Issues and Trends

1

• Issues and Trends

2
Whats the national perspective on healthcare and
nursing?

• Managed Care and Healthcare Financing
• Healthcare Workforce Issues
• AONE Perspectives on the Nursing Shortage
• VHA New England Nurse Executive Council Work
• Magnet Hospital Program
• E.C. Murphy/VHA Studies on Nursing Roles

3
Trends that have affected healthcare
organizations

• Managed Care
• Reductions in Reimbursement
• Cost of healthcare future projections
• Patient Care Redesign Shared Governance
• Quality and Outcomes
• Self-Directed Work Teams
• Patient Satisfaction and Consumerism
• Medical Advances
• IT - opportunities and costs
• ?

4
Whats the national perspective on healthcare and
nursing? Cont.

• Patient Safety/Medical Errors/Public Health
• Evidence-Based Practice and Clinical Guidelines
• Care across the continuum (case management)
• VHA Study on the Impact of Organizational
  Redesign and New Nursing Leadership Skills
• Evolution of the First Line Manager Role

5
Healthcare Workforce Issues

• While nursing shortage is growing acute and
  worsening, many healthcare disciplines are also
  in short supply
• In Connecticut, major shortages projected for
  pharmacists, radiology technicians, nursing
  assistants

6
Nursing WorkforceStatistics
Factors

• INCREASING AVERAGE AGE OF NURSES
• ENROLLMENTS IN NURSING LOWER
• REAL WAGES NOT KEEPING PACE
• INCREASED FAMILY DEMANDS
• GOOD ECONOMY DECREASES HOURS WORKED
• SEEKING WORK/LIFE BALANCE
• PREDICTED GAP MAY APPROACH 200,000 - 300,000
  NURSES IN 2020

• IMAGE/INSTABILITY IN HEALTHCARE
• COST REDUCTION INITIATIVES
• FEWER WOMEN OR MEN CHOOSING NURSING
• SANDWICH GENERATION
• ADJUST HOURS TO HOUSEHOLD NEEDS
• ABOVE PLUS NEED INCREASED BS/MS

7
AONE Perspectives on the Nursing Shortage A
Blueprint for Action Oct 2000

• Drawn primarily from work of Dr. Peter Buerhaus
  and Dr. Mary Wakefield
• Current v. impending/evolving nurse shortage
• Major factors regulation, reimbursement,
  technology, population demographics, and societal
  changes
• Recommendations made in areas of
• Assessing Need
• Cultivating Adequate Supply
• Skilled Workforce and Efficiency
• Monitoring Progress and Understanding Value
• Creating the Future

8
AONE Recommendations

• Assessing Need - improve data, wide collaboration
• Adequate Supply - partnerships, incentives for
  retention, attract future nurses, tuition support
• Skilled Workforce Efficiencies - work/ life
  quality and changing demands for mature nurses
• Monitoring Progress and Value - patient outcomes
  related to delivery models and staffing,
  regulatory barriers to innovation
• Creating the Future - practice models for nurses
  r/t other healthcare workers, maximize use of
  technology to support nursing work

9
VHA New England - Nurse Executive Council

• Ongoing effort to define the situation related to
  nursing workforce supply and demand
• Goal is to involve stakeholders in idealized
  design of nursing and healthcare to assure
  adequate healthcare workforce
• Must deal with both supply and demand side
• Parallels work and findings of AONE report

10
MAGNET HOSPITALS

• The Magnet Nursing Services Recognition Program
  is a national recognition program for nursing
  services that provide quality patient care
  through nursing excellence.
• As of 2010, 377 Magnet Hospitals were recognized
  by ANCC , including 2 Hospitals in CT.
• A three stage process of application ,
  self-study, and site visit
• Based upon the ANA Scope and Standards for Nurse
  Administrators

11
MAGNET DESIGNATION

• Recognizes nurses worth
• Is a major factor in nurse recruitment
  retention- leadership professional practice
• Means a competitive advantage
• Enhances nursing care and patient outcomes
• Mortality, patient satisfaction, falls...
• Increases staff morale
• Attracts high quality physicians/specialists
• Reinforces collaborative relationships
• Creates a magnet culture - excellence goodness

12
E. C. Murphy LLC/VHA Studies of Nursing Roles

• RN role is highly complex ( of work activities)
• RN role is relatively unfocused (doing right
  work)
• RN role overlaps significantly with others
  Right role in right place at right time
• High degree of waste (non-value added work)

13
ECM/VHA Nursing Studies (cont.)

• These characteristics of RN roles lead to
• Decreased morale and increased stress
• High turnover and illness rates
• Decreased quality of care and patient
  satisfaction
• Decreased physician satisfaction
• Increased costs of delivery care
• Murphy, EC et al. Nursing Management, October
  1997

14
PATIENT SAFETY MEDICAL ERRORS

• IOM Report 1999
• Health care errors are between 4th - 8th leading
  cause of preventable deaths
• 44,000 - 94,000 deaths per year may be
  attributable to health care errors

15
Major Medical Error Concerns

• Medication errors
• Wrong side surgery
• Patient safety
• Inadequate monitoring and reporting
• Other

16
Nursing Sensitive Quality Indicators ANA
1996-2007

• Staff mix in acute care
• Nursing hours per patient day
• Pressure ulcers and patient falls
• Patient satisfaction with pain management,
  education, overall care, nursing care
• Nosocomial infection
• Nurse satisfaction

17
Evidence-Based Practice and Clinical Guidelines

• Growing emphasis on interdisciplinary plans of
  care with specific actions required and expected
  outcomes
• Use of research evidence to guide practice v.
  what I learned in school
• Increased need for monitoring and coodination of
  care
• Great potential to enhance care outcomes through
  performance improvement

18

• If we want everything to remain as it is, it
  will be necessary for everything to change.
• Giuseppe Di Lampedusa
  1896-1957

19
Evolution of First Line Managers

• Charge nurse or lead person
• Head nurse or department head
• Patient care coordinator
• Nurse manager or department manager
• Clinical director or department director
• Service line or program director/leader
• ??? Other

20
ROLE OF NURSE MANAGERS

• Planning
• Organizing
• Budgeting
• Staffing
• Assuring quality
• Staff development
• Team relationships
• Problem solving
• Personnel management

• Conceptual skills
• Technical/clinical skills
• Human relations abilities

21
Key Accountabilities of Patient Manager Role

• Staff selection, availability, support
• Effective relationships for quality and standards
• Coaches, mentors, develops and evaluates staff in
  an continuous learning environment
• Provides clinical leadership that fosters
  self-directed work teams