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Emerging and Important Issues for 2015 and Beyond
Emerging and Important Issues for 2015 and Beyond
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he New Year is traditionally a time for new beginnings, resolutions, and anticipation of the new challenges and opportunities that lie in the year ahead. However, many regulators are already looking beyond the start of the year, planning and strategizing for the start of the upcoming 2016 fiscal year in July or October. The National Council of State Boards of Nursing (NCSBN) begins those discussions with an environmental scan: an examination of the health care milieu; a canvass of workforce, education, and legislative issues; and an overview of the accomplishments and needs of boards of nursing (BONs). The findings of this scan provide a foundation for new initiatives, strategies, and the ways we monitor the political and health care environment. We have received so much positive feedback from BONs about this report that this year we are publishing a supplement to this issue for our entire JNR readership. But let me outline a few important emerging issues for nurse leaders in regulation, education, and clinical practice. Education: Expect discussions with educators to revolve around the shortage of clinical sites at the undergraduate and graduate levels. The release of the National Simulation Study data has accelerated discussions on the substitution of simulation for traditional clinical hours in the undergraduate curriculum. An important outcome of the study was the fact that success of simulation is highly dependent on faculty and program preparation. To assist BONs and educators in their discussions and decision making, NCSBN will be convening an expert panel of educators and regulators to develop guidelines and model legislative language for BONs. Workforce: It is still too early to know the full implications of the Affordable Care Act on the nursing workforce. Spetz (2014) proposes that the impact will be setting-specific. There will be higher demand for nurses in outpatient and home health settings and the role of all nurses will expand further into care coordinator, case manager, patient educator, and chronic-care specialist. BONs should be aware of the changing roles and scopes of practice for registered nurses and licensed practical/vocational nurses and the changes regarding how nurses may delegate responsibilities to unlicensed assistive personnel. Practice: The encouraging results of the transition to practice study are reported in this issue. The hospitals enrolled in the study that had established structured, evidence-based transition to practice programs for new graduates had better retention during the first year of practice, and the new nurses in those facilities reported fewer erVolume 5/Issue 4 January 2015
rors, fewer negative safety practices, less stress, and more job satisfaction compared with new graduates working in hospitals with limited onboarding programs or none at all. Recently, the issue of transition to practice has focused on the advanced practice registered nurse (APRN) with six jurisdictions now requiring a transition to practice period before an APRN has full practice authority. However, more data are needed to determine if such requirements are necessary and what they should be. Telehealth: While legislators and others address the challenges of access to care by advancing telehealth legislation, BONs are working on advancements in the nurse licensure compact and an APRN compact to address the licensure issues related to mobility of nurses and practice across state lines. NCSBN is closely monitoring legislation at the state and federal levels and working with lawmakers to ensure licensure remains state-based. Legislative initiatives: NCSBN now has offices in Chicago and Washington, DC, allowing us to be proactive in legislative activities at the state and federal levels. NCSBN is preparing for an active legislative season that we hope will result in many more states coming into alignment with the Consensus Model for APRN Regulation. If you have not already done so, we urge you to work on aligning titles, beginning with the adoption of “advanced practice registered nurse” and the role titles: “certified registered nurse anesthetist,” “certified nurse practitioner,” “clinical nurse specialist,” and “certified nurse midwife.” It is confusing for consumers and policy makers when states do not use uniform terminology, especially for the title of a profession. When titles vary, APRNs’ contributions to health care are obscured. Finally, NCSBN will be assisting states in enacting criminal background checks. We all realize the importance of this initiative, and it will be one of our top priorities for this legislative season. This is a short synopsis of the looming issues that will take us through 2015 and into 2016. Be assured of our support and assistance to help you meet the needs of your BON. To all of our members, colleagues, and the readership of JNR, thank you for your support throughout the year and best wishes for 2015! Maryann Alexander, PhD, RN, FAAN Editor-in-Chief
www.journalofnursingregulation.com
3
T
he New Year is traditionally a time for new beginnings, resolutions, and anticipation of the new challenges and opportunities that lie in the year ahead. However, many regulators are already looking beyond the start of the year, planning and strategizing for the start of the upcoming 2016 fiscal year in July or October. The National Council of State Boards of Nursing (NCSBN) begins those discussions with an environmental scan: an examination of the health care milieu; a canvass of workforce, education, and legislative issues; and an overview of the accomplishments and needs of boards of nursing (BONs). The findings of this scan provide a foundation for new initiatives, strategies, and the ways we monitor the political and health care environment. We have received so much positive feedback from BONs about this report that this year we are publishing a supplement to this issue for our entire JNR readership. But let me outline a few important emerging issues for nurse leaders in regulation, education, and clinical practice. Education: Expect discussions with educators to revolve around the shortage of clinical sites at the undergraduate and graduate levels. The release of the National Simulation Study data has accelerated discussions on the substitution of simulation for traditional clinical hours in the undergraduate curriculum. An important outcome of the study was the fact that success of simulation is highly dependent on faculty and program preparation. To assist BONs and educators in their discussions and decision making, NCSBN will be convening an expert panel of educators and regulators to develop guidelines and model legislative language for BONs. Workforce: It is still too early to know the full implications of the Affordable Care Act on the nursing workforce. Spetz (2014) proposes that the impact will be setting-specific. There will be higher demand for nurses in outpatient and home health settings and the role of all nurses will expand further into care coordinator, case manager, patient educator, and chronic-care specialist. BONs should be aware of the changing roles and scopes of practice for registered nurses and licensed practical/vocational nurses and the changes regarding how nurses may delegate responsibilities to unlicensed assistive personnel. Practice: The encouraging results of the transition to practice study are reported in this issue. The hospitals enrolled in the study that had established structured, evidence-based transition to practice programs for new graduates had better retention during the first year of practice, and the new nurses in those facilities reported fewer erVolume 5/Issue 4 January 2015
rors, fewer negative safety practices, less stress, and more job satisfaction compared with new graduates working in hospitals with limited onboarding programs or none at all. Recently, the issue of transition to practice has focused on the advanced practice registered nurse (APRN) with six jurisdictions now requiring a transition to practice period before an APRN has full practice authority. However, more data are needed to determine if such requirements are necessary and what they should be. Telehealth: While legislators and others address the challenges of access to care by advancing telehealth legislation, BONs are working on advancements in the nurse licensure compact and an APRN compact to address the licensure issues related to mobility of nurses and practice across state lines. NCSBN is closely monitoring legislation at the state and federal levels and working with lawmakers to ensure licensure remains state-based. Legislative initiatives: NCSBN now has offices in Chicago and Washington, DC, allowing us to be proactive in legislative activities at the state and federal levels. NCSBN is preparing for an active legislative season that we hope will result in many more states coming into alignment with the Consensus Model for APRN Regulation. If you have not already done so, we urge you to work on aligning titles, beginning with the adoption of “advanced practice registered nurse” and the role titles: “certified registered nurse anesthetist,” “certified nurse practitioner,” “clinical nurse specialist,” and “certified nurse midwife.” It is confusing for consumers and policy makers when states do not use uniform terminology, especially for the title of a profession. When titles vary, APRNs’ contributions to health care are obscured. Finally, NCSBN will be assisting states in enacting criminal background checks. We all realize the importance of this initiative, and it will be one of our top priorities for this legislative season. This is a short synopsis of the looming issues that will take us through 2015 and into 2016. Be assured of our support and assistance to help you meet the needs of your BON. To all of our members, colleagues, and the readership of JNR, thank you for your support throughout the year and best wishes for 2015! Maryann Alexander, PhD, RN, FAAN Editor-in-Chief
www.journalofnursingregulation.com
3