While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Nurse leaders and their allies in New Jersey, the home of the Robert Wood Johnson Foundation (RWJF), have a long history of working to improve health and health care by transforming the nursing profession. The New Jersey Action Coalition—a group of committed leaders working to make change at the state and local levels—is building on that solid foundation.
The Garden State is indeed a leader in some key ways, from magnet hospitals to public reporting.
The American Nurses Credentialing Center’s Magnet Recognition Program recognizes healthy work environments for nurses. New Jersey is home to 24 “Magnet-designated” hospitals, more than any other state. Healthy work environments for nurses have been shown to improve patient outcomes.
In order to help consumers make better informed decisions about hospital care, New Jersey has also enacted legislation and regulations requiring hospitals to publicly report quality indicators and nurse staffing ratios. The state also boasts a nursing workforce center, the New Jersey Collaborating Center for Nursing, which has been collecting and analyzing data on the nursing workforce for nearly a decade.
Also, it is the site of the New Jersey Nursing Initiative (NJNI), a multi-year, multi-million dollar project of RWJF and the New Jersey Chamber of Commerce Foundation that is working to ensure that the state has the well-prepared, diverse nurse faculty it needs to educate nurses to meet the demand for health care in the 21st century.
That strong foundation is one reason New Jersey was selected to be one of the first states in the nation to host an Action Coalition, says Edna Cadmus, PhD, RN, NEA-BC, clinical professor and specialty director of the Nursing Leadership Program at the College of Nursing at Rutgers University and co-lead of the New Jersey Action Coalition. When it comes to the future of nursing, New Jersey, she says, is on the vanguard.
“We have a lot of great leaders across the health care industry and engaged legislators and regulators to help us move these recommendations forward,” Cadmus says.
The New Jersey Action Coalition was officially formed in 2010, shortly after the release of a groundbreaking report, The Future of Nursing: Leading Change, Advancing Health, by the Institute of Medicine (IOM). Action Coalitions are the driving force behind the Campaign for Action, which is working to implement its recommendations. The goal of the Campaign for Action is to ensure that all Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners.
“The New Jersey Chamber of Commerce Foundation is pleased to be serving as the host organization for New Jersey’s Action Coalition,” said Dana Egreczky, senior vice president of Workforce Development for the New Jersey Chamber of Commerce and president of the New Jersey Chamber of Commerce Foundation. “The recommendations from the Future of Nursing report are consistent with our mission—encouraging education progression and ensuring that New Jersey’s businesses have a healthy workforce. We want to ensure the recommendations are implemented in New Jersey—it makes good business sense.”
The New Jersey Action Coalition has its roots in a conference marking the release of the IOM report. At the meeting, Cadmus, David Knowlton, MA, president and CEO of the New Jersey Health Care Quality Institute, and Mary Ann Christopher, MSN, RN, FAAN, the former president and CEO of the Visiting Nurse Service of Central Jersey, teamed up to develop the infrastructure for their home state’s coalition.
Christopher is now president and CEO of the Visiting Nurse Association of New York, and Mary Wachter, RN, MS, has picked up where Christopher left off. Early on, coalition leaders reached out to supporters and organized around four major pillars: scope of practice, education, leadership, and workforce data. Co-chairs were appointed to each subgroup and action plans were developed around each theme. “We felt that we needed to try to create some successes early on” to build momentum, Cadmus says.
While it has won generous grants from The Horizon Foundation for New Jersey and the Robert A. Mills Foundation T-W, the coalition has met with challenges around funding. “The state is struggling financially and that limits, in some regards, our ability to be able to find funding to implement and test our projects,” Cadmus says. “Therefore we are looking for both private and industry funders to assist us in testing the models we have developed.”
In addition, some of the coalition’s efforts have presented challenges, such as its work to ensure that 80 percent of nurses have baccalaureate degrees by 2020.
“We are asking to make some major changes in how we educate nurses,” Cadmus says. “There is pushback not only within nursing but outside of it as well. However, with the formation of the New Jersey Master Steering Committee, we are removing the walls that have been formed over the years.”
The committee, she says, will bring together stakeholders across their differences, including diploma-, associate- and baccalaureate-degree members; practice partners from home care, long-term care, and hospitals; the director of the New Jersey Board of Nursing; legislative and regulatory staff; and representatives from the New Jersey State Nurses Association and the Organization of Nurse Executives of New Jersey. The group is committed to developing academic progression models that work for New Jersey, she says.
Cadmus is confident the coalition will overcome the hurdles in its path. After two years of work, she has learned some valuable lessons to share with newer Action Coalitions: build partnerships with well-established organizations; create a simple, streamlined infrastructure; engage multiple stakeholders in the project and include them throughout the process; and take an early look at grant opportunities, she says.
As for the New Jersey Action Coalition, she says: “I’m excited about where we are and where we’re going.”
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