1. California Institute for Nursing & Healthcare Betty Irene Moore Nursing Initiative: Nursing Education Redesign for California Jan Boller, RN, PhDDeloras Jones, RN, MSN Project DirectorExecutive Director

2. Boller: BASC Presentation 0407 2 California Institute for Nursing & Health Care A multi-stakeholder, nonprofit organization committed to serving as a catalyst for action as we address nursing and related healthcare issues to improve the health of Californians through strategic workforce planning, research, education, and policy recommendations. “ Optimizing the Health of Californians through Nursing Excellence”

3. Boller: BASC Presentation 0407 3 The Demand: Nursing Excellence Patient/client-centered, (not task-centered): Patient advocates who provide safe passage Critical thinkers, clinical judgment, systems thinkers Use evidence-based practice Community-based, Population-based, Prevention & Health-Promotion-based Technology-proficient High-level patient teaching skills – healthy lifestyle practices Innovators in complex, chaotic care systems Lead interdisciplinary teams in coordinated care throughout the continuum

4. Boller: BASC Presentation 0407 4 The Supply: Sobering Statistics Nursing shortage Gaps in education of new graduates Retention of new graduates Educational advancement

5. Boller: BASC Presentation 0407 5

6. 6 Nurse Shortage California Nursing Workforce 223,000 RNs working in California Average age 47.7 years California ranks next to last in RNs per capita  544 California, 782 national average

7. Boller: BASC Presentation 0407 7 Nurse Shortage Demand for Nurses Hospitals reporting 11 to 15% vacancy rates  14,000 RN vacancies California EDD projected need for nearly 110,000 new nurses between 2000 and 2010  Capacity to educate ½ that number HRSA forecasts by 2010 demand will be 47,600 more than supply…24% short fall HRSA forecasts by 2020 demand will be 116,000 more than supply…45% short fall

8. Boller: BASC Presentation 0407 8 Nurse Shortage Educational Pipeline California schools have capacity to educate only ½ of nurses needed Schools have increased capacity 10% within last 5 years, yet capacity is just over what it was in 1994-95 Most of increase has been through hospitals contributions to education Attrition rates between 20% to 26% Only 40% of qualified applicants are admitted

9. Boller: BASC Presentation 0407 9 NCSBN Elements Study: Gaps in Nursing Education (reported by students) Administer medicine to groups of patients Delegate tasks to others Supervise care by others Knowing when and how to call the physician (also in Carnegie Study)

10. Boller: BASC Presentation 0407 10 Gaps in Nursing Education from NCSBN Elements Study (reported by faculty) Content not being taught consistently  Use of information technology (8.4% of programs)  Evidence-based practice – 11.7% of programs  Critical care – 9.1% of programs  Interdisciplinary elements – 32.5% of programs  Only 55.9% of programs allow students to call MDs

11. Boller: BASC Presentation 0407 11 Key Theme: Demands Immediate Attention Nurses are still “eating their young” Lateral violence Unhealthy workplaces Educational strategies for inoculation?

12. Boller: BASC Presentation 0407 12 Transition Study Practice Errors – New Nurses Charted on wrong record – 55.2% Medication errors – 43.2% Contribute to treatment delays – 39.3% Missed physician/provider order – 38.5% Client falls – 34.9% Error in performance of skills – 28.2% Misinterpreted physician order – 23.8% Client elopement – 13.3% Avoidable client death – 1.1%

13. Boller: BASC Presentation 0407 13 New Nurses Make Significantly Fewer Errors When: More competent in clinical reasoning More competent in communication and interpersonal relationships

14. Boller: BASC Presentation 0407 14 Retention of New Graduates in California & Educational Advancement <65% retention at the end of the second year of employment 70% of new graduates in California are AD prepared. Important entry point for RNs. However, only 17% advance to BSN or beyond with increasing demand for BSN and graduate level credentials

15. Boller: BASC Presentation 0407 15 What is CINHC Doing to Address this Problem? Master Plan: Education, Workplace, Diversity Funding, Policy, Collaboration Strategies for Increasing Educational Capacity Regional Shared Services  Computerized Clinical Placement System  Faculty Resource Center  Regional Clinical Simulation Centers Faculty Development  “Magic in Teaching” Compendium – 2005, November 1, 2007  Clinical Faculty Training Program for Clinical Nurses Leadership Development: Building a Foundation for Leadership Excellence, in partnership with ACNL

16. Boller: BASC Presentation 0407 16 Grant Overview A “Nursing Education Redesign in California: White Paper and Strategic Action Priorities” that examines the need to reshape nursing education, makes recommendation on redesign elements, defines the action steps, and provides plans for building consensus required to accomplish redesign.

17. Boller: BASC Presentation 0407 17 Program/Project Profile 1. Why was this program selected? a. Concerns about student readiness for entry into practice in today’s complex health environment. Concerns about patient safety and quality of care b. Faculty concerns about maintaining quality education with increased enrollments 2. Driving forces affecting quality of education a.Nursing and faculty shortage b. Changes in health care environment c. Availability of simulation and other innovations in education d. Renewed interest in collaboration between academia and service

18. Boller: BASC Presentation 0407 18 Nursing Education Redesign for California: Plan Gather Data About Advances in Education & Key Challenges to Delivering Quality Education Convene Thought Leaders Identify Core Competencies/Gaps Outline Key Action Strategies Meet with Key Stakeholders For Feedback and to Build Consensus Across the State Publish and Dissemination Action Plan (White Paper)

19. Boller: BASC Presentation 0407 19 Project Approach Build relationships through conversation, dialogue, and consensus-building Appreciative inquiry Cultivate communities of practice among clinicians, educators, policy makers Participatory action science approach, focusing on reflection and action Quality improvement processes, using small tests of change.

20. Boller: BASC Presentation 0407 20 Preliminary Data Based on 1 st Thought Leader Survey Gaps in core competencies (Based on Competencies Identified by Oregon Consortium for Nursing Education)  Makes sound clinical judgment  Collaborates as part of a health care team  Practices within, utilizes and contributes to the broader health care system  Uses best available evidence in making practice decision IOM Quality & Safety Competencies  Patient-centered care  Interdisciplinary team  Evidence-based practice  Quality improvement approaches  Informatics

21. Boller: BASC Presentation 0407 21 Preliminary Recommendations Strategic Action Priorities  Core competencies needed for 21 st century: professional & clinical  Transition to practice: Formal residencies/internships  Forging academic/service partnerships; Common unified voice for nursing excellence, clinical rotations, preceptorships, healthy workplace  Collaborative education model: Seamless and timely advancement from ADN to BSN to Graduate  Integrate simulation, other innovations and evidence/based, best practices into curriculum  Faculty development to learn new ways to teach  Explore & evaluate new and innovative “out of the box” programs to respond to the nursing shortage  Economic models for funding education

22. Boller: BASC Presentation 0407 22 We must bridge the chasm between academia and service when it comes to preparing nurses. Smooth transitions Role socialization Community of practice Theory cannot be separated from practice Nursing is a practice- based profession

23. Boller: BASC Presentation 0407 23 Call to Action: Let’s Get Together Stop lateral violence NOW (nurses eating their young) Solve clinical rotation problems Develop high-performing faculty (academic & clinical) Build collaborative curriculum from novice- to-expert

24. Boller: BASC Presentation 0407 24 Contact Information California Institute for Nursing & Health Care 1815 B Fourth Street Berkeley, CA 94710 (510) 486-0627 jan@cinhc.org deloras@cinhc.org www.cinhc.org