Minnesota Action Coalition: Support for the new health care delivery models

Sally Buck, Associate Director

Last fall I was asked to join the Minnesota Action Coalition and while the title wasn’t specific to the type of action, I gathered that it would be focused on nursing as the recommendation came from one of The Center’s Board Officers the Dean of Nursing at The College of St. Scholastica. As I reviewed the materials, I discovered that the Action Coalition was developed to effect long-term changes to meet the Institute of Medicine (IOM) 2010 Recommendations on the Future of Nursing. The goal of the report is to “transform the nursing field to prepare nurses to lead change and advance health for all Americans.” The Action Coalition in Minnesota is just one of forty-eight nationwide and supported by the Robert Wood Johnson Foundation (RWJF) in cooperation with the American Association of Retired Persons (AARP) and the AARP Foundation. This partnership of a leading health foundation and AARP was surprising to me at first; however, I quickly realized, it was highly strategic union. The AARP brought strong technical assistance in advocacy and policy development to the state coalitions and RWJF is supporting the technical assistance instead of providing grant funds to the Action Coalitions.

The Future of Nursing Campaign for Action, which supports the Action Coalitions, is designed to transform the nation’s health care system so that all Americans have access to high quality, patient centered care where they live, work, learn and play across the lifespan. The Action Coalitions have committed to develop and implement specific strategies to address the IOM recommendations. These are not short term efforts such as increasing nursing class size through scholarships. The strategies need to address: scope of practice; higher levels of education and academic progression; leadership in the redesign of the healthcare system; and, workforce planning and policy making through data and information. Any of these areas alone would entail a challenge to states let alone tackling all four through curriculum changes, program development, licensing issues, technology and communication. Therefore the Coalition representatives are diverse and include nursing education (community college, private college and university based programs), the hospital association, board of nursing, aging services association, and rural health.

This initiative is timely with the movement towards new health care delivery models within health care reform such as health care homes and accountable care organizations. AARP and RWJF were wise to focus on nursing to impact change in health care. Nurses encompass the greatest number of health care professions certainly in acute, public and long term care settings and as such they are the face of health care to Americans. In rural communities, with workforce shortages and the small staff size, it is imperative that nurses are able to practice to the extent of their education, have access to nursing education, and be prepared for leadership. Health professionals in small rural health care facilities are largely focused on primary care and practice without a fleet of medical residents and specialized advanced practice nurses and physicians, yet they are caring for the oldest and therefore the sickest patients as well as those with barriers to access such as culture, income, transportation, or language. In addition, many hospitals are staffed with nurses who are prepared at the associate degree level. As urban hospitals add access to baccalaureate education, rural hospitals needs the same access.

From my perspective, our Minnesota Action Coalition, although committed to the strategies including enhanced curriculum to increase the proportion of baccalaureate prepared registered nurses, has stumbled over governance structure and decision making. This stems from a lack of communication and leadership issues. Gaining consensus among nursing leaders is no small feat between an academic health center, state universities, private colleges and community colleges.  In order to establish a unified message, we need to build trust, support ongoing and open communication and focus on the goals. This is imperative in order to establish a unified message and collaborate to impact nursing practice, leadership and education. 

After my initial hesitation to participate in the MN Action Coalition, I’m now excited about the opportunity and appreciative of the expertise and support provided by AARP and RWJF to advance the Future of Nursing: Campaign for Action.