a green thumb is not just for gardeners how to grow new perioperative nursing staff deb herdman, rn,...
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A Green Thumb Is Not
Just for Gardeners How to Grow
New PeriOperative Nursing Staff
Deb Herdman, RN, BSHADirector, PeriOperative
ServicesTrinity Health System
What is our Current State?
“We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health care system — in leadership, ineducation and training, and in the design.”
~ Donna Shalala, University of Miami President and former Secretary of the U.S.
Department of Health and Human Services
The Rising Demand for Nursing Care
According to the 2012 Bureau of Labor Statistics’Employment Projections 2010-2020, for RN workforce:
Number of practicing nurses will grow from 2.74 million in 2010 to 3.45 million in 2020, an increase of 712,000 (26%)
The projections show need for 495,500 replacements bringing the total number of openings for nurses to 1.2 million by 2020
One of the leading occupations that will add the most positions by 2020
Furthermore, in a report released by the Institute of Medicine titled, “The Future of the Nursing: Leading Change, Advancing Health”
The report’s key messages include:
Nurses should practice to the full extent of their education and training
Scope of practice limitations should be removed
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
(United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) 2010)
The report’s key messages include:
Nurses should be full partners with other healthcare professionals in redesigning health care in the US
Effective workforce planning and policy making require better data collection and improved information infrastructure
To achieve these goals and larger national goals of access to high quality, cost-effective care, support for programs that educate the next generation of nurses is vital
(United States Department of Health and Human Services, Health Resources and Services Administration (HRSA) 2010)
Nursing Workforce DevelopmentPrograms: Demonstrating Success
Nursing Workforce Development programs, authorized under Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.), support supply of qualified nurses to meet our nation’s healthcare needs since 1964.
Addressed all aspects of nursing workforce demand–education, practice, retention, and recruitment
Bolster nursing education at all levels
Provide support for institutions that educate nurses
Are essential to solving the current national nursing demand
Supported over 400,000 nurses and nursing students as well as numerous academic nursing institutions and healthcare facilities
Demand for Primary and Specialty Care Providers
Title VIII addresses the current demand for primary care providers and the program helps prepare the advanced practice nursing workforce to meet the needs of our nation.
Over 1/2 of respondents to AACN’s survey reported that their career goal is to become a nurse practitioner
Approximately 80% of nurse practitioners provide primary care services throughout the United States
90% of visits to certified nurse midwives are for primary and preventive care
CRNAs are often the sole anesthesia providers in nearly all rural hospitals, affording patients access to trauma stabilization, pain care, and surgical services. The Title VIII program help
Demand for Faculty to Educate the Next Generation of Nurses
Faculty vacancy has been repeatedly identified as a primary factor hindering maximum student capacity in our nation’s nursing schools
According to AACN, nursing schools were forced to turn
away 75,587 qualified applications from entry-level baccalaureate and graduate nursing programs
Nearly 1,100 vacant faculty positions reported by AACN member schools in academic year 2011-2012.
So How About PeriOp? “…Perioperative nursing is something that takes
place behind the double doors of our hospitals and typically off limits to most other staff.”
Crisis in perioperative nursing is greater – nursing shortages do not effect all specialties equally
Often new nurses are required to work 1-2 years in Med-Surg to develop critical thinking skills
We have unique challenges but have had difficulty getting the attention we deserve
Three Major Factors Contribute to Growing Demand for PeriOp Nursing
Care 275,000+ practicing PeriOp nurses are over the age of
60 and 73.4% of survey respondents are over 50
When the economy rebounds, many PeriOp nurses will seek retirement
America’s aging population will seek more health care services creating an influx of consumers needing surgery
Patients are sicker, require more intensive care and more complex interventions
“Nurses working in PeriOp are older and more experienced than the rest
of the nursing workforce…” For economic reasons OR nurses have not retired on the
same timeline as other nurses
56% of PeriOp leaders report having problems recruiting and there’s already a shortage
68% anticipate problems within 5 years due to ages of their current staff
Economics + declining surgical volumes = reduced staffing making it difficult to recruit staff
21% of OR Managers are over the age of 60 and 2/3 over
50
21.5% plan to retire within 3 years and 37.5% by 2018
New Nurses Not Experienced in PeriOp
PeriOp experience reduced or eliminated from many nursing curriculums in the United States
No better place to learn sterile technique, IV skills, and teamwork
Without exposure, students don’t consider PeriOp
The cost to orient a nurse to the OR is estimated to start at $59,000 but can rise well above that
No other specialty in nursing that has this challenge
Causes for Concern – Patient Access
Severe shortage could have devastating impact on healthcare delivery
Estimated that up to 32 million US residents will become insured and begin using healthcare
May have delayed elective surgeries leading to significant rise in surgical volume
JAMA published study evaluating soaring number of Total Knee replacements - 161.5% increase since 1991
8000 Baby Boomers retiring each day – surgery could skyrocket
Causes for Concern – Patient Safety
The current perioperative nursing workforce is very experienced and knowledgeable
With their departure there is the potential for a huge loss of knowledge in this specialty area that impacts patient safety.
Causes for Concern – Economic Losses
Perioperative Departments contribute 40-60% of the total revenue for most of the 5000 hospitals in the US
They are the “Economic Engines” of hospitals
Delayed surgeries and ORs closings due to staffing issues will result in a serious impact to the bottom line when hospitals already struggling with declining reimbursements
Causes for Concern – Economic Losses
Hospitals rely on the sophisticated management skills of Perioperative Directors
Survey results indicate that these departments are managed by very seasoned leaders with broad surgical experience —72% have more than 10 years experience in PeriOp leadership
Loss of these nurse leaders will be felt in the inefficient
running of these important business lines yet fewer than 40% of hospitals have done succession planning
What’s the Solution? Grow Your Own Nurses!
Where is Our Garden Located? Trinity Health System in Steubenville, Ohio
Our “State of Affairs” 50% of our nurses are age 50+ 75% of our RNFAs are near retirement age Our surgical volume continues to grow
Current Resources Two nursing programs in our area Two surgical technician programs Two NP programs One PA program
Digging Things Up SWOT Analysis – Determining the need
Determine our needs and needs or our competition
Available Allies – the Stakeholders Administration Physicians Hospital Non-Clinical and Clinical Educators Surgery Mentors/Preceptors Nursing Programs’ Administrators and Instructors
Developing the Preliminary Plan PeriOp Managers conducted the analysis together Identified options and determined preliminary plan
Planting the Seeds Phase I – Establish the course description
and goals Students from both nursing programs spent one day of
observation in PreOp/PostOp and one day in OR We talked with students to determine if they would
have an interest in spending more time in PeriOp and at least 50% said “Yes”
Next we talked with the Clinical Instructor at Franciscan University who agreed to be our liaison and set up a meeting with the Dean, College of Nursing
We discussed our needs and our proposal for a more in-depth experience for interested students
Also discussed the same proposal with Trinity School of Nursing – a diploma program
The Pilot Project Phase Il – Develop the curriculum, schedule and
implement the course The curriculum and schedule was developed in conjunction
with Franciscan University
All Junior Students spend one day observing in PreOp/PACU and one day in OR
Senior Students (up to 4 students) with strong interest spend one day per week for half a semester in PeriOp – all areas
Senior Students (2 students) with definite desire to pursue PeriOp Services will be selected by our committee to spend one day per week in PeriOp for entire semester – Capstone Project
Trinity Students will spend one day in PeriOp and selected students who are academically high achievers who desire to have an internship in PeriOp will spend 24 hours per week in their last semester.
The Pilot Project
Phase III – Residency Program Graduate Nurses who participate in this program
and will be given priority status for employment opportunities
Length of Residency Training is up to one year depending on the needs of the nurse
Initial assignments will be in Same Day Services and PACU as an CNA or in Sterile Processing and as a Scrub Tech until granted a nursing license
Weeding Time – How We Determine If You’re a Flower or a Weed
Behavioral Characteristics Demonstrates eagerness to learn, attention to details
and strong stewardship and teamwork
Requires 2 recommendations from Instructors, Professors or Preceptors
Must be approved through the Peer-Interviewing process
Good attendance and performance record
Positive physician input
How Is Our Garden Growing? Measures of Success
Daily feedback from students and preceptors On-going enthusiasm from students, staff and
physicians Retention ratios
One nurse finished through internship and did a great job but left to go to ED with a goal of becoming a flight nurse – still works PRN in OR
Two new hires – one for PreOp/PACU and one for OR
New Program with expanded curriculum starting in September with Franciscan University
Reference List American Association of Colleges of Nursing
Fact Sheet on the Nursing Shortage, Last Update: April 24, 2014, Robert Rosseter
Nursing Workforce Development Programs Title VIII of the Public Health Service Act, March 2012
Emerging RN Leader “Why We Should Be Concerned About a Shortage of
Perioperative Nurses” Rose O. Sherman, Ed. D, RN, FAAN
“Nursing Shortages in the OR: Solutions for New Models of Education” Kay Ball, PhD, RN, CNOR, FAAN, Donna Doyle, MS, RN, CNOR, NE-BC, Nichole I. Oocumma, BSDH, MA, CHES, CHSE AORN Journal, January 2015, Volume 101, No. 1, pages
115-136
QUESTIONS?Deb Herdman, RN, BSHADirector of PeriOperative
ServicesTrinity Health System4000 Johnson Road
Steubenville, Ohio 43952740-264-8192