June 11, 2015 Roles for Nurses in State Workforce Development: A Look at Initiatives by the National Governors Association National Forum of State Nursing Workforce Centers Annual Conference 1

Session Objectives 2 1.Provide context for state health workforce development activities. 2.Describe the role that nurses along the entire professional spectrum will play in helping states meet health workforce challenges.

About the National Governors Association 3 Nation’s oldest organization serving the needs of governors and their staff NGA Office of Federal Relations (OFR): serves as the collective voice of the nation’s governors in Washington, DC NGA Center for Best Practices: a hybrid think tank/consulting firm that works directly with governors on specific policy projects and provides support to OFR

About the National Governors Association 4 Today’s discussion provided by the NGA Center: Does not represent the official position of the Governors or NGA Is the result of our experience working with leadership within states Is not for attribution or dissemination.

Health Workforce Challenges 5 Policy Existing Distribution of the Health Workforce Geographic areas and population groups without access Gaps in needed services Changing How Care is Delivered Poor Outcomes High Costs Governance Many different areas of government making siloed efforts No ownership over the issue Uncertainty about the effect of delivery transformation Incomplete data

6 Governors’ Health Workforce Development Levers PurchaserRegulator and Administrator Convener Medicaid and CHIP Employee and Retiree Coverage Managed Care Contracts Medical Home Initiatives Insurance Regulation Professional Regulation Facilities Licensing Higher Education and K-12 Economic Development Workforce Development Public Health and Health Public Safety State Innovation Model Projects Statewide Health Improvement Plans Health in All Policies

Themes from State Workforce Action Plans 7 Policy Coordination Determining an entity/structure Developing a shared agenda Aligning existing efforts Data Analysis Making data accessible and useful for policymakers Catalogue/understand current data sources Identify gaps Collect consistent data on a regular basis Learn from existing efforts Workforce Redesign Identify and remove unnecessary regulation Use technology to provide services Support practices adopting new models of care Expose trainees to new models of care Create overlapping skills Pipeline Expose trainees to underserved populations and needed specialties Remove unnecessary entry barriers Improve training, career outlooks for frontline workers Ensure clinical placements Increase diversity and cultural competency Align education/training outcomes with health needs

Themes from State Workforce Action Plans 8 Policy Coordination Determining an entity/structure Developing a shared agenda Aligning existing efforts Data Analysis Making data accessible and useful for policymakers Catalogue/understand current data sources Identify gaps Collect consistent data on a regular basis Learn from existing efforts Workforce Redesign Identify and remove unnecessary regulation Use technology to provide services Support practices adopting new models of care Expose trainees to new models of care Create overlapping skills Pipeline Expose trainees to underserved populations and needed specialties Remove unnecessary entry barriers Improve training, career outlooks for frontline workers Ensure clinical placements Increase diversity and cultural competency Align education/training outcomes with health needs

Nevada Health Care Sector Council 9 Structure 25 volunteer members Reports to the Governor’s Workforce Investment Board Subcommittees: Legislative/Regulatory Policy Data Evaluation and Research Education/Training Grants and Resources Outputs Annual report to legislature Statewide strategic plan Studies (ex.: health education program inventory, hospital vacancy rates)

Themes from State Workforce Action Plans 10 Policy Coordination Determining an entity/structure Developing a shared agenda Aligning existing efforts Data Analysis Making data accessible and useful for policymakers Catalogue/understand current data sources Identify gaps Collect consistent data on a regular basis Learn from existing efforts Workforce Redesign Identify and remove unnecessary regulation Use technology to provide services Support practices adopting new models of care Expose trainees to new models of care Create overlapping skills Pipeline Expose trainees to underserved populations and needed specialties Remove unnecessary entry barriers Improve training, career outlooks for frontline workers Ensure clinical placements Increase diversity and cultural competency Align education/training outcomes with health needs

Data-Informed Policy 11 Colorado Primary Care Needs Assessment Compared health outcomes to workforce data No consistent links between poor health outcomes and workforce distribution Georgia GME Closed programs with low in-state retention Provided start-up funds for programs in two high-need areas

Themes from State Workforce Action Plans 12 Policy Coordination Determining an entity/structure Developing a shared agenda Aligning existing efforts Data Analysis Making data accessible and useful for policymakers Catalogue/understand current data sources Identify gaps Collect consistent data on a regular basis Learn from existing efforts Workforce Redesign Identify and remove unnecessary regulation Use technology to provide services Support practices adopting new models of care Expose trainees to new models of care Create overlapping skills Pipeline Expose trainees to underserved populations and needed specialties Remove unnecessary entry barriers Improve training, career outlooks for frontline workers Ensure clinical placements Increase diversity and cultural competency Align education/training outcomes with health needs

13 Scope of Practice The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care The Role of Dental Hygienists in Providing Access to Oral Health Care The Role of Physician Assistants in Health Care Delivery The Expanding Role of Pharmacists in a Transformed Health Care System

Scope of Practice 14 Common Thresholds for Conflict Diagnosing illness Ability to prescribe medications or alter prescriptions Definitions of supervision Practice settings: private practice most restricted Hospital privileges Common Compromises Allow expanded scope with addition training Allow expanded scope for high-need populations

Providing Needed Services: Care Coordination and Oral Health Care 15 Oklahoma PCMH Initiative Participating practices relying almost completely on RNs to provide care coordination State provides technical assistance including training modules North Dakota Health Smiles Fluoride Varnish Program Legislation allowed physicians, PAs, and NPs to screen and apply fluoride RNs and LPNs allowed to under direct or general supervision of a physician

Themes from State Workforce Action Plans 16 Policy Coordination Determining an entity/structure Developing a shared agenda Aligning existing efforts Data Analysis Making data accessible and useful for policymakers Catalogue/understand current data sources Identify gaps Collect consistent data on a regular basis Learn from existing efforts Workforce Redesign Identify and remove unnecessary regulation Use technology to provide services Support practices adopting new models of care Expose trainees to new models of care Create overlapping skills Pipeline Expose trainees to underserved populations and needed specialties Remove unnecessary entry barriers Improve training, career outlooks for frontline workers Ensure clinical placements Increase diversity and cultural competency Align education/training outcomes with health needs

Flexible Pathways for Veterans 17 Making Health Care Skills Portable Providing direct access to CNA and LPN exams Providing accelerated training for LPN and RN license Awarding course credit Waiving required courses Developing shortened curricula

18 Getting a better distribution of the workforce and creating incentives for the workforce to contribute to new models of care Linking data to policy decisions and measure the effectiveness of policy changes and state spending Health outcomes Jobs and economic development Increasing the provision of services instead of the number of people with particular job titles Providing flexible career pathways that lead to good jobs Summary of State Policy Priorities

Questions? Contact: Amanda Dunker, Senior Policy Analyst NGA Center for Best Practices