Julie Thomas, DNP, RN, CPHQ, NEA-BC Co-Chair North Texas Regional Coalition-Texas Team

1. Texas Team: Advancing Health through Nursing Julie Thomas, DNP, RN, CPHQ, NEA-BC Co-Chair North Texas Regional Coalition-Texas Team

2. Implementing the Future of Nursing Recommendations

3. Objectives • Describe how to become involved in efforts to advance the Future of Nursing • Develop grassroots methods for spreading the Campaign for Action at participant’s organization • Demonstrate increased awareness of current and planned initiatives to support the nursing and its impact on the Health of Texans

4. Prepare to Captivate: Know your Audience

5. Remember Who’s In Charge

6. We Are!

7. The Time is Right ! • IOM Reports • Health Care Reform-Affordable Care Act • Primary Care Shortages • Value-Based Purchasing • Increased focus on Research and Evidence-based Care • National Initiatives on Quality and Safety • Care Coordination

8. The 8 Recommendations • Remove scope of practice barriers. • Expand opportunities to lead collaborative improvement efforts. • Implement nurse residency programs. • Increase the proportion of nurses with BSN to 80% by 2020. • Double the number of nurses with doctorate degrees by 2020. • Ensure that nurses engage in life-long learning. • Prepare nurses to lead change. • Build an infrastructure for the collection and analysis of workforce data.

9. First Things First: Getting Out the Message • Frontline Staff-What’s in it for me? • Over 500 page report from nurses-over 2 years of work • Transform Care Delivery • Platform that supports nursing’s commitment to Patient Care • Coalition Efforts-Website updates • Staff Newsletters • Ties to Strategic Initiatives-Vision • Staff Forums and Community Presentations

10. Vision 2015-A Sample Engage and support recommendations for RWJF/IOM Future of Nursing  Remove Scope of Practice Barriers • Advance use of CNS-driven, population-focused programs, e.g. Stroke and Trauma Certifications • Expand role of Unit Secretaries to Health Unit Coordinators Nurses to lead and diffuse collaborative improvement efforts • Continue to improve nurse-to-physician relations as evidenced by increased collaboration/participation of physicians on key house wide initiatives  • Open and sustain advances in throughput with a Clinical Decision Unit Bridge the gap from academia and practice • Build and sustain a mentoring program for new graduates based on Professional Practice Model and Magnet® Model Increase BSN rate to 80% house wide by 2015

11. Vision 2015-A Sample Engage and support recommendations for RWJF/IOM Future of Nursing  Prepare nurses to lead change • Advance number of certified nurses to 50% Double the number of doctorate prepared nurse Embrace Evidence-Based Practice and Research Each unit will engage in 1 EBP/Research Study Enhance a culture of excellence by achieving key performance milestones that affect quality and safety Nurse sensitive metrics will continually improve and outperform national benchmarks: • Fall prevention program promoting efforts to exceed NDNQI 25th percentile for number of falls per 1000 patient days • Sustain and/decrease current rate of HAPU, CAUTI, CLBSI

12. Removing Scope of Practice Barriers • Advanced Practice Nurses • Perryman Report fully supports the IOM stance that APN increase access, safety and continuity of care • Average cost of NP visit is 20-35% lower than the average cost of a physician office visit (MEPS) • No difference in malpractice rates among states • National Council of State Boards of Nursing

13. Removing Barriers • Examining Our Practice-Remember it’s not just APNs… • What you or your colleagues doing that does not require your RN skill set? • What you or your colleagues not doing that we are great at doing? • Care Coordination • Working with State and Federal Regulatory bodies • National Council of State Boards of Nursing • Transition to Practice • Texas Medical Association • Peers In Practice

14. Removing Barriers • Great Work Being Done! • California Study of Regulations • RWJF-Transforming Care at the Bedside • Ways to Expand • Health Care Policy-Duty • Informatics • Customer Service-Advocacy • Certification • Education or Academic Partnerships

15. Collaboration • Meeting the Challenge to Improve the Care • Our ethical code requires it-Provision 8 “the nurse collaborates…” • Engaging those with similar goals • Transforming Care at the Bedside • Community Transition Programs • Medical Services/Ambulances • Geriatric • NICHE

16. Interprofessional Collaboration • IHI Triple AIM • Decrease Cost • Increase Satisfaction or the “patient experience” • Improve the overall health of the population • Community partnerships-Community Health Action Team • HCAHPS questions • Care Coordination/Transition of Care • Clinical Nurse Leader • Partnership-Avoid “acute care centric” • Social Services, Pharmacists, Physicians, Home Care, LTC

17. Nurse Residency Programs • Not just a “product you purchase” • Advantages of formalized program • Data/recruiting • Not Just About Student Placement • Henry Street Project-Public Health • It’s a Partnership! • AACN/AONE Guiding Principles for Practice-Academic Partnerships • Develop Formal Relationships • Advisory committees • Fellowship programs to advance EBP • Shared Visions/Mutual Goals • Dedicated Education Units • Externships

18. Nurse Residency Programs • Why We Need • Increase recruitment and retention • Decrease cost for orientation and training • Internships- “not just 15 weeks” • Mentorships • Journey to Professionalism • Teaching to ANA Standards of Care • ANA Code of Ethics • Get Involved • Preceptor/Clinical Coach

19. Transition to Practice Model-NCSBN

20. Increasing the Number of BSNs

21. Increase the Number of BSN Nurses • What does this mean and why? • Managing complexity • Advancing EBP/Research • Lower mortality and failure to rescue rates • Doesn’t mean forget about the ADNs • Pipeline for BSN enrollees • Often best option for minorities or low-income • Student Experience • Clinical Placement software • Other opportunities/Other industries

22. Ways to Communicate • Presbyterian Hospital of Dallas • Strategic Vision • Academic Partnerships • Recruitment and Retention • Funding and Encouragement = Success! An increase of 12% in 1 year to 67% rate of BSNs • Seton • Long-term strategy with Leadership Established Guiding Principles • Increase BSN hire rate • Increase Nursing retention rates • Increase number of non-BSN nurses returning to school

23. Double Doctoral Prepared Nurses Call to Action to Universities, Colleges and Hospital Systems • The Doctor of Philosophy • Leads Research Efforts • The Doctor of Nursing Practice • Translation and Promotion of Research into Practices • Clinical Specialist

24. Life-long Learning • Advance Education • Certification in area of Specialty • Attend Conferences • Share locally

25. Prepare Nurses to Lead Change • TONE/TNA-Improving EHR Education-HIT • Nurses Members of Boards-Not just hospitals • Boardroom presentations on Micro-level changes • Opinion Polls conducted by RWJF show many believe nurses should have more influence on improving quality of care and preventing errors • Lean Methodology • Support Shared Decision-Making

26. Summary • Keep Texans First • Know your power but more importantly your responsibility • Use Your Resources • Know the Issues • Get Involved • Are you the Carrot, the egg or the coffee??

27. Questions?

28. Visit us on the Web http://thefutureofnursing.org http://championnursing.org Follow us on twitter www.twitter.com/futureofnursing http://twitter.com/#!/championnursing Join us on Facebook http://facebook.com/futureofnursing http://www.facebook.com/TxTeamNursing Campaign Resources