how best to prepare nurses for the future? · just into the 21st century, the discussions took an...

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How Best to Prepare Nurses for the Future?Quarterly circulation approximately 293,000 to all RNs, LVNs, and Student Nurses in Texas.

Inside this IssueWhy the Push for Increasing the Number of BSN Nurses by 2020? . . . . . . . . . . . . . . . . . . . . 3How Will Future of Health Care Look with the Affordable Care Act and Health Care Reform? .6Nurses: Are You Ready for Your New Role in Health Information Technology? . . . . . . . . . . . 7The Growth of Complex Patients . . . . . . . . . . . . 8RN Green Among Board of Director Appointments to Texas Institute of Health Care Quality and Efficiency . . . . . . . . . 9Nursing Practice Question: Is Unsecured Texting/Receiving of Patient Information via Smartphone a Potential Weak Link in Health Care? . . . . . . . . . . . . . . . . . . . . . . . . . 11Membership Application . . . . . . . . . . . . . . . . . . 14

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by J. Cunningham, TEXAS NURSING VOICE Staff

For what by now seems like forever, nursing has been debating how best to prepare nurses for the future. The discussions often labeled as entry into practice or preparedness of future nurse leaders have lacked consensus, so nursing continues to grapple with the question: what is the right preparation – the right levels of education and training – that nurses need when they enter the profession and when they continue on with their careers?

Just into the 21st century, the discussions took an interesting turn. Those outside of nursing joined in. Business, legislators, researchers, educators, other health care providers and the general public brought about a rediscovery for nursing of something it really had always known: nurses are at the very core of quality patient care. They are present at the bedside; in touch with the patient like no other health care provider.

With such a unique focus, why then, many asked, does nursing not achieve more influence in key areas of health care? One

group asking was the polling division of the Gallup organization. On behalf of the Robert Wood Johnson Foundation, Gallup surveyed U.S. opinion leaders in 2009 about their views of nursing and nursing leadership, particularly the role America’s nurses can and should have in improving access and quality of care, and containing costs.

When findings of that Gallup survey titled, Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions were revealed at a news conference in Washington, D.C., Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said, “Expanding the leadership of nurses is critical to health care reform. Opinion leaders recognize that we are squandering opportunities to learn from nurses and implement their ideas.”

While nurses are perceived as having a lot to offer, they are resources relatively untapped. Survey results identified the problem as one of structural issues – there isn’t a structure in place for people to listen and nurses to say. Or as Dr. Frank Newport, editor-in-chief of the Gallup

Poll, put it at the news conference: “nurses lack a single voice on national issues, no leadership opportunities, no strategic vision, and different levels of education.”

In 2010, huge outside influences continued to press the discussion. The Patient Protection and Affordable Care Act was signed into law with an underlying promise of health care reform – of high quality, safe, more affordable and accessible care for millions of Americans. In order to achieve that, however, a transformation of the entire health care system is required. And it puts nursing at the very core of the change.

Also in 2010, an action-oriented blueprint for achieving a similar promise – “seamless, affordable, quality care that is accessible to all, patient centered, and evidence based and leads to improved health outcomes” was put forth by the Institute of Medicine in its milestone report, The Future of Nursing: Leading Change, Advancing Health. Eight recommendations are outlined in the report; four key messages frame the discussion of how it is nursing that will lead

How Best to Prepare continued on page 8

Page 3 Page 5

• Texas Nursing Voice April, May, June 2012

TEXAS NURSING VoiceA publication of Texas Nurses Association

April, May, June 2012Volume 6, Number 2

Editor-in-Chief – Clair B. Jordan, MSN, RNManaging Editor – Joyce Cunningham

Creative Communications – Deborah TaylorCirculation Manager – Belinda Richey

Editorial Contributors

Therese Clinch, MSN, RN; Stan Harmon, MSN, RN, FNP; Joyce Cunningham; Christy Meriwether;

Angelica Ybarra, BSN, RN

Editorial Advisory BoardStephanie Woods, PhD, RN, Dallas

Jose Alejandro, MSN, RN, MBA, CCM, DallasPatricia Allen, EdD, RN, CNE, ANEF, Lubbock

Sandra Kay Cesario, PhD, RN, C, PearlandJennifer D.M. Cook, PhD, MSN, RN, San Antonio

Anita J. Coyle, PhD, RN, CHES, SangerThelma L. Davis, LVN, Giddings

Anita T. Farrish, RN, MHSM, NE-BC, WacoPatricia Goodpastor, RN, The Woodlands

Patricia Holden-Huchton, RN, DSN, DentonTara A. Patton, BSN, RN, Palestine

Dianna Lipp Rivers, RN, CNAA, BC, Beaumont

Executive OfficersMargie Dorman-O’Donnell, MSN, RN, President

Victoria England, RN, MBA, Vice PresidentClaudia Turner, MSN, RN, Secretary-Treasurer

Regional Directors of Texas Nurses AssociationJune Marshall, DNP, RN, NEA-BC – North Region

Eve Layman, PhD, RN, NEA-BC – South RegionKim Belcik, BSN, RN-BC – Central RegionViola Hebert, MA, BSN, RN – East RegionJo Rake, MSN, RN, CNAA – West Region

Executive DirectorClair B. Jordan, MSN, RN

TEXAS NURSING Voice is published quarterly – January, February, March; April, May, June; July, August,

September; and October, November, December by – Texas Nurses Association, 7600 Burnet Road, Suite 440,

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Texas Nurses Association Districts and PresidentsPresidents of the 28 state-wide Districts of Texas Nurses Association, as well as some District offices, are listed below.

They invite you to contact them with questions or comments about TNA District membership and involvement in your local areas. For specific District locations, please refer to the TNA Tri-Level Membership District map on page 14.

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April, May, June 2012 Texas Nursing Voice •

by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association

Staff nurses and some nurse leaders keep asking the question, why the push for increasing the number of nurses with BSN degrees by 2020? Some nurses would argue that by successfully passing a National Council Licensure Examination (NCLEX), they have demonstrated the minimal competencies needed to safely care for patients and they will continue to increase their nursing knowledge and experience as they work in clinical settings with patients.

Taking the NCLEX-PN or the NCLEX-RN is a capstone experience to your studies and so much more. Passing the exam demonstrates your competence so that you can launch your nursing career.

That is true for current and seasoned nurses however, with the changes occurring in health care due to advancements in medicine and technology which are leading to people living longer, the ability to provide a higher level of care for patients with chronic illnesses creates a greater demand on nurses in coordinating care in clinical settings.

Now, it’s no longer simply about having the skill set to care for chronically ill patients. Rather it’s having the in-depth knowledge and ability to utilize evidence-based practice from research and nursing theory, team work, and wellness and prevention concepts in caring for the complex patient of the future alongside highly functioning, interdisciplinary care teams that include physicians, pharmacists, social workers and physical therapists, many of whom have earned doctoral degrees.

Nurses, as care coordinators, will need to see the whole picture when it comes to patients with chronic illnesses. Nurses must have good communication skills in order to communicate patient problems to the care team that are related to medications, treatment modalities, and procedures that are ineffective and/or causing more side effects or adverse effects.

Now is the time for nurses to drive change in their practice and work environments. Gone

Why the Push for Increasing the Number of BSN Nurses by 2020?are the days of “this is how it’s always been done” and “why change it?” Why? Because the landscape has changed for nurses and patients due to an aging population with multiple, simultaneous chronic illnesses accessing health care.

Nursing programs of the future will need to have nursing theory, nursing research, wellness, safety and prevention, care coordination and patient-centered care, health informatics, and teamwork concepts in their curriculum in order to prepare the nurses to care for complex patients with chronic illness(es) including the increasing geriatric population. Nursing programs include key competencies in their curriculum in preparing future nurses for the workforce and care of complex patients resulting in positive patient outcomes. Key competencies in a nursing program curriculum would include nursing practice, research, communication, leadership, professionalism, cultural competency, teaching and critical thinking (Nursing 2012). Nurses will need to elevate their critical thinking skills in making clinical decisions in a systematic and logical manner with an openness to questions and a reflection on the reasoning process used to ensure safe nursing practice and quality care. (Critical Thinking in Nursing, 2008)

Here are some nurses’ statements on their BSN education: (Nursing 2012)

• “Nursing is more than administeringmedications and performing tasks”

• “Nursing practice has changed from task-oriented delivery of care to theory-driven care based on standards of care of the profession”

• “Learning to consider both patient and thehealth system working on a team – better team player”

• “Learning how to utilize resources includingstandards of practice, professional websites, and evidenced-based research when considering nursing interventions”

• “Abilitytocommunicatemyideasbetterdueto the greater understanding of health care policy, organizational structure and nursing practice”

Some health care leaders and educators have suggested that health care professional education programs require and support interprofessional education. Interprofessional education brings together members of the health care team to learn and work together in providing patient-centered care especially in the health care education programs (Linda Cronenwett’s presentation at Texas Nurses Association’s 10th Annual Nursing Leadership Conference, 2010). ★

ReferencesNursing 2012, (March, 2012). Magnet® hospitals are attracted

to the BSN but what’s in it for the nurses? Retrieved on 3/9/2012 from www.nursing2012.com

Critical Thinking (2008). Critical Thinking and Nursing. Retrieved on 3/5/2012 from www.criticalthinking.org

Texas Nurses Association Annual Nursing Leadership Conference (September, 2010). Linda Cronenwett’s presentation on Education Preparation of Primary Care Providers of the Future.

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What would the high-level care coordination model for complex patients including geriatric patients look like in health care of the future for nurses who focus on value-based care of patients? Care coordination has always been part of the nurse’s role so how will it be different in the future?

Care coordination is a set of activities encompassing patient engagement, assessment, care planning, monitoring, support for family caregivers and coordination with all providers especially during the patient transitions from one level of care to the other. The care coordination process consists of:

• Initial, comprehensive assessment ofthe patient and patient’s circumstances including family

• Developmentofacomprehensivecareplanthat addresses the patient’s medical and social and family needs

• Designated individual to take the leadcommunicating and coordinating with the patient’s medical and social service providers

• Including the family and the patient in thepatient’s plan of care

Care coordination models that have been developed are being considered to improve

quality, efficiently or health-related outcomes of care for the chronically ill adults and older adults. Two models being considered are the primary care-based model which would reside in primary care and/or physician office settings and community-based models which would reside in hospital and/or community settings (The Gerontological Society of America Scientific Summit, September 2010).

RNs would be the best choice as care coordinators, functioning in one or both of the care coordination models above. Organizations would need to provide adequate staffing ratios to ensure the nurse is able to function in the care coordinator role, provide education and training of nurses on the higher level care coordinator’s role and process with ongoing evaluation by supervisors. RN care coordinators would ensure ongoing focus on patient-related outcomes and be the team leader on the care team. RN care coordinators would need to elevate their expertise and knowledge of chronic illnesses, disease process, and treatment protocols to achieve the desired outcomes set by the patient’s plan of care as developed by the interdisciplinary team of physician, pharmacist, nurse and other health care providers due to the complexity of the patient. Nurses will need to possess expert leadership skills to manage the complex patients with chronic illnesses and be able to recognize incompatibility of treatment protocols and communicate to the team with the goal of reaching the desired outcomes (The

Gerontological Society of America Scientific Summit, September 2010).

For complex patients in the Medicare system, the Centers for Medicare & Medicaid Services (CMS) is promoting the voluntary development of Accountable Care Organizations (ACO) to include the RN’s role as care coordinator. The ACO model focuses on addressing the need for proactive and effective coordination across all levels and types of health care services. ACOs consist of groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated, high-quality care to their Medicare patients.

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. New clinical workflows and business processes will need to be designed and nurses should be an active part in the development of these entities within ACOs. Some potentially new nursing roles as care coordinators in ACOs are:

• Careoutreach

• Healthandwellness

• Coaching and coordinating medical, socialand psychosocial needs

• Caremanagementstrategies

The Need for High-Level Care Coordination

The Need for High-Level Care continued on page 6


As coordinators of care in the future, nurses will take the lead in delivering and coordinating care for patients, safeguarding them against medical errors and acting as their advocate as they move from

clinical settings to other settings within the health care system.

(Milliman Health Care Reform Briefing Paper, April 2011).

In Texas, an example of a community-coordinated model has started with the goal of reducing adult potentially-preventable hospitalizations in 16 eligible counties with a population rate of less than 100,000 residents that has a high rate of adult hospitalizations of people with preventable hospitalization illnesses over the rate of the state. This community-coordinated approach initiative was a result of the 82nd Texas Legislature allocating funding to Texas Department of State Health Services (TDSHS) to implement an initiative to reduce potentially preventable hospitalizations in fiscal year 2012/2013. Targeted adult potentially-preventable hospitalizations are:

• BacterialPneumonia

• Dehydration

• UTI

• CongestiveHeartFailure(CHF)

• Hypertension

• Asthma

• COPD – Chronic Obstructive PulmonaryDisease

• Diabetescomplications

Community-coordinated approach initiative included the implementation of one or more evidence-based interventions including immunizations, patient education, community education, smoking cessation, health care provider education, diabetes self-management education, patient case management, nutrition and physical activity, weight management, glycemic control and blood pressure control. A coalition was formed of community health stakeholders including hospitals, DSHS, home health agencies and elected officials to assist in implementing the evidenced-based interventions in the county. Each county identified a Project Contact to lead the community coordinated approach interventions. (TDSHS, January 2012)

This initiative and the formation of ACOs in Texas are the beginning of what health care may look like in the future due to the Affordable Care Act. RNs will face a variety of new challenges in the coming years as they are asked to play a greater role in patient care coordination due to their commitment to ongoing education and training and the trust that patients have for them. ★

ReferencesThe Gerontological Soicety of America Scientific Summit

(September 2010). Diffusing Care Coordination Models: Translating Research into Policy & Practice. Retrieved on 3/5/2012 from http://www.geron.org/Diffusing%20CC%20Models-Summit%20Summary.pdf

Milliman Health Care Reform Briefing Paper (April 2011). The Nurse’s Role in Accountable Care. Retrieved on 3/8/2012 from http://publications.milliman.com/publications/healthreform/pdfs/acos-beyond-medicare.pdf

Texas Department of State Health Services (January 2012). Stakeholder Update: Reducing Adult Potentially Preventable Hospitalizations Initiative 01/29/2012. Retrieved on 3/8/2012 from the Assessment & Benchmarking Specialist Office of State Epidemiologist at Texas Department of State Health Services electronic message system.

There has been much written on the changes coming in health care because of the Patient Protection and Affordable Care Act of 2010. So, what is the current delivery system and what is the suggestive delivery system of the future?

The current delivery system has been about volume of services and pay for reporting services by health care organizations and providers, and not as much around the value for patients. Movement toward restructuring the care delivery system to offset the rising costs of an aging population and new medical advances is the thinking surrounding where health care is moving in the future. (NEJM, 2009)

What is the goal of the movement toward an increasing value for patients? It is health outcomes achieved per dollar spent and the accomplishment through a value-based system of achieving and maintaining good health (preventive care). To achieve a value-based delivery system of the future, the following would need to be implemented:

• Outcomes are measured over the fullcycle of care for a medical condition, not separately for each intervention.

• Measurement of true health outcomes andnot process measures/outcomes.

• Move to integrated practice units thatrequire full cycle of care for each medical condition including common coexisting conditions and complications with use of EMR (electronic medical records) to support integrated care and outcome measurement.

• Consumersbecomemuchmoreinvolvedintheir health and health care.

Outcome measurement will drive the restructuring of care delivery. Electronic medical records will facilitate both delivery

restructuring and outcome measurement. Value-based system leads to patient-centered care for the older adults by providers. Patient-centered care includes the patients as active participants in their own care and receives services designed to focus on their individual needs and preferences (AHRQ, 2002). Value-based system and shift to patient-centered care could support the development and expansion of Accountable Care Organizations (ACOs), which are collaborations between physicians, hospitals, and all providers that provide health care delivery in their communities. (CMS, 2010)

Health care strategy will involve a sequence of steps over time rather than changing all at once. What does it mean for nurses and how they care for patients in the clinical setting? It means that nurses will take the lead in the care coordination of the complex patients through the use of their high level critical thinking, in-depth disease knowledge, expert leadership skills, and comprehensive nursing skills and assessment to ensure positive patient outcomes. This is the time for nurses to step up and take the lead in the care of older and complex patients and ensure quality patient care. ★

ReferencesNew England Journal of Medicine (July 2009). Perspective:

A strategy for Health Care Reform – Toward a Value-based System. New England Journal of Medicine 2009, 341: 109-112 retrieved on 3/5/2012 from http://www.nejm.org/doi/full/10.1056/NEJMp0904131

Agency for Healthcare Research and Quality (AHRQ), (May 2002). Research in Action: Expanding Patient-Centered To Empower Patients and Assist Providers. Retrieved on 3/5/2012 from http://www.ahrq.gov/qual/ptcareria.htm

Center for Medicaid and Medicare Services (CMS), (January 2010). Roadmap for Implementing Value Driven healthcare in the Traditional Medicare Fee-For-Service program. Retrieved on 3/6/2012 from https://www.cms.gov/QualityInitiativesGenInfo/downloads/VBPRoadmap_OEA_1-16_508.pdf

How Will Future of Health Care Look With the Affordable Care Act and

Health Care Reform?

The Need for High-Level Care continued from page 5

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Nurses: Are You reAdY for Your New role iN HeAltH iNformAtioN tecHNologY?When health information technology (HIT) is fully integrated into direct patient care at every hospital, there will be new expectations of nurses. For every nurse, the time is now to get ready for your new role in HIT and its impact on patient safety and quality.

To help nurses prepare, Texas Nurses Association and Texas Organization of Nurse Executives have teamed up to deliver two continuing nursing education opportunities on the topic:

� May 23, 2012 – FREE CNE WEbiNaR – UNiNtENdEd CoNsEqUENCEs oF UsiNg ElECtRoNiC HEaltH RECoRds. 12:30-1:30 p.m. Webinar presenters are Mari Tietze, PhD, RN-BC, FHIMSS and Mary Beth Mitchell, MSN, RN, BC. Get more information and REgistER today at texasnurses.org > Events. 1.0 contact hours will be awarded for successful completion.

� JUNE 1, 2012 – CNE aCtivity – iNFoRMatiCs aNd tECHNology: sUppoRtiNg pRoFEssioNal NURsiNg, iMpRoviNg tHE qUality oF CaRE. 11 a.m. to 4 p.m., Houston. This interactive, critical thinking, scenario activity will provide practical approaches for solving common HIT implementation challenges, including workflow redesign for the optimization of patient safety and quality. The activity, provided by Texas Nurses Association and Texas Organization of Nurse Executives and hosted by TNA District 9 in conjunction with the Houston Organization of Nurse Executives, is a must-attend for nursing leaders, clinical directors, middle- and first-line managers.

Get more information and REgistER today at texasnurses.org>Events. Early bird registration (prior to May 18) is $60 per person (includes lunch and all materials); registration until May 30 is $75 per person. Parking is FREE. 4.0 contact hours will be awarded for successfully completing the activity.

Provided by texas Nurses Association and texas organization of Nurse executivesThe CNE activity planning committee reserves the right to cancel this activity or substitute faculty in the event of unforeseen or extenuating circumstances.

Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.


How Best to Prepare continued from page 1

the change to advance health. Again, nursing is placed by others at the core of this monumental realignment of our health care system.

But, the report points out, if nursing is to lead the change that advances health, “nursing education must be fundamentally improved both before and after nurses receive their licenses.”

Why? Because nurses must be better prepared; nursing care must be strengthened. In the future, chronic conditions will replace acute illnesses in patients, care environments will shift and needed competencies will expand to include leadership, research, evidence-based practice, health policy, and interprofessional collaboration. Health care environments will be more complex, technology and health information systems will be implemented more widely, and nurses will be called upon to coordinate care across the continuum and collaborate in a new way.

Now, the 2012 discussion of how best to prepare nurses for the future is being framed by the Initiative on the Future of Nursing as “80 by ‘20”— increasing to 80 percent by 2020 the proportion of nurses with a bachelor of science in nursing degree (BSN) or higher, and doubling the number of nurses with doctorates. Whether that goal can be achieved in Texas and exactly how it might be is the question being considered by the Texas Nurses Association Education Committee and the Advancing Nursing Education Committee of Texas Team Action Coalition.

In this issue of TEXAS NURSING VOICE, we take a look at some of the factors of preparing nurses to lead in the transformation of health care in the state:

• WhythePushforIncreasingtheNumberofBSN Nurses by 2020? – page 3

• TheNeedforHigh-LevelCareCoordination– page 5

• HowWilltheFutureofHealthCareLook?–page 6

• TheGrowthofComplexPatients–page8

And we take a look at the personal explanation of one nurse/nursing student who decided to continue on and further her education – page 13.

Ultimately, stakeholders are valuable and can weigh in with unique and encouraging perspective but it is nursing who must prepare itself for the future. ★


The day of nurses caring for patients with only one chronic condition is becoming less common and less seen in the clinical setting (AHRQ, 2011). Instead, what’s becoming more common is people who are suffering with one or more chronic illness having multiple providers treating them.

The reason could be that people are living longer due to the advancement in medicine and technology, and accessing the Medicare system for coverage. The following is a breakdown of chronic health conditions including chronic conditions and/or functional problems of people in the Medicare system: (Gerontology Society Summit 2010)

• 88percentofpersons65yearsorolderhaveat least one chronic health condition

• 65percenthaveat least twochronichealthconditions

• 24percenthavefourormorechronichealthconditions

These numbers could rise as a large number of Baby Boomers retire and access health care and Medicare. Due to the anticipated rise in the number of people with multiple, chronic conditions who will seek health care, researchers are looking at how to prioritize treatment and preventive care for those patients, such as deciding which medications should be prescribed in the treatment of patients with multiple conditions when the medicines may have dangerous interactions. And they are also determining the harm and/or benefit of preventive tests that may unnecessarily burden patients with multiple chronic conditions who might already be juggling numerous drugs, doctors and office visits. This will result in the move from caring for each of a patient’s conditions to caring for the patient as a whole. (AHRQ, 2011)

Health care of older adults extends beyond the traditional medical management of illness. Health care providers will evaluate all issues

that contribute to or impact the health of older adults including physical, cognitive, affective, social, financial, environmental and spiritual. Basic components of an older adult’s or a geriatric client’s assessment need to include (Medscape):

• Medical – problem list, medication andtreatments reviews, and nutritional status

• Psychological – mental status (cognitive),depression/mood

• Social–supportnetwork,financialsupport

• Environmental–homesafety,transportationand telehealth

• Functionalcomponents–abilitytoperformactivities necessary or desirable in daily life such as activity of daily living (ADLs)

This assessment and evaluation of older adults or geriatric clients will involve an interdisciplinary team that consists of a physician, nurse, social worker or case manager, and pharmacist in developing patient-centered care plans on older adults or geriatric patients who move from clinical setting to clinical setting. (Up-To-Date 2012).

Nurses will need to have astute assessment skills in caring for the older adults, have the ability through clinical reasoning skills to recognize problems, and communicate potential or actual problems to the interdisciplinary team for possible changes in the care plan if needed. Teamwork among the interdisciplinary team is essential in the care for older adults or geriatric clients, and nurses will be expected to take the lead of the team. They therefore must rely on their in-depth knowledge of the disease process or chronic illness, comprehensive nursing process skills, high level critical thinking or clinical reasoning and leadership skills. ★

ReferencesAgency for Healthcare Research and Quality (AHRQ)

September 2011. The challenge of prioritizing care of complex patients. U.S. Department of Health and Human Services, No 3l73, September 2011).

Medscape (2012), Components of Comprehensive Geriatric Assessment. Retrieved on 3/8/2012 from www.medscape.com/viewarticle/465308_4

Up-To-Date (2012), Comprehensive geriatric assessment. Retrieved on 3/5/2012 from www.uptodate.com/contents/comphrehensivie-geriatic-assessment

The Gerontological Soicety of America Scientific Summit (September 2010). Diffusing Care Coordination Models: Translating Research into Policy & Practice. Retrieved on 3/5/2012.

The Growth of Complex Patients

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In early March, Gov. Rick Perry announced the Board of Directors appointments to the newly created Texas Institute of Health Care Quality and Efficiency. Alexia Green, PhD, RN, FAAN, is among those appointed and is the only nurse. She will serve the citizens of Texas alongside seven physicians and six business leaders from across the state. Ben Raimer, MD of Galveston will serve as Board chairman.

The Texas Institute of Health Care Quality and Efficiency resulted from Senate Bill 7 of the 82nd Legislative Session. According to the governor’s office, “the institute will improve health care quality, accountability, education and cost to the state by encouraging health care provider collaboration, effective health care delivery models and coordination of health care services.” It is also intended to provide a cost savings to Texas of approximately $467 million

RN Green Among Board of Director Appointments to Texas Institute of Health Care Quality and Efficiency

by expanding managed care and streamlining efficiencies in the Medicaid program.

Dr. Green is professor and dean emeritus of the Texas Tech University Health Sciences Center School of Nursing, past president of Texas Nurses Association – a co-lead organization of Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action, and a member of the American Nurses Association. She currently serves as a co-leader representing nursing on the Texas Team Action Coalition, a diverse group of stakeholders interested in effecting sustainable change at the state level by capturing best practices, determining research needs, tracking lessons learned and identifying replicable models that can then accelerate improvements nationally.

Through this newly appointed Board seat, Dr. Green can help nurses in Texas better realize the vision of a transformed health care system as put forth by the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. The report outlines the need for a fundamental transformation of the nursing profession. Part of that transformation requires nurses to be “full partners with other health professionals, in redesigning health care in the U.S.”

Dr. Green’s leadership for nursing on this Board presents her with the privilege and opportunity to represent nursing, and to be a “thoughtful strategist” as Texas sets about to improve health care in the state. Dr. Green’s appointed term of office will expire January 31, 2015. ★

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In the last issue of TEXAS NURSING VOICE (January, February, March 2012), my nursing practice question had to do with the appropriateness – and liability – of texting patient information. I asked: “Is Texting/Receiving Patient Information a HIPAA Rules Violation?”

The question was posed as a way to bring awareness to this growing and misdirected trend in health care – and believe me, it did. It stirred up conversation among nurses and some of them phoned me with additional responses and reactions.

In light of the interest in that question, I now offer a follow up from the health informatics industry. Health informatics leaders are working at a fast pace to become compliant with the American Recovery and Reinvestment Act of 2009, and the implementation of Meaningful Use of Electronic Health Records. One common practice that is growing is the sharing of patient information between physicians and independent practitioners, as well as between patients and families via hospital portals and/or smartphones.¹

Although this sharing via portals and smartphones is becoming a best practice in coordination of patient care and improving communication among health care workers and practitioners, it brings challenges to the health care workplace in the way of privacy concerns, workflow issues, and the task of integrating

new technologies in already existing IT systems, and brings potential liability to nurses and organizations if portals and smartphones are not secured with encrypted software.

As mentioned in the first article on this question, a Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation is a concern with this growing practice of sending and receiving texted patient information/orders between physicians and independent practitioners. Violations can lead to criminal and/or civil law suits resulting in fines of up to $50,000 and up to one-year imprisonment for any person who knowingly obtains or discloses individually identifiable patient health information.²

In a Fall 2011 survey of 72 health care organizations conducted by Ponemon Institute LLC, Traverse City, MI, it was determined that the estimated cost of data breaches in these health care organizations was more than $2.2 million per year. In the survey, 80 percent of the respondents stated that they use mobile devices to collect, store and transmit protected patient health information, yet only 23 percent of those respondents use an encryption software or application for security purposes on their mobile devices.

The top causes of data breaches were either lost or stolen computing devices and/or unsecured mobile devices. Use of HIPAA-compliant encryption software or applications on mobile or computing devices is a small cost and can prevent theft or potential HIPAA violations.³

Nursing Practice Question: Is Unsecured Texting/Receiving of Patient Information via Smartphone a Potential Weak Link in Health Care?

Again, it’s the responsibility of all health care practitioners and workers to ensure that patient health information is secure and not breached. If a practice of unsecured data transmission is occurring in your workplace, it’s your duty to report it immediately to your supervisor or to the IT department.

Comments and questions are welcomed at [email protected]. ★

References

1. Healthcare Informatics (February 2012, Vol. 29/No.2), Getting the Message, Securely.

2. US Department of Health and Human Services (2011), HIPAA rules accessed on 12/ 6/2011 from www.hhs.gov/ocr/hipaa.

3. Healthcare Informatics (February 2012, Vol. 29/No.2), Unsecured Mobile Devices: The Weak Link.

Editor’s Note: A reproduction of the original article, Nursing Practice Question: Is Texting/Receiving Patient Information a HIPAA Rules Violation?, can be found at texasnursing.org>Resources.

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Nurse Practitioner Harmon Chooses the

Future of Nursing Mantra by Stan Harmon, MSN, RN, FNP

with Christy Meriwether

My name is Stan Harmon and I am a member of the Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action. The Campaign envisions a nation where every American has access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success. I joined the Campaign for Action to change the future of nursing in Texas. I believe it is unequivocally the right thing to do!

I live and work in El Paso, Tex., and as a family nurse practitioner, I provide care to active duty military soldiers and their family members at Fort Bliss. It is rewarding to know I am helping my country and I am proud of the care we provide although it is difficult for me to comprehend that our level of care is not equally available to all Texans.

Texas leads the nation in the percentage of uninsured residents. Federal legislation passed in 2010 (Patient Protection and Affordable Care Act) promises to add millions to the Texas Medicaid roles. At one point in my nursing career I provided primary care in an emergency room setting at a county hospital. It was clear to me that the primary care in an

acute care facility was far more costly than treating certain conditions in an ambulatory primary care environment consequently, underserved patients waited greater than a year to see a provider for management of diabetes, hypertension or other chronic conditions. I believe provision of quality, primary health care in a community setting would provide positive outcomes while maintaining affordability.

The current health care system is based on a disease process model which tends to spend the greatest amount of financial resources treating diseases and very little on health promotion. Providers receive financial rewards for ordering costly tests and procedures. For example, treating patients in primary care for obesity is far more cost efficient and safer than expensive bariatric surgeries. I’m convinced it will take legislative action to change the mindset of the patient and provider to one of education and smart, healthy choices.

In the military setting, I am free to provide patients the care they need without the cumbersome, site-based, delegated model used in Texas. Currently, advanced practice registered nurses (APRN) must meet the education and national certification requirements to be able to prescribe medications and have a physician to delegate prescriptive authority. Texas’ cumbersome process is further complicated by the four types of practice sites: primary, alternate, medically underserved and facility based. By removing the statutory requirement of delegation from physicians, APRNs would be able to choose practice sites more freely and move to underserved rural areas across the state.

Nurses should be full partners in redesigning the health care system as they collectively provide the largest professional contribution of direct patient care time. It would be far more efficient for hospital RNs to order drugs or x-rays for conditions in the emergency room than to have the patients wait to see providers. Upon completion of studies, RNs trained in laboratory and radiology could evaluate the results and manage conditions.

Nurses Taking Action in Texas: A Series Texas laws which govern the practice of

nursing need to change to allow nurses at all levels to practice to the full extent of their education and training. In my role with the Texas Team Action Coalition, I am actively working with the Texas Nurse Practitioners, Coalition of Nurses in Advanced Practice, and Texas Nurses Association – the lead organization representing nursing in the Texas Team Action Coalition – to find common ground in an effort to advance the role of nursing in improving rural health and increased access to APRN care. I also spend many hours speaking to legislators, local and state groups about the patient care that APRNs provide so they can better understand APRNs’ valuable contributions.

I firmly believe in the Campaign for Action in Texas goals of appointing nurses to leadership positions involving health policy, advocating for a better educated nursing workforce and for nurses being able to practice to the full scope of their education. The ideal picture is for the whole health care team from physicians to nurses to assistive staff to be able to contribute fully to the care of all Texans with a focus on the provision of quality care. ★

About the Authors Stan Harmon has been practicing nursing in Texas for more

than 17 years. With certification as a family nurse practitioner, Harmon has provided high-level health care in both acute and primary care settings. For the Texas Team Action Coalition, he serves as a member of its Advancing Nursing Practice team representing the Upper Rio Grande Region. Among other involvement for nursing, Harmon is the Texas Nurses Association representative to the Texas Board of Nursing’s APRN Advisory Committee and president-elect of Texas Nurse Practitioners.

Christy Meriwether is the director for Customer Support in Education Support Services at Texas Tech University Health Sciences Center School of Nursing. For the Texas Team Action Coalition, she serves as a member of its Tactical Support and Operations Committee.

About Texas Team Action Coalition: Texas Team Advancing Health through Nursing Action Coalition, convened to advance the Future of Nursing: Campaign for Action, is a diverse, statewide group of nurses, nursing organizations, hospitals, schools/universities, consumer businesses and advocacy groups interested in addressing future demand for high quality, cost-effective and accessible health care in Texas. Explore the opportunities to participate and follow the news of Texas Team at texasnurses.org.

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by Angelica Ybarra, BSN, RN

Every nurse regardless of initial academic preparation is an asset to the nursing profession. Collectively, we nurses stand 3 million strong in the U.S. and approximately 200,000 RNs and 90,000 LVNs are licensed in Texas. The Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, recommended that the profession increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. However, only 50 percent of the Texas nursing workforce currently holds a BSN.

It is my opinion that supporting the “80 by ‘20” initiative is a step in the right direction for moving the nursing profession forward. Although returning to school can appear challenging, I can assure you it is attainable.

My nursing career started in 1998 when I began a hospital-based RN diploma program at the Baptist School of Professional Nursing in San Antonio, Texas. Throughout my clinical rotations, I was inspired by the nurses who provided care to patients and their families. It amazed me that one person could make such a difference in the lives of so many and do so with compassion, competence and professionalism. I graduated in 2000, and it was a grand achievement; I was proud of my RN diploma. There was nothing more rewarding than providing care to patients in need and being the nurse entrusted with such an important responsibility.

I married soon after graduation and settled into my new roles as wife and nurse. I temporarily relocated to Savannah, Georgia due to my husband’s military service in the Army. As I practiced in a hospital setting, I kept pondering what my baccalaureate-prepared RN colleagues knew that I didn’t and this bothered me. During the course of my first year of practice, I reflected on what my nursing professors had said. They told us that the roles of nurses were evolving, that the health care environment was changing, and that the future of nursing would require a broader education than an RN diploma program could provide. I contemplated going back to school and because

I still had decades to devote to the nursing profession, I felt my patients would best be served by my being a more educated nurse.

After my first year of nursing practice, while living in Georgia, I enrolled in an RN-to-BSN program at Armstrong Atlantic State University. Although I was married and already working full time, I made the commitment to attend classes in the evening. I knew it wouldn’t be easy. During my academic endeavor, I was thrilled to learn that I was expecting my first child, but then saddened to have my husband deployed overseas to go to war. Yet, I was determined to complete the program.

I must acknowledge that once I started my classes, I quickly understood the in-depth knowledge I was lacking to provide comprehensive nursing care. Knowledge in areas such as nursing research and evidence-based practice, leadership and management, health policy, and population-focused nursing really expanded my view beyond disease processes, care plans, and nursing skills. I was able to understand the broader context of nursing practice and the importance of ensuring safe, high quality, patient-centered and cost-effective care in a health care delivery system that is dependent upon the nursing profession for its success.

After I graduated with my BSN, my husband came home safely from the war and completed his Army service. We welcomed our first child into our lives, and moved back to Texas. I continued to practice for several years, supported my husband while he worked towards his undergraduate and graduate degrees, and had a second child. My nursing journey has taken me through a variety of health care settings that lead to a position in management. It was my management experience that sparked my desire to next pursue an MSN degree in nursing administration.

After years of nursing, I felt compelled to return to school and obtain academic preparation in an advanced practice role consistent with the high-caliber nursing

standard that I wanted to promote and ensure through nursing administration and leadership. After researching nursing schools, I learned that BSN and graduate nursing programs had also evolved. They were more flexible and were now offering new and innovative methods of teaching in traditional face-to-face classes, as well as innovative hybrid and online classes that could be taken from remote locations.

I started the MSN degree program at the University of Houston-Victoria in 2010. While in the MSN program, I learned of the IOM’s Future of Nursing report. When I first read the report, I was quite moved and impressed. I felt as if somebody had finally and officially acknowledged the true worth and importance nurses play in our nation’s health care delivery system. After all, nurses are at the forefront of patient care delivery and far outnumber any other profession within our U.S. health care workforce. I encourage all nurses to read the report, reflect on your own nursing journey, and envision what a BSN and/or advanced degree can do for your career and the profession.

I truly believe that encouraging more nurses to obtain their BSN degree will prepare them for a broader nursing practice arena and support nurses’ professional role synthesis within a rapidly changing health care environment. The “80 by ‘20” movement will strengthen the profession, position nurses as key members of the health care team, and contribute towards better patient outcomes. Overall, a more educated workforce will be instrumental in redesigning our nation’s health care delivery system and will propel the profession to new heights in the 21st century.

Let us move together and join the Future of Nursing: Campaign for Action. Let us encourage one another, and actualize the “80 by ‘20” initiative. ★

About the Author: Angelica Ybarra, BSN, RN is conducting

her Leadership Practicum at the Texas Nurses Association. She is attending the University of Houston-Victoria, School of Nursing and will graduate with an MSN degree in nursing administration in December of 2012.

Nurse Ybarra Takes Action to Support the “80 by ‘20” Initiative

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American Nurses Credentialing Center. All Rights Reserved.The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA).

© 2012


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Educating Nurses for over 30 years!

potential facultyCreate your future with us! School of Nursing Faculty Positions: Loyola University New Orleans, a progressive Jesuit University, is seeking to hire outstanding faculty for newly created tenure track positions at the ranks of Associate and Full Professor. Responsibilities include teaching online; community engagement; student supervision; curriculum development, revision and evaluation; program development funding; research translation for practice and a progressive record of scholarship and community service. Faculty must hold regular office hours and have same on campus availability.

If working in a place where you can blossom is of interest to you, please submit a letter of interest, vitae and three letters of reference for these positions to:Dr. Ann Cary, Director and ProfessorRobert Wood Johnson Executive Nurse Fellow 2008-2011School of Nursing, Loyola University New Orleans6363 St Charles Avenue, Campus Box 45, New Orleans, La. 70118Attn: Debbie Smith, Executive Assistant(504) 865-2823 [email protected] • http://css.loyno.edu/nursing

Candidates will have a doctoral degree and national certification as a Family/Adult Nurse Practitioner or Nurse Administrator. Experience in education and practice is desired. Rank and salary are commensurate with qualifications. Loyola is an EO/AA employer.

Bachelor of Science in nurSing program

rn-BSnrn-mSn

Blend to mSn (504) 865-2307

http://css.loyno.edu/nursing/bachelor-science-nursing

health care SyStemS management mSn

(504) 865-3250

http://css.loyno.edu/nursing/health-care-systems-management-program

all programS100% online

doctor of nurSing practice-dnp

post-masters to dnppost-BSn to dnp

(504) 865-2582

http://css.loyno.edu/nursing/doctor-nursing-practice

Application Deadlines:February 1st and November 1st

Earn a Credential That’s in Demand Nationwide• “Top 15” ranked nursing school• Practice specialties for all interests• State-of-the-art nursing informatics

and facilities• Community of scholars with broad

faculty expertise• Distance learning opportunities• New BSN to DNP option

Master of Science in Nursing (MSN)

Doctor of Nursing Practice (DNP)

PhD in Nursing Scienceclinical interventions, health services research

Learn more. Apply today.www.nursing.vanderbilt.edu

Vanderbilt is an equal opportunity affirmative action university.


Free CE credits. Available 24/7.

Now you can choose the time and place to take the courses you need and want.

We’ve made it easy to take free CE courses online. We offer 24/7 access to more than

40 courses, including when to refer to a pediatric specialist. And even when you’re

not taking a course, you can access the latest references and resources you need.

The CE courses were developed by the Texas Department of State Health Services

and the Texas Health and Human Services Commission. All courses are

comprehensive and accredited.*

To view courses online, visit www.txhealthsteps.com.

*Accredited by the American Nurses Credentialing Center, Texas Medical Association, National Commission

for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council

of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Dietetic

Association, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners.

Continuing Education for multiple disciplines will be provided for these events.

CE Courses Include:

• When to Refer to a Geneticist

• Children with Diabetes

• Children with Asthma

• Newborn Screening

• Case Management

• Developmental Screening

• Many others

Referral Guidelines

• Pediatric Depression

• High Blood Pressures in the Office

• Atopic Dermatitis

• Gastroesophageal Reflux in Infants

• Exercise-Induced Dyspnea

• Referral Guidelines Overview

Taking New Steps

Advanced nursing education today foradvanced healthcare tomorrow.On the front lines of patient care, nurses serve a critical role in shaping the future of healthcare delivery. For over 120 years, Chamberlain College of Nursing has been preparing compassionate and clinically profi cient nurses by increasing access to quality nursing education nationwide and training aspiring nurses, nurse leaders and nurse educators.

For nurse advancers, Chamberlain offers accelerated, fl exible online options:

• RN to BSN Option

• RN-BSN to MSN Option

• Master of Science in Nursing Degree Program

Lead. Achieve. Inspire.

Now enrolling for spring, summer and fall semesters

For more information, please visit chamberlain.edu or call 888.556.8CCN (8226)

© 2012 Chamberlain College of Nursing, LLC. All rights reserved.

National Management Offi ces | 3005 Highland Parkway | Downers Grove, IL 60515 | 888.556.8CCN (8226)

Comprehensive consumer information is available at: chamberlain.edu/studentconsumerinfo

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