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Future of Nursing - Fort Wayne

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A free seminar presented by University of Saint Francis - Fort Wayne

A free seminar presented by University of Saint Francis - Fort Wayne


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  • Welcome and self introduction by Nancy Gillespie, Dean, School of Health SciencesMention 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/
  • (Nancy Gillespie)Thank you to all of our sponsors (name them) Lutheran Health Network, Franciscan Alliance, and Parkview Health. (Nancy and 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.”
  • (Nancy 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 Dr. Dave Johnson, Professor, Department of Nursing…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% ofAmericans 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
  • Dave Johnson PhD,CNS,BC Professor of Nursing, University of Saint Francis
  • Judith A. Boerger MSN, MBA, Sr. Vice President, Chief Nursing Executive, Parkview
  • Judith A. Halstead, PhD, RN, ANEF, FAAN Professor and Executive Associate Dean for Academic Affairs, Indiana University School of Nursing Indianapolis
  • Kimberly J. Harper, MS, RN Executive Director, Indiana Center for Nursing
  • KarraHeggen, MSN RN CNO, Chief Nursing Officer Dupont Hospital
  • Amy Knepp NP-C, MSN, RN Chair, Department of Nursing and Assistant Professor, University of Saint Francis. Family Nurse Practitioner for Parkview Physicians Group
  • Diana Dee Swanson MSN,NP-C NP IU Health Southern Indiana 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
  • Transcript

    • 1. Nancy GillespiePhD, RN, Dean Thank you.
    • 2. Agenda Future of Nursing Presentation Panel Discussion Simulation Showcase
    • 3. Mindy YoderDNP, FNP-BC, RNLeading Change, Advancing Health
    • 4. Overview Healthcare challenges in the U.S. Our Nursing Profession Healthcare Reform IOM Nursing Report-Call for Leadership
    • 5. What is the state of our HEALTHCARE SYSTEM?
    • 6. A short list… Unsustainable costs Equitability of access to care Difficulty building consensus
    • 7. A short list…cont. Care coordination Primary care shortage Aging population and rise of chronic disease Poor outcomes
    • 8. Why does U.S.HEALTHCAREcost so much?
    • 9. Why $$$? Technology Prices are higher in the United States Price insensitivity to end consumer Judgment-based nature of MD care Values and culture
    • 10. Per capita health spending and 15-year survival for 45-year-old women. U.S. and 12 comparison countries, 1975 and 2005Muennig P A , Glied S A Health Aff2010;29:2105-113 ©2010 by Project HOPE - The People-to-People Health Foundation, Inc.
    • 11. Demographics Starting in 201110,000 people in the U.S. have been turning 65 every day
    • 12. Fastest Growing Population, 85+20,000 19,04118,00016,00014,000 14,19812,00010,000 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
    • 13. Older Americans withMultiple Chronic Conditions Medicare beneficiaries with at least one chronic condition Nation’s healthcare spent on treating patients with chronic diseasesSource: AARP. ―Beyond 50.09: Chronic Care: A Call to Action for Health Reform.‖ Washington, DC. 2009
    • 14. What is the state of NURSING?
    • 15. 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
    • 16. Projected shortfall in 20201million NURSES
    • 17. 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
    • 18. The challenges beforeus require significantimprovement in publicand institutional policiesat national, state andlocal levels.
    • 19. What is the impact of HEALTHCARE Reform?
    • 20. 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 & CHIPSource: Health Solutions Division,Manatt, Phelps & Phillips, LLP
    • 21. 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 projectSource: Kaiser Family Foundation
    • 22. Evidence-basedrecommendations for education and practice.
    • 23. 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
    • 24. The Future of NursingIOM 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
    • 25. The Future of NursingIOM 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
    • 26. 8 Recommendations Remove scope of practice barriers Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement nurse residency programs
    • 27. 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
    • 28. 8 Recommendations Prepare and enable nurse to lead change to advance health Build an infrastructure to collect and analyze healthcare workforce data
    • 29. Growth in Doctoral Nursing Programs: 2006-2011 184 153 120 DNP 92 53 20 125 124 120Research-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
    • 30. Enrollments in DNP & Ph.D. Programs: 2003-201110000 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
    • 31. Better CareHealthyPeople/Healthy Affordable CareCommunities
    • 32. Mindy YoderDNP, FNP-BC, RN myoder@sf.edu 260-399-7700, ext. 8510
    • 33. Dave JohnsonPhD, CNS, BC, USF ProfessorLocal, State and National Perspectives
    • 34. PanelistJudith A. Boerger MSN, MBA Sr. Vice President, Chief Nursing Executive, Parkview
    • 35. Panelist Judith A. Halstead Ph.D., RN ANEF, FAAN Professor and Executive Associate Dean for Academic Affairs, IU School of Nursing,Indianapolis, President, National League of Nursing
    • 36. PanelistKimberly J. Harper, MS, RN Executive Director, Indiana Center for Nursing
    • 37. Panelist Karra Heggen, MSN, RN Chief Nursing Officer, Dupont Hospital, Representing Lutheran Health Network
    • 38. Panelist Amy Knepp, NP-C, MSN Chair, Department of Nursing and Assistant Professor, University of Saint Francis, Family Nurse Practitioner for Parkview Physicians Group
    • 39. Panelist Diana Dee Swanson MSN, NP-C NP IU Health Southern IndianaPhysicians Group, Representing Coalition of Advanced Practice Nursing in Indiana
    • 40. The Future of NursingIOM Report Ensure that nurses can practice to the full extent of their education and training
    • 41. The Future of NursingIOM Report Nurses should achieve higher levels of education through an improved education system that promotes seamless academic progression
    • 42. The Future of NursingIOM Report Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States
    • 43. The Future of NursingIOM Report Improve data collection and information infrastructure for workforce planning and policy making
    • 44. Dawn M. MabryMSN, RN, CNESimulation and the Future of Nursing
    • 45. History 2005 Simulation Lab Planning 2007 Simulation Experiences 2008 and 2011 iStan and Metiman
    • 46. Demonstration Basic Assessment of a Teenage Athlete with Fluid and Electrolyte Imbalance
    • 47. Roles Patient – Metiman Patient Voice – Jeb Ray, BSN student Registered Nurse – Janine Shane, BSN student Football Coach – Dr. Dave Johnson, faculty
    • 48. Learning Objectives Performs an accurate basic physical assessment of the patient with fluid and electrolyte imbalance (APPLICATION). Identifies normal and abnormal assessment findings (APPLICATION). Documents normal and abnormal assessment findings in relation to fluid and electrolyte imbalance (APPLICATION).
    • 49. Learning Objectives Identifies strategies for treating dehydration related to heat exhaustion (APPLICATION). Identifies teaching opportunities regarding heat-related illnesses (APPLICATION).
    • 50. Prep Questions Describe the pathophysiology of dehydration. Which types of dehydration are most often associated with heat-related illnesses? What electrolyte findings are common with these types of dehydration? What assessment findings are consistent with dehydration? Describe the difference between heat cramps, heat exhaustion and heat stroke. How do symptoms and treatments differ for these three heat-related illnesses? What are the signs of rehydration?
    • 51. SynopsisThe learner will be providing care for a 19-year-old male admitted to the Emergency Department(ED) for dehydration and electrolyte imbalancecaused by heat exhaustion. The patient is a starathlete on his college football team. He passedout this afternoon during practice. Thetemperature was 90 F, and the relative humiditywas 80%. It is August, and the team has beenpracticing for the last week.
    • 52. Initial healthcareprovider’s orders Admit to Emergency Department CBC and Electrolytes, BUN, Creatinine, Glucose, STAT Start IV and give 500 mL 0.9% normal saline bolus Orthostatic blood pressures Notify of urine output of less than 30 mL/hour Oral fluids as tolerated
    • 53. 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
    • 54. StandardsInterprofessional the Future ofTeam Simulation NURSING EDUCATIONResearch