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”

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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

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The Supply: Sobering Statistics

Nursing shortage Gaps in education of

new graduates Retention of new

graduates Educational

advancement

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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

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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

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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

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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

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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)

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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

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Key Theme: Demands Immediate Attention Nurses are still

“eating their young” Lateral violence Unhealthy workplaces Educational strategies

for inoculation?

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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%

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New Nurses Make Significantly Fewer Errors When:

More competent in clinical reasoning

More competent in communication and interpersonal relationships

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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

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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

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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.

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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

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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)

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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.

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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

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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

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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

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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

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Contact Information

California Institute for Nursing & Health Care1815 B Fourth StreetBerkeley, CA 94710

(510) 486-0627jan@cinhc.orgdeloras@cinhc.orgwww.cinhc.org