North Carolina nurses have a rich and progressive history; they established the state’s first civilian hospital, enacted the first Nursing Practice Act in the country, offered the nation’s first clinical master’s program in nursing and pushed for groundbreaking legislation in the 1970s that gave nurse practitioners unprecedented prescribing powers.
But what was progressive for nurse practitioners then is now considered restrictive, at least when it comes to scope-of-practice policies pertaining to nurse practitioners and certified nurse midwives. Indeed, the Tar Heel State got an ‘F’ on the 2011 edition of the Pearson Report, which grades states on the basis of their nurse practitioner policies.
North Carolina, in fact, is just one of four states in country with joint regulation of nurse practitioners by the state’s medical and nursing boards. As a result, two disciplines, often with divergent perspectives, regulate the practice of advanced practice registered nurses (APRNs), said Mary P. “Polly” Johnson, MSN, RN, FAAN, president and chief executive officer of the Foundation for Nursing Excellence in Raleigh, N.C.
Johnson is co-leading a statewide effort to remove the kinds of practice restrictions that impede access to care and in other ways to transform nursing by advancing nurse education, enhancing nurse leadership and building an interprofessional health care workforce data infrastructure.
The state, she said, needs these changes to better position its nursing workforce to improve the health and health care of all North Carolinians.
The population of North Carolina is aging rapidly, thanks in part to an influx of retirees who are drawn to the state’s temperate climate, its livable cities, and its relatively low cost-of-living. Access to care is especially difficult in the more rural parts of the state, many of which have been designated as areas with shortages of health professionals, Johnson said.
Transforming the nursing profession and, in so doing, improving health and health care in North Carolina, is the goal of a group co-led by Johnson called the North Carolina Future of Nursing Action Coalition. Action Coalitions are the driving force behind the Future of Nursing: Campaign for Action, a collaborative effort of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF) 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.
The campaign is based on a groundbreaking report by the Institute of Medicine (IOM) called The Future of Nursing: Leading Change, Advancing Health that laid out a strategy to transform the nursing profession to ensure that all Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners.
Bringing the Campaign Home
The North Carolina Future of Nursing Action Coalition got its start after the IOM report was released in the fall of 2010. Johnson and other nurse leaders attended an event in Washington, D.C., marking the release of the report and returned to their home states determined to bring the campaign to North Carolina.
Johnson and others organized a summit that was held in April 2011 and was attended by more than 200 people. During the summit, participants identified the four major priority areas and divided into task forces—each with two leaders—to articulate strategies and action plans.
Overseeing the work of the task forces is a coordinating council, which comprises task force leaders, and representatives from partner organizations, which include the North Carolina Chapter of AARP, the Foundation for Nursing Excellence, the North Carolina Organization of Nurse Leaders, the East Carolina Center for Nursing Leadership, the North Carolina Area Health Education Centers, the North Carolina Nurses Association and the North Carolina Board of Nursing.
So far, the Coalition has begun a dialogue with key health care leaders across disciplines to remove unnecessary regulatory and reimbursement requirements; is working to create a common course catalog of pre-requisites for RN-to-BSN programs across all state-funded nursing schools; and is encouraged by the addition of a graduate nursing leadership course at East Carolina University to better equip nurses to lead change through participation on hospital and other health-related boards.
The education task force has seen the most progress so far, Johnson said. That’s largely because it is building on a nurse education project that was in place before the Action Coalition took shape. The project makes it easier for associate-degree nurses to earn higher degrees by creating partnerships between associate and baccalaureate nursing programs.
The goal is to build the supply of more highly educated nurses who will be able to provide more skilled care and who also will go on to earn master’s and doctoral degrees, which will help to curb nurse and nurse faculty shortages. The “RIBN” (Regionally Increasing Baccalaureate Nurses) project is a multiregional initiative led by the Jonas Center for Nursing Excellence and funded by Partners Investing in Nursing’s Future, a program supported by RWJF and the Northwest Health Foundation.
In North Carolina, the first RIBN students were admitted to the four-year, dual community college and university educational track in 2010, and by this fall the number will grow to nearly 100, Johnson said. “It’s very exciting. These are students who probably would only have gone through an associate-degree program. This opens up broader career opportunities for them early in their career development while advancing the overall educational preparation of our workforce.”
In the coming year, the Coalition will be developing a business case for the transformation of the nursing profession, planning a second summit and advancing the task force goals.
But the Coalition’s message is already getting through. Last summer, the North Carolina Medical Journal, one of the state’s premier medical journals, devoted an entire issue to the future of nursing, and the issue got the most website “hits” ever, Johnson said.
“Having such a prestigious medical journal use its pages to acknowledge nurses’ critical, integral role sends a clear message that the time to talk is now,” Johnson wrote on the RWJF Human Capital blog last fall. The high level of reader interest, she wrote, “is reason for optimism.”