Collaboration and resourcefulness: thinking outside the box

Christine Grady RN PhDDepartment of Bioethics

NIH Clinical Center

2013 PHS Nursing Recognition DayEmbracing Diversity: Limitless Possibilities in Nursing

May 3, 2013

• These views are mine and do not necessarily represent those of the Department of Bioethics, Clinical Center, National Institutes of Health, or the Department of Health and Human Services.

• I have no conflicts of interest to declare

The Future of Nursing• Enactment of the ACA will provide unprecedented opportunities for change in the

U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.

• The Future of Nursing, Leading Change, Advancing Health, IOM 2011

Overview

• Leadership• Partnership• Collaboration• Resourcefulness

Nurse Leaders in Health Care

Top 25 Women in Healthcare – 2013• … program honors exceptional female

healthcare executives who are making a positive difference in the industry. The honorees represent all sectors of healthcare, including hospitals, health systems, insurance, government, trade and professional organizations, and labor.

Nurses and Nurse Champions Included in Modern Healthcare's Top 25 Women in Health Care

Top 25 Women in Healthcare – Modern Health Care 2013Honorees with Nursing Background

• Maureen Bisognano is president and CEO of the Institute for Healthcare Improvement, a patient-safety organization. She began her career in health care in 1973 as a staff nurse at Quincy City Hospital.

• Karen Daley is president of the American Nurses Association, a professional organization representing the interests of the nation’s 3.1 million registered nurses.

• Patricia Hemingway Hall is president and CEO of Health Care Service Corp. Hall began her career as an intensive-care nurse in the 1970s, but since 2008, has led HCSC, which covers more than 13 million members in Illinois, New Mexico, Oklahoma and Texas.

• Sister Carol Keehan is president and CEO of the Catholic Health Association, representing the nation’s Roman Catholic health systems and the largest group of not-for-profit health providers in the nation.

• Judith Persichilli is president and CEO of Catholic Health East, a health system that includes 39 acute-care hospitals, 26 long-term-care facilities and other operations in 11 Eastern states.

• Shirley Weis is chief administrative officer and vice president of the Mayo Clinic, one of the most well-known brand names in health care and a system that treats more than 1 million people annually in Arizona, Florida, Georgia, Iowa, Minnesota and Wisconsin.

• Sharon O’Keefe is president of the University of Chicago Medical Center and has more than 30 years of health care experience, initially as a critical-care nurse and then in hospital leadership.

• Marilyn Tavener is acting administrator for the CMS and oversees the $757 billion federal agency that provides health care coverage to 100 million Americans through Medicare, Medicaid and other programs.

• Mary Wakefield is administrator of the Health Resources and Services Administration and leads efforts to work with providers and community programs to improve access to health care services for the needy, uninsured and isolated.

Nurses in Congress

Congresswoman Karen Bass (D-CA-33)

Congresswoman Diane Black (R-TN-06)

Congresswoman Lois Capps (D-CA-23)

Congresswoman Renee Ellmers (R-NC-02)

Congresswoman Eddie Bernice Johnson (D-TX-30) Congresswoman Carolyn McCarthy (D-NY-04)

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Federal/Nurses-in-Congress

Nurse Leaders- Uniformed Services

• Lieutenant General Patricia D. Horoho, Surgeon General and Commanding General of the United States Army Medical Command . (first female and first Nurse Corps officer to be SG & CG in the Army).

• Rear Admiral Kerry Paige Nesseler, Assistant Surgeon General, Chief Nurse Officer, USPHS and Director of the Office of Global Health Affairs, HRSA US DHHS

• “…all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies…”

Developing Leaders • Recommendation 7: Prepare and enable nurses to lead change to advance health.

Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses. – Nurses should take responsibility for their personal and professional growth by continuing

their education and seeking opportunities to develop and exercise their leadership skills.– Nursing associations should provide leadership development, mentoring programs, and

opportunities to lead for all their members.– Nursing education programs should integrate leadership theory and business practices

across the curriculum, including clinical practice.– Public, private, and governmental health care decision makers at every level should include

representation from nursing on boards, on executive management teams, and in other key leadership positions.

The Future of Nursing, Leading Change, Advancing Health, IOM 2011

Leadership

1. “Sit at the table”2. Seek Challenges and take

Risks3. Make your partner a real

partner4. Pursue goals with gusto

“Studies also show that compared to men, women underestimate their performance. If you ask men and women questions about completely objective criteria such as GPAs or sales goals, men get it wrong slightly high; women get it wrong slightly low. More importantly, if you ask men why they succeeded, men attribute that success to themselves; and women, they attribute it to other factors like working harder, help from others. Ask a woman why she did well on something, and she’ll say, “I got lucky. All of these great people helped me. I worked really hard.” Ask a man and he’ll say or think, “What a dumb question. I’m awesome.” So women need to take a page from men and own their own success”S. Sandberg

CELEBRATING NURSES: Nurses are strong, nurturing and selflessLaura Raines, Atlanta Journal Constitution April 26, 2013

• “Woven within our communities are strong, nurturing and selfless people. We call them nurses. They are the trusted professionals we turn to when we’re sick and hurting. But nurses don’t just practice at the bedside. They bring their caring, thinking, teaching, problem-solving, get-it-done qualities into our families, schools, churches, businesses, legislatures and neighborhoods — and we’re all the richer for it. “

And yet…• Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’

Perceptions” (RWJF, 2010, Box 5.1)

• Opinion leaders rate doctors and nurses first and second among a list of options for trusted information about health and health care.

• Opinion leaders perceive patients and nurses as having the least amount of influence on health care reform in the next 5–1 years.

• Reducing medical errors, increasing quality of care, and promoting wellness top the list of areas in which large majorities of opinion leaders would like nurses to have more influence.

• Relatively few opinion leaders say nurses currently have a great deal of influence on increasing access to care, including primary care.

• Opinion leaders identified top barriers to nurses’ increased influence and leadership as not being perceived as important decision makers or revenue generators compared with doctors, having a focus on acute rather than preventive care, and not having a single voice on national issues.

• Opinion leaders’ suggestions for nurses to take on more of a leadership role were making their voices heard and having higher expectations.

LeadershipBOX 7-3: Research Priorities for Transforming Nursing Leadership

Identification of the: –personal and professional characteristics most critical to leadership of health care organizations, such as accountable care organizations, health care homes, medical homes, and clinics.– skills and knowledge most critical to leaders of health care organizations, such as accountable care organizations, health care homes, medical homes, and clinics.–personal and professional characteristics most important to leaders of quality improvement initiatives in hospitals and other settings.–characteristics of mentors that have been (or could be) most successful in recruiting and training diverse nurses and nurse faculty.–influence of nursing on important health care decisions at all levels.–unique contributions of nurses to health care committees or boards.

ANA Leadership Institute

• Webinar 1. Strategic Thinking • Webinar 2: Results Orientation• Webinar 3: Leading People• Webinar 4: Personal Leadership• Webinar 5: Unleashing Innovation and Creativity

http://anawebinarseries.eventbrite.com/#

Partnership and Collaboration

• “Make your partner a real partner”

• Lean In and Lean On

• Health care is a team sport

• Patient as Partner

The Power of CollaborationLord Shiva led the Swami to two doors.

Behind the first door, he saw a large round table with a large delicious smelling pot of stew. The people sitting around the table were thin and sickly and appeared to be famished. They were holding spoons with long handles that were strapped to their arms. They could reach into the pot with the spoon and take a spoonful of stew, but since the handle was longer than their arms, they could not get the spoons back into their mouths.

The Swami shuddered at their misery and suffering.

Behind the second door, things looked similar. A delicious smelling pot of stew sat in the middle of a large round table. The people were equipped with the same long-handled spoons. But here the people were well nourished and plump, laughing and talking.

The Swami said, “I don’t understand”.“It is simple”, said Lord Shiva, “It requires but one skill. You see they have learned to feed each other. They have learned to work together”.

SUFI PARABLE: Author Unknown

Figure 1. Possible skills, knowledge, traits and motives influencing teamwork, from Leggat S. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health Services Research 2008

• Key Message #3: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

• Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions

Leadership and Collaboration

• Leadership from nurses is needed at every level and across all settings. Although collaboration is generally a laudable goal, there are many times when nurses, for the sake of delivering exceptional patient and family care, must step into an advocate role with a singular voice. At the same time, effective leadership also requires recognition of situations in which it is more important to mediate, collaborate, or follow others who are acting in leadership roles.

Healthcare Changes: Need for innovation, collaboration, and leadership

• Affordable Care Act• Workforce changes• Shifting Demographics• Globalization• Genomics and personalized medicine• Learning health systems• Technologic advances

Affordable Care Act

I. Quality Affordable Healthcare for AllII. Role of Public ProgramsIII. Improving quality and efficiency IV. Prevention of chronic diseaseV. Health Care WorkforceVI. Transparency and professional integrityVII. Improving access to innovative therapiesVIII. Community Living Assistive and SupportiveIX. Revenue provisionsX. Reauthorize Indian Healthcare Improvement Act

NEJM April 18, 2013

Figure 7. Growth in the U.S. Nursing Workforce

The U.S. Nursing Workforce: Trends in Supply and Education (2013 HRSA) http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/index.html

Figure 8. Highest Degree Held by RNs, Census 2000 and ACS 2008 to 2010

Figure 18. NCLEX-RN Passers, 2001 to 2011

68,561

70,474 75,821

85,824 98,365

109,726 116,045

127,592134,027

137,834142,390

50,000

60,000

70,000

80,000

90,000

100,000

110,000

120,000

130,000

140,000

150,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Pass

ers

Year

107.7%Growth,

2001-2011

Figure 24. Licensed RNs Graduating With BSN Qualification, 2007 to 2011

Figure 25. Master’s and Doctoral Graduates, 2007 to 2011

Figure 9. The Changing Age Distribution of RNs, in Five-Year Increments

Figure 11. Race/Ethnicity in the RN Workforce and Total Working-Age Population

• The national spotlight on the nursing shortage has raised awareness of the pivotal role nurses play in health care delivery as well as the many career opportunities available in the field. In addition to providing direct patient care, nurses today can conduct research, teach in universities, advise public policymakers, lead healthcare organizations, establish independent practices, and share their expertise in many other ways. This dynamic profession is attracting an increasing number of highly skilled individuals from other disciplines who are seeking new careers in nursing.

• RWJ- New Careers in Nursing, http://www.newcareersinnursing.org/about-ncin/background

Demographic Shifts

Globalization

Why Nurses Are the Unsung Heroes of Global Health Sheila Davis, Huffington Post 2012

country Nurses Doctors

Malawi 25.5 1.1

Tanzania 36.6 2.3

Ghana 64 9

Zambia 113 6.9

Botswana 241 28,7

South Africa 388 69.2

UK 937 256

USA 1212 230

Table 1: The human resource crisis: health personnel (nurses and doctors) per 100,000 population

(Source: WHO 2007 HIV/AIDS Programme. Task shifting to tackle health worker shortages. Table 1 p.2)

• “…although nurses deliver ~90 percent of all healthcare services worldwide, they remain largely invisible at decision-making tables in national capitals and international agencies. Their absence constitutes a global health crisis.” Davis S 2012

Genomics and personalized medicine

Changes in research:Learning Health Care Systems

Technological Advances

Resourcefulness and InnovationTen Innovations That Will Transform Healthcare• Checklists• Behavioral economics• Patient portals• Payment innovations• Evidence based decision making• Accountable Care Organizations• Regenerative Medicine• Virtual Visits• Genetics enters practice• Surgical Robotics

http://hbr.org/web/extras/insight-center/health-care/10innovations/1-checklists

Throughout the years, PHS nurses have demonstrated their innovative flexibility and willingness to adapt to new opportunities, and they continue to bridge the gaps today. http://phs-nurse.org/usphs-nurses/slider-3

The Future of Nursing• Enactment of the ACA will provide unprecedented opportunities for change in the

U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.

• The Future of Nursing, Leading Change, Advancing Health, IOM 2011

LEAN IN, LEAN ON, AND THINK OUTSIDE THE BOX