New York’s more than 20 million residents will now have direct access to primary health care from nurse practitioners. On April 9, Gov. Kathy Hochul signed the state budget into law, and it included a provision that secured improved health care access for residents in the state.

“Full practice authority for advanced practice registered nurses will provide safe care, expand access to rural and medically underserved areas, reduce wait and travel times, and control healthcare costs, as decades of research and overwhelming evidence suggests,” said Beth Finkel, state director of AARP New York, which worked for years to achieve full practice authority.

“Advanced practice registered nurses provide the type of care, care coordination, and links to community resources that patients and family caregivers need to effectively manage chronic conditions. Full practice authority is an important step in AARP New York’s ongoing efforts to disrupt disparities impacting our rural areas and communities of color,” Finkel added.

New York, the fourth most populous state, joins 24 states and the District of Columbia in recognizing nurse practitioners’ full practice authority. This is the culmination, as we reported in 2020, of New York being one of many states that waived laws limiting access to health care as a result of the COVID-19 pandemic.

“New York has taken a critical step forward in our country, increasing access to vital health care services,” said April N. Kapu, DNP, FAANP, FAAN, president of the American Association of Nurse Practitioners. “New Yorkers will now have full and direct access to the comprehensive care NPs provide.”

Since the Future of Nursing: Campaign for Action began, 12 states have increased consumers’ access to care by removing legal barriers that prevented nurse practitioners from providing care to the full extent of their education and training. More than 91 million* people in 25 states and the District of Columbia now have direct access to nurse practitioners who can provide care.

*Source: Annual Estimates of the Resident Population for the United States, Regions, States, District of Columbia, and Puerto Rico: April 1, 2020 to July 1, 2021 (NST-EST2021-POP), U.S. Census Bureau, Population Division.

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This is the 16th in a series of profiles of Campaign leaders talking about their connections to the nursing or health care profession and their interests in healthier communities.

Lucia Alfano, RN, MA, is a public health expert with a focus on diversity, nursing leadership, mentoring, and building cross-sector partnerships. Alfano was assistant professor of nursing at Concordia College, N.Y., before leaving to pursue her doctorate at Columbia University. She is founding president of the National Association of Hispanic Nurses Westchester chapter and has been a member of the Campaign for Action’s New York State Action Coalition since 2013. She is a 2015 Campaign Breakthrough Leader in Nursing as well as a Campaign Outreach Advocate for a Culture of Health, or COACH.

Why did you decide to become a nurse?  

I became a nurse by accident. At 18 years old, with little direction and not much support, I did not know where I would end up or what I wanted to be when I grew up. A friend told me she was attending nursing school and that I should apply—so I did. Not realizing the immense challenge this entailed, I dove right in and began my journey as a dedicated learner and soon after as a nurse.

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

When I entered community college, I had to take remedial courses for a year before I could take the core courses for the nursing program. I spent countless hours and days in the tutoring center and in library. I became a lover of learning—in fact, 20 years later, I am still in school.

When I began the nursing courses, I knew that I was born to care for people. That applied not just to the patient during clinical rotation, but also for my peer who needed to understand the lecture; a junior student who needed mentoring; and even alumni who wanted to come back and help the seniors in the program. There seemed to be a lot to do and I was in the midst of it all. I became president of the student nurses association and then founded the first-of-its kind mentoring/tutoring program. This was essential for our success as nurses, and it proved to help many nursing students succeed. At this time, I was dubbed “the teacher” because I loved to reteach the lecture and create notes to share, with colorful details. I loved helping others excel, learn, rejuvenate to improved health, and thrive.

Today, I continue to be this teacher, avid learner, and willing to build or conceptualize something that will help people rise. This is my philosophy, to help as many people rise to their greatest potential—weather it be via health, education, mentoring, friendship, policy change, advocating, or picketing—an advocate and an activist by nature for all people in need.

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

I am most proud of where I am today—in a doctoral program at an Ivy League school, living my dream to be pursuing my doctorate.

I am also very proud of the founding of the National Association of Hispanic Nurses in Westchester County, which has served thousands of community members and professional nurses in a positive and uplifting way.

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

I aim to change the way nurses are educated. My vision is to create interprofessional education models that will help nurses become effective team members immediately after graduation. Nursing education is lagging in innovative strategies and modalities. We need to update curricula.

We also need to give more opportunities and support to people of diverse backgrounds. Less than 1 percent of nursing faculty is Hispanic, yet we are the largest population in our nation. We need to encourage more nurses from diverse backgrounds to pursue academia. Our students thrive when they can see educators who look like them.

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

Nurses need to stand forward in advocacy in their communities, professional organizations, and in policy and politics. Their voices need to be heard and their presence felt in decision-making arenas. Nurses have the potential of becoming influential in changing laws and policy by presenting their specialties, their research, their experience. Nurses are diverse, caring, smart—there is nothing we can’t do. We must be present. We must vote. We must run for office. We must educate and mentor the incoming generation. Each one must teach one. Don’t let others fail because of lack of support and resources—let’s stand together in seeing this does not happen.

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

As an educator with a doctoral degree, I want to be at the helm of decision-making for nursing education. I want to work with community, government, and academia in order to improve curricula around the nation. The foundation of how nurses are educated needs to be updated and revolutionized. I plan to be leading these conversations and building models and integrating them in universities and colleges—so that they can lead the way in educating nurses for generations to come.

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Approach: A survey was conducted at the New York State Action Coalition’s booth at the Great New York State Fair. This anonymous survey assessed two domains: individual health behaviors and activities of community engagement. Discussions regarding the role of nursing and health were ongoing between fair goers and the volunteer nurses who staffed the booth during 12 days of August/September 2016.   The survey findings represent a convenience sample of 326 adults with nurses representing 33.4% of participants.  Survey participants identified as White (86.2%), Black (8.6%), Hispanic (3.1%), Native American (3.4%), and Asian (2.2%). Nearly 80% of the participants identified as female and 47.5% indicated at least a Bachelor’s degree or higher education.

Products/Outcome: Nurses are more likely to participate in healthy behaviors and community engagement activities as compared to other survey participants.  Most survey participants, including nurses, do not eat the recommended amount of 5 cups of fruits and vegetables per day, nor sleep the recommended 7 to 8 hours per night.  Only 20% of the nurse survey participants strongly agree their life is in balance. Contribution of time or money to a health-related organization is the most common community engagement activity for all survey participants.

Implications: Nurses have opportunities to build a Culture of Health through personal and professional activities, collaborations with community stakeholders, and community engagement. The findings of this survey suggest areas to improve individual and community health.  The survey also reveals a need to reach a more diverse audience.

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Since 2011, the New York State Action Coalition has gone to the fair, staking out a place in the science and industry building to recruit would-be nurses and educate everyone about nurses and well-being.

More than 2,500 fairgoers stopped by the booth this year, say Maria MacPherson, RN, MPH, a practicing public health nurse in Syracuse who was selected by the Robert Wood Johnson Foundation to be part of its Public Health Nurse Leader program; and Deborah Elliott, RN, BSN, MBA, executive director of the Center for Nursing. To show fairgoers how nurses promote healthy lives—this year’s theme—and get their thoughts on health, the nurses had two blunt instruments: For the children, crayons. For the parents, grandparents, and the general public, a survey.

“Would you like to draw a picture of what you do to stay healthy?”

Yes, said children (and teens!), who immediately took crayons to the blank paper that covered the tables to draw images of fruits, vegetables, water, and people jogging. Often the children seemed more attuned to what good health demands than the adults, some of whom were reluctant to complete a survey—even one that allowed people to stay anonymous and took five to 10 minutes to fill out—that asked about their own healthy behaviors. But others were eager; in all, 326 filled out the form, which was offered on tablets and a QR app that let people respond on their smartphones.

The booth was staffed by six to eight a nurses a day—100 volunteers altogether—who had plenty of healthy food for thought for fairgoers not taking the survey. In a split second, nurses could use the County Health Rankings & Roadmaps to show someone exactly how his or her county ranks on measures such as smoking, physical activity, even sleep habits.

Volunteers also had time to talk about the many ways in which nurses are integral to the health care system, a conversation that lots of people careening between carnival rides and concerts probably did not expect to have.

It was unexpected fun for the volunteers, too, who included student nurses and those from agencies such as the Visiting Nurse Association. Trudy Hutchinson, a registered nurse who is part of the New York State Action Coalition, told of a mother and daughter who came to the booth in particularly good moods. The mother explained: “I have been a nurse for many years and love my work on ortho. Now my daughter has just been accepted to a nursing program.” Not just any program—her daughter was just about to start the dual degree partnership in nursing program between LeMoyne College and St. Joseph’s College of Nursing. The daughter said, “I’m excited and anxious at the same time.”

Meeting people where they are is wonderful, says Elliott, because the surroundings are wholly different from the typical nurse-meets-patient scene. The booth was a place for easy conversations about healthy behaviors and healthy communities. As nurses handed out fans and rubber bracelets (“caring+passion=nursing” was a favorite), they talked to people of all ages about careers in nursing; posters showed doing their jobs in all sorts of settings, including businesses, camps, schools, and the Armed Forces.

The fair isn’t over for Elliott and MacPherson, who are eager to delve into findings from the survey. With more than 300 responses, they hope they’ll get at least a broad idea of what the needs are in New York, as well as the good activities that can be tried elsewhere. They will be looking for overlap in behaviors, and opportunities to tie in the findings with actions the Future of Nursing New York State Action Coalition (NYSAC) can take to build healthier communities throughout the state. It’s a big charge for a big area: NYSAC has seven regional offices, all with various interventions to advance the nursing profession so that that New Yorkers can count on being able to see a nurse when and where they need to.

For more information about NYSAC and nursing in the state of New York, visit www.fnysn.org.

Top photo: Two young girls drawing pictures of what they do to stay healthy. 

Bottom photo: Booth volunteers Carol Braund, David Cadet, Deb Elliott, Maria MacPherson, and Trudy Hutchinson.

The post New York Nurses Go to the Fair 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.

Since nurses know the patients more, on a day-to-day basis when they are hospitalized, they know what works and doesn’t work for the patients. By sharing this information with the providers, the nurses and health care providers can come with the s suitable plan that actually works for this particular patient.

“The concept of collaboration is commonly defined through five underlying concepts: sharing, partnership, power, interdependency and process” (D’Amour, 2005). The idea of sharing and implies collective action oriented toward a common goal, in this case, improving the quality and safety of patient care.  The notion of the partnership implies to the honest communication, mutual trust, respect and pursuing the common set of goals between the health care professionals, especially the between the nurses and physicians. And so on, all these concepts of collaboration must take place for an effective collaboration to take place. (D’Amour, 2005).

By trusting one another, respecting and working together for a common goal, interprofessional collaboration can easily be achieved in healthcare. This collaboration does help to improve patient care and safety and even implement plan of care and discharge plan. Not only it improves the quality of care, it can reduces costs, especially those associated with re-hospitalization.

References

D’Amour, D., Ferrada-Videla, M., Rodriguez, L., & Beaulieu, M. (2005). The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. Journal Of Interprofessional Care, 19116-131.

The post Fostering Interprofessional Collaboration in Health Care appeared first on Campaign for Action.

Since nurses know the patients more, on a daily-day basis when they are hospitalized, they know what works and doesn’t work for the patients. By sharing this information with the providers, the nurses and health care providers can come with the s suitable plan that actually works for this particular patient.

“The concept of collaboration is commonly defined through five underlying concepts: sharing, partnership, power, interdependency and process” (D’Amour, 2005). The idea of sharing and implies collective action oriented toward a common goal, in this case, improving the quality and safety of patient care.  The notion of the partnership implies to the honest communication, mutual trust, respect and pursuing the common set of goals between the health care professionals, especially the between the nurses and physicians. And so on, all these concepts of collaboration must take place for an effective collaboration to take place. (D’Amour, 2005).

By trusting one another, respecting and working together for a common goal, interprofessional collaboration can easily be achieved in healthcare. This collaboration does help to improve patient care and safety and even implement plan of care and discharge plan. Not only it improves the quality of care, it can reduces costs, especially those associated with re-hospitalization.

References

D’Amour, D., Ferrada-Videla, M., Rodriguez, L., & Beaulieu, M. (2005). The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. Journal Of Interprofessional Care, 19116-131.

The post Fostering Interprofessional Collaboration in Health Care appeared first on Campaign for Action.

Many registered nurses (RNs) start—and finish—their post-secondary education with an associate degree in nursing (ADN). But health care experts want more nurses to see the ADN as a first step on a career-long educational journey.

“Our goal is to improve health and health care for all Americans,” said Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF). “One key way to do that is to build a more highly educated nursing workforce.”

That is what RWJF and AARP are doing through the Future of Nursing: Campaign for Action, a nationwide effort to ensure that nurses are essential partners in providing care and promoting health. It is rooted in a 2010 report by the Institute of Medicine (IOM), which recommended that 80 percent of nurses hold bachelor of science in nursing (BSN) degrees or higher by the year 2020, and that the country double the number of nurses holding doctorates.

The IOM report recognized that ADN-prepared nurses are essential to the delivery of health care and that the community colleges that offer ADN programs play a critical role in preparing and diversifying the nursing workforce. But more highly educated nurses are needed to provide more highly skilled care to an aging and more complex patient population, it said. Additionally, more nurses are needed to fill faculty positions and advanced practice roles such as nurse practitioners, nurse midwives, and nurse anesthetists. Having a large enough pool of nurses to draw from for these faculty and advanced practice roles will require that more nurses have a BSN from the onset.

BSN-prepared nurses, in fact, are associated with improved patient outcomes, according to Linda Aiken, PhD, RN, FAAN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. In a study published this past February in the Lancet, Aiken found that hospitals that employ larger numbers of BSN-prepared nurses have lower patient mortality rates.

The Campaign for Action offers strategies to make it easier for nurses to get BSN degrees or higher, including RN-to-BSN degree programs offered at community colleges; state or regionally shared curricula among universities and community colleges; accelerated RN-to-MSN programs; and partnerships that enable students to transition seamlessly from an ADN to a BSN program.

Success Stories

Successes are popping up all over the country. The University of Texas at Arlington College of Nursing, for example, has partnered with Academic Partnerships, a global higher-education service provider, to offer an innovative online RN-to-BSN program. Under the program, students are admitted eight times a year, courses are delivered online in five-week blocks, and academic coaches support the course instructor and help keep students on time and on target.

The program has exceeded expectations, said Beth Mancini, PhD, RN, FAAN, professor and associate dean of undergraduate nursing at the University of Texas at Arlington and a member of the Texas Action Coalition. Enrollment in the RN-to-BSN program has grown exponentially—from fewer than 150 students in 2008 to about 8,000 this spring. The graduation rate is approximately 90 percent, and the student body is more diverse because of the accessible and affordable nature of the program, Mancini said.

In addition, Academic Partnerships has provided the Texas Action Coalition with funds for scholarships to be awarded to minority students entering BSN-completion programs. These scholarships, along with individuals who volunteer as mentors, are part of the Texas Action Coalition’s plan to increase minority participation in BSN-completion programs.

“We knew that there were many nurses in Texas and throughout the country who needed accessible and affordable programs to complete their BSNs and hopefully go on to MSNs or doctorates,” Mancini said. “They couldn’t do it the way most programs were designed, so we developed a program that would work for them.”

In Wyoming, meanwhile, nurse leaders are implementing a common, competency-based, statewide curriculum that enables nursing students to start at a state community college or at the University of Wyoming and continue, seamlessly, toward a BSN or higher. The initiative, called ReNEW—an acronym for Revolutionizing Nursing Education in Wyoming—is supported by an RWJF State Implementation Program grant.

And in New York, nurse educators at the City University of New York (CUNY) launched an initiative in 2008 to enable students to progress seamlessly from ADN to BSN programs within the CUNY system. Currently, there are two programs up and running, and the first students are graduating this spring from Hunter College.

The academic journey has been “much smoother for the students” because of the initiative, said Maureen Wallace, EdD, RN, a faculty fellow with the Office of the University Dean for Health and Human Services at CUNY. The initiative has also led to the inauguration of a new online RN-to-BSN program and the creation of a faculty council that is exploring standardized admissions policies and curricula across all ADN programs in the CUNY system, Wallace said.

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