The Journey to the Future for Nursing

1. Journey Toward Nursing Excellence Conference The Journey to the Future for Nursing Maureen Sroczynski RN, MS Chief Nursing Consultant Massachusetts Department of Higher Education Nursing Initiative President/CEO Farley Associates, Inc

2. Our Itinerary • Defining the forces that are driving the changes we need for the future • Highlight the current state, regional and national models that bringing education and practice together to build the nursing workforce for the future • Provide you with some “keepers” that you can use in and share with other colleagues • Demonstrate that it is the “collective wisdom” of our profession that will lead to a positive future for us all

3. The Journey Is about Transition Movement Passage Evolution Change The psychological process people go through to come to terms with a new situation The understanding that none of us is as smart as all of us.

4. Chaos Theory as a Guide Chaos Old World New World

5. CHAOS THEORY • STEP BACK • LOOK FOR PATTERNS

6. Finding the Patterns– Fractals in Nature

7. Fractals for the Future Did You Know?

8. Future Patterns • Exponential times • Need new models for education • We are all interconnected • The speed of change can be scary

9. The key to achieving success and surviving in the future world is collaboration and connection…building bridges.. breaking down walls. Thomas Friedman

10. The Environment of Healthcare Today Acute Treatment Professional prerogative Inpatient Individual Professional Information as record Patient Passivity Tomorrow Chronic prevention and management Consumer responsive Ambulatory, Home and Community Interdisciplinary team Information as tool Consumer engagement and accountability

11. The New Patterns Aging Technology Epidemiology Costs Consumer Demands Research

12. Healthcare Facility Perspective Adequately sized and well-prepared nursing workforce that: Gets the right work done efficiently Helps hospital respond (profitably) to growing and safety pressures Greater predictability

13. Education Programs’ Perspective Help with expanding capacity to increase production of new nurses and improving curriculum to prepare professionals for the future Faculty Space Clinical education arrangements

14. RNs Perspective An improved work environment that allows them to work more effectively and ergonomically and to focus on patients and not the organization Supporting technologies that work and are co-designed to help them Greater involvement in matters that affect their ability to provide patient care Employment and personal security, reasonable earnings Improved relationships with physicians and co-workers “Want to be safe” Buerhaus

15. Anger Anxiety Boredom Fear Habit Interruption Hurry Fatigue Causes of Errors

16. Resistance Coping To = with Change Loss

17. THINKING DIFFERENTLY

18. Changing Perceptions Think See Feel Act

19. Grooves in Thinking

20. Paris inthe • the Springtime

21. How Many “F” Finished files are the re- sult of years of scientif- ic study combined with the experience of many years.

22. Today perceptiveness is moreimportant than analysis Peter Drucker

26. A New Perspective

27. The Common Ground No one entity can address the education needs of the profession. Partnerships and collaboration are key to our success. Transformation is needed in both education and practice. There is tremendous energy in collaboration.

28. Driving Forces for Change • Nursing and Faculty Shortages • IOM: Health Professions Education-2003 • Carnegie Report: Need for Radical Reform • IOM: The Future of Nursing-2010

29. IOM Quality Chasm Series To Err Is Human: Building a Safer Health System (2000) Crossing the Quality Chasm: A New Health System for the 21st Century (2001) Health Professions Education: A Bridge to Quality 2003 Patient Safety: Achieving a New Standard for Care (2004) Identifying and Preventing Medication Errors (2006)

30. All health professionals should be educated to deliver patient centered care as members of an interdisciplinary team , emphasizing evidence-based practice, quality improvement approaches and informatics The IOM Vision

32. The Carnegie StudyEducating Nurses : A Call for Radical TransformationRecommendations For programs • From focus on covering decontextualized knowledge to an emphasis on teaching for a sense of salience, situated cognition and action in particular situations. • From a sharp separation of clinical and classroom to an integration of the two. • From emphasis on critical thinking to emphasis on clinical reasoning. • From an emphasis on socialization and role taking to an emphasis on formation (identity and self understanding).

33. The Carnegie StudyEducating Nurses : A Call for Radical TransformationRecommendations For the student experience • Introduce pre-nursing students to nursing early in their experience • Broaden the clinical experience • Preserve post clinical conferences and small patient assignments • Develop teaching methods that keep students focused on the patients' experience • Vary the means of assessing student performance • Develop clinical residences for new graduates

34. The Carnegie StudyEducating Nurses : A Call for Radical TransformationRecommendations For faculty • Support robust, ongoing faculty development for all who educate nurses • Include teacher education courses in master’s and doctoral programs • Provide opportunities for educators to learn how to teach students to reflect on their practice • Support faculty in learning how to coach • Improve the work environment for staff nurses and support them in learning to teach • Support educators in the use of narrative strategies • Address the faculty shortage

35. The Carnegie StudyEducating Nurses : A Call for Radical TransformationRecommendations For policy changes • Come to an agreement about a set of clinically relevant prerequisites • Require BSN for entry into practice • Transform diverse pathways into a unified whole • Develop articulation programs to ensure a smooth timely transition from ADN to BSN • Redesign and reconfigure roles of ADN and diploma; Create seamless transitions • Develop more ADN to MSN programs • After 2012 require all who pass NCLEX to get BSN in 10 years

36. RWJF/IOM Report on the Future of Nursing Education • Goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system: • Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues, and current and future technology; • Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands; • Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services

37. The Common Themes • What we should teach nursing? • How should we teach nursing? • Where should we teach nursing? • What will be the work and the role of nurses as we moving into the future?

38. The Common Vision Commitment to Excellence Inclusiveness Collegiality Courage/perseverance Healthy Conflict A “coalition of the willing”

39. Aligning and Acting on Mutual Interests Use the opportunity for the CMS hospital payment changes that went into effect October 1 to bring hospitals, nurses, and nursing educators together to align their efforts around shared interests Buerhaus 2008

40. The New Imperatives The nurse of the future: Will be proficient at a competencies beyond those of traditional nursing programs. Will have a deeper understanding of prevalent health care conditions and situations. Prepared to function in times of chronic nurse shortage.

41. New Models Oregon- Standardized Curriculum ADN/BSN program QSEN: Quality and Safety Education in Nursing Bologna Accords Mass. Nurse of the Future Competencies Developing a Regional Collaboration

42. The New Models A paradigm shift from articulation or 2+2 or ADN/BSN to a new system of education and seamless curriculum models Learning activities are as close to actual nursing practice as feasible Preceptors as clinical teaching associates MSN in 10

43. New Pedagogies Integration of simulation Scenarios around competencies Active engagement in authentic practice situations; Case based Purposeful design of clinical education

44. Purposeful Design of Clinical Education Fill out, deepen theoretical knowledge Develop clinical knowledge Develop skilled know how Develop habits of thought Chris Tanner Oregon

45. Transformation Curriculum- Outcomes, organization and sequencing of content and learning experiences Pedagogy- Assumptions about the learning and approaches that recognize the advances in the science of learning The practice environment- To enhance clinical learning and professional practice

46. BUILDING THE FRAMEWORK FOR THE FUTURE OF NURSING EDUCATION AND PRACTICE Nurse of the Future Project 2006-2010 Creativity and Connections

47. Creativity and Connections Agenda Day One: Understanding Best Practices National Council of State Boards New Graduates Survey The Oregon Model Collaborative Education Model AONE Future Care Delivery Model DHMC Simulation to Increase Competence and Confidence Day Two: Brainstorming Solutions

48. Creativity and ConnectionsMeeting Outcomes Creating a seamless progression through all levels of nursing education Developing sufficient consensus on competencies to serve as framework for educational curriculum Developing a statewide nurse internship/preceptor program Establishing a formal coalition to foster ongoing partnership between nursing education and practice Agreement on Priorities

49. Our Structure: Where we began Nurse of the Future Project MONE Academic Practice Integration Committee Transition into Practice DHE Competency Development Group Curriculum for the Future

50. Volunteers Who Sustain the Effort