While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Most Action Coalitions—state-level groups of nurses and nurse champions working to transform the nursing profession to improve health and health care—are headed by two or three leaders.
Not the Maryland Action Coalition; it is led by 10 people, representing sectors including nursing, business, and government. The broad level of involvement brings “a richness” to the Action Coalition’s work, according to Jane Kirschling, PhD, RN, FAAN, dean of the School of Nursing at the University of Maryland, a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program alumna (2000-2003), and one of the Action Coalition’s co-leads.
“We’re somewhat unusual,” she said. “We don’t just have two-co-leads; we really have a list of folks involved in terms of providing leadership.” Such broad support, she said, increases the potential for projects championed by the Maryland Action Coalition to be implemented and adopted on a wide scale.
The Maryland Action Coalition was officially recognized in September 2011. Action Coalitions, in place in all 50 states and in Washington, D.C., are the driving force behind the Future of Nursing: Campaign for Action, a collaborative effort to transform health care through nursing by mobilizing coalitions representing nurses, other health providers, consumers, educators, and businesses. Backed by RWJF and AARP, the campaign is working to implement evidence-based recommendations from the Institute of Medicine (IOM).
Representing business are co-leads including Neil Meltzer, president and CEO of LifeBridge Health, and Lisa Kraus, vice president of management at CareFirst BlueCross Blue Shield.
The government of the state of Maryland also has a strong presence on the Maryland Action Coalition’s leadership team. Lynn Reed, executive director of the Governor’s Workforce Investment Board, and Shannon McClellan, JD, MBA, an attorney with extensive experience in state government, are co-leads, and state Sen. Delores Kelley and former state Sen. Paula Hollinger are core members.
Maryland Lt. Gov. Anthony Brown, meanwhile, is a “big supporter,” according to Janet Allan, PhD, RN, FAAN, former dean of the School of Nursing at the University of Maryland and a former co-lead of the Maryland Action Coalition. Brown attended the group’s first retreat in 2011, held shortly after the group was officially recognized as an Action Coalition. While there, Brown congratulated members on the group’s new status and offered support for its work.
So far, the Maryland government has agreed to help fund a project to streamline the transition between associate and baccalaureate degree nursing programs via the Nurse Support Program (NSP II), which provides programmatic and administrative support through the Maryland Higher Education Commission. The NSP II is funded though Maryland’s unique Health Services Cost Review Commission, which regulates hospital rates by utilizing a portion of the patient revenue.
The project will develop a model for dual enrollment for students at the University of Maryland School of Nursing (which awards bachelor’s degrees) at its Shady Grove campus, and at Montgomery College (which awards associate degrees). It is also supported by an RWJF State Implementation Program (SIP) grant. Read about the grant here.
Under the direction of Joshua Sharfstein, MD, secretary of the Maryland Department of Health and Mental Hygiene, the government is working with the Maryland Action Coalition to support the creation of a state workforce center to gather data about the supply of and demand for nurses and other health professionals—critical information at a time when more patients are entering the system under the Affordable Care Act (ACA).
“We were able to argue the need” for the center, Allan said. “We know how many people are uninsured, and we can estimate how many people will become insured under the ACA, but we don’t know how many providers we will need.”
In addition, the state is providing funding to develop more academic nurse leaders, a project led by Pamela Jeffries, PhD, RN, FAAN, associate dean for academic affairs at Johns Hopkins University and an RWJF Executive Nurse Fellow (2011-2014). This project, also funded through a NSP II grant, is a collaboration of five schools of nursing. It will provide formalized leadership to promising academic nurse leaders; Kirschling is a member of the project’s executive advisory group.
New Residency Programs
Another significant Action Coalition accomplishment involves the adoption of a number of new nurse residency programs around the state. So far, at least 18 hospitals have agreed to start a nurse residency program for new nurses, Allan said. “That is a major achievement.”
Other Maryland Action Coalition projects include revamping the nursing education curricula at schools around the state, surveying nurses about barriers to doctoral education, and advocating for mandatory continuing education programs for all practicing nurses.
Maryland has a leg up in another key area: scope of practice. There are relatively few practice restrictions on advanced practice registered nurses (APRNs), “so it’s not a matter of doing some of the heavy lifting that other states have to do” to allow nurses to practice to the full extent of their expertise and training, Allan said. But the Action Coalition is working to modify laws and regulations that apply to health professionals so that they are more inclusive of nurses.
Maryland Action Coalition leaders have staked out other goals, including increasing diversity among Action Coalition membership, developing and implementing communications strategies, raising funds, and maintaining enthusiasm among volunteer supporters. “Time is always a barrier,” Kirschling said. “The overwhelming majority of the participants in the Action Coalition are doing this in addition to the day-work that they do.”
Still, leaders and members are proud of their accomplishments in their two years of official existence and optimistic about the future; in the last six months alone, the group raised approximately $60,000—another reason for optimism. “Everyone feels the imperative to be involved in this,” Allan said. “It’s so important. This is our time in nursing, and we must take advantage of opportunities to enhance the profession and improve the health of the public.”
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