Oct 25, 2015
Preparing the Nursing Workforce to Transform Healthcare
National & State Perspectives, Initiatives are Focus of MA Workforce Summit
More than 150 nurses and leaders from across the healthcare spectrum attended the 2nd Annual Massachusetts Healthcare Workforce Summit and shared updates on national and statewide progress in developing a more highly educated and diverse nursing workforce, including data from successful initiatives in academic and practice settings.
The September 25 event was organized by the Massachusetts Action Coalition (MAAC), a partnership of the MA Dept. of Higher Education and the Organization of Nurse Leaders of MA & RI, which is leading a statewide campaign to transform health care through nursing education and practice innovations.
“Over the last four years, the Massachusetts nursing community and Department of Higher Education have made strong progress in implementing the recommendations of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health,” said Patricia Crombie, MAAC Project Director. “Our goals now are to energize and engage more healthcare employers in this work and to develop initiatives and partnerships that can sustain this progress over the coming years.”
“Nurses are integral to building a nationwide culture of health,” Dr. John Lumpkin, Sr. Vice President of the Robert Wood Johnson Foundation (RWJF), said in his keynote address. “Everyone in American can live a healthier life, supported by a system in which nurses are essential partners in providing care and promoting health”
“Nurses are everywhere — where people live, learn, work, and play — and have long been on the forefront of changes to improve health and healthcare,” said Lumpkin. “Through Action Coalitions across the country, nurses are partnering with a wide range of public and private organizations to make health a priority. If we’re going to succeed in building culture of health, nurses are – and will continue to be — critical to our success.”
Massachusetts is one of nine states recognized by the RWJF for their efforts to create a more highly educated, diverse nursing workforce by making it easier for current and future nurses to earn a bachelor’s degree or higher. Nationwide, more BSN-educated nurses are entering the workforce than those without bachelor’s, noted Tina Gerardi, Deputy Director of RWJF’s Academic Progression in Nursing (APIN) initiative.
The number of students in RN-to-BSN programs increased 69% from 2010 to 2014, Gerardi told the participants. Because there is enormous variability in requirements and credits in nurse education programs, APIN is focusing on establishing a set of foundational courses for RN-to-BSN programs.
In addition to keynote addresses by Lumpkin and Gerardi, the daylong summit included examples of initiatives in Massachusetts to increase the diversity of the nursing workforce, facilitate the academic progression of nurses to the baccalaureate level and beyond, expand the use of nursing core competencies in academic and practice settings, and remove barriers that hinder advanced practice nurses from practicing to the full extent of their education and training. In the afternoon, participants shared insights, challenges, ideas, and promising solutions during lively break-out sessions.
Many of the presenters and small group leaders expressed their enthusiasm for the work, leadership experience, and professional partnerships they have experienced as a member of a MA Action Coalition project team. Stephanie Ahmed, President of the MA Coalition of Nurse Practitioners and co-leader of the MAAC “Scope of Practice” project team, echoed the sentiment and added an appeal to Summit participants: “Join us because our patients need us.”
Increasing Diversity of the Nursing Workforce
Deborah Washington, Director of Diversity Patient Care Services at Mass. General Hospital and a leader in the MAAC Diversity Advisory Group, opened her presentation by expressing gratitude to “all the change agents who have and are working to make the nursing profession more accessible to an increasingly diverse population.”
Washington noted key population characteristics of the 32 million newly-insured Americans: first and foremost that they are increasingly diverse, but also tend to have limited familiarity with the healthcare system, unmanaged chronic conditions, and minimal education about preventive and elective care. Increasing the number and percentage of nurses who are similar to and familiar with the populations they serve can improve healthcare delivery and decrease disparities in health.
“Diversity must be embedded in the goals, execution, and strategy of all our projects to advance nursing and improve healthcare,” said Washington. Some of the successful strategies she highlighted were cultural matches for nurse mentoring programs and “pipeline-expanding” efforts to get more students from underrepresented populations to consider nursing as a career option.
Facilitating the academic progression from LPN to BSN is an important way to increase the diversity of the nursing workforce, explained Eileen Costello, Dean of Health Professions, Public Service Programs and Social Sciences at Mount Wachusett Community College. The Nursing Education Transfer Policy that is being implemented across public colleges and universities in Massachusetts creates a seamless, cost-effective, timely, and transparent pathway for students to progress from community college Associate Degree in Nursing (ADN) programs to the Bachelor of Science in Nursing degree.
“The entire nursing community needs to support these students along the BSN pipeline,” said Costello. “Students want to advance their education. All of us – employers, educators, leaders — need to create structures and programs that enable them to earn their baccalaureate or higher degree.”
Increase Academic Progression to BSN and higher
Janet Monagle, President of the MA & RI League for Nursing and a co-lead of the MAAC Academic Progression Working Group, highlighted recent accomplishments in building a more highly educated nursing workforce in Massachusetts, including:
• Encouraging replication of successful academic progression models throughout Massachusetts public and private higher education system;
• Developing a recruitment video for LPN-to-BSN programs;
• Disseminating the “MA Action Coalition Report of Employer Practices” to healthcare employers to promote best practices and programs;
• Implementing the Nursing Education Transfer Compact in state education policy and facilitating credit transfers between two- and four-year nursing programs.
“Research shows that BSN-prepared nurses improve patient outcomes in acute care settings, evidence is now emerging that similar investments in the RN workforce across the continuum of care are equally as important,” noted Jackie Somerville, CNO at Brigham & Women’s Hospital. Healthcare is moving with increasing speed to the post-acute setting (e.g. ambulatory, long-term, home care). “Patients don’t often see the distinction between acute and post-acute care,” said Somerville. “The care needs to be seamless, so we need to build partnerships with post-acute settings to advance the academic progression of that workforce, too.”
Nurse of the Future Nursing Core Competencies© (NOFNCC)
Five years after the publication of the Nurse of the Future Nursing Core Competencies© – Registered Nurse (NOFNCC-RN) and their implementation into academic and practice settings across the state, Massachusetts nurse leaders have developed a similar set of competencies specific to the skills and abilities of the Licensed Practical Nurse (LPN).
“These competencies are based on the understanding that LPNs share with the entire nursing community a commitment to providing safe, quality, cost-effective care and are an essential member of the healthcare team,” said Judy Beal, Dean and Professor at School of Nursing at Simmons College.
Beal emphasized the importance of ongoing promotion of the NOFNCC and dissemination of the accompanying Toolkit in academic and practice settings statewide. The project team is developing a standardized NOFNCC educational PowerPoint presentation and a webinar.
Faculty Challenges Related to Increasing the Percentage of BSN-educated Nurses
If Massachusetts is to reach its goal of 66% BSN-prepared nurses by 2020, it must increase the number of qualified nursing faculty through recruitment, retention, professional development, and “creative use of retired faculty,” Karen Manning, Nursing Chair at Laboure College, told summit participants. Initial findings of a recent Faculty Workload Survey show that nursing faculty are older (mostly over age 50), not very diverse in race or ethnicity, and working harder, with 36% of part-time respondents reporting that they hold two or more academic roles.
Released earlier this year, the MAAC report on nursing faculty workforce challenges identified multifaceted issues of current and future faculty needs and seven recommendations for recruitment, retention, and development of faculty.
Removing Scope of Practice Barriers for Advanced Practice RNs (APRN)
One of the unintended consequences of healthcare reform has been that patients in Massachusetts, particularly those outside Greater Boston, are experiencing difficulty accessing needed care, Stephanie Ahmed, DNP, FNP-BC, DPNAP, of the Mass. Coalition of Nurse Practitioners told summit participants.
Ahmed cited a 2013 survey that documents that, despite boasting the greatest number of physicians per capita, Massachusetts has wait times that are among the worst in the nation. Advanced Practice Nurses have the training and education to provide high-quality, cost-effective patient care; however, they are restricted by Massachusetts laws and regulations. Removing scope of practice barriers for APRNs and strengthening interprofessional collaboration within the healthcare community are priorities for the MAAC. Key legislative proposals to address practice barriers are included in Ahmed’s presentation materials.