Nurse and Government Leaders Team Up to Transform Nursing in Massachusetts

State Action Coalition takes multi-pronged approach to strengthening nursing education programs.

    • May 6, 2013

Nursing student Jennifer Watson, LPN, BA, might be forgiven for falling asleep in class now and then. After all, she works full-time at a medical center in central Massachusetts, where she is on call nights and weekends. Watson also carries a full course load at Fitchburg State University, where she is earning her bachelor’s degree in the science of nursing (BSN). And she is the single parent of two teenagers.

But Watson betrayed no signs of fatigue recently when she told a local reporter that she is forever grateful to have earned a coveted spot in Fitchburg’s innovative LPN-to-BSN “bridge” program, which allows students to use 18 licensed practical nurse (LPN) credits toward completion of a BSN degree.

“It’s a chance to broaden my horizons, open up different job opportunities for me, a chance to stimulate my income, and allow me the flexibility to be a mom, and work, and be successful,” Watson told a reporter for the Fitchburg (Massachusetts) Sentinel and Enterprise. She spoke during a recent tour of the campus’ state-of-the-art nursing facilities that house the program—one that is beginning to draw national interest.

While Massachusetts is proud of its reputation as a leader in both higher education and health care, the state has grappled with the same question that faces most states: How does it create new pathways for nurses to advance their education to meet the complex needs of an aging population and a fast-changing health care industry?

The Massachusetts Action Coalition, co-led by the Organization of Nurse Leaders of Massachusetts & Rhode Island and the Massachusetts Department of Higher Education (which provided grant funding for the Fitchburg program), is working to create “seamless progressions” in nursing education. It is part of the Future of Nursing: Campaign for Action, which is backed by the Robert Wood Johnson Foundation (RWJF) and AARP, and aims to improve health and health care by transforming the nursing profession.

The Fitchburg program is just one of a number of new, successful models taking root across the state. Proponents say such programs, which lower costs and reduce the time it takes for nurses to earn baccalaureate—and higher—degrees, will lead to a more highly educated workforce. In turn, they say, higher education levels among nursing staff have been associated with better patient outcomes. 

“Our nurses can access many different levels of education, from public to private, from the associate’s degree to the doctorate,” says Pat Crombie, MSN, RN, project director of the Massachusetts Action Coalition. “We’ve got to encourage associate-degree and licensed-practical nurses to go back and get their bachelor’s degrees.”

The Action Coalition’s effort to facilitate nurse education is getting a strong boost from RWJF, which awarded it $300,000 over two years to build models of seamless academic progression. Read more about RWJF’s Academic Progression in Nursing (APIN) grants to Massachusetts and eight other states here.

These grants are helping nursing programs rewrite curriculum and advance strategies aimed at creating a more highly educated, diverse nursing workforce. They are addressing concerns contained in a 2010 report issued by the Institute of Medicine (IOM) recommending that 80 percent of nurses hold a bachelor’s or higher degree by 2020. At present, only about 55 percent of Massachusetts are prepared at that level, Crombie said.

Massachusetts Lt. Gov. Timothy Murray agrees. He appeared in the aptly named Nurses Hall at the Massachusetts State House last year along with key legislators and nurse leaders to hail the news of the RWJF APIN grant. “With the support of the Robert Wood Johnson Foundation, our work to advance educational opportunities for currently practicing nurses as well as new candidates will ensure more nurses are prepared to address patient health care needs in the years ahead,” he said at the announcement ceremony.

Prior to 2011, when the Action Coalition was designated  as an official group by RWJF, the Massachusetts Department of Higher Education  and the Organization of Nurse Leaders of Massachusetts & Rhode Island (ONL) had already begun to work with  nursing organizations and hospital associations to develop strategies to address a looming nurse shortage.

In their continuing partnership, they spearheaded projects to expand the number of clinical placements for nursing students at area health care facilities; promote simulation training for nursing students; and help foreign-educated nurses prepare for state licensing examinations. They also oversaw the creation of a set of the Nurse of the Future Nursing Core Competencies (NOFNCC©), and programs to help schools and health care facilities implement those competencies.

A Broader Agenda

In 2011, the Nursing and Allied Health Initiative took on the broader agenda of the Massachusetts Action Coalition by establishing a new set of goals related to practice, leadership, data, diversity, inter-professional collaboration, and education. Throughout its transition, the Action Coalition maintained strong partnerships with Massachusetts government leaders and with other organizations. “We’ve got a very good foundation,” Crombie said. “We’re lucky to have some long-standing trusting relationships.”

Today, the Action Coalition is comprised of 12 working groups and boasts a volunteer team of about 140 people. One of its top goals is to streamline the credit transfer process so that more students, like Fitchburg’s Watson, will have the opportunity to move seamlessly along a path to a BSN and beyond.

Action Coalition members are also creating a “pathway map” that nursing students and working nurses can use to identify optimal ways to advance their education. And they are actively engaging employers so they can learn more about incentives—such as tuition reimbursement, flexible scheduling, on-site courses, and partnerships with colleges and universities—that are effective in helping working nurses continue their education.

The Action Coalition also is developing a toolkit to spur implementation of the core competencies published in 2010 by the Department of Higher Education’s Nurse of the Future Competency Committee. At the same time, it is assessing nursing faculty retirement projections and searching for creative ways to retain senior nursing faculty and to encourage practicing nurses to consider academic roles. Other Action Coalition members are working to better understand and overcome obstacles to diversifying the state’s nursing workforce.

Another sub-set of Action Coalition members is overseeing data collection and use. Almost all of the teams need data of some kind to support and advance their work; eliminating redundancy in collection and interpretation of data is critical to efficiency.

Practice, leadership, and increasing diversity are all integral to the Action Coalition’s efforts.  Encouraging participation from all areas and levels of practice helps to keep the Action Coalition grounded in the reality of day-to-day nursing, while providing leadership opportunities for nurses throughout their career cycle.

A major hurdle is sustainability, but the ONL has already raised close to $200,000 this year, in addition to its RWJF APIN grant. To reach its goal of $500,000  per year, Action Coalition members are reaching out to high-level stakeholders outside the nursing profession and have hired a part-time employee—Crombie—to coordinate the activities of the coalition, including raising money.

“This has been called the coalition of the willing,” Crombie said. “Every one of these project team members is a volunteer.”

While the Action Coalition is squarely focused on the future of nursing, the impact of its efforts will be felt throughout the health care delivery system. Crombie is optimistic that it will get the funding and support it needs to thrive.

“This is a state that really values health care reform,” she said. “The sun and moon and stars are finally in alignment for us.  Many of us who have been in nursing for years have been waiting for a day like today. We’re energized and very hopeful about where this work will lead us.”