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2021 Fall Mini Session Handouts Flipbook PDF
2021 Fall Mini Session Handouts
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Relationship-Based Conflict Prevention & Management Skills for Clinical Leaders Keynote and Q&A with Dr. Brian Mistler This presentation is copyrighted Brian Mistler, 2021. This presentation may not be used by SWHPN and associates for educational purposes, but may not otherwise be reproduced without permission from the presenter. This presentation and all materials provided may not be altered. This presentation is not intended as legal advice and should be considered general information only. The answers to legal and clinical questions generally hinge upon the specific facts and circumstances of an institution. Individuals with specific questions should contact their institution’s legal counsel and local licensed mental health experts as appropriate. The opinions expressed during today’s event are not necessarily those of Vynca or the sponsors. Advancing Palliative Nursing Leadership Today’s Presenter Brian J. Mistler (Ph.D.) Lead Trainer for I CAN HELP free health literacy/suicide prevention program & Chief Clinical Operations and People Officer Vynca, LLC Unstuckness Expert linkedin.com/in/mistler *Not legal/therapy advice. Advancing Palliative Nursing Leadership Conflict as Stuckness • When we’re in conflict there is a reality – and a feeling. • Core feeling is “stuckness”. Advancing Palliative Nursing Leadership Four Kinds of Stuckness 1. Communication (easy) 2. Bottleneck / limited resources 3. First-Order side-effect 4. Interpersonal: A) Non-relationship-oriented (means vs ends) B) Trauma / triggers / stress C) High conflict personality Advancing Palliative Nursing Leadership Two Approaches • Conflict Management, which is responsive, and time-limited with an associated mix of concepts, tools and skills. • Conflict Prevention, which is proactive and ongoing and includes an associated mix of concepts, tools and skills. Advancing Palliative Nursing Leadership • A brief overview of Mistler’s “4 Us” of Conflict Management Advancing Palliative Nursing Leadership source: thecarconnection.com Advancing Palliative Nursing Leadership Prisoner’s Dilemma Advancing Palliative Nursing Leadership sosuorcuerc: ew:iwseisgeegeeke.cko.cmom ? source: wisegeek.com Advancing Palliative Nursing Leadership Power = Better Negotiation Outcomes source: pipocaenanquim.com.br Advancing Palliative Nursing Leadership Power = Better Long-term Outcomes source: pipocaenanquim.com.br Advancing Palliative Nursing Leadership Short-term vs. Long-term Advancing Palliative Nursing Leadership SECURITY DILEMMA source: nerdsnestsoup.files.wordpress.com Advancing Palliative Nursing Leadership source: http://housewivesmag.com/ Advancing Palliative Nursing Leadership source: http://collaborativemn.com/ Advancing Palliative Nursing Leadership Relationship-Based Conflict Management Understand the Problem Untie Interests from Positions Untangle HC Personalities/Issues Unconditionally Positive Advancing Palliative Nursing Leadership Understand the Problem source: http://https://hawkwrites.files.wordpress.com/ Advancing Palliative Nursing Leadership Understand the Problem • Rapport Building • Multilateral Partiality • “I” Language • What about emails? BIFF Advancing Palliative Nursing Leadership BIFF • Brief • Informative • Friendly • Firm Advancing Palliative Nursing Leadership Untie Interest from Positions Advancing Palliative Nursing Leadership Untie Interest from Positions Untie Interest from Positions Untie Interest from Positions Untie Interest from Positions Untie Interest from Positions source: http://housewivesmag.com/ When it’s not about either • Sometimes no matter how hard you try, it seems like the other person isn’t advancing an interest OR a position, but rather an EMOTION…. Advancing Palliative Nursing Leadership Untangle High Conflict Personalities from the Issues • “Personalities, not issues drive much conflict” • What is a HCP? Advancing Palliative Nursing Leadership Tips for Healthy Boundaries • Set time limits. • State the facts. • Set an objective. • Attend to what makes sense, not the piece that doesn’t. • You can be reasonable even when the other person isn’t… Advancing Palliative Nursing Leadership Unconditionally Constructive source: /http://wallpho.com/89807-braveheart-film-id-50419.htm/ Advancing Palliative Nursing Leadership Two heads are better than one. One head is better than none. Advancing Palliative Nursing Leadership Understand the Problem Untie Interests from Positions Untangle HC Personalities/Issues Unconditionally Positive Advancing Palliative Nursing Leadership Ongoing Approaches to Creating a Culture of Reliance CONFLICT PREVENTION Advancing Palliative Nursing Leadership Mistler’s 5 Stages of Conflict Prevention Need Grief DENIAL: Ignore “Work should focus on goals, not emotions… ” ANGER: BARGAINING: Blame “That person just needs to be less sensitive…” DEPRESSION: ACCEPTANCE: Misdirected Creativity “Have we tried…” Later/Never “Let’s look at this over the next year.” “Unfixible” Understanding “We will (better) support the team we have, where we are.” Advancing Palliative Nursing Leadership Developing Trust Advancing Palliative Nursing Leadership Trust Development Exercises • 45-90 Minutes – Progressive Sharing • create a safe space • establish group rules • genuine focused interest • model and validate sharing • invite with respect for differences in introversion/extroversion • repackage people the right amount Advancing Palliative Nursing Leadership 5 Languages of Appreciation Words of Affirmation - uses words to communicate a positive message to another person Praise for accomplishments Affirmation of character Praise for personality How One-on-one In front of others Written (email or hand written) Public Advancing Palliative Nursing Leadership 5 Languages of Appreciation Quality Time - giving person your focused attention. Quality conversation (eye contact, no distractions, listen to feelings AND thoughts) Shared experiences Small group dialogue Close proximity on a project How? Lunch Stop by office and check in Go on walk Off-site retreat Watch sporting event Phone call to check-in Advancing Palliative Nursing Leadership 5 Languages of Appreciation Acts of Service - providing assistance, “What can I do to help?” Remember: Make sure your own stuff gets done Ask before you help Check your attitude Do it their way Complete what you start Advancing Palliative Nursing Leadership 5 Languages of Appreciation Tangible Gifts - physical items Remember: Give gifts to those who appreciate it Gift must be something the person values Can be time off Most common is food Advancing Palliative Nursing Leadership 5 Languages of Appreciation Physical Touch - human to human contact Not primary in the workplace. Examples that do happen: Handshakes Touching shoulders Brief hugs (especially in emotional times) High fives Fist bumps Challenge of telehealth Advancing Palliative Nursing Leadership Trust Development Exercises • 60 Minutes – Languages of Appreciation Discussion • Explain the 5 types • Invite other to self identify • Invite “experts” to share about their type • Pizza versus gluten-free thin crust with pineapple Advancing Palliative Nursing Leadership Key Takeaways • The four primary kinds of stuckness clinical leaders face in themselves and their teams • Conflict management vs conflict prevention • Responding to high-conflict personalities • Trust Pyramid • Simple exercises for developing trust z • The Five Languages of Appreciation Advancing Palliative Nursing Leadership Final Invocation Reminder I am not required to light myself on fire to keep others warm. Advancing Palliative Nursing Leadership The Palliative Nursing Leadership Journey Fall Mini-Conference 2021 Advancing Palliative Nursing Leadership and Professional Development Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN Palliative Nurse Practitioner Palliative Care Consultant [email protected] Advancing Palliative Nursing Leadership Session Topic Focus • Current environmental scan of specialty hospice and palliative nursing. • Explore opportunities for nursing leadership in palliative nursing. • Evaluate resources and tools for professional development of palliative nursing. Session Desired Outcome >80% of participants will indicate that this session validates, enhances, or will lead to a change in the individual’s contributions to advancing palliative nursing leadership and professional development. Advancing Palliative Nursing Leadership Nursing Leadership in Palliative Care Dr. Cecily Saunders “Nurses were the first to respond to this challenge and remain the core of the personal and professional drive to enable people to find relief, support, and meaning at the end of their lives.” Cecily Saunders 2001 – Foreword Oxford Textbook of Palliative Nursing Dr. Florence Wald “Hospice care is the epitome of good nursing care. It enables the patient to get through the end of life on their own terms. It is a holistic approach, looking at the patient as an individual, a human being. The spiritual role nurses play in the end of life process is essential to both patients and families.” Florence Wald 2001 - Yale Bulletin 2001 Advancing Palliative Nursing Leadership What is Leadership? “Leadership involves influencing the attitudes, beliefs, behaviors and feelings of others.” Sullivan & Decker, 2009 “A process of social influence that maximizes the efforts of others toward achieving a goal.” Kruse, 2013 Advancing Palliative Nursing Leadership What is Considered Palliative Nursing Leadership? • The palliative registered nurse leads within the professional practice setting and the palliative nursing specialty. • Demonstrates leadership in the roles of teacher, clinician, researcher, advocate, mentor, consultant, collaborator, administrator, coordinator, case manager, and leader as appropriate to educational preparation, experience, and position. Standard of professional performance delineated in the HPNA Palliative Nursing: Scope and Standards of Nursing Practice 6th Ed 2021. Advancing Palliative Nursing Leadership Leaders Managers Leaders Verses Managers 1. Administer 1. Innovate 2. Maintain 2. Develop Management is doing things 3. Control 3. Inspire/empower right; leadership is doing the 4. Executes plan 4. Articulates vision right things. 5. Manages change 5. Creates change 6. Uses authority 6. Uses influence Peter Drucker Advancing Palliative Nursing Leadership Informal and Formal Leaders • Nurses often serve as informal leaders without titles, by garnering respect of others through their longevity of team membership, an open mentoring process, or a nurturing style. • Nurses are often long-standing interprofessional team members who start and grow a program. • Frequently, nurses are not given the authority commensurate with responsibility, empowerment to lead, nor receive team and/or organizational acceptance into leadership roles. Dahlin & Coyne 2018 Advancing Palliative Nursing Leadership Current Environment • Numbers of Individuals with Serious Illness – numbers of individuals with serious illness rising due to aging population and COVID-19 • Nursing Workforce – varies by region overall a shortage - exhausted, shortages, and early exit due to COVID-19 • Interprofessional Workforce - even before COVID-19 • Physicians – reduced numbers overall and within specialty palliative care • Social Work – never enough and often used in discharge planning rather than in area of expertise • Chaplaincy – spiritual leaders for various communities are often mismatched, and 40% of patients are unchurched Advancing Palliative Nursing Leadership Current Environment • Exciting new mandate for hospice/palliative care/supportive care nursing education • American Association of Colleges of Nursing 2021 - Essentials – Core Competencies for Professional Nursing Education • Need for Primary and Specialty Palliative Care • All nurses practice primary palliative skills by nature of nursing • Need specialists for complex patients • Need for Nursing Leadership • Challenge of developing leadership rather than developing management Advancing Palliative Nursing Leadership Evolution of • In the past, emphasis was mechanistic; Nursing scientific management perspective focused on Leadership an employer-employee model driven by rules, Theory regulations, policies, and procedures. • The present emphasis embraces the dynamic and interdependent (organic) nature of complex adaptive systems and transformational and adaptive leadership. Dahlin and Coyne 2022 (In press) Advancing Palliative Nursing Leadership Call for Future of Nursing Report 2010 – Leading Change, Nursing Advancing Health Leadership • Recommendation 2 – expand opportunities for nurses to lead Future of Nursing Report 2020- 2030 – Charting a Path to Achieve Health Equity • Fostering Nurses’ roles as leaders and advocates HPNA Palliative Nursing: Scope and Standards of Practice, APRN, and RN Competencies • Leadership is one of the competencies for nurses ANA/HPNA Call to Action • Nurses Lead and Transform Palliative Care Advancing Palliative Nursing Leadership Nursing Leadership Roles • Expert clinician • Collaborator • Leader of interdisciplinary • Advocate • Case manager teams • Administrator • Educator • Program developer • Researcher • Policy-maker • Consultant Advancing Palliative Nursing Leadership Clinical Practice Administration Research Focus of Education Policy/Advocacy Public Health Nursing Leadership Quality Social Justice Technology Ethics Advancing PaDlaliahltiinveaNndursCinogynLeea2d0e2rs2hip What Is Leadership and What Does It Entail? • Leadership entails a group of skills - these skills are not fixed • Many resources within the business world – an area nurses have avoided • Three models of nursing leadership that help a nurse develop leadership skills: 1. American Nurses Association – the 3 domains are (1) leading oneself, (2) leading others, and (3) leading the organization 2. Oncology Nursing Society – moves from leading oneself to systems thinking 3. Hospice and Palliative Nurses Association – focuses on the areas of palliative nursing and demonstration of leadership in those areas. https://advancingexpertcare.org/HPNA/Leadership/HPNA_Year_of_Leadership_2021 Advancing Palliative Nursing Leadership ANA Leadership https://www.nursingworld.org/~4a0a2e/globalassets/docs/ce/ 177626-ana-leadership-booklet-new-final.pdf Advancing Palliative Nursing Leadership COMPETENCY FRAMEWORK For Palliative Care LEADING ONESELF LEADING OTHERS LEADING AN ORGANIZATION PALLIATIVE ADAPTABILITY/ COMMUNICATION BUSINESS KNOWLEDGE and NURSE LEADERS NIMBLENESS Communicating effectively SKILL / ACUMEN Openness to influence, flexibility CONFLICT NEGOTIATION Seeks broad business knowledge IMPRESSION /IMAGE Confronting problem employees Presentation ADAPTIVE AND CHANGE DIVERSITY/EQUITY/INCLUSION Change and Adaptive management INITIATIVE / DRIVE Attending to equity Motivates self DECISION MAKING EMPLOYEE DEVELOPMENT Decisiveness INTEGRITY / HONESTY Developing and empowering Builds relationships INFLUENCE / LEVERAGE RELATIONSHIPS Strategic perspective LEARNING CAPACITY Building collaborative Knowledge of job, business PROBLEM SOLVING relationships Getting information, making sense SELF-AWARENESS / EMOTIONAL INTELLIGENCE of it; problem identification Self-awareness SYSTEMS THINKING Acts systematically VISION AND STRATEGY Strategic planning PROJECT MANAGEMENT Organizes Adapted From American Nurses Association 2013 Palliative Leadership Competency Leadership Levels – Individual, Groups & Organizations Personal Mastery Vision Knowledge Interpersonal Awareness Systems Thinking Adapted from Oncology Nursing Society Leadership Competency, 2012 Advancing Palliative Nursing Leadership Palliative Nursing Leadership Domains Clinical Care Policy and Administration Advocacy and Management Quality Education Improvement and Research Advancing Palliative Nursing Leadership HPNA Palliative Nursing Leadership Position Statement 2014, Dahlin & Coyne 2018 Clinical Care Dedicates Active role Strives Leads and Creates Seeks and oneself to in toward motivates environment promotes lifelong expert others in the certification learning translating clinician provision of of skills and quality excellence knowledge palliative care and evidence- based practice HPNA Palliative Nursing Leadership Position Statement 2014, Dahlin & Coyne 2018 Advancing Palliative Nursing Leadership Administration/Management Seeks active role in Leads national and Mentors , leads system changes, global healthcare committees, manages organizational initiatives that promote projects, and directs management, and palliative care initiatives professional activities HPNA Palliative Nursing Leadership Position Statement 2014, Dahlin & Coyne 2018 Advancing Palliative Nursing Leadership Education Precepts undergraduate and graduate nurses, uses CARES and G-CARES Educates health colleagues Provides continuing education = ELNEC Participates or develops palliative nursing education in local, regional, and national venues Advances degree HPNA Palliative Nursing Leadership Position Statement 2014, Dahlin & Coyne 2018 Advancing Palliative Nursing Leadership Research Actively follows, Applies evidence-based, translates, and nurse-led translational applies research research, clinical practice findings guidelines, clinical/critical pathways, and nationally accepted standards of practice to the care of patients with serious illness and their families Engages in Analyzes >[email protected] Advancing Palliative Nursing Leadership References 1. ANA Leadership Institute. Competency Model. (2013). https://www.dphu.org/uploads/attachements/books/books_5520_0.pdf 2. Curtis, E.A., de Vries, J., & Sheerin, F. (2011). Developing leadership in nursing: exploring core factors. British Journal of Nursing, 20(5). 3. Dahlin, C., & Coyne, P.J. (2018). The Palliative APRN Leader. Annals in Palliative Medicine. Epub doi:10.21037/apm.2018.06.03 4. Dahlin, C., Coyne, P.J. (editors). Advanced Practice Palliative Nursing.2nd ed. (2022 in press). Oxford University Press. 5. Frandsen, B. (2014). Nursing leadership management & leadership styles [White paper]. American Association of Nurse Assessment Coordination. https://www.aanac.org/docs/white- papers/2013-nursing-leadership---management-leadership-styles.pdf?sfvrsn=2 6. Hospice and Palliative Nurses Association (2014). Position Statement: Palliative Nursing Leadership. https://advancingexpertcare.org/position-statements/ 7. Hughes, R.I., Ginnett, R.C., & Curphy, G.J. (2019). Leadership: Enhancing the lessons of experience. 9th edition. McGraw Hill, Boston. Advancing Palliative Nursing Leadership References 8. Kruse, K. (2013, April 9). What is leadership? Forbes. https://www.forbes.com/sites/kevinkruse/2013/04/09/what-is-leadership/#5af47c335b90 9. Oncology Nursing Society Leadership Competencies. (2012). Oncology Nursing Society, Pittsburgh, PA. https://www.ons.org/sites/default/files/leadershipcomps.pdf 10. Lunenburg, F.C. (2011). Leadership versus management: A key distinction—at least in theory. International Journal of Management, Business, and Administration, 14(1). 11. Speck, P. (2006). Leaders and followers. In P. Speck (Ed.). Teamwork in palliative care—fulfilling or frustrating. New York, NY: Oxford University Press. p 65-82. 12. Sullivan, E.J., & Decker, P.J. (2009). Effective leadership and management in nursing. 7th ed. Prentice Hall, London. 13. Swenson, S., Pugh, M., McMullan, C., & Kabeenal, A. (2013). High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. 14. Tracy, M.F., & Hanson, C. (2014). Leadership. In Anne Hamric, Charlene Hanson, Mary Fran Tracy, and Eileen O’Grady (Eds.). Advanced Practice Nursing: An Integrative Approach. 5th ed. St. Louis, MO: Elsevier Saunders. p. 266-298. Advancing Palliative Nursing Leadership Resources AARP – RWJF oCampaign for Action http://campaignforaction.org/resources/#p=1 oWisconsin Center for Nursing-A Leadership Toolkit: Leadership Resources for Nurses https://campaignforaction.org/wp-content/uploads/2015/08/Leadership-Toolkit-WI.pdf Advancing Palliative Nursing Leadership Additional Learning Resources Hospice and Palliative Nurses Association Leadership Resources https://advancingexpertcare.org/ oPalliative Nursing: Scope and Standards of Practice, 6th ed, 2021. oCompetencies for the Palliative and Hospice Advanced Practice Registered Nurse, 3rd ed, 2021. oCompetencies for the Palliative and Hospice Registered Nurse, 4th ed, 2021. oThe Hospice and Palliative APRN Professional Practice Guide, 2nd ed, 2017. Advancing Palliative Nursing Leadership American Association of Colleges of Nursing o Essentials – Core Competencies of Professional Nursing Education. 2021. https://www.aacnnursing.org/AACN-Essentials o Leadership Development https://www.aacnnursing.org/Resources-for-Deans/Leadership-Development o Diversity Leadership Institute https://www.aacnnursing.org/Diversity-Inclusion/Diversity-Leadership-Institute o Educating Leaders in Academic Nursing https://www.aacnnursing.org/Academic-Nursing/Professional-Development/Leadership- Development/ELAN o AACN -Wharton Executive Leadership Program https://www.aacnnursing.org/Faculty/Professional-Development/Wharton-Executive-Program Advancing Palliative Nursing Leadership Additional Learning Resources Sigma Theta Tau o Nurse Leadership Academy for Practice • https://www.sigmanursing.org/learn-grow/sigma-academies/nurse-leadership- academy-for-practice o New Academic Leadership Academy • https://www.sigmanursing.org/learn-grow/sigma-academies/new-academic- leadership-academy o Experienced Academic Leadership Academy • https://www.sigmanursing.org/learn-grow/sigma-academies/experienced- academic-leadership-academy Advancing Palliative Nursing Leadership Additional Learning Resources National League for Nurses o Nursing Leadership Network – NLN Leadership Institute – LEAD and SIMULATION • http://www.nln.org/professional-development-programs/leadership-programs o Duke Leadership Program • http://www.fuqua.duke.edu/programs/other_programs/executive- education/programs/duke-leadership/ Advancing Palliative Nursing Leadership Additional Learning Resources Academic Programs for Leadership Development Executive Leadership Certificate Programs Various Business Schools have certificate programs for and nurses Doctor of Nursing Practice – Executive Leadership Various Schools of Nursing have a focus in leadership Master of Business Administration Master of Public Health Programs Master of Health Administration Programs Advancing Palliative Nursing Leadership The Palliative Nursing Leadership Journey Fall Mini-Conference 2021 Workforce Development in Hospice and Palliative Nursing Carla Jolley MN, ARNP, ANP-BC, AOCN, ACHPN Palliative Care APN/Coordinator Palliative Care Consult Service WhidbeyHealth Medical Center Coupeville, WA [email protected] Advancing Palliative Nursing Leadership Session Topic Focus • Hospice and Palliative Care Workforce Landscapes effecting current practice • The Nursing Continuing Professional Development model in developing interventions and apply resources to bridge the gap in hospice and palliative care • Workforce issues to address workforce challenges in caring for patients with serious illness Session Desired Outcome >80% of learners to self-report increased knowledge of the current landscape of the palliative care nursing workforce and care models to better address future workforce challenges in caring for patients with serious illness Advancing Palliative Nursing Leadership SampleWorSkfolricede • The people engaged in or available for work either in a country, area, company or industry Development • The act or process of growing or causing something to grow, become larger or more advanced; creating something over time https://www.merriam-webster.com/dictionary Definitions Definition of Workforce Development Workforce development is considered an interconnected set of solutions to meet employment needs. Workforce development can include changes to culture, changes to attitudes, and changes to people's potential that help to positively influence a business' future success. https://www.wonolo.com/blog/what-is-workforce- development/ Advancing Palliative Nursing Leadership Palliative • Palliative care... Beneficial at any stage of a serious illness, Care palliative care is an interdisciplinary care delivery system designed to anticipate, prevent, and manage physical, psychological, social, and spiritual suffering to optimize quality of life for patients, their families and caregivers. Palliative care can be delivered in any care setting through the collaboration of many types of care provider. Through early integration into the care plan of seriously ill people, palliative care improves quality of life for both the patient and the family. (NCP for Quality Palliative Care 4th ed. 2018) • Palliative nursing is the assessment, diagnosis, and treatment of human responses to actual or potential life-limiting illnesses within the context of a dynamic caring relationship with the patient and family, in order to reduce or relieve suffering and optimize health. (Lynch, Dahlin, Hultman, & Coakley, 2011, page 108). Advancing Palliative Nursing Leadership Who needs us? Estimated 90 million Americans are living with Crunching the serious illness, and this is expected to double numbers in the next 25 years (CAPC, 2020) 2030 all members of the baby boomer generation will be over 65; older individuals will outnumber children for the first time in history. (Congressional Budget Office 2019) Individuals with serious illness represent 14% of the population and account for 56% of the national healthcare expenditures (IOM 2015) Advancing Palliative Nursing Leadership Current Landscape: Crunching the numbers 2020 National Nursing Workforce Survey (n=157,459) • Avg age of RN 52, Male 9.4% • Hospitals primary place of employment 54.8 % RNs, ambulatory care 9.4 % RNs • 6.3% credentialed as APRN • 1/5 planned to retire in the next 5 years • Specialty Position Palliative/Hospice RN 1.6% (522) • Primary setting hospice 2.0% (674) • Secondary nursing position specialty RN 2.7% (139.3) Advancing Palliative Nursing Leadership RNHAPreaNofAFocMus embershHipPNSAtaMtiesmticbsership Statistics Both Hospice HPNA has a membership 9500 members 46% • 2500 APRNs within membership 27% • 5,500 RNs within membership • Other members-students, LPNs, CNAs, and associate members Palliative Specialty Nursing Certification through Hospice and Palliative Credentialing Center (HPCC) 27% APRN Area of Focus Hospice 15% • ACHPN 2388 Both 32% • CHPN 8,597 • CHPPN 234 09302021 Palliative 53% Advancing Palliative Nursing Leadership Existing Programs Hospice Palliative Care 4639 Medicare certified hospices in 72% of hospitals with 50 or greater 2018 (up 13.4% since 2014) beds have palliative care team; up Hospice average daily census (ADC) was from 67% 2015; 53% 2008 66.9 patients with median of 31.8 63% of patients were in programs with CAPC 2019 State by state report Card ADC of less than 50 patients 69.95% of active Medicare provider 890 programs in 3000 community numbers assigned to for-profit agencies sites (homes, nursing homes, offices 26.94% nonprofit and clinics) 3.41% government Mapping Community Care Project 2019 NHPCO Facts & Figures 2020 No clear data on community sites/programs-National Palliative Care Registry has 120 programs reporting voluntarily Advancing Palliative Nursing Leadership Workforce Profile RNs APRNs • Largest/most trusted group of health care • The number of NPs is the largest growing clinicians for 18 consecutive years (Gallup health care sector as the workforce of 2020) physician colleagues has expected shortages • Can lead/partner on teams across the continuum in both hospice/palliative care • Have more flexibility in scope of practice to pursue specialty training/skills • Can develop relationships and influence care delivery/processes • Nurse Practitioner State Practice Environment is growing for more states to • Positioned to coordinate care/transitions have independent practice-but still range • Focused on symptom management: adding is from full/reduced/to restricted to expertise is a natural step in life-long • Can bill for services provided in most learning settings to contribute to financial feasibility of the IDT Flaherty, 2019 Advancing Palliative Nursing Leadership Full Practice American Association of Nurse Practitioners, 2021 Reduced Practice Restricted Practice https://storage.aanp.org/www/documents/advocacy/State- Practice-Environment.pdf Advancing Palliative Nursing Leadership Current Palliative Workforce Landscapes Hospices Palliative Care Small vs Large Academic vs Community Rural vs Urban Multiple Models Profit vs Not for Profit Size & Composition of Team Certificate of Need state vs. None Developing Primary vs Specialist RN>APRN role differentiation expertise Settings: home (as defined by the APRN>RN multiple roles patient), long-term care, assisted Settings: home, long-term care, living, inpatient clinic, acute care Advancing Palliative Nursing Leadership ANA Urges US Department of • Convene stakeholders to identify short-and Health and Human Services to long-term solutions to staffing challenges Declare Nurse Staffing • Work with the Centre for Medicare and Shortage a National Crisis Medicaid Services on methodologies and approaches to promote payment equity Sep 1st 2021 • Education the nation on the importance of • “The nation’s health care delivery the COVID-19 vaccine systems are overwhelmed, and nurses are tired and frustrated as this • Sustain a nursing workforce that meets persistent pandemic rages on with no current and future staffing demands end in sight. Nurses alone cannot solve this longstanding issue and it is not our • Provide additional resources including burden to carry,” said ANA President recruitment and retention incentives Ernest Grant, PhD, RN, FAAN. “If we truly value the immeasurable https://www.nursingworld.org/news/news-releases/2021/ana-urges-us-department- contributions of the nursing workforce, of-health-and-human-services-to-declare-nurse-staffing-shortage-a-national-crisis/ then it is imperative that HHS utilize all available authorities to address this Advancing Palliative Nursing Leadership issue.” The End-of-Life Nursing Education Consortium (ELNEC) Project is a national and international end-of- life/palliative care educational program administered by City of Hope (COH) designed to enhance palliative care in nursing. Materials are copyrighted by City of Hope and the American Association of Colleges of Nursing (AACN) and are used with permission. Advancing Palliative Nursing Leadership • Concern this could negative impact workforce shortage for years on nursing overall • Higher turnover rates • Concern for nurses entering the workforce • Expanding APRN scope of practice • Impact of telehealth • Burnout, exhaustion and moral injury • International migration of nurses Chan et al 2021 Used with permission by HealthImpact Advancing Palliative Nursing Leadership