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Future of Nursing - Crown Point
- 2. Mindy Yoder DNP, FNP-BC, RN Thank you.
- 3. Agenda Future of Nursing Presentation Panel Discussion Simulation Showcase
- 4. Mindy Yoder DNP, FNP-BC, RN Leading Change, Advancing Health
- 5. Overview Healthcare challenges in the U.S. Our Nursing Profession Healthcare Reform IOM Nursing Report-Call for Leadership
- 6. What is the state of our HEALTHCARE SYSTEM?
- 7. A short list… Unsustainable costs Equitability of access to care Difficulty building consensus
- 8. A short list…cont. Care coordination Primary care shortage Aging population and rise of chronic disease Poor outcomes
- 9. Why does U.S. HEALTHCARE cost so much?
- 10. Why $$$? Technology Prices are higher in the United States Price insensitivity to end consumer Judgment-based nature of MD care Values and culture
- 12. Per capita health spending and 15-year survival for 45-year-old women. U.S. and 12 comparison countries, 1975 and 2005 Muennig P A , Glied S A Health Aff2010;29:2105-113 ©2010 by Project HOPE - The People-to-People Health Foundation, Inc.
- 13. Demographics Starting in 2011 10,000 people in the U.S. have been turning 65 every day
- 14. Fastest Growing Population, 85+ 20,000 19,041 18,000 16,000 14,000 14,198 12,000 10,000 8,745 8,000 6,597 6,000 5,751 4,000 4,240 2,000 0 2000 2010 2020 2030 2040 2050 Projected Number of Americans 85 years and over
- 15. Older Americans with Multiple Chronic Conditions Medicare beneficiaries with at least one chronic condition Nation’s healthcare spent on treating patients with chronic diseases Source: AARP. ―Beyond 50.09: Chronic Care: A Call to Action for Health Reform.‖ Washington, DC. 2009
- 16. What is the state of NURSING?
- 17. A short list… Lack of nursing educational preparation to meet the demands of our current healthcare system Practicing clinicians regularly make decisions on tradition rather than empirical evidence Chronic, cyclical nursing workforce shortage Nursing faculty shortage, yet faculty are poorly compensated Shortage of doctoral nurses Education—practice gap
- 18. Projected shortfall in 2020 1million NURSES
- 19. The bottom line High-quality, patient-centered health care for all will require remodeling of health care system Three national healthcare goals (Donald Berwick) Improve health Enhance the patient experience Reduce/contain costs Nurses are essential partners in achieving success
- 20. The challenges before us require significant improvement in public and institutional policies at national, state and local levels.
- 21. What is the impact of HEALTHCARE Reform?
- 22. Patient Protection and Affordable Care Act 2010 Health Insurance Reform • Expand insurance coverage • Expand consumer protections • Reform industry practices Status Quo • Health costs exceed general inflation • Sub-optimal population health • Unexplained Payment Reform, variations in Delivery Systems practice patterns • Evolve Medicare payment • Questions about systems from fee-for-service evidence base of to value based payment some procedures • Test new payment methodologies and patient care delivery models for Medicare, Medicaid & CHIP Source: Health Solutions Division, Manatt, Phelps & Phillips, LLP
- 23. Payment Reform, Quality, and Delivery System Change Timeline 2010 2011 2012 2013 2015 Shared Savings/ Dual New National pilot: Accountable Reduced Eligibles Center, Medic Bundled Health payment for Office are & Payments for Organizations hospital- established Medicaid Hospital & (ACOs) acquired Innovations post-acute care (FCHCO) conditions (CMMI) Reduced payments for preventable Estimate: these initiatives hospitalizations will reduce Medicare Value-based spending by $12b over purchasing 10 years for hospitals Independence at home demonstration project Source: Kaiser Family Foundation
- 24. Evidence-based recommendations for education and practice.
- 25. Why Nurses? A high-quality health system will provide: • Chronic care management • Care coordination • Prevention and wellness • Care across the lifespan Nurses can help address these needs
- 26. The Future of Nursing IOM Report Ensure that nurses can practice to the full extent of their education and training Nurses should achieve higher levels of education through an improved education system that promotes seamless academic progression
- 27. The Future of Nursing IOM Report Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States Improve data collection and information infrastructure for workforce planning and policy making
- 28. 8 Recommendations Remove scope of practice barriers Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement nurse residency programs
- 29. 8 Recommendations Increase proportion of nurses with BSN degree to 80% by 2020 Double the number of nurses with a doctorate by 2020 Ensure that nurses engage in lifelong learning
- 30. 8 Recommendations Prepare and enable nurse to lead change to advance health Build an infrastructure to collect and analyze healthcare workforce data
- 32. Growth in Doctoral Nursing Programs: 2006-2011 184 153 120 DNP 92 53 20 125 124 120 Research-Focused Doctoral 116 111 103 0 20 40 60 80 100 120 140 160 180 200 2011 2010 2009 2008 2007 2006 Source: © American Association of Colleges of Nursing. All Rights Reserved
- 33. Enrollments in DNP & Ph.D. Programs: 2003-2011 10000 9000 9,094 8000 7000 7,037 6000 5000 5,165 3,927 3,982 3,976 4,907 3,718 4,161 4,611 4000 3,439 3,229 3,415 3000 2000 1,874 1000 862 170 329 70 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 Research Focused Doctoral Doctorate of Nursing Practice Source: © American Association of Colleges of Nursing. All Rights Reserved
- 34. Better Care Healthy People/Healthy Affordable Care Communities
- 35. Mindy Yoder DNP, FNP-BC, RN myoder@sf.edu 260-399-7700, ext. 8510
- 37. Mindy Yoder DNP, FNP-BC, RN Local, State and National Perspectives
- 38. Panelist Natalie Eddy,DNP,FNP-BC,RN IU Health Southern Indiana Physicians Group, Coalition of Advanced Practice Nurses in Indiana
- 39. Panelist Tracey Franovich,MHA,RN Vice President of Operations Franciscan Alliance
- 40. Panelist Kimberly J. Harper, MS, RN Executive Director, Indiana Center for Nursing
- 41. Panelist Marsha King,MS,MBA,NEA-BC,RN Adjunct Faculty/Clinical Simulation University of Saint Francis
- 42. Panelist Amy Knepp,NP-C,MSN Chair, Department of Nursing and Assistant Professor, University of Saint Francis, Family Nurse Practitioner for Parkview Physicians Group
- 43. Panelist Shelly Major,MS,MBA,NEA-BC,RN Vice President-Patient Care Services, CNO Methodist Hospitals
- 44. Panelist Ronda McKay,MSN,CNS,RN Vice President-Patient Care Services, CNO Community Hospital
- 45. Panelist Carol Schuster,BSN,MBA,RN Northern Indiana Region CNO Vice President Patient Care Services Franciscan Alliance
- 46. Panelist Paula Swenson,MPA,BSN,RN Vice President-Patient Care Services, CNO St. Catherine’s Hospital
- 47. The Future of Nursing IOM Report Ensure that nurses can practice to the full extent of their education and training
- 48. The Future of Nursing IOM Report Nurses should achieve higher levels of education through an improved education system that promotes seamless academic progression
- 49. The Future of Nursing IOM Report Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States
- 50. The Future of Nursing IOM Report Improve data collection and information infrastructure for workforce planning and policy making
- 52. Marsha King MS, MBA, NEA-BC,RN Simulation and the Future of Nursing
- 53. History 2010 Grant Monies for Development of Simulation Lab 2011 High Fidelity Simulators- PediaSim and Metiman 2012 First Simulated Clinical Experiences (SCE’s) implemented
- 54. Simulation Preplanning and Preparation Identifying Learning Outcomes and Questions for Students Simulated Clinical Experience (SCE) Debriefing
- 55. Demonstration Basic Cardiac Assessment of a resident in a assisted living facility
- 56. Synopsis This is a 76 year old retired truck driver that has agreed to a focused cardiac assessment in his assisted living apartment.
- 57. Roles Patient – Metiman Patient Voice – Marsha King, USF Faculty Registered Nurse –Stephanie Spolarich, USF Faculty
- 58. Learning Objectives Demonstrates how to obtain a focused history of the cardiovascular system using appropriate communication techniques. Demonstrates an assessment of the cardiovascular and peripheral vascular system
- 59. Learning Objectives Recognize normal and abnormal assessment findings related to the cardiovascular and peripheral vascular systems Identifies modifiable and non- modifiable risk factors from the history
- 60. Prep Questions What data would be significant to obtain a cardiovascular focused history? What lifestyle factors affect the cardiovascular and peripheral vascular systems? What risk factors are modifiable and which are not? How is a cardiovascular and peripheral vascular assessment performed?
- 61. Prep Questions What are normal and abnormal pulses related to the hear and pulses? How are pulses and pitting edema graded? What findings would be important to document?
- 62. Debriefing Introduction: Discuss faculty role as a facilitator, expectations, confidentiality, safe environment for discussion Personal Reactions: Allow learners to recognize and release emotions, explore learner reactions Discussion of Events: Analyze what happened during the SCE, using video playback if available Summary: Review what went well and what did not, identify areas for improvement and evaluate the experience
- 63. Standards Interprofessional the Future of Team Simulation NURSING EDUCATION Research
Notas do Editor
- Welcome and self introduction by Margaret Stoffregen DeYoungMention the incredible mix of the audience (students, educators, practicing LPNs and nurses and other professionals). What a unique opportunity, nursing profession essential to quality healthcare outcomes. When else has our nursing community had this opportunity to come together/
- Mindy YoderThank you to all of our sponsors (name them) Methodist Hospitals, Franciscan Alliance, and Community Healthcare Systems. (USF personnel should start an enthusiastic applause.) After that, you might mention what Franciscan Alliance is…some/most in the audience will not know the name. Thank the Sisters in the audience for joining us today (they can rise and we can applaud).Today’s event is the first in a series of lectures under the “Future of” concept. Periodically, the university will be holding public lectures on substantive topics that we believe benefit our community. The University of Saint Francis is proud to introduce our signature series with the Future of Nursing—which represents a deeper conversation of this vital and dynamic profession in the healthcare field.”
- (Mindy continues…name features of today’s program AND the names of the presenters)Future of Nursing by Dr. Mindy Yoder, BSN/MSN Program Director, Department of Nursing. Explain the origin of the study (Robert L. Wood Foundation of Johnson & Johnson fame led ION to commission the study). …we will then dig deeper by looking at the Future of Nursing by asking what Chief Nursing Officers and other experts know about the future of nursing locally and across the state. Panel Discussion moderated by…looking again to the future, we will turn our attention to MetiMan—on stage with us now for a demonstration of how USF student nurses are learning the profession to become future nurses. Simulation Showcase led by Dawn Mabry, Director, School of Health Science Simulation Lab and assisted by a USF student (name nursing student, or let Dawn do that when she is up.)We will wrap up with ….Summary comments by Amy Knepp, Chair, Department of NursingDon’t worry, we will do our best to keep on track today…we’ll even squeeze in a seventh inning stretch to keep us all alert (NG to ad lib this part…).You each should have received a packet that includes a summary evaluation sheet. That is the form you will need to turn in as you exit today. There will be USF students at the doors collecting your evaluations and distributing certificates for two contact hours. I would like to (thank representative’s name?) from Lutheran who helped us facilitate the contract hours certification. Even if you are not collecting contact hours, we would like your feedback on the presentation to prepare for future events.
- 17% of the GDP is spent on healthcare in the U.S. (as compared with 3-5% in other countries) and is projected to increase to 20% within 7 years (SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, March 2009); focus on rescue care/sick care vs. preventive care; unnecessary re-hospitalizations allocation of healthcare resources: where are we spending HC dollars?-----healthcare disparities part of being in a democracy is that everyone has a voice and everyone’s opinions differ greatly Care coordination: fragmentation of care, duplication of services, safety/errors Outcomes: Ranked 29th in infant mortality rates by OECD (industrialized countries) Organization for Economic Cooperation and DevelopmentRanked 37th in overall health system performance by WHORanked 24th in D.A.L.Y. (disability adjusted life years)All of this has prompted an urgency for healthcare reform
- 17% of the GDP is spent on healthcare in the U.S. (as compared with 3-5% in other countries) and is projected to increase to 20% within 7 years (SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, March 2009); focus on rescue care/sick care vs. preventive care; unnecessary re-hospitalizations allocation of healthcare resources: where are we spending HC dollars?-----healthcare disparities part of being in a democracy is that everyone has a voice and everyone’s opinions differ greatly Care coordination: fragmentation of care, duplication of services, safety/errors Outcomes: Ranked 29th in infant mortality rates by OECD (industrialized countries) Organization for Economic Cooperation and DevelopmentRanked 37th in overall health system performance by WHORanked 24th in D.A.L.Y. (disability adjusted life years)All of this has prompted an urgency for healthcare reform
- Per Capita Health Spending And 15-Year Survival For 45-Year-Old Women, United States And 12 Comparison Countries, 1975 And 2005
- The 85+ population’s growth rate is 2 times that of those 65+ and almost 4 times that for the total population.As the population ages, the number of dementia cases is projected to more than double, exceeding 11 million by 2050.If this trend continues, how will total health care spending change? Where will dementia patients live? Who will provide care? Who will finance their care?
- How will the increasing diversity of the older population change the total prevalence of chronic conditions?What will the impact of increased obesity be on disability rates?Cultural SensitivitiesLifestyle ChangesChronic conditions are the #1 cause of death and disability in the U.S.45% of Americans suffer from at least 1 chronic disease
- 56 percent of current Indiana nurse educator workforce is projected to retire by 2010 2006 report shows an immediate need to fill 48 vacant positions in Indiana Schools of Nursing Nursing shortage is directly related to schools’ inabilities to expand enrollment due to a shortage of nurse educators. Approximately 1,600 qualified students seeking admission are turned away annually (INWDC annual survey of Indiana nursing programs). http://www.ihaconnect.org/Issues/Workforce/default.aspx (Indiana Hospital Association)
- Current economic crisis is keeping nurses in the workforce at presentInter professional collaboration within health care is criticalEducation and practice have different missions
- Source: U.S. Health Resources and Services AdministrationProjected shortfall of nurses in 2020= 1 million
- Donald Berwick (born 1946) is the outgoing Administrator of the Centers for Medicare & Medicaid Services (CMS), and was formerly President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI)[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. (was appointed as head of CMS in July 2010 by President Obama)
- PPACA (A.K.A. Affordable Care Act or “Obamacare”)passed 24 months ago is trying to address these 4 important problems. While the public hears more about the expansion of insurance coverage, the part that will affect providers most is payment reform and testing new delivery systems.CHIP= Children’s Health Insurance Program
- These are not far-into-the future changes, they are happening now. With 2012 being an inaugural year for several new initiatives.
- Landmark, evidence-based report (600 pages) written by a neutral party– 17 member Board/Commission made up of largely non-nurses, published in October 2010.Report discusses: what does the public need in a transformative, sustainable healthcare system? The answer is: nursing will lead us. Nursing has a holistic view and the mentality that “it is all about the patient”.
- Jch/ THIS IS WHAT WE DO!!!!!
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
- Bullet points not on screen:Identifying the “Right” Measures for Public Reporting and Performance-Based PaymentHHS Aims: measuring what is important to patients and construction of measures specific to patient populations rather than provider settings or diseasesDepartment of Health and Human Services (HHS) Chart illustrates National Quality Strategy Aims and PrioritiesMAPProvide upstream, public-private input to HHS on the selection of performance measures for use in public reporting, performance-based payment, and other programsIdentify gaps for measure development, testing, and endorsementAlign measurement across programs, settings, levels of analysis, populations, and between public and private sector programsPromote coordination of care delivery Reduce data collection burdenMeasure Topics in 5 Areas:Quality of Life: Functional Status Assessment, Health-Related Quality of Life, Palliative Care Care Coordination: Care Transition Experience, Communication with Patient/Caregiver, Communication with Healthcare Providers, Hospital Readmission, Medication ManagementScreening and Assessment: BMI Screening, Falls, Management of Diabetes, Pain ManagementMental Health and Substance Use: Alcohol Screening and Intervention, Depression Screening, Substance Use Treatment, Tobacco CessationStructural Measures: Health IT Infrastructure, Medical Home Adequacy, Medicare / Medicaid CoordinationOther: Patient Experience
- Sandie-HELPCredentialsNeed more info
- Kimberly J. Harper, MS, RN Executive Director, Indiana Center for Nursing HELPIS this correct??
- Sandie-Need infoCredentials.
- Amy Knepp NP-C, MSN, RN Chair, Department of Nursing and Assistant Professor, University of Saint Francis. Family Nurse Practitioner for Parkview Physicians Group
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
- KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration