).

38. Recruiting costs and agency staffing that result from turnover are also costly to our hospital. • “In addition to increased costs, shortages at the unit level and higher nurse to patient ratios have been associated with poor patient outcomes and adverse events”( Blake, Leach, Robbins, Pike and Needleman,2013,p.356)

39. Another reason for nurses leaving the profession can be linked to nurse burnout (Weberg,2010).Poor staffing levels, emotional fatigue, diminished job satisfaction,and stressful work environments are only a few of the many factors that can impact burnout.

40. Weberg ’s study,(2010), indicated that “transformational leadership improves employee satisfaction and decreases key factors leading to job burnout”(p.257).

41. In conclusion, we are an organization that values our people. We must live this commitment by building a stronger leadership base to reinforce these values. It is imperative that we join forces today so that we can begin to find a solution to this critical challenge facing our organization.

42. References Blake,N.,Leach,L.S.,Robbins,W.,Pike,N.,Needleman,J.(2013).Healthy work environments and staff nurse retention. The relationship between communication, collaboration, and leadership in the Pediatric Intensive Care Unit. Nursing Administration Quarterly,37(4),pp.356-370. Bland Jones, C.,& Gates, M.(2007). The costs and benefits of nurse turnover: A business case for nurse retention. OJN: Online Journal of Issues in Nursing,12(3). doi:10.3912/OJIN.Vol12No03Man04

43. Sanders,C.L.,Krugman,M.,& Scholffman,D.H.,(2013). Leading change to create a healthy and satisfying work environment. Nursing Administration Quarterly,37(4),pp.346-355. Weberg,D.(2010). Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly,34(3),pp.246-58.

44. Improving Health LiteracyTina Adkins RN BSN

45. Improving Health LiteracyWhat is the meaning • Health literacy is defined by Marshall (2011, p.129) as the ability to obtain, process, understand, and use basic health information to make appropriate healthcare related decisions.

46. Improving Health LiteracyThe Impact of Poor Literacy • Evidence shows that Americans find health information hard to understand. • When patients have a decreased literacy related to health issues, it can cause them to have a misunderstanding of the health care information they receive. • People fail to receive immunizations on a timely basis

47. Improving Health LiteracyThe Impact of Poor Literacy • They have difficulty with making decisions related to prevention and treatment options • There may be difficulty on trying to navigate through a health care system • The chance of hospitalization rises and utilization of expensive services e.g. going to the ER more often • Overall these risks plus others can lead to poor health management.

48. Improving Health LiteracyWho is Affected • As noted in Marshall (2011,p.129) the main population areas that are affected by a decrease in health literacy is noted within varying cultures, race, people with language barriers and socioeconomic status, and education level.

49. Improving Health LiteracyIntervention, Goals and Outcomes • There are many opportunities available to health care workers to turn this problem around • Education is recognized as an integral part of health promotion • Encourage patients to ask questions for clarification • Teach patients to keep a thorough and active list of medications

50. Improving Health LiteracyInterventions, Goals, and Outcomes • Health care workers need to actively listen to what the patient or family member is saying • Give handouts or booklets or any useful visual aid pertaining to a patients disease process • Help the patient ask questions if needed • Encourage patients to know their health history, medications and express any current symptoms