“The Driving Force for Excellence in Nursing”
Margaret Henbest
Executive Director
615 North Seventh Street
PO Box 1278
Boise, Idaho 83701-1278
(208) 367-1171 office
(208) 338-7800 fax
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.
- 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, andspecific 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 CAHemerged.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 graduatehirees 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 February2014. 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 slowedthe 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 surveyhas 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.
- 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.
- 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.
- 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.
- 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
- Is there anything else you would like to tell RWJF?
Thank you for the opportunity to advance so many critical nursing issues in Idaho.
- What was produced during the reporting period?
The APRN survey and the APRN employer survey are attached.