Alexia Green

Public policy on competency: how will nursing address this complex issue?

The evolving contexts in which nursing care is provided and the complexity of clients being served are raising new questions about the nature of nursing practice, the ways in which nurses can best be prepared for such practice settings, and how current staff can continually update their knowledge, skills, and abilities to provide competent care. It is imperative that the profession be forward looking as it reassesses the implications of assuring the public of a competent nursing work force. The mandate to prepare nurses differently to practice competently in future health care systems also suggests a different system for competency assessment. This article provides an overview of international, national, and state perspectives and approaches in addressing the issue of assuring competency from a public policy perspective, including one states experience to date.

Creating and launching. Innovative nursing education programs: perils and pearls.

&NA; Nursings future depends on continuing to seek, create, and launch innovative nursing programs. Successful innovation can improve nursing education delivery and make optimal use of available resources while tapping into the imagination and creativity of faculty and students; in addition, it can create an optimistic environment and encourage beneficial change with the faculty and staff. Innovation has been described as an art, a process of diffusion, and a process of transforming ideas into real value. The purpose of this article is to explore the concepts surrounding innovation, steps in development of an innovation, and share pearls, perils, and lessons learned so that others can explore the process within their nursing education programs.

Innovation in Nursing Education: A Statewide Grant Initiative

Meeting the challenges of the nursing shortage appears to be daunting for schools of nursing across the nation as they struggle to meet educational capacity needs with limited resources. A statewide grant program was developed and implemented through legislative initiatives providing opportunities for schools of nursing to respond to the need for innovation in nursing education. This article shares some of the successes and challenges identified through the process of implementing and evaluating this grant program. Insights into the political and regulatory process are provided as a model for other states to consider. Examples of educational strategies that were successful in improving the recruitment and retention of students and faculty are discussed. Nursing and other health care leaders across the nation should look to policy initiatives such as grant programs to infuse innovation into educational programs and to address educational capacity issues compounding the nursing shortage.

Addressing the Texas Nursing Shortage: A Legislative Approach to Bolstering the Nursing Education Pipeline

This article describes a successful collaborative endeavor by organizations within Texas to address the nursing shortage. As one of the first states to address the nursing shortage from a legislative perspective, passage of the Nursing Shortage Reduction Act of 2001 focused on bolstering the nursing education pipeline. Specifically addressed are the strategic planning process for development and passage of this important legislation, the content of the legislation, and a 2-year summary of the impact of the legislation on the Texas nursing educational infrastructure.

Safe Nurse Staffing: A Win-Win Collaboration Model for Influencing Health Policy

The nursing shortage has resulted in patients seeing fewer registered nurses (RNs) at the bedside in this time of high acuity and high use of health care facilities. A possible solution to the shortage is to improve staffing in hospitals to make them more nurse-friendly. A further benefit is the improvement of safety standards when full nursing staff complements are available. This article describes a collaborative initiative to implement health policy to improve the work environment by incorporating the American Nurses Association (ANA) staffing principles into state rules and regulations. The process described is one that used the political and regulatory arenas to bring together historically competing groups to work toward a mutually acceptable policy initiative that actually increased nurses’ ability to influence staffing in hospitals in the State of Texas. The process of mediation and collaboration is translatable into many health policy and political areas in which a win-win solution benefits everyone.

A Statewide Strategy for Nursing Workforce Development Through Partnerships in Texas

Statewide efforts and partnerships were used for nursing workforce development to address the nursing shortage in Texas. A statewide strategic action plan was developed where partnerships and collaboration were the key components. One of the most important outcomes of these statewide partnerships was the passage of the Nursing Shortage Reduction Act 2001. Through this legislation, the Texas Center for Nursing Workforce Studies and its advisory committee were established. This article describes how a statewide infrastructure for nursing workforce policy and legislative and regulatory processes were further developed. An overview is provided on the contributions made by the organizations involved with these strategic partnerships. The ingredients for establishing successful, strategic partnerships are also identified. It is hoped that nursing and health care leaders striving to address the nursing shortage could consider statewide efforts such as those used in Texas to develop nursing workforce policy and legislation.

Building academic capacity through statewide partnerships.

In 2008, Texas was challenged by the Center to Champion Nursing in America, an initiative of the Robert Wood Johnson Foundation and AARP, to join a nationwide campaign for action to increase nursing education capacity. This article describes how one state created academic partnerships to achieve capacity building and strengthened relationships and commitments to invest in nursing education. Three year outcomes include a) the creation of a statewide team to address nursing education capacity, b) progress toward doubling the number of nursing graduates from the states schools of nursing, c) strengthening and emphasizing retention efforts across the state, d) regionalization, including implementation of a

Data Analysis of Texas RNs with Multiple Disciplinary Actions

1 million grant and e) transitioning the statewide team to a broader focus and commitment to the Initiative on the Future of Nursing via the formation of a Regional Action Coalition.

A road toward the future of nursing: paving the way with trust, collaboration, and strategic alliances.

The purpose of this secondary data analysis was to evaluate the effect of mandated remediation on the recurrence of practice-related disciplinary actions for registered nurses (RNs) in Texas. Helping nurses learn not to engage in practices that result in their return to the state board of nursing for disciplinary action protects patients. Identifying factors that may lead nurses to recidivate is an important step in preventing nursing practice violations. The sample for this study was 59 RNs who received more than one disciplinary action for practice violations during a 5-year period. Additional demographic variables were studied to identify covariate relationships.

PROMOTING CLINICAL COMPETENCE: USING SCAFFOLDED INSTRUCTION FOR PRACTICE-BASED LEARNING

The preface to the Institute of Medicine’s (IOM) Future of Nursing (2011) report begins with a statement that the report is being published at a time of great opportunity in health care. As nurse educators, our great opportunity is the challenge to actualize the recommendations contained in the IOM report. Just as Robert Frost faced a divergence in the road, so too does our profession. Frost’s (1920) poem “The Road Not Taken” describes two roads diverging and the decision to take one road over the other having a major effect on the future. Our profession faces such a divergence in the road toward the future of nursing. Should we, as nurse educators, take the path that is paved with trust and creates strategic alliances? Or should our educational programs continue down the path of separatism, continuing to construct walls around and between educational pathways for our students? Will our educational programs be able to produce graduates capable of the transformations called for in the IOM’s report? It is interesting to note that the creation of associate’s degree programs more than 50 years ago signaled another divergence. At that time, 85% of the nursing workforce was supplied by hospitals, but several factors converged to elevate nursing into community colleges. After World War II, women became interested in a collegiate career, and the profession was eager to take control of its own education. Baccalaureate education supplied 15% of the workforce, but nurse educators at community colleges were able to affect nurse education in a way that the smaller number of baccalaureate institutions could not (Orsolini-Hain & Waters, 2009). Currently, more than 60% of new nurses come from community college programs. Associate’s degree nursing programs provide a dynamic and effective pathway into nursing practice for many students who do not have access to traditional baccalaureate programs (National Organization of Associate Degree Nursing, 2006). Nursing programs today cannot produce enough graduates to meet the demands of health care, which means that associate’s degree nursing programs continue to play a vital role in meeting the need for nurses (Miles, 2008). Therefore, any move toward addressing the future of nursing, including meeting the education needs of future nurses, must rely on strategic alliances, collaboration, and trust. Elmuti and Kathawala (2001) described strategic alliances as partnerships between competing entities to achieve strategically significant objectives that are mutually beneficial. The potential of strategic alliances in achieving the goals identified in the IOM’s Future of Nursing report are enormous, particularly those focused on transforming nursing education. Active and ongoing partnerships must exist between associate’s degree and baccalaureate nursing programs that address seamless transition from associate degree to the baccalaureate, including dual admission, curriculum reframing, articulation agreements that are comprehensive and specific, and addressing the barriers to continuing beyond the current degree. In the past, barriers that have prevented educational programs from working together have included differing philosophies and visions, thereby creating a clash of cultures. Elmuti and Kathawala (2001) cited cultural clashes as the primary problem faced in creating strategic alliances. As educators, we must work to form strategic alliances that will result in achieving the goal that 80% of the nursing workforce hold a baccalaureate degree by 2020. This goal will be achievable only through a new focus on collaboration. Understanding why alliances fail will be integral to our success. Potential causes of failure of strategic alliances include lack of trust, lack of coordination between schools of nursing and other strategic partners, differences in attitudes among partners, varying curricular expectations, and, most importantly, failure to grasp and articulate strategic intent. Building trust will be one of our first challenges in creating strategic alliances. Transparency, integrity, and consistency are three important strategies to assist us in achieving the IOM’s goals. The IOM’s report encourages educational collaboratives, which seamlessly connect students to schools, fostering a culture that promotes and values academic progression. As leaders, we must facilitate constructive relationships among our faculty and administrators, which build trust and commitment toward achieving these common goals. This will require frequent and open communication. The willingness to communicate is often more important than the content of communication, building trust, and good will and contributes to positive energy and perceptions. We challenge our colleagues to con-