A free seminar presented by University of Saint Francis - Fort Wayne

2. Nancy Gillespie
PhD, RN, Dean
Thank you.

3. Agenda
Future of Nursing Presentation
Panel Discussion
Simulation Showcase

4. Mindy Yoder
DNP, FNP-BC, RN
Leading Change,
Advancing Health

5. Overview
Healthcare challenges in the U.S.
Our Nursing Profession
Healthcare Reform
IOM Nursing Report-Call for
Leadership

6. What is the state of our
HEALTHCARE
SYSTEM?

7. A short list…
Unsustainable costs
Equitability of access to care
Difficulty building consensus

8. A short list…cont.
Care coordination
Primary care shortage
Aging population and rise
of chronic disease
Poor outcomes

9. Why does U.S.
HEALTHCARE
cost so much?

10. Why $$$?
Technology
Prices are higher in the United States
Price insensitivity to end consumer
Judgment-based nature of MD care
Values and culture

12. Per capita health spending and
15-year survival for 45-year-old women.
U.S. and 12 comparison countries, 1975 and 2005
Muennig P A , Glied S A Health Aff2010;29:2105-113
©2010 by Project HOPE - The People-to-People Health Foundation, Inc.

13. Demographics
Starting in 2011
10,000 people in the U.S.
have been turning 65 every day

14. Fastest Growing Population, 85+
20,000
19,041
18,000
16,000
14,000 14,198
12,000
10,000
8,745
8,000
6,597
6,000 5,751
4,000 4,240
2,000
0
2000 2010 2020 2030 2040 2050
Projected Number of Americans 85 years and over

15. Older Americans with
Multiple Chronic Conditions
Medicare beneficiaries
with at least one
chronic condition
Nation’s healthcare
spent on treating
patients with
chronic diseases
Source: AARP. ―Beyond 50.09: Chronic Care: A Call to Action for Health Reform.‖ Washington, DC. 2009

16. What is the state of
NURSING?

17. A short list…
Lack of nursing educational preparation to meet
the demands of our current healthcare system
Practicing clinicians regularly make decisions
on tradition rather than empirical evidence
Chronic, cyclical nursing workforce shortage
Nursing faculty shortage, yet faculty are poorly
compensated
Shortage of doctoral nurses
Education—practice gap

18. Projected shortfall in 2020
1million
NURSES

19. The bottom line
High-quality, patient-centered health care for all
will require remodeling of health care system
Three national healthcare goals (Donald Berwick)
Improve health
Enhance the patient experience
Reduce/contain costs
Nurses are essential partners in achieving
success

20. The challenges before
us require significant
improvement in public
and institutional policies
at national, state and
local levels.

21. What is the impact of
HEALTHCARE
Reform?

22. Patient Protection and Affordable Care Act 2010
Health Insurance Reform
• Expand insurance coverage
• Expand consumer protections
• Reform industry practices
Status Quo
• Health costs
exceed general
inflation
• Sub-optimal
population health
• Unexplained Payment Reform,
variations in Delivery Systems
practice patterns • Evolve Medicare payment
• Questions about systems from fee-for-service
evidence base of to value based payment
some procedures • Test new payment methodologies
and patient care delivery models
for Medicare, Medicaid & CHIP
Source: Health Solutions Division,
Manatt, Phelps & Phillips, LLP

23. Payment Reform, Quality, and Delivery
System Change Timeline
2010 2011 2012 2013 2015
Shared Savings/
Dual New National pilot:
Accountable Reduced
Eligibles Center, Medic Bundled
Health payment for
Office are & Payments for
Organizations hospital-
established Medicaid Hospital &
(ACOs) acquired
Innovations post-acute care
(FCHCO) conditions
(CMMI) Reduced
payments for
preventable Estimate: these initiatives
hospitalizations will reduce Medicare
Value-based spending by $12b over
purchasing 10 years
for hospitals
Independence
at home
demonstration
project
Source: Kaiser Family Foundation

24. Evidence-based
recommendations
for education
and practice.

25. Why Nurses?
A high-quality health
system will provide:
• Chronic care management
• Care coordination
• Prevention and wellness
• Care across the lifespan
Nurses can help
address these needs

26. The Future of Nursing
IOM Report
Ensure that nurses can practice to the
full extent of their education and training
Nurses should achieve higher levels of
education through an improved education
system that promotes seamless academic
progression

27. The Future of Nursing
IOM Report
Nurses should be full partners with
physicians and other healthcare
professionals in redesigning healthcare
in the United States
Improve data collection and information
infrastructure for workforce planning and
policy making

28. 8 Recommendations
Remove scope of practice barriers
Expand opportunities for nurses to
lead and diffuse collaborative
improvement efforts
Implement nurse residency programs

29. 8 Recommendations
Increase proportion of nurses with
BSN degree to 80% by 2020
Double the number of nurses with
a doctorate by 2020
Ensure that nurses engage
in lifelong learning

30. 8 Recommendations
Prepare and enable nurse to lead
change to advance health
Build an infrastructure to collect
and analyze healthcare workforce
data

32. Growth in Doctoral Nursing Programs: 2006-2011
184
153
120
DNP 92
53
20
125
124
120
Research-Focused Doctoral 116
111
103
0 20 40 60 80 100 120 140 160 180 200
2011 2010 2009 2008 2007 2006
Source: © American Association of Colleges of Nursing. All Rights Reserved

33. Enrollments in DNP & Ph.D. Programs: 2003-2011
10000
9000 9,094
8000
7000 7,037
6000
5000 5,165
3,927 3,982 3,976 4,907
3,718 4,161 4,611
4000 3,439
3,229
3,415
3000
2000 1,874
1000 862
170 329
70
0
2003 2004 2005 2006 2007 2008 2009 2010 2011
Research Focused Doctoral Doctorate of Nursing Practice
Source: © American Association of Colleges of Nursing. All Rights Reserved

34. Better Care
Healthy
People/Healthy
Affordable Care
Communities

35. Mindy Yoder
DNP, FNP-BC, RN
myoder@sf.edu
260-399-7700, ext. 8510

37. Dave Johnson
PhD, CNS, BC, USF Professor
Local, State and
National Perspectives

38. Panelist
Judith A. Boerger MSN, MBA
Sr. Vice President, Chief Nursing
Executive, Parkview

39. Panelist
Judith A. Halstead
Ph.D., RN ANEF, FAAN
Professor and Executive Associate Dean
for Academic Affairs, IU School of Nursing,
Indianapolis, President, National League of Nursing

40. Panelist
Kimberly J. Harper, MS, RN
Executive Director,
Indiana Center for Nursing

41. Panelist
Karra Heggen, MSN, RN
Chief Nursing Officer, Dupont Hospital,
Representing Lutheran Health Network

42. Panelist
Amy Knepp, NP-C, MSN
Chair, Department of Nursing and
Assistant Professor, University of Saint
Francis, Family Nurse Practitioner for
Parkview Physicians Group

43. Panelist
Diana Dee Swanson
MSN, NP-C NP
IU Health Southern Indiana
Physicians Group, Representing Coalition of
Advanced Practice Nursing in Indiana

44. The Future of Nursing
IOM Report
Ensure that nurses can practice to
the full extent of their education and
training

45. The Future of Nursing
IOM Report
Nurses should achieve higher levels
of education through an improved
education system that promotes
seamless academic progression

46. The Future of Nursing
IOM Report
Nurses should be full partners with
physicians and other healthcare
professionals in redesigning healthcare
in the United States

47. The Future of Nursing
IOM Report
Improve data collection and information
infrastructure for workforce planning
and policy making

49. Dawn M. Mabry
MSN, RN, CNE
Simulation and the
Future of Nursing

50. History
2005 Simulation Lab Planning
2007 Simulation Experiences
2008 and 2011 iStan and Metiman

51. Demonstration
Basic Assessment of a Teenage
Athlete with Fluid and Electrolyte
Imbalance

52. Roles
Patient – Metiman
Patient Voice – Jeb Ray, BSN student
Registered Nurse – Janine
Shane, BSN student
Football Coach – Dr. Dave
Johnson, faculty

53. Learning Objectives
Performs an accurate basic physical
assessment of the patient with fluid and
electrolyte imbalance (APPLICATION).
Identifies normal and abnormal assessment
findings (APPLICATION).
Documents normal and abnormal
assessment findings in relation to fluid and
electrolyte imbalance (APPLICATION).

54. Learning Objectives
Identifies strategies for treating
dehydration related to heat
exhaustion (APPLICATION).
Identifies teaching opportunities
regarding heat-related illnesses
(APPLICATION).

55. Prep Questions
Describe the pathophysiology of dehydration.
Which types of dehydration are most often associated
with heat-related illnesses?
What electrolyte findings are common with these types
of dehydration?
What assessment findings are consistent with dehydration?
Describe the difference between heat cramps, heat exhaustion
and heat stroke.
How do symptoms and treatments differ for these three
heat-related illnesses?
What are the signs of rehydration?

56. Synopsis
The learner will be providing care for a 19-year-
old male admitted to the Emergency Department
(ED) for dehydration and electrolyte imbalance
caused by heat exhaustion. The patient is a star
athlete on his college football team. He passed
out this afternoon during practice. The
temperature was 90 F, and the relative humidity
was 80%. It is August, and the team has been
practicing for the last week.

57. Initial healthcare
provider’s orders
Admit to Emergency Department
CBC and
Electrolytes, BUN, Creatinine, Glucose, STAT
Start IV and give 500 mL 0.9% normal saline
bolus
Orthostatic blood pressures
Notify of urine output of less than 30 mL/hour
Oral fluids as tolerated

58. Debriefing
Introduction: Discuss faculty role as a
facilitator, expectations, confidentiality, safe
environment for discussion
Personal Reactions: Allow learners to recognize and
release emotions, explore learner reactions
Discussion of Events: Analyze what happened during
the SCE, using video playback if available
Summary: Review what went well and what did
not, identify areas for improvement and evaluate the
experience

59. Standards
Interprofessional the Future of
Team Simulation NURSING
EDUCATION
Research