WEBVTT 00:00:04.979 --> 00:00:13.424 position:50% align:middle I'd like to begin my presentation by thanking NCSBN for gathering us together for this APRN Roundtable. 00:00:14.210 --> 00:00:22.950 position:50% align:middle And I would like to thank our nurses globally, who for the past two years have endured the physical 00:00:22.950 --> 00:00:28.781 position:50% align:middle and emotional turmoil associated with delivering nursing care during a global pandemic, 00:00:29.420 --> 00:00:37.101 position:50% align:middle and especially our nurses in the Ukraine, who have been dealing not only with the ongoing pandemic, 00:00:38.290 --> 00:00:41.556 position:50% align:middle but now the trauma associated with war. 00:00:42.210 --> 00:00:49.536 position:50% align:middle The impact of nurse practitioners in acute care and opportunities, ongoing opportunities, 00:00:49.536 --> 00:00:52.186 position:50% align:middle for nurse practitioners in acute care. 00:00:53.940 --> 00:00:58.548 position:50% align:middle So I'd start with the nurse practitioner workforce at the national level. 00:00:58.800 --> 00:01:05.662 position:50% align:middle And some of these data are from 2020, and some a couple of years before that. 00:01:06.160 --> 00:01:12.328 position:50% align:middle But I think we need to revisit the issue and why we have this need for nurse practitioners, 00:01:12.417 --> 00:01:16.039 position:50% align:middle and it's the anticipated physician shortfall. 00:01:16.423 --> 00:01:19.714 position:50% align:middle And I must mention that these data are pre-COVID. 00:01:19.940 --> 00:01:24.510 position:50% align:middle So the numbers will be a bit more exaggerated in the future. 00:01:24.510 --> 00:01:29.039 position:50% align:middle But right now, looking at this, we see that there's roughly a shortage of 45,000 00:01:29.039 --> 00:01:32.833 position:50% align:middle physicians anticipated by 2032. 00:01:34.453 --> 00:01:39.200 position:50% align:middle And similar findings when we look at physicians who are specialists, they have a specialty practice. 00:01:39.200 --> 00:01:45.621 position:50% align:middle There's a projected shortfall of 10,200 physicians by 2032. 00:01:48.056 --> 00:01:52.995 position:50% align:middle At the same time, we have an aging population, with numerous chronic conditions. 00:01:53.216 --> 00:01:59.973 position:50% align:middle And this graph just shows how we're escalating with chronic conditions, such as stroke, heart disease, 00:01:59.973 --> 00:02:08.450 position:50% align:middle cardiovascular disease, diabetes, hypertension, arthritis, dyslipidemia, asthma. 00:02:08.450 --> 00:02:13.555 position:50% align:middle And they're escalating at a rate higher than the actual population is increasing. 00:02:14.083 --> 00:02:20.620 position:50% align:middle These data, I should mention, and all slides are cited with the provider source below, is 00:02:20.620 --> 00:02:25.517 position:50% align:middle from Tim Dall and colleagues that appeared in "Health Affairs," and it just shows us these trends 00:02:26.198 --> 00:02:28.361 position:50% align:middle that are quite alarming. 00:02:29.928 --> 00:02:35.270 position:50% align:middle But at the same time, we have acute care nurse practitioners, hypertension, 00:02:35.270 --> 00:02:42.390 position:50% align:middle heart failure, respiratory illness, GERD, abdominal pain, arrhythmias, anemia, 00:02:42.390 --> 00:02:48.710 position:50% align:middle coronary artery disease and angina, lower respiratory disease, again, hyperlipidemia, 00:02:48.710 --> 00:02:52.150 position:50% align:middle diabetes, COPD, and asthma. 00:02:52.150 --> 00:02:59.619 position:50% align:middle So nurse practitioners are well positioned to fill the need of the aging population in this country. 00:03:01.930 --> 00:03:07.550 position:50% align:middle These data by David Auerbach and colleagues that appeared in "New England Journal of Medicine Catalyst" 00:03:07.550 --> 00:03:12.510 position:50% align:middle just shows the number of full-time equivalent clinicians, physicians, 00:03:12.510 --> 00:03:15.600 position:50% align:middle nurse practitioners, physician assistants. 00:03:15.600 --> 00:03:21.037 position:50% align:middle And you can see how the projected growth, and you look at those actual raw numbers 00:03:21.037 --> 00:03:26.038 position:50% align:middle and it doesn't look bad until you look at the actual projected growth. 00:03:26.180 --> 00:03:31.940 position:50% align:middle And as was indicated in those first couple of slides, the physician workforce is minimal. 00:03:31.940 --> 00:03:35.283 position:50% align:middle There's only 1% growth in the physician workforce. 00:03:35.480 --> 00:03:41.125 position:50% align:middle Physician assistants are a little bit better, with 4.3% growth, 00:03:41.125 --> 00:03:44.948 position:50% align:middle and nurse practitioners at the highest growth at 6.8%. 00:03:45.147 --> 00:03:50.128 position:50% align:middle Now, pre-COVID, probably about three years ago or so, I was with a group of experts here. 00:03:50.128 --> 00:03:56.180 position:50% align:middle We had a roundtable discussion of nationwide experts here in Atlanta, and we were talking 00:03:56.180 --> 00:03:59.700 position:50% align:middle about the APRN workforce. 00:03:59.700 --> 00:04:05.003 position:50% align:middle And there was a concern that we were flooding the market with nurse practitioners, 00:04:05.003 --> 00:04:12.887 position:50% align:middle and would there be jobs available for these clinicians when they went out to actually establish practice? 00:04:13.540 --> 00:04:20.310 position:50% align:middle And overwhelmingly, people were concerned about that, but I think given the current climate, and how much 00:04:20.310 --> 00:04:26.099 position:50% align:middle healthcare has changed with COVID, and that projected physician shortage, that we're going to find that we 00:04:26.099 --> 00:04:27.729 position:50% align:middle need these nurse practitioners. 00:04:30.760 --> 00:04:36.153 position:50% align:middle These maps are from the Bureau of Labor Statistics and the American Association of Nurse Practitioners, 00:04:36.153 --> 00:04:39.257 position:50% align:middle and I thought they were kind of interesting. 00:04:39.802 --> 00:04:44.540 position:50% align:middle The map on the left shows the employment, the darker green the states, 00:04:44.540 --> 00:04:49.146 position:50% align:middle the larger number of nurse practitioners within those states. 00:04:49.146 --> 00:04:50.450 position:50% align:middle And they kind of make sense. 00:04:50.450 --> 00:04:53.337 position:50% align:middle They're the largest states, California, Texas, Florida. 00:04:53.337 --> 00:04:55.830 position:50% align:middle Those are the three largest states in this country. 00:04:55.830 --> 00:05:00.486 position:50% align:middle So we would expect to have more nurse practitioners in those states. 00:05:00.486 --> 00:05:08.303 position:50% align:middle But if you look at the map at the right, which is, to me, a bit alarming, is those same states are 00:05:08.303 --> 00:05:12.797 position:50% align:middle the states that have restricted practice for nurse practitioners. 00:05:13.150 --> 00:05:17.972 position:50% align:middle The states where we have fewer, many of those have full practice or reduced. 00:05:18.156 --> 00:05:23.890 position:50% align:middle But it's the states where we have the largest number of nurse practitioners do we see that we're preventing 00:05:23.890 --> 00:05:27.808 position:50% align:middle them to really practice to the extent of their license. 00:05:31.110 --> 00:05:37.850 position:50% align:middle When we looked at where acute care nurse practitioners call home or their practice setting, 00:05:37.850 --> 00:05:43.067 position:50% align:middle these data from Kleinpell and colleagues, again, from the "Journal of the American Association of 00:05:43.067 --> 00:05:50.990 position:50% align:middle Nurse Practitioners" show, and I found this a bit disturbing, that only 28% of acute care NPs are 00:05:50.990 --> 00:05:52.491 position:50% align:middle working in hospitals. 00:05:52.960 --> 00:05:54.490 position:50% align:middle Now, acute care, that's our hospital. 00:05:54.490 --> 00:05:56.199 position:50% align:middle Hospital care is acute care. 00:05:56.370 --> 00:06:02.964 position:50% align:middle So why only 28% of our acute care NPs are actually in hospitals is a bit concerning. 00:06:03.480 --> 00:06:09.661 position:50% align:middle And we find that they're in hospital outpatient clinics and in other settings and private practice and such. 00:06:09.926 --> 00:06:13.470 position:50% align:middle But I think we're going to have to revisit this. 00:06:13.470 --> 00:06:16.881 position:50% align:middle We need to be able to attract them into our acute care hospitals. 00:06:19.360 --> 00:06:25.140 position:50% align:middle When we looked at the nurse practitioner workforce more regionally, and this would be data from four states, 00:06:25.140 --> 00:06:34.270 position:50% align:middle California, Florida, New Jersey, and Pennsylvania, this is work that I did with colleagues at the time I 00:06:34.270 --> 00:06:39.290 position:50% align:middle was at the University of Florida transitioning here to Emory, but I did this work with colleagues 00:06:39.290 --> 00:06:40.940 position:50% align:middle at the University of Pennsylvania. 00:06:41.599 --> 00:06:47.683 position:50% align:middle This was actually a study that was funded by NCSBN and thus appears in the "Journal of Nursing Regulation." 00:06:48.108 --> 00:06:53.584 position:50% align:middle And we compared acute care nurse practitioners to primary care nurse practitioners. 00:06:54.680 --> 00:06:56.980 position:50% align:middle And this was an extensive survey. 00:06:56.980 --> 00:06:59.338 position:50% align:middle We love doing surveys. 00:06:59.640 --> 00:07:05.640 position:50% align:middle And these were surveys of just nurse practitioners in these four states. 00:07:06.500 --> 00:07:09.235 position:50% align:middle It was a survey that was distributed by mail. 00:07:09.420 --> 00:07:16.526 position:50% align:middle The nurse practitioners had the option to present it in a written format and return it via the mail 00:07:16.526 --> 00:07:17.722 position:50% align:middle or do it online. 00:07:17.910 --> 00:07:25.960 position:50% align:middle We used the well-validated Dillman method, with multiple surveys, and postcards, and reminders, 00:07:25.960 --> 00:07:27.484 position:50% align:middle and telephone calls. 00:07:27.650 --> 00:07:29.460 position:50% align:middle And the survey was extensive. 00:07:29.460 --> 00:07:31.130 position:50% align:middle It had numerous measures. 00:07:31.130 --> 00:07:35.720 position:50% align:middle The ones presented here are actually demographic and practice characteristics, 00:07:35.720 --> 00:07:41.790 position:50% align:middle the Nurse Practitioner Organizational Climate Questionnaire, and nurse practitioner reports, 00:07:41.790 --> 00:07:46.509 position:50% align:middle what they're saying about the quality of care in their hospitals. 00:07:46.630 --> 00:07:52.110 position:50% align:middle And, of course, we used the typical descriptive and inferential statistics to examine these nurse 00:07:52.110 --> 00:07:54.100 position:50% align:middle practitioners by practice site. 00:07:56.510 --> 00:08:02.538 position:50% align:middle We found that we had survey responses from 1,263 acute care nurse practitioners 00:08:02.538 --> 00:08:07.462 position:50% align:middle and 2,343 primary care nurse practitioners. 00:08:07.680 --> 00:08:12.730 position:50% align:middle We did see a significant difference in age, the acute care nurses had a tendency to be 00:08:12.730 --> 00:08:21.005 position:50% align:middle a bit younger, on average, 47.9 years of age, where primary care nurse practitioners were 00:08:21.005 --> 00:08:22.546 position:50% align:middle 50 years of age. 00:08:23.852 --> 00:08:30.185 position:50% align:middle There was a little bit more of a gender diversity in acute care, and this was significantly different, 00:08:30.185 --> 00:08:38.383 position:50% align:middle where we saw a larger percentage of men as nurse practitioners in acute care at 10.1% 00:08:38.383 --> 00:08:41.937 position:50% align:middle compared to 7.9% in primary care. 00:08:42.842 --> 00:08:52.040 position:50% align:middle There was a marginally significant difference in race, where we saw a slightly larger percent of non-white 00:08:52.040 --> 00:09:01.595 position:50% align:middle nurse practitioners being employed in acute care settings, 17.9%, versus 15.3% in primary care. 00:09:02.040 --> 00:09:06.846 position:50% align:middle And there were no significant differences in ethnicity. 00:09:07.600 --> 00:09:12.840 position:50% align:middle Sadly to say that our Hispanic nurses, if they're out there, 00:09:12.840 --> 00:09:22.990 position:50% align:middle they're underrepresented in almost every survey that we see, whether they be federal surveys, those, you know, 00:09:22.990 --> 00:09:28.315 position:50% align:middle executed through the federal government, or surveys by individual investigators. 00:09:28.315 --> 00:09:34.170 position:50% align:middle So that leads us to believe that we really have to do a better job at attracting Hispanic nurses, 00:09:34.170 --> 00:09:38.810 position:50% align:middle not only into traditional RN roles, but into nurse practitioner roles. 00:09:38.914 --> 00:09:49.193 position:50% align:middle And we see here that only 7.6% of our advanced practice RNs in acute care are Hispanic, 6.1% in primary care. 00:09:49.480 --> 00:09:52.067 position:50% align:middle And there were no significant differences in the years in their position. 00:09:52.067 --> 00:09:56.329 position:50% align:middle They were, on average, seven to seven and a half years in practice. 00:09:57.930 --> 00:10:05.170 position:50% align:middle When we looked at their practice characteristics, we found that the acute care NPs were a little bit 00:10:05.170 --> 00:10:13.194 position:50% align:middle better educated, where 89% of them had a master's degree compared to 87% in primary care, 00:10:15.550 --> 00:10:24.549 position:50% align:middle slightly larger percent had a doctor of nursing practice, acute care 6.5% as opposed to 5.5% 00:10:24.549 --> 00:10:25.914 position:50% align:middle in primary care. 00:10:27.480 --> 00:10:33.320 position:50% align:middle We did see some differences in education specialty, and I didn't find this surprising. 00:10:34.286 --> 00:10:39.460 position:50% align:middle A larger percent, and it's a significantly larger percent, of nurse practitioners in acute care trained 00:10:39.460 --> 00:10:40.906 position:50% align:middle as adult NPs. 00:10:43.100 --> 00:10:48.227 position:50% align:middle When we looked at the family NP role, there was a larger percent of family NPs 00:10:48.227 --> 00:10:50.640 position:50% align:middle in primary care, 55.2%. 00:10:50.640 --> 00:10:53.590 position:50% align:middle And that is what we would expect to see. 00:10:54.322 --> 00:10:58.910 position:50% align:middle Again, in these other specialties, neonatal nurse practitioners, 00:10:58.910 --> 00:11:04.725 position:50% align:middle it's not surprising to see a significantly larger percent in acute care hospitals at 7.1% 00:11:04.725 --> 00:11:08.200 position:50% align:middle compared to less than 1% in primary care. 00:11:09.290 --> 00:11:19.127 position:50% align:middle Pediatric nurse practitioners was quite similar between acute care and primary care at roughly 9.5% across. 00:11:20.250 --> 00:11:30.812 position:50% align:middle Mental health NPs, similar percentage in acute care and primary care at roughly 2.5%. 00:11:31.300 --> 00:11:34.370 position:50% align:middle Women's health, now, this is not surprising either that we'd see a larger 00:11:34.370 --> 00:11:41.959 position:50% align:middle percentage in primary care, that's 7.3%, as compared to 1.7% in acute care. 00:11:42.240 --> 00:11:44.839 position:50% align:middle And then there were other specialties. 00:11:45.010 --> 00:11:50.910 position:50% align:middle When we asked nurse practitioners if they were certified in their specialty, again, 00:11:50.910 --> 00:12:00.440 position:50% align:middle this was not a surprising finding, a larger percentage, actually 77.6%, of acute care nurse practitioners 00:12:01.387 --> 00:12:08.462 position:50% align:middle reported that they were certified in a specialty as opposed to 68.8% of primary care nurse practitioners. 00:12:10.790 --> 00:12:20.889 position:50% align:middle When we looked at additional practice characteristics, and the first here, time constraints to finish care. 00:12:20.889 --> 00:12:28.036 position:50% align:middle And it wasn't significantly different, which is fine, but the large percentage was a bit alarming. 00:12:28.340 --> 00:12:34.752 position:50% align:middle So roughly 88% to 89% of nurse practitioners across settings, acute care, primary care, 00:12:34.752 --> 00:12:37.243 position:50% align:middle are saying they didn't have time to finish care. 00:12:39.450 --> 00:12:42.872 position:50% align:middle When we asked if they could bill under their own provider number, 00:12:42.872 --> 00:12:44.710 position:50% align:middle there were also significant differences. 00:12:44.710 --> 00:12:49.961 position:50% align:middle Again, this isn't surprising just based on the way these settings are... 00:12:52.950 --> 00:12:59.631 position:50% align:middle the way they allocate the resources, where nurses in primary care, there was a larger percent, 58.6%, 00:12:59.631 --> 00:13:06.343 position:50% align:middle who said they were able to bill for their services, as opposed to the 43% reported in acute care. 00:13:07.202 --> 00:13:16.310 position:50% align:middle Again, another...it's not surprising finding significant, but a bit concerning is the small 00:13:16.310 --> 00:13:20.520 position:50% align:middle percentage of nurse practitioners that are practicing in rural areas. 00:13:20.520 --> 00:13:28.894 position:50% align:middle We see a slightly larger percent at 17.5% in primary care, 12.4% in acute care. 00:13:28.894 --> 00:13:36.330 position:50% align:middle But, again, this is a national trend even though these are data from four states where we see our rural 00:13:36.330 --> 00:13:37.736 position:50% align:middle areas are underserved. 00:13:40.224 --> 00:13:46.663 position:50% align:middle When we looked at additional employment practice characteristics, we found significant differences, 00:13:46.663 --> 00:13:54.022 position:50% align:middle where a larger percentage of acute care nurse practitioners, that would be 86.2%, are 00:13:54.022 --> 00:14:00.076 position:50% align:middle employed full-time when compared to 70.6% in primary care. 00:14:00.220 --> 00:14:05.810 position:50% align:middle That's, again, not surprising because most acute care hospitals want their nurse practitioners 00:14:05.810 --> 00:14:07.463 position:50% align:middle to be full-time employees. 00:14:09.780 --> 00:14:15.753 position:50% align:middle When we looked at...another not significant but concerning factor is, 00:14:15.848 --> 00:14:18.871 position:50% align:middle are these nurse practitioners working more than one job? 00:14:19.710 --> 00:14:25.390 position:50% align:middle And roughly 24%, 25% of them across the board are saying, yes, they're working a second job. 00:14:26.130 --> 00:14:30.862 position:50% align:middle When we looked at the workload of a nurse practitioner, this is not surprising either, 00:14:31.051 --> 00:14:39.930 position:50% align:middle there were significant differences, where nurses in primary care see a larger number of patients per shift 00:14:39.930 --> 00:14:48.872 position:50% align:middle or per day, being 15, compared to a nurse practitioner in acute care, which is 10.8. 00:14:49.342 --> 00:14:55.010 position:50% align:middle And even more disturbing, I feel, of all the findings, and this was not statistically significant, 00:14:55.010 --> 00:15:02.620 position:50% align:middle but alarming, is the percentage of time that nurse practitioners spend doing work that should be allocated 00:15:02.620 --> 00:15:10.035 position:50% align:middle to registered nurses and support staff, where 84% of acute care nurse practitioners, 00:15:10.035 --> 00:15:18.201 position:50% align:middle 84% of primary care nurse practitioners are doing the work of other providers or clinicians. 00:15:20.360 --> 00:15:30.590 position:50% align:middle When we asked NPs to report on the quality of care in their practice, or on their units, overwhelmingly, 00:15:30.590 --> 00:15:34.970 position:50% align:middle and there were some significant differences, but overwhelmingly, a very large percent of the care 00:15:34.970 --> 00:15:37.071 position:50% align:middle was excellent or good. 00:15:37.270 --> 00:15:46.135 position:50% align:middle And though the primary care nurse practitioners rated a little higher at 95.6% compared to 92.4% reported 00:15:46.135 --> 00:15:51.526 position:50% align:middle by acute care nurse practitioners, but still, that's an outstanding finding. 00:15:51.800 --> 00:15:54.650 position:50% align:middle Another outstanding finding, though not significantly different, 00:15:54.650 --> 00:16:01.336 position:50% align:middle was would the nurse practitioner recommend their facility or their practice to family or friends? 00:16:01.336 --> 00:16:05.930 position:50% align:middle And, again, you know, slightly over 90% of nurse practitioners, 00:16:05.930 --> 00:16:10.640 position:50% align:middle acute care and primary care, would both recommend their facility or practice 00:16:10.640 --> 00:16:11.869 position:50% align:middle to family or friends. 00:16:12.287 --> 00:16:17.610 position:50% align:middle When we asked if they were confident that patients could manage their care at home, again, 00:16:17.610 --> 00:16:22.164 position:50% align:middle an overwhelmingly large response that was positive, yes, but significantly different. 00:16:23.970 --> 00:16:30.172 position:50% align:middle Roughly 95% to 96% of nurse practitioners stated that they felt that their patients could manage their 00:16:30.172 --> 00:16:30.860 position:50% align:middle care at home. 00:16:30.930 --> 00:16:38.535 position:50% align:middle It's a little bit lower in the acute care nurse practitioner response, but those are sicker patients. 00:16:38.535 --> 00:16:43.380 position:50% align:middle If you're being released from a hospital, as opposed to leaving a clinic visit, 00:16:43.380 --> 00:16:48.414 position:50% align:middle you could see where there might be a little bit more concern on a discharge from a hospital, 00:16:48.414 --> 00:16:50.064 position:50% align:middle that there might be issues with care. 00:16:52.942 --> 00:17:00.816 position:50% align:middle When we gathered reports on nurse practitioner ratings of the organizational climate, 00:17:02.410 --> 00:17:12.198 position:50% align:middle we saw that...when we asked them about professional visibility, there were significant differences here, 00:17:12.198 --> 00:17:18.250 position:50% align:middle where actually the primary care nurse practitioner thought that they had better visibility, 00:17:18.250 --> 00:17:24.395 position:50% align:middle professional visibility, 3.1%, acute care nurses reported lower visibility at 2.9%. 00:17:24.829 --> 00:17:29.644 position:50% align:middle When we asked them about the relationships between nurse practitioners and administration, 00:17:30.762 --> 00:17:40.147 position:50% align:middle the acute care nurse practitioners rated this a little lower at 2.7%, primary care rated it higher at 3.0%. 00:17:40.147 --> 00:17:41.975 position:50% align:middle Again, a significant difference. 00:17:42.530 --> 00:17:49.380 position:50% align:middle When we asked them about the relationships between nurse practitioners and physicians, 00:17:49.380 --> 00:17:50.756 position:50% align:middle there was no difference here. 00:17:51.270 --> 00:17:53.897 position:50% align:middle Both of them rated as 3.4%. 00:17:54.363 --> 00:18:00.595 position:50% align:middle And when we asked them about independent practice and support, there were significant differences, 00:18:00.595 --> 00:18:07.181 position:50% align:middle where these acute care nurse practitioners gave a higher score of 3.6% compared to the 3.4% score 00:18:07.181 --> 00:18:10.814 position:50% align:middle reported by primary care nurse practitioners. 00:18:12.130 --> 00:18:19.520 position:50% align:middle Going on further to look at the nurse practitioner workforce in acute care. 00:18:20.089 --> 00:18:26.031 position:50% align:middle Again, data from four states, California, Florida, New Jersey, and Pennsylvania, from 2016. 00:18:26.290 --> 00:18:36.509 position:50% align:middle Again, survey and data and a publication with colleagues, led by Linda Aiken and her staff, 00:18:37.106 --> 00:18:43.220 position:50% align:middle a publication that appears in the journal, "Medical Care." 00:18:44.740 --> 00:18:49.040 position:50% align:middle And this was very similar to the nurse practitioner survey sent out at the same time, 00:18:49.040 --> 00:18:51.480 position:50% align:middle but this survey was sent to registered nurses. 00:18:52.060 --> 00:18:59.190 position:50% align:middle We also had CMS data from the HCAHPS survey, so that's the Hospital Consumer Assessment 00:18:59.190 --> 00:19:01.158 position:50% align:middle of Healthcare Providers and Systems. 00:19:01.158 --> 00:19:05.926 position:50% align:middle We also had the CMS, that's Medicare Spending per Beneficiary reports. 00:19:05.926 --> 00:19:11.390 position:50% align:middle And we also had data on hospital characteristics from the American Hospital Association Annual Survey. 00:19:11.390 --> 00:19:18.360 position:50% align:middle And, again, we used a variety of descriptive and inferential statistics to compute the findings 00:19:18.360 --> 00:19:19.674 position:50% align:middle that are presented. 00:19:21.892 --> 00:19:27.860 position:50% align:middle And what we found is we categorized these data by nurse practitioners per 100 beds 00:19:27.860 --> 00:19:36.739 position:50% align:middle and whether a hospital had less than 1, 1 to 2.2 NPs, or greater than 3 NPs per 100 beds. 00:19:37.000 --> 00:19:42.200 position:50% align:middle And we found...now, these are nurse reports, these are reports from registered nurses who are 00:19:42.200 --> 00:19:43.724 position:50% align:middle working with nurse practitioners. 00:19:43.836 --> 00:19:48.523 position:50% align:middle And we had surveys from 22,273 registered nurses. 00:19:49.220 --> 00:19:58.785 position:50% align:middle And we found that a registered nurse would rate the hospital highly as the number or percentage of 00:19:58.785 --> 00:20:08.250 position:50% align:middle nurse practitioners on their units increased, where we saw only 27% rating the hospital highly if 00:20:08.250 --> 00:20:10.441 position:50% align:middle there was less than an NP on their unit. 00:20:10.700 --> 00:20:14.497 position:50% align:middle And that increased to 37.2% if there were 3 or more. 00:20:15.090 --> 00:20:21.000 position:50% align:middle When we asked the registered nurse, "Would you definitely recommend your hospital to family 00:20:21.000 --> 00:20:28.790 position:50% align:middle or friends?" 38.2% said they would if there was less than or no NPs on their unit, 00:20:28.790 --> 00:20:37.170 position:50% align:middle where that almost went to half, where 51.3% reported they would recommend the hospital to family or friends. 00:20:37.170 --> 00:20:45.970 position:50% align:middle When we asked on report of excellent for quality of care, only 33.6% of registered nurses rated the quality 00:20:45.970 --> 00:20:50.930 position:50% align:middle of care of excellent until they increased the number of NPs on their unit to 3-plus, 00:20:50.930 --> 00:20:54.591 position:50% align:middle where that increased to almost 46%. 00:20:55.094 --> 00:21:03.760 position:50% align:middle When they were asked to grade their hospital as A or B on patient safety, 66.5% of registered nurses thought 00:21:03.760 --> 00:21:05.665 position:50% align:middle their hospital deserved that grade. 00:21:05.900 --> 00:21:12.413 position:50% align:middle But when you increased the number of nurse practitioners to plus 3, that increased to 47.3%. 00:21:12.756 --> 00:21:19.539 position:50% align:middle Similar, when we asked the registered nurse about an A or B grade on the prevention of infections, 00:21:21.933 --> 00:21:30.420 position:50% align:middle originally, 68.4% reported that their hospital did well in preventing infections, with a grade of A or B. 00:21:30.420 --> 00:21:36.835 position:50% align:middle But that increased when you added 3 or more nurse practitioners to 75.3%. 00:21:38.255 --> 00:21:44.547 position:50% align:middle Similarly, when we asked registered nurses on their confidence that management will resolve patient 00:21:44.547 --> 00:21:49.110 position:50% align:middle care problems, 43.2% reported they were confident. 00:21:49.110 --> 00:21:54.165 position:50% align:middle But when you increase the number of NPs to 3-plus, that was almost 50%. 00:21:55.333 --> 00:21:59.325 position:50% align:middle When we asked the registered nurse, "Are you confident patients can manage their care 00:21:59.325 --> 00:22:03.787 position:50% align:middle after discharge?" 52.2% said yes. 00:22:03.787 --> 00:22:10.097 position:50% align:middle Again, when you added 3 or more nurse practitioners to that unit, that increased to roughly for 55%. 00:22:10.446 --> 00:22:15.671 position:50% align:middle Burnout, and there's so much talk about burnout these days in the literature. 00:22:15.671 --> 00:22:18.440 position:50% align:middle And these rates were low, these data were pre-COVID. 00:22:18.660 --> 00:22:26.401 position:50% align:middle But when we asked nurses, when we assessed burnout using the Maslach Burnout Inventory, if they reported 00:22:26.401 --> 00:22:29.786 position:50% align:middle high levels of burnouts, not just burnout, high levels of burnout, 00:22:29.786 --> 00:22:33.800 position:50% align:middle 31.3% of nurses reported high levels of burnout. 00:22:33.800 --> 00:22:38.800 position:50% align:middle But when we increased the number of nurse practitioners on that unit to 3-plus, 00:22:38.800 --> 00:22:42.551 position:50% align:middle that level of burnout dropped to 29.1%. 00:22:42.714 --> 00:22:50.222 position:50% align:middle When we asked them about job satisfaction, roughly 78.7% of registered nurses were satisfied 00:22:50.222 --> 00:22:51.120 position:50% align:middle with their job. 00:22:51.120 --> 00:22:56.271 position:50% align:middle That increased to 80.4% when you had 3 or more nurse practitioners on the unit. 00:22:56.540 --> 00:23:05.830 position:50% align:middle And when it came to intent to stay in their current job, 87% of nurses in 2016 stated that they would stay 00:23:05.830 --> 00:23:07.030 position:50% align:middle in their current job. 00:23:07.030 --> 00:23:13.841 position:50% align:middle And when you added 3 or more nurse practitioners to that unit, that increased to 88.1%. 00:23:15.552 --> 00:23:20.015 position:50% align:middle When we looked at what the patients had to say, these are patient-reported outcomes, 00:23:20.015 --> 00:23:25.865 position:50% align:middle and if they would rate the hospital highly, and 66.4% said they did. 00:23:26.000 --> 00:23:32.053 position:50% align:middle But when there were 3 or more nurse practitioners on that unit, that increased to almost 71%. 00:23:32.862 --> 00:23:36.640 position:50% align:middle When patients were asked, would they recommend, definitely recommend, 00:23:36.640 --> 00:23:41.500 position:50% align:middle their hospital to family or friends, 67.7% said they would, 00:23:41.575 --> 00:23:46.909 position:50% align:middle but when you added 3 or more nurse practitioners, that increased to roughly 73%. 00:23:47.965 --> 00:23:55.075 position:50% align:middle When we asked them if nurses always communicated well, 74.5% agreed, yes. 00:23:55.390 --> 00:24:00.414 position:50% align:middle But when you added 3 or more nurse practitioners, that increased to 78.2%. 00:24:01.066 --> 00:24:10.660 position:50% align:middle And when we asked patients, "Was help always received as you wanted it?" almost 60% agreed, yes. 00:24:10.660 --> 00:24:16.200 position:50% align:middle But when you added 3 or more nurse practitioners to that unit, that increased to 64.1%. 00:24:17.850 --> 00:24:24.965 position:50% align:middle Again, asking patients about the care they received, when they were asked, was their pain always 00:24:24.965 --> 00:24:30.297 position:50% align:middle well controlled, 67.9% said yes. 00:24:30.480 --> 00:24:35.611 position:50% align:middle When you added 3 or more nurse practitioners to that unit, that increased to almost 70%. 00:24:35.958 --> 00:24:43.190 position:50% align:middle Staff always explained medications, 68.8% of patients agreed with that, 00:24:43.190 --> 00:24:48.499 position:50% align:middle and increased slightly when there were three or more nurse practitioners to 62.3%. 00:24:49.139 --> 00:24:54.745 position:50% align:middle And when patients were asked if staff provided information on recovery at home, 00:24:54.745 --> 00:24:58.345 position:50% align:middle 47.7% of patients agreed with that. 00:24:58.640 --> 00:25:03.382 position:50% align:middle That increased to 51.4% if there were 3 or more nurse practitioners on a unit. 00:25:03.671 --> 00:25:13.380 position:50% align:middle And when we looked at hospital efficiency, defined as Medicare spending per patient, 00:25:13.380 --> 00:25:20.929 position:50% align:middle we found that Medicare spending on average was 1.019%. 00:25:20.929 --> 00:25:23.795 position:50% align:middle And in this case, you really want it less than 1%. 00:25:23.909 --> 00:25:27.117 position:50% align:middle When you go slightly above 1%, you're excessive spending. 00:25:27.190 --> 00:25:33.958 position:50% align:middle And we found if you added 3 or more nurse practitioners, that spending went down to 0.993%. 00:25:34.780 --> 00:25:40.966 position:50% align:middle So you had efficiency noted in resource spent. 00:25:42.238 --> 00:25:49.440 position:50% align:middle When we looked at our multi-barrier regression model that was adjusted for all patient hospital and 00:25:49.440 --> 00:25:56.521 position:50% align:middle nurse characteristics, we found that increasing the nurse practitioners on a unit 00:25:57.297 --> 00:26:09.000 position:50% align:middle was associated with a 35% increase in the odds that nurses would highly report their hospitals, 00:26:09.000 --> 00:26:10.330 position:50% align:middle that the hospitals were great. 00:26:10.330 --> 00:26:11.630 position:50% align:middle They were doing a good job. 00:26:12.605 --> 00:26:17.580 position:50% align:middle Again, when we increased the number of nurse practitioners on the unit, 00:26:18.200 --> 00:26:25.820 position:50% align:middle we found that there was a 44% increase in the odds that a nurse would recommend the hospital 00:26:25.820 --> 00:26:27.135 position:50% align:middle to family or friends. 00:26:28.170 --> 00:26:37.090 position:50% align:middle Similarly, as you increased the number of nurse practitioners, there was a 33% increase in the odds 00:26:37.090 --> 00:26:40.714 position:50% align:middle that a registered nurse would report the quality of care as excellent. 00:26:42.570 --> 00:26:50.659 position:50% align:middle Again, and all of these are by increases in the nurse practitioner workforce, was associated with a 20% 00:26:50.659 --> 00:27:00.301 position:50% align:middle increase that an RN would give the hospital a grade of A or B, a 23% increase in the likelihood that a nurse 00:27:00.301 --> 00:27:06.507 position:50% align:middle would give the hospital a grade of A or B not only on patient safety, but on the prevention of infections. 00:27:08.170 --> 00:27:18.060 position:50% align:middle Additional nurse practitioners added to the unit was associated with a 20% increase in the odds that an RN, 00:27:18.060 --> 00:27:24.247 position:50% align:middle a registered nurse, felt confident that patient management would resolve patient care problems, 00:27:24.673 --> 00:27:30.164 position:50% align:middle a 17% increase in the odds that patients could manage their care upon discharge, 00:27:31.780 --> 00:27:40.840 position:50% align:middle an 8% decrease in the odds of burnout, a 7% increase in the odds of job satisfaction, 00:27:40.840 --> 00:27:46.250 position:50% align:middle and a 14% increase in their intent to stay, as in the registered student nurses intend to stay 00:27:46.250 --> 00:27:47.183 position:50% align:middle in their unit. 00:27:48.840 --> 00:27:52.213 position:50% align:middle When we looked at the patient outcomes, and again, in fully adjusted models, 00:27:52.213 --> 00:28:01.270 position:50% align:middle we found that increasing nurse practitioners on the unit was associated with a 11% decrease in 00:28:01.270 --> 00:28:06.350 position:50% align:middle 30-day mortality, and a 1% decrease, these were odds ratio, 00:28:06.350 --> 00:28:13.830 position:50% align:middle so a decrease in the odds or the likelihood of mortality or readmission, 00:28:14.098 --> 00:28:20.200 position:50% align:middle both of which were statistically significant, and a 4% decrease in length of stay, 00:28:20.662 --> 00:28:24.435 position:50% align:middle another finding that was also statistically significant. 00:28:24.435 --> 00:28:30.243 position:50% align:middle So increase in nurse practitioners overall at the end of the day resulted in a sizeable decrease 00:28:30.243 --> 00:28:33.460 position:50% align:middle in 30-day mortality, which is an important finding. 00:28:35.100 --> 00:28:40.420 position:50% align:middle When we look at nurse practitioners in Georgia, and I have to bring this in because, of course, 00:28:40.420 --> 00:28:44.468 position:50% align:middle right now, I'm here in Georgia and recording for Georgia. 00:28:47.323 --> 00:28:52.638 position:50% align:middle The situation here isn't the best that I'd like to report for our nurse workforce. 00:28:52.638 --> 00:28:56.875 position:50% align:middle But I think it's important to just show what happens in some local areas in the country. 00:28:57.030 --> 00:29:04.455 position:50% align:middle So some of these data are from a report that we had compiled through Emory University, 00:29:05.420 --> 00:29:09.671 position:50% align:middle Yin Li is my colleague and others. 00:29:09.878 --> 00:29:12.847 position:50% align:middle And these were some of the findings of what we found here in Georgia. 00:29:13.177 --> 00:29:18.120 position:50% align:middle We found, like in other parts of the country, there was a dramatic increase in the number 00:29:18.120 --> 00:29:19.451 position:50% align:middle of nurse practitioners. 00:29:19.451 --> 00:29:24.010 position:50% align:middle Now, these numbers are smaller and such, so you see...because the sample sizes 00:29:24.010 --> 00:29:28.963 position:50% align:middle are so exaggerated and they're kind of small, that you see a little bit of jumping around in the graph, 00:29:28.963 --> 00:29:30.306 position:50% align:middle but there's growth. 00:29:30.306 --> 00:29:35.340 position:50% align:middle No matter how you look at it, there was growth in CNRAs, and nurse practitioners, 00:29:35.340 --> 00:29:37.260 position:50% align:middle and certified nurse midwives. 00:29:37.260 --> 00:29:41.400 position:50% align:middle These are data from the American Community Survey, and these are similar to findings 00:29:41.400 --> 00:29:42.792 position:50% align:middle we've seen nationwide. 00:29:45.373 --> 00:29:53.047 position:50% align:middle What we do see, again, from the American Community Survey on our nurse practitioners, 00:29:53.380 --> 00:29:55.968 position:50% align:middle this is a weighted sample of 8,049. 00:29:55.968 --> 00:29:58.530 position:50% align:middle And I'll mention a little bit about data later. 00:29:58.530 --> 00:30:03.219 position:50% align:middle The actual sample surveyed here in Georgia through the American Community Survey was only 00:30:03.219 --> 00:30:09.020 position:50% align:middle 59 nurse practitioners, but based on statistical weighting, 00:30:09.020 --> 00:30:12.624 position:50% align:middle the sample was brought up to 8,041. 00:30:12.624 --> 00:30:18.612 position:50% align:middle And we found that on average, they were 41 years of age, overwhelmingly female, 00:30:18.612 --> 00:30:23.031 position:50% align:middle 92%, very similar to the national average. 00:30:24.640 --> 00:30:27.053 position:50% align:middle We're a little more diverse here in Georgia. 00:30:27.641 --> 00:30:34.481 position:50% align:middle The population of nurse practitioners that are white is roughly 67%. 00:30:34.939 --> 00:30:42.830 position:50% align:middle The nurse practitioners that report they are black at 28%, and then a lower percentage of Asians and others. 00:30:42.830 --> 00:30:50.361 position:50% align:middle Again, Hispanic nurse practitioners are just poorly represented at 2.4%. 00:30:52.244 --> 00:30:57.541 position:50% align:middle When we looked at practice characteristics, we looked at their level of education. 00:30:59.727 --> 00:31:05.678 position:50% align:middle Roughly 73% in Georgia prepared at the master's level, 8% at the doctorate. 00:31:06.267 --> 00:31:12.915 position:50% align:middle Again, 23% are employed in acute care, roughly that's what we're seeing nationwide. 00:31:13.630 --> 00:31:18.006 position:50% align:middle If you recall, some of the previous slides were saying 25%, 28%. 00:31:18.755 --> 00:31:23.110 position:50% align:middle Slightly more than half were in primary care, totally expected because that was the original 00:31:23.110 --> 00:31:27.185 position:50% align:middle intention of nurse practitioners, with 56%. 00:31:27.713 --> 00:31:33.710 position:50% align:middle And the earnings are quite low, but that's historic here in Georgia. 00:31:33.710 --> 00:31:40.846 position:50% align:middle Also, the medium earnings for a nurse practitioner, almost $98,000 a year. 00:31:40.846 --> 00:31:43.582 position:50% align:middle And their commute time is on average 27 minutes. 00:31:44.750 --> 00:31:52.130 position:50% align:middle Then we went on to survey nurse practitioners in the state of Georgia in more detail because, to be honest, 00:31:52.130 --> 00:31:58.655 position:50% align:middle the state of Georgia has some of the worst workforce data in the nation. 00:31:59.230 --> 00:32:04.143 position:50% align:middle And we felt that we just had...even though our sample was small at 372 nurse practitioners, 00:32:04.143 --> 00:32:08.181 position:50% align:middle we just felt the need to hear more of what they had to say. 00:32:08.450 --> 00:32:15.612 position:50% align:middle And we found out that, not surprisingly, 75.3% of them were employed full-time. 00:32:15.830 --> 00:32:25.060 position:50% align:middle Again, acute care, that's about the average, 27%, 28% of them reported they are employed in acute care, 00:32:25.135 --> 00:32:32.658 position:50% align:middle little bit more than half, 51.1%, in primary care, 63% said they had their own panel of patients that they 00:32:32.658 --> 00:32:33.890 position:50% align:middle were caring for. 00:32:33.890 --> 00:32:40.124 position:50% align:middle And roughly 74% reported that they were billing under their own provider number. 00:32:43.350 --> 00:32:48.820 position:50% align:middle When we looked at the relationships that these Georgia NPs had with their physicians, 00:32:48.820 --> 00:32:53.482 position:50% align:middle we found that only 6.2% were practicing independently. 00:32:54.870 --> 00:33:00.680 position:50% align:middle That leaves the overwhelming majority, roughly 94%, are either collaborating with a physician 00:33:00.680 --> 00:33:03.324 position:50% align:middle or supervised by a physician. 00:33:03.440 --> 00:33:13.040 position:50% align:middle In a state where we can't afford to lose nurses of any type, we found that roughly 30% of nurse practitioners 00:33:13.040 --> 00:33:20.080 position:50% align:middle in Georgia were saying that the relationships that they had with other professionals was not cohesive, 00:33:20.080 --> 00:33:22.921 position:50% align:middle or only somewhat cohesive in a team effort. 00:33:24.309 --> 00:33:28.652 position:50% align:middle And similarly, when we asked about their relationships with administration, 00:33:28.968 --> 00:33:35.770 position:50% align:middle 46% of nurse practitioners in Georgia thought the administration was not responsive, 00:33:35.770 --> 00:33:41.770 position:50% align:middle administration was not responsive or only somewhat responsive or supportive of nurse practitioners. 00:33:42.060 --> 00:33:49.370 position:50% align:middle We found that roughly 13% of nurse practitioners in the state of Georgia were very dissatisfied or dissatisfied 00:33:49.370 --> 00:33:57.620 position:50% align:middle with their jobs, and roughly 8% of nurse practitioners in the state of Georgia intend to leave their job 00:33:57.620 --> 00:33:59.036 position:50% align:middle in the next 3 years. 00:34:02.690 --> 00:34:11.540 position:50% align:middle So, in conclusion, there has been substantial growth in the nurse practitioner nurse workforce nationwide. 00:34:11.540 --> 00:34:12.580 position:50% align:middle There's no doubt about it. 00:34:12.580 --> 00:34:18.133 position:50% align:middle There was a lot of graphical evidence and numbers in this presentation, but they all showed an upward trend. 00:34:19.590 --> 00:34:26.780 position:50% align:middle Improvements within organizations is one strategy, we know this among nurses and advanced practice nurses, 00:34:27.690 --> 00:34:33.973 position:50% align:middle is one strategy to recruit and retain nurses and improve the quality of care. 00:34:34.170 --> 00:34:41.050 position:50% align:middle And the important takeaway here is that these organizational strategies cost nothing. 00:34:41.050 --> 00:34:42.194 position:50% align:middle They cost nothing. 00:34:42.450 --> 00:34:50.169 position:50% align:middle And the same thing at state and organizational regulations, they can be changed at little or no cost. 00:34:51.770 --> 00:34:55.169 position:50% align:middle Many hospitalized patients require advanced care. 00:34:55.169 --> 00:34:58.300 position:50% align:middle You saw those comorbid diseases in the previous slide. 00:34:58.300 --> 00:35:03.592 position:50% align:middle Their care is complex due to declining health and those multiple comorbid diseases. 00:35:03.660 --> 00:35:08.040 position:50% align:middle These are going to be patients, they're sicker, and especially now with COVID, they're sicker, 00:35:08.040 --> 00:35:12.656 position:50% align:middle they're going to [inaudible] advanced clinicians and providers 24/7. 00:35:13.360 --> 00:35:21.255 position:50% align:middle And nurse practitioners are a valuable resource to acute care physicians, nurses, and patients. 00:35:23.210 --> 00:35:35.610 position:50% align:middle Now, I'd be amiss if I closed without this slide, because this slide in itself is changing the entire 00:35:35.610 --> 00:35:37.477 position:50% align:middle landscape of nursing. 00:35:40.540 --> 00:35:48.003 position:50% align:middle COVID-19, or coronavirus, has had an impact on the workforce that we have never seen in this country. 00:35:48.730 --> 00:35:52.366 position:50% align:middle And the potential ramifications are frightening. 00:35:56.850 --> 00:35:58.280 position:50% align:middle You've probably heard about this. 00:35:58.280 --> 00:36:03.490 position:50% align:middle These are some of our challenges, but the term "The Great Resignation" is 00:36:03.490 --> 00:36:04.692 position:50% align:middle across the board. 00:36:04.860 --> 00:36:07.300 position:50% align:middle It's across all areas of employment. 00:36:07.500 --> 00:36:12.610 position:50% align:middle But recently, I heard it referred to in healthcare as "The Great Awakening." 00:36:14.620 --> 00:36:18.791 position:50% align:middle And this demands that we reevaluate acute care nursing. 00:36:19.820 --> 00:36:25.888 position:50% align:middle Nurses have left their positions, and many are approaching retirement age. 00:36:26.270 --> 00:36:32.528 position:50% align:middle Our hospitals are flooded with nurses from supplemental staffing agencies. 00:36:32.790 --> 00:36:35.320 position:50% align:middle I know it from what's happening here in Georgia. 00:36:35.320 --> 00:36:42.675 position:50% align:middle Some hospitals are reporting units with 70% to 100% travel nurses staffing their units. 00:36:43.320 --> 00:36:53.833 position:50% align:middle And to be honest, I thought maybe this was geographically novel finding, but it's not. 00:36:54.070 --> 00:36:59.730 position:50% align:middle Because I had a conversation with a nurse practitioner from a California hospital the other day, 00:36:59.730 --> 00:37:05.270 position:50% align:middle and those of us that are nurses know that California has the best working conditions of any state 00:37:05.270 --> 00:37:08.320 position:50% align:middle in the country because they have mandated staffing ratios. 00:37:08.910 --> 00:37:14.620 position:50% align:middle And that nurse practitioner told me that there were so many travel nurses, but in California, 00:37:14.620 --> 00:37:20.566 position:50% align:middle they refer to them as registry nurses, that they were outnumbering the full-time employees. 00:37:20.566 --> 00:37:25.770 position:50% align:middle So if it's happening in California, the state that always attracted nurses, 00:37:25.770 --> 00:37:29.196 position:50% align:middle then this is a huge nationwide problem that needs to be addressed. 00:37:29.720 --> 00:37:30.780 position:50% align:middle How do we address it? 00:37:30.780 --> 00:37:38.140 position:50% align:middle With nurse practitioners and bedside nurses through licensure and scope of practice, and data, data. 00:37:38.140 --> 00:37:41.846 position:50% align:middle If we don't have the data, we won't know where these nurses are. 00:37:44.100 --> 00:37:48.270 position:50% align:middle Nurse practitioners took on an expanded role during COVID, during the pandemic, 00:37:48.270 --> 00:37:54.458 position:50% align:middle states let them have more control over practice despite these limitations. 00:37:54.670 --> 00:38:02.663 position:50% align:middle Why can't we retain those expanded roles for nurse practitioners in acute care facilities nationwide? 00:38:03.948 --> 00:38:08.830 position:50% align:middle I mean, why can't we...I really look to NCSBN for this. 00:38:08.830 --> 00:38:09.890 position:50% align:middle We need help. 00:38:09.890 --> 00:38:11.398 position:50% align:middle We need help with the data. 00:38:11.520 --> 00:38:17.850 position:50% align:middle And I can't think of any other organization or agency in this country that is better positioned to help us 00:38:17.850 --> 00:38:23.480 position:50% align:middle as a profession to collect data on nurses, registered nurses, nurse practitioners, 00:38:23.480 --> 00:38:28.700 position:50% align:middle licensed practical nurses, nursing assistants, because we need to know about all of them now. 00:38:30.120 --> 00:38:34.592 position:50% align:middle Emphasis needs to be placed on the economic value of nursing. 00:38:34.770 --> 00:38:41.340 position:50% align:middle Nursing has always been considered a cost to the healthcare system. 00:38:41.340 --> 00:38:43.765 position:50% align:middle It's about time we consider it a revenue. 00:38:44.190 --> 00:38:48.039 position:50% align:middle We need to value the financial contributions of nursing care. 00:38:48.160 --> 00:38:53.351 position:50% align:middle We need to redesign the payment model based on nursing services. 00:38:53.810 --> 00:38:59.995 position:50% align:middle This is where I need my economists to be in there and at the table, and say, "How can we redesign this?" 00:38:59.995 --> 00:39:04.704 position:50% align:middle Because we're not going to bring these nurses back unless there's a dramatic change. 00:39:05.098 --> 00:39:11.200 position:50% align:middle And we have to redesign the entire acute care model, and we have to do it now. 00:39:11.200 --> 00:39:12.430 position:50% align:middle And I know there's talks. 00:39:12.430 --> 00:39:18.130 position:50% align:middle I've heard talks in Georgia, where administrators are desperate to find a way 00:39:18.130 --> 00:39:19.430 position:50% align:middle to staff hospitals. 00:39:19.430 --> 00:39:24.333 position:50% align:middle I think, and this is my opinion, we need to go back to the team-based approach 00:39:24.333 --> 00:39:28.797 position:50% align:middle to nursing, bring back some of those licensed practical nurses. 00:39:29.030 --> 00:39:34.107 position:50% align:middle We can train them in a relatively short period of time, but bring in the nurse practitioners. 00:39:35.250 --> 00:39:40.484 position:50% align:middle Bring them back to play a leading role at the bedside, where they oversee registered nurses, 00:39:40.484 --> 00:39:45.230 position:50% align:middle and licensed practical nurses, and nursing assistants. 00:39:45.230 --> 00:39:47.788 position:50% align:middle It's a model that we have to change now. 00:39:48.270 --> 00:39:49.925 position:50% align:middle And bring in technology. 00:39:51.300 --> 00:39:59.750 position:50% align:middle Why not use technology to help us forge forward as we try to mend or repair this acute care model? 00:40:00.448 --> 00:40:04.305 position:50% align:middle At the end of the day, I think if we bring that nurse practitioner 00:40:04.305 --> 00:40:12.356 position:50% align:middle model of care to the bedside in acute care hospitals and try a team approach, it can only result in positive 00:40:12.356 --> 00:40:15.477 position:50% align:middle and cost-effective nurse and patient outcomes. 00:40:17.634 --> 00:40:18.444 position:50% align:middle Thank you.