Enhancing Navy Nursing through Strategic Initiatives

1. Navy Nursing Update CAPT Sarah Martin Deputy Director, Navy Nurse Corps Active Component 30 April 2012

2. What We Know About Nurses • Knowledge of frontline nurses and their interactions with patients are critical to improving patient outcomes • Nurses at every level across the continuum strengthens the health care system in general • Increasing the time nurses have with the patient to educate is essential to the goal of patient-centered care • Integrated systems that leverage assets (people, technology) are key to increasing efficiency and allowing nurses to spend time with the patients. • Multi-disciplinary care teams improve the quality, safety and effectiveness of care • NURSES MAKE A DIFFERENCE!!!!!

3. What We Also Know • More than 3 million registered nurses in the United States • Nurses have a steadfast commitment to patient care, improved safety and quality, and better outcomes • Nurses can fill multiple roles • Nurses are lifelong learners • Nurses are leaders in advancing health

4. NAVY NURSING Nurse Corps Force Data

5. Nurse Corps Force Structure Flag 1 CAPT 146/146 DOPMA Force Structure (OPA) Actual Force (Inventory) 5% 5% CDR 338/357 12% 12% 21% LCDR 589/648 22% 63% LT & Below 1806/1815 61% TOTAL = 2875 96.9% manned TOTAL =2966 Data Source: OPA to Inventory FEB 2012

7. FY-2012 – Navy Nurse Corps Strategic Plan CLINICAL & INFORMATION RESEARCH STRATEGIC WORKFORCE PROFESSIONAL MANAGEMENT PARTNERSHIPS EXCELLENCE • Maximize Clinical and Professional Excellence • Build , strengthen and advance clinical, operational and professional skills and knowledge • Promote Communication Across the Enterprise • Sustain, advance and evaluate communication across the enterprise • Cultivate a Culture of Scientific Inquiry • Increase interest, submission and selection of evidence based practice research projects to improve the health of our patients and add to the body of nursing knowledge • Foster a Culture of Collaboration • Develop joint and strategic partnerships to strengthen the profession of nursing and maximize utilization of limited resources • Optimize Human Capital Resources • Focus on maintaining the right workforce to provide nursing care across the full range of military operations Vision For Navy Nursing Provide exceptional patient & family centered, interdisciplinary, and evidence-based care. We place quality-caring relationships at the center of our practice resulting in a safe, compassionate and healing environment. The Navy Nurse Corps Strategic Plan is aligned with Navy Medicine ‘s Strategic Plan relative to Quality of Care, Agile Capabilities, Deployment Readiness, Total Force and Research & Development.

9. MEDICAL HOMEPORT AND NAVY NURSING

10. Nearly 40 sites applied for NCQA recognition last year, and 130 are currently applying * This site was a Navy site during the application process and has since realigned to JTF

11. Typical Navy Medical Home Port primary care team Example: Panel size = 4,400 patients Equivalent of 4 full-time providers (not bodies) Provider c-FTE 0.5 RN per provider c-FTE 2 nurses 2.5 CMA per provider c-FTE 10 medical assistants 0.75 clerk per provider c-FTE 3 clerks

12. Behavioral Health is the first specialty to embed its specialists in the MHP team Behavioral Health • 1 Integrated Behavioral Health Consultant (IBHC) per 7,500 enrollees • Depending on population, could include psychiatrists, clinical psychologists, licensed clinical social workers, licensed professional counselors • Practice model has been re-conceptualized to meet the needs of primary care populations • Shorter (15-20 minute) appointments • Fewer encounters per patient (typically 1-2 visits per patient) • Care is co-managed with the Primary Care Manager (PCM) • Brief, focused interventions in which patient drives problem identification, commits to short-term behavioral change, and sets a goal to accomplish by the next visit • Fully-integrated provider provides consultative services and training to MHP Team • Goal: improve early recognition, treatment, and management of psychosocial conditions

13. Additional specialties, based on patients’ needs, will gradually integrate into MHP Pharmacy Case Management Nutrition Case Management Pharmacy Nutrition • 1 per 7,200 enrollees • Need-based assessment of case mix/enrollee complexity • Registered Nurses or Licensed Social Workers • Care management/coordination for high-risk patients, including • Chronic illness or disabled • Complex care needs, • At risk for hospitalization • Hospitalized enrollees • High-risk and high utilizers • Based on population • Dieticians, Nutritionists, or SMEs in nutrition management • Advise patients on • Health promotion and Illness prevention • Nutrition; administering nutrition therapy • Teaching, monitoring, advising the public, • Improve quality of life through healthy behaviors • Based on population • Assist with medication education, reconciliation, other clinic needs • Anticoagulation • Anti-lipidemic • Medication management and patient education • Prescription renewal • Over the Counter (OTC) • Medication reconciliation

14. What is Navy/GS Nurse Role in Ambulatory Care Role? • Advanced Practice Nurses • Experts at primary care with a focus on wellness and preventive care at every encounter; fastest group of primary care providers in the country • Medical Home Port Team Leaders and command champions • Integral to team in delivering timely, easily accessible quality care

15. Navy Nurses (GS/Active Duty) in Role in Medical Homeport? • Clinic Managers • Case Manager • Patient Educators • Team Leaders • Disease Management/Wellness Promotion

16. Ambulatory Nursing Challenges in the Navy • Continuity for Medical Home with deployment cycles • Capturing Workload – no defined workload management system that captures ambulatory care • Budget Constraints • Competency Development – Experts in the Field • Billet Alignment • MISSION OF NAVY MEDICINE?

17. Unanswered Questions • Do we need an Ambulatory/Medical Homeport Subspecialty Code? • How does that fit into Navy’s billet structure? • If assets are shifted, how do we maintain wartime requirement and clinical sustainment?

18. QUESTIONS?

19. BACK-UP

20. NCQA PCMH Levels and Scoring 6 standards = 100 points, including passing score on all 6 Must Pass Elements NOTE: Must Pass elements require a ≥ 50% performance level to pass Although NCQA recognizes practices with a score greater than 34 as a Patient-Centered Medical Home, Navy Medicine requires a score of 60 or greater (Level 2 or 3) for acknowledgement as a Medical Home Port.

21. Each element under the 6 NCQA standards is scored based on how fully the element is met **Must Pass Elements