When nurses are empowered to create health equity in their communities, they bring together a network like nobody else can.

The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, has demonstrated this principle through its Nursing Innovations Fund that supports the Campaign’s state-based Action Coalitions in creating replicable and promising solutions for improving health equity through nursing.

The Nursing Innovations Fund was also designed to spark collaboration with partners outside of nursing. One condition of the award is that applicants must seek matching funds from other organizations. In combination with other tools to engage local stakeholders, the awards have led to an impressive array of new multi-sector relationships, helping nurses discover new allies for creating better access to care and services.

Launched in 2018, the Nursing Innovations Fund has led to new projects in 23 states. The Campaign has awarded more than $850,000 to a wide variety of initiatives, with every dollar being matched by other funders. This blog highlights the collaborations and projects from the 2019 and 2020 cohorts representing 17 states, whom created over a dozen publicly accessible tools to be used for building health equity. All of the resources are available on the Campaign website.

State coalitions secured investment from multiple organizations that understand why it is so important to invest in better access to care and services. They include organizations one might expect, such as hospitals, nursing schools, and regional philanthropies. Action Coalitions also secured funding from unexpected sources:

• In Georgia, funding from the Clayton County Fire and Emergency Services helped create more effective paths for Black men to enter nursing.  
• In Kentucky, the Kentucky Beef Council supported an initiative to prevent suicide in the farming community, and
• In Nebraska, Scoular, an agriculture supply chain company, contributed matching funds to a project aimed at improving health equity.

In addition to funders, Action Coalitions garnered critical support from community partners representing dozens of different organizations. Here are a few of their stories:

• In Pennsylvania, a podcast highlighting nurses in health equity roles featured many local partners, including Sanctuary Farm, a program that converts abandoned areas in Philadelphia to farm plots.
• In Washington, a program to bring culturally appropriate food and essentials to older Filipino community members worked with local and national groups such as the National Alliance for Filipino Concerns.
• In Indiana, nurses from the Indiana Center for Nursing collaborated with the AARP state office to enable nursing schools across the state to implement holistic admissions programs

Crucial to the impact of these projects is the idea that all of them can provide insights that help many other organizations disrupt disparities and improve access to care and services.

Actions Coalitions drew on well-established tools to address health disparities, including the Campaign’s Heath Equity Toolkit and the Centers for Disease Control and Prevention’s (CDC) Healthy People 2030. In turn, many of them developed new resources to help others:

• In Wisconsin, the Action Coalition developed a curriculum to improve nurses’ disaster response capabilities, and it is being shared throughout the state.
• In Massachusetts, nurses developed an anti-vaping resource kit for use in public schools.
• The Pennsylvania initiative centers on a podcast that helps nurses envision new careers in health equity.

Together, these partnerships, resources, and insights add up to a powerful network working to achieve health equity in the U.S. built on strengthened nursing capacity and expertise, as the National Academy of Medicine’s Future of Nursing 2020—2030 report has envisioned.

In the coming weeks, this Campaign blog will feature more detailed explorations of how this work brought together local and state coalitions to address health equity. Projects to be featured include:

• Indiana – This project brought together partners including AARP Indiana State office and Orbis Education to help nursing programs implement holistic admissions and peer-to-peer mentoring for the Nursing Education, Engagement, and Diversity Statewide Initiative, or NEEDS.
• Kentucky – The Kentucky Nurses Action Coalition enlisted school nurses to address the state’s disproportionate suicide rate, culminating in a dramatic presentation designed with the Actors Theater of Louisville. Title: School Nurses to BARN Camp for the Mental Health and Wellness of Kentucky Youth.
• Massachusetts – This project addressed vaping in youth in partnership with education and law enforcement groups from across the state, yielding new curricula to aid teachers in elementary and secondary schools. Title: Promoting Health Literacy to Influence Health and Wellness of Students in the Community: Widening the Connections.
• North Carolina – Working with the North Carolina Action Coalition, the North Carolina Agricultural and Technical University developed a new model of coalition-building to help African American and rural communities. Title: Project RARE (Reciprocal, Authentic, Relationships for Equity).
• Wisconsin. The Wisconsin Nurses Center explored gaps in the state’s emergency preparedness plans, then developed a training to help nurses address the problems. Partners included nursing schools as well as the Rural Wisconsin Health Cooperative and the Wisconsin Primary Health Care Association. Title: Preparing Wisconsin Nurses to Address the Needs of Vulnerable Populations in a Public Health Emergency.

Previous blog entries have also explored Nursing Innovations Fund programs in Pennsylvania, West Virginia, and Wyoming.

Are you interested in addressing health equity in ways like the Campaign’s Action Coalitions? Visit the Nursing Innovations Fund page for a complete list of programs as well as the Campaign resources nurses used to create them.

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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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From left to right: LT Gov Geoff Duncan, Desiree Clement CNM,Molly Bachtel, FNP, and Gov. Brian Kemp.

With his signature, Georgia’s governor has just made law the bill known as Preceptor Tax Incentive Program (P-TIP), a move expected to quickly expand the clinical training opportunities for nurses.

House Bill 287, adopted in the state’s Senate on March 25, has been long sought by those wanting to keep much-needed preceptors in state so that more advanced practice registered nurses are available to provide care for Georgians. Nationally, tens of thousands of qualified prospective nursing students are turned away from nursing schools each year due to a lack of clinical nursing educators.

Clinical training, an integral part of nursing education, requires preceptors. But until now, as the Georgia Nurses Association wrote earlier this month, “Community based faculty preceptors are not compensated for their time teaching students but do so as part of their personal commitment to the health care system.”

P-TIP means that what was a tax deduction has now become a tax credit, and available to all licensed advanced practice providers who provide clinical training. That includes certified nurse-midwives, nurse practitioners, clinical nurse specialists, nurse anesthetists, and physician assistants. Previously, only physicians were compensated for being preceptors.

As the president of Georgia Midwives wrote in the days leading up to the legislative vote, “With growing numbers of students enrolled in out-of-state distance nursing programs also competing for local preceptors, the limited number of available providers for the clinical training of Georgia students restricts the growth of our workforce, in effect restricting access to care for our patients.”

With more preceptors available, programs that train advanced practice providers can expand—which means more students will be trained and ready to provide their services.

The bill will go into effect July 1.

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Each year the American Association of Nurse Practitioners (AANP) recognizes supporters of nursing from across the country, in two categories: nurse practitioners who have made outstanding contributions; and advocates who have made significant contributions toward increasing the awareness and acceptance of nurse practitioners.

This year AANP gives its State Award for Excellence to a number of advocates with close ties to the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation. Those allies include two state legislators who work with AARP state offices and sponsored bills to allow advanced practice registered nurses the ability to practice to their full education and training.

In the advocate category, here are the award winners who also have ties with the Campaign:

• Stephanie Ahmed, DNP, FNP-BC, Massachusetts
• Renee Dahring, MSN, APRN, CNP, Minnesota
• Lauren Inouye, RN, MPP, District of Columbia (Action Coalition leader)
• Beverly Lang, MScN, RN, ANP-BC, Maryland
• Linda Lazure, PhD, RN, FAAN, Nebraska
• Denise Link, WHNP, CNE, FAAN, FAANP Arizona
• Lucy Marion, PhD, RN, FAAN, FAANP, Georgia
• Gaylene Miller, West Virginia (AARP State Director)
• Laura Reichhardt, MS, APRN, NP-C, Hawaii (Action Coalition Leader)

The two state legislators are Oklahoma Rep. Josh Cockroft and Texas Rep. Stephanie Klick. AARP state office representatives had thanks for both:

“Oklahoma is facing a health care crisis across the state, but especially in our rural areas. Courageous leaders like Rep. Josh Cockroft understand the immediate need and urgency of finding a solution,” said Chad Mullen, associate state director of Advocacy at AARP Oklahoma. “We appreciate his willingness to stand up against a powerful and entrenched industry in order to bring much needed access to care to Oklahomans across the state.”

In Texas, Blake Hutson, associate state director for Advocacy and Outreach at AARP Texas, said, “Rep. Klick has been a consistent leader at the Capitol on nurses’ issues and a close partner with AARP in our efforts to promote the role of Advance Practice Nurses. She’s not afraid to stand up against heavyweight interests that want to keep the status quo in medicine to the detriment of Texas patients.”

See the list of all award winners.

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Problem Statement: Research demonstrates that early language exposure is the strongest predictor of 3rd grade reading proficiency, which has a lifelong impact on education and health outcomes. 85% of brain growth occurs before birth and during the first three years of life, creating the foundation for all later learning. Studies find that early language environments differ dramatically based on socioeconomic status and there are measurable differences in the number of words children are exposed to (language nutrition), creating a disparity referred to as the 30 million word gap. By the age of 3, children from high income families have double the vocabulary as children from low income families. Currently, only 34% of Georgia children read proficiently by the end of the third grade, 23% if low-income.

Approach: Talk With Me Baby (TWMB) is the first initiative of its kind to use public health nurses (PHN’s) to bridge the 30 million word gap. PHN’s use naturally occurring contacts they have with expectant women, parents and caregivers of young children to coach parents and caregivers to be conversational partners with their babies. This provides early language exposure rich in quality and quantity, to nourish infants and children neurologically, socially and linguistically.

Products/Outcome:  TWMB is Georgia’s Language Nutrition solution to impact the 30 million word gap disparity. 568 PHNs completed TWMB coach training to provide ongoing coaching for caregivers during public health service delivery. A statewide evaluation is under way.

Implications: The TWMB model of training multiple workforces, including PHNs, to lead by example, coach, model and empower parents and caregivers to develop the habit of talking to their baby early and often will lead to a lifelong improvement in the child’s education and health outcomes.

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