By Geneva Slupski
For the past year, Edna Cadmus, RN, PhD, NEA-BC, and Mary Ann Christopher, RN MSN, FAAN, have visited healthcare organizations and facilities throughout New Jersey to spread the word about the Institute of Medicine’s report on the future of nursing.
New Jersey nurses have taken ambitious strides since the release of the report, titled “The Future of Nursing: Leading Change, Advancing Health.” The New Jersey Action Coalition formed in late 2010, undertaking four pillars from the eight recommendations in the report — nursing leadership; workforce data collection; allowing nurses to practice to the full extent of their education and training; and advanced degrees and continuing education.
Christopher, who has given keynote addresses on the IOM report, considers informing fellow nurses and healthcare workers about the recommendations, an essential component of the coalition’s efforts.
“Every time, the response is the same,” said Christopher, president of the Visiting Nurse Association of Central New Jersey in Red Bank and national advisory chairwoman of the New Jersey Nursing Initiative. “The enthusiasm that it generates is just extraordinary. People realize they can customize the recommendations of the report to their own settings. I think this is probably the most important work we’ve done — creating that momentum.”Aline Holmes, RN
Cadmus, clinical professor and director of the DNP program leadership track at Rutgers, The State University of New Jersey in New Brunswick, agreed. She is focused on the education pillar, working on issues such as helping to develop residency programs for new nurses across all settings, from hospital care to home care and long-term care, as well as a residency program for advanced practice nurses. Another critical topic for Cadmus is academic progression, which includes the IOM’s recommendation that 80% of nurses have their baccalaureate degrees by 2020.
“As healthcare is changing, we want to make sure that nurses understand these recommendations,” Cadmus said. “This is not just about nursing, but more about how we’re going to meet the healthcare needs of the future.”
The nurse leadership recommendation is essential, Cadmus said. “I’ve always felt that nurses need to be more engaged and the whole leadership section really speaks to the fact that nurses need to be engaged at all levels of healthcare,” Cadmus said. “Even as a new staff nurse I always felt that our voices needed to be heard in terms of changing healthcare.”
As part of her students’ leadership assignments, Cadmus has them read the IOM report, take a position on the recommendations and identify how they would implement them.
Leading the wayEdna Cadmus, RN
Leadership is one of the areas of focus for Christopher, who is proud of the coalition’s efforts in getting major organizations to endorse the report and getting nurses appointed to key commissions in New Jersey.
“We have been very successful in working with the governor’s office,” Christopher said. “That’s where policy is set. That’s where decisions are made about how care will be delivered and how care will be funded. That ultimately drives the care that is received by every patient.”
Aline Holmes, RN, MSN, senior vice president of clinical affairs for the New Jersey Hospital Association in Princeton, began collecting resumes in June from nurses wanting to serve on boards and commissions in the state. Since starting the database, Holmes has collected more than 100 resumes from interested nurses. Working with Gov. Chris Christie’s office, she has helped place four nurses in health-related boards and task forces, including a governing body overseeing psychiatric hospitals in New Jersey and a task force examining the needs of veterans in Southern New Jersey. A statewide commission on improving end-of-life care is being formed and a nurse with related experience already has been requested to serve, Holmes said.
“I really think nurses can and should be taking an active role in the design of healthcare systems,” said Holmes, who also is director of the New Jersey Hospital Association’s Institute for Quality & Patient Safety. “As we move toward more of a community-based and population-based health system, managing populations with chronic conditions and increasingly aging populations, the nursing profession should really take the lead in those areas. For me, it’s really developing those skills in nurses to take on those leadership roles and give them the confidence that they can really be active participants in this design.”
To help nurse leaders familiarize themselves with certain governmental processes and rules they might encounter while serving, learning opportunities and resources are being developed, Holmes said. The New Jersey Hospital Association also is creating a curriculum for nurses interested in participating on boards and other leadership positions, she said.
Looking aheadPat Barnett, RN
Among the items on the coalition’s agenda for 2012 are to begin testing residency models for new nurses and for advanced practice nurses entering primary care, Cadmus said.
“We have very strong partnerships that have helped us move this forward,” she said. “Our first year was really the building phase. The second year will really be focused on funding and testing. Our goal is to have a model developed for academic progression in New Jersey.”
The coalition also is working closely with Horizon Healthcare Innovations, a subsidiary of Horizon BlueCross BlueShield of New Jersey to explore ways to integrate psychiatric advanced practice nurses into Horizon’s medical model, said Pat Barnett, RN, JD, CEO of the New Jersey State Nurses Association in Trenton. The group also is working with the state’s department of health and senior services to ensure APNs can practice within the agency and within the regulatory framework the agency proposes, Barnett said.
“We’re working closely with the board of nursing on the role of advanced practice nurses in New Jersey and making sure we’re consistent with the national guidelines,” said Barnett, co-chairwoman of the coalition’s scope-of-practice group, which is focused on nurses practicing to the full extent of their licensure and education.
As New Jersey nurses look toward the future and set goals for implementing IOM recommendations, access to care will be a vital issue, Barnett said. Nurses face another potential shortage in 2020, she said.
“We need to make sure we have enough nurses in the future,” Barnett said. “Nurses are patient advocates first and foremost, and that’s a lot of what we’re focused on. How do we advocate for patients?”