Nursing Opportunities

1
Nursing Opportunities

• The Sky is the Limit!
• Class 152

2
HOUSE KEEPING

• Welcome
• This is a 1.5 hour class
• Please silence your cell phones and pagers.
• If you must answer a call, please leave the
  room.
• Thank you.

3

• Please,
• Hold your questions during the presentation.
• Questions written on the 3X5 cards provided will
  be answered at the conclusion of the
  presentation.
• For all questions,
• the question and the answer will be available on
  the web.

4
Nursing OpportunitiesThe Sky is the Limit!

• Course 152

5
Objectives

• -To explore what the future can hold within the
  nursing profession.
• -To chronicle the shift occurring in nursing that
  is linked to the explosion of the computerized
  patient record system.
• -To examine nursing practice, education, and new
  executive leadership roles against the backdrop
  of a massive infusion of information technology.

6
Introductions

• Nancy H. Prewitt, B.S.N., R.N.C., C.N.A.
• Nurse Manager, Primary Care
• Lexington, Kentucky VAMC
• Cynthia L. Andrus, MSN, RN
• BCMA / Nursing ADPAC
• Houston, Texas VAMC
• Jawel Lemons, RN, MS, FNP-C
• Associate Director, Patient Care Services
• Augusta, Georgia VAMC

7
Have you seen any changes in the Nursing
Profession lately?

• -What changes in process or practice
• have you observed during the last 10 years?
• -What new roles have emerged which have ties to
  Informatics?
• -What are the pros and cons?

8
Traditional Roles Changing

• -Home Health / Extended Care
• -Improved Referral
• Process
• -Improved Processing
• of Physicians Orders
• -Reduced Processing
• Time

9
Home Based Primary Care (HBPC)

• -Dialogue Box Templates
• -Improved Documentation
• -Improved Efficiency

10
Discharge Planner

• -Interdisciplinary Notes
• -Collaborative Care Note
• -Day of Discharge Note
• -Reduced Discharge Errors /
• Omissions

11
Diverse / Expanded Roles

• -Clinical Applications Coordinator
• -BCMA
• Coordinator
• -Informatics Nurse
• -Computer ADPAC

12
More Expanded Roles

• -Decision Support System (DSS)
• -Safety Officer
• -NSQIP surgical data and trending
• -Med-model Consultant
• -Performance Monitor / Measure Expert
• -Home Tele Health (Health Buddy)

13
Even More Expanded Roles

• -Patient Advocate
• -Admissions Coordinator
• -Utilization Management
• -Process Improvement Coordinator

14
And Even More Expanded Roles

• -Case Management
• Manage smaller numbers of patient
  intensively
• -Care Management
• Manage, large number of patients across
  the continuum
• -Telephone Care / Triage
• Automatic Call Distributor
• Triage Software

15
Changes in Delivery of Care

• -Continued Shift from Inpatient to Outpatient
• -Community Based Outreach Clinics (CBOC)
• -Staff Education and Training
• -Group Clinics
• -Access, Access, Access

16
For Those Who Served

• My Health e Vet
• For Staff and Patients
• Disease Management
• Diaries and Logs
• Prescriptions
• Lab Results
• Health Information

17
One VA

• -Standardization / Expectations
• -No Veteran Left Behind
• -Remote Data
• -Cross-country Committees / Task Forces
• -Networking / Knowledge Sharing

18
Summary

• The sky really is the limit.
• See what needs to be done, what processes need
  improvement, and create a niche.
• Have fun, and be careful out there.

19
(No Transcript)
20
Nursing OpportunitiesSky is the Limit
Cynthia Andrus, MSN, RN Bar Code Medication
Administration Coordinator Michael E. DeBakey VA
Medical Center Houston, Texas
21
My Journey

• 1981- 1989 Enter the VA System
• Student Nurse/Health Tech
• Staff Nurse
• Clinic Nurse
• Entered Graduate School
• 1989 -1993 Private Sector
• Clinical Coordinator
• Nursing Supervisor
• Associate Director
• 1993 - Re-entered the VA System

Whole World In My Hands
22

• Opportunities Are Great At The VA
• The Makings of A VA Nurse
• Clinical Care Team Leader
• Staff Educator
• Multidisciplinary Workshop Leader
• Champion for Unit Base Performance Improvement

23
I Returned Home!

• Nurse Manager for the Social Learning Program
• Nurse Manager for the Social Learning Program and
  Day Treatment
• Nurse Manager for the Psychosocial Rehabilitation
  Program with a Collaborative Role as the Acting
  Associate Nurse Executive for Mental Health Care
  Line
• Nurse Manager with a Collaborative Role as the
  Senior Nurse Consultant for Mental Health Care
  Line

Michael E. DeBakey VA Medical Center
1993
24
While at Home

• 2002 Adjunct Clinical Instructor, Adult Mental
  Health, The University of Texas- Houston School
  of Nursing
• Role of the Nurse Manager for the Psychosocial
  Rehabilitation Program expanded to 5 other Mental
  Health Outpatient Programs
• Substance Dependency Program
• Post Traumatic Stress Disorder Program
• Comprehensive Mental Health Program
• Homeless Veterans Program
• Gero-Psychiatry Program
  
• Psychosocial Rehabilitation Program

Magnet Destination 2004
25
Opportunity Knocks

• 2004 Leadership Development Institute (LDI)
  Graduate
• Co-Chair Goal Share Project 2004
• 128 Teams and 1022 Employees Participated
• Co-Chair Combined Federal Campaign (CFC) 2006
• At the End of the Campaign ( October 2006
  to January 2007)
• Total Collection 294,196.11

26
A Shift In Practice

• Bar Code Medication Administration (BCMA)
  Coordinator

April 17, 2005
27
Nursing Practice

• Nurse Managers Computer Skills are developing at
  rapid speed and becoming Proficient
• Graduate Nurses are Computer Competent
• Staff Nurses embracing Computer Tools to monitor
  and Deliver Patient Care

28
Bedside Technology..How Do We Use It In Nursing?

• Patient Safety
• Medication Administration
• Clinical Documentation
• Patient Information
• Clinical Templates
• Patient Education
• Online Educational Material

29
Embarking on New Territory

• Learning a different culture
• Learning to speak the Lingo
• Learning the BCMA Software
• Learning The Team Players and their Roles

30
Blending Roles

• Become A Member of the BCMA Multidisciplinary
  Committee
• Become Visible to Staff and Senior Leadership
• Become an active Listener

31
Leadership Remains The Same

• BCMA Coordinator function as a Middle Manager
• Cohesive Multidisciplinary Team
• Developing Working Relationship with Staff
  (End-Users)

32
AN Opportunity To Advance My Practice

• Technology and Patient Care
• Technology and Nursing Practice
• Technology and Senior Leadership

33
Nursing Informatics A Collaborative Role

• Advance Practice
• Supporting Mainframe Applications
• Developing Databases
• Maintaining Desktops Applications

34
Technology and Patient Care

• Hand-Off Communication
• Interdisciplinary Treatment Planning
• Electronic Medical Records

35
Technology and Nursing Practice

• Bar Code Medication Administration (BCMA)
• Patient Safety (5 Rights)
• Point-Of-Care
• Data Driven
• PRN Effectiveness
• 4. Improving Performance

G. Sue Kinnick, BSN, MS,
36
Technology And Senior Leadership

• Staff Performance
• Early/Late
• Product Evaluation
• Equipment Purchases

37
Opportunities, Opportunities, Opportunities!
38
References

• Sensmeier, Joyce, RN, BC, CPHIMS, FHIMSS, Survey
• Says Care, communication Enhance by IT,
  www.nursingmanagement.com., October 2006.
• Troester, Sandra, RN,MS, Drive Nursing Activities
  to
• the Bedside with a Closed-Loop System,
  www.nursingmanagement.com., December 2006
• Wilholt, Kathryn, RN,CNAA, FACHE, How Does
• Technology Drive Safety? Travel To A
  Patient-Centered
• Culture, www.nursingmanagement.com., October 2006
• Wimms, Teresa, RN, and Oblak, Marlene, Nursing
• Informatics http//cms.clevelandclinic.org

39
Leadership in Nursing

• Jawel Lemons, RN, MS, FNP-C
• Associate Director, Patient Care Services
• Augusta, Georgia VAMC

40
HISTORY

• Started my medical career in the US Army as a
  medic
• Selected to attend a 1-year LVN program while in
  the Army
• Upon discharge enrolled in RN Diploma Program
• Obtained BSN
• Obtained MS, FNP-C

41
HISTORY

• Staff Nurse in ICU
• Visiting Nurse
• IV Team with certification
• Nurse Manager of Telemetry
• Specialized in Cardiology as APN
• Developed and Coordinated Heart Failure Clinic
• Associate Chief Nurse Medicine/Surgery
• ECF participant (Executive Career Field)

42
LEADERSHIP OPPORTUNITIES IN NURSING!

• ECF (PROGRAM) Executive Career Field
• a. A national program to prepare health care
  leaders.
• b. A very competitive program.
• c. A 2-year commitment.
• b. Entry is based on how well one can
  articulate written and orally the 8 Core
  Competencies.

43
LEADERSHIP OPPORTUNITIES IN NURSING!

• Eight Core Competencies
• Interpersonal Effectiveness
• Customer Service
• Systems Thinking
• Flexibility/Adaptability
• Creative Thinking
• Organizational Stewardship
• Personal Mastery
• Technical

44
LEADERSHIP OPPORTUNITIES IN NURSING!

• Performance based interview questions for each
  category and there are 4 levels of questions.
• Level I staff nurse
• Level II Nurse Manager
• Level III Associate Chief Nurse
• Level IV Executive Level (Medical Center
  Director etc.)
• Website www.pbi.com

45
LEADERSHIP OPPORTUNITIES IN NURSING!

• Each core competency is defined with a listing of
  sample questions under each Level.
• SAMPLE COMPETENCY
• A. Systems Thinking The ability to understand
  the pieces as a whole and appreciate the
  consequences of actions on other parts of the
  system.

46
LEADERSHIP OPPORTUNITIES IN NURSING!

• Interviewing Tips
• Be prepared
• Practice your answers prior to the interview.
• Use a process that clearly identifies the problem
  or issue, describe the plan and interventions and
  state the outcome in measurable terms.
• Be concise but thorough.

47
LEADERSHIP OPPORTUNITIES IN NURSING!

• SAMPLE QUESTION
• Describe a change you are responsible for that
  improved the performance of your work area or
  organization.
• 1. How did 1) you come up with the idea for
  the change, 2) you go about implementing the
  change, 3) staff respond to the change, and 4)
  you measure the outcome of the change?

48
LEADERSHIP OPPORTUNITIES IN NURSING!

• ANSWER
• 1. Performance measure CHF
• 2. Required by the VA to comply and measure.
• 3. Pulled all disciplines that impacted the
  completion of this measure, nurses, physicians,
  pharmacist, clerks etc.
• 4. Weekly kudos and posting of increase in
  compliance.

49
NURSING OPPORTUNITIES CPRS

• Nurses create templates to facilitate
  documentation.
• Nurses create templates to capture performance
  measure information
• Nurses create templates to document patient
  education.

50
NURSING OPPORTUNITIES!

• Create Patient Education Materials using Computer
  Technology
• Find a Topic Example Low-literacy!

• Rooster with a sun coming up to indicate to take
  meds in the morning.

51
CREATING PATIENT EDUCATION MATERIALS!

• What time is this medication supposed to be
  taken?

52
MEDICATION BOTTLES LABELED
53
CREATING PATIENT EDUCATION MATERIALS!
SAD FACE INDICATES PAIN, NAUSEA ETC.
CIRCLE THE NUMBER OF HOURS BETWEEN DOSES
54
PUBLICATIONS

• Utilize the VA library to get started publishing
  your article. The library has excellent
  resources.
• Published an article on low-literacy, the symbols
  just shared with you.
• Magazines are constantly looking for articles on
  various subjects. Take a chance, take a risk, try
  it.

55
SUMMARY

• There are multiple opportunities to expand ones
  career in the VA system.
• Every nurse has the opportunity to be creative
  and successful.
• Utilize the computer resources in the VA system
  for your growth and development of patient care
  initiatives.

56
Questions

• -Now its time for your Questions
• -Ask away!