1997 Annual Report
ANNUAL PROGRESS REPORT YEAR 1 July 14, 1997 Colleagues in Caring: Colorado Consortium for Nursing Workforce Development Grant ID #: 029446 July 1, 1996 - June 30, 1997
Table of Contents
1.When the grant in support of this project was
made, the project's principal objectives and strategies.
2. The principal accomplishments of the project to
date, how they have been achieved, and how they
relate to the project's original objectives.
3. What have been the principal shortfalls of the project,
what have been the principal problems encountered,
and how have they been coped with or overcome?
4. What have been the project's other sources of support,
how much have they provided, and when were these
funds received?
5. To the extent not previously covered, what major
factors affecting the project have changed during
this period, and how has the project been affected?
6. What had been planned for the project for the coming
year?
7. What are your plans and progress with respect to
financially supporting this program beyond RWJ funding?
8. Written and oral communication products discussed
in Question Two to meet Goal C’s second objective.
9. No public use data tape and documentation are part
of this grant.
1. When the grant in support of this project was made, the project's principal objectives and strategies were:
GOAL A: Develop regional and statewide employer-educator relationships and statewide educator-educator relationships that identify and address work force and educational needs and expectations.
OBJECTIVES: 1) Identify regional nursing education and work force issues perceived by employers and educators.
2) Develop and implement nursing employer-educator agreements and other strategies that address identified needs and expectations.
3) Obtain commitments from Colorado nursing schools to address work force needs cooperatively, based on an ongoing consensus process of determining needs.
GOAL B: Develop pre- and post-graduate educational strategies that provide mastery in setting specific skills.
OBJECTIVES: 1) Identify skill sets for RNs, LPN's, and nurse-extenders in acute, chronic, home, long-term, primary, and public health care settings at all levels, from entry to leadership.
2) Develop pre-graduate criteria.
3) Develop post-graduate educational programming.
GOAL C: Ensure that the Consortium represents primary stakeholder's and has long-term viability.
OBJECTIVES: 1) Develop strategies for expanding membership and generating funds.
2) Develop and implement ongoing, interactive communications among nurses, employers, and educators at the state, regional, and community levels.
2. The principal accomplishments of the project to date, how they have been achieved, and how they relate to the project's original objectives: (See tables at the end of narrative.)
Goal A: Link Educators and employers to address work force needs.
1 a. Nursing Work Force Issues/Opportunities were identified. Statewide, 12 AHEC regional council meetings were held in January and February, 1997. A focus group strategy was selected to identify issues and concerns in the work force and in education. More than 150 people from 11 communities in Colorado, representing the five Area Health Education Centers (AHEC) regions, participated in these focus groups. Invitations to participate in each regional council were spread broadly to practice, education, and administration through AHEC's networks. Then, the resultant trends and issues were grouped into three categories of Partnerships, Accountability, and Competency. If they were identified in three or more of the five state regions, they were then compiled as the top areas of concern, statewide. This preliminary report was shared through the regional councils, steering committee, and advisory board meetings, and to all individuals who have participated through the Colorado Consortium's newsletter. A second round of regional council meetings was held in May. Along with a report on the statewide results, specific regional responses were discussed and the first areas for action were selected.
1b. Data collection methods were developed and implemented with three specific survey instruments.: 1. Distributed 900 Nursing Work Force surveys statewide (300 respondents). This instrument was adapted from the California survey.
2. Developed with the Colorado Council for Nursing Education a statewide Student survey to be mailed at six-months post-graduation.
3. Refined the RN and LPN license renewal survey tool in collaboration with the State Board of Nursing. This activity directly relates to the other two objectives of Goal A of achieving employer-educator agreements and statewide nursing school commitments based on an agreed upon data collection method and the development of a projection model for nursing supply, based on the client needs and employment demand. The current picture of the nursing work force, the production rate, and migration rate (licensure information) is starting to have more features, e.g., comparing entry with exit figures, numbers of RNs entering the workforce appear to be in rough balance with the numbers of RNs exiting from the workforce. National and state labor statistics and nursing graduates also provide information for comparison and trends.
Goal B: Develop pre- and post-graduate educational strategies in setting-specific skills.
1. Setting specific competencies were obtained using four methods to date:
1. Nursing Work Force Survey Competency Lists: In Part B of the nursing workforce survey, respondents were invited to identify competency sets for their particular practice area. Competencies were defined as critical areas of conceptual knowledge or clinical skills that are expected of nurses who practice in specified area and that nursing schools should teach. Following the identification of their principal area of clinical practice setting, respondents listed the competencies necessary for success in their clinical practice area. These responses have been compiled by AHEC Region of the state and by clinical practice setting to determine trends, common themes, and discrepant or unique responses. In addition, the pattern of responses have been compared to focus group data collected from the first Regional Council meetings. Validation of core and setting specific competencies is evidenced in the preliminary findings as analysis continues.
2. Regional Council Competency Priorities: Through facilitated focus groups, Regional Councils coordinated with the Area Health Education Centers, identified the nursing work force and education issues. Following these sessions, participants were asked to document priority competencies in their clinical practice area. Data from the group process and the individual priority sheets were compiled, compared across clinical practice settings and across AHEC Regions to identify common themes. Summarization and verification with the data obtained through the Nursing Work Force Survey continue.
3. Home Health Care Skill Set Evolution: The project coordinators have collaborated with the Colorado Home Health Care Association through their Professional Development Committee. This sub-group has been actively working on identifying their setting specific critical competencies and skill sets. They have completed one survey of their members and two of the regions of the state have already begun collaborative efforts in providing educational courses for nurses transitioning from another setting to home health.
4. Link with Mountains and Plains Partners Project Established: The Steering Committee, Advisory Board, and Consortium staff have acknowledged that the primary care area of the MAPP project will not be duplicated by our efforts. Rather through ongoing sharing of information, we anticipate building upon the relationships developed in the various statewide communities and the competency set development.
2. Nursing Post-Graduation Employment Survey: At six-months post-graduation, beginning with the December, 1996 class, a survey will be mailed to graduates of all nursing schools in Colorado. Relevant questions include whether or not the graduates are employed in nursing and the reasons if they are not, and whether or not their nursing education adequately prepared the respondent for their current position. Graduate feedback is critical in identifying strength and areas for needed revisions in nursing curricula. These activities relate directly to the mission of identifying and addressing work force issues through regional and statewide collaboration among employers and educators. Specifically, the priority competency list/setting generated through the nursing work force survey, the home health survey, and from the participants at the regional councils will lead to the next step of Goal B's objective to identify core and unique skill sets for RNs, LPN's, and nurse extenders, in acute, home, long term, and public health care. The link with the MAPP project will support the primary care competency skill sets validation. These along with feedback from the students (surveyed at six-months post-graduate) will be invaluable also in the foundation for developing data based changes in pre-graduate curriculum and post-graduate educational programming.
Goal C: Ensure long-term viability of primary stakeholder's.
1.a Initial Structural Development of the Consortium Prior to the formal development of the Consortium, a Steering Committee was convened and given the authority to drive the formative activities. The leadership of the Colorado Coalition of Nursing Education, Colorado Society of Nurse Executives, Colorado Nurses Association, Colorado Federation of Nursing Organizations, Colorado League for Nursing, and representatives of managed care, LTC, home health, and a consumer have served during this period.
1.b Recruitment for Advisory Board Membership Forty-five stakeholder's were identified on the state level and from the five AHEC regions to represent nurse employers in LTC, HMO, home health, public health, school health, mental health, acute care, rehabilitation, temporary nurse service, Health Care System of Care, and nurse educators representing all types of programs; consumers, The Colorado Trust, family practice/occupational health physicians, the Colorado Medical Society, the Colorado Nurses Association, the Colorado Board of Nursing, Colorado Access, students, policy makers from the Colorado Health Professions Panel, the Department of Health Care Policy/Finance, and the Colorado Community College and Occupational Education System. They were nominated by the members of the Steering Committee, the AHEC Directors, and participants of the January Regional Councils. These names were put on a matrix of criteria established and two waves of invitations were completed that resulted in these participants at the April Advisory Board meeting. This provided the first statewide interactive communication centered on the Consortium's goals and objectives. Members committed to three meetings per year, participation in providing expert advice, a statewide perspective, and direction for long term viability.
1c. Recruitment for Regional Council Members The four AHEC Directors and the three project coordinators planned attendees, agendas, and facilitated two regional council meetings in each of the five AHEC regions since January, 1997 (Western region one set). These structural components of the Colorado Consortium for Nursing Work Force Development: the Steering Committee, Regional Councils, and Advisory Board, are the initial strategies for convening local communities in their regions and statewide membership development for partnerships and continuing funding. Thus, these activities are also directly related to meeting Goal C's first objective of developing primary stakeholder members for the long term. Contributions generated are noted in question 4.
2. Communications: There have been four strategies implemented related to Goal C's second objective; to develop and implement ongoing, interactive communications among nurses, employers, and educators at the state, regional, and community levels. 1. Telecommunications were utilized in NE and NC part of the state to facilitate the rural site participation. Four separate meetings were held in the Western part of the state, since the long-distance interactive telecommunication link is not complete, to date. This is expected in the next year. Two meetings were held in SE region and three in Central region.
2. Written news releases, statewide, and then local for each regional council meeting in May: articles in two editions of CNA's American Nurse distributed to every nurse in the state, four newsletters (Droplet and then Communicator) statewide, included in statewide Home Health Care Association's newsletter, two articles in statewide Nurse Executive newsletter, and Brochure developed and distribution begun in April.
3. Information systems for nurses and employers: WWW home page in progress and list server for individual and regional communications in progress.
4. Presentations: statewide introduction in September, 1996, Colorado Society of Nurse Executives (CSNE) statewide report in February and June, CCNE statewide report in February, Brain Trust (central region) January and May, Home Care Association of Colorado (HCAC) in October, February, and May, Differentiated Practice Conference (national) poster presentations in June, and Rural Health Conference (statewide) poster presentation in June.
3. What have been the principal shortfalls of the project, what have been the principal problems encountered, and how have they been coped with or overcome?
Two problems have been encountered: 1. Attaining the diversity of work force and marketplace stakeholder's in the Regional Councils is a challenge, as well as commitment to consistent participation n the development of regional collaborative agreements. At our next regional meetings, invitations to the specific stakeholder's will set the stage for clarifying common expectations as members and Council Co-Chairs are established with roles more clearly defined .
2. Nursing Work Force Survey response rate of 300 of 900 is less than we expected. Also the questions regarding the projection of what work force components they expect to need next year and in three years were left incomplete much of the time. To complete the analysis of this first survey by employers of nurses, we need the answers to these projections, so we are going to a criteria-based representative sample instead of the original convenience sample. We will capture the missing data for that sample group and then consistently through the years (Representation by % of RNs and LPN's employed in each setting, statewide and also then employment in the five AHEC regions of the state).
4. What have been the project's other sources of support, how much have they provided, and when were these funds received?
In Year 1, pledges made during the planning phase were collected and totaled $84,650 of the originally pledged amount of $88,350: COLORADO HEALTH PROFESSIONS PANEL, $40,000, November, 1996
UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER, $30,000, November, 1996
UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER, SCH. OF NRSG, $1,000, January, 1997
CENTURA HEALTH PARTNERS, $1,500, February, 1997CENTENNIAL AHEC, $2,000, January, 1997
COLORADO FEDERATION OF NURSE ORGANIZATIONS, $1,000, February, 1997
COLORADO NURSES' ASSOCIATION, $1,000, January, 1997
HOSPITAL SHARED SERVICES, $700, April, 1997
MOSBY PUBLISHING, INC., $2,000, June, 1997
SAN LUIS VALLEY AHEC, $1,000, pending
SOUTHEASTERN COLORADO AHEC, $2,000, January, 1997
WESTERN COLORADO AHEC, $2,000, February, 1997
UNIVERSITY OF SOUTHERN COLORADO, $1,000, February, 1997
ARAPAHOE COMMUNITY COLLEGE, $50, May, 1997
COLORADO ASSOCIATION OF COLLEGES OF NURSING, $200, January, 1997
COLORADO COUNCIL OF NURSE EDUCATORS, $500, February, 1997
COLORADO SOCIETY OF NURSE EXECUTIVES, $200, February, 1997
COMMUNITY COLLEGE OF DENVER, $100, March, 1997
CONCORDE CAREER INSTITUTE, $50, March, 1997
DELTA-MONTROSE AREA VO-TECH CENTER, $50, January, 1997
MESA STATE COLLEGE, $150, February, 1997 REGIS UNIVERSITY, $200, pending
Year 2 and 3 pledged amounts include another $22,500. Additional funds of $2,000 for the printing and distribution of the student surveys during the next two years was received from Mosby Publishing.
In kind contributions of hours, meals, and travel continue to be collected and have been submitted to data processing.
5. To the extent not previously covered, what major factors affecting the project have changed during this period, and how has the project been affected?
1. External environmental changes include: high vacancy rates, or demand, one facility started offering sign-on bonus with hire; and two of the largest employers of nurses in the state: Columbia and Centura each reported 250 nursing positions to be filled. (April 1997). New graduate "transition" programs have been re-started in both large systems; and use of registry or temporary agency nurses re-started after more than two years of non-utilization of temporary nurses.
2. Time line revisions were recommended by the Steering Committee in December and discussed with Mary Rapson, Kathy Mayle and Terrance Keenan during our annual RWJ site visit in November. Revised time line follows. These include: a) the development of competency skill sets which was moved earlier to work with the Home Health Care Organization, based on their need;
b) the education and work force issues report was moved back three months to meet the regions’ schedule for council meetings;
c) the development of model employer-educator agreements was moved to year two, based on the first two changes.
3) Project staff changes: Kris Wenzel was added and Joyce Falco and Gayle Preheim’ time re-assignment was based on access and availability. The revised year two budget shows the % of time and RWJ funding support for project personnel. Carol Vojir continues to provide statistical and evaluation support, although effort is not funded by grant.
4) Carry Forward In year one, $497 was unspent. The Project Director requests that these funds be carried forward into the new grant year.
6. What had been planned for the project for the coming year?
We will continue to follow the time line and objectives as originally stated in the proposal. The site visit to Ohio in July to investigate the application of their market projection model will add information to Colorado’s work force data system development system. The expertise of Dr. Pat Prescott will be utilized and contacts with Dr. Peter Beurhaus for consultation in the development of our nursing work force projection model.
7. What are your plans and progress with respect to financially supporting this program beyond RWJ funding?
In addition to already stated pledge dollars for Year two and three of $22,500, future contributions will be generated based on the primary stakeholder's’ belief that this consortium has a unique contribution to their work force’s development to meet the new millennium. The Work Force Data System’s performance in showing trends, and providing a network for immediate and meaningful information is imperative. When the practice, employers and educator partnerships yield cooperative agreements for development of practitioners with the competencies necessary for quality and cost-effective service in their settings, then financial support will follow.