Nurses need to be thought lead­ers and de­ci­sion­mak­ers in the trans­for­ma­tion of health­care

Modern Healthcare - - Q & A -

Pam Cipriano be­came pres­i­dent of the Amer­i­can Nurses As­so­ci­a­tion in June.

Cipriano, who holds a doc­tor­ate in ex­ec­u­tive nurs­ing ad­min­is­tra­tion, is a for­mer se­nior di­rec­tor with the con­sult­ing firm Gal­loway Ad­vi­sory by iVan­tage, and for­merly served as chief clin­i­cal of­fi­cer and chief nurs­ing of­fi­cer at the Univer­sity of Vir­ginia Health Sys­tem, Char­lottesville. She also was the first ed­i­tor-inchief of the ANA jour­nal Amer­i­can Nurse To­day. Mod­ern Health­care re­porter An­dis Robeznieks re­cently spoke with Cipriano about the role of nurses as pri­mary-care providers, the amount of time spent in front of com­put­ers and whether there is a nurse short­age. This is an edited tran­script.

Mod­ern Health­care: How have you seen the roles of nurses change over your ca­reer, and how have con­cepts such as pop­u­la­tion health and med­i­cal homes driven th­ese changes in re­cent years?

Pam Cipriano: Nurses are tak­ing on greater re­spon­si­bil­ity in large part as they have gained more ed­u­ca­tion and many have be­come cer­ti­fied as ad­vanced prac­tice nurses. Nurse prac­ti­tion­ers and cer­ti­fied nurse mid­wives are be­ing rec­og­nized as providers of care in the pri­mary-care home.

For many years, the main­stay of em­ploy­ment for regis­tered nurses was in the hos­pi­tal. But as we’ve seen care move out of the hos­pi­tal, more nurses have moved into the are­nas of home care, post-acute care, com­mu­nity health cen­ters and en­tre­pre­neur­ial roles. They are pro­vid­ing a lot of lead­er­ship in the trans­for­ma­tion of U.S. health­care.

MH: What role have nurses played in ad­vanc­ing the use of health in­for­ma­tion tech­nol­ogy and pro­mot­ing pa­tient safety?

Cipriano: Nurses prob­a­bly en­ter and see the largest amount of data that’s put into the elec­tronic health record. They’re re­ally im­por­tant in terms of data col­lec­tion, data doc­u­men­ta­tion and trans­mis­sion of that in­for­ma­tion. In ad­di­tion, they work with a lot of med­i­cal-de­vice data and will be more in­volved as data are ex­changed with set­tings out­side the hos­pi­tal and the pri­ma­rycare of­fice.

A lot of health IT is de­signed to help nurses with med­i­ca­tion man­age­ment and to an­tic­i­pate where there are safety prob­lems and be able to re­spond to alerts.

On pop­u­la­tion health, we want to make sure nurses have ac­cess to a broad range of data so they’re not just look­ing at the set­tings where we have ill­ness but are fo­cus­ing on health pro­mo­tion and un­der­stand­ing the de­ter­mi­nants of health at home and in the com­mu­nity.

MH: Are nurses spend­ing too much time on com­put­ers in­stead of with pa­tients?

Cipriano: Ev­ery health­care provider has a learn­ing curve when they start us­ing health IT, and nurses are like other mem­bers of the health­care team. They are learn­ing the re­quire­ments for doc­u­men­ta­tion. But any nurse or physi­cian will tell you they would not trade it for the old ways be­cause the abil­ity to re­trieve in­for­ma­tion is un­par­al­leled.

MH: Is there a short­age of nurses?

Cipriano: This has been one of the more dif­fi­cult eras to pre­dict sup­ply and de­mand be­cause things are chang­ing so rapidly. Re­cent fig­ures from the Bureau of La­bor Statis­tics show that as we look to the year 2020, we’re pro­ject­ing a short­age of about 1.1 mil­lion regis­tered nurses.

What’s dif­fi­cult in un­der­stand­ing those num­bers is that we know nurses are ac­tu­ally work­ing to a much older age than they used to. The num­bers sug­gest that 24% of nurses are work­ing much longer. Some of it is the econ­omy. For many nurses who look at liv­ing well into their 80s or 90s, re­tire­ment in their 60s is not as at­trac­tive, par­tic­u­larly as there are now new op­por­tu­ni­ties in en­vi­ron­ments that are not as phys­i­cally de­mand­ing as tra­di­tional hos­pi­tal jobs. As nurses follow the jobs out of the hos­pi­tal, they’re able to work longer, which is a good thing.

Another dif­fi­culty is that nurs­ing fac­ulty re­tire­ments are go­ing to ac­cel­er­ate faster than re­tire­ments of clin­i­cal nurses be­cause the av­er­age fac­ulty mem­ber is in her mid-50s, about 10 years older

“They are pro­vid­ing a lot of lead­er­ship in the trans­for­ma­tion of U.S. health­care.”

than the av­er­age clin­i­cal nurse. There also are some para­doxes. We have new nurs­ing grad­u­ates un­able to find jobs as other nurses hold on to those jobs, but at the same time there’s still enor­mous in­ter­est in com­ing into nurs­ing. The 2012 data showed that 80,000 qual­i­fied ap­pli­cants were turned away be­cause we did not have enough nurs­ing school po­si­tions, and that could be re­lated to the num­ber of fac­ulty or the avail­abil­ity of clin­i­cal place­ments.

So it’s a dilemma try­ing to un­der­stand all of the num­bers. But we do know that the baby boom gen­er­a­tion will con­tinue to be rel­a­tively high con­sumers of health­care, and we have rea­son to be­lieve that the de­mand for nurs­ing will con­tinue.

As hos­pi­tals try to un­der­stand how to right-size their work­force in a shrink­ing re­im­burse­ment en­vi­ron­ment, we’re see­ing vo­latil­ity. In some hos­pi­tals we see lay­offs. In oth­ers we see in­creas­ing de­mand to make sure that they have a well-ed­u­cated, ro­bust work­force and they’re get­ting qual­ity out­comes. The short an­swer is we be­lieve we will con­tinue to need more nurses, there is a lot of in­ter­est in pro­duc­ing those nurses, and we have a real de­mand to re­place fac­ulty who will be re­tir­ing.

MH: What do you see as the ANA’s fo­cus for the next year?

Cipriano: We be­lieve strongly in the in­volve­ment of nurses in the na­tional trans­for­ma­tion of health­care. Nurses are very well-versed in look­ing at the di­verse needs of pa­tients and fam­i­lies, liv­ing up to the six aims of care that the In­sti­tute of Medicine has pre­scribed, and very in­ter­ested in cre­at­ing qual­ity out­comes. So nurses need to be part of the thought lead­ers and de­ci­sion­mak­ers. In many places we are in­creas­ing the pres­ence of nurses, whether that’s on fed­eral ad­vi­sory com­mit­tees, hos­pi­tal boards or com­mu­nity boards.

As we look at the op­por­tu­ni­ties for ad­vanced prac­tice nurses, we think th­ese are some of the most crit­i­cal places where we want to have nurses rep­re­sented. Ad­vanced prac­tice nurses pro­vide sim­i­lar if not bet­ter out­comes for pa­tients, so it is im­por­tant that they are a part of pri­mary care or pa­tient-cen­tered med­i­cal homes. We also know they do an ex­cel­lent job with nurse-man­aged health cen­ters.

We’re very in­volved in look­ing at how we pro­mote op­por­tu­ni­ties not only for the gen­eral prac­tice nurse but for ad­vanced prac­tice nurses, re­mov­ing bar­ri­ers for ad­vanced prac­tice.

We’re work­ing through our state as­so­ci­a­tions to make sure nurses can prac­tice to the full ex­tent and scope of their li­cen­sure and ed­u­ca­tion. We also are work­ing to in­crease the ed­u­ca­tion of all nurses so that we have a regis­tered work­force that’s 80% bac­calau­re­ate-pre­pared nurses by 2020.

In ad­di­tion, it’s very im­por­tant that we have a safe work­place that not only pro­tects pa­tients but also pro­tects nurses from in­jury. That’s a sig­nif­i­cant cause of at­tri­tion when nurses ex­pe­ri­ence any kind of mus­cu­loskele­tal in­jury or other work­place haz­ard.

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