Leading Change,
Advancing Health
http://campaignforaction.org/state/virginia
Nursing’s Voice
3.2 MILLION
100,000
30,000
http://campaignforaction.org/state/virginia
Objectives
• To review Institute of Medicine, Future of
Nursing Report
• To define the Campaign for Action
• To define the Virginia Action Coalition
• To describe the workgroups
http://campaignforaction.org/state/virginia
Health Care System Challenges
Fragmentation
High costs
Primary care and
public health
shortages
Health care
disparities
Aging and sicker
population
http://campaignforaction.org/state/virginia
Virginia’s Health Care Challenges
Escalating rate of diabetes*:
 193,000 in 1993
 508,000 in 2010
Aging health care workforce
Primary care shortage, especially acute in rural areas
*Source: Centers for Disease Control and Prevention: National Diabetes Surveillance System
http://campaignforaction.org/state/virginia
Nurses and Health Care
Largest segment of health care
workforce
Critical role in providing patient
care and care coordination
Need to enhance nurses’ skills and capabilities
http://campaignforaction.org/state/virginia
RWJF’s Commitment to Improving Care
RWJF MISSION
To improve health and
health care for all Americans
Need to address challenges
facing nursing to address
challenges facing our health
system
http://campaignforaction.org/state/virginia
Institute of Medicine Report
High-quality, patientcentered health care for all
will require a transformation
of the health care delivery
system
One of the most-viewed
online reports in IOM history
http://campaignforaction.org/state/virginia
A Quote:
" achieving a successful health care system in the future rests
on the future of nursing."
Harvey V Fineberg, MD, PhD
President , Institute of Medicine.
http://campaignforaction.org/state/virginia
IOM Future of Nursing Report
• Committee on the RWJF
Initiative on the Future of
Nursing
• Membership
• Opportunity to transform health
care system
• Provide seamless, affordable, quality care
• Nursing profession is the largest segment of the health
care workforce
http://campaignforaction.org/state/virginia
Campaign for Action: Key Messages
•
Education
Interprofessional Collaboration
Leadership
Access to Care
Workforce Data
http://campaignforaction.org/state/virginia
High-quality
patient
centered
care
Blueprint – Four Key Messages
1. Nurses should practice to the full extent of their education
and training
2. Nurses should achieve higher levels of education and
training through an improved education system that
promotes seamless academic progression
3. Nurses should be full partners, with physicians and other
health professionals, in redesigning health care in the US
4. Effective workforce planning and policy making require
better data collection and an improved information
infrastructure
http://campaignforaction.org/state/virginia
Future of Nursing Recommendations
• Remove scope of practice barriers
• Expand opportunities for interprofessional collaboration
• Implement nurse residency programs
• Increase proportion of nurses with BSN to 80% by 2020
• Double the number of nurses with doctorates
• Ensure that nurses engage in lifelong learning
• Prepare and enable nurses to lead change and advance
healthcare
• Build an infrastructure for data collection
http://campaignforaction.org/state/virginia
Campaign for Action Pillars
Advancing Education
Transformation
Removing Barriers to
Practice and Care
Interprofessional Collaboration
Diversity
http://campaignforaction.org/state/virginia
DATA
Nursing Leadership
Education
Increase the proportion of nurses
with BSN and higher degrees
Increase the number of nurses
with doctorates
Implement nurse residency programs
Promote lifelong learning
http://campaignforaction.org/state/virginia
Education
Evidence
Some association between educational level and patient
outcomes
Twenty percent of BSN graduates get advanced degrees
Six percent of associate-degree graduates get advanced
degrees
Aiken et al., 2003; Estabrooks et al., 2005; Friese et al., 2008;Tourangeau et al., 2007; Van den Heede et al., 2009; Aiken, 2009.
http://campaignforaction.org/state/virginia
Practice
All practitioners should practice to the
full extent of their education and
training
Physicians, nurses and other health
professionals work in a team-based
model of care delivery
Models of care maximize time that
providers can spend on their respective
roles and responsibilities to patients
http://campaignforaction.org/state/virginia
Practice
Evidence
Studies show that APRNs permitted to practice to full extent of
education and training provide equal or better care
Systematic review of published literature between 1990 and 2008
indicate patient outcomes of care provided by APRNs and
equivalent or better than MD
Patient satisfaction • Length of stay • NPs: BP, glucose, lipid
control • CNMs: Fewer C-sections, fewer episiotomies
Sources: Journal of Nursing Economic$, (Sept/Oct 2011), Advanced Practice Nurse
Outcomes 1990 – 2008: A Systematic Review
http://campaignforaction.org/state/virginia
Collaboration
Prepare more
nurses to help
lead
improvements in
health care
quality, safety,
access and
value
http://campaignforaction.org/state/virginia
Interprofessional
education,
training and
practice
Integrated,
collaborative,
patientcentered health
care teams
Leadership
Nurses bring important viewpoint
to management and policy discussions
http://campaignforaction.org/state/virginia
Evidence
Gallup survey of 1,500
opinion leaders* said nurses
should have more:
Influence in reducing medical
errors, increasing quality of
care, promoting wellness
Input and impact in planning,
policy development and
management
*RWJF, 2010
**American Hospital Association, 2011
http://campaignforaction.org/state/virginia
Survey of 1,000 U.S.
hospitals** found:
Nurses account for only six
percent of board members
Physicians account for 20
percent of board members
Other clinicians are five
percent of board members
Data
Research on
health care
workforce is
fragmented
Improved health
care workforce
data collection to
better assess and
project workforce
requirements
Need data on all
health professions
http://campaignforaction.org/state/virginia
Diversity
Nurses should reflect patient population
in terms of gender, race and ethnicity
All nurses should provide
culturally competent care
http://campaignforaction.org/state/virginia
Campaign for Action
• The Campaign for Action is a national initiative
coordinated through the Center to Champion Nursing
in America (CCNA), an initiative of AARP, the AARP
Foundation, and the Robert Wood Johnson
Foundation.
• The campaign has mobilized diverse stakeholders
nationally and in all states to address the nation’s most
pressing health care challenges – access, quality and
increasing cost – by utilizing nurses more effectively
and preparing nursing for the future.
http://campaignforaction.org/state/virginia
Americans have access to
high quality, patient-centered
care in a health care system
where nurses contribute as
essential partners in achieving
success
http://campaignforaction.org/state/virginia
Campaign Strategies
Diverse Stakeholders
Action Coalitions
Policy-makers
RWJF
AARP
Advisory
Committee
Research,
Monitoring,
Evaluation
Communications
Grantmaking
http://campaignforaction.org/state/virginia
Nursing Must be Considered a
Societal Issue!
RWJF/AARP seeking support from:
Health professionals
Philanthropies
Payers
Educators
Consumer advocates
Hospitals and
health systems
Business
Public health agencies
Policy-makers
http://campaignforaction.org/state/virginia
Campaign for Action
How will the eight
IOM recommendations
translate into action?
campaignforaction.org
State Action Coalitions
Regional Action Coalitions
http://campaignforaction.org/state/virginia
AARP Virginia
Virginia Nurses Association
http://campaignforaction.org/state/virginia
Virginia Action Coalition Co-leads
AARP – Virginia
David DeBiasi, RN
Associate State Director - Advocacy
Virginia Nurses Foundation
Shirley Gibson, DNP, MSHA, RN, FACHE
Foundation President
Virginia Nurses Association /
Virginia Nurses Foundation
Janet Wall
Chief Executive Officer
http://campaignforaction.org/state/virginia
Virginia Action Coalition Goals
Nurses should:
• Practice to the full extent of their education and training
• Achieve higher levels of education and training through an
improved educational system that promotes academic progress
and explore residency programs
• Be full partners, with all members of the healthcare team in
redesigning healthcare
• Develop strategies to ensure that nursing is skilled to provide
leadership at all levels
• Ensure effective workforce planning and policy making require
better data collection and an improved information infrastructure
http://campaignforaction.org/state/virginia
Mission
To implement the recommendations in the
Institute of Medicine report,
The Future of Nursing:
Leading Change, Advancing Health
http://campaignforaction.org/state/virginia
Vision
All Virginians have access to affordable,
high quality care and live in
an optimal state of health
http://campaignforaction.org/state/virginia
Virginia Action Coalition
Workgroups
http://campaignforaction.org/state/virginia
VAC Leadership
Lindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RN
Co-leads
IOM Recommendation 7
Prepare and enable nurses to lead change to advance
health.
Objective
Determine strategic boards to which nurse could be
appointed and work with stakeholders to identify,
mentor, and recommend individuals for those
appointments.
http://campaignforaction.org/state/virginia
Leadership Objectives
• Continue “Nurse
Leaders in the
Boardroom” program
piloted with Robert
Wood Johnson
Foundation and AARP in
September 2009
• Continue to support
Nurse Leadership
Institute, a program of
the Richmond Memorial
Health Foundation
http://campaignforaction.org/state/virginia
Outcomes
•
•
•
•
•
•
•
•
Nurse Leaders in the Boardroom – AARP
Nurse Leadership Institute
Partnership with Virginia Student Nurses Association
Survey of nurses for board and potential
board members
Hospital survey for nurses on boards
RWJF Boundary Spanning Leadership
CFA Breakthrough Leadership Nominees
Inaugural Leadership Symposium!
http://campaignforaction.org/state/virginia
Next Steps
• Develop a video campaign re: value of nurse on
boards
• Enhance the Leadership Toolkit
• Develop structure for mentors and mentees serving on
boards
• Publish leadership article with Campaign for Action
• Blog for RWJF on Leadership
• Ongoing leadership development conferences for
nurses who want to serve on boards
http://campaignforaction.org/state/virginia
Outcomes
• Video: Value of Nurses on Hospital Boards
http://campaignforaction.org/state/virginia
Local Boards
• Free Clinics
• Crisis Pregnancy
Centers
• AORN, VNA, Black
Nurses & other
professional nursing
associations
• Public Health Advisory
Commissions
• Red Cross
• Alzheimer’s Association
http://campaignforaction.org/state/virginia
•
•
•
•
Church Affiliated Boards
Performing Arts Council
Historical Councils
County Board of
Supervisors
• AARP
• University &
Community College
Councils
• YMCA
State Boards
• Virginia Partnership for
Nursing
• Virginia Board of Nursing
• Virginia Nurses Association
• Virginia Nurses Foundation
• Multiple professional nurses
associations
• Virginia Board of Health
http://campaignforaction.org/state/virginia
• Virginia Association of
Counties
• VCCS Associates Degree
Nursing Program Heads
• Virginia Association of
Colleges of Nursing
• Health Insurance Exchange
Governing Body
National Boards
• American Nurses
Association & Political Action
Coalition
• National eHealth
Collaborative
• Nurses Organization of
Veterans Affairs
• American Midwifery
Certification Board
• AORN Journal Editorial
Board
http://campaignforaction.org/state/virginia
• National Kidney Foundation
• American Academy of Nurse
Practitioners
• American Organization of
Nurse Executives
• Various National Nursing
Organizations
Next Steps
• Develop a video campaign value of nurse on boards
• Enhance the Leadership Toolkit
• Develop structure for mentors and mentees serving on
boards
• Publish Leadership Article with Campaign for Action
• Blog for RWJF on Leadership
• Ongoing Leadership Development Conferences for
nurses who want to serve on boards
http://campaignforaction.org/state/virginia
VAC Access To Care
Cindy Fagan, RN, MSN, FNP-BC and Kathy Baker, RN, PhD, NE-BC
Co-leads
IOM Recommendation 1
Remove scope-of-practice barriers
Objective
All nurses should practice to the fullest extent of their
training
Objective
Educate stakeholders, legislators and the public about
APRN regulatory barriers that prevent full practice
authority to continue efforts to reform outdated scopeof-practice regulations
http://campaignforaction.org/state/virginia
http://campaignforaction.org/state/virginia
Outcomes
•
House Bill 346 passed and signed by Governor
– Eliminates supervisory language – emphasis on collaboration
– HB 346 manifested in 2013
•
•
Advanced Practice Registered Nurse disciplines
–
Consensus Model for APRN Regulation
• Gap - Licensure, Accreditation, Certification & Education
• Met with the Board of Nursing on agreement and sought advice on
titles
• Met with the House and Senate Finance Committees on language in
budget amendment
Research Project
– Qualitative Descriptive Case Study rebased on Yin’s Methodology for
Case Studies (In IRB status)
– Explore how policies and practices in hospitals either support or inhibit
RNs from practicing to their fullest extent
http://campaignforaction.org/state/virginia
Outcomes
• Video: The Advanced Practice Registered
Nurse
http://campaignforaction.org/state/virginia
Next Steps
• Consider legislation to remove the Joint Board and establish
an Advisory Group for oversight
• Continue education of the public about the APRN scope of
practice
• Continue to use the APRN video for education
• Conduct the Qualitative Descriptive Case Study Research
http://campaignforaction.org/state/virginia
Next Steps
• Conduct research to explore how policies and practices in
hospitals in the state of Virginia either support or inhibit RNs
from practicing to their fullest extent through a Qualitative
Descriptive Case Study rebased on Yin’s Methodology for
Case Studies
• Participants include nurses from all hospitals in the state
• Areas include ICU, Med/Surg/Progressive Care and
Emergency Department
• Include the CNOs, RNs and Advanced Practice Registered
Nurses
http://campaignforaction.org/state/virginia
VAC Academic Progression
Deb Zimmermann, DNP, RN, NEA-BC and Amy Gillespie, RN, MSN, EdD
Co-leads
IOM Recommendation 4
Increase the proportion of nurses with a
baccalaureate degree to 80 percent by 2020
Objective
Convene stakeholders on the implementation of
seamless education progression
http://campaignforaction.org/state/virginia
Future of Nursing Education
The Challenge
• 51% of VA RNs BS prepared
• 32% of AD graduates attain BSN
• 31% of Diploma graduates attain BSN
http://campaignforaction.org/state/virginia
Outcomes
• Regional Groups
– Eastern, Central, Northwest, North and
Southwest
• Inspiration to Aspiration Grant
– Interviews with nursing programs
– RN-BSN Guide
– Survey of RN-BSN students
– Video of students
– http://youtu.be/iT0ygHn4CYg
http://campaignforaction.org/state/virginia
Outcomes
• Academic Progression Models
– Two statewide conferences with stakeholders
– Academic Progression Summit
– RWJF State Implementation Grant
– Met with State Council Higher Education – G. E.
requirements
– Organizational policies to achieve BSN
http://campaignforaction.org/state/virginia
Next Steps
• Collaborate in the design of two pilot programs with
two nursing programs each, providing seamless
access for nurses to achieve higher levels of
education
• Develop mechanisms to track organizational progress
for education progression
• Enhance and expand online Academic Progression
Toolkit
http://campaignforaction.org/state/virginia
VAC Interprofessional Collaboration
Patti McCue, ScD., RN, MSN, NEA-BC
Bonnie Barndt-Maglio, PhD, RN
Co-leads
IOM Recommendation 2
Expand opportunities for nurses to lead and
diffuse collaborative improvement efforts
Objective
Develop and deploy an educational program
that prepares nurses, physicians, and other
care providers to practice in a team-based,
patient-centered care model
http://campaignforaction.org/state/virginia
Outcomes
• Physician Foundation Grant
• Developed leadership program with MSV
• Recruited 20 teams of physicians, nurses and
other health professions – clinical triads
• Required Capstone project on population health
• Provided leadership, business and innovation
skills
• Completed evolvetm Team Based Education
http://www.youtube.com/watch?v=M2PR2oqu66A
http://campaignforaction.org/state/virginia
Next Steps
• In partnership with MSVF, launch phase 2 of Evolve
• Track diversity (cultural, gender, rural / suburban /
urban, etc.) of program participants as well as
populations served.
• Develop an educational program toolkit that can be
presented in a variety of settings to promote the
evolve program and to provide education on the
importance of nurses practicing to the full extent of
their education, training and experience in a
collaborative setting
http://campaignforaction.org/state/virginia
Diversity
• Cultivating Diversity in Academia and the
Workforce – Virginia Nurses Association
Roundtable held July 24, 2014
– Angela Wilkes – Owens and Minor, Diversity Executive
– Elizabeth Carter, PhD, Executive Director VA Board of Health
Professions Workforce Data Center
– Matt Thornhill – Co-founder of Boomer Project
– Panels – Perspectives on Diversity – Strategies and
Successes
http://campaignforaction.org/state/virginia
Sustainability
• Campbell and Company
–
–
–
–
Technical Support
6 State Collaborative
Sharing Best Practices
Developing Tools
•
•
•
•
•
•
Case for Support
Prospective Relationship Building
Individual Support Base
Volunteer Engagement
Special Events
Fundraising Activities
http://campaignforaction.org/state/virginia
Members of the Virginia Action Coalition honored for their
contributions to the nursing profession at the 2012 VNF Gala
http://campaignforaction.org/state/virginia
Engage!
http://campaignforaction.org/state/virginia
Janet Wall
CEO, Virginia Nurses Association
Co-lead, Virginia Action Coalition
804-212-0690 / jwall@virginianurses.com
http://campaignforaction.org/state/virginia