Nurses Leading the Way
Barbara Brunt, MA, MN, RN-BC, NE-BC,
FABC
Magnet Program Director
Summa Akron City & St Thomas Hospitals
Objective
 Identify trends and research priorities for nurses to
provide safe quality care
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Overview of content
 Current healthcare environment, including Affordable
Care Act and IOM Reports
 Research agendas of various national nursing groups
 Strategies to promote quality care, including care
coordination, just culture, and safety initiatives
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Affordable Care Act (ACA)
 Also known as Obamacare
 Signed into law four years ago to reduce healthcare
costs and improve consistency of care
 US Healthcare costs exceed $ 2.8 trillion annually
 Two central themes of the ACA are insurance reform
and healthcare delivery reform
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Healthcare insurance reform
 Children can stay on parents’ health insurance plan
until age 26
 Insurance companies must spend at least 80% of
premiums on medical care
 No dollar limit on essential health benefits
 New health plans must cover certain preventive
services (mammography, colonoscopy, BP and
Cholesterol screening) without charging a deductible,
copay, or co-insurance
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Healthcare delivery reform
 Value-based purchasing initiatives
 Hospital readmission reduction program
 New health reforms for 2014
 Opportunities for nurses
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Institute of Medicine (IOM)
 1999 – To Err is Human: Building a Safer Health System
 2001 – Crossing the Quality Chasm: A New Health
System for the 21st Century
 2010 – The Future of Nursing: Leading Change,
Advancing Health
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IOM Future of 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 baccalaureate
degree to 80% by 2020
 Double the number of 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
interprofessional health care workforce data
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Research Agendas
 American Nurses Association (ANA)
 Magnet ™
 National Institute of Nursing Research (NINR)
 Robert Wood Johnson Foundation Initiative on the
Future of Nursing
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American Nurses Association
 Identification of the value of nursing contributions to
safety, reliability, quality and efficiency
 Identification of factors that increase the impact of
nurses on quality and efficiency
 Identification of use of NDNQI to facilitate patient safety,
quality care and efficiency
 Identification of nurse workforce issues
 Identification of population health issues
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Magnet Research Priorities
 Clinical outcomes
 Satisfaction (patient, nurse)
 Organizational/practice environment
 Human resources
 Financial and material resources
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NINR Research Priorities
 NINR mission statement
 Emphasis on promoting innovation in technology to
improve health and innovative strategies for 21st
century nurse scientists careers in each of research
programs and activities
 NINR strategic plan and key themes
 Symptom science: Promoting personalize health strategies
 Wellness: Promoting health and preventing disease
 Self-management: Improving quality of life for individuals with
chronic disease
 End-of-life and palliative care: The science of compassion
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Robert Wood Johnson Foundation
 Coordinating a unique, multi-funder initiative to identify,
generate, synthesize, and disseminate evidence
essential to informing efforts to implement the
recommendations outlines in the IOM Report
 Purpose is the increase and focus national attention on
a common research agenda related to the IOM
recommendations and to facilitate and coordinate
funding activity across a range of funder of nursing
research
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RWJ Research Questions
 Education
 Leadership
 Interprofessional Collaboration
 Data
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Strategies to promote quality care
 Care Coordination
 Just Culture
 Safety Initiatives
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Care Coordination
 ANA established the Care Coordination Quality
Measures Panel to address important gaps in available
care coordination measures
 This group developed a framework, which provides a
dynamic roadmap that can be used to identify
prioritized measures of care coordination as well as
concept for new measure development, which reflect
nurses’ unique roles, strengthen system
accountabilities, and benefit patients and the health
system.
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Position Statement
 1. Patient-centered care coordination is a core
professional standard and competency for all RNs
 2. RNs provide healthcare coordination based on a
partnership guided by the healthcare consumer’s and
family’s needs and preferences
 3. Care coordination should be infused throughout RNs
curriculum and CE
 4. Research should further examine RNs evolving role
and contributions to care coordination
 Care coordination activities, functions, and roles must
be explicitly identified and funded to enhance
incentives for cost-effective high quality care.
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Value of Care Coordination (2012)
 Research findings include:
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Reduction in ED visits
Noticeable decreases in medication costs
Reduced inpatient and overall charges
Average savings per patient
Significant increases in survival with fewer readmissions
Lower total Medicare costs for beneficiaries in pilot projects
Improved quality of care
Increased patient confidence in the ability to manage their care
Increased safety of older adults during transition from acute care to
home
 Improved clinical outcomes and reduced costs
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Care Coordination Framework
 Provides a dynamic roadmap that can be used to
identify prioritized measures of care coordination as
well as concepts for new measures development, which
reflect nurses’ unique roles, strengthen system
accountabilities and benefits patients and the health
system
 Three elements of the framework
 Guiding principles
 Structural components
 Measurement context
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Just Culture
 What is this?
 Value-supportive model of shared accountability
 How can we get individuals to report errors?
 ANA position statement on Just Culture
 The Joint Commission leadership standards
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Safety Initiatives
 Many organizations are initiating processes to create a
safer environment
 Things Summa is doing:
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I’m 4 Safety classes mandatory for all personnel
Safety huddles
Safety coaches
Safety/quality moments included at the beginning of all meetings and
shared at “Talk with Tom” monthly meetings with staff
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 Questions
 Small Group Activity
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