New ANA President Pam Cipriano on reform-era challenges

Pam Cipriano became president of the American Nurses Association in June. Cipriano, who holds a doctorate in executive nursing administration, is a former senior director with the consulting firm Galloway Advisory by iVantage, and formerly served as chief clinical officer and chief nursing officer at the University of Virginia Health System, Charlottesville. She also was the first editor-in-chief of the ANA journal American Nurse Today. Modern Healthcare reporter Andis Robeznieks recently spoke with Cipriano about the role of nurses as primary-care providers, the amount of time spent in front of computers and whether there is a nurse shortage. This is an edited transcript.

Modern Healthcare: How have you seen the roles of nurses change over your career, and how have concepts such as population health and medical homes driven these changes in recent years?

Pam Cipriano: Nurses are taking on greater responsibility in large part as they have gained more education and many have become certified as advanced practice nurses. Nurse practitioners and certified nurse midwives are being recognized as providers of care in the primary-care home.

For many years, the mainstay of employment for registered nurses was in the hospital. But as we've seen care move out of the hospital, more nurses have moved into the arenas of home care, post-acute care, community health centers and entrepreneurial roles. They are providing a lot of leadership in the transformation of U.S. healthcare.

MH: What role have nurses played in advancing the use of health information technology and promoting patient safety?

Cipriano: Nurses probably enter and see the largest amount of data that's put into the electronic health record. They're really important in terms of data collection, data documentation and transmission of that information. In addition, they work with a lot of medical-device data and will be more involved as data are exchanged with settings outside the hospital and the primary-care office.

A lot of health IT is designed to help nurses with medication management and to anticipate where there are safety problems and be able to respond to alerts.

On population health, we want to make sure nurses have access to a broad range of data so they're not just looking at the settings where we have illness but are focusing on health promotion and understanding the determinants of health at home and in the community.

MH: Are nurses spending too much time on computers instead of with patients?

Cipriano: Every healthcare provider has a learning curve when they start using health IT, and nurses are like other members of the healthcare team. They are learning the requirements for documentation. But any nurse or physician will tell you they would not trade it for the old ways because the ability to retrieve information is unparalleled.

MH: Is there a shortage of nurses?

Cipriano: This has been one of the more difficult eras to predict supply and demand because things are changing so rapidly. Recent figures from the Bureau of Labor Statistics show that as we look to the year 2020, we're projecting a shortage of about 1.1 million registered nurses.

What's difficult in understanding those numbers is that we know nurses are actually working to a much older age than they used to. The numbers suggest that 24% of nurses are working much longer. Some of it is the economy. For many nurses who look at living well into their 80s or 90s, retirement in their 60s is not as attractive, particularly as there are now new opportunities in environments that are not as physically demanding as traditional hospital jobs. As nurses follow the jobs out of the hospital, they're able to work longer, which is a good thing.

Another difficulty is that nursing faculty retirements are going to accelerate faster than retirements of clinical nurses because the average faculty member is in her mid-50s, about 10 years older than the average clinical nurse. There also are some paradoxes. We have new nursing graduates unable to find jobs as other nurses hold on to those jobs, but at the same time there's still enormous interest in coming into nursing. The 2012 data showed that 80,000 qualified applicants were turned away because we did not have enough nursing school positions, and that could be related to the number of faculty or the availability of clinical placements.

So it's a dilemma trying to understand all of the numbers. But we do know that the baby boom generation will continue to be relatively high consumers of healthcare, and we have reason to believe that the demand for nursing will continue.

As hospitals try to understand how to right-size their workforce in a shrinking reimbursement environment, we're seeing volatility. In some hospitals we see layoffs. In others we see increasing demand to make sure that they have a well-educated, robust workforce and they're getting quality outcomes. The short answer is we believe we will continue to need more nurses, there is a lot of interest in producing those nurses, and we have a real demand to replace faculty who will be retiring.

MH: What do you see as the ANA's focus for the next year?

Cipriano: We believe strongly in the involvement of nurses in the national transformation of healthcare. Nurses are very well-versed in looking at the diverse needs of patients and families, living up to the six aims of care that the Institute of Medicine has prescribed, and very interested in creating quality outcomes. So nurses need to be part of the thought leaders and decisionmakers. In many places we are increasing the presence of nurses, whether that's on federal advisory committees, hospital boards or community boards.

As we look at the opportunities for advanced practice nurses, we think these are some of the most critical places where we want to have nurses represented. Advanced practice nurses provide similar if not better outcomes for patients, so it is important that they are a part of primary care or patient-centered medical homes. We also know they do an excellent job with nurse-managed health centers.

We're very involved in looking at how we promote opportunities not only for the general practice nurse but for advanced practice nurses, removing barriers for advanced practice.

We're working through our state associations to make sure nurses can practice to the full extent and scope of their licensure and education. We also are working to increase the education of all nurses so that we have a registered workforce that's 80% baccalaureate-prepared nurses by 2020.

In addition, it's very important that we have a safe workplace that not only protects patients but also protects nurses from injury. That's a significant cause of attrition when nurses experience any kind of musculoskeletal injury or other workplace hazard.