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  1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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December is the time of year when we reflect on our accomplishments, comparing outcomes to goals. How did you, your organization, the profession of nursing, and healthcare do this year? Are you cheering or groaning? Or is your response a lukewarm "meh...?"

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Healthcare in general seems to be in turmoil. As I write, there's no Secretary of Health and Human Services and no Affordable Care Act reform. Access and the insurance exchanges still need stabilization; without it, the first arm of the Triple Aim-population health-is in jeopardy.


Is the quality/outcomes arm of the Triple Aim in a better place? Maybe, depending on what metric you're using to define success. We still read journal articles with titles questioning why medical errors continue to be the third-leading cause of death in the United States. Don Berwick, MD, spoke about roadblocks to improving patient safety in his keynote to the National Patient Safety Foundation this year. Outlining roadblocks seems to be more of a call to action than a sign of success.


Let's take a look at the Triple Aim's third arm-patient experience. The Centers for Medicare and Medicaid Services tools are proliferating for many settings besides inpatient care. The last posted aggregate Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results show that two out of the three highest scored domains are nursing's: communication with nurses and discharge information. This is something to cheer about. However, I don't know about you, but it seems that trying to sustain improvement in HCAHPS scores is challenging at best for most frontline managers.


How did the profession do? If you consider the work environment as the fourth arm, creating the Quadruple Aim, it's looking more like a groan. Nurse Wubbels was believe-it-or-not arrested for patient advocacy, thankfully with a nationwide cry of outrage. The news media site Medscape recently conducted a national poll of 2,300 healthcare professionals in which 88% indicated that they've been verbally abused and 40% have been physically attacked. These incidents were highest among nurses, especially in the ED. Unfortunately, violence in the workplace-both physical and verbal-is on the rise all over the country.


Have we made progress on the Institute of Medicine's Future of Nursing report recommendations? Eighty percent BSN-prepared nurses by 2020? Not even close. Doubling the number of doctorally-prepared nurses? Done! Removing practice barriers for advanced practice nurses? Fourteen states have made improvements. Ten thousand nurses on boards by 2020? We're at 3,200. Diversity in the workforce? A lagging indicator because we don't mirror the U.S. population, another groan. It's encouraging that action coalitions in every state are actively addressing multiple aims: improving access, transforming nursing education, promoting nursing leadership, increasing diversity, collecting workforce data, fostering interprofessional collaboration, and building healthier communities.


What about the American Nurses Association's (ANA) current advocacy agenda? The ANA notes that top issues for the country include nurse staffing, scope of practice, interstate nurse licensure compact, safe patient handling, and workforce violence. Professionally, the importance of these issues isn't debatable; staffing is one of the most controversial and essential concerns we face, and one that our clinical nurses feel every day.


It may be a wrap for 2017, but certainly not for improvements in healthcare and nursing. Nurse leaders like us are more imperative now than ever before. I'm looking toward 2018 with hope and energy to continue the fight for improvements in all of the areas mentioned above. Join me at every level-on your unit, within your organization, regionally, and nationally. There's a lot to do.



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