WEBVTT 00:00:06.720 --> 00:00:09.800 position:50% align:middle Welcome to this year's CEO Report. 00:00:09.800 --> 00:00:13.780 position:50% align:middle My name is David Benton, and I have the honor of serving as NCSBN's 00:00:13.780 --> 00:00:15.870 position:50% align:middle chief executive officer. 00:00:15.870 --> 00:00:20.210 position:50% align:middle This report reflects on the past, but looks to the future. 00:00:20.210 --> 00:00:24.180 position:50% align:middle More than a century ago, nurses in many parts of the world argued that there was 00:00:24.180 --> 00:00:27.900 position:50% align:middle a need to regulate the profession of nursing. 00:00:27.900 --> 00:00:32.924 position:50% align:middle This development started in several countries almost simultaneously, and it is now spread to 00:00:32.924 --> 00:00:35.530 position:50% align:middle almost all nations of the world. 00:00:35.530 --> 00:00:40.678 position:50% align:middle Indeed, for anyone that wants more information on this topic, I recommend you visit our global 00:00:40.678 --> 00:00:46.485 position:50% align:middle regulatory atlas or review the content of our global profile published as a supplement to the 00:00:46.485 --> 00:00:49.310 position:50% align:middle "Journal of Nursing Regulation." 00:00:49.310 --> 00:00:53.765 position:50% align:middle Furthermore, the founding mothers of this organization recognize the unique and essential 00:00:53.765 --> 00:00:59.971 position:50% align:middle contribution that regulators could make, and as a result, bonded together and founded more than 00:00:59.971 --> 00:01:07.450 position:50% align:middle 40 years ago NCSBN, an organization that has been at the forefront of regulatory advancement for more 00:01:07.450 --> 00:01:09.400 position:50% align:middle than 4 decades. 00:01:09.400 --> 00:01:16.000 position:50% align:middle But the past 18 months has highlighted the need for regulators to take a further quantum step 00:01:16.000 --> 00:01:21.470 position:50% align:middle in our evolution, a step where we are braving new pathways and leading the way 00:01:21.470 --> 00:01:24.210 position:50% align:middle for regulatory transformation. 00:01:24.210 --> 00:01:29.980 position:50% align:middle Now, over the next 10 minutes or so, I will provide you with an insight into the journey, 00:01:29.980 --> 00:01:36.980 position:50% align:middle not a blueprint, but more of an example of the kind of thinking we will need to explore as we take the 00:01:36.980 --> 00:01:40.750 position:50% align:middle next steps in our journey towards regulatory excellence. 00:01:40.750 --> 00:01:42.760 position:50% align:middle So let's get started. 00:01:42.760 --> 00:01:45.950 position:50% align:middle During the pandemic, we have seen several policy documents, 00:01:45.950 --> 00:01:52.150 position:50% align:middle particularly pertinent to the advancement of nursing services and their associated regulation. 00:01:52.150 --> 00:01:57.630 position:50% align:middle We have seen the publication of both the state of the world nursing and midwifery reports. 00:01:57.630 --> 00:02:02.879 position:50% align:middle Earlier this year at the World Health Assembly, nations of the world came together to endorse the 00:02:02.879 --> 00:02:08.830 position:50% align:middle latest iteration of the strategic directions document for strengthening nursing and midwifery. 00:02:08.830 --> 00:02:15.670 position:50% align:middle This document focuses on four major areas, education, jobs, leadership, and service delivery. 00:02:15.670 --> 00:02:20.370 position:50% align:middle And encompasses 12 areas of work, many of them with specific relevance 00:02:20.370 --> 00:02:22.470 position:50% align:middle to regulatory reform. 00:02:22.470 --> 00:02:26.460 position:50% align:middle In countries around the world, we have also seen a plethora 00:02:26.460 --> 00:02:28.170 position:50% align:middle of nursing-related publications. 00:02:28.170 --> 00:02:33.720 position:50% align:middle For example, here in the United States, "The Future of Nursing," the Tri-Council summit report, 00:02:33.720 --> 00:02:37.780 position:50% align:middle and work currently underway by Johnson & Johnson. 00:02:37.780 --> 00:02:41.740 position:50% align:middle Increasingly, we have seen numerous policy contributions across a wide range 00:02:41.740 --> 00:02:46.770 position:50% align:middle of nursing-related topics, adding significantly to the evidence base and providing 00:02:46.770 --> 00:02:51.370 position:50% align:middle a basis for influencing future health-care delivery and design. 00:02:51.370 --> 00:02:56.960 position:50% align:middle It is not the intention to examine these nursing examples as that analysis is currently the focus 00:02:56.960 --> 00:03:00.550 position:50% align:middle of work NCSBN is doing as part of the Tri-Council. 00:03:00.550 --> 00:03:04.850 position:50% align:middle And we will be sharing that analysis in due course. 00:03:04.850 --> 00:03:09.700 position:50% align:middle But as President Douglas just noted, the board of directors and the CEO have a 00:03:09.700 --> 00:03:13.750 position:50% align:middle responsibility to constantly look up and out. 00:03:13.750 --> 00:03:18.460 position:50% align:middle Over the past 18 months, we have done that in partnership with our membership 00:03:18.460 --> 00:03:23.360 position:50% align:middle and many other nursing and regulatory stakeholders as well as representatives of state 00:03:23.360 --> 00:03:25.350 position:50% align:middle and federal government. 00:03:25.350 --> 00:03:30.521 position:50% align:middle It has been an exciting, although at times, exhausting period where legislative change has 00:03:30.521 --> 00:03:34.610 position:50% align:middle been frequent and for the most part, liberating. 00:03:34.610 --> 00:03:41.660 position:50% align:middle However, this is only a stimulus for change, not the policy terminus, and a great deal of work is 00:03:41.660 --> 00:03:42.820 position:50% align:middle still to be done. 00:03:43.950 --> 00:03:48.440 position:50% align:middle Now, as we move forward, we need to move from evidence-based policy 00:03:48.440 --> 00:03:50.190 position:50% align:middle to evidence-based action. 00:03:50.190 --> 00:03:55.497 position:50% align:middle We need to embrace the opportunities of the post-COVID world, saving those changes that have 00:03:55.497 --> 00:04:01.050 position:50% align:middle brought efficiency and effectiveness and rolling back those that have placed the public at risk. 00:04:01.050 --> 00:04:06.510 position:50% align:middle We must play our full part in the orchestra for transformational change that will create 00:04:06.510 --> 00:04:08.720 position:50% align:middle a safer tomorrow. 00:04:08.720 --> 00:04:14.550 position:50% align:middle So looking up and out at braving new pathways will require us to navigate the landscape, 00:04:14.550 --> 00:04:20.960 position:50% align:middle a landscape that is becoming increasingly complex and one that requires considerable agility. 00:04:20.960 --> 00:04:23.070 position:50% align:middle But this is not a solo journey. 00:04:23.070 --> 00:04:26.570 position:50% align:middle For us to be successful, we will need to generate synergy 00:04:26.570 --> 00:04:33.400 position:50% align:middle with other stakeholders, regulators, educators, policymakers, and other professional groups 00:04:33.400 --> 00:04:35.930 position:50% align:middle as well as the public themselves. 00:04:35.930 --> 00:04:41.210 position:50% align:middle The old ways of engaging stakeholders will be insufficient, and new and innovative ways of 00:04:41.210 --> 00:04:46.561 position:50% align:middle engaging and collaborating with others will be needed if rapid and quantum reform is 00:04:46.561 --> 00:04:47.517 position:50% align:middle to take place. 00:04:47.517 --> 00:04:53.990 position:50% align:middle Creating a safer tomorrow will require us to move from a model that responds to failures to one that 00:04:53.990 --> 00:04:59.760 position:50% align:middle is preemptive, anticipating the issues, and working far more closely with employers, educators, 00:04:59.760 --> 00:05:01.290 position:50% align:middle and the public. 00:05:01.290 --> 00:05:07.970 position:50% align:middle We need to build on our current model that assure safe entry to practice to one that maintains safety 00:05:07.970 --> 00:05:10.020 position:50% align:middle throughout the entire career journey. 00:05:10.020 --> 00:05:15.240 position:50% align:middle As healthcare becomes more complex, the focus will need to move from competence 00:05:15.240 --> 00:05:18.540 position:50% align:middle of individuals to competence of teams. 00:05:18.540 --> 00:05:22.740 position:50% align:middle And in part, because of the success of our current treatment-based model, 00:05:22.740 --> 00:05:28.420 position:50% align:middle we will need to determine how we regulate for services that achieve optimal life rather 00:05:28.420 --> 00:05:31.150 position:50% align:middle than just safe practice. 00:05:31.150 --> 00:05:34.770 position:50% align:middle So, what does that mean for us as regulators? 00:05:34.770 --> 00:05:40.930 position:50% align:middle In short, it requires us to have foresight, scanning wider horizons, and influencing to avoid 00:05:40.930 --> 00:05:45.490 position:50% align:middle problems rather than reacting to foreseeable consequences. 00:05:45.490 --> 00:05:48.590 position:50% align:middle Let me give you an example of what I mean. 00:05:48.590 --> 00:05:51.160 position:50% align:middle We tend to stay in our lane. 00:05:51.160 --> 00:05:57.650 position:50% align:middle We eagerly consume policy content that relates to regulation, but we often restrict our analysis to that 00:05:57.650 --> 00:05:59.930 position:50% align:middle material emanating from health domain. 00:05:59.930 --> 00:06:04.730 position:50% align:middle For this example, I wish to step outside our comfort zone. 00:06:04.730 --> 00:06:09.060 position:50% align:middle I am going to look at school, vocational, and higher education. 00:06:09.060 --> 00:06:15.350 position:50% align:middle I contend that regulators need to be aware of the potential implications of the educational disruption, 00:06:15.350 --> 00:06:19.580 position:50% align:middle both on the caliber and the number of nursing student candidates. 00:06:19.580 --> 00:06:26.440 position:50% align:middle I also wish to suggest that it is important to look at this topic right now as it takes time to change the 00:06:26.440 --> 00:06:33.320 position:50% align:middle direction of the educational oil tanker, and it has been repeatedly recognized that there is 00:06:33.320 --> 00:06:37.560 position:50% align:middle an increasing demand for nursing services into the future. 00:06:37.560 --> 00:06:42.153 position:50% align:middle The reports you see on the screen have been published by the Organization for Economic 00:06:42.153 --> 00:06:45.740 position:50% align:middle Collaboration and Development based in Paris. 00:06:45.740 --> 00:06:52.288 position:50% align:middle In this intergovernmental agency, the United States, along with 37 other high-income countries work 00:06:52.288 --> 00:06:55.020 position:50% align:middle together to identify issues of common concern. 00:06:55.020 --> 00:07:00.400 position:50% align:middle They examine a wide range of topics, such as regulation, education, health, mobility, 00:07:00.400 --> 00:07:02.880 position:50% align:middle and many, many more. 00:07:02.880 --> 00:07:08.830 position:50% align:middle I'm not presenting this brief analysis as a comprehensive thesis on the potential regulatory 00:07:08.830 --> 00:07:15.434 position:50% align:middle impacts of these studies on professional self-regulation, but rather as an example of why if 00:07:15.434 --> 00:07:21.390 position:50% align:middle we are to navigate the future, we need to look beyond our normal horizon of interest. 00:07:21.390 --> 00:07:27.692 position:50% align:middle I am, if you will, simply going to present three examples of the multitude of issues that these 00:07:27.692 --> 00:07:33.124 position:50% align:middle reports cover as a means of illustrating the importance of taking a wider perspective if we are 00:07:33.124 --> 00:07:39.200 position:50% align:middle to equip ourselves with a periscope that can see beyond our normal gaze. 00:07:39.200 --> 00:07:46.470 position:50% align:middle In short, this is looking upstream or over the horizon, so we can be mindful of the potential issues in the 00:07:46.470 --> 00:07:48.530 position:50% align:middle workforce supply chain. 00:07:48.530 --> 00:07:53.751 position:50% align:middle For this first example, I will argue that basic math skill is important if you 00:07:53.751 --> 00:07:56.940 position:50% align:middle are to be a safe clinical practitioner. 00:07:56.940 --> 00:08:02.776 position:50% align:middle Now, for those of you that are of a certain age, you will recall how we had to manually calculate 00:08:02.776 --> 00:08:09.520 position:50% align:middle drip rates to ensure that patients receive the correct infusion over a particular time without overloading 00:08:09.520 --> 00:08:11.900 position:50% align:middle their cardiac or renal systems. 00:08:11.900 --> 00:08:18.010 position:50% align:middle So let's look at the impact of introducing hybrid learning differentiated on the basis of the 00:08:18.010 --> 00:08:20.460 position:50% align:middle income of families. 00:08:20.460 --> 00:08:24.800 position:50% align:middle All learners were impacted by the pandemic and lost learning. 00:08:24.800 --> 00:08:29.803 position:50% align:middle But as you can see from this graph, it was the lowest income family children that were 00:08:29.803 --> 00:08:31.666 position:50% align:middle impacted the most. 00:08:31.666 --> 00:08:38.048 position:50% align:middle At a time when we are aware that we need to diversify the workforce, this potentially makes the 00:08:38.048 --> 00:08:41.450 position:50% align:middle challenge of recruiting diverse candidates more challenging. 00:08:41.450 --> 00:08:46.280 position:50% align:middle It may place additional demands on faculty to help remediate learning loss. 00:08:46.280 --> 00:08:52.940 position:50% align:middle And ultimately, if those gaps are not addressed, the passing rate of the NCLEX exam for those most 00:08:52.940 --> 00:08:55.420 position:50% align:middle impacted may decline. 00:08:55.420 --> 00:09:01.410 position:50% align:middle Knowing that this is an issue ahead of time means we can work to remediate the problem. 00:09:01.410 --> 00:09:06.500 position:50% align:middle Now, as you are aware, I have raised the issue of educational programs before, 00:09:06.500 --> 00:09:12.685 position:50% align:middle and hence working with the education policy community becomes, as a result of COVID, even 00:09:12.685 --> 00:09:14.590 position:50% align:middle more of an imperative. 00:09:14.590 --> 00:09:20.780 position:50% align:middle Advocating for education programs that focus exclusively on nursing content that articulates 00:09:20.780 --> 00:09:25.780 position:50% align:middle across levels from support worker, to licensed practical nurse, to registered nurse, 00:09:25.780 --> 00:09:29.690 position:50% align:middle and then onto advanced practice, may be a good starting point. 00:09:29.690 --> 00:09:35.680 position:50% align:middle Such an approach would, as has been shown in other countries, help diversify the workforce and 00:09:35.680 --> 00:09:41.830 position:50% align:middle provide a ladder of progress, lifting people out of poverty, and providing the workforce that we need 00:09:41.830 --> 00:09:45.700 position:50% align:middle to meet access to service gaps. 00:09:45.700 --> 00:09:47.920 position:50% align:middle What about graduation rates? 00:09:47.920 --> 00:09:54.765 position:50% align:middle Well, we will need to see what happens, but some countries appeared to let many more 00:09:54.765 --> 00:09:59.270 position:50% align:middle students graduate than would have been expected in a normal year. 00:09:59.270 --> 00:10:05.874 position:50% align:middle As they progress into higher levels of education, passing rates may fall and the use of graduation 00:10:05.874 --> 00:10:11.790 position:50% align:middle scores will potentially be less reliable as a selection indicator for programs. 00:10:11.790 --> 00:10:18.710 position:50% align:middle More importantly, faculty may find that they have a more educationally diverse range of students. 00:10:18.710 --> 00:10:24.900 position:50% align:middle As a result, additional remedial support may be needed if passing rates are to remain stable. 00:10:24.900 --> 00:10:30.676 position:50% align:middle These factors may further complicate workforce planning, and expected and needed yield 00:10:30.676 --> 00:10:31.956 position:50% align:middle may not be met. 00:10:31.956 --> 00:10:38.930 position:50% align:middle To this end, and linked to the first example, working with employers to design progressive levels 00:10:38.930 --> 00:10:44.630 position:50% align:middle of performance that delineates step-on and step-off points that assist in minimizing attrition 00:10:44.630 --> 00:10:46.540 position:50% align:middle may be needed. 00:10:46.540 --> 00:10:51.210 position:50% align:middle This final example has some important data that needs to be considered. 00:10:51.210 --> 00:10:56.780 position:50% align:middle It was not just nursing that struggled to find access to practice during the pandemic. 00:10:56.780 --> 00:11:02.029 position:50% align:middle Now, we have seen several excellent examples of how education and practice work together 00:11:02.029 --> 00:11:03.397 position:50% align:middle to find solutions. 00:11:03.397 --> 00:11:09.760 position:50% align:middle Many of these examples were born out of strong local relationships between leadership in both 00:11:09.760 --> 00:11:11.250 position:50% align:middle service and education. 00:11:11.250 --> 00:11:18.370 position:50% align:middle But we should not forget that there may be lessons to be learned from other sectors that are reliant 00:11:18.370 --> 00:11:20.340 position:50% align:middle on practice-based learning. 00:11:20.340 --> 00:11:26.170 position:50% align:middle This slide also identifies other areas of challenge that if we open dialogue, 00:11:26.170 --> 00:11:32.420 position:50% align:middle some benefit may result to all of us, both in designing new regulatory models that are more 00:11:32.420 --> 00:11:36.140 position:50% align:middle agile and capable of dealing with disruption. 00:11:36.140 --> 00:11:43.210 position:50% align:middle These examples have only looked at one policy topic area from one intergovernmental agency. 00:11:43.210 --> 00:11:48.501 position:50% align:middle We could have looked at material from the World Bank Group, the World Trade Organization, 00:11:48.501 --> 00:11:54.910 position:50% align:middle the international organization on migration, or the International Labour Organization to mention 00:11:54.910 --> 00:12:03.190 position:50% align:middle but a few of over 200 intergovernmental agencies that can impact on our regulatory landscape. 00:12:03.190 --> 00:12:10.760 position:50% align:middle Managing up and out is a challenge that we must face if we are to design a sustainable regulatory 00:12:10.760 --> 00:12:12.787 position:50% align:middle model fit for the future. 00:12:12.787 --> 00:12:16.550 position:50% align:middle So, let me conclude with three final thoughts. 00:12:16.550 --> 00:12:21.880 position:50% align:middle Public protection in a post-COVID world will be assured by proportionate, reformed, 00:12:21.880 --> 00:12:27.960 position:50% align:middle and agile regulation that delivers in the present and anticipates the evolving health and well-being 00:12:27.960 --> 00:12:29.050 position:50% align:middle needs of all. 00:12:29.050 --> 00:12:35.430 position:50% align:middle Secondly, if we are proactive, regulators will be viewed as key policy actors in the 00:12:35.430 --> 00:12:42.910 position:50% align:middle design and implementation of increased quality and equitable access to the entire continuum of safe, 00:12:42.910 --> 00:12:46.930 position:50% align:middle effective, and efficient nursing services. 00:12:46.930 --> 00:12:54.580 position:50% align:middle And thirdly, regulatory reform will be recognized as a critical component of optimal workforce deployment 00:12:54.580 --> 00:12:56.026 position:50% align:middle and economic recovery. 00:12:56.026 --> 00:13:04.010 position:50% align:middle We are no longer solo performers protecting the public from aberrant practitioners through setting 00:13:04.010 --> 00:13:06.839 position:50% align:middle standards for practice, education, and conduct. 00:13:06.839 --> 00:13:14.239 position:50% align:middle We are part of an orchestra that creates a future where we are braving new pathways and leading 00:13:14.239 --> 00:13:17.200 position:50% align:middle the way for regulatory transformation. 00:13:17.200 --> 00:13:23.540 position:50% align:middle Later this year, we will start to define our next strategic planning cycle. 00:13:23.540 --> 00:13:31.410 position:50% align:middle To transform regulation to what it could be is a challenge, but one that if we face it together can 00:13:31.410 --> 00:13:35.550 position:50% align:middle deliver the next evolution of regulation. 00:13:35.550 --> 00:13:41.190 position:50% align:middle An evolution that will be fit for today's mobile, complex, digital world. 00:13:41.190 --> 00:13:48.090 position:50% align:middle A contemporary system that protects the public, advances the profession, 00:13:48.090 --> 00:13:53.240 position:50% align:middle and delivers quality access and economic advancement for populations. 00:13:53.240 --> 00:13:54.690 position:50% align:middle Thank you.