The Future of Nursing: Campaign for Action, a Robert Wood Johnson Foundation initiative, announced March 1 that 10 more states were selected as regional action coalitions, or RACs.
New York and New Jersey were among the initial five states selected to form RACs last fall, along with Michigan, Mississippi and California. The states of Washington, Idaho, Utah, Colorado, New Mexico, Illinois, Indiana, Louisiana, Virginia and Florida recently joined them.
Based on the Institute of Medicine and the RWJFs Future of Nursing initiative, RACs focus their efforts on fostering interprofessional collaboration in delivering care, enabling health professionals to practice to the fullest level of education and training, promoting seamless nursing education, preparing and enabling RNs to lead change and improving workforce data collection and analysis.
The initiative serves as a blueprint, and its recommendations aim at transforming our healthcare system in a number of ways, said Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing of the Robert Wood Johnson Foundation and director of the RWJF Initiative on the Future of Nursing at the Institute of Medicine. For example, when we speak about nurses practicing to their fullest, we are not just speaking about nurse practitioners. We have nurses in schools, hospitals and physicians offices who have been trained and are not able to use all of their skills and knowledge. Its a waste of our resources.
Models of PracticeEdna Cadmus, RN
At a Feb. 25 New Jersey Campaign for Action Forum at the College of New Jersey in Ewing, Hassmiller, David Knowlton, president and CEO of the New Jersey Health Care Quality Institute and former deputy commissioner of the New Jersey Department of Health, and nurse leaders addressed ways the New Jersey RAC is piloting efforts to further the Campaign for Action. The RACs capture best practices, determine research needs, track lessons learned and identify replicable models.
Edna Cadmus, RN, PhD, NEA-BC, clinical professor and director of the DNP Program-Leadership Track at Rutgers University College of Nursing, and Mary Ann Christopher, RN, MSN, FAAN, president of the Visiting Nurse Association of New Jersey and national advisory chairwoman of the New Jersey Nursing Initiative, presented nurse-driven evidence-based models of care in New Jersey, which demonstrate the fullest scope of practice, seamless education and leadership in healthcare redesign.Susan Hassmiller, RN
Through these snapshots of real people, we showcase what we can accomplish and that we cant do it without nurses, Christopher said. In New Jersey, a nurse who serves people with mental illness and who are homeless living at shelters and other facilities, has prevented unnecessary ED visits and decreased the necessity for local services. Another nurse, a school-based nurse practitioner, provides primary care services to children who are at risk for abuse, neglect and teen pregnancies. Through her services, she has averted 22,000 hours of absenteeism among parents and children.
Other nurses leaders are responsible for changing public policy and creating lasting roles for nurses in federally funded programs. In the future, we want to continue to sit nurses at every policy table at which healthcare system redesign is taking place, Christopher said.
But education needs to become more seamless. As far as the IOM recommendation of 80% of nurses with BSN degrees by 2020, we need to make radical changes in our progression of nurses along the educational pathways in New Jersey. This means testing models like the Oregon model, only making it New Jersey style, Cadmus said. We also need to look at students clinical placements in long-term care, home care and new models, such as medical/health homes and transitional care models.
Implications for PracticeChristine Kovner, RN
On Feb. 17, a Future of Nursing program took place at New York University with panelists Julie A. Fairman, RN, PhD, FAAN, professor of nursing and director of the Barbara Bates Center for the Study of History of Nursing at the University of Pennsylvania; Christine Kovner, RN, PhD, FAAN, professor at NYU College of Nursing, senior fellow at the Hartford Institute for geriatric nursing and nurse attending at NYU Langone Medical Center; Kimberly Glassman, RN, PhD, NEA-BC, senior vice president of patient care services and CNO at NYU Langone Medical Center; and Marc N. Gourevitch, MD, MPH, at Bellevue Adult Primary Care Clinic and codirector of the Community Engagement and Population Health Research Core.
Although the meetings of the IOM committee were secret, we werent surprised at the issues that were addressed, for example, the need for more nurses with their baccalaureate degrees, Kovner said. Now that we have the recommendations on the table, the coalition groups will identify how to accomplish them. Kovner served as one of four researchers who answered questions from the IOM committee throughout its nursing investigations.
As far as collaboration, our nurses work with our physician partners, peers and outside organizations to research, share and propose best practices that can be applied to improve patient care, Glassman said. According to Glassman, through its Partnering for Quality program, nurse managers and physician leaders at NYU Langone together identify and create clinical quality improvement projects at the unit level to ensure appropriate standards of care, based on their study and work.Kimberly Glassman, RN
The development of post-baccalaureate nurse residency programs is an IOM recommendation aimed at improving new graduate nurses transition into practice. For more than a decade, NYU Langone has had an established nurse residency program in place. This standardized curriculum, developed in partnership with five other academic medical centers in the University Healthsystem Consortium and the American Association of Colleges of Nursing, has graduated more than 22,000 nurses nationwide. We believe that it is now important to develop an APRN residency program to provide a similar and supportive transition for new APRNs, Glassman said.
The recommendation calls for nurse residency programs to be established for all significant job transitions: early-career, APRN and new clinical settings. The first step is getting post-baccalaureate nurse residency programs accredited through the Commission on Collegiate Nursing Education, which is under way across the nation, Glassman said.
Led by Donna Shalala, PhD, professor and president at the University of Miami, and Linda Burnes Bolton, RN, DrPH, FAAN, vice president and CNO at Cedars-Sinai Health System and Research Institute in Los Angeles, the IOM committee consisted of 16 healthcare leaders from multidisciplinary backgrounds, four of whom were nurses. We want to continue to enlist a broad base of support, and now our job is to recruit committed and engaged stakeholders from all walks of life so that we can improve the value and quality of healthcare, Kovner said.