Nurse Leaders Mount Campaign in Large State with Small-Town Feel

Nurses and nursing champions in Montana tap personal networks to improve health and health care by transforming the profession.

    • March 19, 2013

For Cynthia Gustafson, a nurse leader from Montana, living in a frontier state has its advantages.

“It’s like living in a small town,” Gustafson said. “We know each other. We have easy access to policy-makers. They might be your neighbors or your friends—or even your students.”

So it is for Gustafson. Just last month she attended a legislative hearing on a bill that would strengthen nursing workforce data collection efforts in the state. When she got there, she met a lawmaker who was studying to be a nurse and had attended a lecture she had given—and the beginnings of a partnership were born. “He said, ‘Didn’t you come and speak to our class?’ And here he is a representative in the state Legislature. It’s good to make those connections.”

The small-town feel of Montana—one of the country’s largest states by area but one of its smallest by population—makes Gustafson’s job as co-lead of a campaign to improve health and health care by transforming the nursing profession that much easier. When Gustafson, PhD, RN, executive director of the Montana Board of Nursing (MHA), wants to hold a statewide meeting on nurse education policy, for example, she can simply contact her friends at the state’s nurse education programs and arrange a conference call.

Another advantage is the state’s pioneer culture, which in previous centuries translated into early support for voting rights for, and political representation by, women, among other things. In more recent years, that cultural tradition has led to independence for nurse practitioners.

Indeed, unlike their peers in many other states, nurse practitioners in Montana have full prescriptive authority and are not required to practice under the supervision of a physician. “Montanans look at nurses as very capable individuals who really serve a need in our rural state,” Gustafson said. “We’re always looking at ways to maximize the expertise of our citizens, and this is a way we can do that.”

The ‘Outback of the United States’

But the campaign to transform nursing also faces hurdles. Promoting the work of the coalition in a state as large as Montana is difficult, as is working on a national campaign from the mountainous West. “Sometimes we feel really isolated,” Gustafson said. “I call us the outback of the United States.” The campaign also faces more typical challenges, such as raising enough money to sustain its work and cultivating partnerships with non-nursing professionals.

The Montana Center to Advance Health through Nursing came together in 2010 when Gustafson and Casey Blumenthal, MHSA, RN, CAE, a nurse who is now vice president of MHA…An Association of Montana Health Care Providers, held a gathering to watch a webinar marking the release of a report by the Institute of Medicine (IOM) on the future of the nursing profession.

Participants organized and formed the center, which was recognized in 2011 as an Action Coalition by the Future of Nursing: Campaign for Action, a joint effort of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation (RWJF). Action Coalitions, state-level groups of nurses and nursing champions, are the driving force behind the campaign, which aims to transform health care through nursing.

The center has a mailing list of about 200 people and is governed by a steering committee comprised of a diverse array of nurses (and a non-nurse). Members have targeted four main priorities relating to education, practice, leadership, and data collection.

A big accomplishment came last summer when the center was awarded a $300,000 grant from RWJF to help implement a plan to increase the proportion of nurses with baccalaureate degrees to 80 percent—a key recommendation of the IOM report on the future of nursing. Montana is using its RWJF Academic Progression in Nursing grant to facilitate the seamless transition of academic progression in nursing through a statewide model curriculum.

The center is also promoting legislation that would enable the State Board of Nursing to collect certain data points from nurses when they apply to renew their practice licenses. That, proponents say, would improve data about the state’s nursing workforce, which in turn would help the education and health care communities identify emerging problems and take steps to avert them.

Other specific goals include the creation of nurse residency programs to help new nurses transition into practice, which will help health care organizations recruit and retain nurses—a particular challenge in a rural state like Montana. The center is also working to cultivate nurse leaders across the state so they can play a larger role in the redesign of the health care system.

But perhaps the biggest accomplishment has been the coming together of the state’s nurses and nurse champions and the creation of shared goals for the future of the profession, Gustafson said. Last year, the center held a statewide leadership conference that drew 150 people—a gathering that is considered a “huge crowd” in Montana, she noted. The center plans to hold its second annual conference in April.

Organizations such as the State Board of Nursing, nurse education systems, and health care employers are “on the same page,” Gustafson said. “We are really excited to be part of the coalition and have support from the Robert Wood Johnson Foundation. It’s incredible for us, as a small state, to be at the table with everyone else.”

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Cynthia Gustafson, PhD, RN

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