Nursing's Long-Term Limbo
A call by some for new RN grads to work in long-term care goes largely unanswered.
By Candy Goulette


Nurses tend to work more when the economy is bad.

And things are no different in the current economic downturn. Rather than retiring, they are returning to work in acute
care settings and even taking on extra shifts.

This is good for hospitals, with national vacancy rates hovering in the 2-4 percent range, but not so good for new nursing
grads looking for their first jobs in the same acute care settings.

Hence, many are calling for newly graduated registered nurses to consider long-term care as the place to begin their
careers.

But while leadership at some LTC facilities are embracing the scenario as an opportunity to recruit graduate RNs, are the
industry - and the new grads - ready?

Training Ground

Deloras Jones, MSN, RN, for one, believes they are.

Long-term care offers a potential training ground for new nursing graduates, she said, and she is working to develop
programs that do just that.

More specifically, Jones, executive director of the California Institute for Nursing & Health Care, has been working
throughout California to develop transitional residency programs for new nursing grads unable to find positions in acute
care.

So far, the programs, regional collaborations between schools of nursing and service providers, are offering a small
number of new grads placement in public health, schools, clinics and some specialty placement in acute care. A few grads
will be able to move into home health after gaining some acute care knowledge though experiential learning, Jones said.
"Depending on the needs of regional employers, the proposed programs could include training in a non-acute healthcare
setting such as long-term care," she explained. "New nurses would have the opportunity to increase competencies,
confidence and skills to strengthen the transition from education to service."

Workforce development consultant, Ken Merchant, agrees.

"Now, with RNs unable to find other work, is a great time to change the long-term care staffing model to bring more RNs
into the long-term workplace," said Merchant, who has worked extensively with the California Association of Health
Facilities, a nonprofit trade association serving the LTC industry.

Ready or Not

Toward that end, Country Villa Health Services, owner of a chain of 50 long-term care facilities in California, has a
program designed specifically for new grads. The 21-day internship gradually introduces new RNs to the chain's "resident
first" culture as it ensures they have the skills necessary to care for them.

"We hire the best candidates, and in some facilities that means new grads," said Cindy Pavelka, RN, director of education.
The new grad internship is broken down into step-by-step instructions, she said, with a test at the end of each day. "They
don't move forward until they can show they've learned the information from each day."

"New grads come in used to taking care of just a few patients, but in our facilities they could take care of up to 30
residents when they're passing meds," Pavelka continued. "So we put them in the best match with the best mentor in their
facility and they shadow her until they can handle things on their own.

"We're investing a lot of money in each new hire, so a thorough and thoughtful orientation is important."

Deborah Kania, RN, administrative director, Sutter Oaks Nursing Center, Sacramento, said LTC has long had difficulty
recruiting and retaining RNs.

"There is a stigma that long-term care is unpleasant," Kania said. "But today's long-term care is far different from the
nursing homes of the past. Your skills as a nurse have to be particularly crisp to work in this environment.
LTC nurses "must have the ability to create therapeutic relationships with patients," she continued. "It's a nurturing
environment, but you're not managing machines like you do in the acute care setting. You're managing the disease process
here."

For that reason, Kania doesn't take new grads - new hires must have at least 6 months of experience.

Growing Market

In Florida, Jen Nooney, PhD, associate director of research, Florida Center for Nursing, said no systematic efforts exist to
place new grads in non-acute settings, even though non-hospital employers seem to be more willing to take on training.
"Vacancy rates are low in hospitals, but growing in home health because the industry is growing," Nooney said. "The
vacancy rate in skilled care in Florida is about 7 percent because of need and attrition. There is a high rate of current need
and high rate of expected growth for services to the elderly, but no real move to combine the new grads with these
openings."

Charlotte Eliopoulos, PhD, ND, MPH, RN, former director of the National Association Directors of Nursing
Administration in Long Term Care and founder and executive director of the American Association for Long Term Care

Nursing (AALTCN), noted only 7 percent of RNs nationally work in LTC.

"There's been some increase [in new grads choosing long-term care] but nothing dramatic, given the number of vacancies
across the country," she said. "It's a real culture shock when they hit any setting, [but] especially long-term care, where
there is so much more patient contact and supervisory responsibilities."

Eliopoulos noted that, as patients in LTC facilities have grown more complex, the need to have more clinically competent
nurses caring for them also has increased.

"It's not only the amount of skill, but in the acute setting, there are other nurses to turn to," she said. "In long-term care,
you might be working with only one or two other RNs."

Fast-Track Career Path

To help, AALTCN has developed certification programs for all levels of nurses in LTC, including core competencies, and
encourages using such facilities for clinical experience during nursing school.
"We practice holistic care - mind, body and spirit," Eliopoulos said. "This is not just a place for our patients, but their
home. Their families are involved. It's not a simple specialty - we need the cream of the crop. It's a dynamic and complex
form of nursing if you do it right."

LTC also offers a great career path and one newly graduated RNs should follow, noted John Sherman, president of
recruitment firm JSA Search Inc.

"We're pushing for placement, but there are a couple of reasons why new grads aren't going this route," Sherman said.
"Lots of nursing grads have never been inside a long-term care facility and, because of the social stigma about them, think
they're places no one would want to work. This is slowly changing, but it still takes a special person to do this work."
Sherman said it's a matter of creating a perception of LTC as desirable employment and re-educating the nursing
community.

"Long-term care now is exacting and technically challenging," he said. "And it's the area that's going to boom. Nurses
really have an opportunity to connect with their patients on an ongoing basis. These patients need good nurses.
LTC also offers a fast-track to management, Sherman added.

"You can become a supervisor in 6 months, then a shift supervisor in another 6-7 months. Within 2-3 years, you could be
a director of nursing in a medium-sized facility," he pointed out. "We need to educate new grads on the opportunities here.
You can have a good career in an acute care facility, but long-term care is a way of life."

Candy Goulette is public relations/editorial liaison at ADVANCE.

Copyright ©2010 Merion Publications
2900 Horizon Drive, King of Prussia, PA 19406 • 800-355-5627
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"I CARE ABOUT NURSING:" One School at a Time
Geri L. Dickson, RN
August 04, 2009


The I CAN Nurse Team
 
The I CAN Nurse Team
 
 
The New Jersey Collaborating Center (The Center) is actively seeking nurse member volunteers to join the I CARE ABOUT NURSING (I CAN) team, particularly in Essex County. The I CAN program focuses on connecting experienced nurses, nursing students and retired nurses with their community, helping schoolchildren learn positive health habits while experiencing nursing as a viable career. I CAN team members educate children and teenagers about healthy lifestyles and about the vast opportunities available within the nursing profession.
 
I CAN started in the summer of 2004 as part of the Nurse Workforce Solution Project, which was coordinated by the Atlantic Cape May Workforce Investment Board and funded through a grant by the New Jersey Health Initiative of the Robert Wood Johnson Foundation (RWJF). Now under the oversight of the Center, I CAN continues to be involved in urban communities. The New Jersey Collaborating Center, founded in 2003 with a grant from the RWJF, is a future-oriented research and development organization for nursing in the College of Nursing, Rutgers University, Newark Campus. I CAN is one of the Center’s projects designed to enhance the image of nurses and promote nursing as a career.
The Center worked closely with the Newark Office of Health Services in getting I CAN approved for launching in the Newark Public School System. We began our program by conducting I CAN health activities in Newark during the summer of 2007 and branched out into other schools in the following years. 

I CAN has now been presented to over 280 children in the city of Newark. These health activities have been conducted in both parochial and public elementary schools. The health learning activities presented continue to advance the I CAN mission by striving to expose children to the greatness and diversity of the nursing discipline, while emphasizing the importance of proper hygiene.

Health literacy is the basic concept of the I CAN program, which includes wellness promotion through good hygiene, healthy lifestyles, illness prevention, how to use the health care system, and safety topics. All school programs integrate New Jersey Core Curriculum Educational Standards.

I CAN members have access to information guides, scripts, and materials for children of all ages. A wide variety of age-appropriate materials are used in our health activities. Such materials include puppet shows, storytelling, career brochures, coloring books, computer games, videos, presentations, certificates, handouts, stickers, and much more.   
In the above picture, you will find the presenters of an I CAN health program, left to right, Franklin Montero, Allison Creary, Center staff members, Grace Jacquet, School Nurse, and Dr. Anne Brandes, Rutgers College of Nursing. The picture above illustrates the various puppets used to demonstrate health habits, as well as a variety of nurses.
 
Would you like to have the opportunity to "give back" to your profession by joining us in this volunteer activity to engage children in health promotion activities? Not only does the program engage students in healthy lifestyle activities, but also it demonstrates the career opportunities available in nursing. The children receive handouts to take home to discuss health and nursing with their families, helping to build healthier communities. Moreover, I CAN encourages children to think of nursing as a learned profession, which involves rigorous study, starting as early as possible with an interest in science.
 
For more information on this program, visit us at www.njccn.org or contact Franklin Montero at monterof@andromeda.rutgers.edu. Watch for our expansion into other areas within the State.




NEW JERSEY’S EDUCATIONAL NURSE SHORTAGE
New Jersey’s Nursing Shortage is Not Over
May 28, 2009

Since its inception in 2003, the New Jersey Collaborating Center for Nursing has collected data annually on the State’s nursing education capacity. In the 2007-2008 academic year, the majority of nursing schools reported that interest in schools has remained static. Further, there has been a very slight increase in enrollments between 2007 and 2008.  Additionally, several nursing programs reported their current graduates are experiencing difficulty finding desired positions in hospitals close to home. However, evidence indicates that this current situation is TEMPORARY! New Jersey will experience a severe nursing shortage in the near future.
 
At the root cause is the recent, severe downturn in our economy, which has changed the dynamics within the nursing workforce. It is most important that a sense of complacency about the nurse shortage being over not be developed because the basic cause of a looming nursing shortage crisis has not changed.  Rather, the shortage will not be as soon as earlier forecasts indicated. Most recent estimates now cite 2025 as the time of the height of the shortage and somewhat less severe than the earlier projections of 2020. According to Buerhaus, Staiger, & Auerbach (2008), we can still expect a shortage three times that of 2002, when vacant positions were in the double digits.
 
Since World War II, nursing shortages have cycled through the nursing workforce every decade or so. However, this recent shortage has lasted longer than any in the past and will accelerate again because this shortage is substantially different from those in the past.  The current shortage is all about demographics: the increased demand for health care by the aging general population and a concurrent decreased supply of nurses as the baby boom generation of nurses reach retirement age. Moreover, nursing faculty, with an average age of 55 years, are six years older than the average New Jersey staff nurse. Notably, 48% of faculty are 55 years or older, indicating that we could loose 50% of our faculty due to retirement in the next 10 years. In addition, graduate-prepared nurses can earn much more, sometimes double their salary, in practice or administration than they can in academia. The increased demand and the decreased supply of nurses, combined with a projected faculty shortage, will create a massive shortage in the foreseeable future.
 
Most importantly, the major economic crisis that exists at global, national, and state levels has had a direct impact on the supply of Registered Nurses (RNs),. Hospitals usually prefer to hire experienced nurses, such as nurses returning to work for economic reason or who have lost their jobs because they were employed in one of the New Jersey hospitals that has closed. Hospitals can reduce costs by hiring experienced nurses and foregoing expensive orientations and preceptorships necessary to integrate new graduates into the work place. Additionally, previously part time nurses are now increasing their hours, and older nurses are delaying retirements. Because many people have lost, or are concerned about losing, their jobs, and others no longer have health insurance, more profitable, elective procedures have been postponed, resulting in hospitals tightening their budgets.  All of these factors have coalesced to create the current lull in the shortage of nurses.
 
It is essential to emphasize that reports of graduates being unable to obtain jobs in hospitals is transient.  Ironically, there are positions for nurses available outside of hospitals, but new graduates tend to shy away from non-hospital settings for various reasons. In New Jersey, 46% of nurses are employed outside of hospitals and the long-term sector is, and will continue to increase dramatically. Home health care also is in greater demand, but often new graduates are not hired in home care. However, home care agencies have or are developing internships that provide the added knowledge, experience, and confidence to work in home health.
 
Buerhaus, P., Staiger, P., & Auerbach, D. A. (2008). The Future of the Nursing Workforce in the United States: Data, Trends and Implications. Sudbury, MA: Jones and Barlett Publishers.
 
Flynn, L.  (2007). The State of the Nursing Workforce in New Jersey from Statewide Survey of Registered Nurses. Newark, NJ.  New Jersey Collaborating Center for Nursing
 
For more information about the educational capacity and the faculty shortage, please check our Web site at http://njccn.org. The most recent 2008 data will be posted soon.
 

#  #  #  #  #

 
For more information, please contact:
Geri L. Dickson, PhD, RN
Executive Director
gdickson@rutgers.edu
973-353-1307

 


A Snapshot of the New Jersey Nurse Workforce Shortage and its Consequences
May 2009

A Snapshot of the New Jersey Nurse Workforce Shortage and its Consequences (May 2009)

The New Jersey nurse workforce shortage, similar to the national scene, arises from three documented shortage factors: (1) The consistently heavy work load of nurses, which can lead to stressed out nurses missing vital changes in a patient’s condition; (2) The aging population, both of the nurse workforce and the population-at-large, and (3) the lack of capacity of schools of nursing to admit all of the qualified applicants (http://njccn.org). Most important to this topic are the consequences of an understaffed and undereducated nurse workforce. National and New Jersey research support the contention that nurses are the key to quality healthcare. The fewer the nurses, the higher the risk of patient complications, thereby resulting in an increased need for healthcare.

Summary of New Jersey Research Findings

  • According to our unique county-based New Jersey Nurse Demand Forecasting Model, in just 5 years, by 2014, New Jersey will have an increased demand for an additional 5,820 RNs (total workforce 91,900 RNs);
  • Our research also indicates that with the age of the average working New Jersey RN at 49.7 years, in 5 years we can expect to replace 15% of the current workforce of 86,080 RNs or 12,914 replacement nurses;
  • According to our annual educational surveys, the total number of graduates in the 2007-2008 school year out paced the previous peak graduation year of 1994 with 2,951 pre-service graduates from all schools;
  • However, the 2008 enrollment data indicate a slight decrease in enrollments, which will lead to smaller graduating classes, mostly due to changes in the Diploma schools;
  • In order to meet the increased demand, plus the replacement nurses, we would have to continue t increase the current rate of graduates by 25% each year;
  • The Baccalaureate and Higher Degree (BSN) Schools, which produce most of the potential faculty, reported the severest shortage of faculty, particularly doctorally prepared;
  • As of October 15, 2008, the BSN schools reported a faculty vacancy rate of 9.1%;
  • In our 2008 educational survey, the schools were asked to rank from 1 – 4 the factors that served as barriers to hiring new faculty. Of the 15 out of 16 eligible BSN schools responding: 8 (53%) schools rated “not enough faculty lines available” as #1; 6 (40%) of the schools rated “not enough qualified applicants” as #1, one (7%) rated “faculty jobs are less attractive than other jobs” as #1; and none rated “not able to offer competitive salaries” as a priority concern. Clearly, the major barriers to increasing educational capacity are the financial resources distributed to schools by their parent institutions and the lack of qualified faculty applicants.
  • The most important data delineate what happens when there are too few RNs available to meet the demand for nursing care. For just one example, Needleman and his colleagues (2006) reported that when the proportion of RNs among licensed staff (RNs and LPNs) increased to 75%, without raising the number of hours worked, 59,938 patient adverse events could be averted nationally each year. These events include such patient conditions as urinary tract infections, hospital-acquired pneumonia, upper gastro-intestinal bleeding, and failure to identify life-threatening complications in surgical patients.

Reference: Needleman, J., Buerhaus, P., Mattke, S, Stewart, M., & Zelevinsky, K. (2006). Nursing staffing in hospitals: Is there a business case for quality? Health Affairs, 25, (1), 204-211.

#  #  #  #

For further information contact:
     
Geri L. Dickson
     
gdickson@rutgers.edu


NJCCN Launches ICAN Program at Sacred Heart Summer Camp

 Memo

To:        NJCCN BOARD
From:    Franklin Montero
Date:     September 22, 2008
Re:       ICAN Presentation at Sacred Heart: Tuesday, July 29, 2008

Our first ICAN presentation took place at Sacred Heart School’s summer camp on Tuesday, July 29th. Sacred heart is located in the Vailsburg section of Newark, New Jersey. The presenters were Dr. Geri Dickson, Franklin Montero, Allison Creary and Benjamin Evans (volunteer). The children in the audience ranged from the age of four through seven-years-old. Two separate presentations were held in which we first presented to the kindergartners and first graders, and later presented to the pre-kindergartners. The two groups were comprised of approximately 27 and 24 children, respectively.   

The presentation was held in an open space adjacent to the cafeteria. This presentation proceeded with the use of visuals including the puppet show, "Do You Know a Nurse?" book, and the GloGerm kit.  

The presentations were opened with an introduction of the "Nursing Squad", which was then followed by the puppet show. The pre-kindergartners appeared to be more interested in the puppet show; smiles could be heard in the audience when Ramon Corazon, Nurse Carey and Nurse Murphy were performing. The GloGerm presentation was a big success and really engaged the children. This germ presentation should definitely be implemented in future ICAN presentations. The children were entertained by the readings from "Do You Know a Nurse?" In presenting this book, it would be best for the volunteer to improvise during the reading by bringing their own nursing background and perspective into the presentation. Both presentations were followed by a "question & answer" period that also proved quite effective in getting the children involved. Overall, the children were quite engaged and offered plenty of dialogue throughout the presentations.

The hand-outs distributed during the presentations included stickers, instructional hand washing flyers, coloring books, and certificates. All these handouts were well received by both the children and the teachers. Additionally, the teachers evaluated our presentations and gave them high marks.  

Please see the attached pictures.
 


Nurses straining under workload

Read the Full Report by clicking here.
 


The New Jersey Nurse Shortage and Its Public Policy Implications
April 19, 2007

The New Jersey Collaborating Center for Nursing (the Center) recently presented current data in an educational forum about the New Jersey nurse and faculty shortage at the State House. The event was sponsored by the Office of Legislative Services and was well received. Geri L. Dickson, PhD., RN, Executive Director, and Linda R. Flynn, PhD, RN, Research Director, graphically described the present and future critical nurse shortage that is compounded by the shortage of nurse faculty. The shortage is global in nature, but the predicted New Jersey shortage is more severe than in many other U.S. states.

Three Shortage Factors

Since its inception, the Center staff has systematically collected data through annual educational capacity surveys of all New Jersey nursing schools, random sample surveys of RNs/LPNs in 2002 and 2006, and a survey of nurses who did not renew their licenses in the 2002/2003 cycle, as well developed and updated the New Jersey Nurse Demand Forecasting Model.  

Meeting their mission to measure, monitor, and forecast the demand for the nurse workforce, the Center has identified three shortage factors that play a major role in the current and projected shortages, which can be used to develop a series of public policy initiatives.

Shortage factor #1 is the aging population, both of the nurse workforce and the population at large. Data from the Center’s most recent research in 2006 indicate that the average age of a New Jersey RN is close to 52 years of age. At the same time the general population is living longer and the fastest growing segment of the general population is those over the age of 85. Taken together, the increasing age of the nurse workforce and the growing demand for healthcare by the general population results in a growing shortage of nurses reaching massive proportions by 2020, unless concerted, deliberate, and well-thought out policies are put into place.

Shortage factor #2 grew out of the current Center study, funded by a grant from the Robert Wood Johnson Foundation and in collaboration with the New Jersey Board of Nursing. The study, conducted under the direction of Dr. Flynn, documents the dissatisfaction of New Jersey nurses with their jobs and, for some, with nursing. The major reasons related to nurses’ dissatisfaction revolve around retirement benefits, salaries, job opportunities, and the work environment. Nurse workload is a crucial factor in their dissatisfaction with more than 50% of the direct care RNs reporting that there were too few RNs and support staff to complete their work. Further, almost 40% reported that because of their workload their ability to identify important changes in patients’ conditions was diminished. Care left undone, such as patient surveillance, documentation of care and patient teaching, are predictors of New Jersey nurses’ job dissatisfaction, burnout and intent to leave their nursing positions.

Nurse burnout is reported by New Jersey nurse respondents to be a growing epidemic. Burnout was measured by a valid and reliable tool developed for other professionals such as firefighters and police officers. Using this tool, more that one/fourth of New Jersey RNs suffer from high burnout, which is identified as emotional exhaustion.  Those respondents who reported burnout were four times more likely to leave their current positions (hospitals and nursing homes reported highest burnout rates).

Shortage factor #3 is the lack of the capacity of New Jersey schools of nursing to meet the growing demand for education by qualified potential nursing students. The schools lack the resources to hire additional faculty and RNs with a graduate degree are in great demand; also, there is a serious disparity between academic salaries and healthcare industry salaries. The salary disparities are further compounded by disparities within universities between such schools as business or engineering and nursing. Adequate clinical placements, laboratory, and classroom space also are problematic for some schools.

           

Although enrollments and graduations have increased steadily each year since 2002, more that 1,400 qualified students have been denied admission for each of the past three years because of the lack of capacity of New Jersey schools to educate them. In 2005, 1,898 graduates (90% of 2,110 BSN, AD, Diploma graduates) passed the NCLEX RN licensing exam. RNs coming into New Jersey (2,439) surpassed those leaving the state (1,282), with a net gain of over 1,100 new RNs. Schools reported 2,218 openings for new students in New Jersey.  However, 2,979 applicants were enrolled indicating that schools are operating above capacity resulting in an increased workload for faculty.  In spite of steady growth in the capacity to educate RNs, the number of new graduates would have to triple to prevent the 2020 scenario predicted by the U.S. Department of Health and Human Services for New Jersey (42,200 unfilled RN FTEs).

 

Expert Panel Dialogue

An expert panel responded to the presentations by Dickson and Flynn. Sharon Rainer, RN, MSN, New Jersey State Nurses Association (NJSNA) Associate Director and lobbyist, led a panel that offered testimony that reinforced the presentations and identified the need for action. The panel included Dean Susan Bakewell-Sachs, PhD, RN, President, Association of  Baccalaureate and Higher Degree Programs in New Jersey; Linda Gural, RN, NJSNA President; Robyn Begley, MSN, RN, President, Organization of Nurse Executives/New Jersey; Ann Twomey, RN, President, Health Professionals and Allied Employees; and James Moore,  PhD., Assistant Commissioner, New Jersey Department of Labor. Each, from their own perspective, predicted an ever increasing, serious challenge to New Jersey’s healthcare delivery system and negative outcomes for all of New Jersey’s patients and families.

The panel discussion was followed by audience participation. The dialogue validated the problems identified and some solutions were presented. The downside is that most solutions will require additional funding and public funds are in short supply right now.

In summary, there is a severe shortage of nurses now and in the foreseeable future in New Jersey. Many members of the New Jersey nurse workforce and faculty are aging and will soon retire in 5 to 10 years, thereby, exacerbating the problems  Further, since many nurses are leaving the profession because of the work environment, patient safety, and quality of care concerns, and with educational resources preventing hundreds of qualified students from entering New Jersey nursing schools, immediate legislative and workplace action is vital to ensure that there will be the right nurse, with the right education and work experience, to care for New Jersey patients and aging population.

The New Jersey Collaborating Center for Nursing

The Center was established by legislation on December 12, 2002, but without an appropriation. However, 2003 funding from the Robert Wood Johnson Foundation (RWJF) created a public/private funding partnership between the State of New Jersey and the RWJF. The Center is a future-oriented research and development organization created to develop and disseminate objective information about nurses and the workforce to the Governor, Legislators, and the public at large (NJ P.L 2002, c116). The Center is located in Rutgers University, the State University of New Jersey, College of Nursing, on the Newark Campus.

In addition, the Center has developed several projects designed (a) to ease the transition from one educational level of nurse education to another; (b) inductively developed a competency-based nursing practice model with four levels of practice; and (c) enhanced the image and profession of nurses by distributing a series of posters and CDs to all New Jersey schools that depict the wide variety of workplace options for nurses.

All of the Center’s work is based on the foundational values of: visibility, credibility, and neutrality through a collaborative made up of nurses and other healthcare stakeholders.

Watch for our column in every issue of the Institute for Nursing Newsletter and check out our Web site at http://njccn.org.

 


TAKING THE LONG VIEW: FROM EVIDENCE TO POLICY
Louann Lamattina, RN, MPA
New Jersey Collaborating Center for Nursing
July 2006

The 4th National Conference of State Nursing Workforce Leaders was held at the Hyatt Regency Jersey City on the Hudson on April 27-28, 2006. This national conference was designed for leaders and stakeholders of state-based nursing workforce centers that focus on measures to address long term nursing workforce solutions at the grass roots level. The conference was attended by 155 nursing workforce leaders, nurse educators, and other stakeholders representing all regions of the country with a total of 30 states plus the District. A comprehensive picture of nursing workforce issues was offered with participants and presenters working on providing evidence about education, retention, funding, and public policy. By the conclusion of the two day session, the many facets of nursing practice were addressed through presentation of current evidence and formulation of research and policy questions for the future.

Among the key issues addressed on the agenda were critical analyses of the national nursing shortage both in workforce and faculty settings, the methods and strategies to accurately measure nursing supply and demand, work satisfaction, and the impact of nursing practice on health outcomes. Other topics addressed the development of effective workforce centers, the formulation of public policy and funding to support nursing workforce education and professional development of nurses, and the provision of qualified nursing faculty through nursing education and retention strategies. Presentations also focused on more global issues such as the development of change in nursing practice and work design, national and local health care policy, and the mastery of those skills necessary to communicate the most important needs of nursing practice and education to legislators, foundations, employers, and other stakeholder communities.

Although the details of the current and future nursing shortage have been well established, the conference presentations raised the issues from a variety of provocative viewpoints. Conference participants had the opportunity to hear presentations from nationally recognized researchers in nurse workforce issues. The Thursday keynote was delivered by Sean Clarke, PhD, RN, CRNP, Assistant Professor, and Deputy Director the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, who discussed the current state of research on nurse staffing and work environment and its link to patient safety and stability of the nursing workforce. Dr. Clarke stressed the importance of developing a body of evidence that would support improved patient outcomes and drive health policy reform. A patient safety climate and culture was promoted as a key contributor to reaching desirable levels of nurse satisfaction, competency and staffing.

The Friday keynote was delivered by Julie Sochalski, PhD, RN, FAAN, Associate Professor, University of Pennsylavania School of Nursing, who challenged attendees to critically analyze the nursing shortage as a perception and function of inadequacy of nursing role design in relation to the structure of health care, the relationship to other health care provider roles, and the care needs imposed by trends in aging, chronic illness and health risk factors. Dr. Sochalski discussed the impact of nursing on patient outcome by analyzing the public health need in relation to the capacity of the current infrastructure of our health care system.

Nursing leaders also considered innovative approaches to defining nursing's primary role in the creation of more effective health care delivery and the commitment evidence based practice that will lead to improved patient outcomes. In spite of regulatory trends in the collection of outcome data according to evidence based indicators, the value of nursing practice in addressing our most prevalent diseases and in managing our current health risks has not been utilized in the current health care infrastructure. The nursing shortage will remain in crisis proportions unless strategic change of roles and integration with a more patient centered health care delivery system can be established. Workforce leaders accepted the call to drive change in order to preserve the valuable components of nursing practice.

To further the understanding of nursing shortage and future design requirements, discussions addressed the issues with inconsistent and inaccurate data available to determine the actual number of nurses in the workforce by region and by work setting. Workforce centers are challenged to collect accurate data and to direct policy that will streamline, consolidate, and standardize information on the number of working licensed registered nurses across the country. Variations in data collection practices by State Boards of Nursing have made research and survey activities time consuming and expensive. Accurate data on local, regional, and national nursing workforce trends is vital to educating lawmakers on the nursing role and impact in effectively meeting the national health care needs. Workforce leaders expressed their commitment to collaboration and consolidation efforts to achieve consistency and standardization of nursing workforce data. This unified network will design methods to gather nursing data at the point of licensure and to maintain current records that can be utilized in local and regional research and planning.

Nursing leaders discussed ways to more accurately survey the current workforce and to seek funding from government agencies and private foundations to further the study of student enrollment, nurse retention, and work redesign strategies. Presentations were conducted by a number of leaders outside the nursing profession who were active in the administration of workforce programs, funding, or research. Researchers and executive leaders in the fields of law, sociology, and public health presented their research and program models in areas of survey research, work satisfaction studies, creative funding designs, and workforce center projects.

A common thread throughout all presentations was the expressed need for additional research in all issues related to workforce. Colleagues from large funding sources such as AHRQ and the Robert Wood Johnson Foundation expressed their strong organizational commitment to funding the study of nursing roles, their relationship to other health care providers, work redesign, and the linking of nursing practice to positive health outcomes.

Workforce leaders were invited to partner with large scale funding sources combined with smaller local resources to target studies that will impact populations segmented by health risk, disease, age, or disability. They were encouraged to tap funding resources to support innovative models. Ideas presented ranged from sophisticated virtual clinical learning labs to small consortium of rural hospitals working to improve work environment and outcomes of care in their own organizations. Other models presented ideas such as a community -based collaborative, partnerships offering unique approaches at the local level in targeted funding, support of specific initiatives, and primary involvement of local nursing leadership. Funding opportunities were described in areas of advocacy, policy development, and grant pilot programs.

Workforce leaders and other stakeholders gained insight into the skills and strategies of large scale survey techniques. A panel of experts offered model approaches and their experience in surveys designed to achieve desirable response rates. Discussion included the importance of using findings to create concise and focused information tailored for educating lawmakers and other interested supporters. Successful approaches were evidenced in presentations and in the many posters displayed for review. The efforts of the nursing workforce centers throughout the states included a concerted resolve to support the growth of additional workforce centers nationally while leveraging the current impact with continued collaboration and communication.

All is all, the conference was a success and participants gleaned information to take home as well as the opportunity to network with colleagues with similar interest and experience. Geri Dickson, PhD, RN, Executive Director of the New Jersey Collaborating Center, closed with the idea that the time has come for nurses to play an active role in shaping their future as Victor Hugo emphasized: "Mightier than the tread of armies is an idea whose time has come."


 

 

 

LARGE STUDY OF NURSING CARE AND OUTCOMES UNDERWAY IN NEW JERSEY!

Large Study of Nursing Care and Outcomes Underway in New Jersey!
Reprinted with permission from the Institute for Nursing Newsletter, February 2006.


NEW JERSEY COLLABORATING CENTER FOR NURSING
Report of the Second Annual Center conference:
Improving Quality Through Nursing October 24, 2005

The second Annual conference of the New Jersey Collaborating Center for Nursing was held on October 24th at the Woodbridge Hilton. The title was "Improving Quality Through Nursing." Approximately 160 persons attended the conference.

Opening remarks and welcome was given by Dr. Judith Mathews, Chair of the NJCCN Board. Dr. Mathews stressed the need to chart new paths but maintain the good from the past.

Dr. Linda Flynn, Research Director at the Center, was unable to attend the conference due to a family emergency. Dr. Geri Dickson presented the research and the nursing education programs that are ongoing at the Center. The research activities at the Center during the past year include a survey of RNs/LPNs in nursing facilities about the important factors in their work environments.

The New Jersey Nurse Survey 2005 being done in collaboration with the University of Pennsylvania and funded by grants from Robert Wood Johnson Foundation and the NJ State Board of Nursing was introduced. One half of all registered nurses in NJ will receive this survey and the importance of responding promptly, either by returning it by mail or on the internet was stressed. The purpose of the study is to identify specific work environment traits across practice settings that contribute to nurses' job satisfaction, patient safety and good patient outcomes.

Dr. Dickson presented the Center's work that clarifies the existing situation for nursing education in New Jersey: programs that produce nurses as well as programs that enhance nursing preparation. Enrollments in diploma, AD and BSN programs have all increased in the past year and the diploma and AD programs are operating well above their capacity. This information regarding the State's ability to produce a supply of nurses is vital for policy development. The Center has formed a partnership with the National League for Nursing. This collaboration will ensure that one educational survey will be developed that will simplify and consolidate information for all nursing schools in the State. This effort will provide one set of numbers to be used by all organizations and will potentially strengthen nursing's voice at policy levels.

Dr. Dianne Cooney –Miner presented the New York State initiative to advance the profession of nursing. The proposed legislation would require that all registered nurses would be required to have a Bachelor's degree within 10 years of being licensed in the State. She discussed education and entry levels for many professions in the US such as social workers, art therapists, athletic trainers and physician's assistants, all who require a college degree. She presented an international perspective on nursing education levels. There was animated dialogue and many interesting questions following this presentation.

Transforming Care at the Bedside" was the topic for the afternoon session. This is a Robert Wood Johnson Foundation project involving 15 sites throughout the country. The purpose of these projects is to change the culture of care for the patient. Dan O'Neal from the James Haley Veteran's Hospital and Maureen White of the North Shore/Long Island Jewish Health System gave excellent presentations regarding their progress to date on this project. One of the main themes from both experiences is the importance of communication—among nursing staff members, with patients and their families, with other health team members and with hospital administration. The main themes for the project are patient centered care, teamwork, patient safety and reliability within a value-added care process.

The evaluation of the conference provided by the participants was excellent. Many nurses expressed appreciation for the new ideas and innovations that they could bring to their own practices. Dr. Cooney –Miner's presentation provided an innovative approach to strengthening the nursing profession within her State and a stimulus for all of us to develop creative approaches to improve the quality of care for our patients.


NEW ALLIANCE DESIGNED TO REDUCE BURDEN ON
NURSING ADMINISTRATORS AND FACULTY

Read the full press release here: http://www.nln.org/newsreleases/njdataalliance05.pdf


Issues Derived from the Small Group Work at the November 1, 2004 Conference The New Jersey Collaborating Center for Nursing

The staff at the Center continues to work on the results of our successful November 1st Conference. Dr. Rice introduced the session, "How to Get There from Here." Many suggestions were made during this participant dialogue. Dr. Rice asked for three pertinent areas for which the Center might develop innovative strategies to reach the desired future of nursing.

After much sorting and sifting of ideas four main areas of concentration evolved that are consistent with the mission and visions of the Center. . The areas that the Center will focus on for the next year are:

RESEARCH

Data collection and analysis Create a research advisory group

INFORMATION

Public information programs on role and value of nurses Maintain a website for nursing information

COLLABORATION

Facilitate collaboration among AD, diploma and BSN programs Assist in creating service and education partnerships Promote Competency-Based Practice Model as a mechanism to mesh quality education and practice

ADVOCACY

Seek funding to stabilize and guarantee the future of the Center Develop a strategy to influence the allocation of State resources for nursing

Volunteers: Many of the participants offered to work with the Center to achieve these objectives. We have attempted to reach all those who volunteered and hopefully they all have been contacted. Several advisory councils are being created to address particular issues.

The staff of the Center currently work in all of these arenas. If you are interested in working on a particular topic, please contact Allison Creary, the administrative assistant, so that we can include you in our communications.


Report of the First Annual Center Conference: Strategies for the Future of Nursing
November 1, 2004

The first Annual Conference of the New Jersey Collaborating Center for Nursing, Strategies for the Future of Nursing," was held on November 1st at the Woodbridge Hilton. Two hundred thirty-eight people registered for the conference.

Following opening remarks by Julia Plotnick, Geri Dickson reviewed the journey of the Center, from Colleagues in Caring to its present configuration as the Center.

Geri raised an essential question: "How do we respond to this nursing shortage?" She suggested that when facilities work with nurses as valued assets and collaborative partners, there are realistic and possible solutions. She presented several new ideas suggested for future solutions, as well as ones that are already being tested in some locations.

Linda Flynn presented data collected from the Educational Capacity Study in 2003 at all schools of nursing in New Jersey. Based on the findings of that study and other survey data, the 2005 NJ Nurse Survey is in the works, in collaboration with Linda Aiken at the University of Pennsylvania. Phase I encompasses data collection while Phase II will link survey data with existing patient databases.

Pamela Thompson, CEO of the American Organization of Nurse Executives, posed the question to the group: What are the principles that can guide us as we try to define our future delivery models and the nurses who will be providing care to our patients? Thompson envisions our guiding principles to fit like puzzle pieces, with one piece connecting to the next. Central to the puzzle is the patient. Pieces that are needed to complete the puzzle are nursing knowledge and caring, user-based care, access-based and synthesized knowledge, the relationships of care and then how we manage the journey.

Nancy Langston, dean and professor of the School of Nursing at Virginia Commonwealth University, captivated her audience at the start by her phrase: TOGETHER WE CAN! THE WORLD AWAITS US! NOW GO! She talked about preferred futures, where nurses can transform words into action. She presented several ideas such as to include adjunct faculty in clinical experiences, surround the nurse with every resource she or he needs to work effectively and efficiently and increase the technology in learning.

Becky Rice summarized the day's presentations and asked each table of nurses to discuss what they had gleaned from the presentations and chose three issues affecting nursing that they felt the Collaborating Center could address in the future.

Evaluations were collected and were very positive. Becky is categorizing the suggestions and will list them according to priorities in relation to our mission. The results will be posted on our website: http://njccn.org

All in all, a very successful 1st conference.


"THE PROMISE OF NURSING IN THE COMING HEALTH CARE SYSTEM"

State nursing workforce groups and interested health stakeholders from around the country met in Orlando, Florida, April 29 and 30 for the 2nd Annual Conference of State Nursing Workforce Centers to discuss what is being done at the various state levels to address the current nursing shortage and the chronic, underlying issues that attend it.

The keynote speaker, Dr. Edward O'Neil, Director of the University of California Center for Health Professions, emphasized the need for nurses to own the continuum of service. He advocated that a strengthened nursing leadership needs to "articulate, differentiate, and integrate a full range of nursing service, declare victory, and push ahead." Dr. O'Neil believes that nursing has hampered its development into one strong, unified, respected voice because of fragmentation in the areas of education and timidity in taking hold of the profession and asserting its rightful place in the medical hierarchy.

Dr Geri Dickson, Executive Director of the NJ Collaborative Center for Nursing (NJCCN), presented a poster exhibition showing the development of the Center and the models that were created collaboratively with other NJ healthcare stakeholders. These models included the NJ Forecasting Model, the education Articulation Model, and the NJ Competency-Based Nursing Model. Elementary through high school recruitment posters and DVDs promoting nursing as a profession were also available at the display table.

Nursing Workforce groups from Iowa, North Carolina, North Dakota, Illinois, Vermont, Mississippi, Oregon, California, Wisconsin, and Missouri presented their research or programs that have been conducted in addressing the nursing shortages in their states. Topics centered on education and retention practices and offered a glimpse at the variety of ideas and strategies that are being used to resolve the current and future shortages.

The education speakers looked at funding issues, seamless nursing education curricula, legislative pre-requisites for nursing courses, standardization of admission policies, regional articulation agreements across a state, and model curricula.

Retention Practices included several awards programs that celebrate nursing excellence and strive to encourage and inspire the pursuit of advanced education; a pilot program that actively addressed the four major areas of nursing discontent, i.e., time with patients, intellectual stimulation, healthy workplace cultures and teams, and ergonomics and safety; research that looked at "Nurse's Perception of Workload"; and a second presentation that described a tool to measure the gap between the importance employees place on organizational issues and their perception of organizational performance.

The 3rd Annual Conference of Nursing Workforce Centers will meet in Oregon in the spring of 2005.



NJ Collaborating Center for Nursing Has Vital Presence at NJSNA Convention

The NJ Collaborating Center for Nursing hosted a festive reception on the evening of April 1, 2004 from 5-7 PM during the NJSNA Convention in Atlantic City. The event was well attended with sixty nurses stopping by the beautiful suite at the Tropicana Hotel and Resort. Materials and information about the Center and the Articulation Model for Nursing Education were distributed to the attendees and an opportunity was provided to meet the Center's Executive Director, Dr. Geri Dickson, RN, Ph.D. Lovely refreshments were provided for all to enjoy.

Also present at the reception were several NJCCN Board members. Mimi Cappelli, Interim Board Chair, Sharon Rainer, Barbra Tofani, and Louise DeBlois were on hand to greet the nurses and speak with them informally. Gay Lutton, MSN, MS, RN, who recently joined the NJ Collaborating Center as its Associate Director served as co-hostess for the event.

Ms. Lutton brings a knowledge base in recruitment and retention issues gathered over many years at the bedside and fine tuned at the NJ Department of Human Services where she was the Director of Nursing Recruitment and Retention for four of its Divisions. She is looking forward to and eager to participate in the Center's activities as it discusses and studies the current and future nursing issues that shape nursing's role in the 21st century.

NJCCN made its presence known again on Friday morning when Carolyn Tuella, Ed. D, RN, Chairperson, Division of Nursing, Bloomfield College and Co-chair of the Center's Competency Advisory Group presented the competency nursing practice model that was developed at the Colleagues In Caring and the NJCCN. Her presentation at the NJSNA Convention was entitled "An Integrated Competency Based Nursing Practice Model". A full text describing this model can be accessed on the NJCCN website. The Competency model will soon be published for distribution as well.

The NJ Collaborating Center For Nursing is a primary source for data based evidence to formulate reliable health policy that has a positive impact on nursing care, nursing education, and patient outcomes. The next Board meeting for the NJCCN will be held on May 14, 2004 in the Center's office at Rutgers-Newark. For more information about NJCCN, please visit our website.

   
Richard Aughenbaugh and Barbara Wright                              Guests at the NJCCN Reception        


Hanna Tracy and Maureen Clark-Gallagher


 

New Jersey Collaborating Center for Nursing Open House 

The New Jersey Collaborating Center for Nursing hosted an open house on the afternoon of January 23, 2004. The event was attended by 45 people, who met the Center's board of directors and staff and heard a brief overview of the Center's activities by Executive Director Geri Dickson, RN, Ph.D. and Board Chair Mimi Cappelli.

Assemblywoman Linda Greenstein (D -15th District) spoke to the group about the importance of nursing in health care and of the nursing shortage. Laverne Parish, RN, Acting Supervisor, Newark Department of Health and Human Services, represented the Honorable Sharpe James, Mayor of Newark, and relayed his greetings to those assembled.

Twelve members representing different areas of nursing are currently appointed to the 17-member board. They are: Ms. Mimi Cappelli (NJSNA), Ms. Marianne Duffy NJ-ONE), Dr. Lucille A. Joel (NJSNA), Dr. Judith Mathews (ADSPN), Ms. Kathleen Pavalkis (LPN Educational Council), Ms. Sharon Rainer (NJSNA), Ms. Faith Scott (Home Health Assembly), Dr. Kathi Kendall Sengin (Council of Teaching Hospitals) Ms. Janice Testa (NJ Association of Health Care Facilities), Ms. Barbara Tofani (NJHA), and Ms. Connie Wilson (LPN Nurse Association of NJ). Board members yet to be appointed are the representatives from: the Council of Baccalaureate and Higher Degree Nursing Programs, NJ Council of Associate Degree Programs, the New Jersey League for Nursing, and two public members.

 
                                                                                   Geri Dickson and Assembly woman Linda Greenstein         

 
Annette Hubbard and Lavern Parish.                             Gay Lutton and Sharon Rainer.

 
         Luz Ramos and Bernie Gerard                               Julia Plotnick and Laverne Parish         

 
Linda Greenstin addressing the guests at the open house.

To keep up with our activities, visit our website from time-to-time. Thanks. 


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