In This Issue:

New Jersey Playing a Leading Role in National Nursing Campaign
Leader’s Column – Nurses Are Ground Zero for Quality and Safety
New Jersey Hospital Teams Up with Local Nursing Schools to Solve Nurse Faculty Shortage

New Jersey Playing a Leading Role in National Nursing Campaign

Inaugural meeting of New Jersey Regional Action Coalition provides roadmap for state efforts
Nursing in America is in the midst of a major transformation, and New Jersey has a leadership role.
The New Jersey Nursing Initiative (NJNI) kicked off 2011 by co-hosting a meeting of diverse health care stakeholders from across the state. These leaders will help implement an unprecedented and ambitious initiative to use all the skills, talents, knowledge and experience of nurses to meet the increased demand for health care. The meeting is part of the NJNI’s work as a leader of the New Jersey Regional Action Coalition (RAC) for the Robert Wood Johnson Foundation’s (RWJF) Future of Nursing: Campaign for Action.
In November, RWJF announced that the Campaign would work closely with five states to initiate implementation measures that can be successfully emulated in other parts of the country. New Jersey is one of those five states, and NJNI and the New Jersey Chamber of Commerce Foundation are working together to lead a long-term coalition that will be part of the national effort to advance key nursing-related issues .
In January 2011, the members of the New Jersey RAC met in Princeton to begin the important work of identifying measures to implement. The meeting was led by David Knowlton, president and CEO of the New Jersey Health Care Quality Institute and former deputy commissioner of the New Jersey Department of Health, NJNI National Advisory Committee Chair Mary Ann Christopher, M.S.N., R.N., F.A.A.N, and Edna Cadmus, Ph.D., R.N., N.E.A.-B.C., clinical professor and director of the DNP Program of the Leadership Track at Rutgers University.
Attendees included diverse stakeholders from across the state, including representatives from
AARP New Jersey, Hotel and Restaurant International Union Welfare Fund, New Jersey Assembly Health and Senior Services Committee, New Jersey Association of Health Plans, New Jersey Collaborating Center for Nursing, New Jersey State Council of Carpenters, New Jersey State Nursing Association, Robert Wood Johnson Medical School, St. Francis Medical Center, Rutgers, State Employment and Training Commission, the Visiting Nurse Association of Central Jersey and many others.
Knowlton outlined the key messages from The Future of Nursing: Leading Change, Advancing Health, a report from the Institute of Medicine that is driving the Campaign:
  • Nurses should practice to the full extent of their education and training;
  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression;
  • Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the U.S.; and
  • Effective workforce planning and policy-making require better data collection and an improved information infrastructure.
He asked the group to develop two measures for each message that could be implemented in New Jersey within the next nine months.
NJNI Director Susan Bakewell-Sachs, Ph.D., R.N., P.N.P.-B.C., Chamber of Commerce Foundation President Dana Egreczky and Mary Ann Christopher provided guidance, suggesting that the group consider the health care workforce and education environment in the state as they proceeded.
Edna Cadmus outlined some underlying goals of this work. “On our side, we’ll be working to be sure we meet the needs of the citizens of New Jersey,” she said. “We need to work collaboratively and the effort must be interdisciplinary. We should look at the models that exist and see if there are ways to bring them into New Jersey.”
Knowlton led the group in a brainstorming discussion which yielded the following ideas for measures to implement:
  • Collect information on what advanced practice nurses in a variety of specialties are legally allowed to do in the state, as well as the applicable regulations and laws governing their work. Identify the impact of those limitations on the state’s ability to provide access to health care and share that information with health care facilities.
  • Identify demonstrations of collaborative models, including Accountable Care Organizations, patient-centered medical homes, and clinics.
  • Work with New Jersey hospitals and nursing schools to develop a system similar to the American Association of Colleges of Nursing’s model for nursing residency programs that include academic credits. 
  • Identify best practice models of degree articulations (such as ASN to BSN shared curriculum and simultaneous enrollment, e.g. Oregon Model).
  • Join the RWJF Nurse Leaders in the Boardroom program to support current and emerging nursing leaders in New Jersey.
  • Encourage the Governor to name nurses to two cabinet or subcabinet positions.
  • Establish a functional database of information about the health care workforce in New Jersey.
  • Develop a program to conduct outreach to New Jersey high schools to educate students about careers in health care and the education they need to pursue them.
As the meeting drew to a close, participants were asked to complete forms indicating which areas they would like to work on over the next nine months.

Leader’s Column – Nurses Are Ground Zero for Quality and Safety

Mar 15, 2011
By David Knowlton, President & CEO, New Jersey Health Care Quality Institute; former Deputy Commissioner, New Jersey Department of Health, Co-Chair of New Jersey Regional Action Committee
The great thing about my job as President and CEO of the New Jersey Health Care Quality Institute is that everyone in the world of healthcare agrees that quality and patient safety are the top goals for our health care system. And having worked alongside nurses since the earliest days of my career, I can say without reservation that they are our most important allies in this work as they are at “ground zero” when it comes to quality and safety.
Our mission at the New Jersey Health Care Quality Institute has always been to take on projects that will ensure that quality, accountability and cost containment are all closely linked to the delivery of health care services. We understand that one of the best ways to strengthen the quality and safety of our health care system is to make sure that nurses are an integral part of the system, from the delivery of care to decision-making and everything in between.
Squandering Manpower
In today’s challenging climate, we do not have the luxury of squandering limited resources. In no arena is that more true than in making sure that the right person is doing the right job. As the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health, notes, in order to transform our health care system, we must ensure that nurses can work to the full extent of their training and education.
The time has come for the value of nurses to shine beyond hospital walls and physician offices. We want nurses to use the full extent of their skills and training, to get to the highest level of education and training available, and to work as real partners with physicians and hospitals. Our vision is to see more nurses in the boardroom, in state government and even legislating in the halls of Congress.
Fully Integrating Nurses
In many respects, nurses are the “missing link” to health care reform. Without their crucial knowledge on quality and safety, any reform effort will fail to achieve our goals of greater access, improved quality and reduced costs. The only way we can hope to see a difference is to make sure that nurses have a seat at the table. We can do this with your help.
New Jersey today finds itself in the exciting position of being a hub of activity for health care reform. I feel passionately about quality and safety in health care and have long been an enthusiastic advocate for nurses. I was delighted to recently be named a co-chair of New Jersey’s newly-formed Regional Action Committee (RAC), which provides me the opportunity to give back and a platform for something I strongly believe in. [For more on the RAC read: New Jersey Playing a Leading Role in National Nursing Campaign].
Fully integrating nurses in the health care system is something from which everyone would benefit, but experience tells us we cannot do this alone. With the RAC, we hope to start a conversation among new, diverse and influential groups including the Chambers of Commerce, municipal planning commissions, policy-makers and others. Our work is only just beginning.
The future of nursing starts now, and New Jersey is proud to be leading the way.

New Jersey Hospital Teams Up with Local Nursing Schools to Solve Nurse Faculty Shortage

Atlanticare sends its clinical nurses to fill vacancies at local nursing schools and benefits from a larger pool of better-prepared nursing graduates.
One way to improve the health care system of the future is to look to the past.
That, at least, is the view of Robyn Begley, D.N.P, R.N., N.E.A.-B.C., a nurse executive who works with the New Jersey Nursing Initiative (NJNI) to help ensure that New Jersey has the well-prepared, diverse nurse faculty it needs to educate nurses to meet the demand for health and health care in the 21st century.
One key way to do that, according to Begley, chief nursing officer at Atlanticare, a magnet-designated hospital in southeastern New Jersey that won the Malcolm Baldrige National Quality Award in 2009, is to strengthen the link between nurse education programs and area hospitals.
In the past, most nurse training programs were run by hospitals, but these so-called diploma programs receded in recent decades as academic institutions took over the responsibility of educating aspiring nurses. But, Begley says, nurses and the patients they serve would benefit from stronger ties between the institutions where nursing is taught and where it is practiced.
“We learn from history,” Begley says. “There are some really good components of nurse education programs of the past that we want to use in the future.”
One key way to do that is through the kind of joint appointment faculty system put in place by Begley and partners at nearby nursing programs. Under the joint appointment system, clinical nurses with master’s degrees at Atlanticare spend part of their workweeks teaching nursing students at the Richard Stockton College of New Jersey and at the Atlantic Cape Community College (ACCC).
Although joint appointment faculty systems are not new, the partnership between Atlanticare, Stockton and ACCC is unique because, unlike other partnerships between universities and their affiliate hospitals, this system is bringing separate entities together, according to Brenda Stevenson Marshall, Ph.D., M.P.H, M.A.E, the dean of health sciences at Stockton.
“We’ve created a new model that can be replicated by other organizations,” she said. “We’re taking two separate entities and joining them together. It’s extremely useful for anyone else trying to do this.”
The system is a major plus for all involved, Begley, Stevenson Marshall, and others say.
To start, more instructors enable nurse education programs to fill vacancies caused by a severe shortage of nurse faculty and then to accept more nursing students. That helps ensure that the nursing workforce of the future will be prepared to meet the growing demand for health care in New Jersey and across the country.
For their part, nursing students benefit from instruction from practicing nurses who are able to share clinical knowledge and real-world patient experiences with students in health care systems they know well. They may also be more likely to consider teaching in the future, Stevenson Marshall said. “If they see academics going to the clinical setting, and vice versa, they will be much more amenable to that sort of model in future,” she said. “That will help alleviate the severe shortage of qualified academics in the future.”
At the same time, the system allows clinical nurses to step back from clinical jobs and explore opportunities in nursing research and education. “The joint appointment opens up a world to clinical nurses that they didn’t realize was there,” said CheryleEisele, Ed.D., R.N., A.P.N., B.C., program coordinator of the B.S.N. program at Stockton. “It sparks an interest that they carry on.”
Indeed, several clinical nurses who have participated in the joint appointment system at Stockton have gone back to school in preparation to teach full-time, Eisele said.
Last, but certainly not least, hospitals and health care organizations benefit from a larger supply of better-trained nurses and from stronger ties with academic institutions that help ensure that nursing practice is continuously informed by cutting-edge scientific research. And that, in turn, helps hospitals get and keep magnet status, according to Michelle Sabatini, R.N., Ph.D., A.P.Nc., graduate director of M.S.N. programs and assistant professor of nursing at Stockton. “It’s extremely beneficial.”
Barriers to Joint Faculty Appointment Programs Not Insurmountable
Setting up such a program is not without its challenges.
To establish the appointment system, Atlanticare officials, for example, provided clinical nurses with refresher courses to ensure they understood current teaching methodologies; subsidized clinical nurse salaries to make up for lower pay rates for instructors; and made room in nursing schedules to allow nurses to leave the bedside and go to the classroom.
“There are barriers,” Stevenson Marshall said. “But we didn’t find any that were insurmountable.”
Supportive administrators at health care organizations and educational institutions are also critical, Begley and Stevenson Marshall said.
The seeds of this particular joint faculty appointment program were planted a decade ago when Begley, a veteran nurse executive and past president of the Organization of Nurse Executives of New Jersey, was working with the local associate degree nursing program to increase the number of nursing students in anticipation of an impending regional nursing shortage.
Begley began to explore joint faculty appointment system models as a way to stem the nurse faculty shortage in order to produce more graduate nurses. Soon after, Begley approached nursing schools in the area and offered to “share” Atlanticare nurses with schools on an interim basis. Now, Begley and her partners are working to formalize and expand the program.
“The thought of expansion is exciting,” Stevenson Marshall said. “It’s a win-win all the way around.”