1. Nursing in the New Millennium Phyllis M. Connolly PhD, APRN, BC, CS

2. Nursing’s responsibility is awesome—in patient care and also in creating a new society (Nyberg, 1998, p. 209)

3. 3 Assumptions Life at warp speed Life at warp speed New type of change, age of unreason New type of change, age of unreason Constant change, permanent white water Constant change, permanent white water

4. Changing Work Environment Technology Technology Demographics Demographics Managed Care Managed Care Purchaser’s Influence Purchaser’s Influence Health Insurance Industry Health Insurance Industry Changing Health Systems Changing Health Systems

5. Report Card: Managed Care Access Access Quality/Appropriateness Quality/Appropriateness Promotion/Prevention Promotion/Prevention Outcomes Outcomes General health improved General health improved Quality of life improved Quality of life improved Treatment reduces psychological stress Treatment reduces psychological stress More productive & independent More productive & independent

6. ANA Initiatives Improve Quality of Health Care 1994 Nursing’s Safety and Quality Inititive 1994 Nursing’s Safety and Quality Inititive 1996 Nursing-Sensitive Quality Indicators for Acute Care Settings 1996 Nursing-Sensitive Quality Indicators for Acute Care Settings 1997 National Data Base of Nursing Indicators (NDQI) 1997 National Data Base of Nursing Indicators (NDQI) CalNOC largest ongoing nursing quality measurement data set in nation CalNOC largest ongoing nursing quality measurement data set in nation

7. IOM (2001)Crossing The Quality Chasm: Changes Needed Safe Safe Effective Effective Patient-centered Patient-centered Timely Timely Efficient Efficient equitable equitable

8. IOM Rules for Redesign (2001) Care is based on continuous healing relationships Care is based on continuous healing relationships Care is customized according to patient needs & values Care is customized according to patient needs & values The patient is the source of control The patient is the source of control Knowledge is shared & information flows freely Knowledge is shared & information flows freely Decision making is evidence-based Decision making is evidence-based

9. IOM (2003) Keeping Patients Safe: Transforming the Work Environment of Nurses Address management practices Address management practices Workforce capability Workforce capability Work Design Work Design Organizational safety culture Organizational safety culture

10. Impact of Nursing Studies Patient Outcomes Needleman et al.(2002) 1997 data Needleman et al.(2002) 1997 data  hrs care/day RNs medical pts.  hrs care/day RNs medical pts.  LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest & “failure to rescue”  LOS, rates of UTI, UGI bleeding, pneumonia, shock or cardiac arrest & “failure to rescue”  hrs. care/day RNs surgical pts.  hrs. care/day RNs surgical pts.  UTI, “failure to rescue”  UTI, “failure to rescue” Aiken et al.(2003) Aiken et al.(2003) 10%  in proportion of BSN 10%  in proportion of BSN  5% risk of patient death & “failure to rescue”  5% risk of patient death & “failure to rescue”

11. Strategies & Skills For Future Ability to understand systems Ability to understand systems Critical thinking, analysis and problem solving Critical thinking, analysis and problem solving Reframing Reframing Personal growth & mastery, ability to tolerate ambiguity & take risks Personal growth & mastery, ability to tolerate ambiguity & take risks Emotional intelligence; self- restraint (impulse control) & compassion Emotional intelligence; self- restraint (impulse control) & compassion

12. Strategies & Skills For Future Cont. “can do” spirit “can do” spirit Business leadership & intelligence Business leadership & intelligence Ability to manage change Ability to manage change Group management skills, negotiating & conflict resolution Group management skills, negotiating & conflict resolution Stewardship Stewardship Collaborative leadership skills Collaborative leadership skills

13. AACN: Role New Clinical Nurse Leader (Summary draft 2003) Clinician: Leadership in care of sick across all environments Clinician: Leadership in care of sick across all environments Outcomes manager Outcomes manager Client Advocate Client Advocate Educator Educator

14. AACN Clinical Nurse Leader Role Cont. Information manager Information manager Systems analyst/Risk Anticipator Systems analyst/Risk Anticipator Team Manager Team Manager Member of Profession Member of Profession

15. “To be active participants in shaping the health care system, nurses must learn new skills” Alderman (2001, p. 50)