The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation (RWJF), is pleased to announce that 10 projects proposed by its state-based Action Coalitions, or in a few cases, organizations designated by an Action Coalition, have been selected to receive awards up to $25,000 each for new or ongoing work that strengthens nursing’s role in building a Culture of Health and promoting health equity. All 2020  Nursing Innovations Fund secured dollar to dollar matching funds from a variety of partners, including local county fire and emergency services, a state beef council, United Way, local foundations, health and hospital systems, universities and individual donors, to name a few.

The winning projects from nearly every region of the country range from developing nurse leaders to serve on local boards to a mentoring program for Black men that promotes educational attainment and employment opportunities in nursing. All are designed to address policies that impact the many different social, economic and environmental factors that shape our health, and that will lead to greater health equity for all.

RWJF defines health equity as, “everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments and health care.”

“As a co-chair of the Campaign’s Equity, Diversity and Inclusion Steering Committee (EDISC),

I am proud that these 2020 Nursing Innovation Fund projects are committed to advancing health equity, particularly at a moment when our nation is finally paying increased attention to addressing systemic racism,” said Carmen Alvarez, PhD, CRNP, FAAN, assistant professor, Department of Community-Public Health, Johns Hopkins University.

“A pathway to equity is to help build better health through nursing,” said Eric J. Williams, DNP,  RN, FAAN, assistant director and faculty chair and professor of nursing at Santa Monica College, and fellow co-chair of the EDISC. “These efforts are a step in that direction and I applaud the Action Coalitions for their work.”

The Campaign’s Nursing Innovations Fund was created in 2018 to support work of its Action Coalitions and allies that inform and influence policy, produce replicable strategies that place nurses in positions as essential partners in providing care, and strategically involve a diversity of stakeholders. This competition was limited to the Action Coalitions or organizations designated by Action Coalitions and required applicants to raise funds to match the award dollars. To date, 23 Action Coalitions and allies have received Nursing Innovation Fund awards to build healthier communities through nursing.

“As our nation continues to face the devastation wrought by COVID-19, nurses remain on the frontlines as trusted providers of care. Now, more than ever, our country is relying on nurses to apply their unique knowledge and understanding of community needs for better health. These states demonstrate how nurses use that critical perspective to implement innovative programs to improve health and well-being,” said Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at RWJF and director of the Campaign for Action and Susan C. Reinhard, PhD, RN, FAAN, senior vice president and director of the AARP Public Policy Institute, and chief strategist at the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP, and RWJF, which coordinates the Campaign for Action.

The winners and an overview of their proposals are listed below:

Arkansas and Tennessee

The Arkansas Center for Nursing and the Tennessee Action Coalition aims to develop nurse leadership and places nurses on local housing and planning boards throughout the Arkansas Tennessee Delta region, to help create healthier communities through the project, “Nurses Building a Culture of Health in the Arkansas-Tennessee Delta”. This geographic area has a history of inequities, poverty and poor health outcomes. Matching funds were provided by the Arkansas State Board of Nursing, the Tennessee Department of Health and the Tennessee Housing Development Agency.

Georgia

The Georgia Nursing Leadership Coalition plans to implement a mentoring program for Black men that promotes educational attainment and employment opportunities in nursing through the “High School to Higher Education: Increasing Black Male Representation in Nursing” project. The efforts will engage community partners as stakeholders and employ a holistic approach to providing professional and personal development opportunities to assist mentors and mentees build the skills needed for educational attainment and employment success.

Kentucky

The Kentucky Nurses Action Coalition’s project, “Kentucky Partners to the BARN (Bringing Awareness Right Now) Program for a Farmer Dinner Theater Addressing Mental Health & Wellness” is a three-part intervention program designed to help address farmer mental health issues and prevent suicide. Fifty high school students with an agricultural career interest will receive tailored training sessions to raise self-awareness about mental health and wellness, learn suicide prevention skills and theater skills to produce a dinner theater addressing mental health and wellness for approximately 100 Kentucky farmers and their families.

Nebraska

The Nebraska Action Coalition’s project, “Striving for Health Equity in Nebraska,” works to address social determinants through a multipronged approach.

1. Build professional students’ knowledge of population health by having them design and disseminate health information at school health fairs.
2. Develop community-based partnerships via an advanced practice registered nurse led clinic which provides integrated behavioral health care for rural and underserved populations.
3. Promote awareness and build partnerships through an annual Leadership/Culture of Health conference. The conference will address topics such as advocacy, policy, mental health/self-care, implicit bias, and it will also include a “COVID-19 Lessons Learned” panel.

North Carolina

North Carolina Agricultural and Technical State University’s project, “On the Ground: Access to Care through Building Faith, Health, and Community Partnerships,” supported by the North Carolina Action Coalition, seeks to develop a faith, health, and community engagement model utilizing the Campaign’s Health Equity Toolkit. The program aims to enhance the health equity advocacy and partnership/coalition building skills of nurses, nursing students, pastors and church members to promote the health and well-being of communities through congregations. It will also create a regional steering committee to engage stakeholders to prioritize and address social determinants of health that adversely affect the health and well-being of African American and rural communities, and promote health-related congregational activities focused on the needs of the community.

Pennsylvania

Through its “At the Core of Care” podcast, the Pennsylvania Action Coalition will showcase stories of nurses and their partners driving change by addressing social determinants of health. The series will be incorporated into nursing school classrooms to inspire public health leadership and advocacy.

Washington

The National Alliance for Filipino Concerns launched the “Bayanihan Response to COVID-19″ to respond to the immediate and long-term health and wellness needs of Filipino communities in the United States and the Philippines. Via a telephone weekly check in and screening with elders identified as high need, callers assess for COVID-19 symptoms, food, prescription, utilities, housing needs and pre-paid phone minutes. They also offer a grocery and meal delivery program to ensure clients have access to nutritious and culturally appropriate food.  Lastly, they will conduct a community wellness survey. Focus group results will be disseminated to community members, stakeholders, and the public. In collaboration with Seattle University College of Nursing, and support of the Washington Action Coalition, they will use survey data to create interventions and initiatives to address community needs.

West Virginia

The West Virginia Action Coalition project, “RN Entrepreneur Project Continuation,” will create five sustainable nurse businesses and teach the entrepreneur course to 20 additional nurses. The training curriculum and program will expand across the state.

Wisconsin

The Wisconsin Action Coalition’s project, “Preparing Wisconsin Nurses to Address the Needs of Vulnerable Populations in a Public Health Emergency”, will design and develop trainings for Wisconsin nurses in response to the specific educational needs created by COVID-19. Trainings will address disparities impacting Wisconsin’s most vulnerable populations. Components include: launching educational programs for Milwaukee nurses who care for diverse and vulnerable populations, evaluating and improving learning content and methodologies and expanding the program statewide.

Wyoming

The aim of the Wyoming Institute for Disabilities, University of Wyoming, in support with the Wyoming Action Coalition project, “Facilitating Seniors’ Use of Technology to Decrease Social Isolation,” is for nursing students to help older adults use technology in their homes to access health care, purchase groceries and household goods, and communicate with their friends and family.

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Problem Statement:  In 2016 in Arkansas, 34.5% of adults were obese, 39.2% of public school students were overweight or obese, 19% percent were food-insecure, and only 61 percent had access to places for physical activity. This highlights the need to address the social determinants of health (SDH) that make it hard for people to make healthy choices. Nurses are well poised to transform health and health care, but most are not prepared for board service where they lead cross-sector collaborations to build a Culture of Health (COH). Future and current nurses need to learn about SDH, COH, and leading collaborations that create community changes, such as increasing access to healthy food and places to walk.

Approach: We engaged Arkansas nursing deans and directors through workshops about SDH and the COH Framework, and conducted a Delphi study to learn about their perceptions of integrating COH into nursing curricula. We engaged seasoned and emerging nurse leaders through resources, surveys, and Nurses on Boards (NOB) training with the intent of increasing participation and leadership on boards that promote a COH.

Products/Outcome: 1. All deans and directors discussed the importance of including COH and SDH in nursing education in order to improve health. There was no consistency in curricular content/experiences among schools, but consensus in need to update curricula. 2. Emerging nurse leaders reported need for NOB training. A new NOB training model was developed by national facilitators who incorporated COH into the training. Attendees reported increased participation/desire to participate on boards that promote a COH. 3. An online resource list of Arkansas boards that promote a COH was disseminated.

Implications: Engaging schools of nursing on integrating SDH and COH into nursing education, and incorporating COH into NOB training can help develop nursing leaders who are prepared to build healthier communities and transform health.

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Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, is an associate professor at the University of Arkansas for Medical Sciences College of Nursing (UAMS), is a co-leader for the Hartford Center of Geriatric Nursing Excellence, and is president of the Academic Senate for UAMS. She is a Robert Wood Johnson Foundation Culture of Health Breakthrough Nurse Leader in Nursing, and is a board member of the Arkansas Action Coalition for the Future of Nursing. She received her Bachelor of Science in Nursing in 1982 from Arkansas Tech University, her Master of Science in Nursing in 2001 from the University of Central Arkansas, and her Doctor of Philosophy in Nursing Science in 2006 from UAMS.

Why did you decide to become a nurse?     

I was very practical about it, I thought it would be a steady job! I quickly learned that it was a vocation—one requiring great dedication. I took to it wholeheartedly.

Can you describe your (philosophical) evolution from making that decision to where you are today?

Probably one of the most profound moments was in graduate school while in research utilization class. I raised my hand and asked, “Do you mean that with research, I perhaps can change the health of populations of people?” When my instructor said yes, I knew that instant, this is what I want to do. I decided that moment I would get a PhD, be a nurse research scientist and to work towards health and wellness in older adults with cardiovascular disease.

Of all that you have accomplished, what are you most proud of?

Choosing one thing is too difficult. I am very proud of all the students that I have taught and mentored in my 18 years of academic education. My hope is that I inspired them to care, and care deeply. I’ve always been a rule-breaker and thought outside of the box…this has led me to develop alternative ways to help promote cardiovascular health in the research and community work I have done.

If you could change the profession in any one way, what would you change and why?

I would love to change our higher education system into one that has true interprofessional education, especially for graduate students studying health, wellness, and healthcare. I really believe this type of education would help improve quality of care for our citizens. We would work so much better as a team in promoting wellness and providing treatment.

What is the most important action that nurses can take to lead the way to improve health and health care in America?

I believe that nurses could lead the shift that is so needed in health and health care—that is, from a disease-driven model to a model of wellness. Lead …meaning influencing others to join in, such as other health care providers, but also individuals and communities. We are everywhere, we are smart, we are savvy, and we know different interventions work for different people and communities.

What role do you see for yourself in building a healthier America?

You mean roles? As an educator, to teach the principles of building a Culture of Health and inspire my students to run with it in their lives and in their practices. As a research scientist, to develop better ways of promoting wellness than we have had in America. As a citizen, to fight for healthy workplaces, communities, and homes.

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The event was planned by Tina Lear, executive director of the Missouri Center for Nursing and Missouri Action Coalition, and Patti Scott,  DNP, RN, PNP -BC, NCSN, Director, Center for Health Advancement, Arkansas Department of Health, Little Rock, Ark and a Robert Wood Johnson Foundation Public Health Nurse Leader working with the Arkansas Center for Nursing/Action Coalition.

Lear and Scott consulted with national experts, Marion Karr and Kimberly McNally. McNally is a nationally recognized nurse executive, executive coach, trainer and author, including co-author of the Nurse Executive’s Coaching Manual, published by Sigma Theta Tau. Karr is president of Avery Executive Search and developed the Accomplishment Culture program.

The 44 attendees, 30 from Missouri and 14 from Arkansas, learned about the importance of having nurses at the table, how to apply nursing expertise on boards or committees, types of boards or committees that promote a culture of health, and engaging stakeholders to foster change. Participants completed individual leadership assessments and worked as teams to understand and capitalize on their leadership styles to promote change and best practices. There will be follow-up webinars to continue leadership development. There will also be surveys and follow-up of attendees over time to assess their participation on boards and committees.

Missouri and Arkansas were excited to work together on this event and look forward to a lasting partnership as they foster these dynamic nurses through their service careers.

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• Distribution of population by race/ethnicity
• Percentage of population living in rural versus urban areas
• Distribution of population by federal poverty level
• Areas in which there is a shortage of primary health professionals

These statistics can guide your Action Coalition’s work in shaping a nursing workforce to better meet local needs and overcoming health disparities in your state. As you integrate other Culture of Health aspects into your work, consider how demographics play a role in health equity and fostering cross-sector collaboration.

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Maria Torchia LoGrippo (left) and Edna Cadmus review notes from LoGrippo’s leadership training held in June at the Center for Creative Leadership in North Carolina

If you ask a nurse manager, chief nursing officer, or a nurse leader how they got where they are, it’s likely they will mention mentors who helped along the way. It’s just as likely that the experience benefited both teacher and student—while contributing to a nursing culture that promotes and values leadership.

Just ask Maria Torchia LoGrippo how mentoring helps nurses learn and grow. As aNew Jersey Nursing Initiative scholar, LoGrippo was able to finance her doctorate in nursing at Seton Hall thanks to the Robert Wood Johnson Foundation (RWJF)—and found equally important help afterward in her mentor.

LoGrippo was guided in her postdoctoral position at Rutgers University by Edna Cadmus, who provided her protégé with opportunities to lead, including LoGrippo’s current position as project director for an RWJF State Implementation Program grant.

Cadmus, who is specialty director of the Nursing Leadership Program at Rutgers’ School of Nursing and co-lead of the New Jersey Action Coalition, has helped guide LoGrippo’s career trajectory, LoGrippo said, and was “the key” to her being hired by Rutgers as an assistant professor. Now LoGrippo has been asked to direct the RN-to-BSN program at Rutgers—another role that LoGrippo attributed to Cadmus’ ongoing conversations, advice, and counsel.

The Institute of Medicine’s landmark 2010 report on the future of nursing cites mentoring as a good way to strengthen the workforce and improve the quality of care and patient outcomes. That’s why mentoring is one strategy the Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP, is implementing through its 51 state Action Coalitions.

Amy McCarthy, a charge nurse at Texas Health Presbyterian Dallas, receives mentor support from Cole Edmonson, the hospital’s chief nursing officer and co-lead of the Texas Team.

“Mentoring is really a bidirectional relationship,” said Cole Edmonson, chief nursing officer at Texas Health Presbyterian Hospital Dallas, and an RWJF Executive Nurse Fellow. Edmonson mentors Amy McCarthy, a charge nurse at the hospital. When McCarthy met Edmonson, she said right away: “I want your job, now how do I get it?” Edmonson has been showing her the ropes since.

Thanks to Edmonson’s selecting McCarthy as the new nurse representative on the National League of Nursing Accelerating to Practice Advisory Board, said McCarthy, she’s been exposed to people and ideas at the national level in a way that wouldn’t have been possible otherwise. McCarthy has relied on Edmonson on matters large and small: “He connects me with people interested in what I need to know. He has been a constant source of support.”

“Mentors help us through the difficult times, celebrate our accomplishments, and guide us through decisions and difficult situations,” said Edmonson, who has benefited from the efforts of several nursing mentors over his career.

Like many other RWJF Executive Nurse Fellows, Edmonson is using his leadership skills to mentor younger nurses; he also leads an Action Coalition—in his case, the Texas Team.

Nursing students HuiHui Sun, Carley Bruscato, Natalie Dumont, and Raquel Torres are part of the Arkansas Action Coalition Young Leaders program, which provides them with mentoring, networking, and leadership development opportunities.

Several state Action Coalitions, including those in Arkansas and Vermont, use mentoring to help prepare nurses to lead change. In Vermont, nurse leaders were encouraged to find a mentor; in Arkansas, the Action Coalition creates the pairings.

“Mentoring is particularly important for nurses who want to advance into positions of leadership, including positions on boards,” noted Mary Val Palumbo, co-lead of the Vermont Action Coalition and a University of Vermont associate professor of nursing.

Nurses completing the coalition’s yearlong Vermont Nurse Leaders Fellowship Program were encouraged to identify and seek out mentors. Palumbo credits her mentor, University of Vermont Professor of Health Policy and Nursing Betty Rambur, with helping her “set new goals, strive for excellence, and be willing to step up to the plate.”

In Arkansas, the Action Coalition made sure that mentoring was part of its Young Leaders Program, designed for nursing students earning their bachelor’s degrees. The program pairs participating students with experienced nurses; students then complete nurse leadership projects under the guidance of their mentors, who help them hone leadership skills.

“Each of the youth leaders is having a unique experience outside of traditional bedside nursing,” said Erin Fifer, coordinator for the Arkansas Action Coalition. “The mentoring and networking opportunities each student receives will be invaluable to their nursing career.”

This story appeared in the July 2015 issue of Advancing Health: News from the Campaign for Action. 

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The State Implementation Program bolsters efforts already underway in 50 states and the District of Columbia—the Future of Nursing: Campaign for Action—to improve health and health care through nursing. A joint initiative of AARP and RWJF, the Campaign is working to implement the Institute of Medicine’s (IOM) evidence-based recommendations on the future of nursing. It provides a vehicle for nurses at all levels to lead system change to improve care for patients and families through collaboration with business, consumer, and other health professional organizations.

The State Implementation Program is providing two-year grants of up to $150,000 to a total of 30 state-based Action Coalitions that have developed or made substantial progress toward implementing the IOM recommendations. States must obtain matching funds to receive the grant. Grants were announced today in: Alabama, Alaska, Arkansas, Illinois, Minnesota, Nevada, Ohio, South Carolina, Vermont, and Virginia. The 20 states that received grants in February are: Colorado, Connecticut, Florida, Georgia, Iowa, Idaho, Kansas, Louisiana, Maryland, Michigan, Missouri, Mississippi, Nebraska, New Jersey, Pennsylvania, Rhode Island, Tennessee, Utah, Wisconsin, and Wyoming.

The Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, serves as the national program office for the Future of Nursing State Implementation Program. To learn more, read the full press release from the Robert Wood Johnson Foundation.

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