“The Driving Force for Excellence in Nursing”
Margaret Henbest
Executive Director
615 North Seventh Street
PO Box 1278
Boise, Idaho 83701-1278
mhenbest@nurseleaders.org
(208) 367-1171 office
(208) 338-7800 fax
www.nurseleaders.org
ANNUAL NARRATIVE REPORT
Date: March 9, 2014
Title: “Advancing Nursing In Idaho to Improve Health”
Program: Future of Nursing: State Implementation Program (SIP) #70686
Dates: February 1, 2013 - January 31, 2014
Amount: $150,000 over 2 years
Goal: 1) Develop a statewide continuum for transition to and within nursing practice
2) Improve access to health care services provided by advanced practice nurses in Idaho
through the creation of an actionable plan to overcome barriers that limit APRN’s ability to
practice to the full extent of their education and training.
1. What did you accomplish during this reporting period:
This grant initiative actually encompasses four separate projects. Three of the projects are
focused on developing and enhancing statewide opportunities for nursing professional
development during career transitions in three key areas: the transition from student to
professional nurse, the transition to a leadership and management role, and the transition from
the clinical to the educator role. The fourth project is focused on identifying non-statutory
barriers to practice as perceived by APRN’s and their employers.
Transition to the Professional Nurse Role: New Graduate Residency
Val Greenspan, project manager, reviewed the literature, interviewed state and national experts
and Critical Access Hospital (CAH) representatives, and identified and engaged key
stakeholders. The stakeholders included nurses associated with existing Idaho Nurse Residency
Programs serving both large hospitals and CAH as well as several nurse educators. An
environmental scan revealed that large medical centers and hospitals associated with health
systems either had, or had budgeted for, Nurse Residency programs. A gap analysis indicated
CAH and some hospitals with less than 200 beds, lacked access to a Nurse Residency Program
currently and were unlikely without additional resources or assistance to access a NRP in the
future. In the process, the project manager also discovered a lack of knowledge about the term
“Nurse Residency,” which was sufficient to warrant extensive discussion to achieve agreement
among the stakeholders on the definition of a NRP. This resulted in the development of a general
information flyer which included definitions, key points, and specific Idaho data. This flyer was
distributed to CAH interviewees and at a conference attended by CAH representatives. After
laying this groundwork, the stakeholders were asked “What should the New Graduate Nurse
Residency Model be in Idaho?” A practical design that addressed travel and scheduling issues
raised by rural CAH emerged. The proposed hybrid/blended model combines: 1) on-line content
with an interactive component 2) a minimum of one regional face-to-face cohort interaction with
specifically designed simulation experiences. The project examined currently available NRP
options which included: IOWA Action Coalition Residency Project, “The Nurse Residency
Company”(proprietary, in development), and the Veteran’s Administration. The Idaho
Simulation Network has also been contacted and is interested in partnering in this project once
one or more pilot site (s) is identified. Finally, a second round of interviews of CAH Chief
Nursing Officers was completed to evaluate their initial reactions to the proposed new graduate
Nurse Residency model, interest in participating in the proposed Idaho Nurse Residency and
ascertaining their projected number of new graduate hirees in 2014. This activity was necessary
for planning year 2 work and outreach.
Transition to the Leadership Role: Leadership Course Development
Deena Rauch is the project manager for this project. Deena succeeds Sharon Kensinger, who
stepped down after taking a interim CNO position outside Idaho. After both Deena and Sharon
reviewed courses available across the country, both recommended purchase of the Association of
California Nurse Leaders (ACNL) 4 day leadership course. Contract negotiations were
concluded with ACNL in January 2014. The course content was delivered to the Idaho Nursing
Action Coalition (INAC) in February 2014. The pilot course will be held in the northern part of
Idaho, in the city of Coeur d Alene, the week of May 12, 2014. Faculty have been identified for
most of the course content, and they are currently reviewing specific sections of the course. The
course will be thorough evaluated in preparation for the first regular statewide course offering in
November, 2014.
Transition to the Educator Role: Effective Preparation of the Clinician to Assume the Educator
Role
Jane Grassley, a professor of nursing at Boise State University, is the project manager for this
project. Personnel changes slowed the beginning of the systematic review. The project manager
changed in the Fall and it took several months to hire a graduate research assistant, whose
employment began in January and is grant-supported. A systematic review of qualitative
evidence is in progress to answer the following question: “How do nurse clinicians with
advanced degrees experience the role transition to academic nurse educator?” A review protocol
has been developed using the guidelines of the Joanna Briggs Institute for Evidence-Based
Nursing. Preliminary findings illuminate the challenges of transitioning from clinical expert to
novice academic nurse educator. A common theme of the experience is a lack of preparation for
the teaching role. For example, being an expert perinatal nurse does not necessarily translate to
teaching perinatal nursing skills to undergraduate students. Another aspect of the experience
highlights the cultural differences between practice and academic settings. Mentoring is an
essential component of a successful transition. We anticipate that the literature will provide
insights into defining effective mentoring. Since much of the qualitative evidence is based on
individual and focus group interviews, focus groups are not planned at this point.
APRN Practice Barriers: Design and Distribute a Survey to Evaluate barriers to APRN Practice
in Idaho
Julie Marcum is the project manager for this project which is designed to identify non-statutory
barriers to APRN practice in Idaho including any professional, employment, financial and
institutional limitations on practice. Julie began her work developing the surveys by reviewing
the literature concerning barriers to practice for APRN’s. She identified a stakeholder group
composed of practicing APRN leaders in Idaho, nurse regulators, and researchers.
The APRN and employer surveys were then developed with final input from health professions
researchers at the Idaho Department of Labor and the Boise State University Center for Health
Policy. RWJF approved the APRN survey and the APRN and employer surveys received IRB
approval from BSU. It is anticipated that the APRN survey will be mailed in the second week of
February under Idaho Board of Nursing letterhead. In addition to the option of completing the
written mailed survey, respondents are being offered the opportunity to complete the survey
electronically via Survey Monkey instead of by hardcopy.
The survey project was presented at the Annual Nurse Practitioners of Fall Conference, and then
postcards were mailed to all Idaho APRNs informing them of the upcoming survey and
encouraging participation. A reminder postcard will be mailed to all Idaho APRNs two weeks
following the survey mailing.
A pilot study was completed during January with participation of eight APRNs from all APRN
roles (two did not respond). Extensive interviews were conducted with each and the survey was
amended based on comments received. All pilot participants commented on the importance of
the findings and look forward to learning of the resultsThe survey has been funded through a
grant received from the Idaho Board of Nursing, which has the ability to use nursing license fees
for workforce related initiatives. The IBN has placed a priority on monitoring progress in Idaho
on the OOM recommendations on the Future of Nursing.
2. Do you have any stories that capture the impact of this project?
APRN Practice Barriers: Design and Distribute a Survey to Evaluate barriers to APRN Practice
in Idaho
During the survey pilot interviews, many anecdotes were shared that emphasize the importance
of gathering this data. For example, one rural NP noted that the health system that operates two
facilities in her catchment area have differing privileges for the same APRN. Another noted the
difficulties of attempting to consult with other providers about her patients and the lack of
communication about their treatment by those providers.
3. What, if any proposed activities were not completed?
No activities were not completed. A change in the target group of employers for the employer
survey will be proposed if there is a less than 50% response rate to the APRN survey. This has
been approved by the grant manager, Jennifer Peed.
4. Did RWJF assist or hinder you in any way during this time period?
RWJF has not hindered these projects. CCNA has been helpful to develop relationships with
other grantees, in particular the action coalition in IOWA which is also working on a nurse
residency project.
5. Has your organization received funding from other foundations, corporations, or
government bodies for the project RWJF is supporting?
St Luke’s Health System: $5000 2012; $5000 2013
Idaho Alliance of leaders in Nursing: $10,000 2013
Idaho Hospital Association: $10,000 2013
Boise State University: $1000 in 2013; $9000 GRA support 2014
College of Southern Idaho: $1000 2013
Idaho Nurses Association: $250 2013
Idaho State University: $1000 2013
Kootenai Medical Center: $5000 2013
Lewis Clark State College: $1000 2013
Northwest Nazarene University: $1000 2013
Idaho Board of Nursing; $16,000 2014
6. Is there anything else you would like to tell RWJF?
Thank you for the opportunity to advance so many critical nursing issues in Idaho.
7. What was produced during the reporting period?
The APRN survey and the APRN employer survey are attached.