Navy Nursing Update

CAPT Sarah MartinDeputy Director,

Navy Nurse Corps

Active Component

30 April 2012

What We Know About Nurses

• Knowledge of frontline nurses and their interactions with patients are critical to improving patient outcomes

• Nurses at every level across the continuum strengthens the health care system in general

• Increasing the time nurses have with the patient to educate is essential to the goal of patient-centered care

• Integrated systems that leverage assets (people, technology) are key to increasing efficiency and allowing nurses to spend time with the patients.

• Multi-disciplinary care teams improve the quality, safety and effectiveness of care

• NURSES MAKE A DIFFERENCE!!!!!

What We Also Know

• More than 3 million registered nurses in the United States

• Nurses have a steadfast commitment to patient care, improved safety and quality, and better outcomes

• Nurses can fill multiple roles• Nurses are lifelong learners• Nurses are leaders in advancing health

NAVY NURSING

Nurse CorpsForce Data

Nurse Corps Force StructureNurse Corps Force StructureFlag

1

CAPT146/146

CDR 338/357

LCDR 589/648

LT & Below 1806/1815

96.9% manned

5%

12%

22%

61%

DOPMA Force Structure(OPA)

5%

12%

21%

63%

Actual Force(Inventory)

Data Source: OPA to Inventory FEB 2012

TOTAL =2966TOTAL = 2875

FY-2012 – Navy Nurse Corps Strategic Plan

CLINICAL & INFORMATION RESEARCH STRATEGIC WORKFORCE PROFESSIONAL MANAGEMENT PARTNERSHIPS EXCELLENCE

Maximize Clinical and Professional Excellence

• Build , strengthen and Build , strengthen and advance clinical, advance clinical, operational and operational and professional skills and professional skills and knowledgeknowledge

Promote Communication Across

the Enterprise

• Sustain, advance and Sustain, advance and evaluate evaluate communication across communication across the enterprisethe enterprise

Vision For Navy NursingProvide exceptional patient & family centered, interdisciplinary, and evidence-based care.

We place quality-caring relationships at the center of our practice resulting in a safe,

compassionate and healing environment.

Cultivate a Culture of Scientific Inquiry

• Increase interest, Increase interest, submission and submission and selection of evidence selection of evidence based practice research based practice research projects to improve the projects to improve the health of our patients health of our patients and add to the body of and add to the body of nursing knowledge nursing knowledge

Foster a Culture of Collaboration

• Develop joint and Develop joint and strategic partnerships strategic partnerships to strengthen the to strengthen the profession of nursing profession of nursing and maximize and maximize utilization of limited utilization of limited resourcesresources

The Navy Nurse Corps Strategic Plan is aligned with Navy Medicine ‘s Strategic Plan relative to Quality of Care, Agile Capabilities, Deployment Readiness, Total Force and

Research & Development.

Optimize Human Capital Resources

• Focus on Focus on maintaining the right maintaining the right workforce to provide workforce to provide nursing care across nursing care across the full range of the full range of military operationsmilitary operations

GOALS FY-12 ACTIVE COMPONENT (AC) OBJECTIVES CHAMPION/TEAM LEADER

CLINICAL AND PROFESSIONAL EXCELLENCE

Goal: Maximize Clinical and Professional Excellence.

Goal Team Purpose: Build, strengthen and advance clinical, operational and professional skills and knowledge.

Develop standardized guidance for career development boards (CDB) building on existing tools for use across the enterprise.

Develop a standardized Director of Nursing (DNS) dashboard to measure and track key elements across the leadership and professional continuum.

Champion(s)CAPT Vince Starks

Email: lavencion.starks@navy.milCAPT Lisa Houser

Email: lisa.houser@med.navy.milTeam Leader(s) CDR Pat Taylor

Email: patricia.taylor2@med.navy.milCDR Janine Allen

Email: janine.allen@med.navy.milINFORMATION MANAGEMENT

Goal: Promote communication across the enterprise.

Goal Team Purpose: Sustain, advance and evaluate communication across the enterprise (up, down, across the chain, internal and external).

Publish and market the Communication Playbook via NKO and other media for enterprise access.

Implement the most effective substitute for List Serve. Targeted communication action group members attend Executive

Development Strategic Communication Program at Monterey Postgraduate School to structure the enduring Strategic Communication plan.

Repeat the original environmental scan and analyze results.

Champion (s)CDR Julie McNally

Email: julie.mcnally@navy.milTeam Leader LCDR Guidry

Email: stephen.guidry@med.navy.mil

RESEARCH

Goal: Cultivate a Culture of Scientific Inquiry.

Goal Team Purpose: Increase interest, submission and selection of Evidence Based Practice (EBP) research projects to improve the health of our patients and/or add to the body of nursing knowledge.

Market and launch the annual Navy Nurse Corps recognition program that promotes and acknowledges excellence in EBP.

Develop a two – three day regional EBP Course. Facilitate the initiation of three multi-site, regional Evidence Based Practice

(EBP) project. Establish research “knowledge broker” at each command.

Champion CAPT Mary Greenwood

Email: mary.greenwood@med.navy.milTeam Leader:

CDR Michele KaneEmail: michele.kane@med.navy.mil

STRATEGIC PARTNERSHIPS

Goal: Foster a culture of collaboration

Goal Team Purpose: Develop joint and strategic partnership across Federal (Military, VA and Active Reserve Component) and civilian healthcare systems. These partnerships will strengthen the profession of nursing and maximize utilization of limited resources.

Establish and electronically publish a joint service Senior Nurse Executive (SNE) directory.

Establish a forum to foster joint collaboration and explore best practices and networking opportunities among uniformed service regional SNE, specialty leaders and consultants.

Champion(s)CAPT Denise Johnson

Email: denise.johnson@med.navy.milTeam Leader(s):CAPT Anna Hurt

Email: anna.hurt@med.navy.mil CDR Cindy Baggott

Email: cindy.baggot@navy.milWORKFORCE

Goal: Optimize human capital resources.

Goal Team Purpose: Focus on maintaining the right workforce to provide nursing care across the full range of military operations.

• Perform a comprehensive review of the 1960 critical care community and provide recommendations to the Office of the Nurse Corps (MOOC3). Define and optimize the role of the Clinical Nurse Specialist (CNS).

Champion(s)CAPT Brenda Davis

Email: brenda.davis@med.navy.milTeam Leader (s):

CDR Amy McBrideEmail: amy.mcbride2@med.navy.mil

CDR Erin RobertsonEmail: erin.robertson@med.navy.mil

MEDICAL HOMEPORT AND NAVY NURSING

2008 Standards

2011 StandardsRound 1

2011 StandardsRound 2

Navy Medicine East 10 7 14

Navy Medicine West 2 8 24

Navy Medicine National Capital Area

3 0 0

Army 17 20 30

Air Force 6 15 10

JTF 1* 0 2

TOTAL 39 50 80

* This site was a Navy site during the application process and has since realigned to JTF

Nearly 40 sites applied for NCQA recognition last year, and 130 are currently applying

Typical Navy Medical Home Port primary care team

Equivalent of 4 full-time providers (not bodies)

3 clerks

10 medical assistants

2 nurses

Provider c-FTE

0.5 RN per provider c-FTE

2.5 CMA per provider c-FTE

0.75 clerk per provider c-FTE

Example: Panel size = 4,400 patients

Behavioral Health is the first specialty to embed its specialists in the MHP team

1 Integrated Behavioral Health Consultant (IBHC) per 7,500 enrollees

Depending on population, could include psychiatrists, clinical psychologists, licensed clinical social workers, licensed professional counselors

Practice model has been re-conceptualized to meet the needs of primary care populations

Shorter (15-20 minute) appointments

Fewer encounters per patient (typically 1-2 visits per patient)

Care is co-managed with the Primary Care Manager (PCM)

Brief, focused interventions in which patient drives problem identification, commits to short-term behavioral change, and sets a goal to accomplish by the next visit

Fully-integrated provider provides consultative services and training to MHP Team

Goal: improve early recognition, treatment, and management of psychosocial conditions

Behavioral Health

Additional specialties, based on patients’ needs, will gradually integrate into MHP

1 per 7,200 enrollees Need-based assessment of case

mix/enrollee complexity Registered Nurses or Licensed

Social Workers Care management/coordination

for high-risk patients, including • Chronic illness or disabled • Complex care needs, • At risk for hospitalization • Hospitalized enrollees• High-risk and high utilizers

Case Management

Based on population Assist with medication

education, reconciliation, other clinic needs

• Anticoagulation

• Anti-lipidemic

• Medication management and patient education

• Prescription renewal

• Over the Counter (OTC)

• Medication reconciliation

Pharmacy

Based on population Dieticians, Nutritionists, or

SMEs in nutrition management

Advise patients on• Health promotion and

Illness prevention • Nutrition; administering

nutrition therapy • Teaching, monitoring,

advising the public,• Improve quality of life

through healthy behaviors

Nutrition

What is Navy/GS Nurse Role in Ambulatory Care Role?

• Advanced Practice Nurses– Experts at primary care with a focus on wellness

and preventive care at every encounter; fastest group of primary care providers in the country

– Medical Home Port Team Leaders and command champions

– Integral to team in delivering timely, easily accessible quality care

Navy Nurses (GS/Active Duty) in Role in Medical Homeport?

– Clinic Managers– Case Manager– Patient Educators– Team Leaders– Disease Management/Wellness Promotion

Ambulatory Nursing Challenges in the Navy

• Continuity for Medical Home with deployment cycles

• Capturing Workload – no defined workload management system that captures ambulatory care

• Budget Constraints• Competency Development – Experts in the Field• Billet Alignment• MISSION OF NAVY MEDICINE?

Unanswered Questions

• Do we need an Ambulatory/Medical Homeport Subspecialty Code?

• How does that fit into Navy’s billet structure?• If assets are shifted, how do we maintain

wartime requirement and clinical sustainment?

QUESTIONS?

BACK-UP

NCQA PCMH Levels and Scoring

Level of RecognitionTotal Score

Must Pass ElementsPassed

Level 3 85 - 100 6 of 6

Level 2 60 - 84 6 of 6

Level 1 35 - 59 6 of 6

Not Recognized 0 - 34 < 6

Although NCQA recognizes practices with a score greater than 34 as a Patient-Centered Medical Home, Navy Medicine requires a score of 60 or greater (Level 2 or 3) for acknowledgement as a Medical Home Port.

6 standards = 100 points, including passing score on all 6 Must Pass Elements

NOTE: Must Pass elements require a ≥ 50% performance level to pass

Each element under the 6 NCQA standards is scored based on how fully the element is met

Standard 1: Enhance Access and Continuity

A. Access During Office Hours**B. After-Hours AccessC. Electronic AccessD. ContinuityE. Medical Home ResponsibilitiesF. Culturally and Linguistically

Appropriate ServicesG. Practice Team

Pts

442222

4

20

Standard 2: Identify and Manage Patient Populations

A. Patient InformationB. Clinical DataC. Comprehensive Health AssessmentD. Use Data for Population

Management**

Pts

3445

16

Standard 3: Plan and Manage Care

A. Implement Evidence-Based GuidelinesB. Identify High-Risk PatientsC. Care Management**D. Medication ManagementE. Use Electronic Prescribing

Pts

43433

17

Standard 4: Provide Self-Care Support and Community Resources

A. Support Self-Care Process**B. Provide Referrals to Community

Resources

Pts

63

9

Standard 5: Track and Coordinate Care

A. Test Tracking and Follow-UpB. Referral Tracking and Follow-Up**C. Coordinate with Facilities/Care Transitions

Pts

666

18

Standard 6: Measure and Improve Performance

A. Measure Performance B. Measure Patient/Family ExperienceC. Implement Continuously Quality

Improvement**D. Demonstrate Continuous Quality

ImprovementE. Report PerformanceF. Report Data ExternallyG. Use of Certified EHR Technology

Pts

444

3

320

20

**Must Pass Elements