A diverse nursing workforce is essential to achieving health equity in the United States. Holistic admissions practices are an important tool nursing schools can use to contribute to that goal.

But changing admissions systems is complex, and a successful transformation requires the use of best practices and coordination with a wide variety of stakeholders. An Indiana program supported by the Future of Nursing: Campaign for Action’s Nursing Innovations Fund and executed in partnership with the AARP Indiana State Office shows it can be done. What began with an initial investment of $25,000 from the Campaign, has grown into $2.2 million grant from the Health Resources and Services Administration (HRSA).

Holistic admissions broaden the range of factors nursing schools can consider when they admit students, as explained in the National Academy of Medicine’s (NAM) report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. According to the American Association of Colleges of Nursing, holistic review for admissions is “a university admissions strategy that assesses an applicant’s unique experiences alongside traditional measures of academic achievement such as grades and test scores. It is designed to help universities consider a broad range of factors reflecting the applicant’s academic readiness, contribution to the incoming class, and potential for success both in school and later as a professional.”

As part of its call for nursing schools to “continue and expand their efforts to recruit, support, and mentor diverse students” the NAM report highlights research showing the effectiveness of holistic admissions. Well-designed plans to account for applicants’ experience and attributes as well as quantitative metrics can result in a more diverse student body while maintaining academic excellence, this research found. But well before the report was published, nurse leaders in Indiana were working with AARP to help the state’s nursing schools achieve exactly that.

In 2019, the Indiana Center for Nursing (which also houses the Indiana Action Coalition)  launched the Indiana Nursing Education, Engagement, and Diversity Statewide Initiative (NEEDS) with the goal of improving health equity through increasing diversity and inclusion among the state’s nursing workforce. At the program’s core were 14 nursing schools that committed to work together and implement holistic admissions programs.

“It’s been great to see so many nursing schools in our state go from just looking at quantitative metrics to a holistic approach to admitting students,” said Kimberly J. Harper, MS, RN, FAAN, chief executive officer of the Indiana Center for Nursing. “You do the work to make sure that they can be academically successful, but not everyone in the school will necessarily have a 3.9 GPA. Other things are important too. Because we know from research and experience that grade point average isn’t the only thing that makes a great nurse or keeps someone in nursing.”

In particular, Harper said that nursing schools value lived experiences that can help nurses address health disparities. Many of these nurse graduates will eventually address health issues that they or a friend or family member may have faced in their own lives.

An essential ingredient to the NEEDS program’s success was a strong coalition of community partners who supported the goal of a more diverse nursing workforce. A crucial member of this coalition was AARP Indiana.

“We have long recognized that there needs to be a diverse and inclusive healthcare workforce,” said Ambre Marr, AARP Indiana’s state legislative director. “A workforce that reflects our communities allows older Hoosiers to access healthcare exactly where they are. We need to care for nurses because they are caring for us now and will continue to care for us as we age.”

Harper explained that while support for holistic admissions among nurses is strong, there are logistical and institutional challenges to implementing this new way of doing things.

Based on extensive research and their own experience, the NEEDS team developed a comprehensive resource, a Holistic Review for Admissions Toolkit that anticipates these challenges. This toolkit is online and easily accessible for use by other schools, at no charge  

The toolkit offers a framework for holistic review admission and a detailed literature review. It also explains and provides guidance and resources on six areas critical to ensure successful implementation of a holistic admission process: mission fit; stakeholder engagement; implicit bias and cultural intelligence; implementation of the holistic review process, support for student success; and evaluation of processes.

A companion Peer-to-Peer Mentoring Toolkit offers nursing programs tools and resources for implementing a Peer-To-Peer Mentoring Program during prelicensure nursing education.

Now the knowledge generated by the Indiana NEEDS program is inspiring more efforts to diversify nursing in Indiana and beyond. The Indiana Center for Nursing received a $2.2 million grant from HRSA to expand scholarships, mentoring, and health equity partnerships at eight of the original nursing schools from the program. Harper also sees Indiana emerging as a national model of what holistic admissions can achieve.

When she and her colleagues first began working on holistic admissions, proven models and definitive research were hard to find. Nowadays, Harper explained, someone wants to talk with her about the topic at every conference she attends. She says that is in no small part due to the recommendations of the Future of Nursing report. “This is already a hot topic, and because of the report, it is becoming even hotter. There are a lot of folks who would like to be where we are now.”

To learn more about the Indiana program and the toolkits to implement holistic admissions in more states, visit the Nursing Innovations Fund page or the Indiana Center for Nursing.

The post Beyond GPA: Holistic Admissions appeared first on Campaign for Action.

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.

The post Nursing Innovations Funds Stimulate Partnerships appeared first on Campaign for Action.

The state capitol building of Indiana, located in Indianapolis.

Thanks to a coalition of organizations that have coordinated efforts for years, Hoosiers and those in nearby states can now more readily find health care. That’s because Indiana’s registered nurses and licensed practical nurses can convert their home state licenses to a multistate license that allows them to practice in 33 other states as well. That’s right: On July 1, Indiana became the 34th state to join the Nurse Licensure Compact (NLC).

AARP Indiana and the state’s Action Coalition, the Indiana Center for Nursing, were among forces behind the success.

Ambre Marr, state legislative director for AARP Indiana, says that Indiana’s being an NLC compact state will help quickly expand access to health care for Hoosiers and consumers in neighboring states, particularly in rural and underserved communities. Echoing that is Indiana Center for Nursing CEO Kimberly Harper, MS, RN, FAAN, who notes as well that this cuts some red tape for nurses, who can work across state lines without obtaining duplicate licensure.

Marr points to two state legislators who ushered the bill to this point: State Rep. Edward Clere (R) and Sen. Andy Zay (R) introduced bills in 2019. Their support included helping address questions from other lawmakers about what being a compact state would mean, such as which state would have jurisdiction and how states could maintain their own standards.

The National Council of State Boards of Nursing (NCSBN), which coordinates the NLC, helped allay such concerns years ago when it introduced an “enhanced” NLC. The update to the original 2001 compact set requirements and aligned standards among states. For instance, nurses seeking a multistate license must submit to a federal criminal background check. They also need to have a Social Security number, have graduated from an approved education program, and have passed the NCLEX.

Southern Indiana’s Hosparus Health, part of the coalition pushing for the compact status, is an example of how the NLC improves health care for consumers, nurses, and employers. Hosparus, which provides hospice and palliative care, operates in Kentucky, too (also a compact state). Indiana’s being part of the NLC means that RNs and LPNs can live in either state and provide care in all facilities.

AARP’s Marr notes more other ways the multistate license helps: Employers save on the costs they formerly shared with nurses for multiple nursing licenses. These savings can be reinvested into the health care system and drive down costs for consumers—probably just one reason that chambers of commerce in cities in both Indiana and Kentucky were also partners in Indiana’s obtaining NLC status.

The NLC opens the door to telehealth options: Indiana’s RNs and LPNs nurses who hold a multistate license can provide care over the phone, online, and in person in compact states. A patient with a chronic condition living in a rural part of a state, for example, can receive care from more providers across multiple states without the need to drive for hours each time.

Compact agreements among states is also a boon in time of disaster, so that nurses can help in areas hit by hurricanes or other emergencies that demand an influx of help from outside.

Indeed, the pandemic has brought home the need for collaboration among states to ease the burden on health care providers and patients of states hit hard. NCSBN has posted stories about those states whose compact agreements meant that, when COVID-19 hit, they were ready to work with nurses from other states. Many non-compact states have put into place emergency orders that allow out-of-state providers to administer care. NCSBN has posted the state-by-state response to COVID-19 to better meet workforce shortages.

Harper is grateful for all of the partners who helped make this happen, and thrilled that it’s now law: “Working collaboratively with the Indiana State Board of Nursing/Indiana Professional Licensing Agency, we at the Indiana Center for Nursing and Action Coalition have been extremely supportive of bringing the compact to Indiana. There was so much change that had to take place in the Indiana Professional Licensing Agency to make this work—but we finally made it.”

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Andrea Tanner, MSN, RN, NCSN, is coordinator of health services and a school nurse in Indiana’s New Albany Floyd County School Corporation Health Services and part of the Campaign Outreach Advocates for a Culture of Health program. She received her Bachelor of Science in Nursing from Murray State University and Master of Science in Nursing from the University of Missouri.

Q: Why did you decide to become a nurse?   

A: I always knew that I wanted a career in the health care field, but it took me a bit to find my way. I began my college search believing I wanted to be a medical laboratory scientist. An interview with the director of the program revealed that I was more interested in hands-on care and direct human interaction. I moved toward occupational safety and health, where I realized the only piece of that career path that excited me was occupational nursing. Finally, I landed on the career path that connected with my deep-rooted desire to help others, show others love during difficult times, and support others on a journey to health and wellness.

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

A: In nursing school, I believed that all of the “best” nurses worked in a hospital. The great majority of my clinical work occurred in the hospital setting, where we paid great attention to hands-on skills, medication management, and acute care. I always left these clinical experiences saddened that there wasn’t more time to connect with the patient and build trust that would allow for deeper assessment of the patients’ needs beyond the hospital.

There was one clinical experience where I saw that happen—my clinical experience with a school nurse. From that point forward, I had my heart set on a career as a school nurse. I began to see nurses as change agents that could promote health and wellness and help prevent infectious or preventable diseases outside the walls of a hospital or health care setting.

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

A: I am most proud of the work I am doing to mobilize school nurses to reach the goals set forth by the Robert Wood Johnson Foundation to create a Culture of Health. We are a small but mighty specialized group of nurses uniquely positioned to meet people where they are, bring health care and health promotion to where they are, and turn the health care world upside down. As president-elect of the Indiana Association of School Nurses, I am excited to be a part of an initiative to train school nurses to be leaders in their areas of influence to improve the health of students, families, schools, and communities.

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

A: I would change the misconceptions that hold nurses back from being the leaders and change agents they can be.

I wish I had learned more in nursing school about how to be a leader, not just among other nurses but in the general community and beyond. I also wish I had been a part of an educational program that emphasized interdisciplinary collaboration rather than siloed learning and practice. Many nursing schools are already making great strides toward emphasizing the leadership and intercollaborative spirit of this great profession.

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

A: Nurses need to find what they are passionate about and take ACTION!

For example, for me, I often heard myself saying, “I wish I could take this child home!” This, combined with my family’s core values, led us to become a licensed foster home.

When I felt school nurses were working in isolation in an already isolating field focusing on health goals within the world of education, I decided to invite school nurses from our region to an annual breakfast-and-learn event. We have all been blessed by the resulting connections, shared struggles, and learning opportunities.

When I felt I wanted more from my role as a school nurse, I said “yes” to an opportunity with the National Association of School Nurses that has led to amazing opportunities to promote my profession nationally and internationally. The passion and resulting action has made this ride an amazing one, and it’s not over yet!

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

A: As a connector. As a school nurse, I connect students with free vision and dental care, families with free health services and community resources, and schools with lessons on preventing the spread of disease and promoting health through nutrition, physical activity, and healthy habits. I bring a team of school and community members together as a Wellness Committee to ensure our 12,000 students are the healthiest learners possible. I connect our nation’s school nurses through national presentations and leadership trainings to ensure we are equipped to be the leaders America needs us to be in today’s political and financial healthcare climate.

As a National Association of School Nurses (NASN) Epinephrine Resource school nurse, I also helped NASN, American Academy of Pediatrics, and National Association of School Nurse Consultants together develop a national epinephrine policy and protocol.

And I will always enjoy my nursing role connecting with community members and health professionals to make sure every American has the ability to live the healthiest life possible, no matter their ZIP code, education level, or income.

The post Clinical Experience With School Nurse Was Her Wake-Up Call appeared first on Campaign for Action.

This is the sixth in a series of profiles of leaders who are part of the Campaign talking about their connections to the nursing or health care profession and their interests in healthier communities.

Jessica Gonzalez, MPH, BSN, RN, CLC, is assistant director of prevention and health promotion at the NCAA Sport Science Institute. Gonzalez’s 11-year commitment to health care has improved the lives of under-served communities along the Texas border, vulnerable populations across Indiana, and now college athletes. She works with the Indiana Action Coalition to create a culture of health by advocating for diversity and mentoring, and serves on the board of the Indiana Public Health Association. She earned her Bachelor of Science in Nursing from the University of Texas-Pan American and her Master of Public Health from the Indiana University Richard M. Fairbanks School of Public Health.  Gonzalez is part of the Campaign Outreach Advocates for a Culture of Health program.

Why did you decide to become a nurse?     

During high school, my grandfather was diagnosed with cancer. Seeing the care that the hospice nurses gave him and my family sparked my interest in the field; I wanted to be able to not only help my own family but others. Most recently, I assisted the hospice nurses when my aunt passed away—an experience that made me feel I’ve come full circle.

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

If you had told me during nursing school that I’d be working with collegiate athletes, I would have said, “Really, I can do that?!”  The wonderful thing about nursing is you can work and create a culture of health anywhere.

I’ve had the great experience of dabbling in different specialties such as long-term care, research, and maternal child home visiting, but found my passion in public health nursing. Now, I’m the first nurse to be hired at the NCAA Sport Science Institute, where I work on promoting the health and wellness of about half a million student-athletes in areas such as mental health, substance abuse prevention, sexual violence prevention, sleep, and nutrition. I have so much respect for the skills, discipline, and talents of student-athletes. I’m inspired to keep our next generation healthy for their lives on and off the field. Nursing has given me the opportunity to combine my passions of sports, wellness, and public health.

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

I’m most proud of my journey of being here because it was a fight against the odds.

My grandparents were immigrants from Mexico, and my father was part of the first generation navigating America.  My parents—one a former migrant worker and the other a high school dropout—had me young, and life started in poverty. Tools such as Head Start and the support of my family led me to be a first-generation college graduate, which paved the way for my graduate degree in public health. Mentors provided the opportunities for me to study health care abroad in China and South Africa. I went from a 20-year-old taking her first flight to Washington, D.C., to trips across the globe. My background helped shaped my interest in serving diverse communities and shaped my philosophy of nursing.

In my early years, graduating from college seemed like such a far-fetched dream but wow, never did I think I’d be here.

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

I would rephrase the question and say if I could further advance the field of nursing it would be to continue to change the face of nursing. (I am taking a cue from my colleague, Jake Creviston!)

As America becomes more diverse, so should the field to match the demographics of the patients we serve. Being a bilingual nurse has allowed me to connect with patients, colleagues, and nursing students. But not just diversity of our field but also of the mindset of where nurses can work. If there’s a need for a health solution, nurses can be there at the table! I’d like the mindset to be:

I care because I’m a nurse but also because I’m a member of my community, where I work, live, and play. Because I’m a nurse I can help shape health for this generation and future ones. Because I’m a nurse, I can translate the needs of where I live to those abroad. Because I’m a nurse, I’m here to help.

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

 We have to think outside of our profession and collaborate with other health colleagues and community stakeholders, work with all who care about our patients’ lives. As the largest health profession in the United States, nurses are primed to build interdisciplinary teams.

At the NCAA Sport Science Institute, I work alongside a chief medical officer, an athletic trainer and a health educator to look at improving safety and wellness for college athletes. For instance, when we look at how we can remove the stigma of mental health on campus and within athletics having the expertise of this diverse team helps me think of solutions from different perspectives.  Our team also works collaboratively with public health professionals at the Institute to Promote Athlete Health and Wellness at the University of North Carolina at Greensboro to create educational tools to promote health in student-athletes.

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

I’ve had guidance from mentors who believed and invested their time in me. It was hard to navigate college as a minority, first-generation student and they were my lifelines. To build a healthier America, I am helping create a foundation of future leaders, diverse in their fields and backgrounds. My goals are to continue to seek learning opportunities in public health nursing and mentoring. Through the Future of Nursing: Campaign for Action, I mentor an extraordinary second-career nurse who’s shaping the culture of health in Kentucky. If you get invited to the table, bring someone new with you. As health care changes, we need the skills and assets of our colleagues in and out of the field.

The post First Nurse at NCAA Is “Inspired to Keep Next Generation Healthy” appeared first on Campaign for Action.

• 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.

The post Demographic and Workforce Facts appeared first on Campaign for Action.

INDIANA Nurses on Boards Coalition is part of this effort and is working to develop state-level goals. The Indiana Coalition currently includes the Indiana Center for Nursing/Indiana Action Coalition, Indiana League for Nursing, Indiana State Nurses Association, Black Nurses Association of Indianapolis, Inc., Indiana Organization of Nurse Executives, Indiana Association of Nurse Anesthetists, Indiana Association of Hispanic Nurses, Indiana Association of Nursing Students and Sigma Theta Tau International. Additional members will be added to mirror organizations that join the national coalition.

We encourage everyone to visit Nurses on Boards Coalition. Sign up to be counted for serving on a board or to show your willingness to have a seat at the decision-making table. When nurses lead, everyone wins!

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