Kentucky Nursing Capacity Consortium Update

1. Kentucky Nursing Capacity Consortium Update Kim Dees, MSN, RN, MBA/HCM Kentucky Hospital Association Vice President of Health Professions Sherry Holmes, MSN, RN University of Kentucky College of Nursing Coordinator of Assessments and Special Projects Kentucky Organization of Nurse Leaders 8th Annual Conference September 21, 2012 Louisville , Kentucky

2. Objectives • Provide a brief overview of the 2010 IOM Report recommendations on the future of nursing • Describe the current activities of the Kentucky Nursing Capacity Consortium (KNCC) • Summarize the outcomes of the Pilot: Supporting Transition to Practice in Rural Kentucky

3. Institute of Medicine October 2010 Report: The Future of Nursing Leading Change, Advancing Health • Remove scope-of-practice barriers • Expand opportunities for nurses to lead and diffuse collaborative improvement efforts • Implement nurse residency programs • Increase the proportion of nurses with a baccalaureate degree to 80% in 2020 • Double the number of nurses with a doctorate by 2020 • Ensure that nurses engage in lifelong learning • Prepare and enable nurses to lead change to advance health • Build an infrastructure for the collection and analysis of interprofessional health care workforce data

4. Relationship of KNCC and Kentucky Action Coalition • KNCC applied to and was selected by the Future of Nursing Campaign for Action to become the Kentucky Action Coalition (KYAC) (9/23/2011) • http://www.campaignforaction.orgis the website for the Campaign for Action • Early October the website will be upgraded to have a link to the KYAC for progress reports

5. KYAC Goals and Objectives • Short term goal - position KYAC to achieve long-term goals (Fall 2011-Fall2012) • Establish plan for strengthening stakeholder base • Develop media plan to influence public and health professions awareness of the IOM Report and KYAC • Complete Rural Residency Pilot and determine need for statewide implementation

6. KYAC Goals and Objectives • Long term goal - Kentucky will have a highly educated nursing workforce that can practice at full scope (12+ months) • Actively engage Kentucky nurses in policy making • Reduce barriers for APRN practice • Increase percentage of BSN and doctorally prepared nurses • Develop tracking mechanisms to measure outcomes of our work

7. IOM Recommendations:KYAC Focus/KNCC Activities • Barriers to APRN Practice • 80% BSN by 2020

8. IOM Recommendations:KYAC Focus/KNCC Activities Barriers to APRN Practice

9. Kentucky Statutes:Impact on APRN Practice • Prevent APRNs from ordering some services and performing certain exams • Prohibit reimbursement or provide reduced reimbursement – Medicaid reimburses APRNs at 75% of the physician rate • Complexity of laws produces confusion • Kentucky APRNs may practice independently; however, they must have a Collaborative Agreement for Prescriptive Authority in order to prescribe medications

11. Legislative Update 2012 • HB 512 and SB 190 bills, which would have removed the requirement that advanced practice registered nurses have a collaborative agreement with a physician in order to prescribe non-scheduled drugs, did not pass during the most recent legislative session. HB 512 did make it through the approval process within the House. SB 190 was not heard in the Senate. • Advocacy work resulted in additional House and Senator champions for the issue and the plan is to reintroduce the legislation in the next session • Legislative leadership worked with nursing to get the necessary changes made to HB 4 (This bill incorporated increased use of KASPER for reporting and monitoring prescriptions)

12. Legislative Preparation 2013 • In follow‐up to House Bill 1, the Kentucky Board of Medical Licensure has issued a 39 page document for regulation of prescribing and dispensing medications which is being circulated around the state for comment • Dr. Ardis Hoven (from Lexington) has been elected president of the AMA which may impact the activity of KMA to assure that nothing happens in Kentucky that is in opposition to the AMA agenda

13. Legislative Preparation 2013 • Pay close attention to those running for election this fall in order to determine who nursing should support • The many calls made by KNCC and KNA during the 2012 session were positively noticed by the legislators and their staff • Nursing leaders need to be knowledgeable regarding the legislation that impacts nursing practice so that they can easily educate others • VOTE

14. IOM Recommendations:KYAC Focus/KNCC Activities 80% BSN by 2020

16. Kentucky(2008 National Sample Survey of RNs)

17. Kentucky Licensure StatisticsSeptember 2012 Kentucky Board of Nursing RN Current Licensure Count - By Educ. Level & County of Residence http://www.kbn.ky.gov/stats

18. RN-BSN KentuckyAACN, 10 Schools reporting • 2010-2011 • Enrolled 708 • Graduated 217

19. RN-BSN: Barriers to Progression • Exploring barriers to academic progression for Associate Degree nurses • Completed an audit of 11 anonymous transcripts from the technical and community college system • Plan developed with the technical and community college system Associate Degree programs to modify their programs to assure that all graduates are “core certified” in order to reduce the number of credits required at a state supported RN-BSN program in KY

20. Pilot: Supporting Transition to Practice in Rural Kentucky • One year project designed to assist new nurse in the transition from student to practice • Four major components: • Support sessions for the new nurses • Local mentoring • Educational modules delivered via web • Change Projects

21. Rural Residency Pilot: Findings • Pilot did not provide base line data or conclusive findings due to lack of participation • New nurses and mentors were not given paid time to participate • Information obtained and lessons learned are applicable to the design of future residency programs

22. Joint Education Conference • KBN and KNCC will hold a joint education conference this fall (November 30 tentative date in Louisville) • Nancy Specter, from the National Council of State Boards of Nursing will deliver the keynote, “Mind the gap: Best Practices for Accelerating the Practice Readiness of Nursing Students” • Participants: hospitals/employers and educators

23. KNCC/KYAC Priorities for 2012-2013 • Accessibility of BSN programs • Legislation regarding prescriptive authority of APRN and Medicaid authority to improve access to healthcare for Kentuckians • Engaging more practice partners into the group • Look at the need for education of nurse educators (MSN for nurse educators)

24. In Conclusion • Commit to take action on recommendations from IOM report, this is about patient-centered care and health care reform, essential that nurses mobilize • Support nurses to advance their education • Optimize the voice of nurses in supporting Kentucky legislature to eliminate barriers to APRN practice

25. References • Institute of Medicine. (2011). The Future of Nursing Leading Change, Advancing Health. Washington, DC: The National Academies Press • Kentucky Board of Nursing RN Current Licensure Count - By Educ. Level & County of Residence. (September 18, 2012) http://www.kbn.ky.gov/stats • U.S. Department of Health and Human Services Health Resources and Services Administration. (September 2010) The Registered Nurse Population Findings from the 2008 National Sample Survey of Registered Nursing http://bhpr.hrsa.gov/healthworkforce/rnsurvey/2008/nssrn2008.pdf

26. Become part of KNCC Send email to janek@email.uky.edu