New and Expanded RWJF Initiatives Aim to Strengthen Nursing

Public health nursing, academic progression, primary care and Future of Nursing recommendations are the focus as Foundation launches programs to help health care system meet emerging challenges.

    • March 28, 2012

The Human Capital portfolio of the Robert Wood Johnson Foundation (RWJF) launched three new initiatives that relate to nursing in recent weeks, as well as an expansion of the Future of Nursing:. Together, the initiatives reflect RWJF's deep, ongoing commitment to ensuring that nurses can contribute as full partners in a reformed health care system.

In early March, the Campaign for Action announced that 12 new Action Coalitions have joined the effort to implement recommendations from the landmark Future of Nursing: Leading Change, Advancing Health report, issued by the Institute of Medicine (IOM) in 2010. The 12 new Action Coalitions are state-based collaborations among nursing, other health care, business, consumer and other leaders.

"With this announcement, we are thrilled to have Action Coalitions in nearly every state," said Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing and director of the Future of Nursing: Campaign for Action. "The Campaign for Action is working in states and at every level to build and sustain the changes necessary to improve health care for all Americans…. Through the tremendous work of these Action Coalitions, the country is poised to implement the IOM report recommendations, which will advance the nursing profession’s success in providing better health care for all Americans in a transformed health care system.”

The newly named Action Coalitions are in Alabama, Arizona, Connecticut, Iowa, Maine, Nevada, New Hampshire, North Dakota, Oklahoma, South Dakota, Tennessee and Vermont. They join 36 others previously designated by the campaign for a total of 48 state Action Coalitions across the country—in all states except Oregon and Alaska. The Campaign for Action is coordinated through the Center to Champion Nursing in America, a project of AARP, the AARP Foundation and RWJF.

Making Good on ‘80 by ‘20’

One key recommendation from the Future of Nursing report calls for significantly increasing the percentage of the nursing workforce with baccalaureate degrees.

RWJF president and CEO Risa Lavizzo-Mourey, MD, MBA, echoed that call in a recent post on the RWJF Human Capital blog. She also published an editorial in the March 2012 issue of Nursing Outlook that outlines the growing need for highly educated nurses and describes the benefits to nurse employers of supporting education progression through preferential hiring, higher compensation, career-ladder programs, flexible scheduling, and tuition support.

About half of U.S. nurses have baccalaureate degrees or higher today. While acknowledging the contributions of Licensed Practical and Licensed Vocational nurses and associate-degree-prepared Registered Nurses, the IOM called for upping that to 80 percent by 2020, noting that a better educated nursing workforce would help ensure that all Americans have access to high-quality, patient-centered care. Getting from here to there—increasing the percentage of nurses with baccalaureate or advanced degrees—requires the creation of new pathways for nurses’ academic progression.

Accordingly, RWJF has funded a new Academic Progression in Nursing (APIN) initiative launched this March by the Tri-Council for Nursing, which includes the American Association of Colleges of Nursing (AACN), the National League for Nursing, the American Nurses Association and the American Organization of Nurse Executives (AONE). The grant will provide funding of up to $300,000 over two years to each of nine state Action Coalitions that have developed or made substantial progress toward statewide or regional action plans to achieve the IOM’s 80-percent workforce goal.

The funded Action Coalitions will work on at least one strategy related to academic progression and at least one related to employment for baccalaureate-trained nurses, to ensure demand for their services. That will make academic-service partnerships key to the success of the effort, so the program will encourage partnerships between community colleges and universities that ensure seamless transition. In addition to implementing and refining models, the program’s goals include increasing the diversity of the nursing workforce, and ensuring that nurses have such critical competencies as leadership, cultural competence, interprofessional collaboration, and quality and safety.

“Without a better educated workforce, we will not be able to meet the needs of a rapidly aging and more diverse population, solve the shortage of primary care providers and faculty, improve care coordination and in other ways meet emerging needs,” said Pamela Austin Thompson, MS, RN, CENP, FAAN, the chief executive officer of AONE, the organization that will lead the APIN program as the Tri-Council’s representative.

The APIN initiative is timely. The same week it was announced, AACN released data showing that enrollment in baccalaureate, master’s, and doctoral nursing programs increased last year as more nurses answered the call to advance their education. But even though nursing schools were able to expand student capacity, the new data show that 75,587 qualified applications to professional nursing programs were turned away last year, including more than 14,354 applications to graduate programs.

LEAPing Forward on Primary Care Practices

Another new initiative from RWJF focuses on making primary care more efficient and effective. The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP) Project will identify primary care practices that deploy health professionals and other staff in ways that maximize access to their services, so that such workforce models can be replicated and adopted more widely.

Millions more Americans are poised to enter the health system in the next few years, as a result of the health reform law, increasing the strain on the health care system in general and particularly on doctors, nurses and other staff member who provide primary care. The LEAP Project will identify changes in policy, workforce, culture, education and training related to primary care that can improve the way practices function. The goal is to identify and then study up to 30 high-functioning primary care practices to learn about innovative staffing arrangements that maximize the contributions of health professionals and other staff.

Ed Wagner, MD, MPH, and Margaret Flinter, PhD, APRN, are co-directors of LEAP, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center, and Flinter, a family nurse practitioner by clinical background, is senior vice president and clinical director of the Community Health Center, Inc., a statewide Federally Qualified Health Center in Connecticut and director of its Weitzman Center for Innovation. She is an alumna of the RWJF Executive Nurse Fellows program.

“The Foundation’s mission is to improve health and health care, and we cannot succeed unless we address the shortage of primary care services,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of RWJF’s Health Care Group. “The nation will not be able to train new primary care providers quickly enough to meet the need, so part of the solution must be to use the workforce we have more effectively. This new program will identify ways to do that.”

“This project is particularly important because it recognizes that there is tremendous diversity in primary care settings across the country,” Flinter said, “from small private practices to large health systems to community health centers. We need all of these practices to perform at the highest level.”

A National Advisory Committee, chaired by Thomas S. Bodenheimer, MD, MPH, adjunct professor at the University of California, San Francisco, School of Medicine, will develop and apply the criteria for selecting the exemplary primary care practices, which will represent a variety of settings, practice configurations and locations. A research team will conduct site visits, and then the sites will join together in a learning community to share best practices and help distill their innovations into a toolkit that can be used by others.

A Closer Look at Public Health Nursing

At the same time, RWJF is moving to build the base of knowledge about the critically important field of public health nursing through a new, exploratory initiative.

While public health nurses represent the largest segment of the nation’s public health workforce, the field is in transition and budget cuts are complicating the work, just as reform is increasing the emphasis on population-wide services. Those in the field now and those considering careers in public health nursing need to align with that transition.

In order to develop an agenda for this work, RWJF convened a national summit with public health and nursing leaders in February. The “RWJF Forum on the Future of Public Health Nursing” brought together 50 experts who Shirley Orr, MHS, APRN, NEA-BC, a public health consultant and RWJF Executive Nurse Fellow, described as diverse leaders from practice, academe, federal agencies and the policy arena with expertise in health, public health and public health nursing education and practice.

Orr worked with RWJF and the National Network of Public Health Institutes to plan the conference. “The overall goal,” she said in a blog post, was “to develop some consensus around a shared vision for the future of public health nursing, and beyond that shared vision, a shared agenda, and [to] begin to prioritize some action steps around that agenda.”

Going forward, Orr says that RWJF’s public health nursing initiative will gather data about the profession. “One of the things we will be looking into over the coming year is exactly what the workforce currently looks like,” she explains. “Where do public health nurses practice, for example? We have some data, but we need to do a better job of quantifying information about the workforce, especially in terms of how we need to prepare for the future. There will likely be a large number of public health nurses leaving the workforce in the coming years, so certainly that presents issues of recruitment and retention. Retirement has been one factor of nurses leaving the workforce in recent years, but there has also been the economic downturn that has led to budget reductions and to reductions in positions.”

Following the collection and analysis of such data, RWJF will further examine training models that incorporate core public health competencies for improving population health.