Fuller says the outcomes of the model change have been outstanding. "Employee satisfaction scores improved and our nurse-sensitive indicators were good before and after," she says. The redesign also improved productivity from 10.2 hours per patient day to 7.8 hours per patient day, indicating an increase in efficiency. Nurses now average 60% of their time in direct patient care, compared to a national average of around 30%.
Education of nurse leaders
"Nursing leaders are increasingly becoming pivotal at the strategic planning level—as well as at the new delivery system design level—to position us for healthcare reform," says Deborah Zastocki, RN, DNP, FACHE, president and CEO at Chilton Memorial Hospital in Pompton Plains, NJ. "With healthcare reform, our focus is shifting toward the continuum of care, population health, and disease management. I think the nursing role is being acknowledged so significantly because of the fact that nursing education is one of holistic education. We focus on all aspects of patients' lives: keeping them well, providing treatment when they're ill, getting them back to normal daily activities. These are highly desirable skill sets in the new healthcare world.
"All in all, we have to become increasingly certified and specialized and be able to demonstrate the use of evidence-based practice as part of our nursing care models," says Zastocki.
Doing so requires new graduate nurses to enter the workforce with a different set of skills than in the past. Colleges of nursing are working to prepare nurses to not only handle clinical responsibilities, but also to understand the whole care continuum, be technologically adept, and be ready to assume leadership skills.
Earlier this year, the National Council of State Boards of Nursing raised the passing standard on the National Council Licensure Examination for Registered Nurses. The higher passing standard went into effect in April, but despite the tougher standards, many feel nurses still are not sufficiently prepared to tackle the realities of practice once they graduate.
One solution that has been touted for decades is to raise the minimal educational preparation for nurses to baccalaureate level. The argument was given greater support earlier this year when Patricia Benner, RN, director of the Carnegie Foundation for the Advancement of Teaching released a national nursing education study arguing that all entry-level registered nurses should be prepared at the baccalaureate level and they should be required to earn a master's degree within 10 years of initial licensure.
"Currently, only 21% of community college graduates go on for a baccalaureate degree. However, the profession cannot do without the community college pipeline. We need to develop much better articulation programs between the community college and the baccalaureate programs so that associate degree candidates don't get discouraged," Benner says.
While the move was applauded by the American Association of Colleges of Nursing and other nursing organizations, it seems unlikely to be adopted any time soon.
"We're one of few professions in healthcare that operates with an associate-level degree," says Susan Hassmiller, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing, who advises on nursing-related work done by RWJF. She is also the director of the RWJF Initiative on the Future of Nursing at the Institute of Medicine, an initiative launched in 2009 with a goal of producing a report in late 2010 detailing how nursing should evolve so it can meet the demands of the ever-changing health system. "Pharmacists, physical therapists, etc., all have BA or higher degrees. The majority of nurses have [associate degrees in nursing] from community colleges.