Becky MontesinoKing DNP RN MSHSA CENP Laura Carey

Becky Montesino-King, DNP, RN, MS/HSA, CENP Laura Carey, MSN, RN, M. Ed Baptist Hospital MINC Project Update

BAPTIST HOSPITAL Miami, Florida

America’s 50 Best Hospitals 1 THE BEST PLACE TO BE YOUR BEST

DEMOGRAPHICS �Located in Miami, Florida �Not-for-profit community hospital � 680 licensed beds �Fully staffed; strong financially �Fortune 100 Company for 12 years �Modern Healthcare Top 10 Hospital �Best Employer: Working Mothers Magazine

IMPORTANT TO KNOW �Not an academic medical center at this time �Genetics and genomics are not buzz-words �Opening a Cancer Treatment Center, with a research arm, in 2016

Pre-Survey � Direct care nurse participants = 21. 4% (n=352) � Survey period from July 15, 2012—August 13, 2012 � Survey from WVU; data gathered from 21 Magnet hospitals � Data from survey provided September 8, 2012

Pre-Survey Results Question 1 � How important do you think it is for nurses to become more educated about the genetics of common diseases? Very important=64. 7% Somewhat important=27. 8%. Neutral=6% Not very important=0. 9% Not at all important=0. 0% Not sure=0. 6%

Pre-Survey Results Questions 10, 14, and 15 � Do you intend to learn more about genetics? Yes=69. 6% No=20. 6% Unsure=9. 9% � Would you be able to attend a course during work hours? Yes=59. 2% No=38. 0% Unsure=2. 7% � Would you attend a course on your own time? Yes=75. 5% No=19. 4% Unsure=5. 1%

Pre-Survey Results Question 7 � To what extent do each of the following limit your ability to discuss the genetics of common diseases with individuals? (Choose all that apply) My limited expertise in genetics=76. 2% My difficulty in finding information on genetics and common diseases=32. 9% Lack of use of genetics in my clinical area=58. 0% Not in my scope of practice=36%

Conclusions � Baptist Hospital nurses have little genetic/genomic knowledge: start from the beginning � About 30% of Baptist Hospital nurses do not recognize the need to learn more about genetics/genomics for their practice: make the case and manage the dissenters � 75. 5% of Baptist nurses are willing to learn it on their own time: interesting but they don’t have to

Action Plan/Timeline � The CNO/educator dyad becomes educated in genomics— 10/2012; Cincinnati Children’s Hospital � A 1 hour genomics overview course is developed and submitted for approval: approved 11/2012; now ANCC approved for 1 CEU � On unit education rolls out—April 2 nd-April 30 th, 2013 � Post-Survey—May 2013

GENOMICS EDUCATION SPECIFICS � One hour program � Hand-outs—definitions � Film clip (in production) � Case histories with targeted discussion � Classroom setting � 3 generation assessment � Reference sources (CDC, G 2 C 2, etc. ) � One educator dedicated to project—engaging early adopters and other educators to assist

Education Plan/Progress �Classes held in small classrooms that hold 30 participants � 69 classes scheduled covering time for all shifts and days �Each nurse will be instructed by their nurse leader to register through Baptist Health University

Theory of Constraints

Diffusion of Innovations

Introducing Genomics: The Next Nursing Competency Becky Montesino-King, DNP, RN, MS, CENP Laura Carey, MSN, RN, M. Ed WHAT IS GENOMICS? WHAT YOU NEED TO KNOW The study of all genes in the human genome together, including their interactions with each other, the environment, and the influence of other psychosocial and cultural factors. An independent panel of nurse leaders from clinical, research, and academic settings met and developed nursing’s consensus on the minimal amount of genetic and genomic competency expected by every registered nurse, regardless of academic preparation, practice setting, role, or specialty. HOW IS GENOMICS LINKED TO NURSING? According to the American Nurses Association, genomics is a central science for all nursing practice because essentially all diseases and conditions have a genetic or genomic component. Health care for all persons will increasingly include genetic and genomic information along the pathways of prevention, screening, diagnostics, selection of treatment, and monitoring of treatment effectiveness. Check out: http: //www. cdc. gov/genomics/ This body of work is, “Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators, 2 nd edition, established by the Consensus Panel and published by the ANA. The Competency and Curricula Guidelines have been endorsed by 47 nursing organizations including the ANA, the AACN, the ANCC, the NLN, and STTI. WHAT IS HAPPENING NOW A large research project, “Expanding RN Scope of Practice: A Method for Introducing a New Competency into Nursing Practice, ” is underway to determine the best way to introduce genomics into the world of practicing nurses. West Virginia University and 21 Magnet hospitals are conducting the study, funded by the National Council of State Boards of Nursing, and endorsed by the National Institutes of Health and the National Cancer Institute. The survey addresses genomic knowledge, competency, attitudes, and utilization. Florida has one Magnet hospital participant—Baptist Hospital of Miami. The study is in the implementation stage, concluding in September 2013. More to come!

“Where did you get those eyes? ” Such a flattering question elicits a meaningful genetic probe into your family history. You could just as easily be asking a patient, “Do allergies, high cholesterol, or cancer run in your family? ” “Genetics is a central science for all nursing practice because essentially all diseases and conditions have a genetic or genomic component. Health care will increasingly include genetic and genomic information along the pathways of prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness. ” (The Consensus Panel on Genetics/Genomics Nursing Competencies, Essentials of Genetic/Genomic Nursing, Curricula Guidelines, and Outcome Indicators, 2 nd Ed. , 2009, Silver Spring, MD: American Nurses Association. )

YOU AND YOUR GENES � YOU CAN’T CHANGE YOUR AGE—(”I’M 29…AGAIN…”) � YOU CAN’T CHANGE YOUR PAST—(”I ONLY SMOKED FOR 10 YEARS…”) � YOU CAN’T CHANGE YOUR GENES—BUT YOU CAN CHANGE YOUR FUTURE � BE INFORMED ABOUT GENOMICS—OUR GENES IN OUR ENVIRONMENT: INFORMATION COMING!!!

21 MAGNET HOSPITAL DYADS: SEPTEMBER 2012—Washington, DC