Even before the Institute of Medicine released the much-anticipated report “The Future of Nursing: Leading Change, Advancing Health” in October, plans were under way for the critical next step: turning the report’s recommendations into reality.
The effort is led by Susan Hassmiller, RN, PhD, FAAN, senior advisor for nursing for the Robert Wood Johnson Foundation, and the effort is dubbed “Future of Nursing: Campaign for Action.”
According to the report released by the IOM and sponsored by RWJF, nurses’ roles, responsibilities and education should change significantly to meet the increased demand for care that will be created by healthcare reform. The report included eight recommendations that would allow nurses to innovate and improve patient care.
Hassmiller knew the report called for change at both the state and national levels. To engage states in the Campaign for Action, Hassmiller asked AARP to collaborate with her to call nurse leaders in five states and ask them to form Future of Nursing Regional Action Coalitions. The states — California, New Jersey, New York, Michigan and Mississippi — were selected for their strong leadership infrastructure and capacity to implement change. In selecting RAC leaders, Hassmiller sought those whose past accomplishments demonstrated their leadership ability, whose states had strong nursing work force centers and provided geographical reprentation from across the country.
In January, Campaign for Action organizers asked for applications from other states. The goal is to add eight more RACs.
Hassmiller asked each state-level nurse leader to find a non-nurse co-leader for the RAC because she believes it is essential to involve outside constituents, such as the state government, the business community, consumers and foundations, in the process of implementing the recommendations.
“I’m excited because we are actually going to do this,” Hassmiller says. “It is not going to be just another interesting report that comes out and then sits on the shelf. The goal is for the RACs to implement policies and practices that can be modeled by other states.”
States Pick Priorities
The RACs are in the early stages of organizing committees and action plans. The leaders’ first task was to form steering committees. The committees then evaluated which of the eight recommendations would be given the highest priorities in their states. “We can’t be prescriptive and tell the states what to work on,” Hassmiller says. “They have to look at the recommendations and determine what they have the most need for, the most passion for.”
One of the goals of the California RAC, for example, is to focus on the fourth recommendation — to increase the proportion of nurses who hold a bachelor’s degree to 80% nationally by 2020. California already has developed a model in which community colleges collaborate with baccalaureate programs to seamlessly provide a BSN to nurses who are educated in ADN pre-licensure programs.
For example, students have dual admission into both programs. After completing the associate’s degree, they have to take only one more year of courses for the BSN.
The RAC will work to expand the program to more schools statewide. “That is California’s answer for how to get more nurses with a BSN,” says Deloras Jones, RN, MS, co-leader of the California RAC, and executive director of the California Institute for Nursing & Health Care. “It’s important to build on the existing school infrastructure.”
The California RAC also will focus on the third recommendation — implementing nurse residency programs. The Transition-to-Practice programs already are under way in the San Francisco Bay Area at Samuel Merritt University in Oakland, University of San Francisco, California State University, East Bay, Evergreen College in San Jose and San Jose State University. The RAC aims to expand these programs statewide, Jones says.
She says that nurses and non-nurses are eager to participate in the RAC and continue the momentum started by the IOM report. “I have been very impressed with the high degree of enthusiasm that is building around the IOM recommendations,” she says. “Now it is important for us to be able to manage that enthusiasm and come up with actionable steps we can take.”
Carole Stacy, RN, MSN, MA, co-leader of the Michigan RAC, also was impressed by the level of interest. “The response from my colleagues in Michigan has been absolutely phenomenal,” says Stacy, vice president of the Michigan Health Council.
She included a call for help in the bimonthly Michigan Center for Nursing newsletter and was pleased by the response. “When I asked if anyone was interested in working on the subcommittees, I had 40 e-mails within the first day,” Stacy says.
Michigan is focusing on the same recommendations as California. The Michigan RAC also has created a subcommittee to address the eighth recommendation — to build an infrastructure for collection and analysis of interprofessional healthcare work force data. The subcommittee will gather data from hospitals, public health departments and long-term-care facilities to gauge what types of nurses will be needed in the future. This data will inform strategies for nursing education, Stacy says.
Members of the Michigan RAC also created a communications committee to inform nurses and other healthcare professionals about the IOM’s report and recommendations. The group might use social media, such as Facebook, and work with other organizations to get the word out. “People in nursing leadership are aware of the IOM recommendations, but there are a lot of nurses who have not heard about the report,” Stacy says. “Nursing leadership talks to each other about this, but we don’t do a good job of getting the information out to the nurse on the unit.”
Although implementing the recommendations might seem like an ambitious task, the leaders are optimistic. “I think that being an RAC co-leader is one of the most exciting professional opportunities I’ve had,” says Cathryne Welch, RN, EdD, co-leader of the New York RAC, and director of the Institute for Nursing: New York State Nursing Workforce Center. “Most of the eight recommendations are virtually identical to priorities that the nursing profession has identified in the past for advancing the profession and elevating the quality of healthcare. The fact that these priorities have been embraced by the IOM and RWJF places the pursuit of these goals in a totally new context. It has electrified and galvanized the nursing community.”
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