Colorado Nurses Association brings in nursing experts to inform task force.

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August 10, 2007 Meeting

At this meeting there was continuing review of nursing sensitive measures, a focus on the NQF developed measures, and other measures identified by task force members and the public. A discussion also took place on what the task force members perceived were the critical nurse workforce issues. The draft principles which had been revised were again discussed.

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In the morning, Sharon Pappas, Chief Nursing Officer with Porter Adventist Hospital presented on the Porter Nursing Dashboard. She discussed their organizational and unit based measures, including staffing effectiveness measures. Organizational measures which focus on People, Cost, and Quality were presented. For example, for people: their facility measures RN turnover, percentage of BSN, percentage of nurses Certified, and the Gallup Satisfaction Survey, among others. Examples where measures were further looked at on a unit basis were provided. Data could then be looked at from different levels to identify opportunities for change or improvement.

Following the presentation, the task force reviewed many of the NQF measures with discussion ensuing relating to their suitability to capture data under the task force objectives. There was particular focus on nursing sensitive measures. Some of the measures discussed included: failure to rescue, pressure ulcer prevalence, falls prevalence, restraints, skill mix, nursing care hours per patient day, the Practice Environment Scale, and voluntary turnover, among others.

After lunch, Alexandra Hall from the Colorado Department of Labor and Employment presented statistical data on nurse workforce. Some interesting data: Colorado ranks #6 in percentage of Baby Boomers. The Healthcare and Social Assistance sector makes up 11% of Colorado's total employment. By the year 2015, hospital employment is expected to grow 30% (19,437 new jobs) in Colorado. Job growth in the hospital setting, nursing projections, and other demographic data were presented.

Later, Amy Downs, of the Colorado Health Institute presented a summary of the 2005 Colorado RN Workforce Survey. This was a survey of 24,000 RNs who were renewing licenses in 2005. Age distribution of nurses were presented. Many variables were examined in the survey, including: reasons not working in a nursing position, number of years respondents plan to work in nursing, salary comparisons for urban and rural nurses, assessment of workplace environment by work setting and perceptions of primary workplace by age and by number of hours worked. A second survey is tentatively planned for 2008.

Nurse Workforce Data was discussed in the afternoon session in an attempt to identify what data would be relevant and next steps for focus. Some of the issues identified for further discussion included: retention, educational capacity, ability to attract "good" students, compensation, reorientation and refresher courses, schedules, hours, and worklife, "On Boarding", identification of best practices, and staffing. One positive example for new graduates entering the workplace was mentioned as the University of Colorado's residency program for new nursing graduates.

August 24, 2007 Meeting

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The Colorado Nurses Association provided opportunity for the Task Force to hear directly from an NDNQI expert from the American Nurses Association. Isis Montalvo, RN, MS, MBA, Manager of Nursing Practice 10000 and Policy from ANA provided an educational session on NDNQI at the August 24th meeting. Ms. Montalvo oversees the NDNQI program. NDNQI is the National Database of Nursing Quality Indicators.

NDNQI was established in 1998 as part of the American Nurses Association's Patient Safety and Quality Initiative. The database includes established nursing sensitive measures that collectively reflect the structure, process, and outcomes of nursing care. Nationally 1147 hospitals participate in the NDNQI. In Colorado, there are currently 22 hospitals participating.

Ms. Montalvo presented that the NDNQI is not simply a set of measures--it includes the data collection and reporting process which also allow for national comparisons. Specialty and state comparisons can also be provided under a separate contract. The program also has a formal pilot testing of indicators, and a strong educational and research focus.

Ms. Montalvo discussed the structure, process, and outcome components of the NDNQI. To clarify, structural components of nurse sensitive measures look at the supply of nursing staff, the skill level, and the education/certification of the staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nurse sensitive are those that improve when there is a greater quantity or quality of nursing care.

Ms. Montalvo' s presentation to the task force was well received. In the afternoon, she was invited to sit in to answer questions as the task force discussed possible endorsement of specific measures, including NQF measures.

Action moved forward in the afternoon session with identification of measures the task force selected as informing the objectives of the task force. Several nursing structural measures were added by consensus. This is an important piece of data collection on nursing workforce. Patient outcome measures were also discussed and added as potential indicators.

There is still opportunity for inclusion of more nursing process indicators. There was discussion on the components of the RN Survey under NDNQI. Some task force members stated a preference to only do the Practice Environment Scale. Others supported the importance of both the job Satisfaction Scale and the Practice Environment Scale. There were some who felt more information was needed to make a decision. The two components measure different aspects of nursing satisfaction and the work environment. It was decided to discuss this further at a future date. Ms. Montalvo offered the expertise of Dr. Diane Boyle, ANA expert on the Nursing Survey.

This was probably one of the more effective task force meetings with action moving forward on potential indicators.

September 24th Meeting

Focus on the Nursing Workforce Shortage--relating to Education was presented by Task Force Members Sue Carparelli, Kristy Reuss, and Nancy Smith. Data on the impact of the faculty nursing shortage was presented. Some information cited: Four year nursing programs are experiencing a shortage of 15% fewer faculty members than they need right now. For two year programs, there is a 25% shortage. Within the next five years, there will be a 50% turnover in nursing faculty positions. me average age of a nursing faculty member in Colorado is 53.5 years. These were sobering statistics. There was also sobering data on Colorado's current standing nationally with respect to minimum educational requirements for nursing.

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Other issues also mentioned included wait lists for entrants to nursing programs, faculty salaries which are below many other nursing professional salaries, turnover rates for faculty, and tenure issues. Kristy Reuss mentioned new technology opportunities for learning such as use of simulation, use of internet, CD, DVDs, downloadable textbooks, and use of technology in clinical settings.

Some of the possible solutions discussed for education workforce issues included the need to have public policy emphasis on nursing education at the Master's Degree, PhD, and Doctorate of Nursing Practice level. One task force member, Colleen Goode reminded of the importance of making sure there were enough baccalaureate graduates to bring up through educational programs for faculty positions. Producing nurses "too fast" and with not enough baccalaureate graduates will make the nursing shortage worse, she warned.

Aligning policy with actual workforce data was cited by Sue Carparelli as also important. Planning to deal with these complex issues should be comprehensively focused.

Other suggestions included changes in redesign and revision of the Board of Nursing rules for nursing education to accommodate increased numbers of nursing students. Full time/Part Time faculty ratios were mentioned as a possible focus.

"Talent Management Approaches" were suggested by the presenters on this topic. Some suggestions included: a comprehensive nursing faculty workforce assessment needs to be done, there needs to be market based compensation structures for faculty, increased funding for nursing education, recruitment campaigns are needed, succession planning is needed, there needs to be redesign of faculty educational loan forgiveness programs, investing needs to be encouraged in faculty professional development, and opportunities for public-private partnerships explored.

How to offer incentive for new graduates to work in Colorado patient care settings was discussed. The need for strategic targeting for specific needs was also related. The need to understand what kind of place Colorado is like for nurses to live and work was also mentioned in discussion. Matching nurses entering the profession to the right roles was also identified as a need.

Nursing Survey--In the afternoon task force members were allowed to ask questions via conference call with ANA expert Isis Montalvo, and University of Kansas Nursing Researchers, Diane Boyle, PhD, and Nancy Dunton, PhD on nursing survey and nursing job satisfaction instruments under the National Database of Nursing Quality Indicators. An advantage of the instruments is the ability to collect unit level data and the ability to compare data at the national level.

Meeting Dates for future Task Force Meetings: November 30, and December 19th. These are open meetings. The public may attend. Please check Colorado Hospital Association website for any changes in schedule or location at www.cha.com.

Colorado Nurses Association Updates on this topic are available at: www.nurses-co.org.