Nurses Matter:
The Role of the Nursing
Support Program I (NSP I) in
Maryland
Miriam Haviland
PHASE Presentation
Maryland Department of Health and Mental Health Services
May 10th, 2013
Presentation Overview
 Value of nurses in the U.S. health care
system
 NSP I background
 NSP I evaluation
• Data sources and methods
• Findings
 NSP I and IOM recommendations for
the future of nursing
The Value of Nurses
 Largest group of providers in the health
care system
 Nurses impact patient outcomes
• Time spent with patients
• Education
• Job satisfaction
Overview of HSCRC
The Health Services Cost Review
Commission (HSCRC) is an independent
agency with authority to regulate 47 acute
care hospitals in Maryland.
Because of its authority, HSCRC is able
to fund programs to address hospital
nursing staff needs through rate
increases.
NSP I Background
 Originally funded in July of 2001 to
address the nursing shortage in Maryland
 Program provides participating hospitals
with up to 0.1% of gross regulated patient
revenue for activities
 Goal of the program is to recruit and
retain high quality nurses in Maryland
hospitals
 Funding renewed in July of 2012 for
another 5 years
The Need for Evaluation of NSP I
 Review previously unanalyzed
qualitative data
 Facilitate coordination and discussion
of best practices among participating
hospitals
Data Sources
 NSP I Coordinator Reports FY2009FY2012
 FY2013 NSP I Hospital Program
Descriptions
 Site Visits conducted during April 2013
Methods: Coordinator Reports
FY2009-FY2012
 Reviewed five qualitative
questions regarding activities to
improve the nursing environment
 Identified and coded common
activities and programs
Methods: FY2013 Program
Description
 Programs broken into three categories:
1. Education and Career Advancement
2. Patient Quality and Satisfaction
3. Advancing the Practice of Nurses
 Activities were extracted and sorted
into thematic categories
Methods: Site Visits
Four site visits conducted by HSCRC staff
during April 2013:
• MedStar Harbor Hospital
• LifeBridge Northwest and Sinai
Hospitals
• MedStar Union Memorial Hospital
• Mercy Medical Center
Findings: Coordinator Reports
Evidence Based
Practice (EBP)
Initiatives
Shared
Governance
•
•
•
•
Councils
Retreats and
other
governance
trainings
Quarterly
newsletter
Governance
training
•
•
•
•
Created EBP
fellowship
(GBMC)
Councils
review
literature and
implement
EBP
Support EBP
research
EBP training
workshop
Implemented
Nurse Quality
Indicators
•
•
•
Applied Nurse
Research Projects
Subscription to •
NDNQI
Increased
•
number of
nurses with
certifications
•
Training and
evaluation on
patient safety
initiatives
Research
councils
EBP research
practices and
initiatives
Online
research
education
programs
New approaches
to staffing and
patient allocation
•
•
•
Nursing staff
involved in
Unit Design
Electronic
scheduling
Subscription to
Nurse
Sensitive
Quality
Indicator
database
Findings: FY2013 Program
Descriptions
•
•
•
•
•
•
•
•
•
Scholarships for Nurses
Nurse Residency
Programs
Mentoring Programs
Resource Subscriptions
Evaluation of Nursing
Practices
Governance
Support for Special Staff
Training Programs
Initiatives to Support
Nurses’ work
•
•
•
•
•
Outreach
Fellowships
Acknowledgements
Evidence Based
Improvements in
Nursing Environment
and Practice
Other Initiatives
Findings: Site Visits
Hospital
Date of Visit
MedStar Harbor
Hospital
4/5/13
MedStar Union
Memorial Hospital
4/26/13
Primary Program
Activities
Scholarships for
Nursing staff
(RNBSN and
BSNMSN)
Nurse Extern Program
Feedback on NSP I
Very appreciative of NSP I
funds. Program is improving
nursing talent and job
satisfaction.
Funding from NSP I has helped
to provide extra training to
nursing students, especially in
areas of critical care and time
management. Many externs
become hospital employees
and are better prepared to
enter the workforce.
Findings: Site Visits
Primary Program
Activities
Hospital
Date of Visit
LifeBridge Northwest
& Sinai Hospitals
4/26/13
Nurse Residency
Program (Project
Connect)
Mercy Medical Center
4/29/13
•
•
•
Magnet hospital
activities
Preceptor program
High School
outreach
Feedback on NSP I
Funds from NSP I are
helping to improve nursing
quality by assisting newly
graduated nurses as they
transition from the
classroom to the units.
Funding from NSP I has
helped improve nurse job
satisfaction. It has also
helped staff collect data on
their activities to better
evaluate nursing quality in
their hospital.
Limitations
 Annual Reports FY2009-FY2012
•
•
Two questions were not asked on the
FY2009 and FY2010 Coordinator Annual
Report
Low response rate
 FY2013 Program Descriptions
• New Instrument
 Site Visits
• Limited standardization
NSP I in the Context of the IOM
Recommendations for Nursing
Eight IOM recommendations are organized into four
major categories:
1. Nurses should practice to the full extent of their
education and training
2. Nurses should achieve higher levels of education
and training through an improved education
system that promotes seamless academic
progression
3. Nurses should be full partners, with physicians and
other health care professionals, in redesigning
health care in the United States
4. Effective workforce planning and policy making
require better data collection and an improved
information infrastructure.
Concluding Remarks
 NSP I is an effective program for
Maryland nurses, hospitals, and
patients
 Overwhelming feedback indicate that
the program has made a significant
difference in the quality of nursing care
and nurse job satisfaction
Acknowledgements
HSCRC Preceptors
• Claudine Williams
• Oscar Ibarra
NSP I Coordinators
PHASE Staff
• Jennifer Le
• Beth Resnick