Transcript Slide 1

Nursing Paradigm Shift & Healthcare
Meg Beturne MSN, RN, CPAN, CAPA
Objectives
 Explain changes in healthcare that are redefining
our nursing practice
 Describe roles that can evolve into meaningful
work
 Discuss barriers and benefits to successful role
transitions
Let’s begin with Optimism!
 “ I see nursing’s glass as full- full of potential, if
we are going to pick ourselves up, dust ourselves
off, and start all over again”
From: Ziggy Cartoon by Wilson,1995
Affordable Care Act- 2010
 Aims at advancing the roles and responsibilities of nurses
 Presents new options for patients to choose: health over
disease, wellness over illness, prevention over cure,
opportunity to lead productive lives and avoid more costly
care
 Wellness and prevention services will be more accessible
and affordable as health plans are required to cover them
 Eliminates cost-sharing; services at no added cost
 Pay- for -performance replaces pay-for-services
ACA Affects Nursing
 Work outside hospitals will grow
 Nurses will be in short supply
 Providers are welcoming older patients
 New standards mean a new specialty
 Advanced practice nurses are in demand
ACA Purpose & Demands
 Reforms health care industry in 4 ways
improved quality
added consumer protection
decreased cost
increased access to healthcare
 Predicted job openings: 250, 000 to 400, 000
annually over next 10 years
 By 2020, as NPs fill in more for doctors,
projected jobs for RNs and LPNs= 1.2 million!
But Wait…
 “ Everything which succeeds, is not the
production of a scheme, of rules and of
regulations made beforehand, but of a mind
observing and adapting itself to wants and needs”
Florence Nightingale
Significant Changes
 Shift to ambulatory care
 Decreased length of stays
 Growth in managed care
 Soaring healthcare expenditures
 Emphasis on cost containment
 Emphasis on quality (outcomes)
 Emphasis on service (outcomes)
 Emphasis on prevention, wellness and rehab
 Technological advances
 Challenges regarding workforce needs (shortage)
The List Goes On….
 Care for aging population as well as pediatric services
 Shifting values: over live and death
 Lack of access: maternity & newborn care
 De-jobbing: occurs in hospitals as services expand in
communities
 New infectious diseases needing management
 Increased substance abuse: need for treatment
 Increased violence: need for behavioral health
 Chronic disease management
 Need to renovate & expand school-based health centers
Back to the Future!
 “Welcome to the year 2036. A lot has changed
since the old days in nursing, especially
throughout the healthcare field. There is still
death, of course, but not from illness; that was
taken care of long ago. Technology has made
surgery obsolete and you may be surprised to
learn that the government is picking up most of
the healthcare tab these days. As for hospitals,
well, what’s a hospital?”
Farley, 2012
The Future has Become the Present
In the book, Pulling Together to Make a Difference,
The following quote hits the mark:
“Constant training, re-training, job hopping, and even
career hopping, will become the norm.”
Bob Johansen
Rewarding , Relevant Roles
 Advanced role requiring advanced education (i.e.
Nurse Practitioner)
Disciplines: primary care, nurse midwives,
psychiatric nurse specialists, geriatrics
Vacancies: 1,700 at hundreds of locations nation
wide including health centers
 Critical care nurses: greater need in hospitals
 Patient-centered medical homes: settings in
which tech-savvy nurses function as Care
Managers and Data Analysts
Population Health
 Care Managers:
advise on evidence-based diagnoses, treatments and
interventions
measure progress in real-time
 Data analysts:
generate and analyze disease registries
interpret data and track clinical measures
determine if population health management works
Roles are in Medicare Advantage & Insurance Programs
National Health Service Corps
 Looking for a new work setting, role or specialty?
 NHSC supports health care providers dedicated to
working in areas of U.S. with limited access to care
 Scholarships are awarded in exchange for service in
these underserved communities
 Administered by Health Resources & Service
Administration
 75% of professionals continue to practice where they
are after their contracts expire
 ½ choose to make a career out of the experience!
More Rewarding Roles
 Hospice nurses
 Geriatric practitioners
 Pediatrician office nurse: “well-baby visits,
developmental screenings to increase
 Experts in Clinical Performance measures
 Experts in new billing and reporting mechanisms
 Experts in digitizing medical records (I.T.)
 Potential: hospital/patient liaison: post-discharge,
nurse assures that patient fills prescriptions, goes
for follow-up visit, follows prescribed regimen
Expand Your Current Role
 Preceptor/mentor
 Patient/family advocate
 Care coordinator: for patients with multiple
chronic conditions
 Enhanced role in health coaching, transitional
care, prevention activities and quality
improvement
 Change agent: lead change in healthcare that the
populations around you need
Become a Nursing Leader
 If you see yourself moving into this role:
 You will help lead improvements in health care
quality, safety, access, and value
You will become a decision-maker
You will be able to influence health outcomes
You will participate on public policy and health
care organization boards
How About a Nurse Educator?
 Everybody has to get more education: nurses, patients,
families, communities, partners in care
 Nurse undergrads are already participating in courses
with medical students (i.e. doing patient safety
together)
 Chronic care management, palliative care and public
health are topics that allow nurses to play a bigger role
upfront!
 Nurses need to learn now how to use their voices more
effectively to improve quality and access
From Novice to Expert
 Some roles that never change:
The helping role: comfort, being present
The teaching-coaching function: readiness to learn
Effective management of rapidly changing situations:
reacting to early warning signals
Administering and monitoring therapeutic
interventions and regimens: medications, skin care
Monitoring and ensuring quality of healthcare
practices: back up system to ensure safe care
Organizational and work-role: how nurse “fits in”
Facilities with Critical Nursing Shortages
 Home health agencies
 Rural health clinics
 Outpatient clinics, extension clinics
 Hospice programs
 Skilled nursing facilities
 Ambulatory surgical centers
 Federally qualified health centers
 Health Service Health Centers: esp. Indian & Hawaiian
 State or local Public Health departments
Examples
 Community Health Centers:
Deliver primary and preventive care
Many specialize ( i.e. oral and behavioral health)
Currently, about 16,000 nurses- including 4,300
advanced practice nurses are employed there
• Home Visiting:
Nurses, social workers visit pregnant women and
children
Offer intervention services and counseling to
improve outcomes
Barriers to Role Transitions
 Unclear perspective about roles
 Unsure about skills preference
 Inability to match up interests with roles
 Negative attitude toward transitions
 Unfocused about possibilities
Timely Advice
 “ I think one’s feelings waste themselves in words;
they ought all to be distilled into actions which
bring results.”
Florence Nightingale
Successful Role Transitions
 Depends on your perspective
o Is it just a job? Low on self-fulfillment, negligible rewards
o Is it your chosen career? High public acceptance and
prestige; but with external environment changes, comes
diminished self-fulfillment
o Is it driven by a mission? High on dedication to a cause
but low on financial reward or successes
o Is it a true calling? Higher level of awareness that skills,
passions and experiences result in joy and contributions to
the common good!
Caring For Your Nursing Career
CALLING
MISSION
CAREER
JOB
5 Constructs of a Healthy Nurse
 Calling to care: compassionate offering of self;
nurse builds relationships with patient and family
 Opportunity to role model: nurse confidently
identifies personal health challenges in self and
patients; enables patients and self to overcome them
 Priority to self-care: nurse effectively manages
emotional and physical stressors
 Authority to advocate: nurse empowered to
advocate at all levels within work environment and
community
Follow This Advice
 “ I attribute my success to this- I never gave or
took any excuse”
Florence Nightingale
Know Your Skill Preferences
Totally
Satisfying
Skills
Very
Satisfying
Skills
Prefer Not To
Use These
Skills
Somewhat
Satisfying
Skills
Strongly
Dislike These
Skills
Career Interests Leading to New Roles
 Investigative: evaluate, analyze, systemize, observe
Research, informatics, academic faculty, consultant,
computer analyst, infection control, H.R. resource, work
process design, systems development
 Artistic: perform, write, design, draw
Education/training development, art/music therapy,
computer graphics, promotional displays
 Enterprising: plan, supervise, lead; persuade, innovate
Project/committee management, self-employment
Legislative work, patient advocacy, recruitment,
marketing, fund-raising
More Career Interests
 Social: instruct, guide, communicate, help
P.R., health education advocacy, rehab, ethicist, direct
patient care
 Conventional: financial, clerical, detail and data-driven
Staff coordinator, regulatory compliance officer, cost
analyst, equipment manager, policy resource
 Realistic: manual dexterity, motor-coordination, athletic
Equipment demonstrator, technical product vendor, handson trainer, staff in dialysis, surgery or rehab
Surrounded by Negativity?
• Conquer it by:
Practicing appreciative inquiry: explore what is
right with a group or organization ( value,
strengths, potential)
Build healthy relationships
Laugh and engage humor
Live open-ended questions: What is my calling?
Move ever forward and remain open to inner and
outer voices of wisdom~ “active-receptive stance”
Be Positive
“ The single most important employee trait in the
21st century is attitude- with regard to change,
adventure and risk.”
Farley, 2012
Unfocused About Possibilities?
• Switch the paradigm by asking:
What assumptions am I making that I’m not aware I’m
making?
What might I invent that I haven’t yet invented that would
give me other choices?
• Explore expectations of others & what they can expect of
you
• Be intentional in life and career: helps inform actions and
choices
• Place an anchor in the present
Wise Advice
 Alice in Wonderland said to the Cheshire Cat
“Would you please tell me which way I ought to
go from here?” and the Cheshire Cat said, “ That
depends on where you want to go.”
Lewis Carroll, 1865
Toolkit To Successful Role Transitions
• On your journey, don’t forget to bring:
Helmet for the knocks
Cushion for the falls
Mop for the tears
Earplugs for the gossip
Good shoes for running twice as fast as others to
get to the same place at the same time
Hammer to nail down promises
Key to open closed minds
Hatchet to open closed doors
Might as Well Pack……
Gavel to command attention
Microphone so you will be heard
Box to pick up the pieces
Certificate of merit
Medal of honor
Badge of Courage
Friend for good times and especially for bad
times
Natasha Josefowitz, 2012
Manage Career Transitions Through…
o Self-assessment: skills, knowledge, attitude
o Goal setting and priorities
o Alignment of assessment with goals
o Market assessment for what is best for YOU
o Skill strengthening
o Action plan
o Implementation
o Reflection and feedback
o Adjust as necessary to reach successful outcome
AH HA: Illumination
 Listen to yourself
 Trust your hunches
 Stop questioning your qualifications
 Be a risk taker: failure is not fatal
 Give up fearing the unknown
 Heed your dreams and your mentors
 Turn things around: interpret trends so you see
things differently
 Be prepared: so timing will be on your side
Benefits of Successful Role Transitions
 Achievement of outcomes (personal and patient)
 Increased productivity
 Sense of accomplishment ( making a difference)
 Appreciation of adaptability
 Freedom and adventure
 Commitment to a purpose
 Power to deliver results
 Economic security
 Control of future career
Make a Difference by Managing All 3
 Quality
Cost
Service
Follow the Leader
• Just like Florence Nightingale, “we must be
tough, canny, powerful, autonomous and even
heroic.”
Farley, 2012
Imagineering
 Vivid imagination according to Walt Disney
 Combine it with repetition and you will be a
Winner
imagination
repetition
All Roles Become One
 “Gentle gestures drift from one to another,
(listening, gazing, touching, holding); Feelings
rendered in, around and through, (warmth,
interest, concern, caring); Shared memories
converge, (I and you become we); Actions
offered, regard given, love bestowed, create a
trickle of compassion, that feels like a river of
kindness, that courses to the sea of humanity, and
in mingling with the vastness, purifies all
Farley, 2012
Final Words: What is Life?
 Life is a gift… accept it
 Life is an adventure…dare it
 Life is a mystery… unfold it
 Life is a game… play it
 Life is a struggle… face it
 Life is beauty… praise it
 Life is a puzzle… solve it
 Life is an opportunity… take it
 Life is sorrowful… experience it
 Life is a song… sing it
 Life is a goal… achieve it
 Life is a mission… fulfill it
Author Unknown
 This sums up my advice to you, so I will only add:
 Life in both your personal and professional lives
is a journey, not a destination… never stop taking
it!
Thank You