While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
An important achievement of the Future of Nursing: Campaign for Action is that, all around the country, it has brought nursing organizations and other stakeholders together in pursuit of shared goals. The Campaign is a collaborative effort of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF) to implement recommendations from the groundbreaking Institute of Medicine (IOM) nursing report.
The Minnesota coalition may be barely one year old, but it has an advantage: It is building on a long record of nursing collaboration in the state. One key to that history of cooperation is an earlier RWJF project called Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development. RWJF’s 1996 grant to Minnesota State Colleges and Universities, renewed in 2000, supported nursing leaders as they identified and began addressing the needs of the nursing community. When the grant expired in 2003, the infrastructure created to support the effort evolved into the Minnesota Center for Nursing, which was then—and remains now—a lead organization in helping resolve the state’s nursing workforce issues.
In September 2011, the Campaign for Action formally recognized the Minnesota coalition as a state Action Coalition, and the president of the Minnesota Center for Nursing, Elizabeth Sether, RN, BA, MHA, became one of two co-leads, along with HealthForce Minnesota’s Jane Foote, MSN. “The truth is that we’d been collaborating for years,” Sether said, “and we’d already begun to turn our focus to the Future of Nursing recommendations and their implementation.”
Every Nurse Has a Role
Indeed, four months earlier, the Minnesota Association of Colleges of Nursing—together with the Center for Nursing, HealthForce Minnesota, the Minnesota Board of Nursing, and the Minnesota Hospital Association—sponsored a day-long conference in the state capital on “IOM and the Future of Minnesota Nursing: A Call to Meet Expanding Public Need.”
Some 200 nurse leaders and others turned out for the May 2011 event. They heard keynote speaker Michael R. Bleich, PhD, RN, FAAN, an alumnus of the RWJF Executive Nurse Fellows program (2000-2003) and a committee member of the RWJF Initiative on the Future of Nursing at the Institute of Medicine, frame the report as a challenge to individual nurses.
“When it comes to the report, its messages and recommendations, the first thing I want [is for] every nurse…to figure out what she or he needs to do,” Bleich said. “There are many things in this report that are a call to nurses to be true professionals, not represented by anyone other than your own professional commitment. Each day I wake up and I choose my day. I have the professional license that frees me to do that, and there are pieces in this report that only I personally can do. Someone else can’t do it for me. So I want nurses to read this report and say: ‘This is my piece of the world today. I’m working on this.’”
The conference was also the occasion for the official announcement that nursing organizations in the state were applying for recognition as a state Action Coalition—recognition that was granted just four months later.
Once formally recognized, the state Action Coalition began setting its priorities and reaching out to nurses to build consensus. The steering committee mapped out an agenda focused on increasing the proportion of nurses in the state with baccalaureate degrees from the current 37 percent to the Future of Nursing-recommended 80 percent; removing scope-of-practice barriers for nurses; and expanding nurses’ opportunities for leadership.
The group then distributed a survey to all licensed nurses in Minnesota. With more than 10,000 responses, nurses collectively affirmed the steering committee's priorities. “We have solid agreement across the state on our priorities,” Sether said. “But the real takeaway from the survey is that we have nearly 1,200 nurses who want to join in the work of the Action Coalition.”
Sether also says that the survey results underscored the need to cultivate nursing leaders and to create opportunities for them to lead. “The survey results encouraged us to identify the various boards and panels in Minnesota that are making health care and workforce decisions and then to make sure nurses are represented,” she says.
Other opportunities emerged from the nursing survey, Sether says, and the steering committee is analyzing the results along with other feedback from stakeholders, and developing strategies.
Push for Baccalaureate-Prepared Nurses Already Under Way
To increase the percentage of baccalaureate-prepared nurses, the Action Coalition plans to take good advantage of the work of the Minnesota Alliance for Nursing Education, which launched in 2010 to develop a shared competency-based nursing curriculum for use in the state’s community colleges and four-year institutions. The approach follows the lead of the “Oregon Model,” developed by the Oregon Consortium for Nursing Education, in which community and four-year colleges collaborate. The goal is to ensure that students can be admitted to community colleges, study a unified curriculum while working toward a baccalaureate degree, and move seamlessly to a four-year institution for their final two years of study. The approach helps bring baccalaureate nursing degrees within reach of many more students.
With a grant from HealthForce Minnesota, a member of the Action Coalition steering committee, the Action Coalition’s co-lead, the Minnesota Alliance for Nursing Education, began developing the structure of a unified curriculum in 2010. It also is planning for the initial class of four-year nursing students to be admitted to six community colleges and one university in 2013.
Scope of Practice Restrictions
On another front, the Action Coalition faces a stiffer challenge: removing barriers that prevent nurses from practicing to the full extent of their education and training. For example, advanced practice registered nurses (APRNs) may only prescribe medication to patients while under the supervision of doctors.
In his remarks at the May 2011 conference, Bleich addressed such restrictions, observing that “states are coming to grips with the…scope of practice issue. Now mind you, federal dollars and state dollars have gone into educating APRNs.” Then, raising one hand above his head, he observed that nursing colleges, “get them up to here, and then they go to practice in a state that regulates, [telling them] ‘you get to practice down here.’ This gap is a human capital waste in our country.”
Sether says that overcoming such challenges is vital in Minnesota. “The population is increasingly diverse, and it’s aging,” she says. “We’ve already got a gap in our workforce numbers, and it’s only going to grow if we don’t step up to address the challenge.”
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