TCC Site Visit December 18 – 19, 2012 Richmond, VA

Objectives To participate in the RWJF evaluation process To define the Virginia Action Coalition To describe the workgroups To review next steps

IOM Future of Nursing Campaign for Action

Vision Reaffirm the vision Americans have access to high quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success Reaffirm the vision

Action Coalition Goals Short and long term Field strategy to move key nursing issues forward at local, state and national levels In 15 states before moving nationwide Capture best practices, track lessons learned and identify replicable models

Campaign for Action: Key Messages Leadership Access to Care Workforce Data Education Interprofessional Collaboration High-quality patient centered care

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

How action coalitions got started 2010 Landmark IOM Report: Future of Nursing: Leading Change, Advancing Health November 2010 Campaign for Action Launch Summit RWJ Foundation and AARP Center to Champion Nursing in America State Action Coalitions – 5 pilots, New Jersey, New York, Michigan, Mississippi, California

Virginia Action Coalition Co-Leads AARP Virginia David Debiasi , RN, Associate State Director – Advocacy Bill Kallio, State Director VNA Shirley Gibson, MSHA, RN, FACHE, President

Virginia’s Action Coalition Application Submitted February 2011 - input from more than sixty stakeholders Awarded designation in March 2011 Focuses on technical support and exchange of best practices Catalyst to convene diverse stakeholder around common themes

Virginia Action Coalition Goals Nurses should practice to the full extent of their education and training Nurses should achieve higher levels of education and training through an improved educational system that promotes academic progress and explore residency programs Nurses should be full partners, with all members of the healthcare team in redesigning healthcare Nurses should develop strategies to ensure that nursing is skilled to provide leadership at all levels Nurses should ensure effective workforce planning and policy making require better data collection and an improved information infrastructure

Virginia Action Coalition Wave II – 10 States – Idaho, Utah, Colorado, New Mexico, Illinois, Indiana, Louisiana, Virginia, Florida and Washington Awarded designation in March 2011

Engagement Five workgroups with many volunteers – April 2011 Kickoff : June 16, 2011 Nursing Roundtable ww.vaifn.org website Blog and wiki -media training that Chelsea Savage, Lindsey Cardwell-Jones and Linda Ault participated with AARP Featured articles in the Virginia Nurses Today and media coverage across state

Partnerships Funding In-kind-engagement of non nursing partners Virginia Nurses Foundation Virginia Council of Nurse Practitioners, Virginia Nurses Association Virginia Partnership for Nursing In-kind-engagement of non nursing partners PIN Synergy grant awarded to Richmond Memorial Health Foundation and partners

AARP Partnership AARP volunteers including 4 state legislative specialists join VAC workgroups AARP 2012 legislative platform included supervision should be removed from the code of Virginia with regard to Nurse Practitioners Testimony given “on the record” at Department of Health Professions Town Hall Meeting on supervision of APRNs being a barrier to access to care

AARP Partnership AARP 2011 Voter Education Pamphlet Questions anyone running for VA General Assembly should answer : If elected/re-elected, how would you ensure advanced practice registered nurses can practice to the full extent of their education and expertise? Do you support or oppose allowing advanced practice registered nurses to practice without physician supervision?

Lindsey Jones-Cardwell, BSN, RN and Loressa Cole DNP, MBA, RN Co-Leads Leadership

Leadership Goal Develop strategies to ensure nursing is skilled to provide leadership from the bedside to the boardroom

Leadership Objectives Continue to determine strategic boards to which nurses could be appointed and work with stakeholders to identify, mentor, and recommend individuals for those appointments Collaborate with schools of nursing to ensure the curriculum focuses on leadership skills necessary for today’s complex healthcare environment Recognize leaders “from the bedside to the boardroom” at the annual Virginia Nurses Foundation Excellence in Nursing gala

Leadership Objectives Continue “Nurse Leaders in the Boardroom” program piloted with Robert Wood Johnson and AARP in September, 2009 Continue to support the current and expanded Nurse Leadership Institute, a program of the Richmond Memorial Health Foundation and a 2007 Partners Investing in Nursing’s Future (PIN) grantee, by participating on committees, providing scholarships, assisting in encouraging employers to nominate fellows and nurses to serve as faculty

Outcomes Networking and educational event for the nurses identified as 40 under 40 Recognized at VNF Gala - 2011 Mentoring event – May 31, 2012 Collaboration with: VONEL VNA VNF

Outcomes Utilizing WikiSpace to facilitate online discussion of objectives Hosting monthly conference calls to update the team on the background of objectives and develop implementation strategies for each objective Survey has been completed to determine boards nurses are serving – regional, state and national Survey also identified those who want to serve on boards Determining which boards nurses should be serving

The Survey Survey was released in January 2012 Closed in March 2012 344 started the survey 282 (82%) completed the survey

Do you currently serve on a local board or organization’s board of directors? 142 198

What type of local board are you serving on?

Local Boards Free Clinics Crisis Pregnancy Centers AORN, VNA, Black Nurses & other professional nursing associations Public Health Advisory Commissions Red Cross Alzheimer’s Association Church Affiliated Boards Performing Arts Council Historical Councils County Board of Supervisors AARP University & Community College Councils YMCA

What is your role on the local board you serve? 54.1% of those serving on a local board are board Members 45.9% of those serving on a local board are board Officers

Do you currently serve on a state-wide board or organization’s board of directors?

What type of state board are you serving on?

State Boards Virginia Partnership for Nursing Virginia Board of Nursing Virginia Nurses Association Virginia Nurses Foundation Multiple professional nurses associations Virginia Board of Health Virginia Association of Counties VCCS Associates Degree Nursing Program Heads Virginia Association of Colleges of Nursing Health Insurance Exchange Governing Body

What is your role on the state board you serve? 36.2% of those serving on a state board are Members 63.8% of those serving on a state board are Officers

Do you currently serve on a national board or organization’s board of directors?

What type of national board are you serving on?

National Boards American Nurses Association & Political Action Coalition National eHealth Collaborative Nurses Organization of Veterans Affairs American Midwifery Certification Board AORN Journal Editorial Board National Kidney Foundation American Academy of Nurse Practitioners American Organization of Nurse Executives Various National Nursing Organizations

What is your role on the national board you serve on? 72.4% of those serving on national boards are Members 27.6% of those serving on national boards are Officers

Experienced Nursing Board Leaders Willing to Mentor New Board Members 64.1 % or 118 Experienced Nurse Board Leaders were willing to mentor other Registered Nurses interested in board leadership

Future Nurse Board Leaders Of the Registered Nurses surveyed, 60.3% of those not currently serving on a board, were interested in future board leadership 181 Virginia Registered Nurses are future board leaders!

Next Steps for the Nurses on Boards Initiative Continue compilation of potential boards for nurse leaders to serve on Identify key boards that nurses should be present on and facilitate nurse leaders to apply for these positions Identify a forum to facilitate mentorship of future registered nurse board leaders Provide resources to current nurse board leaders to advance and mentor new board leaders Provide resources to future nurse board leaders

2013 Objectives Provide the CCNA Nurse Leaders in Boardroom DVD to targeted groups; facilitate presentations Develop a Nurse Leaders in the Boardroom resource toolkit and post this on the VAC and VNA websites Develop a mentorship support structure Contact survey participants to enlist involvement and continue to identify interested nurses to serve on boards

2013 Objectives Provide the VAC Nurse Leader in the Boardroom toolkit and mentorship resources to targeted leaders Categorize the targeted Boards list and link to VAC and VNA websites Identify 5 associations to target for nursing membership on Boards Develop a forum to continue to identify nurses interested in board leadership

Linda Ault, BSN, MSN and Cindy Fagan, RN, MSN, FNP-BC Co-Leads Access to Care

Access to Care Objectives All Nurses should practice to the full extent of their education and training

Progress Identified barriers to APRN practice in statutory (code) and each facility determines what the practice parameters will be for their institution. Published a series of “Myth Busters” in VNT to educate nurses regarding what the various APRNs are actually licensed to do Collaboration with VCNP and MSV

Progress House Bill 346 passed and signed by Governor Eliminates supervisory language Emphasized collaboration and consultation between NPs (LNP & CNMs) and physicians to practice in teams Increased from 4 to 6 number of APRNs physicians can collaborate with Joint Boards of Nursing and Medicine have 280 days from July 1 to develop regulations HB 346 may not manifest until early 2013

Progress APRN Video has been completed

Progress Collaborating with Center for Championing Nursing Diana Mason PhD, RN, FAAN and Andrea Brassard DNSc, MPH, FNP – scope for other RNs Broadening focus on scope for other RNs Linda Ault, RN MSN appointed to national Center for Championing Nursing committee for long term care

Next Steps Call for stories: to demonstrate through real practice stories how APRNs were either able to successfully bridge a gap to care or how the current statutes hindered and negatively impact access to care throughout the state Developing an APRN video to educate public on new regulations Plan to conduct focus groups to identify institutional restriction to practice for RNs Plan to develop tool kit based on results to educate administrative teams, physicians and other stakehoder

Next Steps Create a dashboard on the VAC website to track the speakers and organizations that have been addressed. To date we have visited various APRN meetings in Virginia to educate them on the VAC and recruit future speakers. Secure more support statements for legislative change such as the one obtained by AARP  Culminate results of identified RN/APRN barriers into a qualitative research project Long term goal: Implement legislative strategies to impact statutory and regulatory barriers that prevent nurses from practicing to the full extent of their education and training. This can be done through the development of a white paper in addition to education of professional and consumer groups.

Next Steps Publish results of the survey Developing a list of potential emerging leaders Mentoring potential leaders to be selected for boards identified Targeting boards nurses should be appointed Developing a list of leadership programs Collaborate with schools of nursing on curriculum

Education Advancement Deb Zimmermann, DNP, RN, NEA-BC, Amy Gillespie, RN, MSN, EdD, Nancy Langston, PhD, RN, FAAN, Lauren Goodloe, PhD, RN, NEA-BC, Linda Dedo, RN, MSN, MHA Co-leads Education Advancement

BACKGROUND: Advances in science and increasing patient complexity have accelerated the need for nurses with the skill and knowledge to manage a challenging and increasingly diverse healthcare environment. Researchers have demonstrated a significant relationship between nursing education and improved patient outcomes A Call to Action: Transformation of Nursing Education Aiken et al. 2003, 2008; Benner, Stuphen, Leonard, & Day, 2010; Blegen & Goode, 2009; Estabrooks, et al., 2005; Institute of Medicine, 2011; Tourangeau et al., 2006

Institute of Medicine Report High-quality, patient-centered care requires transformation of the health care delivery system

Call for Action on Education Achieve 80% BSN workforce by 2020 Double doctorally prepared RNs Transform Curriculum Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington D.C.: The National Academies Press

VA Education Coalition Objectives Educate workforce and stakeholders on the importance of education. Support implementation of strategies to achieve a more educated workforce. Convene stakeholders on the implementation of seamless education progression. Consider role of residency programs in the Commonwealth.

The Evidence Supporting BS Education

As Nurse Education Increases, Patient Mortality Decreases Deaths per 1000 patients with complications 90 deaths in 1,000 patients 84 76 death As Nurse Education Increases, Patient Mortality Decreases Aiken (2003) Education Percentage of hospital nurses with BS degrees

Research supporting education and improved patient outcomes Estabrooks et al. (2005) Tourangeau et al. (2006) Blegen &Goode (2009)

More Benefits from Education RNs twice as likely to remain in job with tuition assistance BS prepared RNs reported higher job satisfaction and lower job stress BS prepared nurses more than ten years of tenure Ingersoll et al., 2002; McGinnis & Martiniano, 2008; Megginson, 2008; Rambur et al., 2005

NCLEX AD vs BS: Added Value? NCLEX tests for competency of new graduates. Does not test content in: Scholarship for evidence based practice Information management Health care policy and finance Inter-professional communication and collaboration Organizational and systems leadership, as well as patient safety Disease prevention and population health

Education around the World Countries Requiring BSN: Nurses per capita increased or remained the same following advances in education standards Australia Italy Belgium Netherlands Canada New Zealand Denmark Norway Finland Philippines Ireland Spain Organization for Economic Cooperation and Development. (2009)

A Growing Profession 2,724,570 RNs employed in the U.S. Mean U.S. Salary: $69,110 Projected employment 2018: 3,200,200 83% all RNs employed Bureau of Labor Statistics (2011) U.S. Department of Health and Human Services, HRSA, 2010

RN Employment Settings Health and Human Services, 2010

Virginia RN Statistics October 2012 Virginia Number Registered Nurses 100,000 Nurse Practitioners 7,023 Clinical Nurse Specialists 433 Licensed Practical Nurses 31,408 Nursing Programs Number Associate Degree 45 Baccalaureate and Accelerated Masters 31 Diploma 6 Total 82 Virginia Board of Nursing (2012) http://www.dhp.state.va.us/nursing/nursing_reports.htm

Virginia State Board of Nursing (2010). http://www.dhp.virginia.gov Virginia Graduates Virginia State Board of Nursing (2010). http://www.dhp.virginia.gov

Initial education of graduates in VA Year 2005 2006 2007 2008 2009 2010 2011 BSN 40% 37% 38% 36% 35% AD 48% 51% 45% 52% 53% 54% Diploma 12% 13% 15% 8% Total 2,912 2,909 3,265 3,228 3,492 3,548 3,686 Virginia State Board of Nursing (2012).http://www.dhp.virginia.gov

Projected Need for RNs in VA Expected growth in VA population 1 million 16% of Virginians will be 65 or older Need 30,000 RNs over next 20 years (replace retiring nurses and care for growing, aging population) Virginia Board of Nursing (2010) www.dhp.virginia.gov

Future of Nursing Education: Challenge 50% of VA RNs BS prepared Only 32% of AD and 31% of Diploma grads attain BSN

Where to Begin?

Regional Groups Eastern: Grace Meyers, RN, MS, Karen Karlowicz, EdD, RN Central Lauren Goodloe, PhD, RN, Susan Bodin, EdD, RN Northwest: Amy Black, MSN, RN, NEA-BC, Katherine Ganske, PhD, RN North: Robin Remsburg, PhD, RN, Maureen Swick, PhD, RN, MSN, NEA-BC, Joyce Hahn, PhD, APRN-CNS, NEA-BC Southwest: Carolyn Webster, BSN, MBA, RN, Kimberly Carter, PhD, RN, Ava Porter, DNP, RN, Charlotte Ramsey, RN, MSN

Partners Investing in Nursing’s Future Inspiration for Aspirations Analysis of the Gaps: Interviews with VA Nursing Programs Amy Gillespie, RN, EdD Nancy Langston, PhD, RN, FAAN Partners Investing in Nursing’s Future Inspiration for Aspirations

Partnerships for Progression: Inspiration for Aspirations Partners Investing in Nursing’s Future (PIN) is a partnership of the Northwest Health Foundation and the Robert Wood Johnson Foundation to support the capacity, involvement and leadership of local foundations to advance the nursing profession in their own communities. Mission: The Partnerships for Progression: Inspiration for Aspiration project is to help regions in Virginia develop a culture of educational progression, where colleagues in associate and baccalaureate institutions work together, side-by-side, to “pull” students into advanced educational preparation and lifelong learning.   Goal: Partnerships for Progression: Inspiration for Aspirations will result in sustainable partnerships between and among local community colleges and universities and their community partners to create seamless educational progression programs starting with ADN to BSN.

Inspiration for Aspirations Accomplishments Interviews with nursing programs in VA Major findings: Programs are working to create partnerships, procedures in place to make progression more seamless. Barriers for students center on personal and home life issues – family responsibilities, need to work full time for benefits Completion of RN-BSN Directory Easy access to information about RN-BSN programs Response to finding that RN-BSN information is difficult to find and confusing

Accomplishments (cont) Survey of current RN-BSN students Major findings: personal issues and family responsibilities cited as primary barriers, tuition support and flexible scheduling listed as vital to success Identified that “information is not inspiration” Academic Progression Models: What’s Out There, What Works Statewide conference brought stakeholders together to share partnership and academic progression model information

Accomplishments (cont) Inspiration for Aspirations: School Again Video of five nurses who returned to school and successfully completed a Bachelors of Science degree in nursing share their experiences.   What motivated you to go back to school? What were the challenges? What kept you going? What does having a BSN mean to you? What insights can you offer to other nurses? http://youtu.be/iT0ygHn4CYg

Future Steps Manuscripts to be developed Creation of Academic Progression Toolkit Website with tools to facilitate progression Development of sustainability plan Identification of agency to maintain, update, and possibly expand the toolkit Spring Conference Follow-up to summer conference Format for networking

Survey of Chief Nursing Officers 2012 Lauren Goodloe, PhD, RN, NEA-BC

About the Survey Survey sent to all Virginia Hospitals 29 completed surveys were returned from all regions of Commonwealth. Bed size ranged from 25 to >500. Goal of the survey was to explore employer RN support of educational progression.

Barriers for Progression 21 Hospitals found barriers that included: Financial support. (12) Distance of schools. (6) Flexibility of the schools. (3) Family Obligations (3) Nurses not receiving additional salary for education progression. (2) Current HR policy. (1) The most common barrier listed was financial concerns. Examples includined lack of tuition reimbursement, nurse having to pay tuition fees upfront and current tuition reimbursement policy not covering entire cost. Second most common was distance of schools. Examples: Community Memorial Healthcare “only AD programs local, must travel long distance” and Centera Southside Community listed lack of local affiliation for RN to BSN bridge program.

Tuition Assistance for Full-Time Employees 100% responded “YES” to offering tuition assistance for full-time employees. Only 3 Hospitals offer tuition waiver: VCU, HealthSouth Northern VA, Carilion (no limits on amount). 28 offer tuition reimbursement and 15 scholarships. Tuition reimbursement ranged from $750 to $5,500. With an average being $3,700. VCU listed 18 credit hours. Sentara RMH Healthcare offers tuition reimbursement but in comments “not for RN to BSN” Sentara Princess Anne Hospital $2300 for full time and employed more than 10 years

At what point do tuition benefits begin?

Tuition Assistance for Part-Time Employees 16 of the hospitals offer part-time employees tuition assistance. Most hospitals prorated their full-time tuition assistance in half for part-time employees. Tuition assistance varied from $750 to $2,500. Definition of part-time varies: 1040 hours per year, 40-64 hours per pay period, 20 hours per pay period and 16 hours per pay period. Sentara Princess Anne Hospital prorated based on years of service: 6 months – 3 years $700, 3 years – 10 years $1,000.

Does your hospital offer any of the following supports to nurses returning to school? Flexible Scheduling 21 – most self schedule or by management discretion Support Study Groups 7 – based on request Weekend Incentive Programs 5 – Halifax Regional 32 hours equal full time Loan Repayment 4 Full health benefits while working reduced hours 3 – Lewis Gale Hospital Pulaski full health benefits at 32hrs On-Site RN-BSN program 2 – Martha Jefferson (Sentera) partnered with Old Dominion provided via satellite on Monday evenings in conference rooms.

Do you hire new RN’s who graduated from schools that are not NLNAC or CCNE accredited? Community Memorial Healthcenter – “our local community college is not currently accredited but is in the process.” Pioneer Health Services – “never come across that situation, probably would if the nurse look like a good employee.” Other 5 included: Sentera Health Care, Lewis Gale Hospital, Centera Southside Community, Halifax Regional, Southern Virginia Regional Medical Center,

Do you hire unlicensed assistive personal who are RN students enrolled in schools not accredited by NLNAC or CCNE? Community Memorial Healthcenter – “usually only a summer position”

Do you allow schools who are not accredited by NLNAC or CCNE to bring students to your organization for clinical or observational experience? Lewis Gale Hospital “we allow new non accredited technical program clinical rotation if space available.” Community Memorial Healthcenter – “our local community college is not currently accredited but is in the process.” Other Restrictions placed on Schools of Nursing: Sentara Healthcare - Instructors must go through our system orientation and be onsite whenever students on site. Community Memorial Healthcenter – not internet or proprietary programs except for Master’s or Doctorate projects. Martha Jefferson – within our geographic location so as to provide a pool of candidates for hire

Degree requirements with clinical ladder? 21 of the hospitals have a clinical ladder in place. 16 of the 21 require a particular degree in nursing in order to attain a certain level. Most requiring a BSN at level 4 And a MSN at level 5

Does your organization have a plan if place to attain an 80% BSN workforce by 2020? 14 Hospitals answered Yes 11 Hospitals answered No 3 stated plans under development Common Plans Forecasting – BSN must be attained within 3 – 5 years of hire (5) Hiring only BSN (4) Changing job description to BSN requirement Inova Loudoun Hospital – “Bedside RNs will be required to have a BSN in the next 5 years if they are going to utilize tuition reimbursement or scholarship funds.” Inova Health System – “Established steering committee of system staff nurses to develop plan for how current non BSN staff will attain their BSN.”

Does your health system have a defined relationship with a school of nursing that provide you with innovative solutions for increasing your BSN prepared RN YES – 14 NO – 12

Know where you are to best determine the course you need to follow Analyze Gaps Then Forecast Outcomes with potential policy changes

Forecasting Model - Background American Association of Colleges of Nursing (September 2009) Virginia Board of Nursing (January 2010) Virginia Department of Health Professions, Healthcare Workforce Data Center (November 2010) U.S. Bureau of Labor Statistics (March 2011) U.S. Census Bureau (2011) U.S. Department of Health and Human Services, HRSA (March 2010)

RN Education Cadres Non-BSN # and % BSN or Higher Current Workforce Projected Completions New Graduate New Hires Experienced RN Terminations Acquisitions

What Changes Will Lead to Your Success? Policy changes: In hiring In tuition assistance In student affiliations In contracts Collaboration: Seamless transition Onsite education Elimination of barriers

The Decision Don’t make it alone Make it in Public

Example Education Progression Standard Effective January 1, 2012, ALL New hires without BS(N) sign agreement to: Enroll in an RN-BS(N) or RN-MS(N) accredited program within 24 months of hire Graduate from an RN-BS(N) program within 5 years of hire Failure to meet either term results in separation from organization Includes employees in school

Wording in Letter of Hire As a [diploma prepared; associated degree prepared] nurse, please be aware that continuation of employment in your position as a registered nurse is contingent upon the following requirements: Enrollment in an accredited RN to BSN program within 24 months of your hire date (i.e., no later than [mm/dd/yyyy]) Successfully obtain your BSN no later than 5 years or 60 months from your hire date (i.e., [mm/dd/yyyy]) Failure to enroll in the RN to BSN program by the date specified or failure to obtain your BSN by [specify date] will result in the termination of your employment as a registered nurse.   Employee tuition assistance benefits may be available to assist you in achieving this expectation after you have successfully been employed for twelve months in a continuous benefit-eligible role.

Example of Governance Decisions New RNs Hired Must be a graduate of an NLN-AC or CCNE accredited school of nursing Student Workers Must be enrolled in an accredited NLN-AC or CCNE accredited program Tuition Reimbursement Restricted to NLN-AC or CCNE accredited programs Contracts Only NLN-AC or CCNE accredited schools eligible for clinical experiences in the health system

Communication State Board of Nursing Schools of Nursing in Region Community College Presidents VA Magnet Consortium VA Nurses Association, VONEL Healthcare Leaders in Region

Progress Summary of all RN to BSN in VA posted on VNA website Magnet Consortium CNO’s lead VA Education Action Coalition with academic leaders Survey of schools, CNO’s & students completed Testimonial video completed

Progress Regional meetings with clinicians, leaders, and academe are underway. A forecasting & strategy tool was developed , piloted, and available for predictive modeling. Directory of RN to MS programs almost complete Virginia’s CNO’s committed to academic progression

Future Plans Second meeting on education progression and innovative models Completion of Comprehensive Tool kit Collaboration on curriculum and articulation agreements

Future Plans Development of a FAQ page on “What to look for and questions to ask when choosing a Nursing School.” Will be located on the VAC and VNA websites Development of a list of all Virginia Nursing Schools - displaying all programs and concentrations offered by each school

Future Plans Submission of a grant proposal to NCSBN to study level of RN Education and relationship to BON action and type of action taken on a license – Collaborative study between VCU and Va BON

A Profession United In Purpose Can Change the World If not now, then when, if not us, then who? A Profession United In Purpose Can Change the World

References Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623. Benner P, Sutphen M, Leonard V, Day L. (2010). Educating nurses: A call for radical transformation.. Stanford, CA: The Carnegie Foundation Bureau of Labor Statistics, U.S. Department of Labor. (2011). Occupational outlook handbook: May-2011 Edition, registered nurses. Retrieved from http://www.bls.gov/oes/current/oes291111.htm Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P. (2005). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, (2),74-84. Goode CJ, Blegen MA. The link between nurse staffing and patient outcomes. ANCC National Magnet Conference; October 2, 2009; Louisville, KY. Available at http://softconference.com/ancc/sessionDetail.asp?SID=153876. Ingersoll GL, Olsan T, Drew-Cates J, DeVinney BC, Davies J. (2002). Nurses job satisfaction, organizational commitment, and career intent. Journal of Nursing Administration. 32(5), 250-263. Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington D.C.: The National Academies Press Institute of Medicine. (2010, October). The future of nursing focus on education (Report Brief). Washington, DC: National Academy of Sciences. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf

McGinnis S, Martiniano R. (2008) McGinnis S, Martiniano R. (2008). The hospital workforce in New York: Findings from a survey of hospital registered nurses. Rensselaer, NY: Center for Health Workforce Studies, School for Public Health, SUNY Albany. Megginson LA. (2008). RN-BSN education: 21st century barriers and incentives. Journal of Nursing Management, 15, 47-55. NetMBA Business Knowledge Center. (2010). Scenario planning. Retrieved from www.netmba.com/strategy/scenario/ Organization for economic Cooperation and Development. (2009). OECD health data 2009: Statistics and indicators for 30 countries. Retrieved from http://www.oecd.org/health/healthdata. Rambur B, McIntosh B, Palumbo V, Reiner K. (2005). Education as a determinant of career retention and job satisfaction among registered nurses. Journal of Nursing Scholarship, 37(2), 192-195. Tourangeau AE, Doran DM, Hall LM, et al. (2007). Impact of hospital nursing care on 30-day mortality in acute medical patients. JAN, August 14, 32-44. U.S. Census Bureau, Statistical Abstract of the United States: 2011. Table 18.Resident Population by Age and State – Projections: 2010 and 2015. Washington, D.C.: Author. Retrieved from http://www.census.gov/compendia/statab/2011/tables/11s0018.pdf U.S. Department of Health and Human Services Administration. (2006). The registered nurse population: Findings of the March, 2004 national sample survey of registered nurses. Washington, DC: U.S. Government Printing Office. Retrieved from http://bhpr.hrsa.gov/healthworkforce/msurvey04.

U.S. Department of Health and Human Resources, Health Resources and Services Administration. (2010, September). The registered nurse population. Findings from the 2007 national sample survey of registered nurses. Washington, DC: Author. Retrieved from http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf U.S. Department of Labor, Bureau of Labor Statistics. (2011, March 11). Job openings and labor turnover survey highlights, January 2011. Washington, DC: Author. Retrieved from http://www.bls.gov/jlt U.S. Department of Labor, Bureau of Labor Statistics. (2011, March 17). Occupational employment and wages, May 2009: 29-111 registered nurses. Occupational Employment Statistics. Washington, DC: Author. Retrieved from http://www.bls.gov/oes/current/oes291111.htm Virginia Department of Health Professions, Healthcare Workforce Center. (2010, January). Forecasting nurse supply and demand in Virginia: 2008-2028. Richmond, VA: Author. Retrieved from http://www.dhp.virginia.gov/hwdc/docs/ForescastingNurseSandD2008-2028.pdf Virginia Department of Health Professions, Healthcare Workforce Center. (2010, January). The 2007-2008 Virginia licensed nursing workforce survey findings and recommendations. Richmond, VA: Author. Retrieved from http://www.dhp.virginia.gov/hwdc/docs/20072008NursingWorkforceSurveyFindings.pdf  Zimmermann, D. T. (2011, March). A more highly educated workforce. A model for the future. PowerPoint presentation at meeting of the Virginia Magnet Consortium, Roanoke, VA.

Thank You Virginia Magnet Consortium Richmond Memorial Health Foundation Virginia Action Coalition on Education The Partners Investing in Nursing's Future program, a collaborative initiative of the Robert Wood Johnson Foundation and the Northwest Health Foundation

Lauren Goodloe, PhD, RN, NEA-BC VCU Health System Transitional Care Programs Highlighted by the Center for Championing Nursing.

Model Program Highlighted By the Center for Championing Nursing/AARP: Pat Polansky & Jen Cooper Virginia University – Geriatric Services Division: Focus on successful transition, prevention of readmissions and management of highly complex patients: Multiple Programs incorporating extensive use of NPs as equal partners and leaders of the intraprofessional team. House Calls Transitional Care Long Term Care Ambulatory Care Independence At HCommonwealth ome (CMS Demonstration Project)

Nina Beaman, PhD, MS, RN-BC (PMH), RNC-AWHC and Richardean Benjamin, PhD, MSN, MPH, RN Co-Leads Workforce Data

Workforce Data Objective Improve data collection and information infrastructure Develop and implement specific geographical demand models for nursing and other health professionals

Progress Conducted briefings: Components of minimum data sets Results of recent Nurse Licensure Survey HRSA plans to discontinue RN Sample Survey Created a matrix of supply and demand data to inform members about available data and sources on the workforce Discussed advantages and disadvantages of data collection and reporting methods

Progress WHITE PAPER Completed comprehensive white paper- Addressing Nursing Workforce Issues in the Commonwealth of Virginia Finalized In distribution

Progress Continue participation on DHP Healthcare Workforce Data Center Participation and dissemination of information from the VA Workforce Development Authority to inform AC workgroups VHHA Workforce Development

Next Steps Serve as data experts to other workgroups Assist VAC with compiling necessary statistics for any grant proposals

Interdisciplinary/Team Based Care Delivery Sallie Eissler, MSN, CPNP, RN and Patti McCue Sc.D., RN, MSN, NEA-BC Co-Leads Interdisciplinary/Team Based Care Delivery Sallie/Patti

Objective Develop and deploy best practices in team/inter professional models that promote nurses and other health care professionals in all settings to practice according to their level of education and licensure to improve and transform health care to patients, families and communities Sallie/Patti

Progress Kickoff session hosted by Centra in Lynchburg – September 2011 Facilitated by Pamela Cipriano, PhD, RN, NEA-BC Diverse group of participants including nurses, physicians, chaplains, pharmacists & nurse practitioners Presentations: Centra ED model & NP Single Provider model Two small workgroups: ambulatory and inpatient services 119

Next Steps Commitment from MSV, VHHA, VphA and VNA has been solidified to support the development of a curriculum to educate current healthcare professionals on practicing in team based care delivery models Develop a fundraising strategy to provide on-going financial support for a new leadership institute focused on preparing physician and nurse leaders to engage in and promote inter professional collaboration and team based care delivery models Grant request submitted to The Physicians Foundation to fund a pilot in 2013

Next Steps Identify 4 models in VA Identify pilot potentials PACE Education – interprofessional Define champions in the models Ambulatory and inpatient Identify pilot potentials Identify transitions for education to practice across settings

Finance Committee Nina Beaman, Ed.D, MS, RN-BC (PMH), RNC-AWHC and Amy M. Walker, MS, RN, CPHQ, FACHE, NEA-BC Co-Leads Finance Committee

Initial Fundraising Campaign The Virginia Action Coalition does not receive funding or financial support through RWJF or AARP. VNA/VNF must raise at least $50,000 each year for the support of VAC workgroups and volunteers. Public relations/fundraising campaign conducted May to coincide with Nurses Week 2012 (May 6-12) Campaign - “Give $5 for Nursing” - Continuing the work of Florence Nightingale and Nancy Vance raised about $8000 in 30 days Small-scale promotion– email, VNA Voice, VNT, website

Finance Committee July 30 Strategic Planning Session – Fundraising Workshop Finance Committee began as a result of this workshop Developed marketing one-sheet Conversion foundations –VAC members who have connections will solicit funds Developing long-term fundraising initiative

Planning, Promotion and Outreach Sallie/Patti

Meeting Dates Next steps Workgroups continue work – monthly conference Co-Lead Meetings face to face February 7, 2012 April 9, 2012 June 1, 2012 July 30, 2012 November 5, 2012 Over 200 volunteers engaged Funding strategy – RWJF Grants

Virginia Action Coalition VNA Education Day – September 29, 2012 The Jefferson Keynote - Dr. Linda Aiken, PhD, FAAN, FRCN, RN Collaborative sponsorship VONEL VNA VMC

VNF Gala Gala – September 29, 2012 - The Jefferson Hotel Honoring and celebrating the VAC Honorary Chair – Bill Hazel, M.D., Virginia Secretary of Health & Human Services Magnet Awards Nancy Vance Scholarships Friend of Nursing

Members of the Virginia Action Coalition honored for their contributions to the nursing profession at the 2012 VNF Gala

Pat Polansky speaks at the VNF Gala about the importance of the work of the Virginia Action Coalition.

Advocacy Outreach Shirley Gibson, Loressa Cole, and Pat Polansky met in November 2011 with Marilyn Tavenner, Acting Administrator Centers for Medicare and Medicaid Services to review the IOM FON recommendations and discuss a role for CMS in facilitating the implementation of recommendations.

Advocacy Outreach Shirley Gibson and other nursing leaders met with staff from the office of Governor McDonnell, Secretary of Education Laura Fornash, and Secretary of Health and Human Resources, Bill Hazel, MD, to gain a commitment to collaborate with our statewide nursing community to further education progression. As a part of this commitment, Secretary Fornash spoke at VNA’s Annual Meeting on September 28, 2012

Outreach with CCNA and RWFJ Sue Hassmiller visited the VAC on July 30, 2012 and facilitated a strategic planning session Pat Polansky and Jennifer Cooper of the Center to Champion Nursing in America held a planning session with VAC leadership on November 5, 2012

Research Presentation The Leadership Workgroup presented the results of their Nursing Leadership Survey to over 300 attendees at VNA’s Education Day The poster will also be on display at VNA’s Annual Nurses Day at the General Assembly, attended by 700-1000 nurses and nursing students.

RWJF Human Capital Blog

Virginia Nurses Today

Virginia Nurses Today

Virginia Nurses Today

2013 Promotion and Marketing VAC promotion and marketing needs will be a major part of the 2013 Strategic Communications plan. Social media development Dedicated VAC sections in quarterly VNT and biweekly VNA Voice, Development of a stand-alone sister website hosted by VNA for VAC New long-term fundraising initiative built upon “Give $5” from 2012

Campaign for Action Pillars Advancing Education Transformation Removing Barriers to Practice and Care Nursing Leadership So what Advancing Education Transformation Removing Barriers to Practice and Care Nursing Leadership Interprofessional collaboration and diversity are threads woven through each pillar. And the foundation is data. Interprofessional Collaboration Diversity DATA

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