The 2018 Nursing Innovations Fund projects were initiated on June 1, 2018 and ended on December 31, 2019, with nine state Action Coalitions having received awards. These states included: Colorado, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Rhode Island, Utah and West Virginia. The Action Coalitions used a variety of approaches and projects to address the Institute of Medicine (IOM) recommendations and advance a Culture of Health (CoH). Through unique approaches, connections to community partners, and creativity and commitment, these states successfully achieved their identified goals.

Themes

In examining the unique approaches used by the Action Coalitions, a commonality of themes emerged. These common themes included: 1) advancing nursing leadership, 2) cross-sector collaboration, and 3) the use of technology to increase outreach and connection across their states. The state Action Coalitions that focused on advancing nursing leadership included: Colorado, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Utah, and West Virginia. Examples of advancing nursing leadership include:

1. Colorado in two “Cultivating Nurses in Primary Care” summits assisted organizations in making changes for nurses to have increased leadership roles in the primary care delivery system.
2. Massachusetts worked with school wellness councils to increase awareness of the role and value of school nurses and nurses within the community.
3. Michigan connected more than 50 experienced mentors with new nurses.
4. Nebraska developed a Community Health Workers (CHW) supervision toolkit to share the perspective of nurses as supervisors.
5. Ohio assisted in placing nurses on the boards of 18 (out of 26) Court Appointed Special Advocates (CASA) programs, which served as a national model for the Nurses on Boards Coalition (NOBC) to collaborate with the United Way.
6. Pennsylvania completed ten podcasts to generate awareness and audience interest in the work of nurses.
7. Utah reached out to over 300 middle and high school students to identify best practices for encouraging higher education degrees such as nursing and identified the barriers that first-year diverse nurses experience.
8. West Virginia developed a Nurse Entrepreneur Course curriculum with 35 nurses completing the offering and ten nurses that established new businesses.

The cross-sector collaboration theme is seen in a broad outreach of the Action Coalitions to partner with organizations across states to advance their work, and included:

1. Colorado – Federally Qualified Health Centers;
2. Massachusetts – school systems, National Libraries of Medicine;
3. Michigan – Michigan Health and Hospital Association;
4. Nebraska – health departments;
5. Ohio – Court Appointed Special Advocates for Children (CASA) program;
6. Pennsylvania – Health Promotion Council, LGBT Community Center, and refugee centers;
7. Rhode Island – Community College of Rhode Island;
8. Utah – high school and middle school counselors, Area Health Education Centers (AHECs); and
9. West Virginia – Small Business Development Center.

Key learnings from this cross-sector collaboration were the identification of the need to build relationships, set clear roles and expectations, and maintain constant communication with all partners. This process entailed understanding that collaboration with other groups and stakeholders involves recognition of varying priorities and schedules that need to be considered in setting project goals and timelines. Coordinating and communicating with other organizations within a state doing similar work is essential to avoid duplication.

Action Coalitions that engaged technology as a methodology to broaden their outreach and connection across their states and across the country included:

1. Colorado – ongoing Web-based learning sessions;
2. Michigan – built a networking program for mentoring and access to a repository for professional development with 21 e-learning modules;
3. Pennsylvania – ten podcasts to showcase stories of patients, families, and communities and the work of nurses; and
4. Utah – online surveys to determine barriers that first-year diverse nurses experience.

Learnings from this use of technology included the need to address cybersecurity and quality assurance issues and allocating time for development components. While some projects had staff and budget constraints that prevented in-person meetings/trainings, implementation of online opportunities provided for completion of project goals with success.

These commonalities of themes demonstrate that while there is a uniqueness in state Action Coalition projects, there is also a unity of purpose that advances their work.

Success Rate

Approximately 90 percent of the Action Coalitions fully met their identified goals. When faced with challenges, most Action Coalitions re-grouped and re-focused to continue moving forward with their work. Two Action Coalitions adjusted their initial plans in order to achieve their anticipated results.

Overall success can be seen in the results, which include:

• Colorado has been awarded a four-year $699,890 Health Resources and Services Administration (HRSA) grant to continue “Cultivating Nurse in Primary Care” Web-based learning and coaching.
• Massachusetts increased the engagement of nurses on school wellness councils from five nurse facilitators to 20 statewide.
• Michigan’s Mentoring Project is now part of the Michigan Health Council’s ongoing workforce mission, and a planned partnership is underway to develop a social determinants of health (SDoH) curriculum to add to the Mentoring Project e-modules.
• Nebraska’s interdisciplinary team, in collaboration with the Department of Health and Human Services (DHHS), published a statewide report on the importance of the Community Health Workers’ (CHW) role to interdisciplinary healthcare teams.
• Ohio developed a model for partnership with CASA to incorporate nurses on boards of nonprofit organizations.
• Pennsylvania provided a series of podcasts with 1,985 listeners across the two largest metropolitan areas in the state, which was adopted by a weekly radio program.
• Rhode Island incorporated the Community College of Rhode Island into statewide interprofessional education activities.
• Utah completed a full assessment of nursing programs recruitment, retention, and priorities for support of diverse nursing students. Additionally, it used a multi-pronged research-based approach to increase diversity across the state, including barriers and support needed for diverse new graduate nurses and nurses on boards.
• West Virginia developed a nurse entrepreneur course with 35 nurses completing the course and ten opening new businesses. The program received a “change maker award” from Greater Kanawha Valley Foundation. The co-leads have been asked to contribute to a chapter in a Springer Publication entitled, “Advance Practice Leadership: A Global Perspective.”

Partnerships/Funding

The cross-sector collaboration theme demonstrates the broad outreach that the Action Coalitions have made to increase collaboration with community-based organizations across the states. Some of these partners have provided funding while others have provided logistical, technical, and outreach support. Examples include:

• In Colorado, the Clinica Family Health and Valley Health Systems provided connections to Federally Qualified Health Centers (FQHCs), and tools and resources such as nursing protocols. They also supported a grant application to HRSA for a four-year $699,890 grant to fund the continuation of the project.
• In Massachusetts, the Massachusetts Health Council and the National Libraries of Medicine provided education resources and the National Libraries of Medicine provided matching funds.
• The Michigan Health and Hospital Association provided the technical support to launch the networking platform and connection to other community organizations and groups such as the Community Health Equity Partners.
• In Nebraska, the Douglas County Health Department provided connection to FQHCs and regional behavioral health services which led to a collaboration to provide matching funds.
• Ohio connected to CASA, which provided a network of boards for the Action Coalition to link with for nurses to serve on the boards.
• Pennsylvania engaged a number of partners to provide content for their podcasts and worked with these organizations to publicize the podcasts.
• The Utah Action Coalition forged several new partner relationships, including the State Board of Education, the Health Occupational Student Association, Area Health Education Centers (AHEC), the Ute Nation, the Navajo Nation nurses, and the Young Women’s Christian Association (YWCA)/Women’s Leadership Network. The matching funds for their project came from a collaboration of Intermountain Healthcare, University of Utah College of Nursing, MountainStar Corporation and the Utah Hospital Association.
• In West Virginia the Small Business Development Center provided content support and coaching for the participants, and The Greater Kanawha Valley Foundation provided both matching funds and a continuation grant of $20,000.

Replicability, Sustainability and Scalability

Most of the Action Coalitions have worked with their partners to replicate, expand, and sustain their projects. Examples include:

• Colorado obtained additional funding to offer its Cultivating Nurses in Primary Care two-day summit in 2020 and 2021 with their partner organization, Clinica Family Health, offering tools and resources to other organizations for a small fee.
• In Massachusetts, the initial partnership with schools has led to a more formal partnership with the School Superintendents Association to move forward with an additional program to address school health needs by developing an anti-vaping curriculum.
• In Michigan, the Michigan Health Council (MHC) continues to build the Alliance for Clinical Experiences Matching and Placing Program (ACEMAPP library), giving participants in the Mentoring Project access to a growing repository of relevant material for professional development and career support. Additionally, the MHC organizes the Michigan Nursing Summit where the Mentoring Project will be exhibited annually.
• The Nebraska Action Coalition collaborated with the Nebraska Department of Health and Human Services (DHHS) to crosswalk existing CHW curricula across the state to continue to build a statewide CHW workforce.
• The Ohio model for partnering with a non-profit organization to increase nurse participation on boards is now being duplicated by the Nursing on Boards Coalition (NOBC) with the United Way. Additionally, the CASA program is being expanded to include sites across the country.
• Pennsylvania is in the process of developing an additional ten podcast episodes with a marketing plan to attract additional sponsors.
• To synergize and align the diversity work, the Utah Action Coalition is planning a statewide diversity summit for all health care professionals in collaboration with the Utah Hospital Association.
• West Virginia is planning to continue its project for two additional years, and is continuing to seek additional publication opportunities.

The outcomes of the Nursing Innovations Fund projects demonstrate the commitment of these Action Coalitions to continue to share and expand their projects, while providing strong examples and opportunities for other state Action Coalitions to build on their work.

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