Legislative Update

Summer Legislative Update May 1, 2012
Judy Klaver
Celebrate National Nurses Week May 6–12

All across the United States, registered nurses are being saluted. On May 6, 2012, ARN is joining the American Nurses Association (ANA) in celebrating Nurses: Advocating, Leading, Caring as part of National Nurses Week, which is held May 6–12 every year. The purpose of the weeklong celebration is to raise awareness of the value of nursing and help educate the public about the role nurses play in meeting the healthcare needs of the American people.
    In honor of the dedication, commitment, and tireless effort of the nearly 3.1 million registered nurses nationwide to promote and maintain the health of this nation, the ANA and ARN are proud to recognize registered nurses everywhere on this particular day for the quality work they provide 7 days a week, 365 days a year.
    In honor of Nursing: Advocating, Leading, Caring, all registered nurses in America are encouraged to proudly wear the official ANA “RN” pin or any other pin that clearly identifies them as registered nurses, as well as their nurses uniform on May 6, 2012.

WCN Wisconsin Center for Nursing Report of 2010 Survey of Nursing Programs
Sue Dean-Baar, PhD, RN reported the results of the 2010 Survey of Nursing Programs to the members of the Wisconsin Board of Nursing on Thursday, March 22, 2012. The executive summary is below. To access the full report please go to: http://www.wicenterfornursing.org/documents/WCN2010EducationSurveyReport.pdf
Executive Summary
This report presents the findings from the 2010 Survey of Nursing Programs in Wisconsin, sponsored by the Wisconsin Center for Nursing (WCN). These findings create a profile of nursing education programs at the present time and the foundation for identifying and analyzing trends over time. Surveyors identified 41 nursing education institutions at the outset and are aware of the introduction of new programs since the survey was conducted. Such growth is seen in other states and is likely to continue in Wisconsin.
Key findings in the 2010 survey include:
Survey response rate was 70.7%
• The findings under represent the capacity and enrollment in Wisconsin nursing education programs because of the response rate and what appears to have been some confusion over the labels of some of the survey categories; other confounding factors included the limitations of self-reporting, absence of caps on enrollment in some programs, and competing requests to complete complicated surveys from other organizations
• Wisconsin nursing programs are preparing and graduating large numbers of nurses at the graduate and undergraduate levels, and it appears that there is currently sufficient capacity to meet demand in graduate programs
• Deans and directors identified barriers to growing nursing programs; limited clinical sites, insufficient campus resources, and lack of funds to hire faculty were named most frequently
• Institutions reported an increase in the number of faculty retirements coupled with reported growth plans for faculty
• Wisconsin nursing student demographic characteristics mirrored the population of Wisconsin as well as national distributions
• Associate degree nursing students were the most ethnically diverse of the nursing programs in the state
• Faculty demographics were not consistently reflective of the student population across programs in either genderor ethnic distribution
WCN makes the following recommendations:
• Continue work needed to attain the desired 100% response rate
• Collaborate with other state and national agencies to encourage the use of the national nursing education data set
• Monitor barriers to nursing education programs and cooperate with appropriate constituencies to promote access to clinical sites, campus funds, and qualified faculty in sufficient numbers
• Monitor the impact of DNP, CNL, and other emerging nursing roles
• Anticipate and monitor faculty retirement trends
• Develop strategies to promote diversity within the nursing student and faculty populations
• Nursing education data comprise an important component of the nursing workforce picture. WCN remains firmly committed to facilitating collection and analysis of education, supply, and demand data.
This and future surveys will reveal trends in all three components and must be monitored closely to derive meaningful and ongoing conclusions and recommendations.

Advance care planning conference article
Work Begins on Implementing WNA’s 2011 Reference on Increasing Awareness of Advanced Care Planning
WNA partnered with the Wisconsin Nursing Coalition (WNC) in sponsoring the first in a series of activities to implement the 2011 Reference on Increasing Awareness of Advanced Care Planning.
The 2011 Reference called for the following two actions:
1. Support the education of nurses and other health care professionals to increase competencies in initiating and participating in meaningful conversations regarding advance care planning and end-of-life choices with their patient; and
 2. Promote and participate in the development and implementation of a culture in every community that embraces and demonstrates meaningful conversations regarding advance care planning and end-of-life care choices by all individuals.

A planning committee comprised of WNA and Wisconsin Nursing Coalition (WNC) developed a Nurse Summit, The Nurse’s Role in Advance Care Planning: Developing A Wisconsin Action Plan, which was held on February 22, 2012 in Wisconsin Dells. The 70 plus attendees were RNs interested in partnering with other healthcare professionals and the people of Wisconsin to define Wisconsin nurses’ unique roles in helping prepare and support end-of-life conversations and decisions. The summit was facilitated by WNA President, Pat Borgman, RN, MSN and WNA Lead Facilitator, Barb Haag-Heitman, PhD, RN, PHCNS-BC –ANCC Magnet and Pathway to Excellence Programs, Cardinal Stritch and Kaplan University.
The agenda for the day included an overview of the American Academy of Nursing’s position statement on advance care planning, which calls for the endorsement of nurses’ essential role in advance care planning as an urgent public health concern http://www.aannet.org/policy--briefing-papers.
The Academy’s position and other information regarding end-of-life care was provided by American Academy of Nursing and WNA member, Christine Kovach, PhD, RN, FAAN– Professor, Methods Core Director, Self-Management Science Center, University of Wisconsin-Milwaukee.
Participants heard a presentation from representatives of the Wisconsin Medical Society, Tim Bartholow MD, Chief Medical Officer and John Maycroft, MPP, Policy Analyst. They described the Wisconsin Medical Society’s agenda and actions for promoting advance care planning in the State of Wisconsin. Both presenters were very clear about the need for RN involvement in order to increase the number of Wisconsinites participating and making decisions regarding their own advance care plan. Dr. Bartholow requested WNA and the members of WNC to be collaborative partners in this initiative.
Kent Wilson MD, Medical Director of the Twin Cities Medical Society Honoring Choices program of Minnesota provided information on the conceptual framework, model and process used in developing their initiative “Honoring Choices” http://www.honoringchoices.org. He also described the important contributions of nurses in the development and implementation of their program along with their on-going role.
One other model supporting advance care planning directive was presented by Verona Lachman, RN, BSN, who is a RN Care Coordinator at Gundersen Lutheran Medical Center. Verona presented the framework and strategies used in the La Crosse community to promote and support advance care planning utilizing Gundersen Lutheran’s Respecting Choices’ http://respectingchoices.org/model. Verona also described the role of the nurse within their model. A panel comprised of seven RN leaders provided their ideas successful strategies or best practices for promoting advance care planning with unique populations.The panelist were:
Beverly L. Hoege, RN, BSN, MS, FACHE Executive Vice President, Patient Care, Reedsburg Area Medical Center, Inc. (Executive/CNO)
Susan D. Fuhrman, MS, MSN, CCNS, RN-BC, APNP – Stroke Program Coordinator/Clinical Nurse Specialist ,ProHealth Care (Advanced Practice Nurse)
Patricia Borgman, RN, MSN – Occupational Health Nurse and Geriatric CNS, Lutheran Homes of Oconomowoc, Inc. (Assisted Living/Long-Term Care)
Amy Hermes, RN, BSN – Interim VP of Inpatient Services, Stoughton Hospital (Rural Health)
Patti Varga, MSN, RN – Assistant Professor, Alverno College; Parish Nurse, Aurora Healthcare (Nursing
Education/Parish Nursing)
Teri Vega Stromberg, MSN, RN, ACHPN, AOCN – Clinical Nurse Specialist: Oncology & Palliative Care,
Wheaton Franciscan Healthcare: St. Joseph (Hispanic Nurses Association)
Yvette Johnson, BSN, NCSN - Independent Nurse Provider, Impact Health! (African American community)
For the remainder of the day, participants spent time discussing and identifying a vision for Wisconsin nurses’ roles in advance care planning using the World Café process.
Next Steps
The next steps in advancing WNA’s reference are as follows:
1. The list of ideas from the World Café process will be reviewed for themes and reported by senior level nursing students from UW-Eau Claire.
2. The nurse summit planning committee will sponsor an on-line survey that participants can review and vote on the priorities regarding the strategies nursing should adopt.
3. The participants will reconvene to develop the Community of Nursing’s Action Plan for the RN Role in Advance Care Planning for Wisconsin.

ARN and NQF Striving for Improvement of Healthcare Quality
Terrie M. Black, MBA BS RN-BC CRRN; Veronica Martin, DNP RN CNE-BC CRRN
What Is the National Quality Forum (NQF)?

NQF is a nonprofit organization that operates under a three-part mission to improve the quality of American healthcare by

NQF’s vision is

   NQF is comprised of more than 375 members who represent a wide variety of healthcare stakeholders, including consumer organizations, public and private purchasers, physicians, nurses, hospitals, accrediting and certifying bodies, supporting industries, and healthcare research and quality improvement organizations. NQF’s unique structure enables private- and public-sector stakeholders to work together to craft and implement crosscutting solutions to drive continuous quality improvement in the American healthcare system.
   NQF is one of many organizations working to improve the quality of health care in the United States. NQF has several roles in the quality landscape, include setting national priorities and goals, endorsing measures, and sponsoring various education and outreach activities aimed at facilitating achievement of the national goals. Each of these roles is vital to the quality improvement process and, ultimately, to the creation of a system of increased quality in healthcare (NQF, n.d.).
Where Does ARN Fit in with NQF?

Improving health care is a matter of critical importance that will require action by a wide variety of healthcare stakeholders. The adage of “you can’t manage or improve what you can’t measure” holds true for those of us in rehabilitation. Metrics can help identify where there are gaps in performance and allow us to gauge progress. Publicly reporting the results of measurement provides valuable information to patients choosing high-quality providers and services. Rehabilitation nurses have a holistic view of caring for patients and families; therefore, if we wish to improve nursing processes and care for patients, we must learn
 As a member of NQF’s Professional Councils, ARN is poised to review information and provide input and solicit feedback regarding quality initiatives. This is particularly important because the August 5, 2011 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Final Rule (76 FR 47836) established a quality reporting program for IRFs. Although an IRF may decide not to submit data on the Quality Indicators section (Items 48A through 50D), failure to complete such items may result in payment reduction of two percentage points starting in fiscal year 2014 (CMS, 2011). ARN will communicate NQF updates and opportunities for members through the Health Policy Digest and ARN Network when appropriate.
   The Centers for Medicare & Medicaid Services and NQF have increased their focus on patient and family engagement measures, patient-centered care, and care coordination, providing rehabilitation specialists with a wealth of information and experience to share and helping with the central goal of rehabilitation programs: returning patients to the community. The exchange of information between these agencies and ARN will enhance overall efforts to provide seamless care across continuums of care and prevent readmissions to acute care.

National Quality Forum. (n.d.). About NQF. Retrieved March 2, 2012, from www.qualityforum.org/About_NQF/About-NQF.aspx.

Centers for Medicare and Medicaid Services. (2011). Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric Unit. Federal Register, 76(151


Past updates

February 2012 update
Winter 2011 update

Fall 2011 update
July 2011 update

May 2011 update
December 2010 update
May 2010 update
February 2010 update
Fall 2009 update