Collaboration and resourcefulness: thinking outside the box - PowerPoint Presentation

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Collaboration and resourcefulness: thinking outside the box

Christine Grady RN PhDDepartment of BioethicsNIH Clinical Center2013 PHS Nursing Recognition DayEmbracing Diversity: Limitless Possibilities in Nursing May 3, 2013Slide2

These views are mine and do not necessarily represent those of the Department of Bioethics, Clinical Center, National Institutes of Health, or the Department of Health and Human Services.

I have no conflicts of interest to declareSlide3

The Future of Nursing

Enactment of the ACA will provide unprecedented opportunities for change in the U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.

The Future of Nursing, Leading Change, Advancing Health, IOM 2011Slide4

Overview

LeadershipPartnershipCollaborationResourcefulnessSlide5
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Nurse Leaders in Health Care

Top 25 Women in Healthcare – 2013… program honors exceptional female healthcare executives who are making a positive difference in the industry. The honorees represent all sectors of healthcare, including hospitals, health systems, insurance, government, trade and professional organizations, and labor. Nurses and Nurse Champions Included in Modern Healthcare's Top 25 Women in Health CareSlide7

Top 25 Women in Healthcare – Modern Health Care 2013

Honorees with Nursing BackgroundMaureen Bisognano is president and CEO of the Institute for Healthcare Improvement, a patient-safety organization. She began her career in health care in 1973 as a staff nurse at Quincy City Hospital.Karen Daley

is president of the American Nurses Association, a professional organization representing the interests of the nation’s 3.1 million registered nurses.

Patricia Hemingway Hall

is president and CEO of Health Care Service Corp. Hall began her career as an intensive-care nurse in the 1970s, but since 2008, has led HCSC, which covers more than 13 million members in Illinois, New Mexico, Oklahoma and Texas

.

Sister Carol

Keehan

is president and CEO of the Catholic Health Association, representing the nation’s Roman Catholic health systems and the largest group of not-for-profit health providers in the nation

.

Judith

Persichilli

is president and CEO of Catholic Health East, a health system that includes 39 acute-care hospitals, 26 long-term-care facilities and other operations in 11 Eastern states.

Shirley Weis

is chief administrative officer and vice president of the Mayo Clinic, one of the most well-known brand names in health care and a system that treats more than 1 million people annually in Arizona, Florida, Georgia, Iowa, Minnesota and Wisconsin.

Sharon O’Keefe

is president of the University of Chicago Medical Center and has more than 30 years of health care experience, initially as a critical-care nurse and then in hospital leadership.

Marilyn

Tavener

is acting administrator for the CMS and oversees the $757 billion federal agency that provides health care coverage to 100 million Americans through Medicare, Medicaid and other programs

.

Mary Wakefield

is administrator of the Health Resources and Services Administration and leads efforts to work with providers and community programs to improve access to health care services for the needy, uninsured and isolated

.Slide8

Nurses in Congress

Congresswoman Karen Bass (D-CA-33)Congresswoman Diane Black (R-TN-06)Congresswoman Lois Capps (D-CA-23)

Congresswoman Renee

Ellmers

(R-NC-02)

Congresswoman Eddie Bernice Johnson (D-TX-30)

Congresswoman

Carolyn McCarthy (D-NY-04

)

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Federal/Nurses-in-CongressSlide9

Nurse Leaders- Uniformed Services

Lieutenant General Patricia D. Horoho, Surgeon General and Commanding General of the United States Army Medical Command . (first female and first Nurse Corps officer to be SG & CG in the Army).Rear Admiral Kerry Paige Nesseler, Assistant Surgeon General, Chief

Nurse Officer,

USPHS and Director

of the Office of Global Health Affairs, HRSA US DHHSSlide10

“…all

nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies…”Slide11

Developing Leaders

Recommendation 7: Prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses. Nurses should take responsibility for their personal and professional growth by continuing their education and seeking opportunities to develop and exercise their leadership skills.Nursing associations should provide leadership development, mentoring programs, and opportunities to lead for all their members.Nursing education programs should integrate leadership theory and business practices across the curriculum, including clinical practice.Public, private, and governmental health care decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions.

The Future of Nursing, Leading Change, Advancing Health, IOM 2011Slide12

Leadership

“Sit at the table”

Seek

Challenges and take

Risks

Make your partner a real partner

Pursue goals with gustoSlide13

“

Studies also show that compared to men, women underestimate their performance. If you ask men and women questions about completely objective criteria such as GPAs or sales goals, men get it wrong slightly high; women get it wrong slightly low. More importantly, if you ask men why they succeeded, men attribute that success to themselves; and women, they attribute it to other factors like working harder, help from others. Ask a woman why she did well on something, and she’ll say, “I got lucky. All of these great people helped me. I worked really hard.” Ask a man and he’ll say or think, “What a dumb question. I’m awesome.” So women need to take a page from men and own their own success”

S. SandbergSlide14
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CELEBRATING NURSES:

Nurses are strong, nurturing and selflessLaura Raines, Atlanta Journal Constitution April 26, 2013“Woven within our communities are strong, nurturing and selfless people. We call them nurses. They are the trusted professionals we turn to when we’re sick and hurting. But nurses don’t just practice at the bedside. They bring their caring, thinking, teaching, problem-solving, get-it-done qualities into our families, schools, churches, businesses, legislatures and neighborhoods — and we’re all the richer for it. “Slide16
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And yet…

Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions” (RWJF, 2010, Box 5.1) Opinion leaders rate doctors and nurses first and second among a list of options for trusted information about health and health care.Opinion leaders perceive patients and nurses as having the least amount of influence on health care reform in the next 5–1 years.Reducing medical errors, increasing quality of care, and promoting wellness top the list of areas in which large majorities of opinion leaders would like nurses to have more influence.

Relatively few opinion leaders say nurses currently have a great deal of influence on increasing access to care, including primary care.

Opinion leaders

identified top barriers to nurses’

increased influence and leadership as not being perceived as important decision makers or revenue generators compared with doctors, having a focus on acute rather than preventive care, and not having a single voice on national issues.

Opinion leaders’ suggestions for nurses to take on more of a leadership role were making their voices heard and having higher expectations

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Leadership

BOX 7-3: Research Priorities for Transforming Nursing LeadershipIdentification of the: personal and professional characteristics most critical to leadership of health care organizations, such as accountable care organizations, health care homes, medical homes, and clinics. skills and knowledge most critical to leaders of health care organizations, such as accountable care organizations, health care homes, medical homes, and clinics.

personal and professional characteristics

most important to leaders of quality improvement initiatives in hospitals and other settings.

characteristics of mentors

that have been (or could be) most successful in recruiting and training diverse nurses and nurse faculty.

influence of nursing

on important health care decisions at all levels.

unique contributions

of nurses to health care committees or boards.Slide20

ANA Leadership Institute

Webinar 1. Strategic Thinking Webinar 2: Results Orientation Webinar 3: Leading PeopleWebinar 4: Personal LeadershipWebinar 5: Unleashing Innovation and Creativity http://anawebinarseries.eventbrite.com/#Slide21

Partnership and Collaboration

“Make your partner a real partner”Lean In and Lean OnHealth care is a team sportPatient as PartnerSlide22

The Power of Collaboration

Lord Shiva led the Swami to two doors.Behind the first door, he saw a large round table with a large delicious smelling pot of stew. The people sitting around the table were thin and sickly and appeared to be famished. They were holding spoons with long handles that were strapped to their arms. They could reach into the pot with the spoon and take a spoonful of stew, but since the handle was longer than their arms, they could not get the spoons back into their mouths.

The Swami shuddered at their misery and suffering.

Behind the second door, things looked similar. A delicious smelling pot of stew sat in the middle of a large round table. The people were equipped with the same long-handled

spoons. But

here the people were well nourished and plump, laughing and talking.

The Swami said, “I don’t understand”.

“It is simple”, said Lord Shiva, “It requires but one skill. You see they have learned to feed each

other. They have learned to work together”.

SUFI PARABLE:

Author

UnknownSlide23

Figure 1.

Possible skills, knowledge, traits and motives influencing teamwork, from Leggat S. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health Services Research 2008Slide24

Key Message #3: Nurses should be full partners,

with physicians and other health professionals, in redesigning health care in the United States.Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the

boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering

high-quality care while working collaboratively with leaders from other

health professionsSlide25

Leadership and Collaboration

Leadership from nurses is needed at every level and across all settings. Although collaboration is generally a laudable goal, there are many times when nurses, for the sake of delivering exceptional patient and family care, must step into an advocate role with a singular voice. At the same time, effective leadership also requires recognition of situations in which it is more important to mediate, collaborate, or follow others who are acting in leadership roles.Slide26

Healthcare Changes:

Need for innovation, collaboration, and leadershipAffordable Care ActWorkforce changesShifting DemographicsGlobalizationGenomics and personalized medicineLearning health systemsTechnologic advancesSlide27

Affordable Care Act

Quality Affordable Healthcare for All Role of Public Programs Improving quality and efficiency Prevention of chronic disease Health Care Workforce

Transparency and professional integrity

Improving access to innovative therapies

Community Living Assistive and Supportive

Revenue provisions

Reauthorize Indian Healthcare Improvement ActSlide28

NEJM

April 18, 2013Slide29

Figure 7. Growth in the U.S. Nursing Workforce

The U.S. Nursing Workforce: Trends in Supply and Education (2013 HRSA) http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/index.htmlSlide30

Figure 8. Highest Degree Held by RNs, Census 2000 and ACS 2008 to 2010Slide31

Figure 18. NCLEX-RN Passers, 2001 to 2011Slide32

Figure 24. Licensed RNs Graduating With BSN Qualification, 2007 to 2011

Figure 25. Master’s and Doctoral Graduates, 2007 to 2011Slide33

Figure 9. The Changing Age Distribution of RNs, in Five-Year IncrementsSlide34

Figure 11. Race/Ethnicity in the RN Workforce and Total Working-Age PopulationSlide35

The national spotlight on the nursing shortage has raised awareness of the pivotal role nurses play in health care delivery as well as the many career opportunities available in the field.  In addition to providing direct patient care, nurses today can conduct research, teach in universities, advise public policymakers, lead healthcare organizations, establish independent practices, and share their expertise in many other ways.  This dynamic profession is attracting an increasing number of highly skilled individuals from other disciplines who are seeking new careers in nursing. 

RWJ- New Careers in Nursing, http://www.newcareersinnursing.org/about-ncin/backgroundSlide36

Demographic ShiftsSlide37
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Globalization

Why Nurses Are the Unsung Heroes of Global Health Sheila Davis, Huffington Post 2012Slide39

country

NursesDoctorsMalawi25.51.1

Tanzania

36.6

2.3

Ghana

64

9

Zambia

113

6.9

Botswana

241

28,7

South

Africa

388

69.2

UK

937

256

USA

1212

230

Table 1: The human resource crisis: health personnel (nurses and doctors) per 100,000 population

(Source: WHO 2007 HIV/AIDS

Programme

.

Task shifting to tackle health worker shortages.

Table 1 p.2)Slide40

“…

although nurses deliver ~90 percent of all healthcare services worldwide, they remain largely invisible at decision-making tables in national capitals and international agencies. Their absence constitutes a global health crisis.” Davis S 2012Slide41

Genomics and personalized medicineSlide42

Changes in research:

Learning Health Care SystemsSlide43

Technological AdvancesSlide44

Resourcefulness and Innovation

Ten Innovations That Will Transform HealthcareChecklistsBehavioral economicsPatient portalsPayment innovationsEvidence based decision makingAccountable Care OrganizationsRegenerative MedicineVirtual VisitsGenetics enters practice

Surgical Robotics

http://hbr.org/web/extras/insight-center/health-care/10innovations/1-checklistsSlide45

Throughout the years, PHS nurses have demonstrated their innovative flexibility and willingness to adapt to new opportunities, and they continue to bridge the gaps today

. http://phs-nurse.org/usphs-nurses/slider-3Slide46

The Future of Nursing

Enactment of the ACA will provide unprecedented opportunities for change in the U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a

collaborative

environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both

within and beyond the health care environment.

The Future of Nursing, Leading Change, Advancing Health, IOM 2011Slide47

LEAN IN, LEAN ON, AND THINK OUTSIDE THE BOX