Since its launch in 2003, the Betty Irene Moore Nursing Initiative has sought 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 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 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

Registered Nurses (RNs) significantly impact patient care, as they provide approximately 95 percent of direct patient care in hospitals, and serve on the front lines of rapid change affecting the health care industry. Studies in the past ten 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. RNs are essential to safe, effective, timely, and patient-centric care.  

RNs face a number of challenges to delivering this care. These include: 

• The United States faces a long-term shortfall of Registered Nurses (RNs), forecast to begin in 2018 and to expand to a shortfall of 260,000 FTE RNs by 2025. Major factors contributing to the growing RN shortage include inadequate capacity to enroll new nursing students and a projected increase in the proportion of RNs reaching retirement age. 
• Patients have multiple and more highly acute illnesses, yet treatment is limited to shorter hospital stays. 
• The work environment continues to become more complex and technologically advanced, fostering a growing need for continuing RN education to prepare nurses adequately to deliver high quality patient care. For RNs to be successful in providing high quality patient care, they must be equipped with strong clinical and patient management skills. It is equally important that nurses use evidence-based practices and orchestrate their work processes within a broader system-level care plan. Coordination between healthcare professionals (e.g., RNs, physicians, pharmacists, etc.) is essential to ensuring that patients consistently receive the best evidence-based care. 

Description of Strategies

To address these challenges, the Betty Irene Moore Nursing Initiative (BIMNI) was established in 2003 to improve the quality of patient care in San Francisco Bay Area and Greater Sacramento hospitals by developing a larger, better prepared hospital RN workforce, and by implementing more effective hospital practices. BIMNI works closely with the local, state, and national stakeholder community (health agencies, hospitals, nursing schools, nursing unions, insurers, and other funders) to implement its two major strategies: developing a larger, more highly skilled RN workforce, and implementing more effective hospital practices. 

Develop a larger, more highly skilled RN workforce. 

To close the gap between supply and demand of nurses in the San Francisco Bay Area, BIMNI has selected four approaches to develop a larger, more highly skilled RN workforce: 1) train and fund more RN educators, 2) expand and enhance pre-licensure programs, 3) create continuing clinical training for new RNs, and 4) optimize the efficiency of the RN education system to expand existing capacity and increase collaboration among key stakeholders. To date, the initiative has committed over $35 million to support these strategies.

 

For example, BIMNI has partnered with the Foundation for California Community Colleges on a grant to implement the Centralized Clinical Placement System (CCPS, http://ccps.foundationccc.org/) to maximize clinical placement opportunities for nursing school students. To date, 80% of five-county Bay Area schools of nursing and hospitals continue to participate in CCPSin CCPS. 

 

Implement more effective hospital practices. 

To implement more effective hospital best practices, the initiative supports the implementation of evidence-based practices in nursing, a systems approach to patient safety, and improved discharge planning for high-risk, elderly patients. To date, the initiative has awarded approximately $83 million toward a portfolio of programs supporting these strategies.  

 

For example, BIMNI supported the creation of a regional patient safety collaborative among San Francisco Bay Area hospitals participating in the “100K Lives Campaign,” a national initiative led by the Institute for Healthcare Improvement (IHI, http://www.ihi.org/IHI/Programs/Campaign/100kCampaignOverviewArchive.htm), which 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 date, 20 participating San Francisco Bay Area hospitals along with the Hospital Council of Northern and Central California have saved over 200 lives. To implement these best practices locally, BIMNI provided funding for 20 Bay Area hospitals and the Hospital Council of Northern and Central California.