Testimony of Risa Lavizzo-Mourey
President and CEO, Robert Wood Johnson Foundation
Before the Senate Health, Human Services and Senior Citizens Committee
New Jersey State Legislature, Trenton, New Jersey

Thank you, Chairman Vitale, Vice Chair Weinberg, Senators Singer and Kean. And thanks to all your colleagues for joining us at this timely and important hearing on nursing workforce issues in New Jersey.
I am Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. We are the largest philanthropy based in New Jersey and the largest philanthropy in the nation devoted exclusively to improving the health and health care of all Americans. Assuring that everyone in America has stable, affordable health care coverage is a key part of our mission, and we recognize that nurses are absolutely critical to providing the high-quality, patient-centered care we all deserve.
As you know, we are based here in New Jersey and have a special commitment to our home state. We are proud to support more than 150 programs right here: they include programs to increase the quality of cardiac care in hospitals; efforts to improve children’s health and development in Trenton; and planned initiatives to work with schools and communities to reverse the epidemic of childhood obesity.   
Since our inception in 1972, we have had a deep, long-term commitment to nursing. Through our programs, we have worked to strengthen the nursing workforce; apply nurses’ knowledge to health and health care challenges; and advance nurses as leaders, so they can inform policy and practice. In one of many examples, in the late 1980s when most of the nation’s hospitals were struggling with a nursing shortage, we focused on an important underlying problem – the working conditions of hospital nurses. Our initiatives aimed to improve the work environment in order to keep nurses on the job, and enable them to give their best to patients. 
We continue our efforts to tackle the multiple challenges facing the nursing profession. We understand that a strategic approach and a long view are essential to solving the nursing workforce shortage and other problems, which threaten to undermine the availability and quality of care here and across the nation.
Before I came to the Foundation, during my years in academic medicine, I made house calls with a nurse practitioner and developed a deep appreciation for nurses as partners in patient care and community health. Today I continue to practice part-time at a community health center, the Chandler Clinic in New Brunswick. At Chandler, and throughout my career, I have seen first-hand the vital role nurses play in delivering health care. Nurses care for patients with skill and compassion—and they do much more, beyond the bedside. There is significant evidence to document how nurses bring powerful insights to today’s health challenges, such as lack of access to insurance, rising costs, health disparities as well as patient safety and quality of care. 
That is why the Robert Wood Johnson Foundation places such a high priority on nursing. But as we look at the field, we see a problem—no, make that a real crisis, in real time: a significant mismatch between the nursing workforce that’s in place and in the pipeline, and the growing health care needs of our state and our nation.
Just as baby boomers are aging, developing more chronic conditions that will cause their health care needs to grow dramatically, the nursing workforce we need to deliver their care is shrinking. A large percentage of the nursing workforce is nearing retirement, and when these nurses leave their jobs, they will take decades of wisdom and skill with them. These seasoned nurses don’t have a chance to transfer their knowledge to the next generation, because there are not enough younger, up-and-coming nurses to take their place. One key reason is that there aren’t sufficient faculty at nursing schools to prepare a generation of young people who want to become nurses. 
If we don’t solve this problem, there is no question that patient care—and patients—will suffer.
Right now, we’re caught in a conundrum: the economic downturn is making the nursing shortage appear less pressing. But it isn’t. Let me explain. Some hospitals are laying off workers or closing their doors, which eliminates nursing jobs. At the same time, more older nurses are postponing retirement—or even coming out of retirement to return to work—often because their spouses lost jobs or their retirement savings collapsed. As a result, we are actually seeing a temporary increase of the ranks of nurses, and a decline in nursing vacancies.
So why are we here today? Because there is a real danger that the short-term easing of the nursing shortage in some communities will create the false impression that we’ve found a solution to the more serious nursing shortage that lies ahead. We have not. Layoffs and older nurses staying in or returning to the workforce postpone but do not fix the problem. Unless we act now, New Jersey, along with the rest of this nation, is heading for a nursing catastrophe that will affect us all.
We ignore the looming nursing crisis at our peril. It would be nothing less than reckless to avert our eyes and pretend the problem has gone away. The quality of health care for patients in this state and throughout the U.S. will suffer if we don’t address it.
The data paint a grim picture. A new report from the New Jersey Collaborating Center for Nursing at Rutgers finds that the “average” registered nurse in this state is a 50-year-old woman who works more than ten hours a day. More than half of New Jersey’s RNs (54.4 percent) are between the ages of 46 and 60. This means that nearly a third of the state’s nursing workforce will reach retirement age in the next decade.
The report also states that New Jersey nursing schools cannot help close the gap, because they do not have enough faculty to train the next generation of nurses.
As the effects of the recession wear off, this stark demographic reality will set in and demonstrate clearly that New Jersey will need more—not fewer—nurses in coming years. By 2025, the number of New Jersey residents who are 65 and older will increase by 39 percent. That will mean one in seven state residents will be a senior citizen. As a geriatrician, I’m especially mindful of the increased health care needs of this population.
We need solutions now. Solutions begin with putting more faculty in place to prepare the next generation of nurses.
So it is my great pleasure to announce an exciting new program that has the potential to transform the nursing workforce in this state: the New Jersey Nursing Initiative. The Initiative’s tagline is: “So a Nurse Will Be There for You.” That is our goal, to transform nursing education in the state so we will have the well prepared, diverse nursing faculty needed to educate nurses to meet the looming demand for nursing care.
This is a major initiative for the Robert Wood Johnson Foundation—a five-year, $22 million investment. We are particularly proud that our partner is the New Jersey Chamber of Commerce, which recognizes that the state’s businesses and its economy can only thrive if our health care system works, and that nurses are the beating heart of that system.
The New Jersey Nursing Initiative is led by Susan Bakewell-Sachs, Dean and Professor of Nursing at the School of Nursing, Health and Exercise Science, the College of New Jersey. Dean Bakewell-Sachs has been a perinatal nurse for 30 years, and has taught at the baccalaureate and masters’ degree levels. She will describe the initiative in detail and you will hear from her shortly. 
The New Jersey Nursing Initiative is informed by an expert National Advisory Committee. Many of its members are here today. They include some of the best minds on health care and public policy in the nation. Our National Advisory Committee is led by Mary Ann Christopher, President and Chief Executive Officer of Visiting Nurse Association of Central Jersey, and our moderator this morning. I’d like to recognize the National Advisory Committee members who are seated in the first row.
We expect the New Jersey Nursing Initiative to be part of the solution to the nursing workforce challenges facing this state. We expect to make New Jersey a nursing model and a leader for the nation. We aim to ensure that in this state a nurse will be there for you. Nurses protect our health, save lives and reduce health care costs. Substantive research bears this out. A compelling report by the Institute of Medicine found that nurses are the health care professionals most likely to intercept medical errors, which cost hospitals over $3 billion annually (IOM, Keeping Patients Safe, 2004).
As a Foundation, we see our role as taking a long view and helping address and solve problems that lie ahead. I know your responsibility as lawmakers is to do the same. Thank you for your time this morning, and I am gratified to know that you take seriously the nurse and nurse faculty shortages in our state. We would like to come back to update you on nursing issues in our state, and to provide a progress report on the work of the New Jersey Nursing Initiative.
At the Robert Wood Johnson Foundation, we consider solving nursing workforce issues to be an essential part of our mandate to improve health care. Without enough nurse faculty to prepare the next generation of nurses, no health reform plan—state or nationwide—can be fully effective, because patients will go without the care they need and our state will struggle to thrive, be healthy and prosper. We can—and must—do better. Thank you.