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Nursing in the New Millennium

Nursing in the New Millennium. Phyllis M. Connolly PhD, APRN, BC, CS. Nursing’s responsibility is awesome—in patient care and also in creating a new society (Nyberg, 1998, p. 209). Life at warp speed New type of change, age of unreason Constant change, permanent white water. 3 Assumptions.

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Nursing in the New Millennium

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  1. Nursing in the New Millennium Phyllis M. Connolly PhD, APRN, BC, CS

  2. Nursing’s responsibility is awesome—in patient care and also in creating a new society (Nyberg, 1998, p. 209)

  3. Life at warp speed New type of change, age of unreason Constant change, permanent white water 3 Assumptions

  4. Changing Work Environment • Technology • Demographics • Managed Care • Purchaser’s Influence • Health Insurance Industry • Changing Health Systems

  5. Report Card: Managed Care • Access • Quality/Appropriateness • Promotion/Prevention • Outcomes • General health improved • Quality of life improved • Treatment reduces psychological stress • More productive & independent

  6. ANA Initiatives Improve Quality of Health Care • 1994 Nursing’s Safety and Quality Inititive • 1996 Nursing-Sensitive Quality Indicators for Acute Care Settings • 1997 National Data Base of Nursing Indicators (NDQI) • CalNOC largest ongoing nursing quality measurement data set in nation

  7. IOM (2001)Crossing The Quality Chasm: Changes Needed • Safe • Effective • Patient-centered • Timely • Efficient • equitable

  8. IOM Rules for Redesign (2001) • Care is based on continuous healing relationships • Care is customized according to patient needs & values • The patient is the source of control • Knowledge is shared & information flows freely • Decision making is evidence-based

  9. IOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses • Address management practices • Workforce capability • Work Design • Organizational safety culture

  10. Impact of Nursing Studies Patient Outcomes • Needleman et al.(2002) 1997 data •  hrs care/day RNs medical pts. •  LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest & “failure to rescue” •  hrs. care/day RNs surgical pts. •  UTI, “failure to rescue” • Aiken et al.(2003) • 10%  in proportion of BSN •  5% risk of patient death & “failure to rescue”

  11. Strategies & Skills For Future • Ability to understand systems • Critical thinking, analysis and problem solving • Reframing • Personal growth & mastery, ability to tolerate ambiguity & take risks • Emotional intelligence; self-restraint (impulse control) & compassion

  12. Strategies & Skills For Future Cont. • “can do” spirit • Business leadership & intelligence • Ability to manage change • Group management skills, negotiating & conflict resolution • Stewardship • Collaborative leadership skills

  13. AACN: Role New Clinical Nurse Leader (Summary draft 2003) • Clinician: Leadership in care of sick across all environments • Outcomes manager • Client Advocate • Educator

  14. AACN Clinical Nurse Leader Role Cont. • Information manager • Systems analyst/Risk Anticipator • Team Manager • Member of Profession

  15. “To be active participants in shaping the health care system, nurses must learn new skills” Alderman (2001, p. 50)

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