Nursing in the New Millennium

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Nursing in the New Millennium

• Phyllis M. Connolly PhD, APRN, BC, CS

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Nursings responsibility is awesomein patient
care and also in creating a new society (Nyberg,
1998, p. 209)
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3 Assumptions

• Life at warp speed
• New type of change, age of unreason
• Constant change, permanent white water

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Changing Work Environment

• Technology
• Demographics
• Managed Care
• Purchasers Influence
• Health Insurance Industry
• Changing Health Systems

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Report Card Managed Care

• Access
• Quality/Appropriateness
• Promotion/Prevention
• Outcomes
• General health improved
• Quality of life improved
• Treatment reduces psychological stress
• More productive independent

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ANA Initiatives Improve Quality of Health Care

• 1994 Nursings Safety and Quality Inititive
• 1996 Nursing-Sensitive Quality Indicators for
  Acute Care Settings
• 1997 National Data Base of Nursing Indicators
  (NDQI)
• CalNOC largest ongoing nursing quality
  measurement data set in nation

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IOM (2001)Crossing The Quality Chasm Changes
Needed

• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• equitable

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IOM Rules for Redesign (2001)

• Care is based on continuous healing relationships
• Care is customized according to patient needs
  values
• The patient is the source of control
• Knowledge is shared information flows freely
• Decision making is evidence-based

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IOM (2003) Keeping Patients Safe Transforming
the Work Environment of Nurses

• Address management practices
• Workforce capability
• Work Design
• Organizational safety culture

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Impact of Nursing Studies Patient Outcomes

• Needleman et al.(2002) 1997 data
• ? hrs care/day RNs medical pts.
• ? LOS, rates of UTI, UGI bleeding, pneumonia,
  shock or cardiac arrest failure to rescue
• ? hrs. care/day RNs surgical pts.
• ? UTI, failure to rescue
• Aiken et al.(2003)
• 10 ? in proportion of BSN
• ? 5 risk of patient death failure to rescue

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Strategies Skills For Future

• Ability to understand systems
• Critical thinking, analysis and problem solving
• Reframing
• Personal growth mastery, ability to tolerate
  ambiguity take risks
• Emotional intelligence self-restraint (impulse
  control) compassion

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Strategies Skills For Future Cont.

• can do spirit
• Business leadership intelligence
• Ability to manage change
• Group management skills, negotiating conflict
  resolution
• Stewardship
• Collaborative leadership skills

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AACN Role New Clinical Nurse Leader (Summary
draft 2003)

• Clinician Leadership in care of sick across all
  environments
• Outcomes manager
• Client Advocate
• Educator

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AACN Clinical Nurse Leader Role Cont.

• Information manager
• Systems analyst/Risk Anticipator
• Team Manager
• Member of Profession

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• To be active participants in shaping the health
  care system, nurses must learn new skills
• Alderman (2001, p. 50)