- Email: [email protected]
Future-of-Nursing Report: The Impact on Emergency Nursing
EMERGENCY NURSING ADVOCACY
FUTURE-OF-NURSING REPORT: THE IMPACT EMERGENCY NURSING
ON
Authors: Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, and AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, Lexington, KY, and Philadelphia, PA Section Editor: Kathleen A. Ream, MBA, BA
Earn Up to 10.5 CE Hours. See page 598. t has been almost 2 years since the release of the Institute of Medicine (IOM) consensus report entitled The Future of Nursing: Leading Change, Advancing Health.1 The key messages of the report have the potential to create change across the profession that will benefit patients, families, and the global nursing community. These messages are as follows:
I
• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. • Nurses should be full partners with physicians and other health care professionals in redesigning health care systems in the United States. • Effective workforce planning and policymaking require better data collection and an improved information infrastructure.
Within the key messages, there are some specific recommendations: 1. Removing scope of practice barriers 2. Expanding opportunities for nurses to lead and diffuse collaborative improvement efforts
3. Implementing nurse residency programs 4. Increasing the proportion of nurses with a baccalaureate degree to 80% by 2020 5. Doubling the number of nurses with a doctorate by 2020 6. Ensuring that nurses engage in lifelong learning 7. Preparing and enabling nurses to lead change to advance health 8. Building an infrastructure for the collection and analysis of interprofessional health care
Nursing organizations are responding to the report in varied ways. The Emergency Nurses Association (ENA) adopted a proactive response in its approach to the report. The organization’s response includes endorsement of the report, dissemination of the information to its members through educational sessions, a General Assembly resolution supporting the report recommendations, and the formation of the Future of Nursing Work Team. The Future of Nursing workgroup developed a series of articles in ENA Connection depicting the relevance and value of the report to members. A position statement and white paper have been drafted to highlight the impact of the report on emergency nursing practice. ENA will continue to inform members and promote implementation of the strategies outlined in the report. Emergency nurses are in a position where
• They must be leaders in the design, implementation, Patricia Kunz Howard, Member, Kentucky State Council, is Operations Manager, Emergency and Trauma Services, University of Kentucky Chandler Medical Center, Lexington, KY. AnnMarie Papa, Member, Pennsylvania State Council, is Clinical Director, Emergency Nursing, The Hospital of the University of Pennsylvania, and Penn Presbyterian Medical Center, Philadelphia, PA. For correspondence, write: Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, 2108 Thorndale Way, Lexington, KY 40515; E-mail: [email protected]. J Emerg Nurs 2012;38:549-52. Available online 1 October 2012. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2012.08.001
November 2012 VOLUME 38 • ISSUE 6
and evaluation of the ongoing change in their patient care environment. • They must take a leadership role in building professional and interprofessional partnerships with their colleagues to ensure that the patient receives optimal care. • They must develop leadership skills and competencies that assist them with the demanding professional and physical environment that exists in the changing emergency department. • They must step forward and work in mutually respectful teams to enhance the quality of the care and services provided.
ENA has long recognized the pivotal role the registered nurse plays in the successful outcomes and coordina-
WWW.JENONLINE.ORG
549
EMERGENCY NURSING ADVOCACY/Howard and Papa
tion of care in the emergency department. There are many tools and opportunities that ENA has developed to help individual emergency nurses grow in their staff and leadership roles. Two great examples of this work, the ED Benchmarks Collaborative2 and the development of a consensus statement that defines standardized ED metrics,3 will help nurses work in collaboration with other health care professionals to research strategies to reduce ED crowding and boarding. The IOM report’s recommendations and key messages have the potential to create even more change in a health care environment that is constantly evolving and integrating new practices and technology into patient care based on best evidence. These movements are rapidly changing the patient care environment and have an intense impact on care provided in the emergency department. Emergency nurses are versatile and flexible. They must balance expertise in technologic tools and information management systems while working to use evolving evidence-based interventions to deliver safe care to a complex and diverse patient population. All of this is done while building interprofessional alliances and collaborating and coordinating care across teams of health professionals that may be located in the community, the emergency department, and/or the health care facility. ED leaders play a pivotal role in driving these collaborative partnerships. Research has shown that a leadership style that involves working with others as full partners in a context of mutual respect and collaboration can result in direct patient care improvements. Specifically, the IOM report describes improved patient outcomes, reduced length of stay, costs savings, a reduction in medical errors, and less staff turnover.1 Knowing this, as leaders, emergency nurses must do their part to create a more collaborative ED environment while planning for the future. Succession planning is essential for the future not just for new leaders but also for ED staff. Integration of novice nurses interested in emergency nursing is one method to ensure our future while fostering a collegial and collaborative environment. Well-delineated orientation programs for new graduates, such as residency programs that include support for the new nurse with limited or no emergency nursing experience, have been successful in the emergency department. Nurse residencies or internships have been used to provide a structured approach creating the essential framework of knowledge for emergency nursing care. Although some residencies have been in place for more than 20 years, most are relatively new, as the cadre of qualified nurses has dwindled. Data regarding emergency nursing residency programs are limited. One potential model for a new graduate resi-
550
JOURNAL OF EMERGENCY NURSING
dency program is the BSN Residency Program developed by the University HealthSystem Consortium with the American Association of Colleges of Nursing.4 An emergency nursing residency could be modeled using some of the tenets of the BSN residency. Formal and informal educational sessions/strategies, coaching/ counseling, defined timeframes/benchmarks, and supervised clinical experience under the tutelage of a qualified preceptor for a period of up to 12 months would be the basis for a well-structured program. Clinical nurse specialist or staff development oversight would be essential to resolve issues and ensure compliance with program objectives. The emergency nursing residency should be competency based with well-defined objectives that must be met to proceed. Educational content may include the use of the online ENA Emergency Nursing Orientation program, the Core Curriculum, a critical care program, and/or a variety of institution-specific classes. Clinical simulation should be used to provide team-building and decision-making activities while verifying competency. ENA courses such as the Trauma Nursing Core Course and Emergency Nursing Pediatric Course may be components of the program and help to develop and foster critical thinking. New graduates in the emergency department are a reality. Turnover rates for graduates are high, ranging from 35% to 60% within 1 year of employment, resulting in an institutional cost of nurse replacement of approximately $40,000,5 as well as substantial psychological impact on both the preceptor and preceptee. New graduate residency programs reduce attrition and make economic sense. Because new graduates in the emergency department are a reality, it is imperative that they are well educated and prepared for their role, are truly integrated members of the care team, and are supported in their personal and professional development, and success will be ensured as an emergency nurse. Having an adequate supply of well-prepared emergency nurses is just one challenge the profession faces. To be effective in increasing the number of nurses with baccalaureate degrees, the pipeline must be expanded. This can be accomplished by embracing private-public partnerships to increase the size and number of baccalaureate programs. Partnerships with high schools and primary schools are an effective strategy to help recruit a large diverse group of future nursing students. Entry into practice sets the stage for lifelong learning. Diploma and associate degree programs must provide a clear path to obtaining the baccalaureate degree, promoting the recommendation of seamless academic progression. This can be accomplished by establishing partnerships between diploma and associate degree programs and institutions that offer baccalaureate degrees. Nursing schools must put their students
VOLUME 38 • ISSUE 6 November 2012
Howard and Papa/EMERGENCY NURSING ADVOCACY
on the path to a seamless academic progression for the goal to be met. Increasing the percentage of nurses with a baccalaureate degree from 50% to 80% will not be easy or inexpensive. Health care organizations should encourage nurses to start a baccalaureate program within 5 years of entering the profession. Some organizations are currently requiring nurses without a baccalaureate to agree to obtain this degree within 5 years of hire as a condition of employment; other organizations require the BSN on initial hire. Health care organizations are uniquely positioned to facilitate nurses to obtain additional education. Organizations can offer scholarships and/or tuition reimbursement or build degree progression into the compensation structure. It is essential for improved outcomes of patients and the progression of the nursing profession that the core group of nurses are baccalaureate prepared. Diploma and associate degree programs will remain a valuable source of the initial preparation for registered nurses. Graduate nursing education is consistent with the recommendation encouraging nurses to practice to the full extent of their knowledge and training. Advanced practice registered nurses (APRNs) are highly trained with advanced education, certification, and clinical training and serve as health care providers in a broad range of acute care and outpatient settings. The delineation of scope of practice and responsibilities for APRNs is not well defined and stated across the nation. Challenges encountered by the APRN vary and may include an inability to obtain medical staff privileges in many hospitals, being subjected to stringent professional liability insurance requirements, and antiquated laws governing APRN education, training, and experience. Despite these many challenges, APRNs continue to provide high-quality care across the nation and impact patient outcomes. As the delivery of health care becomes more complex and the patient care acuity increases, nurses are expected to show greater knowledge and expanded competencies in providing health care to their patients. With the nursing shortage, as well as the decreasing number of nursing faculty to educate the new nurses, this places a challenge on the educational system and to the supply of nurses needed by 2020. An increase in the number of doctorally prepared nurses is essential to ensure availability of faculty for both undergraduate and graduate nursing education as well as development of new knowledge. The IOM recommendation advocates for doubling the number of nurses with a nursing doctorate degree by 2020. This is necessary to correct existing faculty shortages, to fulfill nursing leadership roles needed for policy development and research, and to lead organizational change. Faculty members of nursing programs are being asked to support the need for more
November 2012 VOLUME 38 • ISSUE 6
faculty and lobby for an increase in salaries and more federal funding. Nurses are being encouraged to pursue doctoral education earlier in their careers. What will the nurse doctorate look like in the year 2020? No longer are nursing schools reporting nursing students as fresh out of high school, white, and female. The nurse of the future will be different from the stereotypical nurse of the past. Nursing is being de-gendered; it is being seen as more of a life choice, which has created more diversity and has been positive for the profession. As emergency nurses of the future, it is essential to focus on the changing health care system, consider personal career paths, establish goals, and meet the challenge to accomplish these goals. Lifelong learning is essential in the constantly changing health care arena. Nurses are providing care to more patients who are sicker in more complex systems. Valuebased purchasing creates opportunities for nursing to show great relevance with outcomes correlated with nurse-sensitive indicators. Nurses have an obligation to remain abreast of new technology, treatments, and trends across health care. The public deserves well-educated care providers as patients also become more knowledgeable about their care. ENA has a strong history of providing education for emergency nurses that facilitates lifelong learning. Evidence-based education offerings such as the Trauma Nursing Core Course and Emergency Nursing Pediatric Course are excellent examples of how ENA has invested in the promotion of lifelong learning. The annual conference, online orientation, Key Concepts, and many other educational courses provide support for the commitment of ENA. Emergency nurses have been heard to voice concern about how “others” make decisions that impact emergency nurses’ practice, their patient care, their work hours, staffing in the department, the equipment they use, the systems used to care for their patients, the documentation, the policies, and the legislation. A great many people make decisions that impact emergency nursing practice, and they are not emergency nurses. The landmark IOM report provides the emergency nurse the opportunity to be the decision maker, the problem solver, the policy determiner, the legislative influencer, and the difference maker. It calls to action the policymakers, hospital administrators, thirdparty payers, business, government, academia, and philanthropy, as well as our physician colleagues, to include the largest segment of health care providers in the United States in their planning—us, the nurses. Nurses have the ideas and solutions for change; it is time to be engaged in groups where we can make a difference. ENA does this on a national level by partnering with other nursing and physician groups, The Joint Commis-
WWW.JENONLINE.ORG
551
EMERGENCY NURSING ADVOCACY/Howard and Papa
sion, Occupational Safety and Health Administration, and the Centers for Medicare and Medicaid Services. ENA provides training/courses for ENA members on government affairs issues and supports the EN411 Key Contact program for members to develop relationships with their legislators. ENA nominates members to relevant federal advocacy groups and provides leadership education for members to increase their competency and confidence. Emergency nurses can be and should be involved at all levels: obtain a copy of the ENA Public Policy Agenda and keep it handy; refer to it and use it for scripting in meetings and in group discussions. Each emergency nurse should be aware of the ENA position statements, as well as the consensus and joint statements with other organizations. It is our responsibility to know what is happening in our practice and use it to speak up and speak out. According to the National Council of State Boards of Nursing, there were nearly 3.854 million licensed registered nurses in 2010, yet the data about this workforce are not well-known across the nation. Effective data collection about the nursing workforce will be critical to the future of nursing. The National Health Care Workforce Commission was established by the federal government in 2010 as part of the Patient Protection and Affordable Care Act. The purpose of the commission is to facilitate coordination among federal, state, and local levels to accurately assess the demand for health care workers and identify workforce trends such as impending shortages. An ongoing initiative is the development and distribution of a national nursing workforce minimum data set. The goal is to establish standardized data about the health care workforce to be collected by each state.
552
JOURNAL OF EMERGENCY NURSING
Gaining a clear understanding of the current and potential future state of the nursing workforce is important to all of us. One of us or our family or friends has or will need care in an emergency department. It is our responsibility as emergency nurses to understand the ramifications of The Future of Nursing report on our practice, our profession, and the nation. As emergency nurses, we have the opportunity to create and shape our preferred future. Let’s get to it! REFERENCES 1. Institute of Medicine. The future of nursing: leading change, advancing health. Available at: http://www.iom.edu/Reports/2010/The-Future-ofNursing-Leading-Change-Advancing-Health.aspx. Accessed September 5, 2011. 2. Emergency Nurses Association, ED Benchmarks Collaborative (EDBC). Available at: http://sites.mckesson.com/edbc/webinars.htm. Accessed September 5, 2011. 3. Emergency Nurses Association. Consensus statement—definitions for consistent emergency department metrics. Available at: http://www.ena. org/media/PressReleases/Documents/07-13-11_DefinitionsED_Metrics. pdf. Accessed July 16, 2012. 4. University HealthSystem Consortium/American Association of Colleges of Nursing. Executive summary of the Post-Baccalaureate Residency Program. Available at: https://www.aacn.niche.edu. Published 2011. Accessed September 5, 2011. 5. Halfer D, Graf E. Graduate nurse perceptions of the work experience. Nurs Econ. 2006;24(3):150-5.
Submissions to this column are encouraged and may be sent to Kathleen A. Ream, MBA, BA [email protected]
VOLUME 38 • ISSUE 6 November 2012
FUTURE-OF-NURSING REPORT: THE IMPACT EMERGENCY NURSING
ON
Authors: Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, and AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN, Lexington, KY, and Philadelphia, PA Section Editor: Kathleen A. Ream, MBA, BA
Earn Up to 10.5 CE Hours. See page 598. t has been almost 2 years since the release of the Institute of Medicine (IOM) consensus report entitled The Future of Nursing: Leading Change, Advancing Health.1 The key messages of the report have the potential to create change across the profession that will benefit patients, families, and the global nursing community. These messages are as follows:
I
• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. • Nurses should be full partners with physicians and other health care professionals in redesigning health care systems in the United States. • Effective workforce planning and policymaking require better data collection and an improved information infrastructure.
Within the key messages, there are some specific recommendations: 1. Removing scope of practice barriers 2. Expanding opportunities for nurses to lead and diffuse collaborative improvement efforts
3. Implementing nurse residency programs 4. Increasing the proportion of nurses with a baccalaureate degree to 80% by 2020 5. Doubling the number of nurses with a doctorate by 2020 6. Ensuring that nurses engage in lifelong learning 7. Preparing and enabling nurses to lead change to advance health 8. Building an infrastructure for the collection and analysis of interprofessional health care
Nursing organizations are responding to the report in varied ways. The Emergency Nurses Association (ENA) adopted a proactive response in its approach to the report. The organization’s response includes endorsement of the report, dissemination of the information to its members through educational sessions, a General Assembly resolution supporting the report recommendations, and the formation of the Future of Nursing Work Team. The Future of Nursing workgroup developed a series of articles in ENA Connection depicting the relevance and value of the report to members. A position statement and white paper have been drafted to highlight the impact of the report on emergency nursing practice. ENA will continue to inform members and promote implementation of the strategies outlined in the report. Emergency nurses are in a position where
• They must be leaders in the design, implementation, Patricia Kunz Howard, Member, Kentucky State Council, is Operations Manager, Emergency and Trauma Services, University of Kentucky Chandler Medical Center, Lexington, KY. AnnMarie Papa, Member, Pennsylvania State Council, is Clinical Director, Emergency Nursing, The Hospital of the University of Pennsylvania, and Penn Presbyterian Medical Center, Philadelphia, PA. For correspondence, write: Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN, 2108 Thorndale Way, Lexington, KY 40515; E-mail: [email protected]. J Emerg Nurs 2012;38:549-52. Available online 1 October 2012. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2012.08.001
November 2012 VOLUME 38 • ISSUE 6
and evaluation of the ongoing change in their patient care environment. • They must take a leadership role in building professional and interprofessional partnerships with their colleagues to ensure that the patient receives optimal care. • They must develop leadership skills and competencies that assist them with the demanding professional and physical environment that exists in the changing emergency department. • They must step forward and work in mutually respectful teams to enhance the quality of the care and services provided.
ENA has long recognized the pivotal role the registered nurse plays in the successful outcomes and coordina-
WWW.JENONLINE.ORG
549
EMERGENCY NURSING ADVOCACY/Howard and Papa
tion of care in the emergency department. There are many tools and opportunities that ENA has developed to help individual emergency nurses grow in their staff and leadership roles. Two great examples of this work, the ED Benchmarks Collaborative2 and the development of a consensus statement that defines standardized ED metrics,3 will help nurses work in collaboration with other health care professionals to research strategies to reduce ED crowding and boarding. The IOM report’s recommendations and key messages have the potential to create even more change in a health care environment that is constantly evolving and integrating new practices and technology into patient care based on best evidence. These movements are rapidly changing the patient care environment and have an intense impact on care provided in the emergency department. Emergency nurses are versatile and flexible. They must balance expertise in technologic tools and information management systems while working to use evolving evidence-based interventions to deliver safe care to a complex and diverse patient population. All of this is done while building interprofessional alliances and collaborating and coordinating care across teams of health professionals that may be located in the community, the emergency department, and/or the health care facility. ED leaders play a pivotal role in driving these collaborative partnerships. Research has shown that a leadership style that involves working with others as full partners in a context of mutual respect and collaboration can result in direct patient care improvements. Specifically, the IOM report describes improved patient outcomes, reduced length of stay, costs savings, a reduction in medical errors, and less staff turnover.1 Knowing this, as leaders, emergency nurses must do their part to create a more collaborative ED environment while planning for the future. Succession planning is essential for the future not just for new leaders but also for ED staff. Integration of novice nurses interested in emergency nursing is one method to ensure our future while fostering a collegial and collaborative environment. Well-delineated orientation programs for new graduates, such as residency programs that include support for the new nurse with limited or no emergency nursing experience, have been successful in the emergency department. Nurse residencies or internships have been used to provide a structured approach creating the essential framework of knowledge for emergency nursing care. Although some residencies have been in place for more than 20 years, most are relatively new, as the cadre of qualified nurses has dwindled. Data regarding emergency nursing residency programs are limited. One potential model for a new graduate resi-
550
JOURNAL OF EMERGENCY NURSING
dency program is the BSN Residency Program developed by the University HealthSystem Consortium with the American Association of Colleges of Nursing.4 An emergency nursing residency could be modeled using some of the tenets of the BSN residency. Formal and informal educational sessions/strategies, coaching/ counseling, defined timeframes/benchmarks, and supervised clinical experience under the tutelage of a qualified preceptor for a period of up to 12 months would be the basis for a well-structured program. Clinical nurse specialist or staff development oversight would be essential to resolve issues and ensure compliance with program objectives. The emergency nursing residency should be competency based with well-defined objectives that must be met to proceed. Educational content may include the use of the online ENA Emergency Nursing Orientation program, the Core Curriculum, a critical care program, and/or a variety of institution-specific classes. Clinical simulation should be used to provide team-building and decision-making activities while verifying competency. ENA courses such as the Trauma Nursing Core Course and Emergency Nursing Pediatric Course may be components of the program and help to develop and foster critical thinking. New graduates in the emergency department are a reality. Turnover rates for graduates are high, ranging from 35% to 60% within 1 year of employment, resulting in an institutional cost of nurse replacement of approximately $40,000,5 as well as substantial psychological impact on both the preceptor and preceptee. New graduate residency programs reduce attrition and make economic sense. Because new graduates in the emergency department are a reality, it is imperative that they are well educated and prepared for their role, are truly integrated members of the care team, and are supported in their personal and professional development, and success will be ensured as an emergency nurse. Having an adequate supply of well-prepared emergency nurses is just one challenge the profession faces. To be effective in increasing the number of nurses with baccalaureate degrees, the pipeline must be expanded. This can be accomplished by embracing private-public partnerships to increase the size and number of baccalaureate programs. Partnerships with high schools and primary schools are an effective strategy to help recruit a large diverse group of future nursing students. Entry into practice sets the stage for lifelong learning. Diploma and associate degree programs must provide a clear path to obtaining the baccalaureate degree, promoting the recommendation of seamless academic progression. This can be accomplished by establishing partnerships between diploma and associate degree programs and institutions that offer baccalaureate degrees. Nursing schools must put their students
VOLUME 38 • ISSUE 6 November 2012
Howard and Papa/EMERGENCY NURSING ADVOCACY
on the path to a seamless academic progression for the goal to be met. Increasing the percentage of nurses with a baccalaureate degree from 50% to 80% will not be easy or inexpensive. Health care organizations should encourage nurses to start a baccalaureate program within 5 years of entering the profession. Some organizations are currently requiring nurses without a baccalaureate to agree to obtain this degree within 5 years of hire as a condition of employment; other organizations require the BSN on initial hire. Health care organizations are uniquely positioned to facilitate nurses to obtain additional education. Organizations can offer scholarships and/or tuition reimbursement or build degree progression into the compensation structure. It is essential for improved outcomes of patients and the progression of the nursing profession that the core group of nurses are baccalaureate prepared. Diploma and associate degree programs will remain a valuable source of the initial preparation for registered nurses. Graduate nursing education is consistent with the recommendation encouraging nurses to practice to the full extent of their knowledge and training. Advanced practice registered nurses (APRNs) are highly trained with advanced education, certification, and clinical training and serve as health care providers in a broad range of acute care and outpatient settings. The delineation of scope of practice and responsibilities for APRNs is not well defined and stated across the nation. Challenges encountered by the APRN vary and may include an inability to obtain medical staff privileges in many hospitals, being subjected to stringent professional liability insurance requirements, and antiquated laws governing APRN education, training, and experience. Despite these many challenges, APRNs continue to provide high-quality care across the nation and impact patient outcomes. As the delivery of health care becomes more complex and the patient care acuity increases, nurses are expected to show greater knowledge and expanded competencies in providing health care to their patients. With the nursing shortage, as well as the decreasing number of nursing faculty to educate the new nurses, this places a challenge on the educational system and to the supply of nurses needed by 2020. An increase in the number of doctorally prepared nurses is essential to ensure availability of faculty for both undergraduate and graduate nursing education as well as development of new knowledge. The IOM recommendation advocates for doubling the number of nurses with a nursing doctorate degree by 2020. This is necessary to correct existing faculty shortages, to fulfill nursing leadership roles needed for policy development and research, and to lead organizational change. Faculty members of nursing programs are being asked to support the need for more
November 2012 VOLUME 38 • ISSUE 6
faculty and lobby for an increase in salaries and more federal funding. Nurses are being encouraged to pursue doctoral education earlier in their careers. What will the nurse doctorate look like in the year 2020? No longer are nursing schools reporting nursing students as fresh out of high school, white, and female. The nurse of the future will be different from the stereotypical nurse of the past. Nursing is being de-gendered; it is being seen as more of a life choice, which has created more diversity and has been positive for the profession. As emergency nurses of the future, it is essential to focus on the changing health care system, consider personal career paths, establish goals, and meet the challenge to accomplish these goals. Lifelong learning is essential in the constantly changing health care arena. Nurses are providing care to more patients who are sicker in more complex systems. Valuebased purchasing creates opportunities for nursing to show great relevance with outcomes correlated with nurse-sensitive indicators. Nurses have an obligation to remain abreast of new technology, treatments, and trends across health care. The public deserves well-educated care providers as patients also become more knowledgeable about their care. ENA has a strong history of providing education for emergency nurses that facilitates lifelong learning. Evidence-based education offerings such as the Trauma Nursing Core Course and Emergency Nursing Pediatric Course are excellent examples of how ENA has invested in the promotion of lifelong learning. The annual conference, online orientation, Key Concepts, and many other educational courses provide support for the commitment of ENA. Emergency nurses have been heard to voice concern about how “others” make decisions that impact emergency nurses’ practice, their patient care, their work hours, staffing in the department, the equipment they use, the systems used to care for their patients, the documentation, the policies, and the legislation. A great many people make decisions that impact emergency nursing practice, and they are not emergency nurses. The landmark IOM report provides the emergency nurse the opportunity to be the decision maker, the problem solver, the policy determiner, the legislative influencer, and the difference maker. It calls to action the policymakers, hospital administrators, thirdparty payers, business, government, academia, and philanthropy, as well as our physician colleagues, to include the largest segment of health care providers in the United States in their planning—us, the nurses. Nurses have the ideas and solutions for change; it is time to be engaged in groups where we can make a difference. ENA does this on a national level by partnering with other nursing and physician groups, The Joint Commis-
WWW.JENONLINE.ORG
551
EMERGENCY NURSING ADVOCACY/Howard and Papa
sion, Occupational Safety and Health Administration, and the Centers for Medicare and Medicaid Services. ENA provides training/courses for ENA members on government affairs issues and supports the EN411 Key Contact program for members to develop relationships with their legislators. ENA nominates members to relevant federal advocacy groups and provides leadership education for members to increase their competency and confidence. Emergency nurses can be and should be involved at all levels: obtain a copy of the ENA Public Policy Agenda and keep it handy; refer to it and use it for scripting in meetings and in group discussions. Each emergency nurse should be aware of the ENA position statements, as well as the consensus and joint statements with other organizations. It is our responsibility to know what is happening in our practice and use it to speak up and speak out. According to the National Council of State Boards of Nursing, there were nearly 3.854 million licensed registered nurses in 2010, yet the data about this workforce are not well-known across the nation. Effective data collection about the nursing workforce will be critical to the future of nursing. The National Health Care Workforce Commission was established by the federal government in 2010 as part of the Patient Protection and Affordable Care Act. The purpose of the commission is to facilitate coordination among federal, state, and local levels to accurately assess the demand for health care workers and identify workforce trends such as impending shortages. An ongoing initiative is the development and distribution of a national nursing workforce minimum data set. The goal is to establish standardized data about the health care workforce to be collected by each state.
552
JOURNAL OF EMERGENCY NURSING
Gaining a clear understanding of the current and potential future state of the nursing workforce is important to all of us. One of us or our family or friends has or will need care in an emergency department. It is our responsibility as emergency nurses to understand the ramifications of The Future of Nursing report on our practice, our profession, and the nation. As emergency nurses, we have the opportunity to create and shape our preferred future. Let’s get to it! REFERENCES 1. Institute of Medicine. The future of nursing: leading change, advancing health. Available at: http://www.iom.edu/Reports/2010/The-Future-ofNursing-Leading-Change-Advancing-Health.aspx. Accessed September 5, 2011. 2. Emergency Nurses Association, ED Benchmarks Collaborative (EDBC). Available at: http://sites.mckesson.com/edbc/webinars.htm. Accessed September 5, 2011. 3. Emergency Nurses Association. Consensus statement—definitions for consistent emergency department metrics. Available at: http://www.ena. org/media/PressReleases/Documents/07-13-11_DefinitionsED_Metrics. pdf. Accessed July 16, 2012. 4. University HealthSystem Consortium/American Association of Colleges of Nursing. Executive summary of the Post-Baccalaureate Residency Program. Available at: https://www.aacn.niche.edu. Published 2011. Accessed September 5, 2011. 5. Halfer D, Graf E. Graduate nurse perceptions of the work experience. Nurs Econ. 2006;24(3):150-5.
Submissions to this column are encouraged and may be sent to Kathleen A. Ream, MBA, BA [email protected]
VOLUME 38 • ISSUE 6 November 2012