Moving Health Care Forward: Empowering Nurse Leaders

Transcription

1 Moving Health Care Forward: Empowering Nurse Leaders Janet Stifter, PhD, RN, CPHQ Associate Vice President, Professional Nursing Practice Rush University Medical Center August 28, 2018

2 Disclosures This session s presenter does not have any relevant financial interests, any unlabeled/ unapproved uses to disclose or products to endorse This session is presented without commercial support or bias

3 Objectives Identify the role of the AONE in developing nurse leaders from the bedside to the boardroom Describe the call for Nursing Leadership identified through the IOM report The Future of Nursing Understand the role of the nurse leader in the health care system Discuss the unique role of the Advanced Practice Nurse in meeting the call for leadership

4 Part I. What is the AONE?

5 American Organization of Nurse Founded in 1967 Executives (AONE) A subsidiary of the American Hospital Association The professional organization for nurse leaders Provides a voice for nursing leadership from bedside to the boardroom Supports professional development, advocacy and research to advance nursing practice and shape public policy for health care

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7 AONE Key Initiatives Center for Care Innovation and Transformation (CCIT) AONE Foundation for Nursing Leadership Research AONE Certification - Executive Nursing Practice - Nurse Manager and Leader Academic Progression in Nursing (APIN) Grant Nurse Fellow Designation Leadership Development Programs

8 Leadership Development Initiatives Nurse Manager Fellowship Emerging Nurse Leader Institute Nurse Manager Institute Nurse Manager and Nurse Executive Certification Nursing Director and Chief Nursing Officer Fellowships Nurse Manager Learning Labs Dynamic Leadership for Shared Governance 8

9 AONE Nurse Leader Development Executive Health Care Finance, CENP, CIT, SG, AM, Board Governance Nurse Director Health Care Finance, Fellowship, CENP, Board Governance, CIT, SG, AM Nurse Manager NMI, Fellowship, CNML certification, ENMO, CIT, SG, AM Emerging Nurse Leader ENLI, ENMO, CIT, SG, AM Bedside Nurses CIT, Shared Governance, Annual Meeting

10 Critical Contemporary Nurse Leader Challenges Nurse Engagement Nurse Retention Nursing Professional Development Empowering nurses on the frontlines to create a safe, high quality and satisfying environment for their practice and to provide care for patients and families

11 AONE Leadership Bedside to Board Room AONE believes that APNs play a key leadership role in developing empowered nurse leaders at the frontlines of care

12 Part II. What is the call for nursing leadership?

13 Institute of Medicine (IOM) and Nursing 2010 Report: The Future of Nursing: Leading Change, Advancing Health The nursing profession has the potential capacity to implement wide-reaching changes in the health care system Transforming nursing in 3 key areas: practice, education, and leadership

14 Four Key IOM Nursing Messages Nurses should practice to the full extent of their education and training Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States For nurses to effect workforce planning and policy implementation requires better data collection and an information infrastructure

15 IOM Nursing Recommendations Remove scope of practice barriers Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement nurse residency programs Increase the proportion of nurses with a BSN to 80% and double the nurses with a doctorate by 2020 Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change to advance health Build an infrastructure for the collection and analysis of interpersonal health care workforce data

16 Part III. What are the issues of nursing leadership?

17 Nursing Leadership Concerns Labor/Staffing retention and staff engagement Violence in the Workplace, Opioid Addiction Patient Safety Hospital acquired conditions driving payment Patient/family and staff satisfaction and engagement Declining volumes and declining reimbursement Health Information and other forms of technology Education and professional development of the team Values based purchasing vs old emphasis on volumes

18 Addressing the IHI Quadruple Aim

19 Creating a Culture of Shared Shared governance... Governance Entails retraining managers, engaging staff, reallocating accountability, and building a staffdriven model of decision making and action Creates a forum for clinical staff communication and collaboration, a means to let the staff voices be heard, to improve patient care in all health care settings

20 Part IV Why is the APN role uniquely situated to be the key leader for the contemporary healthcare setting?

21 Characteristics of an Effective Leader The person in the leadership role establishes trust and credibility to enlist the support of followers; builds relationships with those followers that motivates them to contribute their energy and resources to the collective effort; and manages, directs, and applies those collective resources to accomplish the group s mission or tasks. (Chemers, 2001, pg. 8580)

22 Engaging Staff and Patient Outcomes Organizations that foster a culture of highly engaged caregivers are best positioned to prevent harm, improve quality, build resilience, and advance the overall patient care experience (Brooke Petrillo, MA) (Caven, 2017).

23 Definition and Characteristics of the NP/APN Role ( Integrates research, education, practice and management High degree of professional autonomy and independent practice Case management/own case load Advanced health assessment skills, decision-making skills, and diagnostic reasoning skills Recognized advanced clinical competencies Provision of consultation services to other health providers Plans, implements and evaluates programs Recognized first point of contact for clients

24 Core Elements of APN Practice Direct Patient Care Evidence or Research Based Consultation and Collaboration Provide services across the care continuum Uniquely situated as the link between organizational priorities and improving nursing practice Leadership! (Gaylord and Grace, 2012)

25 APN Role and Leadership Basis of the APN practice evolves around: Communication Collaboration Mediation Referral Mentoring

26 APN Leadership Expectations Provides leadership in the management of clinical care and is a resource person, educator and role model Acts as a preceptor, mentor and coach to nursing colleagues, other members of the health-care team and students Articulates and promotes the role of the nurse practitioner to clients, other health-care providers, social and public service sectors, the public, legislators and policy-makers Provides leadership in the development and integration of the nurse practitioner role within the health-care system

27 APN Leadership Expectations Advocates for and participates in creating an organizational environment that supports safe client care, collaborative practice and professional growth Guides, initiates and provides leadership in the development and implementation of standards, practice guidelines, quality assurance, and education and research initiatives Guides, initiates and provides leadership in policyrelated activities to influence practice, health services and public policy (Canadian Nurses Association, 2010)

28 Case Example: Rush University Medical Center

29 Rush University Medical Center (RUMC) is located within the City of Chicago in the medical district Mission: The mission of Rush is to improve the health of the individuals and diverse communities we serve through the integration of outstanding patient care, education, research and community partnerships. 667 Bed Academic Medical Center >8,000 Employees Rush is a not-for-profit health care, education & research system

30 APNs at Rush University Medical Center

31 Rush University College of Nursing A LEADING INNOVATOR IN NURSING EDUCATION SINCE St. Luke s Training School of Nursing Presbyterian Hospital School of Nursing Presbyterian-St. Luke s Hospital School of Nursing 1966 Nurse Anesthesia program Present Rush University College of Nursing 1977 DNSc/PhD 1988 ND/DNP 2008 Graduate Entry Master s program

32 Rush University Degree Options MSN Generalist Entry Master s (GEM) for Non-Nurses Clinical Nurse Leader (CNL) for RNs DNP and PhD Doctor of Nursing Practice (BSN/MSN-DNP) Advanced Public Health Nursing (APHN) Clinical Specialist (CNS) Options Nurse Anesthesia (CRNA) Nurse Practitioner (NP) Doctor of Nursing Practice (MSN-DNP) Transformative Leadership: Systems Transformative Leadership: Population Health Doctor of Philosophy (BSN/MSN-PhD) Post-Graduate Non-Degree Certificates

33 Growth of Advanced Practice Providers at Rush University Medical Center

34 Historical Timeline of APPs at Rush University

35 Shared Governance Model

36 Rush APNs Meeting the IHI Quadruple Aim Population Health Practitioner to Practitioner Discharge Report Reducing Costs Reducing CLABSIs with Eyes on Lines Initiative Patient Experience STAT Acuity Team Care Team Well Being Code Lavender and SOS

37 Parting Thoughts on Leadership and Change Change has a considerable psychological impact on the human mind. To the fearful it is threatening because it means that things may get worse. To the hopeful it is encouraging because things may get better. To the confident it is inspiring because the challenge exists to make things better. - King Whitney Jr

38 References Ballard, N. (2010). Factors associated with success and breakdown of shared governance. Journal of Nursing Administration, 40(10), Canadian Nurses Association. (2010). Canadian nurse practitioner core competency framework. Retrieved from: Caven, S. (2017). Maintaining engagement during times of change. Voice of Nursing Leadership. 15(2), Chemers, M.M. (2001). The psychology of leadership. In N.J. Smelser & P.B. Baltes (Eds.), International Encyclopedia of the Social and Behavioral Sciences (pp ). Burlington, MA: Elsevier Committee on the Robert Wood Johnson Foundation on the Initiative on the Future of Nursing. (2011). Future of Nursing: Leading Change, Advancing Health. Washington, D.C.: National Academies Press. Retrieved from Grace, P. J. (2012). Ethical leadership by advanced practice nurses. In P. J. Grace (Ed.), Nursing Ethics and Professional Responsibility in Advanced Practice (pp ). Burlington, MA: Jones & Bartlett Learning, LLC Moore, S. C., & Hutchinson, S. A. (2007). Developing leaders at every level. The Journal of Nursing Administration, 37(2), Porter-O Grady, T. (1992). Implementing Shared Governance: Creating a Professional Organization. St. Louis, MO: Mosby-Yearbook.

39 Dank U! 39