The Problem: The nursing shortage persists across America and is expected to become even more severe as our population ages. Many factors influence the shortage, including inadequate nurse faculty to train new nurses and a large number of nurses preparing to retire. Local and regional philanthropies work closely with their communities to solve problems and are natural partners in this effort; however, many are unfamiliar with nursing workforce issues or how they might use their strengths to develop solutions.
Community foundations are natural conveners and can bring together diverse community organizations in collaborative partnerships to address these and other nursing issues. Small foundations, and in particular family foundations, may have limited resources but, if encouraged with external funding, can find matching support-and creative solutions-in their communities. Foundations that typically do not support health-related projects can be encouraged to find linkages to their focus areas, including support for education, economic development, and aging services.
Grantee Perspective: "I was trained as a lawyer but people say I talk 'nurse'," says Judith Woodruff, J.D. And it is precisely that combination that Woodruff brings to her position as national program director of RWJF's Partners Investing in Nursing's Future (PIN), a collaborative program of RWJF and the Northwest Health Foundation (NWHF). She also directs the NWHF's regional nursing program, which has been involved in nursing workforce issues for several years and has dedicated more than $5 million to the effort in Oregon and southwest Washington. For Woodruff, her current position represents a convergence of expertise, experience and interest.
Before joining NWHF in 2001, Woodruff served as an assistant attorney general with the Oregon Department of Justice, Charitable Activities Section, which has primary regulatory oversight for approximately 12,000 nonprofits in the state. She had also worked in hospital community relations and marketing prior to law school. When NWHF decided to invest more financial resources to nursing, Woodruff was an ideal choice to head the nursing program and the PIN program when it started in 2005.
Susan Hassmiller, Ph.D., R.N., senior program officer, says that as a non-nurse, Woodruff "brings the perfect blend of analytic and advocacy skills to our implementation and dissemination strategy. She is a tremendous friend to nursing." The leaders of the Oregon Consortium for Nursing Education agree; earlier this year they named Woodruff an honorary nurse.
"A lot of my skills as an attorney translate to nursing workforce issues and to philanthropy-problem solving, analyzing and critical thinking," says Woodruff. "Lawyers are trained to look at things differently, which is good for nursing. Sometimes it takes someone from philanthropy with a variety of experience to ask the really hard questions to get nursing leaders to think outside the box."
NWHF's gravitation towards nursing as a major priority area was also a "natural." Originally, the foundation, chartered to address health and health care issues, was a purely responsive grantmaker and tried to be "a lot of things to all people," says Woodruff. But after it commissioned a study on the nursing shortage, the foundation's board realized the seriousness of the problem and the need for a focused initiative to have a systemic impact. "Rather than focusing on health care service projects, such as providing a nurse practitioner for a community clinic, we wanted to deal with 'upstream issues' that could improve health."
"We are not going to solve much of the health issues in the United States or the world without the involvement and presence of the nursing workforce, the largest percentage of health care workers," says Woodruff. "Typically, however, nurses have been viewed as a cost rather than a resource."
To develop nursing resources, PIN grantees are working in the broad areas of nurse education, nurse faculty development, promoting diversity in the nursing workforce and investing in issues related to the aging population. The RWJF board approved a renewal authorization for the PIN program of $12 million over five years, beginning June 2008, to support two-year grants of $250,000 to approximately 30 local foundations. Each project site brings together multiple organizational partners and funders.
The Illinois Prairie Community Foundation, based in Bloomington/Normal, a rural college town of 100,000 halfway between Chicago and St. Louis, is a good example of a PIN grantee. "The project represents innovation in terms of its partnerships and its focus," says Woodruff.
Even though it is home to the Mennonite College of Nursing at Illinois State, the community has experienced difficulty attracting nurses, who tend to gravitate to urban centers. As a result, the college created an accelerated degree program for students who already have a non-nursing baccalaureate degree. The average age of students enrolled in the program is 28 years old.
"These are mature students, who have a vested interest in staying in the community," says Kelli Hill, M.S., PIN project director. "They have mortgages and expenses. To go to school fulltime for a year they have to quit their jobs. Yet they are ineligible for traditional financial aid like traditional first-degree students."
To help these potential nurses meet their financial needs, the local chamber of commerce and the economic development council formed a partnership that then enlisted four local banks to provide student loans. They saw the value to the community in developing strong baccalaureate-trained nurses with expertise in geriatric care and a commitment to the community.
"Our business and community leaders understood that nursing workforce issues are important community issues," says Hill. "The PIN grant provided a platform for communication and discussion of nursing issues among the partners."
Moving forward, Woodruff would like to spread the geographic distribution of PIN projects to additional states beyond the current grantees. "We hope to have 60 or more projects that have gone through the program and to develop some kind of alumni network to spread innovation through a peer-support model," she says.
RWJF Perspective: As the RWJF point person for nursing issues, Susan Hassmiller regularly received calls from local foundations asking what they could do in their communities to address the nursing shortage. "They wanted to be strategic and were seeking our advice and, in some cases, a partnership with us," Hassmiller says. RWJF launched PIN in 2005 and in 2006 published a toolkit with Johnson & Johnson for local foundations about the nursing shortage and specific ways they might help.
After identifying the important issues to be tackled-the nursing faculty shortage and increasing diversity in nursing schools-RWJF then sought out local foundations as partners. "We intended to invite one local foundation per grant to take the lead with the nursing leaders in their community, but apparently we set our intentions too low," says Hassmiller. "Right now, with just 21 grants implemented, we have 82 local foundations and funders signed on as partners. With the third cohort of grants our total will exceed 110 foundations/funders.
"This program builds nursing leaders across the country and also is building leadership among the ranks of local foundation leaders," says Hassmiller. "They are being recognized nationwide for stepping up to address one of our nation's most pressing concerns-the American nursing shortage."