One of the first state action coalitions charged with addressing the Institute of Medicine’s Future of Nursing: Campaign for Action, New York has made significant progress during the past year, focusing its efforts on four recommendations, with plans to expand to all eight in the near future.
“The report itself is giving nurses the opportunity to know more clearly the necessity for working together and to strategize about how that can best be done,” said Cathryne A. Welch, RN, EdD, executive director of the Foundation of New York State Nurses and co-leader of the Future of Nursing NYS Action Coalition Steering Committee.
The Campaign for Action — coordinated through the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation — aims to ensure all Americans have access to high-quality healthcare, with nurses contributing to the full extent of their capabilities. Welch said support from the IOM, AARP and RWJF emphasizes the importance for nurses to seize the opportunity for change and to work together.
NYS Action Coalition co-chairman Robert O’Connell, an AARP New York Executive Council member, has promoted involvement of people from outside the nursing profession, including business leaders who pay for much of the healthcare in this country and foundations who could fund pilots to model some of the changes.
“We have to avoid being insular, just looking at the nursing perspective,” O’Connell said. “I see these other organizations as allies in the effort to ensure the ultimate goal of quality healthcare, and nursing plays a critical role in that.”
The coalition has built on existing momentum and activities spearheaded by other organizations and zeroed in on recommendations with the highest potential for achievement, including removing scope-of-practice barriers, increasing the number of RNs with a baccalaureate degree to 80% by 2020, doubling the number of nurses with a doctorate by 2020 and creating an infrastructure for collection and analysis of workforce data. The coalition has established subcommittees to work on each priority.
“As soon as we became active and were gaining visibility, it became clear to us that there are pockets of activity in relation to the other four recommendations or a great interest in initiating activity,” Welch said.
Advanced practice legal reforms
Removing scope-of-practice barriers was one of the first focus areas. “Liberating nurse practitioners has been an issue in New York State for a very long time,” Welch said.
Statutory and regulatory reform for APNs is one of the scope-of-practice subcommittee’s highest priorities, said scope-of-practice subcommittee co-chairwoman Bobbie Berkowitz, RN, PhD, FAAN, dean of the Columbia University School of Nursing in New York City. The committee also has worked with the Medicaid redesign team and is looking at inequity in insurance payments, lack of reimbursement for nurses, advancement of healthcare-reform goals, the role of care coordination and consumer choice.
Nurses received a boost in their efforts to remove mandatory physician collaborative-practice agreements for NPs when the Medicaid redesign workforce and scope team recommended the requirement be lifted for NPs.
“We will continue to work with particular legislators, educating them about the evidence in the IOM Future of Nursing report and the value, cost-effectiveness and quality of utilizing advanced practice nurses,” Berkowitz said.
Subcommittees also are moving forward with strategies to support initiatives to increase the number of RNs with baccalaureate and doctoral degrees and to create an infrastructure for collection and analysis of workforce data.
Partnerships are developing between public and private educational institutions to offer dual associate and baccalaureate programs and the City University of New York is piloting a program for seamless transition from the ADN to the BSN.
The doctoral subcommittee has completed a survey of the 13 existing programs to determine the number of nurses with doctorates and how many are pursuing doctoral degrees. In New York state, about 1,000 nurses hold a doctoral degree, and 221 students began their studies this fall, said Darlene Curley, RN, MS, executive director of the Jonas Center for Nursing Excellence in New York and co-chairwoman of the doctoral-education subcommittee. The subcommittee also learned from the American Association of Colleges of Nursing that 81 doctoral degrees were conferred in New York in 2011.
“There appears to be an increase in the number of nurses seeking a PhD or DNP,” Curley said. “Our goal is to have a specific strategy, once we have the data, to reach the goal. We will then be working with colleges and universities, providers and healthcare organizations to support staff and policymakers at the state and federal levels.”
The workforce data subcommittee began by assessing existing sources for data, exploring what information other entities possess and recurring data collection efforts, such as annual surveys by schools of nursing and the state education department, said Carol Brewer, RN, PhD, FAAN, professor of nursing at the University at Buffalo (N.Y.) School of Nursing, who is heading the data subcommittee.
“Undertaking projects to obtain specific data needed to assess the supply, demand and distribution of nurses in New York state will depend on resources available to fund the work,” she said.
The action coalition also has established a subcommittee to develop media plans and is working on creating seven smaller regional action coalitions, recruiting champions to organize action teams in each area. Three of the seven regions have mobilized. Nurses can learn more and sign up to participate at the regional level at the coalition’s website, www.ifnrac-ny.org.
“It’s an exciting time, and it’s wonderful to be part of this,” Welch said. “The momentum is almost palpable.”
Pending New York legislationMary Beth Koslap-Petraco, RN
Three bills of interest to nurse practitioners are pending in the New York State legislature: the NP Modernization Act (A 5308/S 3289), which would remove the requirement of mandatory collaboration with a physician; the Valid Signature Bill (A 2157/S 3881), allowing nurse practitioners to sign DNR orders, immunization exemptions, etc.; and the Mental Health Bill (A 1603/S 4525), which would allow NPs to admit patients to inpatient mental health units. All three bills remain in committee.
“We believe we have the votes, if we can get these bills out of committee,” said Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP, legislative issues chairwoman of the Nurse Practitioner Association of Long Island in Hauppauge, N.Y. She explains the mandatory collaboration agreement requires a retrospective review by a physician, and if that physician retires, it often is difficult for an NP to find a new collaborator. Koslap-Petraco reports at least one instance in which the NP could not find another collaborator, forcing her to give up a practice with 3,000 patients.
NPALI member Susan Marks, RN, MS, ANP-C, said the bills are moving forward and have support in the legislature, as lawmakers hear from constituents who want care from nurse practitioners, but she acknowledges change remains a challenge.