Nurse Advocates Blaze Trail in California

California Action Coalition leaders share lessons learned from the campaign to transform nursing to improve health and health care.

    • January 29, 2012

California leads the nation in areas such as technology, agriculture and entertainment.

A group of nurse leaders is working to add one more thing to that list: health care.

And they are making considerable headway. In 2010, California became one of the first states in the nation to have an Action Coalition—a diverse group of stakeholders working at the state and local levels to transform the nursing profession to improve health and health care.

Action Coalitions are the driving force behind the Future of Nursing: Campaign for Action, a collaborative effort to implement solutions to the challenges facing the nursing profession and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care. An initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF), the campaign is focused on a report released by the Institute of Medicine (IOM) in 2010 that lays out a strategy to ensure that all Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners.

In the last year, California Action Coalition leaders have taken their first major steps toward that goal. They have created a multi-tiered campaign infrastructure, secured funding to sustain efforts into the future, forged partnerships with stakeholders and some unexpected allies, engaged hundreds of volunteers in all parts of the state, and raised awareness about the IOM report and the campaign to implement its recommendations.

“We spent the first year building our team, our brand and our vision,” said California Action Coalition Statewide Director Mary Dickow, MPA. “We’re now starting to roll out our major priorities.”

The California Action Coalition got its start in November 2010 with the release of the groundbreaking IOM report, The Future of Nursing: Leading Change, Advancing Health. It was one of five pilot coalitions launched at the time. There are now Action Coalitions in 35 other states, and more are expected to launch this year.

Action Agenda

One of the first items on the California coalition’s agenda was to establish team leadership and create a functional and effective organizational hierarchy—a necessity in a state as large and diverse as California.

At the top of the coalition’s structure is a 10-member executive committee that oversees campaign strategy and policy goals. The coalition also established eight “workgroups,” which focus on strategies to implement the IOM report’s eight major recommendations in California. Each of those groups is now identifying priorities and creating plans to reach those goals.

The coalition also has put in place eight regional subgroups, which are working to ensure all parts of the state are engaged in the campaign. A leadership council, comprised of representatives from workgroups, regional groups and other stakeholders, provides input and support. As statewide director, Dickow serves as liaison between the executive committee, the workgroups and the regional groups to ensure smooth functioning.

In addition to creating an organizational infrastructure, the coalition made sustainability a top priority in its early days. Coalition leaders held “funders roundtables” to which they invited key donors to hear presentations about their goals. “We wanted to start a conversation among groups of funders rather than make isolated pitches to individual donors,” Dickow said.

At the same time, the coalition listened to the goals of the foundations and funders and identified shared priorities. “It’s not just them listening to us, it’s us listening to them, too,” noted Casey Shillam, PhD, RN-BC, the nurse co-lead of the California Action Coalition and a postdoctoral fellow at the Betty Irene Moore School of Nursing at the University of California, Davis.

The coalition also took early steps to forge partnerships with groups representing student nurses, family physicians, business communities and others. “These kinds of partnerships are going to be really helpful in moving our work ahead,” Dickow said.

Now in its second year, the coalition is actively engaged in raising awareness about the report and the campaign to implement its recommendations. It is currently developing communications materials and creating a website to be launched this spring. “There are still a lot of people in our state, including nurses, who don’t even know the report exists,” Dickow noted.

In California, the climate is ripe for change, thanks to leaders in nursing and nurse education who have toiled for years to advance the nursing profession, Dickow said. Nurse advocates have helped to enact legislation that provides for seamless progression from associate-degree to baccalaureate programs; implement pilot initiatives to help student nurses who are unable to find employment transition into practice through community-based internships at schools of nursing; and enable California universities to offer more doctorate-level nursing programs.

These efforts provide fertile ground for the work of the coalition, Dickow said.

The Action Coalition is housed within the California Institute for Nursing and Health Care, which has successfully implemented programs critical to the success of nursing students and the nursing workforce, Dickow said. Several of the report’s recommendations fit naturally within the institute’s ongoing work, giving the state a “real advantage” in moving those programs to the next level, she added.

By the end of the year, the group expects to have detailed short- and long-term plans in place and to have made progress on several priorities. This year, for example, workgroups plan to analyze the state’s scope-of-practice laws and regulations; survey opportunities to help develop nurse leaders and create ways to share those opportunities with the nurse workforce; and inventory existing data sources to determine gaps in data on the nursing workforce.

But there are significant obstacles yet to overcome. Generating the kind of momentum needed to transform the nursing profession will take enormous resources over a sustained period, Dickow said. The California Action Coalition has the additional challenge of having to cover a large and diverse area. “In some parts of the state, just getting people to come to a meeting can be difficult.”

But that weakness is also a strength, Shillam said. California’s large population means there are ample opportunities to create a diverse and well-funded organization.

That is just one lesson Shillam has learned as one of the leaders of the state’s Action Coalition. She urges other coalitions to create strong partnerships, bounce ideas off allies in other states and, perhaps most importantly, recognize the enormity of the task ahead.

“The reality is this is an enormous undertaking,” Shillam said. “This campaign really takes time and entails a lot of work. Don’t be discouraged if you think you’re getting off to a slow start. It took the entire first year for our coalition to engage in planning our strategy; give yourself that time to create a strong and sustainable plan for success.”