the future of nursing, credentialing, and efforts to...

IOM Credentialing Workshop Susan B. Hassmiller September 3, 2014

The Future of Nursing, Credentialing, and Efforts to Improve Quality

IOM Credentialing Workshop September 3, 2014

Susan B. Hassmiller, PhD, RN, FAAN, RWJF Senior Adviser for Nursing, and director, Campaign for Action


IOM Report

Noted complexity of health system. Nurses need to be prepared. Key recommendations: • Practice. • Education. • Leadership

Implications for credentialing research national agenda.

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Remove Barriers to Practice and Care

• All clinicians should be able to practice to the full extent of their education and training.

• Remove barriers that limit nurses from expanding access to care.

• Use all clinicians more efficiently.

• Right care by the right clinician, at the right time, in the right place.

Nurses provide an immediate and cost-effective solution to care shortages.

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Practice: Increasing Access to Care

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Removing Barriers to Practice & Care

• Public opinion shifting in favor of enabling APRNs to practice to full extent of education and training.

• 11 states requested and received FTC opinion on removing barriers.

• FTC policy paper: “expanded APRN practice is good for…consumers.”

Progress

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Credentialing Research Questions

• Do the credentials of advanced practice nurses lead to quality and value for the consumer?

• Can certification serve as a proxy for competence?

Best case scenario: Credentialing research on scope of practice could be used in policy arena to remove barriers.

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Academic Progression in Nursing

Prepare nurses to deliver more efficient, coordinated care.

• Increase the proportion of nurses with BSN and higher degrees.

• Increase the number of nurses with doctorates.

• Implement nurse residency programs.

• Promote lifelong learning.

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Advancing Education Transformation

• Academic progression infrastructure being developed.

• Number of students enrolled in RN-to-BSN programs up 53% since 2010*.

• 30 states adopting promising models to strengthen nursing education.

• Medicare Graduate Nurse Education Demonstration underway.

• Magnet program promotes BSN education.

8 Source: AACN, 2014.


Questions for Credentialing Researchers

Evidence inconclusive that increased knowledge assessed through examination leads to improve patient outcomes. • Does holding a certification improve performance? • Does the certification of a nurse improve patient outcomes

within the organization? • If certification examinations require a minimum of

baccalaureate education, what is the effect of a baccalaureate degree at the unit, organizational and systems level?

• How do lifelong learning, certification and professional education interact to affect health care quality and outcomes?

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Promote Nurse Leadership

Nurses bring a unique perspective to management and policy discussions. • Nurses spend the most time with people receiving health services.

• Nurses are the largest segment of the health care work force.

• Nurses are vital to improving quality.

• Yet nurses account for only 6 percent of hospital board positions.

Source: American Hospital Association 2011

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Leveraging Nursing Leadership

• 190 nurses appointed to leadership boards.

• North Carolina and Wyoming: Nursing Leadership Institutes.

• Virginia: 40 Under 40 Awards.

• New Jersey: Goal to place nurse leader in every hospital boardroom.

• Texas: Governance and leadership education.

• Leapfrog Group requires nurses to be integrated into governance for hospitals to attain Magnet status.

• Goal: National initiative to place 10,000 nurses on boards by 2020.

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Questions for Credentialing Researchers

• Which leadership competencies are most important for improving patient outcomes?

• What types of leadership programs help leaders to improve care?

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Future of Nursing and Credentialing Research Agendas

• Produce evidence needed to guide implementation of Future of Nursing recommendations.

• Credentialing research agenda and Future of Nursing efforts aim to improve health and health care.

• Need to demonstrate that

credentialing makes a difference in patient outcomes.

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Don’t Let Perfect Be Enemy of Good

• For some, sufficient or even extensive research will never be enough

• Determine key barriers • Focus resources/research on key process indicators

as opposed to improving patient care • Know when to shift resources to

communications/messaging/advocacy • Examples: 80/20; Scope; Interprofessional

Collaboration


Thank You

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