While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Physicians and nurses often work hand in hand, but when it comes to decisions about health and health care, they don’t always see eye to eye.
But that’s not the case at the Indiana Action Coalition, where nurses and doctors are joining together to transform the nursing profession to improve health and health care in the state.
Kimberly Harper, RN, MS, executive director of the Indiana Center for Nursing, and Richard Kiovsky, MD, FAAFP, professor of clinical family medicine at Indiana University, have teamed up as co-leads of the Indiana Action Coalition, a group of nurses and nursing champions who are working to transform the nursing profession. It is one of 51 similar groups across the country.
The partnership between physicians and nurses at the Indiana Action Coalition runs deep. The Coalition is co-led by a doctor and a nurse; the executive committee is comprised of two nurses and two doctors; and its 22-member steering committee includes six people who are not nurses, three of whom are physicians.
“Nursing can’t change health care alone,” Harper says.
Many doctors, pharmacists, and other professionals she works with agree—and are willing to champion the effort to advance nursing because they believe it will ultimately benefit patients, she says. “We’re the Midwest. I’ve worked here my entire career, but my peers and colleagues from other places continue to say they’ve never found any place that is so collegial, where people work so well together.”
Improving Interprofessional Collaboration
The Indiana Action Coalition was recognized shortly after the Institute of Medicine (IOM) released a report in 2010 on the future of the nursing profession. Action Coalitions are the driving force of the Future of Nursing: Campaign for Action, a joint effort of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF) that is rooted in the IOM report’s evidence-based recommendations.
Improving interprofessional education and collaboration is a top priority of the Indiana Action Coalition. “Instead of just the physician being the captain of the ship, you now have team-based care,” says Kiovsky, who directs the Indiana Area Health Education Centers Network. It aims to improve health by recruiting, educating, and retaining health care professionals to work in underserved communities in Indiana, placing a strong emphasis on interprofessional education. The Action Coalition took a step toward that goal in October when it hosted an interdisciplinary event that brought together students from nursing, pharmacy, and other fields to practice simulated health care scenarios on high-fidelity mannequins.
The Action Coalition is also focusing on improving patient safety, another goal that depends heavily upon interprofessional collaboration. It is working with Indiana hospitals and regional safety centers to find ways to share resources and work toward common goals. They include engaging front line nurses with interprofessional teams with a focus on patient safety and preventing harm; building capacity and competencies to support patient safety and quality across the continuum of care, particularly with care transitions; and connecting to current Indiana patient safety efforts related to the national Partnership for Patients initiative.
“One of the important ways that we can partner with our interprofessional colleagues is through safety,” Harper says. “There’s a component of safety that cuts through every practice area and every part of nursing. By engaging in work regarding patient safety, we can cover a lot of areas and include a lot of people and make some major changes.”
A third goal of the Indiana Action Coalition is to enable nurses to practice to the full extent of their training and education. Coalition members recently completed a white paper outlining the roles of advanced practice registered nurses (APRNs) in Indiana and barriers to their work. The coalition will use it as a platform for ongoing discussions with nursing and other health care colleagues to find improved ways to enhance collaborative practice, while allowing APRNs to practice at the full extent of their training and education.
A fourth goal is to advance nursing education. The Coalition recently completed a “gap analysis” study to evaluate the status of all levels of nursing education in Indiana and determine how best to facilitate the seamless transition between associate’s-degree and baccalaureate-degree nursing programs. Currently, 49 percent of Indiana’s practicing nurses are educated at the BSN level or higher. The Coalition is working to identify additional support to boost that percentage to 80 percent by 2020.
The Indiana Action Coalition faces hurdles, too. Like most Action Coalitions, it relies on nurse leaders across the state who already hold leadership positions in health care systems and schools of nursing to carry out its work. “The commitment of these individuals is unparalleled,” Harper says.
Though the Coalition has achieved remarkable success since its inception in 2011, there is still much to be done, Harper says. As a state-wide organization based in Indianapolis, the Coalition also has had some geographic difficulty engaging members in the northern and southern reaches of the state in face-to-face meetings. As a result, it has used technology in innovative ways to bring people together.
Harper and Kiovsky are excited about the changes ahead. “The nursing movement is coming along at a good time to energize a lot of people about making change in health and health care,” Kiovsky says.
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