The Future of Nursing - Verband der Schwesternschaften vom DRK e.V.

„Initiative on the Future of Nursing“ in den USA
Ein Beitrag zur Qualitätssteigerung in der Pflege
Forum 4 – Grenzen öffnen sich:
Pflege und ihr Image im internationalen Vergleich
Ideen überwinden Grenzen
Bundeskongress
Verband der Schwesternschaften vom DRK e.V.
Prof. Dr. Martina Roes
DZNE / Witten
Gruppenleitung Implementierungs- und Disseminationsforschung
Mitglied und stellv. Sprecherin in der
Sektion Dissemination und Implementation
Roes (2013-05-23)
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Aufbau
•
Warum die Initiative
•
Intention der Initiative
•
Vier zentrale Empfehlungen
•
Campaign of Action
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The Future of Nursing: Leading Change, Advancing
Health from the Institute of Medicine (IOM) and the
Robert Wood Johnson Foundation (RWJF)
Warum die Initiative / der Report
•“A number of barriers prevent nurses from being able to respond effectively to rapidly
changing health care settings and an evolving health care system.
•These barriers need to be overcome
•to ensure that nurses are well-positioned to lead change and advance health”
2 Jahres
Initiative
(2008-2010)
Einschätzen des Bedarfs an
professioneller Pflege
und
Antworten finden, welche Änderungen von
der Profession vorzunehmen sind
Roes (2013-05-23)
Empfehlungen für einen
nationalen Aktionsplan zu
Zukunft der Pflegeberufe im
Gesundheitswesen
Seite 3
The Future of Nursing: Leading Change, Advancing
Health from the Institute of Medicine (IOM) and the
Robert Wood Johnson Foundation (RWJF)
Robert Wood Johnson Foundation (RWJF)
and Institute of Medicine (IOM)
Intention der Initiative
•Zukunft der (pflegerischen) Versorgung in den USA
•Rolle der Profession Pflege
•Pflegerischer Beitrag einer sicheren,
qualitativ hochwertigen Versorgung
•Angebot für alle, die der Pflege bedürfen
(Donna E. Shalala, Ph.D., chair of the Committee on the Robert Wood Johnson Foundation
Initiative on the Future of Nursing, at the Institute of Medicine (IOM)
2010
Affordable
Care Act
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The Future of Nursing –
Recommendations
Fokus der vier Kernempfehlungen
Die Empfehlungen beziehen sich
ganz allgemein betrachtet auf
die Bereiche
•Fertigkeiten, Fähigkeiten und
Verantwortungsbereiche der
Profession Pflege
•Bildung
•Leadership im System
•politische Prozesse
Empfehlung 1
Pflegende sollten die Möglichkeit haben, entsprechend ihrer
Qualifikation und Kompetenz, verantwortlich tätig zu sein
Empfehlung 2
Pflegenden sollten hohe Qualifikations-/Kompetenzlevel
anstreben, in einem Bildungssystem das nahtlose Übergänge
zwischen den Leveln ermöglicht
Empfehlung 3
Pflegende sollten gleichberechtigte Partner sein und
zusammen mit Ärzten und anderen Gesundheitsprofessionen
das Versorgungssystem verbessern
Empfehlung 4
Effektive Arbeitsbedingungen und politisches Handeln
erfordern bessere Daten und eine verbesserte Infrastruktur
hinsichtlich Informationstransparenz
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The Future of Nursing –
Empfehlung 1
Pflegende sollten die Möglichkeit haben, entsprechend
ihrer Qualifikation und Kompetenz, verantwortlich tätig
zu sein
d.h. …
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The Future of Nursing –
Empfehlung 1
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The Future of Nursing –
Empfehlung 1
PCP = primary care physician (Hausarzt)
PCNP = Nurse Practitioner (Masterlevel)
in der ambulanten Pflege
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Beispiele für überlappende
Aufgaben zwischen Ärzten
und Pflegenden
(ab Bachelor Level)
The Future of Nursing –
Empfehlung 1
Category of activities
Specific activities that overlap
Physical exam
Assessing vital signs such as measuring pulse, blood pressure, respiratory rate, temperature, and oxygen saturation
Auscultating lung, heart, and abdominal sounds
Assessing cranial nerves
Assessing eyes and ears using
ophthalmoscope and otoscope
Testing vision and hearing
Performing breast exam
Testing range of motion and muscle strength of upper and lower extremities
Assessing pain
Health assessment
Obtaining health history
Administering screening tests (e.g., domestic violence, depression)
Performing in person or telephone triage to determine need for further care
Identifying emergent complications, expected, or adverse response to medical treatment (e.g., a RN monitors blood
pressure after administration of blood pressure lowering medication or monitors for bleeding after surgery)
Identifying epidemiologic trends (e.g., a school RN notes sudden increase in flue cases and notifies health department of
the changes in population health trend changes)
Medical diagnosis
No overlap
Prescribing diagnostic tests and
pharmacological treatments
No overlap
Category of activities
Specific activities that overlap
Implementing treatments
Administering medications
Collecting blood, urine, stool samples
Obtaining sputum and wound cultures
Providing mental health and addiction counseling
Providing health counseling related to management of chronic diseases
Coordinating care
Providing wound care
Inserting foley catheter and nasogastric tube
Inserting peripheral intravenous catheter
Obtaining 12-lead electrocardiogram (ECG)
Roes (2013-05-23)
Source: Djukic, M. and C. Kovner. 2010. Overlap of Registered Nurses and Physician Practice: Implications for U.S.
Health Care Reform. Policy, Politics, & Nursing Practice 11(1): 13-22.
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The Future of Nursing –
Empfehlung 1
Transitional
care
concepts
(Healthcare
Reform ‘10)
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Source: Stange K.M.; Sampson D.A. 2010. Nurse Practitioner and Physician Assistants in the United States: current
patterns of distribution and recent trends. White report
Seite 10
The Future of Nursing –
Empfehlung 2
Pflegenden sollten hohe Qualifikations/Kompetenzlevel anstreben, in einem Bildungssystem
das nahtlose Übergänge zwischen den Leveln
ermöglicht,
d.h. …
Roes (2013-05-23)
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The Future of Nursing –
Empfehlung 2
Question: In your opinion, do you feel that there is a nursing shortage in
America today, or not?
Source: Gallup poll conducted in November 2009
• State boards of nursing, accrediting bodies, the federal government, and health care organizations should take
actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have
completed a pre-licensure or advanced practice degree program or when they are transitioning into new clinical
practice areas.
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The Future of Nursing –
Empfehlung 2
Erhöhung des Anteils von Pflegenden mit einem Bachelor Abschluss, d.h. …
•Academic nurse leaders across all schools of nursing should work together to increase
the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020.
These leaders should partner with education accrediting bodies, private and public
funders, and employers to ensure funding, monitor progress, and increase the diversity
of students to create a workforce prepared to meet the demands of diverse populations
across the lifespan.
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Sicherstellung lebenlangen Lernens
The Future of Nursing –
Empfehlung 2
Erhöhung des Anteils von Pflegenden mit einer Promotion
Schools of nursing, with support from private and public funders, academic
administrators and university trustees, and accrediting bodies, should double the
number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and
researchers, with attention to increasing diversity.
certificate/licensed
Bachelor
Generalisten
Master - APRN
(advanced practice registered nurse)
• nurse practitioner (NP) mit Spezialisierung
• clinical nurse specialist (CNS)
• clinical registered nurse – aneasthesia (CNA)
• clinical nurse – midwifery (CNM)
Doctor of Practice
(DNP)
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Generalisten
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The Future of Nursing –
Empfehlung 3
Pflegende sollten gleichberechtigte Partner sein und
zusammen mit Ärzten und anderen
Gesundheitsprofessionen das Versorgungssystem
verbessern, d.h. …
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The Future of Nursing –
Empfehlung 3
•Private and public funders, health care organizations, nursing education programs, and
nursing associations should expand opportunities for nurses to lead and manage
collaborative efforts with physicians and other members of the health care team
• to conduct research and
• to redesign and
• to improve practice environments and health systems.
•These entities should also provide opportunities for nurses to diffuse successful
practices.
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The Future of Nursing –
Empfehlung 3
Anzahl an Nurse Practitioners per Primary Care Arztpraxis pro Region, 2009
Durchschnitt 0,5 NP pro Arztpraxis
Kein Primary Care
(Arztpraxis)
Keine Daten
Roes (2013-05-23)
Source: Stange K.M.; Sampson D.A. 2010. Nurse Practitioner and Physician Assistants in the United States: current
patterns of distribution and recent trends. White report
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The Future of Nursing –
Empfehlung 3
Durchschnitt 27% gemeinsame Praxis
Keine Daten
Roes (2013-05-23)
Source: Stange K.M.; Sampson D.A. 2010. Nurse Practitioner and Physician Assistants in the United States: current
patterns of distribution and recent trends. White report
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The Future of Nursing –
Empfehlung 3
Bundesstaaten mit Restriktionen hinsichtlich Zusammenarbeit zwischen Nurse
Practitioners per Primary Care (Arztpraxis)
Unabhängige NP’s
a us
epte
z
e
llt R
’ ste
c
o
D
Doc’ stellt verantwortlich
für Diagnose,
Behandlung und
Rezeptausstellung
Roes (2013-05-23)
Source: Stange K.M.; Sampson D.A. 2010. Nurse Practitioner and Physician Assistants in the United States: current
patterns of distribution and recent trends. White report
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The Future of Nursing –
Empfehlung 3
TC in Verantwortung von
Mixed Professionals
TC in Verantwortung
von NP’s
TC in Verantwortung von
Mixed Professionals
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The Future of Nursing –
Empfehlung 3
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The Future of Nursing –
Empfehlung 4
Effektive Arbeitsbedingungen und politisches Handeln
erfordern bessere Daten und eine verbesserte
Infrastruktur hinsichtlich Informationstransparenz,
d.h. ….
Roes (2013-05-23)
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The Future of Nursing –
Empfehlung 4
•The National Health Care Workforce Commission, with oversight from the Government
Accountability Office and the Health Resources and Services Administration, should lead
a collaborative effort to improve research and the collection and analysis of data on
health care workforce requirements.
•The Workforce Commission and the Health Resources and Services Administration
should collaborate with state licensing boards, state nursing workforce centers, and the
Department of Labor in this effort to ensure that the data are timely and publicly
accessible.
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The Future of Nursing –
Empfehlung 4
9 national leaders with nursing backgrounds, as well as outspoken nurse
champions are included in Modern Healthcare's yearly ranking of the Top 25
Women in Healthcare.
Maureen Bisognano
• president and CEO of the Institute for Healthcare Improvement, a patient-safety organization.
Patricia Hemingway Hall
• president and CEO of Health Care Service Corp. Hall began her career as an intensive-care nurse in the 1970s, but
since 2008, has led HCSC, which covers more than 13 million members in Illinois, New Mexico, Oklahoma and Texas
Marilyn Tavener
• is acting administrator for the CMS and oversees the $757 billion federal agency that provides health care coverage to
100 million Americans through Medicare, Medicaid and other programs.
• Ms. Tavenner, a nurse who worked for more than two decades at the Hospital Corporation of America, will be the first
Senate-confirmed administrator since Dr. Mark B. McClellan stepped down in October 2006.
• Mr. Obama’s first choice for the job, Dr. Donald M. Berwick, never won Senate confirmation. The president
circumvented Congress by giving Dr. Berwick a temporary recess appointment, which lasted for 17 months in 2010-11.
Mary Wakefield
• administrator of the Health Resources and Services Administration and leads efforts to work with providers and
community programs to improve access to health care services for the needy, uninsured and isolated
•plus
Risa Lavizzo-Mourey
• president and CEO of the Robert Wood Johnson Foundation, one of the nation’s leading philanthropic organizations
focused on health and health care.
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Nach Publikation des Reports in 2010
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• Eine gemeinsame Initiative der American Association of Retired Person (AARP)
und der Robert Wood Johnson Foundation (RWJF)
• Mobilisiert verschiedene Stakeholders bundesweit, in 50 Bundesstaaten plus District of
Columbia (D.C.)
• Um die 8 genannten Empfehlungen in ihren Verantwortungsbereichen umzusetzen
• Intention: Pflege kann substantielle Beiträge liefern zu Beantwortung zentraler
Probleme im us-amerikanischen Gesundheitssystem:
• Zugang zu Leistungen
• Qualität der Versorgung
• Kosten der Versorgung
• wenn es gelingt
• Pflegende entsprechend ihrer Qualifikation und Kompetenzen in allen Bereichen
der Gesundheitsversorgung verantwortlich einzusetzen
• und sie auf zukünftige Herausforderungen vorzubereiten.
• www.CampaignforAction.org
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Nicht ob, sondern wann!!!
Vielen Dank für Ihre Aufmerksamkeit
[email protected]
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