1998 Annual Report
July 14, 1998 Colleagues in Caring: Colorado Consortium for Nursing Work Force Development Grant ID #: 029446 - July 1, 1997- June 30, 1998
Table of Contents
The Eight Questions:
1. What were
the project’s objectives and how has the project met them this
year?
2.
Have any internal problems been encountered during this year that are
related to the project’s design, collaborations, staffing, operations,
or other project factors?
3. Are there problems or successes caused by factors external to the project?
4. If you are working collaboratively with other organizations, or depend
on other organizations or institutions to meet the objectives of this
project, how are these relationships working?
5. With a perspective of the entire project, what have been its key dissemination activities?
6. Has the project had other sources of support?
7. What are your plans for the project next year?
8. How do you see the Foundation’s role?
Annual Report Bibliography
1. What were the project’s objectives and how has the project met them this year?
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.
Goal A: Objective 1
Through focus groups held statewide and attended by representatives from education, practice, and administration key nursing education and work force issues have been identified that will have the greatest impact on the role development of nursing in 2001. The three key themes that emerged are: (1) pre-service and post-employment partnerships, (2) accountability, and (3) competencies essential to nursing roles in clinical specialty settings.
At a statewide meeting of some educators/employers facilitated by National Advisory Committee member Barbara Donaho, in January 1998 the group decided that the issue of the lack of mentorships/preceptorships is a critical one that needs to be addressed. A survey has been designed and is being distributed to collect information on the best practices that currently address this issue and how they may be expanded through partnerships in areas of the state where they are lacking.
A model for Nursing Work Force Projection is evolving to describe the balance/imbalance of the regional and statewide nursing market by comparing demand with supply. Four survey instruments have been used in the data collection process. They are: The Nursing Work Force Employer Survey (adapted from the California Model), the Ohio Nursing Work Force Modeling Tool, the Nursing Post-Graduate Employment Survey, and The Nursing Re-Licensure Survey.
We adapted the California Work Force Employer Survey and in Year One mailed approximately 900 surveys to employers of nurses statewide. Since the return rate was approximately 33%, the project staff asked each AHEC Director to identify the key employers in each of their regions. Data from each of these were collected for 1997 and 1998 and following the validation of these data, it will be analyzed and displayed graphically for dissemination and feedback.
We are also acting as a test site for the Ohio Nursing Work Force Simulation Tool. Three acute care organizations have agreed to be pilot sites and offer feedback about the potential utilization of this tool for future projections.
The Nursing Post-Graduate Employment Survey, the printing of which was funded by Mosby Publishing, is continuing to be mailed out six months post-graduation to all nursing graduates. In 1996-1997, 39% of the 818 graduates responded.
The key findings based on these respondents include:
- Approximately two-thirds are employed full-time in nursing.
- Almost 15% are currently enrolled in another nursing program to continue their education.
- Nearly 60% indicated the Hospital is where they spend most of their nursing time.
- Long Term Care is the next highest setting with 15% spending most of their nursing time.
- About 60% had positions prior to or at the time of graduation.
- Approximately two-thirds accepted their first choice position.
- The majority work as staff nurses, positions for which they feel prepared by their education.
- Three-fourths are in positions that include a benefits package.
The Nursing Re-Licensure survey is being used to gather data on the nursing demographics and employment status of RNs and LPN's in the state.
Another source of data we collect is "in kind" contributions from our consortium members. The amount of $26, 956.65 has been contributed from July, 1996 through January, 1998. Many organizations contributed to the success of the project by donating meeting spaces, lunches, and most importantly the time of their nurses to participate in the process by attending the many meetings essential to accomplishing the goals of the project.
Goal A, Objectives 2,3
We do not envision developing Employer/Educator Model agreements until the Spring of 1999 as these agreements must be based on our findings and recommendations following the analysis of the data collected on the work force issues.
Goal B, Objectives 1,2
Task Forces have been formed to represent public health, home health, long term care and acute care settings to identify the type, mix, and competencies for each of their settings. Forty-two competencies were drawn from a variety of national, state, and local resources that include: The National League for Nursing, The American Association of Colleges of Nursing, The Colorado Articulation Model for Nursing, The Colorado Differentiated Practice Model for Nursing, the previous Regional Council meetings, Employer Surveys, and the Pew Competencies for Health Professions for the 21st Century. At Regional AHEC Council meetings held in eleven communities statewide, the competencies were ranked as "not important" to "very essential" for ADN, BSN, LPN's and nursing assistants using group process for consensus building. In addition to identifying the competencies, each task force will look at both the pre-graduate and post-graduate educational programming issues.
The Home Health Task Force is working collaboratively with our AHEC's to develop a statewide home health certificate course that can be delivered via the telecommunications network based on the skill sets/competencies they have determined are needed for nurses to successfully practice in the specialty in the future.
The Long Term Care Task force have identified and defined the competencies that will be needed by both LPN's and RNs to ensure that the industry has qualified nurses to meet their increasing demand. They also have compiled a suggested list of recommendations for both service/education to forge model agreements in order to operationalize the competencies.
The Public Health and Acute Care Task Forces met with the Deans and Directors of some of the nursing schools in the state to inquire about adaptation of clinical experiences and curriculum content to incorporate the competencies they have identified as essential to deliver high quality cost effective care to the clients they serve in the future. Another meeting is planned in September when all of the setting specific task forces will be coming together with educators from all of the nursing programs in the state to discuss specific recommendations and to develop an action plan.
Goal B: Objective 3
The link with the Mountains and Plains Partnership Project, an RWJ Partnership for Training, has been established and continues to ensure that efforts will not be duplicated. A presentation was done jointly at the Rural Nursing Conference in April 1998 which emphasized the common themes of collaborative efforts of education programs and clinical faculty.
Goal C, Objective 1
Advisory Board officers have been elected to provide leadership to the Consortium and to help plan for the transition once grant funds no longer support the project. The staff and officers are working to facilitate this transition through collaborative planning and shared responsibilities, development of a marketing plan and fund raising-activities. The project staff and officers are conducting monthly telephone conferences and quarterly meetings to accomplish the transition.
A marketing plan has been developed that outlines the strategies for fundraising to ensure the long-term viability of the consortium. This plan will be presented first to the Advisory Board officers in August and be brought forward at the next full meeting of the Board which is scheduled for October for discussion and to develop an implementation plan.
Goal C, Objective 2
A variety of ongoing communication strategies have been successful in encouraging participation in the Consortium which will hopefully contribute to its long-term viability. These include: two-way interactive teleconferencing; regional, statewide, and practice specific written newsletters and articles; and presentations at regional and national professional meetings.
2. Have any internal problems been encountered during this year that are related to the project’s design, collaborations, staffing, operations, or other project factors?
During the second year of the project it was decided that the Nursing Work Force Survey we distributed to more than 900 employers of nurses (adapted from the California Survey) needed to be revisited as the return rate was quite low, approximately 33% and many were not filled out correctly. The tool was then adapted and questions that posed difficulty revised. For example, instead of asking for actual numbers to some questions a percentage was requested. After consulting with the Advisory Board and Research Evaluator the decision was made that each AHEC Director would identify the key employers in his/her region. Data for 1997 were then completed for these facilities via telephone or through in-person visits, and in 1998 the surveys were only mailed to those key employers. We enlisted assistance from each of our AHEC's, and they contacted the key employers in their regions to facilitate the data collection. The return rate, however, was still low, so it was decided to do an analysis on a statewide basis rather than by each region of the state. Analysis will occur by August 1998. Then there will be a discussion with the research evaluator to determine the best strategy for collecting the data for year 3. One possible suggestion is to ask The Colorado Hospital Association to send out a letter to each CEO asking for support for having each of their organizations complete the data.
The piloting of the Ohio Work Force Modeling tool has not gone along as easily as anticipated. It has been more difficult to get nursing directors/administrators to project their work force needs in five years because of the nursing practice climate currently in our state. Confidentiality has also been an issue for some organizations in our state and a statement is currently being drafted for that purpose. Some "glitches" in the tool were also identified that have now been rectified which hopefully will facilitate further data collection. We will complete the tools for the three organizations that have committed to do so at this point and then re-evaluate further use. Also the tools for home health and long term care have not yet been completed for application as quickly as anticipated.
3. Are there problems or successes caused by factors external to the project?
Attaining the diversity and numbers of work force and marketplace committed stakeholder's on our Task Forces as well as on our Advisory Board continues to be an issue as we are again faced with a nursing shortage in our state. Due to the "right-sizing" that occurred in many of our acute care facilities, nursing leaders who had been involved in other successful endeavors, i.e., The Colorado Nursing Articulation Model, are no longer employed in that setting or in our state. Thus there is a void in nursing leadership statewide. This gap in nursing leadership and knowledge in many of our organizations has contributed to the poor results in filling out the survey information requested. Other trends such as the growing managed care penetration, growth in population, the increased use of unlicensed nursing assistants, and the shift from inpatient to outpatient care are also impacting nursing practice and the ability of nurses to actively participate in the project.
One of the success factors that is contributing to more statewide involvement is the expansion of the telecommunications/teleconferencing capabilities now available through the UCD and AHEC systems. Specifically, three new bridge sites have been set up on the Western slope.
4. If you are working collaboratively with other organizations, or depend on other organizations or institutions to meet the objectives of this project, how are these relationships working?
The Colorado Consortium for Nursing Work force Development has continued to work through the AHEC system during this past year quite effectively. They continue to contribute both financial and staff support to the project. They all serve on the Advisory Board and at their monthly meetings an update is always provided on the project, goals, and timeline.
The Consortium has also been collaborating with the Colorado State Board of Nursing and the Colorado Health Professions Panel in the development, analysis and distribution of a survey for nurses to complete when they renew their license. Since the LPN's will be renewing this year, the RN Survey was collaboratively adapted and will be mailed in the summer. Since half of the RNs renew their licenses every year, an RN survey will also be sent out in the fall, 1998 to get a more representative sample. The data from the 1997 RN surveys will be analyzed in September and put into a report for dissemination.
The Consortium also is maintaining collaborative relationships with all of the major nursing organizations in the state by participating in their meetings and by having a representative from each group serve on the Advisory Board. This collaboration is viewed as critical in maintaining the viability of the Consortium when the grant funding ends.
The Consortium also has a partnership with The Colorado Health Professions Panel (CHPP) whose mission is to advance the creation of an integrated system that develops adequate types and numbers of health professionals with the knowledge, skills and attitudes that meet the need of Colorado communities. Their Executive Director, Benjamin Cordova, sits on our Advisory Board and the following members of our Advisory Board are CHPP members: Marie Miller, Ida Walden and Clay Whitlow. Since our missions and visions are clearly aligned, this collaborative relationship is essential in maintaining the viability of the Consortium when the funding ceases.
Dr. Pat Prescott has been collaborating with us regarding the supply and demand model that we want to develop for this state. Her expertise has been invaluable in keeping us on the right track.
We have been working with the Ohio Group to pilot their Work Force Modeling Tool and hopefully our input and experience will facilitate the collection of the data that is necessary to begin to assist organizations to project their nursing work force needs for the future.
5. With a perspective of the entire project, what have been its key dissemination activities?
The Principal Investigator and Project Coordinators serve on many boards and commissions. Several press releases have focused on the Nursing Work force issues that are being addressed by the Consortium in Colorado.
- The "Communicator" newsletter has been published and distributed to all stakeholder's involved in the project in August of 1997 and January, April, and July of 1998.
- An article on the project has appeared in each edition of the Colorado Nurses' Association Newspaper, published quarterly and mailed to every nurse in the state.
- The WWW home page continues to be developed to facilitate communication.
- Presentations have been make locally, statewide and nationally to the Colorado Society for Nurse Executives, The Colorado Federation of Nursing Organizations, the Brain Trust, the Colorado Council on Nursing Education, at the Colorado Rural Nursing Conference and in Texas, New Jersey, Virginia, North Carolina, and Wisconsin.
- Consulting services have also been provided on differentiated practice to organizations in Texas, New Jersey, Virginia, and California.
6. Has the project had other sources of support?
In year 2, pledges made during the planning phase have continued to be collected and at this point are as follows:
University of Colorado Health Sciences Center: $2,000 - May, 1998
University of Colorado Health Sciences Center: SCH. OF NRSG: $1,000 - 1998 pending
Centennial AHEC: $2,000 - May, 1998
Colorado County Nurses Association: $100 – pending
Colorado Federation of Nurse Organizations: $1,000 pending
Colorado Nurses' Association: $1,000 – Pending
Colorado Society for Nurse Executives: $200 - pending
Hospital Shared Services: $700 - May, 1998
Mosby Publishing, Inc.: $2,000 - June, 1997
San Luis Valley AHEC: $1,000 - March, 1998
Southeastern Colorado AHEC: $2,000 - June, 1998
Western Colorado AHEC: $2,000 - May, 1998
University of Southern Colorado: $1,000 - February, 1998
Arapahoe Community College: $50 - May, 1998
Community College Of Denver: $100 - 1998 pending
Concorde Career Institute: $50 - 1998 pending
Delta-Montrose Area Vo-Tech Center: $50 - 1998 pending
Mesa State College: $150 - February, 1998
Regis University: $200, pending
In kind contributions of hours, meals, and travel continue to be collected and have been submitted to data processing. The amount of the "in kind" contributions from our task force and consortium members from July, 1997 through June, 1998 is $6477.66.
7. What are your plans for the project next year?
We will continue to follow the time line and objectives as revised in the first annual report.
In year 3, we will continue to collect data from the Nursing Work Force Employer Survey, the Nursing Post-Graduate Employment Survey , the Ohio Nursing Work Force Simulation Tool, and the Re-Licensure survey.
We will continue to face the challenges of the project which include: refocusing on the goals, interpreting what trends mean, translating data to information that is useful for forming recommendations, prioritizing products to complete, integrating the pieces for future planning, embracing risk to bring about significant change, asking new questions as old ones are answered, and accomplishing transition from ideas to action in the form of model agreements for partnerships between education and practice.
8. How do you see the Foundation’s role?
The Foundation's role has been critical in assisting us to raise the matching dollars needed to accomplish the goals and objectives of the project. As we enter the final year it is critical for the foundation to provide networking opportunities like the one being planned in Washington in July to allow the project staff from multiple states to collaborate on the issues, trends, and data collected through the first two years so that a comprehensive plan can be developed for year 3.