Idaho Nurses Work to Transform Nursing

Idaho nurse leaders work to ease transitions to practice for future nurses, nurse educators, and nurse leaders.

    • October 3, 2013

Launching and sustaining an advocacy campaign in a state as wide and disparate as Idaho is no small potatoes.

But the Idaho Nursing Action Coalition, a group that is working to transform the nursing profession to improve health and health care in the state, is busy advancing that goal.

The Action Coalition is part of the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that aims to implement evidence-based recommendations from the Institute of Medicine (IOM). Action Coalitions are in place in all 50 states and in the District of Columbia and are the driving force of the Campaign.

The Idaho Nursing Action Coalition has identified four main priorities: developing more nurse leaders, enhancing both its nurse education and nurse residency programs, and improving access to health care in the rural state. The Action Coalition got a big boost in in its efforts to reach those goals last year, when it was selected to receive an RWJF Future of Nursing State Implementation Program  (SIP) grant. The $150,000 initial grant was matched with $78,000 from supporting state organizations.

The SIP grant is being used to support a number of initiatives, including one to help nurses transition into new positions as clinicians, educators, and leaders. “We need to enhance professional development during a variety of transitions to practice,” said Margaret Henbest, RN, MSN, CPNP, a former co-lead of the Idaho Nursing Action Coalition who is overseeing the group’s SIP-funded projects. The Action Coalition has narrowed in on three transition points: new nurse graduates who are transitioning into practice for the first time; practicing nurses who are taking on new roles in education; and nurses who aspire to become nurse leaders.

For the first category, the Action Coalition is working to create a uniform statewide system of nurse residency programs for new nurse graduates, said Sandra Nadelson, PhD, RN, co-lead of the Idaho Nursing Action Coalition and associate director of undergraduate studies at Idaho State University. Some large medical centers have nurse residency programs, but most rural centers—“the ones that really need nurses who are ready to go when they start”—do not, she said. In the next year, the Action Coalition plans to identify hospitals to include in a pilot nurse residency project.

The Action Coalition is also working on ways to help aspiring nurse educators make the leap into academia.  One work group is currently reviewing the scientific literature about how nurses make transitions from clinical work to academic life. Using this information, a plan will be developed to assist nurses in making the move more smoothly.

It is also developing a nurse leadership course to help nurses develop the skills they need to move into leadership and management. Nurse managers in rural communities often have difficulty accessing higher education programs, which tend to be located in more urban areas, Nadelson said. The course will help them develop the skills they need to run health care organizations and serve as leaders in their state, she added.

Additional Goals

The Action Coalition is also working with the Idaho State Board of Nursing to develop a survey to send to advanced practice registered nurses (APRNs) and their employers to gather data about their scope of practice and work. The goal is to understand what non-regulatory barriers limit APRN practice and thereby circumscribe access to APRN-provided care.

And because Idaho already allows nurse practitioners to practice independently, the Action Coalition will explore ways to remove non-statutory barriers to practice involving issues such as insurance reimbursement rates and nurse practitioners’ ability to admit and discharge patients. “In general, our state is ahead in terms of giving practice freedom to APRNs, but we still have a ways to go,” Nadelson said.

In 2012, legislation was passed that allows the Idaho Board of Nursing to use license fees to fund nursing workforce research and analyze state progress on the recommendations in the IOM report. The funds will be used to support the APRN survey, a biennial overview of data pertaining to nurse education and the nursing workforce, and possibly a survey of new graduates in 2014.  “We’ll be able to do the workforce research that we need to do,” Henbest said.

In addition, it has created new partnerships with student nurses as a way to encourage them to set their future sights on leadership roles. In March, the Action Coalition is holding its first-ever joint conference with the Idaho State Nurses Association. “That’s pretty exciting, and they’re excited about it too,” Nadelson said.

But achieving those goals will be a tough row to hoe in a state that is large in size but small in population.

Funds are difficult to raise in a state that lacks a lot of “deep pockets,” Nadelson said. Face-to-face communication can be difficult among the state’s far-flung nurses. And the small population also means that the number of nurse leaders available to take on the massive work of transforming the profession is also small. “The same nurses keep getting tapped to help,” Henbest said. “It seems like everybody is working harder than they’ve ever worked before.”

Still, Idaho’s weakness is also one of its strengths, Henbest and Nadelson said. The small group of nurse leaders in the state has a long history of working together and long-standing personal relationships.Years ago, the state’s nurse leaders came together to form Nurse Leaders of Idaho, a group that has worked together to advance nursing leadership, practice, and education through networking, workforce development, and health policy advocacy.

After the release of the IOM report on the future of the nursing profession, the group decided to work together, along with partners at the Idaho Hospital Association, to implement its recommendations. They submitted an application to become an official Action Coalition—a designation received in 2011.

The group’s shared history and small numbers makes connecting—at least by phone or email—and cooperating relatively easy. “We’re like one big happy family,” Nadelson said.