california institute for nursing & healthcare betty irene moore nursing initiative: nursing...
Post on 02-Jan-2016
218 Views
Preview:
TRANSCRIPT
California Institute for Nursing & Healthcare
Betty Irene Moore Nursing Initiative: Nursing Education Redesign for
California
Jan Boller, RN, PhD Deloras Jones, RN, MSN
Project Director Executive Director
Boller: BASC Presentation 0407 2
California Institute for Nursing & Health Care
A multi-stakeholder, nonprofit organization committed to serving as a catalyst for action as we address nursing and related healthcare issues to improve the health of Californians through strategic workforce planning, research, education, and policy recommendations.
“Optimizing the Health of Californians through
Nursing Excellence”
Boller: BASC Presentation 0407 3
The Demand: Nursing Excellence Patient/client-centered, (not task-centered): Patient
advocates who provide safe passage Critical thinkers, clinical judgment, systems thinkers Use evidence-based practice Community-based, Population-based, Prevention &
Health-Promotion-based Technology-proficient High-level patient teaching skills – healthy lifestyle
practices Innovators in complex, chaotic care systems Lead interdisciplinary teams in coordinated care
throughout the continuum
Boller: BASC Presentation 0407 4
The Supply: Sobering Statistics
Nursing shortage Gaps in education of
new graduates Retention of new
graduates Educational
advancement
Boller: BASC Presentation 0407 5
Projected Supply and Demand for US RNs and Effect of Increasing Enrollment
(Source: DHHS Health Workforce Report, 2002)
189
207200
201
214 211
200
281
216
234
180
190
200
210
220
230
240
250
260
270
280
290
2000 2005 2010 2015 2020
Projected Supply of FTE RNs
Effect of increasing RN graduates beginning 2007, doubling 2010
Number of FTE nurses needed
Boller: BASC Presentation 0407 6
Nurse Shortage
California Nursing Workforce 223,000 RNs working in California Average age 47.7 years California ranks next to last in RNs
per capita544 California, 782 national average
Boller: BASC Presentation 0407 7
Nurse Shortage Demand for Nurses Hospitals reporting 11 to 15% vacancy rates
14,000 RN vacancies
California EDD projected need for nearly 110,000 new nurses between 2000 and 2010 Capacity to educate ½ that number
HRSA forecasts by 2010 demand will be 47,600 more than supply…24% short fall
HRSA forecasts by 2020 demand will be 116,000 more than supply…45% short fall
Boller: BASC Presentation 0407 8
Nurse Shortage Educational Pipeline California schools have capacity to educate only
½ of nurses needed Schools have increased capacity 10% within last
5 years, yet capacity is just over what it was in 1994-95
Most of increase has been through hospitals contributions to education
Attrition rates between 20% to 26% Only 40% of qualified applicants are admitted
Boller: BASC Presentation 0407 9
NCSBN Elements Study: Gaps in Nursing Education (reported by students)
Administer medicine to groups of patients Delegate tasks to others Supervise care by others Knowing when and how to call the physician
(also in Carnegie Study)
Boller: BASC Presentation 0407 10
Gaps in Nursing Education from NCSBN Elements Study (reported by faculty)
Content not being taught consistently Use of information technology (8.4% of programs) Evidence-based practice – 11.7% of programs Critical care – 9.1% of programs Interdisciplinary elements – 32.5% of programs Only 55.9% of programs allow students to call MDs
Boller: BASC Presentation 0407 11
Key Theme: Demands Immediate Attention Nurses are still
“eating their young” Lateral violence Unhealthy workplaces Educational strategies
for inoculation?
Boller: BASC Presentation 0407 12
Transition Study Practice Errors –New Nurses
Charted on wrong record – 55.2% Medication errors – 43.2% Contribute to treatment delays – 39.3% Missed physician/provider order – 38.5% Client falls – 34.9% Error in performance of skills – 28.2% Misinterpreted physician order – 23.8% Client elopement – 13.3% Avoidable client death – 1.1%
Boller: BASC Presentation 0407 13
New Nurses Make Significantly Fewer Errors When:
More competent in clinical reasoning
More competent in communication and interpersonal relationships
Boller: BASC Presentation 0407 14
Retention of New Graduates in California & Educational Advancement <65% retention at the end of the second
year of employment 70% of new graduates in California are AD
prepared. Important entry point for RNs. However, only 17% advance to BSN or beyond with increasing demand for BSN and graduate level credentials
Boller: BASC Presentation 0407 15
What is CINHC Doing to Address this Problem? Master Plan: Education, Workplace, Diversity
Funding, Policy, Collaboration Strategies for Increasing Educational Capacity Regional Shared Services
Computerized Clinical Placement System Faculty Resource Center Regional Clinical Simulation Centers
Faculty Development “Magic in Teaching” Compendium – 2005, November 1, 2007 Clinical Faculty Training Program for Clinical Nurses
Leadership Development: Building a Foundation for Leadership Excellence, in partnership with ACNL
Boller: BASC Presentation 0407 16
Grant Overview
A “Nursing Education Redesign in California: White Paper and Strategic Action Priorities” that examines the need to reshape nursing education, makes recommendation on redesign elements, defines the action steps, and provides plans for building consensus required to accomplish redesign.
Boller: BASC Presentation 0407 17
Program/Project Profile1. Why was this program selected?
a. Concerns about student readiness for entry into practice in today’s complex health environment. Concerns about patient safety and quality of care
b. Faculty concerns about maintaining quality education with increased enrollments
2. Driving forces affecting quality of educationa. Nursing and faculty shortage
b. Changes in health care environment c. Availability of simulation and other innovations in education d. Renewed interest in collaboration between academia and
service
Boller: BASC Presentation 0407 18
Nursing Education Redesign for California: Plan Gather Data About Advances in Education &
Key Challenges to Delivering Quality Education Convene Thought Leaders Identify Core Competencies/Gaps Outline Key Action Strategies Meet with Key Stakeholders For Feedback and
to Build Consensus Across the State Publish and Dissemination Action Plan (White
Paper)
Boller: BASC Presentation 0407 19
Project Approach
• Build relationships through conversation, dialogue, and consensus-building
• Appreciative inquiry• Cultivate communities of practice among clinicians,
educators, policy makers• Participatory action science approach, focusing on
reflection and action• Quality improvement processes, using small tests
of change.
Boller: BASC Presentation 0407 20
Preliminary DataBased on 1st Thought Leader Survey Gaps in core
competencies (Based on Competencies Identified by
Oregon Consortium for Nursing Education)
Makes sound clinical judgment Collaborates as part of a
health care team Practices within, utilizes and
contributes to the broader health care system
Uses best available evidence in making practice decision
IOM Quality & Safety Competencies Patient-centered care Interdisciplinary team Evidence-based practice Quality improvement
approaches Informatics
Boller: BASC Presentation 0407 21
Preliminary Recommendations Strategic Action Priorities
Core competencies needed for 21st century: professional & clinical
Transition to practice: Formal residencies/internships Forging academic/service partnerships; Common unified
voice for nursing excellence, clinical rotations, preceptorships, healthy workplace
Collaborative education model: Seamless and timely advancement from ADN to BSN to Graduate
Integrate simulation, other innovations and evidence/based, best practices into curriculum
Faculty development to learn new ways to teach Explore & evaluate new and innovative “out of the box”
programs to respond to the nursing shortage Economic models for funding education
Boller: BASC Presentation 0407 22
We must bridge the chasm between academia and service when it comes to preparing nurses.
Smooth transitions Role socialization Community of practice Theory cannot be
separated from practice Nursing is a practice-
based profession
Boller: BASC Presentation 0407 23
Call to Action: Let’s Get Together
Stop lateral violence NOW (nurses eating their young)
Solve clinical rotation problems
Develop high-performing faculty (academic & clinical)
Build collaborative curriculum from novice-to-expert
Boller: BASC Presentation 0407 24
Contact Information
California Institute for Nursing & Health Care1815 B Fourth StreetBerkeley, CA 94710
(510) 486-0627jan@cinhc.orgdeloras@cinhc.orgwww.cinhc.org
top related