NACNEP'S primary activities during the
year were centered on furthering two major
facets of the prior work described in
the first mandated report: 1) the COGME
and NACNEP joint interdisciplinary activities
and 2) the issues underlying the continuing
nursing shortage with special attention
to the nurse faculty shortage.
Interdisciplinary
Activities
Health Professions
Education Summit
NACNEP, along with COGME, participated
in organizing and coordinating a multidisciplinary
invitational summit of leaders to discuss
and develop strategies for restructuring
health professions education to advance
and better prepare health professionals
to practice in today's health care system.
The summit, which was held on June 17-18,
2002, was sponsored by the Institute of
Medicine (IOM). Federal contributions
in support of the summit were made by
the Division of Medicine and Dentistry,
and the Division of Nursing, Health Resources
and Services Administration (HRSA) and
the Agency for Healthcare Research and
Quality. Private partners included the
American Board of Internal Medicine Foundation
and the California Healthcare Foundation.
Over 150 national experts in health professions
education, regulation, quality, health
policy, and industry participated in the
summit.
The participants examined the new skills
and roles health professionals need to
successfully address the health needs
of the population: patient-centered care,
interdisciplinary teams, evidence-based
practice, quality improvement and informatics.
The attendees, working in small interdisciplinary
groups, developed strategies around these
five skill areas, which were synthesized
into seven crosscutting strategies for
the reform of health professions education.
Once again working in small interdisciplinary
groups, the participants then developed
personal action steps to take over the
next 1-3 year period to implement these
seven strategies. Over 200 action steps
were generated. These will be covered
in a report to be published and distributed
by IOM toward the end of 2002.
Furthering Interdisciplinary
Education and Practice
The joint NACNEP and COGME recommendations
described in the report Collaborative
Education to Ensure Patient Safety fostered
a number of cooperative agreements with
public and private nonprofit entities
that were cosponsored by HRSA's nursing
and medicine divisions. For one of the
projects resulting in a cooperative agreement,
a grantee was selected to develop a national
"train the trainers" program to create
nurse and physician faculty leaders in
interdisciplinary education specifically
directed toward enhancing patient safety.
Faculty graduates of this program would
then lead in training other medical and
nursing faculty in the curricula and techniques
learned under this program. The University
of Washington in Seattle received an award
of $1.2 million for the 3-year project
period.
The second call for applications by
the two divisions was to provide awards
of $300,000 each to four awardees for
improving patient safety at the direct
care level in hospitals and in communities
through collaborative, interdisciplinary
activities focusing on the planning, development,
and implementation of patient safety curricula/activities,
including simulations and informatics
to prepare physicians and advanced practice
nurses to promote safety and prevent errors
in health care delivery. The four awards
were made to the following institutions
for the specific purposes listed:
- University of California, San Francisco:
Medical and nursing faculty and clinicians,
as well as their students who complete
this competency-based, web and seminar-based
curriculum will learn to improve outcomes
for patients with vascular access devices.
- University of Colorado Health Science
Center: This award will develop
case studies for use by interdisciplinary
teams of medical and nursing faculty
to collaboratively teach students from
both disciplines to improve care of
patients in the seven State Area Health
Education Center (AHEC).
- Health Research and Educational
Trust, Chicago: This award will
use executive walkrounds in 10 traditional
and nontraditional clinical sites to
teach graduate medical and nursing students,
clinicians and faculty about open discussions
of adverse events (misses and near misses).
The presence of executives in the rounds
will ensure that the issue is heard
and discussion of systems changes and
implications are exchanged to promote
change. The project will take place
in 10 hospitals in urban and rural Massachusetts.
- University of Mississippi, Jackson:
This State-wide project is a partnership
between the only school of medicine
in Mississippi and the State's five
graduate nursing programs that prepare
advanced practice nurses. The partnership
will develop, implement and evaluate
a patient safety curriculum to teach
to graduate medical and nursing students
across the State in regional workshops
and to provide the students with on-going
electronic consultation.
The five cooperative agreements were
awarded in September 2001 for a 3-year
period. The grantees are now completing
their first year of work.
The characteristically significant shared
experience of each of these undertakings
is the personal and professional commitment
and participation of academic faculty,
clinical faculty from health care settings,
and administrators from both academia
and the health care settings. Such involvement
of both faculty and administration promises
to deal with the usual "controversies"
associated with interdisciplinary education,
such as confusion about definitions and
terms, curriculum length and content,
faculty and departmental resistance, questions
about university support of interdisciplinary,
collaboratively taught courses, license
requirements and scopes of practice.
Nursing
Shortages
The Continuing RN
Shortage
As NACNEP continued its work during the
year to "provide advice and recommendations
to the Secretary and Congress concerning
policy matters arising in the administration
of [Title VIII], including the range of
issues relating to the nurse workforce,
education, and practice improvement",
it was clear that the nursing shortage
had not abated. The elements identified
as affecting the future supply of RNs
were still relevant. Therefore, the most
critical issues facing the availability
of nursing care continued to be those
of the nursing shortage from both short-term
and long-term perspectives. Major segments
of the three meetings that NACNEP held
during the year were devoted to the study
of the issues through presentations made
by nursing organization representatives
and experts reporting on relevant research.
Members of NACNEP during those meetings
worked on refining and prioritizing the
recommendations in their broad action
plan presented in the first mandated report.
NACNEP recognized that solutions for the
presently on-going nursing shortage rest
within the use of already available nursing
resources. Activities undertaken to newly
develop additional resources will be effective
in the future because of the time involved
in attracting and educating students.
During the meetings, the Council explored
possible approaches that have been or
may be taken to access those already educated
as registered nurses. However, NACNEP,
given its role as an advisory body, agreed
that it was imperative to look for and
recommend possible actions that could
increase the capacity to produce more
RNs and thus ward off future shortages.
Any actions that could be taken to alleviate
the immediate shortfall in the RN supply
are those pertaining to recruiting and
retaining current RNs into the active
workforce and enhancing the effective
use of these current RNs. RNs who are
working in non-nursing positions primarily
point to better pay, more rewarding work
and personal or family needs as the reasons
for their not working in nursing. RNs
who are not employed are considerably
older, on the average, than employed RNs.
Those inactive RNs who come from the younger
segments of the population tend to have
family responsibilities, often including
the care of young children. The retention
of already employed RNs in positions is
of paramount importance as well. Maintaining
the stability of the RN workforce is complex,
associated with a variety of factors,
both economic and non-economic. The solutions
engage many segments both within and outside
the health care delivery system including
examining wage structures, schedules,
support systems and the professional work
environment.
Nurse Faculty Shortage
In the long term, however, the availability
of an adequate and qualified RN workforce
is dependent upon the education of sufficient
numbers of new RNs as both replacements
for those retiring and additions to satisfy
the increasing demands. All projections
of the future state of the adequacy of
the RN supply show that the picture will
only deteriorate given the aging of the
RN workforce if the present rate of production
of new RNs continues into the future.
Therefore, the future of adequate nursing
resources relies on the addition of substantial
numbers of new RNs. Such an expansion
cannot be accomplished without the availability
of appropriate educational resources.
Sufficient qualified faculty is a vital
component of the educational resources
needed. Nursing school administrators
throughout the country point to vacant
faculty positions and difficulties in
recruiting. Even within the current climate
of reduced numbers of applications for
schools of nursing, the lack of faculty
has caused a number of educational programs
to limit admissions. An even greater shortage
is anticipated for the future as substantial
numbers of the current faculty members
are expected to retire. A critical first
step, then, in obtaining an adequate future
supply of RNs, is to make certain that
a cadre of qualified faculty will be available
to teach them. This, then, becomes the
first priority in alleviating the anticipated
future nursing shortage. Thus, while mindful
of the many critical issues facing patient
care and nursing documented in its first
mandated report, NACNEP focused this past
year on the nurse faculty workforce shortage.
Future Activities
In its future activities NACNEP will
continue to participate in ways of fostering
interdisciplinary approaches to education
and the delivery of health care. At the
same time, continuing concerns about the
availability of nursing resources lead
to a special presentation in this report
of NACNEP's most recent study of the nursing
shortage and the underlying components
of the nurse faculty shortage. With the
nurse faculty shortage seen as the issue
requiring immediate attention actions
are recommended to improve the availability
of sufficient qualified faculty critical
to ensuring an appropriate future supply
of RNs. In examining ways in which nursing
can be most effective in delivering quality
health care to the nation's population,
NACNEP will continue to monitor the country's
nurse supply for approaches to ensure
its adequacy. NACNEP will also continue
to examine the effect of Title VIII programs
for their impact on ensuring a sufficient
supply of RNs and enhancing nursing's
contribution to the nation's health care.
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