PAM BURNETTE & GRACE PARANZINO

How nontraditional roles are reshaping nursing careers

A NEW ERA FOR NURSING:

/02

Today, nursing is no longer solely about caring for patients. It’s about technology, community-wide health management, and consistently improving the overall outcomes of a growing industry.

Over the next 10 years, the United States will need more registered nurses

than ever before.

In fact, employment of registered nurses is projected to grow 19 percent from 2012

to 2022—significantly above the average growth rate for all occupations.

Clearly, much of this growth will occur in response to the expansion of preventative care

initiatives; the increase in rates of chronic conditions, such as diabetes and obesity;

and demand for healthcare services from an aging population.

There is growing demand for registered nurses outside hospital settings too,

calling for an altogether new kind of nurse.1

Here, we outline the social and community trends that are shaping a new world of opportunities

for nurses, and also shaping the skill sets and opportunities of tomorrow’s nurses.

INTRODUCTION

KEY HIGHLIGHTS

In this ebook, you

will learn about:

• Growth and demand

on the increase

• Big data and how it

continues to shape the

nursing profession

• The skills new

nurses require

1 http://www.bls.gov/ooh/healthcare/registered-nurses.htm

/03

THE FUTURE OF AFFORDABLE CARE

In the wake of the Affordable Care Act, the role of the nontraditional nurse in the community has changed.

The value of nurses’ work in delivering the right messages at the right times to vulnerable

and at-risk groups is now a key focus for communities that are seeking to lower the cost

of acute healthcare delivery, and this is only going to increase.

Now more than ever, governments, businesses, and communities understand that

prevention is far better, and far cheaper, than the cure. As a result, the focus is on patient-

care specialists who can deliver proactive outreach care to individuals in hopes

of alleviating more costly hospital visits down the road.

Educational facilities, corporate settings, and even government-funded initiatives to

support the elderly in their own homes, all require specific expertise that only registered

nurses can deliver. The focus on positive lifestyle changes is leading to more consultative

work for nurses outside healthcare facilities, and there is evidence to suggest that there

are qualified nurses not currently employed in hospital settings that could be leveraged

for this kind of work:

In 2013, there were more than 2.6 million registered nurses employed across the United

States, yet there is a total of 3.1 million registered nurses nationwide. There could be up

to 500,000 licensed nurses that these new fields could re-engage.2

THE FUTURE OF AFFORDABLE CARE /04

3.1mregistered

2.6memployed

500,000difference

2 http://www.bls.gov/oes/current/oes291141.htm http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf

/05

Nurses have always been important. But in the battle to deliver preventative care on a grand scale, nontraditional nursing roles are now more important than ever.3

Consider the top five reasons students say that they choose the field of

nursing as a career:

• Personal satisfaction and growth

• Career mobility

• Job security

• Scheduling flexibility

• Competitive salaries4

These drivers, such as growth, mobility, and security line up nicely to the benefit of

emerging nontraditional nursing roles.

THE FUTURE OF AFFORDABLE CARE

3 http://www.fiercehealthcare.com/story/more-registered-nurses-step-nontraditional-roles/2014-04-284 https://www.son.rochester.edu/prospective-students/why-choose-nursing.html

“Nontraditional nursing careers have emerged due to technological growth and healthcare reform.

Areas such as patient safety and quality of care, informatics, behavioral modification, and care coordination have become areas where nursing is at the forefront of integrated care delivery.”

Grace K. Paranzino, EdD, RN, CHES, FAAOHN Chief Clinical Officer, Healthcare Product, Centers of Excellence, Kelly Services, Inc.

/06

NURSING IS ALREADY A VARIED ROLE

NURSING IS ALREADY A VARIED ROLE

“Occupational health nursing is an expanding field as employers strive to demonstrate ROI on preventive care and create a culture of wellness for employees. In addition, occupational health nurses are well-positioned to coordinate care and provide expertise on work and non-work related medical concerns. As workers spend most of their day in a work environment, occupational health nurses have a perfect setting to positively impact behavior change, and provide a safe workplace.”

Grace K. Paranzino, EdD, RN, CHES, FAAOHN Chief Clinical Officer, Healthcare Product, Centers of Excellence, Kelly Services, Inc.

/07

6 hhttp://explorehealthcareers.org/en/Career/117/Occupational_Health_Nurse 7 http://www.cmsa.org/Consumer/FindaCaseManager/WhatisaCaseManager/tabid/276/Default.aspx 5 http://explorehealthcareers.org/en/Career/21/Registered_Nurse_RN

A registered nurse is already a varied and flexible resource working inside many different clinical and non-clinical settings.

Some of the nontraditional nursing roles that fall underneath the category of

registered nurse include:

1. Occupational health nurses: professionals in these roles are tasked with

independently observing and assessing workers’ health status with respect to job tasks

and hazards. Using their specialized experience and education, they recognize and

prevent health effects from hazardous exposures and treat workers’ injuries and illnesses.6

2. Case management nurses: these professionals provide services to help

individuals and families cope with complex and difficult health-related situations. Their

aim is to assist people and their support networks to achieve the best possible quality

of life. They are goal oriented and help patients to identify their own version of success

in their lives. “From an assessment, the case manager and the client—whether an

individual or a family—together formulate a plan to meet those goals. The case manager

helps clients to find resources and facilitates connection with services. Sometimes she

or he advocates on behalf of a client to obtain needed services. The case manager also

maintains communication with the client to evaluate whether the plan is effective in

meeting the client’s goals.”7

“A registered nurse requires a large base of knowledge to assess, plan, and intervene to promote health, prevent disease, and help patients cope with illness.

Registered nursing roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, directing complex nursing care systems, conducting clinical research, and teaching in nursing programs.”5

/08NURSING IS ALREADY A VARIED ROLE

3. HEDIS® nurses: HEDIS nurses are responsible for scheduling and performing on-site

medical record reviews at physician offices. People in these roles work to ensure specific,

measurable service standards, and assist in developing process improvement initiatives where

required. A HEDIS nurse “provides oversight in the planning, implementation, and coordination

of HEDIS healthcare audits to ensure high-quality, cost-effective care.”8

4. Quality assurance (QA)/process improvement nurses: nurses in QA roles

“evaluate the work and behavior of employees in their departments, whether at a hospital,

doctor’s office, or healthcare facility. By monitoring their colleagues, they can ensure qualitative

requirements are being met as specified by the hospital or state.” The goal of a QA nurse is to

deliver best practice approaches in healthcare facilities. They focus on continuous improvement

and take a data-driven and measurable approach to achieving improvements.9

5. Nurse in-service educators: these nursing roles are designed to deliver “training

support on the features, benefits, and use of medical devices. Typically in a hospital setting,

nurses educate other medical professionals on medical devices that are new to the market or

have been updated or modified. Device training is an integral part of overall patient safety and

is designed to increase the skills and competence of the staff in a specific area.”10

8 http://www.execu-search.com/197261/health-services-healthcare 9 http://education-portal.com/articles/Quality_Assurance_QA_Nurse_Career_Information_and_Requirements.html 10 http://www.nurse.com/students/CareersInNursing/CareerAlternatives/PHAR.htm

/9/09

A SNAPSHOT OF NURSING TODAY

SALARIES FOR THE FIVE NONTRADITIONAL NURSING AREAS:

Occupational Health Nurses $63,472

Case Management Nurses $69,00012

HEDIS Nurses $67,000

Quality Assurance/Process Improvement Nurses $61,23613

In-service Education Nurses $83,000

/10/10

Registered nurses earn on average

$65k

Almost one-quarter of all registered nurses are 55 years of age or older.

YEARLY SALARY GUIDE FOR TODAY’S NURSE

11 NACE Salary Survey 12 http://www.indeed.com/salary/RN-Case-Manager.html13 http://www.payscale.com/research/US/Job=Quality_Assurance_(QA)_Coordinator_(RN)/Salary

55years or

older

Nursing graduates have an average starting salary of

$52.8k11

Experienced registered nurses with advanced education can earn

$80k

/11

Around

of job growth over the next decade will be in these cities:

30%CHICAGO, IL

LOS ANGELES, CA

PHOENIX, AZ DALLAS, TX

ATLANTA, GA

WASHINGTON, D.C.

PHILADELPHIA, PA

NEW YORK/NEW JERSEY

BOSTON, MA

WHERE THE JOBS ARE:TOP METROPOLITAN AREAS FOR NURSING

Of them all, Houston, Texas, is expecting the strongest growth, projecting an increase of 32% between now until 2023.

32%increase

HOUSTON, TX

/12/12

GROWTH AND DEMAND ON THE INCREASE

How fast is the number of nursing jobs growing? Over the next ten years, there will be more than 432,000 registered nursing jobs available in the U.S.

There will be excellent job opportunities in nursing in the coming years, according

to the BLS, due in part to an aging population and an increase in long-term care

facilities for patients.

Hospitals and national security will dominate in the hiring of nurses; the statistics

show just how significant the number of nurses being hired by organizations in the

administrative, insurance, and home healthcare industries will be, as demonstrated on

the following page.

GROWTH AND DEMAND ON THE INCREASE /13

“With the rollout of the Affordable Care Act many more Americans are insured and have access to healthcare. This has driven up the need for healthcare professionals, especially in nontraditional nursing roles. The health insurance industry is one more example, as more Americans are insured there are more opportunities for case management, utilization review, and HEDIS nurses. What an exciting time to be a nurse in the healthcare profession, as we watch opportunities for career growth and patient care, as well as access to care.”

Pam Burnette MBA, BSN, RN Director of Kelly Services Healthcare Product Kelly Services, Inc.

INDUSTRY

General Medical and Surgical Hospitals 62,290

National Security 35,098

Offices of Physicians (except Mental Health Specialists) 33,723

Temporary Help Services 21,284

Home Healthcare Services 16,112

Nursing Care Facilities 14,846

All Other Miscellaneous Ambulatory Healthcare Services 13,636

Employment Placement Agencies 12,945

Direct Health and Medical Insurance Carriers 5,974

Office Administrative Services 5,560

/14/14

WHICH INDUSTRIES ARE HIRING?

Despite peaks and valleys in demand, the

overall trend line for nursing skill sets has

been on a steady incline for some time.

“Staffing agencies will need to demand strong, skilled nursing professionals moving forward. The demand for these highly skilled nurses will increase 26% by 2020. Most of these increases will be in healthcare offices and community clinics with the implementation of the ACA.”14

14 Spetz, J. How Will Health Reform Affect Demand for RNs? Nursing Economics. 2014; 32 (1): 42-43.

26%2020

VOLUME

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BIG DATA WILL SHAPE NURSING TOO

“In every healthcare environment, there is a growing need for care coordination. The role of care coordinator may take many forms. It may involve providing coordination directly in complex or rapidly changing situations, supervising other team members when care is relatively predictable (tiered coordination), or advising entire communities (populations) on the best choices for the highest levels of wellness.“16

/16BIG DATA WILL SHAPE NURSING TOO

16 California Institute for Nursing and Health Care. (2013, September). Nurse Role Exploration Project: The Affordable Care Act and New Nursing Roles. Available online at: http://cinhc.wpengine.netdna-cdn.com/wp-content/uploads/2013/09/CINHC WhitePaperNurseRoles-100420131.pdf

Over the decades ahead, it is likely that registered nurses will be increasingly involved in large-scale population health management programs.

The growth of big data opportunities will impact the nursing profession too. It is likely

that a stronger connection between data and analysis will drive longer-term, large-

scale health improvements.

In many areas, there are shortages of qualified nursing professionals. There are

growing opportunities for nurses to work remotely, particularly as Internet connectivity

becomes more widespread and e-health initiatives benefit from improved validation

and testing capabilities. In fact, nursing is no longer a job that is tied to a hospital

or clinical setting—it is benefiting from trends in flexible working and

telecommuting, as are many other professions.

“There is a need for a shift toward RNs playing critical roles in the development

of software and its application. The roles envisioned included informatics design,

application, and interpretation across settings. Many opportunities will be in

community settings, as RNs use technology to provide one of the most critical

components of care: touch. Although it would be a ‘virtual touch,’ when

combined with an occasional physical presence, it could be very powerful in

supporting successful independent living.”

Clearly, changes in nursing education are critical to realizing the new roles aligned

to the skill set, and in developing registered nurses that are prepared to deliver

care outside the acute care setting.

/17BIG DATA WILL SHAPE NURSING TOO

17 http://cinhc.wpengine.netdna-cdn.com/wp-content/uploads/2013/09/CINHC-WhitePaperNurseRoles-100420131.pdf

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THE SKILLS NEW NURSES REQUIRE

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Employers today are looking for healthcare professionals that can demonstrate skills and

expertise beyond patient care.

They must express themselves clearly and professionally, display strong teamwork and

project management abilities, and work collaboratively to solve complex problems that

may not always have technical causes.

When applying for roles, registered nurses need to focus not only on technical skill but

soft skills as well—this is often the differentiating factor between job candidates.

We surveyed our healthcare recruiters and the top five soft skills they look for in nursing job candidates are:

Reliability and dependability

Communication skills

Self-direction /Self-motivation

Flexibility and adaptability

Positive work ethic

WHAT EMPLOYERS ARE LOOKING FOR

As nurses become more pivotal to preventative care initiatives, they are in higher demand and will command higher salaries, too.

With just a few years of experience under their belt, registered nurses can begin to

practice within specialty areas of nursing where they can find a niche outside of a

hospital setting.

A nursing qualification no longer limits candidates to one specific role in one specific

setting. And there are more jobs available than there are qualified candidates to fill

the growing demand for nontraditional nursing roles.

With the right mix of technical skills and soft skills, nurses have a diverse and

rewarding career ahead of them.

/20CONCLUSION

/21/21

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Kelly Services, Inc. (NASDAQ: KELYA, KELYB) is a leader in providing workforce solutions. Kelly offers a

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ABOUT THE AUTHORS

Dr. GRACE K. PARANZINO is currently the Corporate Chief Clinical Officer for Kelly Healthcare

Resources, a leader in providing workforce solutions. Dr. Paranzino is a nurse executive with

30 years of progressive management and leadership experience in the hospital environment,

academia, and the healthcare staffing industry. Dr. Paranzino is actively involved with the

American Association of Occupational Health Nurses (AAOHN). She is Past-President of the

Michigan State Chapter, serves on the Board of Directors as Secretary for AAOHN, and is

on the Editorial Review Board for the AAOHN Journal.

PAM BURNETTE is Director of Healthcare Product for Kelly Services®. Ms. Burnette is responsible

for selling healthcare solutions, including education, sales generation, innovation, and community

immersion activities. Ms. Burnette is an active member of AONE, the American Organization of

Nurse Executives. AONE is a national organization of nurse leaders who design, facilitate, and

manage care. Ms. Burnette received her undergraduate nursing degree from Western Carolina

University and her master’s degree in Business Administration from Montreat College. Ms. Burnette

has also been honored as a Great 100 Nurse in North Carolina.

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