national nursing strategy

Through development and adoption of data standards, the EHR can be used for electronic quality reporting. Engaged patients are more effective managers of their own care. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health. Nurses are the most plentiful clinicians and the most proximal to the patient, thus their input toward effective use of incentives to improve care is important to successful implementation (Kaplan, 2013) For more information about EHR incentives, see the Medicare & Medicaid EHR Incentive Program website (CMS, 2013). There is much work to do once an EHR is installed before an organization has attested to and achieved MU. To help stakeholders track opportunities, many professional associations, such as ANA and the Association of periOperative Registered Nurses (AORN) monitor these announcements and post information about them on their websites. Read More In April 2011, the Department of Health called together nurses at a national nursing summit with the aim of reconstructing and revitalizing the nursing … JAMA: The Journal of the American Medical Association, 309(21), 2215-2216. doi: 10.1001/jama.2013.4929, Federal register. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means (Beattie, Shepherd, & Howieson, 2013; Wharam & Sulmasy, 2009). This work includes creating an environment in which use of the EHR becomes essential to support an ongoing, programmatic approach to improve patient care safety and quality and drive the changes to decrease cost. The Nursing Strategy sets out the Trust’s Nursing Philosophy along with its vision, aspirations and direction for the next three years. Input from nurses has helped HHS to promote and support the transition from traditional paper-based quality measure formats to the electronic quality measures (eMeasures) format that can be processed by EHRs to generate quality measure reports (ONC, 2012). 111-5; Blumenthal, 2010). Successes, challenges and needs regarding rural health medical education in continental Central America: a literature review and narrative synthesis. Building an electronic data infrastructure is a fundamental backbone for successful quality measurement and improvement. Email: (2009). To illustrate how an eMeasure differs from a traditional, paper-based quality measure, consider how NDNQI currently captures the number of unit-acquired pressure ulcers (UAPU) per 1,000 patient days, as a measure of unit quality today, versus how it might collect UAPU using an eMeasure in the future. The QDM is an information model that clearly defines concepts used in quality measures. The eMeasure is the electronic format for quality measures using the Quality Data Model (QDM) and the Healthcare Quality Measure Format (HQMF), which is formatted under an international data standard known as Health Level 7 (HL7; Fu, Rosenthal, Pevnick, & Eisenberg, 2012). In addition, hospitals and other healthcare employers often have committees to address quality improvement, automated documentation, and patient engagement. Because continuous quality and process improvement are essential elements of MU of EHRs, eligible professionals, healthcare facilities, and critical access hospitals must attest to meeting MU criteria to earn federal incentives. (n.d.). (2013). While the Federal Register is publicly available, few people review it with enough regularity to track FACA calls. For example, earlier this year the Agency for Healthcare Research and Quality (AHRQ) solicited public comments on the National Quality Strategy originally published as a result of the PPACA. Retrieved from, He earned graduate degrees in Nursing Informatics and Policy Sciences from the University of Maryland School of Nursing and the University of Maryland Baltimore County (UMBC), respectively. Journal of Research in Nursing, 18(4), 288-304. doi: 10.1177/1744987112440568. The Department of HHS spearheaded the development of eMeasures, which are quality measures represented in a standardized electronic format, allowing a consistent, replicable comparison of quality (Knecht, Boberg, Kiley, & Giles, 2012; White, McColm, Kmetik, & Fischer, 2010). There are several gaps in the quality conversation to which nurses could contribute valuable insights. Even nurses who choose not to participate can remain aware of activities at the organizational, state, and national levels. Federal law requires the federal government to announce FACAs in the Federal Register (n.d.). The “meaningful use” regulation for electronic health records. Changes in documentation and care brought on by eMeasures will affect nurses as well as other clinicians. National Health Policies, Strategies and Plans play an essential role in defining a country's vision, policy directions and strategies for ensuring the health of its population. Nurse Leader, 11(2), 50-51. doi:10.1016/j.mnl.2012.10.001, Stone, P. W., Glied, S. A., McNair, P. D., Matthes, N., Cohen, B., Landers, T. F., & Larson, E. L. (2010). As evaluation scientist, nurse informatician, clinical researcher, policy advisor, and university educator, Dr. Roberts gives a unique perspective to health care and nursing. Strategic Plan for Nursing Education, Training and Practice 2012/13 – 2016/17 4 Acknowledgement by the Director-General of Health The Department of Health is deeply grateful to all participants of the country’s first national Nursing Summit in April 2011 whose contributions provided the … ANA is currently developing eMeasures of nursing quality for NDNQI using the QDM and HQMF. He has been a nurse with 25 years of experience in such diverse areas as chronic pulmonary care, hospice, mental health, informatics, health care quality, and the learning healthcare system. Professional issues panels. Clipboard, Search History, and several other advanced features are temporarily unavailable. Current UAPU data collection requires that nurses on a given unit report the midnight census (number of patients admitted to that unit as of midnight). Judy served on the American Medical Informatics Association (AMIA) Board of Directors and the Health Information and Management Systems Society (HIMSS) Board of Directors. Edwards N, Kaseje D, Kahwa E, Klopper HC, Mill J, Webber J, Roelofs S, Harrowing J. Regulate: We promote and uphold high standards, maintain the register of professionals eligible to practise, and step in to investigate on the rare occasions when care goes wrong. HHS (2008). MU of EHRs provides three main benefits: 1) to improve completeness and accuracy of health information; 2) to improve accessibility and sharing of information; and 3) to facilitate patient engagement by encouraging clients to access their own health information electronically and securely over the Internet; share that information with their families; and more actively participate in their own care (ONC, 2012). Prior to this, she was Vice President-Electronic Health Record Applications at Aurora Health Care in Wisconsin, where she led the EHR program and was involved with health informatics for over 25 years. eMeasures allow for the explicit representation of quality measures through use of data standards. AIMS AND OBJECTIVES: To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff. Retrieved from, Ricciardi, L., Mostashari, F., Murphy, J., Daniel, J. G., & Siminerio, E. P. (2013).  |  (2013). In addition to being an informatics domain expert, she holds many leadership roles through her work with the American Medical Informatics Association (AMIA) and Technology Informatics Guiding Educational Reform Board (TIGER). Results: Nursing colleagues from across the Trust gathered with Julie Attfield, Executive Director for Nursing, for a first look at the new strategy. The NPP provides input to HHS on the development of a national strategy as well as priorities for healthcare performance measurement and improvement. This strategy sets out what the NHS will do to achieve its vision to continuously improve patient safety. Meaningful use of health IT is best considered as a platform for continuous quality and process improvement, as opposed to simply implementing technologies as an end unto themselves. Quality improvement solutions from ANA. Health Affairs, 30(4), 690-698. doi: 10.1377/hlthaff.2010.1277, Wharam, J. F., & Sulmasy, D. (2009). For instance, ANA supported the nominations of Norma M. Lang, PhD, RN, FAAN, FRCN, LL to the Health Information Technology Policy Committee Quality Measures Workgroup and Patricia Flatley Brennan, RN, PhD, FAAN, FACMI to the Food and Drug Administration Safety Innovation Act Workgroup. Health Affairs, 32(2), 376-384. doi: 10.1377/hlthaff.2012.1216, Schumann, M. J. ANA develops positions relevant to nursing practice, health policy, and social concerns impacting the health of patients and families; and our position statements guide the profession, amplify the views of nursing, and educate consumers and decision makers. Quality measure data is extracted from EHRs and generates a report that must also follow a standard format so clinicians can compare outcome data across the nation (Fu et al, 2012). Get the latest public health information from CDC: This requires an electronic data infrastructure (Ricciardi et al, 2013). In nursing informatics positions, nurses may move from individual contributions to becoming team leaders on EHR or other health IT implementation projects. Nursing and Midwifery Code (NMC) Nursing & Midwifery Leadership at Sherwood Forest Hospitals CARE Values The four themes are: Prioritise people Preserve safety Practice effectively Promote professionalism EP informatics & technology. Nursing human resources for health is progressing. eMeasure fact sheet. Hospital results.  |  Leadership makes a difference. Guiding nurses and patients toward engagement. Helping people to stay independent, maximise well-being and improving health outcomes. OJIN: The Online Journal of Issues in Nursing Vol. Health IT impacts quality by providing users the unique ability and opportunity to truly capture and derive the benefits from data. Through strong leadership and active participation, nurses will be able to complete the hard work necessary to create changes to drive the quality agenda and transform healthcare. Historically, EHRs often contained rich and critical clinical data but access to the data has been a difficult and manual process. The effect of pay-for-performance in hospitals: Lessons for quality improvement. Citation: Kennedy, R., Murphy, J. Roberts, D., (September 30, 2013) "An Overview of the National Quality Strategy: Where Do Nurses Fit?" She received the 2006 HIMSS Nursing Informatics Leadership Award, was named one of the “20 People Who Make Healthcare Better” in 2007 by HealthLeaders magazine, and was selected as one of 33 Nursing Informatics’ Pioneers to participate in the Nursing Informatics History Project sponsored by AMIA, NLM, AAN, and RWJF. The overview provided above discussed several examples of nurses working to make a difference in the national quality agenda. When data necessary for quality measurement are captured as a byproduct of care delivery, and when those data are easily shared between health IT systems, care can be better coordinated, and is safer, more efficient, and of higher quality. The future of quality measurement for improvement and accountability. eMeasures allow for the explicit representation of quality measures through use of data standards. 23 Sepember 2013. One is the Health IT Policy Committee, charged to make recommendations on development and adoption of a nationwide health information infrastructure, including standards for healthcare data exchange. Nurses teach patients and families and can influence their perceptions of how to engage in their own care. Our strategy is based on three key roles that underpin our purpose: regulate, support, and influence. ET Retrieved from Epub 2015 Sep 25. Evolution of quality standards and measurement tools often occurs through standing committees at professional organizations. The development of shared governance programs that give nurses a voice in scheduling, workflows, and hospital policies can also help. They can then talk to every patient they care for and to their colleagues about the importance and value of having and maintaining an up-to-date health record. Retrieved from:, NDNQI. Maximising our reputation for excellence in nursing and leading the way in nurse education and research. These discussions occur at multiple levels through councils, committees, workgroups, task forces, and expert panels. Nurses could consider involvement in the work of their specialty organizations or state nurses associations on quality initiatives, quality committees, task forces, or on the American Nurses Association Professional Issues Panels (ANA, 2013). Retrieved from, National Quality Forum. The agency or contractor seeking participation will detail recommended backgrounds and time commitments in the request (GSA, 2012). (2011b). 3, Manuscript 5. Committee membership by nurses helps to ensure that the proposed standards represent nursing practice. For example, the term “medications” was not explicitly represented across measures, to indicate whether the measure required medications ordered, dispensed, or administered (NQF, 2013). In the case of health IT, nurses can lead as role models who use their own electronic personal health records. Medicare & Medicaid EHR incentive program registration and attestation system. This change in measurement modality would simplify data collection, reduce nursing workload, and decrease ambiguity in pressure ulcer definitions by setting a standard for specific EHR data to represent a pressure ulcer. Issued by the Department of Health, the strategy aims to address the seven major problem areas identified during recent national consultations. The triple aim: Care, health, and cost. Using an eMeasure, UAPU data capture would occur as a byproduct of care using documentation already entered into individual patient EHRs from the nurses’ assessments at admission and throughout the patients’ stays. The three selected countries in Central and South America championed networks to revive nursing education. Wilson R, Godfrey CM, Sears K, Medves J, Ross-White A, Lambert N. JBI Database System Rev Implement Rep. 2015 Oct;13(10):146-55. doi: 10.11124/jbisrir-2015-2150. A national action plan to support consumer engagement via e-health. To identify and examine the current national nursing strategies and policy impact of workforce development regarding human resources for health in seven selected countries in the Region of the Americas: Argentina, Canada, Costa Rica, Jamaica, Mexico, Peru, and the United States. Nursing as a learning discipline: A call to action. The ICN Leadership For Change™ Programme--20 years of growing influence. Email: Dr. Kennedy, RN, MBA, FAAN, is President and CEO of eCare Informatics, and also Associate Professor and Associate Dean of Strategic Initiatives at Thomas Jefferson University School of Nursing in Philadelphia, PA. Deliver the right care in the appropriate setting, underpinned by referral guidelines, care pathways and evidence-based practice. This statement supports use of standards-based health IT, specifically electronic health records (EHRs), whereby data are accurately and efficiently collected, analyzed, and reported to generate knowledge that leads to improved outcomes through all segments of the healthcare system (Androwich, 2013). Bryant-Lukosius D, Valaitis R, Martin-Misener R, Donald F, Peña LM, Brousseau L. Rev Lat Am Enfermagem. Get the latest research from NIH: A keyword search of PubMed was supplemented by searches of websites maintained by Ministries of Health and nursing organizations. It is not their role. The Nurse Practitioner, 38(4), 7-8. doi: 10.1097/01.NPR.0000427600.71325.28, Knecht, K., Boberg, C., Kiley, S., & Giles, S. (2012). She is currently on the TIGER board and sits on the safety council for the American Association of Medical Instrumentation. One way for this process to occur is with quality through development of effective transition of care documents (ANA, 2010a). Androwich, I.M. If nurses do not engage in discussions about quality in healthcare, their ideas and opinions will not be heard. Nurses are clinicians and caregivers for children, families, and a diverse array of patients. In addition, he is an adjunct professor at Stevenson University School of Graduate and Professional Studies and at the University of Baltimore College of Public Affairs. Implementation depends especially on nurses, as they understand the work of patient care and can assist in integrating health IT with existing or new work processes. Nurses can take on leadership roles to influence healthcare delivery, improving quality, safety, and efficiency, and bring evidence for decision-making to the point of care to empower patients as partners. As more nurses participate in leadership roles such as these to impact quality, more of the nursing perspective will become a part of quality initiatives. (2013). Improving healthcare quality. Furthermore, the ANA document supports capturing data once and reusing it many times by taking advantage of interoperability standards that promote unencumbered transmission of data, information, and knowledge. It can also remind or inform them of best practices. 18, No. Judy Murphy, RN, FACMI, FAAN U.S. Government Services Administration, (2012). Health reform affects nearly every part of the U.S. healthcare system (PL 111-148). A Word from the Experts To defeat COVID-19, ‘we need a unified national strategy,’ says public health expert Dr. Howard Koh Published: Nov. 9, 2020 at 6:42 a.m. Launching HITECH. The National Nursing Conference offers leading policy insights and professional development in supporting outstanding patient outcomes and enhanced care delivery across the nursing workforce. Health Affairs, 29(6), 1214-1219. doi: 10.1377/hlthaff.2010.0503, Centers for Medicare and Medicaid Services. 2017 Jan 30;25:e2826. Dr. Kennedy is widely presented and published in the field of nursing informatics, clinical documentation and terminology standards. Nurses have provided input into the QDM since its inception. The development of National Health Policies, Strategies and Plans is a complex and dynamic process. Nurses can lead from any chair. Of most significance to this article, the PPACA outlines many of the criteria and subsequent incentives paid to eligible professionals (e.g., physicians, nurse practitioners) and hospitals for improving the quality of healthcare delivered in the United States. Support: To ensure we regulate as progressively as possible, we proactively support our professions. Nurses are an essential part of healthcare delivery, but often their voices are lacking in the development and implementation of the learning health system. Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review. Through strong leadership and active participation, nurses will be able to complete the hard work necessary to create changes to drive the quality agenda and transform healthcare. Methods: According to the National League for Nursing (NLN), between 1995 and 1999, the number of programs of most types has increased in the United States. While meaningful use criteria are not nursing specific, nurse leaders sitting on FACAs and measurement development teams are working to think about how to leverage MU to drive a patient-centered, quality and safety agenda that includes nursing input. Programmers writing this eMeasure are using the QDM as a framework and the HQMF as the standardized mechanism for capturing the UAPU data from EHR database fields. Hospital Cpmpare. To make quantifiable progress toward achieving the NQS vision, the use of health information technology (health IT) for performance improvement is essential. The QDM also describes information so EHRs and other health IT systems consistently interpret and locate data required for measurement. The NQS aims of better care, affordable care, and healthy people and communities set forth a unified vision of the healthcare system that was understandable and applicable to all stakeholders at every level—local, state, and national (Berwick, Nolan, & Whittington, 2008). Email: Before summer’s end, an estimated 27 million people will lose their health insurance due to the COVID-19 pandemic, in addition to the 29 million who were uninsured before this pandemic even began. Nurses can also engage in the quality agenda by helping their organizations develop position statements on important healthcare issues, volunteering to provide expert testimony at hearings on quality topics, or writing a letters to federal and state representatives or senators. The strategy has been reaffirmed by the health ministers a number of times since 1992. They are also keenly interested in safeguarding patients across transitions in care from the hospital to their own homes, to home health, or to skilled nursing facilities. Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. Colon-Gonzalez MC, El Rayess F, Guevara S, Anandarajah G. Rural Remote Health. The National Strategic Plan for Nurse Education, Training and Practice 2012/13 - 2016/17. The NHS and wider political environment has undergone a period of unprecedented change … ...nurse leaders sitting on FACAs and measurement development teams are working to think about how to leverage MU to drive a patient-centered, quality and safety agenda that includes nursing input. Nurses have an essential role to engage patients in their own care; patients and their families trust nurses (ANA, 2010b; Schumann, 2013). As we move towards 2030, nursing will: be a personalised, rights-based service embedded within a caring and compassionate professional relationship with individuals and communities focus not only on people's immediate perceived problems, but also take into account their wider physical, psychological, social, family and community life to make a real and lasting difference to their health and wellbeing There are other ways that nurses can participate in quality work within their own organizations, such as getting involved in shared governance or professional practice activities (e.g., standards of practice, quality assurance, or performance improvement committees). Journal of Biomedical Informatics, 45(4), 772-781. doi: 10.1016/j.jbi.2012.06.002, Kaplan, L. (2013). Additionally, CMS publishes Hospital Compare, which reports metrics (e.g. The ANA statement on nursing’s social policy clearly articulates that nurse input is not only essential, but is a responsibility of practice for both nurses and professional nursing organizations (ANA, 2010b). The body of his work has been captured in numerous publications, as well as presentations at research and professional conferences nationally and internationally. As committees form, or as vacancies on existing committees occur, HHS publishes requests for participation in FACAs in the Federal Register. For many years, she was the Chief Nursing Informatics Officer for Siemens Healthcare Solutions. Conclusions: Our 2020 Speakers. New England Journal of Medicine, 363(6), 501-504. doi: 10.1056/NEJMp1006114, Bowles, K., Gélinas, L., & Clancy, T. (2013). Collectively, nurses must respond to the challenges and opportunities outlined in this article, such as increasing awareness of initiatives and/or committee participation, to advance the nursing role in leading change and advancing positive health outcomes through quality care. (2010a). The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization whose purpose is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. Ferguson SL, Al Rifai F, Maay'a M, Nguyen LB, Qureshi K, Tse AM, Casken J, Parsons T, Shannon M, Napa MD, Samson-Langidrik M, Jeadrik G. Int Nurs Rev. The Chief Nursing Officers national framework for nursing, “Leading Change, Adding Value” is intended to be an overarching framework to which local Trusts and their nurses can add operational and professional detail, and as such is strongly reflected in our trust nursing strategy. NQF: Quality positioning system. The QDM is the backbone for representation of eMeasures and is used by stakeholders involved in electronic quality measurement and reporting, such as measure developers, federal agencies, health IT vendors, standards organizations, informatics experts, providers, and researchers. (2009). 1). The use of health IT for quality measurement and improvement aligns closely with a position statement published by the ANA (2009). Improving the quality of health care. In response to the dire need for systemic reform, National Nurses United will be hosting a Summer Strategy Call for thousands of activists across the country. This introductory information about quality and MU is intended to provide context for readers to be conversant on this important and fast-moving topic. readmissions, complications, and deaths) for public reporting and comparison. These activities can make a real difference to the quality of care provided at an organization. Integrate efficient and effective hospital services across healthcare providers. 3, Manuscript 5. Rosemary Kennedy, PhD, RN, MBA, FAAN Even the most respected and knowledgeable experts cannot come to consensus on exactly what quality means. The eMeasure program would combine those data with the midnight census for that unit and report those data to NDNQI. Retrieved from, Fu, P. C., Rosenthal, D., Pevnick, J. M., & Eisenberg, F. (2012). This Strategy delivers a clear roadmap for HMC to build on the strong It is also an essential component for meeting the criteria for MU (Blumenthal & Tavenner, 2010; Buntin, Jain, & Blumenthal, 2010). 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