The Betty Irene Moore Nursing Initiative (BIMNI) seeks to improve the quality of patient care in Bay Area hospitals by developing a larger, more highly skilled nursing workforce, and by implementing more effective hospital practices. To improve the RN workforce, the BIMNI /initiative is supporting programs to train more RN educators, expand and enhance clinical training opportunities for nursing school students, create continuing clinical training for new RNs, optimize the RN educational system, and to increase collaboration between nursing community stakeholders. To promote more effective hospital practices, the initiative supports the implementation of best practices in nursing, a systems approach to patient safety, and improved discharge planning for high-risk, elderly patients.
Background
The Institute of Medicine estimates that 44,000 to 98,000 Americans die each year in hospitals due to medical errors. RNs significantly impact patient care, as they provide continuous care during a patient’s hospitalization and are typically the first to assess the need for medical intervention. Overall, nurses provide approximately 95 percent of direct patient care in hospitals. Studies in the past 10 years have demonstrated the link between RN staffing and the level of RN educational preparation with hospital mortality rates, lengths of stay, hospital-acquired infections, medication errors, and patient satisfaction. For RNs to be successful in providing high quality patient care, it is critical that they are equipped with strong clinical and patient management skills. It is equally important that nurses use evidence-based practices and that their work processes are orchestrated within a broader system-level care plan. Coordination between healthcare professionals (RNs, physicians, pharmacists, etc.) is essential to ensuring that patients consistently receive the best evidence-based care.
A shortage of nurses threatens the overall quality of care for patients. The United States currently faces a nursing shortage of more than 149,000 RNs and the Bureau of Labor Statistics projects the problem to worsen over the next 30 years. Through our research we have learned that major factors contributing to the country's growing nurse shortage include inadequate educational capacity and a large portion of the RN workforce reaching retirement age. California faces similar challenges, and, currently, California is experiencing a RN shortage of more than 20,000 full-time equivalent RNs. This shortage is expected to worsen each year through 2015, reaching between 50,000 and 80,000 (approximately 34 percent of the demand in 2015).
Description of Strategies
The Betty Irene Moore Nursing Initiative team works closely with the local, state, and national stakeholder community (health agencies, hospitals, nursing schools, nursing unions, insurers, other funders) to implement its two major strategies: Developing a larger, more highly skilled RN workforce, and implementing more effective hospital practices.
The initiative takes a collaborative approach to its grantmaking and prioritizes projects which involve partnerships, particularly between nursing schools and hospitals, and which can be sustained. The initiative team works with the stakeholder community to actively monitor and shape key developments at the macro-level that may impact the initiative.
Develop a larger, more highly skilled RN workforce.
To close the gap between supply and demand of nurses in the San Francisco Bay Area, the BIMNI team has selected four approaches which will collectively increase the number of new RNs: 1. Train and fund more RN educators; 2. Expand pre-licensure programs; 3. Create continuing clinical training for new RNs; 4. Optimize the efficiency of the RN education system to expand existing capacity and increase collaboration among key stakeholders.
To date, the initiative has awarded approximately $38 million over ten years to support these four approaches. One example is a grant supporting the creation of a Centralized Clinical Placement System (CCPS) to maximize clinical placement opportunities for nursing school students. Community support for this program is strong; all Bay Area nursing schools and more than 50 percent of hospitals are participating in CCPS.
Implement more effective hospital practices.
To reduce errors and improve patient outcomes, BIMNI is taking a three-pronged approach to improve hospital practices—implementing best practices in nursing, improving patient safety by addressing the hospital system, and improving discharge planning for high-risk, elderly patients. To date, the initiative has awarded approximately $20 million over several years toward a portfolio of programs supporting this strategy. For example, we supported the creation of a regional patient safety collaborative among Bay Area hospitals participating in the “100K Lives Campaign,” a national initiative led by the Institute for Healthcare Improvement focused on implementing scientifically-based clinical interventions to reduce mortality and complications within hospitals. These interventions are endorsed by major scientific groups (e.g., American College of Cardiology, American Heart Association, Centers for Disease Control and Prevention), regulators (e.g., Centers for Medicare and Medicaid Services, Joint Commission on Accreditation of Healthcare Organizations), and other stakeholders (e.g., American Medical Association, American Nurses Association, California Hospital Association). To implement these best practices locally, this nursing initiative provided funding for 20 Bay Area hospitals and the Hospital Council of Northern and Central California.