The Future of Nursing (As Seen in ADVANCE for Nurses - January 31, 1011)
One Midwest hospital uses IOM's report as a model to better the nursing profession.
By Maria Connolly, PhD, CNE, FCCM, ANEF, & Jackie Medland, PhD, RN
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The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation released their final report, "The Future of Nursing: Leading Change, Advancing Health" in October. Four key transformational recommendations were made after 2 years assessing the nursing profession.
- Nurses should practice to the full extent of their education and training.
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
- Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the U.S.
- Effective workforce planning and policymaking require better data collection and an improved information infrastructure.
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One regional medical center, Presence Saint Joseph (PSJMC), in Joliet, IL, with a watchful eye on the national trends in nursing and working closely with the area nursing schools, has been successful in implementing strategies that closely align with IOM's recommendations.
This past summer, PSJMC's nursing division received a $759,000 5-year (2010-15) grant from the Department of Health and Human Services' Health Resources and Services Administration (HRSA) Division of Nursing to implement their proposed "Promoting Leadership in Clinical Practice" to overcome critical shortages in behavioral health, perioperative and neuroscience services.
"Supporting our nurses and helping prepare new nurses for specific areas by offering education opportunities is of utmost importance. Nurses are vital to providing high-quality healthcare and, as a nation, we are going to face critical shortages, specifically in certain fields of nursing that require specialized knowledge and training," explained Jackie Medland, PhD, RN, chief nurse executive, PSJMC.
Practice to the Full Extent
In concert with the IOM's recommendation that nurses should practice to the full extent of their education and training, PSJMC will continue to educate, support and guide their 51 new graduate nurses in their first year of practice. The IOM report underscores the transition-to-practice programs and this is one of PSJMC's grant objectives. They are developing a transition-into-practice program focusing no diverse minority populations for both experienced RNs (transition nurses) and new graduate RNs (nurse interns). Unique aspects of this program include a "coaching component" for all new grads and preceptors, an outward-bound experience designed to strengthen emotional and team intelligence, and an emphasis on both the new graduate and preceptor designed to build a collaborative approach to both leadership skills and quality care of their patients.
Higher Levels of Education and Training
To deliver safe, patient-centered care, nurses need to attain requisite competencies that include leadership, health policy, system improvement, research and evidence-based practice, and teamwork and collaboration. The HRSA grant funding enables PSJMC's nursing leaders to construct an innovative education and preparation program that will enhance the skills and knowledge of those who will be shepherding the RN interns and transition nurses as preceptors. In the past, preceptors were chosen randomly based on staffing needs, the RN volunteers or clinical competence. Now preceptors are carefully selected based on the Growth and Advancement in Nursing (GAIN) program that reviews the potential preceptor's experience/competence, professionalism, desire to lead and enthusiasm for the profession of nursing. Preceptors are teaching their assigned RNs both in the classroom and on the clinical units. There will be ongoing case studies and debriefing throughout an entire year. The preceptors will learn now to coach individuals and groups and lead the outward-bound experience.
Full Partners in Redesigning Healthcare
Efforts to cultivate and promote leaders within the nursing profession is vital to IOM's recommendation for nurses to become full partners with physicians and other health disciplines. PSJMC's grant proposal details their leadership program for 120 RNs to enhance the skills, knowledge and competence to mentor new graduates and transition nurses as preceptors and RN coache over the next three years.
In one year of the GAIN Program, these RNs will experience core development sessions in role transition, leadership styles, communication skills and delegation. The GAIN Core Development II focuses on conflict management and resolution and how to have those crucial conversations with new RNs. The GAIN Core Development III focuses on advancing the nursing profession, which includes topics on generational and culture similarities and differences, stress management, and teaching prioritization and time management.
Effective Workforce Planning
The nursing grant's fourth objective is to initiate an infrastructure and process for replicating the transition-into-practice model and disseminating project findings. This requires keeping detailed quantitative and qualitative statistics. PSJMC has hired a grant coordinator and is searching for a research assistant to help meet this grant objective. In addition, an advisory board made up of a team of senior nurse educators from local universities and community colleges along with a representative from Will County's Center for Economic Development and Workforce Investment Board will oversee the grant's progress in implementing program objectives that will ultimately strengthen nursing leadership and improve the quality and safety of patient care at this regional center. Stay tuned!
Maria Connolly is a grant consultant, professor and director of research and grantsmanship at the University of St. Francis College of Nursing, and Jackie Medland is HRSA project director and chief nurse executive at PSJMC.
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