Landing the Flight: Bringing the 30,000 Foot View to the Bedside Teresa L. Anderson EdD, MSN, RNC-OB, NE-BC President, Nebraska Nurses Association

Disclaimer The speaker acknowledges the following affiliations but has no financial conflicts of interest related to the contents of this program: President of the Nebraska Nurses Association ANCC Magnet Program Consultant, the American Nurses Association, Silver Spring, Maryland Chief Nursing Officer of Voalte, Inc., Sarasota, Florida

Objectives Identify the trends affecting patient care in the United States today. Discuss the potential impact of these programs on nursing policy and practice. Describe the nursing skill set of the future.

Trends and Manifestations Affordable Care Act Guaranteed issue and community rating (premiums/pre-existing) Individual mandate (federal subsidies sliding scale) Minimum health insurance policy standards Health insurance exchanges Medicaid expansion option Employer shared responsibility Elimination of the “co’s” (co-pay, co-insurance, deductibles) Fee-4-Service to “bundles” and ACOs President Obama signing the bill

Trends and Manifestations Pay 4 Performance (aka P4P or Value- Based Purchasing) Rewards for meeting pre-established targets for care delivery (quality and patient satisfaction (HCAHPS scores) Disincentives - removal of payments for adverse “never” events Foreign object unintentionally retained after surgery Surgical site infection after bariatric, orthopedic, and bypass surgery Vascular-catheter associated infection Catheter-associated urinary tract infection Administration of incompatible blood Pressure ulcer stages III and IV Falls with injury Air embolism Readmission within 30 days http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/pay4per.html

Trends and Manifestations Meaningful Use Stage 1 Objective domains: Improve Quality, Safety, Efficiency Engage Patients & Families Improve Care Coordination Improve Public and Population Health Ensure Privacy and Security for Personal Health Information Stage 2 Objectives Increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information

Meaningful Use Improve Quality, Safety, Efficiency CPOE, Problem List, Patient List, Patient Reminders, Clinical Lab Test Results e-Prescribing, Formulary Checks, Drug Interaction Checks, Active Medication & Medication Allergy List Record demographics, VS, Smoking CQMs & Clinical Decision Support Engage Patients & Families Clinical Summaries Electronic Copy of Health Information Patient Electronic Access Pt- Specific Education Resources

Meaningful Use Improve Care Coordination Electronic Exchange of Clinical Information Medication Reconciliation Transition of Care Summary Improve Public and Population Health Immunization Registries Data Submission Syndromic Surveillance Data Submission Ensure Privacy and Security for Personal Health Information Protect Electronic Health Information

Trends and Manifestations IOM, Future of Nursing Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States Effective workforce planning and policy making require better data collection and an improved information infrastructure http://www.neactioncoalition.org

Trends and Manifestations Magnet Recognition Program® Transformational Leadership Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations, and Improvements Empirical Outcomes Global Issues in Nursing and Healthcare

Potential Impact Financial Provider Consumer

Potential Impact Technical Costs in financial and human capital Extension of the healthcare continuum Chasing innovation

Potential Impact Social Communication Confidentiality (includes social media) Portability

Professional (includes advocacy) Potential Impact Professional (includes advocacy) Policy and Practice www.nursingworld.org

Professional Nursing Skill Set BSN, MSN, and Beyond Specialty certifications Cross-training to a minimum of three areas Multiple home-unit mind set

Professional Nursing Skill Set Quality, EBP, and Research Performance improvement methodologies Quality toolkit Global access to information

Professional Nursing Skill Set Communication and Collaboration Interprofessional collaborative education and training Strong professional communication

Professional Nursing Skill Set Professional involvement and advocacy Professional organization membership and leadership Partnerships and affiliations to support healthy communities Understanding public policy from multiple viewpoints Legislative advocacy

Professional Nursing Skill Set Strategic and Tactical Management Networking? Social media? Project management?

Excellence… begins AND ends with YOU!

Teresa (Terry) Anderson, EdD, MSN, RNC-OB, NE-BC nnapresident@nebraskanurses.org 402-556-4274 (home) 402-679-1551 (cell)