Leading beyond your comfort zone: Is nursing recession proof?

1. Leading beyond your comfort zone: Is nursing recession proof? Marcia Hern, EdD, CNS, RN Dean, School of Nursing University of Louisville

2. Overview • Update about national trends and nursing shortage • Update about the SON and KY • Future nursing workforce • How you can lead your own unique health care journey, especially working with nurses

3. External forces to health • 47 Million without health care (15%) • US population 307 Million (7.20.09) • US unemployment rate near 10% • >98,000/year patients die from medical errors (IOM, 2000) • System measures improving patient safety & quality

4. States with Projected Shortages of FTE RNs in 2020 http://bhpr.hrsa.gov/healthworkforce/reports/rnproject/report.htm

5. Projected FTE RN bhpr.hrsa.gov

6. American Association of Colleges of Nursing (2009) • 2003 BSN enrollment ↑ 16.6% • 2007-08 BSN enrollment ↑ 2%: faculty shortage • Deny 50,000 qualified BSN applications • MSN enrollment ↓ • PhD ↓ DNP ↑ • Be(a)ware economic indicators $$$$$$

7. Stretching nursing comfort zone • HIGH impact, critical mass profession • Front line caregivers; 24 X 7 • Most intimate profession that serves through science and art of caring • Most honest profession • Cost effective & high quality health care • Best health care value $$ and ROI

8. Kentucky RN Education • Lags the nation in BSN nurses at 28% • Only Mississippi has less BSN • 50% 52,223 RNs with Associate degrees • 8 % master’s prepared APNs and doctoral nurses (www.kbn.ky.gov)

9. SON Educational Programs • Baccalaureate: traditional 1st degree; 2nd degree career; RN-BSN • Master’s: Nurse practitioners- Adult, family, neonatal, psych; • Starting acute care NP Jan. 2010 • Master’s as nurse educators • PhD: first three graduates

10. SON BSN Applications

11. New Programs & Partnerships

12. Owensboro BSN Program & Partnership Owensboro Medical Health System (OMHS) and new SON 159 seat auditorium: synchronous audio/video First baccalaureate distance education program in KY!

13. Joint psychiatric mental health nurse practitioner (NP) major in Bowling Green • Post Traumatic Stress Disorder ↑ and Depression

14. Scottsville clinical placement with pediatric patients with chronic health conditions MSN with Certificate Health Professions Education. New Programs & Partnerships

15. Mutual alumnae events: Keeneland • & Louisville Boat Club • Research collaborators • Neonatal NP • Acute care NP • UofL 2009 distinguished Alumna: Dr. Pat Howard

16. Digital Natives Wants & Needs · Students and new RN hires · Perform best networked · Web: 1st source of information during this data tsunami · Thrive on instant gratification and frequent rewards · Prefer games to “serious” work

17. Digital Immigrants • Faculty and late and mid career RNs • Digital immigrants: maintaining some of our accent and traditions of the past • We cannot afford to teach as we were once taught • We cannot afford to practice as we have once practiced

18. Simulation & EHRs

19. Nurses will always have a job! • Largest group of health care providers (2.5M) • February, 2009: 27,000 new RN jobs • Bureau of Labor Statistics www.bls.gov 587,000 RN jobs needed through 2016 • But what kind of job will they have?

20. New RN economic competitors • May not get 1st pick job as new grad • Retired RNs returning to work • Delaying retirement • Increased shift in part-time to full-time • Working harder, faster, more shifts • Hospital patient volume down but more acutely ill, some RN downsizing

21. New RN challenges • Move beyond educational comfort zone • Earn MSN as Nurse Practitioner • (only 2% of 4th medical students plan to work in primary care) • Expand knowledge of genetics, informatics, geriatrics & forensic nursing • Earn PhD to teach/conduct research

22. Ask about the education of your RN • Aiken, L. JAMA (2004; 2003) • N= 232,342 general, orthopedic, vascular surgery pts from 168 PA hospitals • Education: 10% ↑BSN nurses → 5%↓surgical mortalities and morbidities 30 days post admit. • Practice:  magnet hospitals: recruit/retain RNs/MDS • Policy: advocacy for lower pt/RN ratios • 4:1 rather than 8:1

23. Evidence Based Practice • Translates nursing research and other disciplines’ research to practice • Promotes data driven decisions • Supports PhD nurse scientists and future DNP & practitioners

24. New areas: Informatics • Integration of healthcare sciences, computer science, information science, and  cognitive science to assist in the management of massive healthcare information.  • Nursing informatics • Dental informatics • Medical informatics • Pharmacy informatics • Allows health care providers to make improved clinical decisions • Saba, V. & McMormick, K. 4th ed, (2006). Essentials of nursing informatics. New York; McGraw Hill.

25. New areas: Genomics • Almost every disease has a genetic component • Nurses need to do 3 generation pedigrees on every patient • Nurses need to consider pharmogenomic properties

26. What does this mean to you? • Lead your own health care journey • Focus on own health with • diet, exercise, stress relief • Obese children in Ky 21%; Tx 20.4% • Listen to your own body and follow scheduled preventive exams • Become a digital immigrant and search WebMD.com or Netwellness.org

27. What does all this mean to you? • Know thy nurse! • BSN or AD • Ask questions, write them down, take a friend/ spouse to your health care visits • Use NPs and advocate for NP reimbursement at 100% • Support nursing students’ scholarships and faculty to educate more students

28. Summary • Medicine = cure of illness • Nursing = care and prevention • Both: once avocations, now industries • Health care now much like housing, auto and bank industries • 17% GNP 2009; 20%-2015; 50%-2050 • Older adults double in 2030

29. Summary • Out of balance health care • US health care is quite good, but is most expensive in the world • 1/5 of ER visits are uninsured (Secy. HHS Kathleen Sebelius) • Health care (insurance) reform for costs and access • Nurses can play a significant role!