Nursing Paradigm Shift & Healthcare

1. Nursing Paradigm Shift & Healthcare Meg Beturne MSN, RN, CPAN, CAPA

2. Objectives • Explain changes in healthcare that are redefining our nursing practice • Describe roles that can evolve into meaningful work • Discuss barriers and benefits to successful role transitions

3. Let’s begin with Optimism! • “ I see nursing’s glass as full- full of potential, if we are going to pick ourselves up, dust ourselves off, and start all over again” From: Ziggy Cartoon by Wilson,1995

4. Affordable Care Act- 2010 • Aims at advancing the roles and responsibilities of nurses • Presents new options for patients to choose: health over disease, wellness over illness, prevention over cure, opportunity to lead productive lives and avoid more costly care • Wellness and prevention services will be more accessible and affordable as health plans are required to cover them • Eliminates cost-sharing; services at no added cost • Pay- for -performance replaces pay-for-services

5. ACA Affects Nursing • Work outside hospitals will grow • Nurses will be in short supply • Providers are welcoming older patients • New standards mean a new specialty • Advanced practice nurses are in demand

6. ACA Purpose & Demands • Reforms health care industry in 4 ways • improved quality • added consumer protection • decreased cost • increased access to healthcare • Predicted job openings: 250, 000 to 400, 000 annually over next 10 years • By 2020, as NPs fill in more for doctors, projected jobs for RNs and LPNs= 1.2 million!

7. But Wait… • “ Everything which succeeds, is not the production of a scheme, of rules and of regulations made beforehand, but of a mind observing and adapting itself to wants and needs” Florence Nightingale

8. Significant Changes • Shift to ambulatory care • Decreased length of stays • Growth in managed care • Soaring healthcare expenditures • Emphasis on cost containment • Emphasis on quality (outcomes) • Emphasis on service (outcomes) • Emphasis on prevention, wellness and rehab • Technological advances • Challenges regarding workforce needs (shortage)

9. The List Goes On…. • Care for aging population as well as pediatric services • Shifting values: over live and death • Lack of access: maternity & newborn care • De-jobbing: occurs in hospitals as services expand in communities • New infectious diseases needing management • Increased substance abuse: need for treatment • Increased violence: need for behavioral health • Chronic disease management • Need to renovate & expand school-based health centers

10. Back to the Future! • “Welcome to the year 2036. A lot has changed since the old days in nursing, especially throughout the healthcare field. There is still death, of course, but not from illness; that was taken care of long ago. Technology has made surgery obsolete and you may be surprised to learn that the government is picking up most of the healthcare tab these days. As for hospitals, well, what’s a hospital?” Farley, 2012

11. The Future has Become the Present In the book, Pulling Together to Make a Difference, The following quote hits the mark: “Constant training, re-training, job hopping, and even career hopping, will become the norm.” Bob Johansen

12. Rewarding , Relevant Roles • Advanced role requiring advanced education (i.e. Nurse Practitioner) • Disciplines: primary care, nurse midwives, psychiatric nurse specialists, geriatrics • Vacancies: 1,700 at hundreds of locations nation wide including health centers • Critical care nurses: greater need in hospitals • Patient-centered medical homes: settings in which tech-savvy nurses function as CareManagers and Data Analysts

13. Population Health • Care Managers: • advise on evidence-based diagnoses, treatments and interventions • measure progress in real-time • Data analysts: • generate and analyze disease registries • interpret data and track clinical measures • determine if population health management works Roles are in Medicare Advantage & Insurance Programs

14. National Health Service Corps • Looking for a new work setting, role or specialty? • NHSC supports health care providers dedicated to working in areas of U.S. with limited access to care • Scholarships are awarded in exchange for service in these underserved communities • Administered by Health Resources & Service Administration • 75% of professionals continue to practice where they are after their contracts expire • ½ choose to make a career out of the experience!

15. More Rewarding Roles • Hospice nurses • Geriatric practitioners • Pediatrician office nurse: “well-baby visits, developmental screenings to increase • Experts in Clinical Performance measures • Experts in new billing and reporting mechanisms • Experts in digitizing medical records (I.T.) • Potential: hospital/patient liaison: post-discharge, nurse assures that patient fills prescriptions, goes for follow-up visit, follows prescribed regimen

16. Expand Your Current Role • Preceptor/mentor • Patient/family advocate • Care coordinator: for patients with multiple chronic conditions • Enhanced role in health coaching, transitional care, prevention activities and quality improvement • Change agent: lead change in healthcare that the populations around you need

17. Become a Nursing Leader • If you see yourself moving into this role: • You will help lead improvements in health care quality, safety, access, and value • You will become a decision-maker • You will be able to influence health outcomes • You will participate on public policy and health care organization boards

18. How About a Nurse Educator? • Everybody has to get more education: nurses, patients, families, communities, partners in care • Nurse undergrads are already participating in courses with medical students (i.e. doing patient safety together) • Chronic care management, palliative care and public health are topics that allow nurses to play a bigger role upfront! • Nurses need to learn now how to use their voices more effectively to improve quality and access

19. From Novice to Expert • Some roles that never change: • The helping role: comfort, being present • The teaching-coaching function: readiness to learn • Effective management of rapidly changing situations: reacting to early warning signals • Administering and monitoring therapeutic interventions and regimens: medications, skin care • Monitoring and ensuring quality of healthcare practices: back up system to ensure safe care • Organizational and work-role: how nurse “fits in”

20. Facilities with Critical Nursing Shortages • Home health agencies • Rural health clinics • Outpatient clinics, extension clinics • Hospice programs • Skilled nursing facilities • Ambulatory surgical centers • Federally qualified health centers • Health Service Health Centers: esp. Indian & Hawaiian • State or local Public Health departments

21. Examples • Community Health Centers: • Deliver primary and preventive care • Many specialize ( i.e. oral and behavioral health) • Currently, about 16,000 nurses- including 4,300 advanced practice nurses are employed there • Home Visiting: • Nurses, social workers visit pregnant women and children • Offer intervention services and counseling to improve outcomes

22. Barriers to Role Transitions • Unclear perspective about roles • Unsure about skills preference • Inability to match up interests with roles • Negative attitude toward transitions • Unfocused about possibilities

23. Timely Advice • “ I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” Florence Nightingale

24. Successful Role Transitions • Depends on your perspective • Is it just a job? Low on self-fulfillment, negligible rewards • Is it your chosen career? High public acceptance and prestige; but with external environment changes, comes diminished self-fulfillment • Is it driven by a mission? High on dedication to a cause but low on financial reward or successes • Is it a true calling? Higher level of awareness that skills, passions and experiences result in joy and contributions to the common good!

25. Caring For Your Nursing Career CALLING MISSION CAREER JOB

26. 5 Constructs of a Healthy Nurse • Calling to care: compassionate offering of self; nurse builds relationships with patient and family • Opportunity to role model: nurse confidently identifies personal health challenges in self and patients; enables patients and self to overcome them • Priority to self-care: nurse effectively manages emotional and physical stressors • Authority to advocate: nurse empowered to advocate at all levels within work environment and community

27. Follow This Advice • “ I attribute my success to this- I never gave or took any excuse” Florence Nightingale

28. Know Your Skill Preferences

29. Career Interests Leading to New Roles • Investigative: evaluate, analyze, systemize, observe • Research, informatics, academic faculty, consultant, computer analyst, infection control, H.R. resource, work process design, systems development • Artistic: perform, write, design, draw • Education/training development, art/music therapy, computer graphics, promotional displays • Enterprising: plan, supervise, lead; persuade, innovate • Project/committee management, self-employment • Legislative work, patient advocacy, recruitment, marketing, fund-raising

30. More Career Interests • Social: instruct, guide, communicate, help • P.R., health education advocacy, rehab, ethicist, direct patient care • Conventional: financial, clerical, detail and data-driven • Staff coordinator, regulatory compliance officer, cost analyst, equipment manager, policy resource • Realistic: manual dexterity, motor-coordination, athletic • Equipment demonstrator, technical product vendor, hands-on trainer, staff in dialysis, surgery or rehab

31. Surrounded by Negativity? • Conquer it by: • Practicing appreciative inquiry: explore what is right with a group or organization ( value, strengths, potential) • Build healthy relationships • Laugh and engage humor • Live open-ended questions: What is my calling? Move ever forward and remain open to inner and outer voices of wisdom~ “active-receptive stance”

32. Be Positive “ The single most important employee trait in the 21st century is attitude- with regard to change, adventure and risk.” Farley, 2012

33. Unfocused About Possibilities? • Switch the paradigm by asking: • What assumptions am I making that I’m not aware I’m making? • What might I invent that I haven’t yet invented that would give me other choices? • Explore expectations of others & what they can expect of you • Be intentional in life and career: helps inform actions and choices • Place an anchor in the present

34. Wise Advice • Alice in Wonderland said to the Cheshire Cat “Would you please tell me which way I ought to go from here?” and the Cheshire Cat said, “ That depends on where you want to go.” Lewis Carroll, 1865

35. Toolkit To Successful Role Transitions • On your journey, don’t forget to bring: • Helmet for the knocks • Cushion for the falls • Mop for the tears • Earplugs for the gossip • Good shoes for running twice as fast as others to get to the same place at the same time • Hammer to nail down promises • Key to open closed minds • Hatchet to open closed doors

36. Might as Well Pack…… • Gavel to command attention • Microphone so you will be heard • Box to pick up the pieces • Certificate of merit • Medal of honor • Badge of Courage • Friend for good times and especially for bad times Natasha Josefowitz, 2012

37. Manage Career Transitions Through… • Self-assessment: skills, knowledge, attitude • Goal setting and priorities • Alignment of assessment with goals • Market assessment for what is best for YOU • Skill strengthening • Action plan • Implementation • Reflection and feedback • Adjust as necessary to reach successful outcome

38. AH HA: Illumination • Listen to yourself • Trust your hunches • Stop questioning your qualifications • Be a risk taker: failure is not fatal • Give up fearing the unknown • Heed your dreams and your mentors • Turn things around: interpret trends so you see things differently • Be prepared: so timing will be on your side

39. Benefits of Successful Role Transitions • Achievement of outcomes (personal and patient) • Increased productivity • Sense of accomplishment ( making a difference) • Appreciation of adaptability • Freedom and adventure • Commitment to a purpose • Power to deliver results • Economic security • Control of future career

40. Make a Difference by Managing All 3 • Quality Cost Service

41. Follow the Leader • Just like Florence Nightingale, “we must be tough, canny, powerful, autonomous and even heroic.” Farley, 2012

42. Imagineering • Vivid imagination according to Walt Disney • Combine it with repetition and you will be a Winner imagination repetition

43. All Roles Become One • “Gentle gestures drift from one to another, (listening, gazing, touching, holding); Feelings rendered in, around and through, (warmth, interest, concern, caring); Shared memories converge, (I and you become we); Actions offered, regard given, love bestowed, create a trickle of compassion, that feels like a river of kindness, that courses to the sea of humanity, and in mingling with the vastness, purifies all Farley, 2012

44. Final Words: What is Life? • Life is a gift… accept it • Life is an adventure…dare it • Life is a mystery… unfold it • Life is a game… play it • Life is a struggle… face it • Life is beauty… praise it • Life is a puzzle… solve it • Life is an opportunity… take it • Life is sorrowful… experience it

45. Life is a song… sing it • Life is a goal… achieve it • Life is a mission… fulfill it Author Unknown • This sums up my advice to you, so I will only add: • Life in both your personal and professional lives is a journey, not a destination… never stop taking it! Thank You