Nebraska is home to “the good life”—at least according to one of the state’s best-known advertising slogans. Now nurses in the state are working to make life even better.
They’re doing that under the auspices of the Nebraska Action Coalition, a group led by nurses and nurse champions who are working to transform the nursing profession to improve health and health care.
Nursing organizations “used to be more separate and divided; nobody knew what the others were doing,” said Victoria Vinton, MSN, RN, director of the Nebraska Action Coalition. “The birth of the Nebraska Action Coalition has helped us look at the importance of speaking with one voice.”
Action Coalitions are the driving force behind The Future of Nursing: Campaign for Action, a national initiative backed by the Robert Wood Johnson Foundation (RWJF) and AARP to implement recommendations from a groundbreaking report on the nursing profession that was issued three years ago by the Institute of Medicine. Action Coalitions are in place in all 50 states and in the District of Columbia and have collectively raised more than $6 million to support their work.
In Nebraska, as in many states, nurses and their allies face a daunting set of challenges.
The Cornhusker State, like many others, faces a looming shortage of nurses at a time when demand for nursing services is increasing thanks to an aging population and an influx of people who now have access to health care coverage under the Affordable Care Act. The state’s nursing shortage is expected to increase to 20 percent by 2020. And, at the same time, demand is set to intensify; by 2030, more than one in five Nebraska residents (21 percent) will be older than 65.
Shortages will be especially acute in the state’s vast rural stretches. Already, nearly two thirds of the state’s 93 counties (65 percent) have been designated as health professional shortage areas. There are no nurse practitioners in one-third of the state’s counties, and no registered nurses in seven of them. Diversity in the nursing workforce is also lacking. Racial and ethnic minorities comprise 18 percent of the population, but only 5 percent of the nursing workforce. Men comprise 49 percent of state residents, but only 4 percent of its nursing workforce.
There are few nurses in positions of leadership, meanwhile, to usher in change. Fewer than 6 percent of the state’s nurses serve on hospital boards, depriving the profession of influence it needs to help redesign the health care system.
Changing the Picture
The Nebraska Action Coalition is working to change these sobering statistics. Formed in 2010 and officially recognized in 2011, the Action Coalition has laid out three main priorities: advancing nurse education, promoting nurse leadership, and freeing up nurses to practice to the full extent of their expertise and training.
Earlier this year, it received a two-year, $150,000 RWJF State Implementation Program grant to support its nurse education and leadership efforts. Regarding education, the Action Coalition is implementing a statewide initiative to help make it easier for nurses with associate degrees (ADNs) to progress into baccalaureate degree programs in the science of nursing (BSN). It has drafted a statewide competency-based curriculum model to help nurses avoid repeating courses and move more easily into BSN programs.
The ultimate goal is to boost the share of nurses with baccalaureate degrees, especially among students who will help diversify the predominantly White and female profession. In the short term, the Action Coalition aims to increase the percentage of BSN-prepared nurses between the ages of 20 and 40 by 10 percent by December 2014. “I’m very happy to say we are on track,” Vinton said.
The Action Coalition is also devoting considerable energies to promoting nurse leadership. Last year, it sponsored two well-attended events: a “40-under-40” event to recognize emerging nurse leaders across the state, and a conference for nurse leaders, which featured a keynote address by internationally renowned nurse leader Angela Barron McBride, PhD, RN. “They were very successful events,” Vinton said.
In addition, Action Coalition leaders are analyzing the results of a leadership survey sent to nurses across the state. More than 1,100 nurses responded, providing the Action Coalition with a rich level of detail about Nebraska nurses who are already engaged in leadership, nurses who aspire to leadership positions, nurses who are willing to serve as mentors, and opportunities to serve in leadership positions. The survey identified 191 nurses who are “likely interested” in becoming members of a decision-making body. “That,” Vinton said, “will help us reach our goal of 10 percent of nurses serving on boards and other decision-making bodies by 2014.”
“We are taking baby steps, but we are hoping that by October of next year we will have 10 percent of those nurses on boards or learning how to be board members,” Vinton said.
The Action Coalition is also supporting the state’s nurse practitioners, who are working to enact legislation that would grant them full practice authority; convening leaders from governmental agencies and academic institutions to identify data needed to promote research on team-based models of care; and working to build membership in minority nurse organizations.
The journey to a better life, or at least better health and health care, is not without its challenges, though.
Reaching out to and connecting with supporters in rural parts of the state can be difficult, and engaging allies who are not nurses is also challenging, Vinton said. “It’s easy to get nurses excited about this, but it’s a little harder sell to other organizations.”
To address that, Vinton and other Action Coalition members are hosting “stakeholder breakfasts” with potential allies from non-nursing sectors, such as business, academia, and other health care organizations, in every region in the state. “We’re making sure we have a variety of voices at the table to discuss the future of health care and how we see working together,” Vinton said.
Fundraising continues to be a challenge, as does spreading the message about the importance of health care transformation in a politically conservative state that largely opposes the Affordable Care Act. “We have to be sensitive,” Vinton said.
On the upside, Vinton can turn to a stable of dedicated supporters to carry out the Action Coalition’s work. “I’ve got just an extremely passionate executive committee,” she said, full of “people who put in lots of hours, in addition to their full-time jobs.”