Naperville
Trish Anen
Michele Bromberg
Joanne Condi
Ashley Currier
Janet Davis
Larinda Dixon
Bonnie Elliott-Zahorik
Lisa Evoy
Dilyss Gallyot
Susan Gardiner
Kathi Gehrke
Elaine Graf
Cathy Grossi
Carol Gugerty
Vickie Gukenberger
Robin Hocevar
Carmen Hovanec
Deborah Jezuit
Zeb Koran
Mary Elaine Koren
Alma Labunski

Mary Lebold
Shannon Lizer
Maryanne Locklin
Brigid Lusk
Janet Lynch
Maureen Montgomery
Linda Olson
Cheryl Portner
Laurel Quinn
Kim Shapiro
Alice Sima
Barbara Small
Bev Standley
Mary Tebbe
Phyllis Thomson
Darla Weirich

Springfield
Kelly Alkire
Debbie Birk
Jessica Duft
Tammy Fralicker

Deidra Glisson
Cheri Hammer
Margie Harris
David Kerwin
Janet Krejci
LaVerne Landers
Sue Livingston
Linda Mabus
Cynthia Maskey
Marcia Maurer
Yvonne Pellum
Jane Pond
Sandi Scheidenhelm
Katherine Tarvin
Jennie VanSchyndel
Angie Williams
Leanna Wynn

Staff
Nancy Krier, Executive Director
Eileen McEntire
Linda Searcy

Topic

Discussion

Action

Welcome and Introductions

ICNR President Vickie Gukenberger called the meeting to order, welcomed everyone and attendees introduced themselves.

Consensus Agenda

President Gukenberger listed the documents that were in the pre-meeting mailing and asked for comments, corrections, questions, about any of them.  There being none, the consensus agenda items were approved. They are:
Minutes from the February 25, 2010 Membership Meeting
Treasurer’s Report
Membership Report
President Gukenberger thanked the panelists for their contributions to the February membership meeting.

A motion was moved and seconded to approve the consensus agenda times.

Board of Director’s Report

President Vickie Gukenberger referred attendees to the report of the April 15, 2010 ICNR Board meeting which was included in their packets.  She pointed out that the #2 ICNR Strategic Plan Goal is: “Maintain vitality and visibility of the association through engaged membership and sound financial planning”.   She said the Board Is very concerned about ICNRs financial stability, membership numbers, role diversity and engagement.
Operation expenses currently exceed revenue.  The projected budget shortfall for this year is between $10,000 and $15,000.  ICNR still has $11,000 of the Chicago Community Trust grant and the Executive Director has offered to reduce her salary temporarily, if necessary to meet budget goals. 
In order to meet the Strategic Plan Goal ICNR will need to determine the future vision, goals and tactical plan of the organization.  Objectives include: developing realistic and contemporary organizational and operational structure in order to achieve our goals; and implementing strategies to promote financial stability.
The Board proposed that the mission (and primary goal) of ICNR should be to “provide a unique forum to promote collaboration and dialogue among nurse educators, practitioners and leaders to advance the profession of nursing to meet the health care needs of the people of Illinois”. 
The Board also proposed some key themes to promote as reasons to get involved in ICNR.  These included: opportunity for collaboration; formal and informal professional involvement; information sharing; the uniqueness of the organization and its eclectic membership; statewide representation; ICNR is about unity, not uniformity; and ICNR offers continuity of education.
The Board of Directors proposed that the ICNR Vision Statement should read: “To be the organization of choice to promote nurses’ proactive, informed and engaged decision-making to meet the health care needs of the people of Illinois”.  The three main values identified were: (1) Diversity; (2) Respect; and (3) Collaboration. 
Immediate steps the Board of Directors will take are: (1) Board members will contact identified key stakeholders, informing them of the value of ICNR membership and offer a mid-year membership that includes a commitment through 2011; (2) Draft a tactical plan by the July Board meeting; and (3) Identify opportunities to telecast meetings to the southern part of the state, and conduct a cost/benefit analysis.  Nancy Krier, Executive Director reported that the capability to conduct meetings from southern Illinois is there, but survey results do not show much interest at this time.  She suggested marketing southern Illinois with the promise of offering a meeting site in the region.  Marcia Maurer, Dean & Professor, Nursing, Southern Illinois University in Edwardsville, commented that there needs to be a focus on ICNR involvement in the southern Illinois area and acknowledged that the culture and needs in that region may differ from other areas of the state.
Other actions taken by the Board at their April 15, 2010 meeting were: (1) approved the Executive Director job description; (2) will suggest IOADN membership to the Board of Directors; and (3) develop a Board orientation and select policies.   It was also decided that the educational focus for the remaining 2010 membership meetings will be on health care reform issues. 

ICNR Information, Dialogue and Discussion Topic:  Health Care Reform: Implications for Education, Practice and Licensure- Target:  Nurse COMPETENCIES Information

Health Reform Overview and Competencies
Nancy Krier, ICNR Executive Director, summarized the discussion on Health Care Reform: Implications for Illinois Nurses that was included in the February ICNR 2010 Policy Forum. She stated that quality and safety come into play in health care reform cost and access.  Ms. Krier discussed major financing components, including hospital and health system reductions, hospital readmission and Medicare payment bundling, Medicare hospital-acquired conditions reporting and payment policy and HC Workforce. 
Executive Director Krier suggested that key questions to try to answer at today’s meeting include:    What does “competent nurse” mean, and what competencies are needed to care for greater numbers of patients without decreasing quality or risking patient safety.  She stressed that staffing must increase, not decrease and that the retirement of baby boomer nurses will greatly increase the need for new nurses.  Also discussed were competencies needed to avoid readmissions and complications. She pointed out the need for nurses to be knowledgeable regarding payment issues and that nurses are at the center of patient care quality and safety. 
IONL and MCHC Initiatives for Competency
Trish Anen, Vice President Clinical Services, MCHC and Chair, IONL Policy & Advocacy Committee, reported on the IONL survey of chief nursing officers that went out in January and February 2010.  Seventy-six hospitals responded.  IONL is partnering with graduate students to do follow-up interviews to gather more specific information.  The survey was conducted in response to CNO feedback and inquiries regarding the Nurse Staffing by Patient Acuity Act (added as Section 10.10 of the Illinois Hospital Licensing Act in 2007) and rules (finalized in March, 2010). The purpose of the survey was to gather current practices and identify opportunities for collaboration and learning.
Ms. Anen summarized the Nurse Staffing by Acuity Act provisions and reported on the Nursing Care Committee survey results.  She said that IONL was pleased 95% of hospitals reported that their committees have met and that staff nurses are well represented.  She also stated that 90% of hospitals felt their Nursing Care Committee helped promote quality and improve delivery of service in their organizations. 
Ms. Anen summarized examples of committee recommendations regarding changes to practices and staffing and stated that the committees have become quite influential and impact major processes and systems at the work place.  The majority of the Nursing Care Committees are reviewing quality data during meetings and ask staff to notify their committee representatives of issues they want discussed.
Future nursing competencies will need to focus on quality improvement, leadership and resource utilization.
Ms. Anen also reported on the Advanced Practice Nurses Forum whose purpose is to discuss questions/concerns, share current practices and work together to develop best practices on a regular basis. There are currently 17 CNOs and 16 APNs Participating as members of the Forum.  A statewide summit will be held in October 2010. 

IOM (Future of Nursing) and National Council of State Boards of Nursing
Vickie Gukenberger, ICNR President, Director, Nursing Programs, College of DuPage Nursing Program,  presented a summary of the October 2009 Forum on the Future of Nursing:  Acute Care and the Post-Entry Competence Study. 
Conclusions from the Forum indicated the following 5 areas where nurses spend most of their time:  Documentation; Care coordination; Patient care; Medication administration; and Assessment/vitals.  President Gukenberger summarized the core concepts for imagining the future of nursing and the importance of using data to see the “big” picture. Also discussed were quality and safety and recommended priorities.   The Forum’s report also itemized 3 impacts on the future of nursing: (1) The courage to stop doing work that is not value added; (2) The ability to build reliable nursing care delivery systems; and (3) The redesign of care teams led by nurses.  The report also focused on technology in regards to nursing and quality and safety education for nurses.
The methodology for the Post-Entry Competence Study asked about practice and followed practitioners over time.  (49 from start to finish).  The study focused on competence and asked how nurses define and demonstrate competent nursing practice. Competency can be influenced by education and work setting.  Implications for the study findings for competence development included the importance of various areas of emphasis and teaching methods to promote competence development after licensure.

Transforming Care at the Bedside
Kelly Alkire, Staff Nurse, Family Care Center, OSF St. Joseph Medical Center, reported that St. Joseph was chosen to participate along with 32 other hospitals across the nation in the Robert Wood Johnson Foundation program: T.C.A.B. – “Transforming Care at the Bedside”.  Staff brainstormed on ideas that can improve care in order to spend more time at the bedside.  Lots of ideas were heard and data was entered into hand held PDAs to track the task for TCAB’s data bank.
One accomplishment derived from TCAB findings was a change in reporting style.  Benefits of bedside reporting were summarized and included nurses were better prepared to answer physician questions; better able to delegate care to assistive personnel; and face to face communication improved staff relationships and led to more of a team outlook on patient care.  OSF St. Joseph Medical Center is now more able to set patient centered goals and patients have decreased anxiety and increased confidence in their care team.

Magnet Designation
Elaine Graf, Research & Funding Coordinator, Clinical & Organizational Development,
Children’s Memorial Medical Center reported that Illinois quickly went to the top of the list of states with the most Magnet hospitals.  As of May 2010 there are 23 Magnet hospitals in Illinois, which is an outstanding accomplishment.  Ms. Graf summarized the minimum expectations for Magnet status and reviewed the required documentation.  She pointed out that achieving and maintaining Magnet level care are two different things.
She also stressed the importance of continuing education and itemized areas where education is beneficial.  Important issues in nursing were also summarized and included the trend to hire only BSN or higher degree nurses; clear educational differentiation between QI, Research & EBP; preparation for nursing research in practice; nurses’  identification of nurse sensitive indicators; and the limited clinical time students have in specialty clinical areas.

Illinois Law:  Rules, Regulations (NPA)
Michele Bromberg, IDFPR Nursing Coordinator and Chairperson of the Illinois Center for Nursing, reviewed the Illinois Department of Financial and Professional Regulation Nursing Act with particular emphasis on scope of practice for LPNs, RNs and APNs.   Ms. Bromberg stated that nurses are concerned with expectations and competency levels partly because of the lack of practice time in both nursing schools and orientation programs. She also presented information on the duties of the Board of Nursing, the IDFPR website and continuing education requirements for RNs. 
The second part of Ms. Bromberg’s presentation focused on the state of nursing in Illinois.  She provided data on the present supply and demand of the RN workforce, the estimated annual shortage of RNs through 2016 and current nursing demographics.  Data indicated that 63% of nurses are aged 49 or older and 16% of RNs intend to retire within 5 years with 53% eligible for retirement within 15 years.
The enrollment of students in nursing programs is important to the future of nursing in Illinois.  Ms. Bromberg provided attendees with enrollment data and stated that she is pleased to announce that there is a 25% overall increase in enrollment since FY 2006.

Advanced Practice Nursing
Marcia Maurer, Dean & Professor, Nursing at Southern Illinois University, Edwardsville and Robert Wood Johnson Executive Nurse Fellow, stated the importance of focusing not only on the nursing shortage, but also the mix of nurses that will be needed.  Too few nurses are pursuing advanced degree preparation.  The lack of APNs adversely affects patient care in hospitals and the advancement of technology.  Too few physicians are opting for primary care which creates a shortage especially in inner cities and rural areas.
Ms. Maurer outlined the future workforce demands and the need to look at new approaches to health care.  APNs can assist in reducing the rate of readmissions which in turn reduces the cost of health care.  It is important that a greater majority of graduates from the basic degree program pursue advanced study.  The education system, employers and professional associations need to support and recognize professional level experience.  Ms. Maurer also listed key arguments regarding why we need APNs and Nursing education’s role in preparing APNs. 

ADNs – Education and Practice for the Future
Cynthia Maskey, Dean of Health Professions, Lincoln Land Community College, Springfield, reported on ADN nursing education and the IOM.  She stated that associate degree nursing educators support patient-centered care; inter-professional teams; evidence-based practice; patient safety standards, clinical reasoning/critical thinking; quality improvement; cultural competency and sensitivity and professionalism.  She emphasized the importance of bridging the practice-preparation gap.

Health Care Reform Competencies Dialogue and Discussion and Discussion Group Reports

Meeting attendees at both the Springfield and Naperville sites were divided into practice and education groups to discuss competencies and summarize key points identified during their group dialogue.  The discussion report summaries are itemized below.
EDUCATION WORK GROUPSs
Generic: Competencies Needed

• Communication-
• multi-lingual and interpersonal diversity skills
• interdisciplinary communication skills
• Research
• Leadership- for changes needed to patient care delivery
• Informatics
• Genetics
• Professionalism
• Patient and Family Advocacy
• Health Promotion

Recommendations

• Interdisciplinary approach to education
• Too much focus on NCLEX (suggest step exams/longitudinal testing throughout curriculum
• Create curriculum starting with practice and build backwards…start with the end in mind/ partnership between practice and education
• New paradigms
• Internship but not as nurse extenders
• Role/place for education in this
• Orientations pre-licensure; defined by IDFPR
• Education issues: faculty pay; nursing moving into practice; too much role –specific “pigeon- holing” in current curriculum Less pigeon holing in the name of specialization; medical model
• NCSBN, Practice and Education need to come to the table: define practice and build education to match practice
• Create a curriculum that is concept driven and that focuses on reflective learning, critical thinking and reasoning and service learning. 
• New paradigm
• Generic competencies
• Last phase would be a 6 month pre-licensure internship with focus on communication, research and leadership; governed by IDFPR
• 2+2

APN Comments

• (need) Genetics
• Education for ACNPs needs to be different than for primary care
• Confusion over skill set
• Skill set varies from state to state
• Utilization varies
• CNS not being utilized as such
• Facilities do not really know what to do with APNs
• Focus
• Leadership
• Mentoring
• Business model education
• CNS should be bedside directors of care in Acute care; research at bedside
• Levels need clarification
• CNS and NP being taught together in same schools
• $$ for educators. The importance of payment for nursing care is critical for doctors, patients and insurance reimbursement.

PRACTICE WORK GROUPS
Competencies needed:

• Prevention and wellness focused
• Effective communicators
• Ability to effectively educate patients
• High level of assessment and triage
• Aware of continuum of care
• Interdisciplinary communication enhanced
• Holistic functioning (not just with patient but with operations)
• RNs valuing care of all patients (there will be a decrease in segmented diagnosis --- more co-morbidities)
• Family centered care as well as patient centered
• Critical thinking skills across all levels of care
• Research and EBP competency enhanced
• Enhancing “handoffs”
• More efficient utilization of technology in practice that gives nurses more time at the bedside
• More work with preventing readmissions
• More diversity education

Recommendations:

• Improve what current nurses need to know
• Diversity education
• Breakdown silos
• Enhance discharge teaching- develop plans of care that include continuing care.
• More awareness with quality disciplines (i.e. risks)
• “broader” views
• Follow up phone calls
• Maintain staffing ratios
• More broad experiences for nurses
• Meet unmet competency needs
• Enhance comfort with research, i.e. literature reviews
• Personal impact on quality indicators and how to do QI
• Utilize multiple technology avenue to get info to nurses
• Enhance practice environment
• Inter-generational learning and practice
• Mentoring programs
• De-emphasize task-centered “jobs” and emphasize critical thinking “profession”
• Enhance nursing education programs
• Educators understanding of regulatory requirements
• Educate across the continuum of care
• Educate with other disciplines
• Articulation agreements
• Standardized curriculum
• Need Illinois to focus on how to provide resources to meet future needs of higher education

Conclusions, Summary

Vickie Gukenberger, ICNR President, presented a summary of the meeting’s discussions on Health Care Reform and nurse competencies.  She acknowledged that the future will show more opportunities for nurses and emphasized the importance of patient centered care, advocacy, collaboration and safety.  Health Care Reform will allow 32 million more individuals to be insured leading to an increased focus on prevention.  Locations of care and public health need increased attention.
The challenge to nursing will be how to do the work and improve the work.  Nancy Krier, ICNR Executive Director, expressed her belief that practice and education need to talk together and that a goal of ICNR is to bridge that gap. 

Adjournment and Next Meeting

The meeting was adjourned at 1:00 p.m.  The next ICNR membership meeting will be held on August 13, 2010.  The topic for the August membership meeting will be “Health Care Reform:  How to Maximize the Efficiency and Effectiveness of Care Across the Continuum (“wrap around care”).    A tactical/marketing plan for ICNR will also be presented at the next meeting.

Recorders:

Vickie Gukenberger, Nancy Krier and Linda Searcy