Emerging Nursing Roles

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Emerging Nursing Roles

• Pathway to the Stars
• Course 192

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HOUSE KEEPING

• Welcome
• This is a 1.5 hour class
• Please silence your cell phones and pagers.
• If you must answer a call, please leave the
  room.
• Thank you.

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• Please,
• Hold your questions during the presentation.
• Questions written on the 3X5 cards provided will
  be answered at the conclusion of the
  presentation.
• For questions not answered,
• the question and the answer will be available on
  the web.

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Objectives

• To express the shift occurring in nursing
  practice related to Information Technology
• To identify future IT career opportunities within
  the nursing profession.
• To recognize the diversity of VA career pathways

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Introductions

• Nancy H. Prewitt, BSN, RNC, CNA
• VAMC Lexington
• Patricia Costa, MBA, BSN PI/IS Coordinator
• VAMC Providence
• Cynthia Andrus , MSN, RN
• VAMC Houston
• Paula Miller RN, MSN, CNL TVHCS,
  Nashville

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Changes, Changes, Changes

• What changes have you seen in
• the past 10 years?
• Have those changes involved technology and
  information management?
• Have those changes improved your practice?

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Traditional to Expanded Roles

• Primarily inpatient nursing leading to the
• Expansion into many various roles
• Case Management Managing smaller numbers of
  patients intensively
• Care Management Managing large numbers of
  patients across the continuum
• Telephone Care / Triage Assessing symptoms /
  changes in condition and offering education and
  advice by protocol

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More Expanded Roles

• Patient Advocate
• Admissions Coordinator Bed Czar
• Utilization Management
• Process Improvement Coordinator
• Decision Support System
• Safety Officer
• NSQUIP surgical data and trending
• Med Model Consultant
• Performance Monitor / Measures Expert
• Care Coordination Home Tele-health (CCHT)
• Discharge Planner
• Home Health / Extended Care / HBPC (Home Based
  Primary Care)
• Clinical Applications Coordinator
• BCMA Coordinator
• Informatics Nurse
• Computer ADPAC

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Population Specific Roles

• Poly-trauma Team
• OEF/OIF Transition Team
• Suicide Prevention Coordinator
• Rehabilitation Coordinator

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Nurse Manager

• Contrast Traditional Head Nurse Role
• Present Day Nurse Manager Role
• Managing work unit and resources (human and
  otherwise) through data
• Developing staff
• Improving processes for staff, facility and
  particularly for patients
• Managing outcomes through data
• Building Teams
• Mentoring others
• Promoting stewardship through good resource
  management

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Nurse Practitioner (ARNP)

• Wise use of resources
• Improve efficiency and productivity
• Function in variety of settings
• Role as Primary Care Provider

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Changes in Delivery of Care

• -Continued Shift from Inpatient to Outpatient
• -Community Based Outreach Clinics (CBOC)
• -Telemedicine / Remote Care
• -Staff Education and Training
• -Remote training and Team Building
• -Group Clinics
• -Access, Access, Access 30 mile access
• -Right Care, Right Place, Right Time

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For Those Who Served

• My Health e Vet
• For Staff and Patients
• Disease Management
• Diaries and Logs
• Prescriptions
• Lab Results
• Health Information

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One VA

• -Standardization / Expectations
• -No Veteran Left Behind
• -Remote Data
• -Cross-country Committees / Task Forces
• -Networking / Knowledge Sharing

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Find your pathway to the stars!
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Moving To the Dark Side???

• Nursing Informatics in the VA
• Patricia A. Costa RN, MBA, BSN

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Digital Landscape

• Digital Refugees denial
• Digital Voyeurs look wait
• Digital Immigrants participants
• Digital Natives live it

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Nursing Informatics

• Explosive Growth in Computers
• Combination of Nursing Skills and Computer
  Expertise
• Found in any arena related to healthcare

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What Is Nursing Informatics

• The use of information technologies in relation
  to any of the functions that are within the
  purview of nursing and are carried out by nurses
  in the performance of their duties. This
  comprises the care of patients, administration,
  education and research. (Hannah 1985)

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What Is Nursing Informatics

• Nursing informatics (NI) integrates nursing
  science, computer and information science, and
  cognitive science to manage, communicate, and
  expand the data, information, knowledge, and
  wisdom of nursing practice.ANA 2008

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What Is Nursing Informatics

• "... use of information technologies in relation
  to those functions within the purview of nursing,
  and that are carried out by nurses when
  performing their duties.

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Why Nursing Informatics

• "Computers are incredibly fast, accurate and
  stupid. Human beings are incredibly slow,
  inaccurate and brilliant. Together they are
  powerful beyond imagination." - Albert Einstein

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Who is Nursing Informatics?
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ADPAC

• Automated Data Processing Applications Coordinator

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CAC

• Clinical Applications Coordinator

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PI/IS Coordinator

• Performance Improvement/Information Systems
  Coordinator

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BCMA Coordinator

• Bar Code Medication Administration Coordinator

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OIT

• Office of Information Technology

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How Do I Get Theah From Heah

• Become a Super User
• Volunteer for projects
• Continue education
• Obtain a BSN
• Certification
• Obtain a Masters in Nursing Informatics

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Merging Roles

• Clinical Practitioner and Clinical Instructor
• Cynthia Andrus, MSN, RN,
• BCMA/ADPAC Coordinator
• Michael E. DeBakey VA Medical Center
• Houston, Texas
• July 17, 2008

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The Nursing Professional Career Challenges

• Nursing Shortages (Hospital)
• Limited Nurse Educators (School Of
• Nursing)
• Competent Graduate Nurse
• Professional Role Models

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Nursing Shortages (Hospital Setting)

• Baby Boomer Age and the Health Care Needs Grow
• Increase Workload Potential Threat to Quality
  Care
• Newly Licensed RNs Changed Principal Jobs after
  One Year

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Limited Nursing Educators (School Of Nursing)

• A Wave of Faculty Retirement Increase
• Higher Compensation in Clinical and Private
• Sector Settings
• Limited Qualified Master and Doctoral Professors

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Competent Graduate Nurses Challenges

• Inadequate Transition from a Graduate Nurse to a
  Competent Practitioner

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Professional Role Model for Nurses

• Ability to Handle Stressful Moments
• Working With Limited Resources
• General Attitude About Nursing Profession
• Exemplifying Leadership

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Strategies To Address Nursing Shortage

• Creating a Healthy Work Environment
• Developing more Public-Private Partnership
• Using Technology as a Training Tool
• Designing more Flexible Roles for Advance
  Practice Nurses
• Raise the Imagine of Nursing in the Media
• Work together with Schools to Increase the
  Interest in Nursing Careers

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Continue Strategies For Nurse Shortage

• Provide Financial Support
• Education Debt Reduction (EDRP)
• Employee Incentive Scholarship Program (EISP)
• National Nursing Education Initiative (NNEI)
• Tuition Support Program
• Tuition Reimbursement Program

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Strategies to Address Faculty Shortage

• Develop an incentive Program for Graduate Nurses
  to Teach in a School of Nursing after Graduation
• Launched an Online Resource to Support Nurses in
  obtaining a Teaching Career in Nursing
• Develop a Partnership with Healthcare Delivery
  Model and Academia

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Producing a Competent, Successful and Happy Nurse

• Partnership between Nursing School and Healthcare
  Organization
• Example VA Learning Opportunities Residency
• (VALOR) for Senior Nursing Students
• Design Specific Orientation for the Graduate
  Nurse Basic patient care skills development to
  extensive assessment and intervention skills
• Example Internship Program A Year Long Program
  for the Novice Nurse

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Positive Nursing Imagine Sets the Tone for
Emerging Nursing Roles

• Increase Recruitment and Retention
• Creates and Maintains a Healthy Environment
• Open Dialogue for Collaboration with other
  Agencies
• Promotes Advance Nursing Practice
• Embraces Technology Positively
• Enhances Evidence-Based Practice

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Bridging Theory With Practicum

• Dr. Betty Adams,
• Dean, Prairie View,AM
• College of Nursing

• Ms. Thelma Gray Becknell, Chief Nurse, Michael
  E. DeBakey VA Medical Center

Develop a partnership to bridge practice and
theory with the same goal in mind to provide
quality nursing care and patient outcome
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The Partnership

• Two Master Prepared Nursing Staff, VA Medical
  Center received Positions As Clinical Instructor
  for Prairie View AM School of Nursing
• 
  Medical Surgery
• 
  Adult Mental Health
• Medical Surgical Clinical Instructor Role
  Clinical Practice Manager that provides support
  to the clinical units this role serves as an
  education clinical leader for assigned Nursing
  Units

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Continue With Partnership

• Adult Mental Health Clinical Instructors Role
• BCMA/ADPAC Coordinator, Houston VA Medical
  Center
• BCMA Coordinator manages business and clinical
  operational for medication administration and
  ADPAC works with Nursing Application

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Benefits of Partnership

• Opportunities
• Blending theory and practice at the bedside
  support same school of thoughts
• Increase the understanding of Evidence-Based
  Practice
• Demonstrates Evidence-Based Practice at the
  bedside
• Increase the knowledge of Hospital Policy and
  Procedures with Nursing Practice

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Additional Benefits of Collaboration

• Develop Basic Skills for Patient Care
• Increase Recruitment and create a stronger
  environment for retention
• Increase awareness of Nursing Emerging Roles

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Projected Partnership

• Houston Community College School of Nursing and
  Michael E. DeBakey VA Medical Center
• Developing an Assimilation Lab for Bar Code
  Medication Administration
• First Phase Discussing with both Agencys IT
  efforts to begin and complete this project

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Emerging RolesPathway To The Stars

• Lets invest in our future and watch how the
  Novice Nurse will manifest into an Expert Nurse
  as they float
• through

A Nursing Career following a Pathway of Stars
leading the way!
Nursing Administration
Informatics Nurse
Performance Improvement/Information System
Clinical Nurse Leader
BCMA Coordinator
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Emerging Nursing Roles
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The Clinical Nurse Leader--A New Nursing Care
Delivery Role

• By Paula Miller MSN, RN
• Clinical Nurse Leader

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Objectives

• Provide Historical background of CNL role
  development by AACN
• Define and identify role of the CNL
• Education required for CNL Role
• Describe CNL Outcomes

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HISTORY OF CNL

• 2000 American Association of Colleges of
  Nursing engaged in extensive collaboration about
  the future of nursing e.g. Nursing education,
  shortages, aging workforce
• - Task Force on Education and
• Regulation or Professional Nursing
• Practice (TFER1)
• - Task Force on the Hallmarks of
• Professional Practice Environments
• (TFER2)

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American Association of Colleges of Nursing
(AACN) Functions

• Recognize health organizations for nursing
  excellence through the Magnet recognition program
• Provides certification for nurses in specialty
  areas
• Accredits providers and approves continuing
  nursing education.
• Offers information and educational services and
  products to support credentialing programs

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TFER1

• Concluded that there needed to be more nurses
  educated at the Masters Level to guide practice
  at the point of care.
• Determined that the patient care delivery system
  needed to be redesigned to assure the skills and
  competencies at the point of care were maximized
• Final report recommended that new nursing
  educational models and a new nursing role needed
  to be developed

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TFER2

• TFER2 - Created with members of both education
  and practice Charged to create this new role
  from both education and practice to meet the
  current and future demands of healthcare
• May 2003 The Working Paper or Working White
  Paper on the Role of the Clinical Nurse Leader
  was developedled to creation of new role in
  Nursing.

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What is a Clinical Nurse Leader?

• Not a nursing role of Administration or
  Management
• Not an Assistant to the Nurse Manager
• Not a Charge Nurse Role
• Should not fill in for Nurse Manager in absence
  nor should Nurse Manager fill in for Clinical
  Nurse Leader

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Clinical Nurse Leader Roles

• Clinician
• Outcomes Manager
• Client Advocate
• Educator
• Information Manager
• Systems Analyst/Risk Anticipator
• Team Managerworkload flow
• Member of a Profession
• Lifelong Learner

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What does the CLINICAL NURSE LEADER do?

• Provides and manages care at the point of care
• Designs, Implements, and Evaluates Client Care
  Outcomes
• Coordinates, Delegates and Supervises THE CARE
  provided by the healthcare team

• Promotes Evidence Base Practice
• Implement and evaluate change at the micro-system
  levelthat will greatly influence the
  macro-system environment.

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CNL Education and Title

• Requires a Masters or Post Masters certificate
  in Clinical Management Program
• Requires passing certification exam to carry CNL
  title
• 2007 The CNL title became a Registered trademark
  nursing title by Federal Trademark Office.

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The CNL Role Growing

• As of February 2008, 329 individuals have
  successfully achieved the CNL credential and over
  1,250 students were enrolled in CNL programs
  across the country (AACN, 2008)

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How can a CNL be used?

• Nursing Role Model
• Change Agent
• Unit based or facility based problem solver
• Collect/Analyzes and trends data
• Introduce Microsystem Changes
• Introduce Evidenced Based Practice at the bedside

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Examples of CNL Outcomes

• Decrease in No Show/Cancellation Rates in
  procedure labs and clinics
• Decrease in Surgery Cancellations
• Decrease LOS

• Decrease surgical infection rates
• Decrease ventilated assist pneumonia
• Decrease staff turnover rate
• Increase quality in delivery of care at the
  bedside

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Questions