The Kansas Action Coalition: Creating a Culture of Health for Kansans Jill Peltzer, PhD, APRN-CNS, Qiuhua Shen, PhD, APRN, Debra Ford, PhD, & Cynthia Teel, PhD, FAAN, RN University of Kansas School of Nursing

Session Objectives Describe the Future of Nursing report’s key messages and eight recommendations. Examine the Kansas Action Coalition. Describe the Kansas nursing workforce. Explain the Kansas Action Coalition projects. Explore opportunities to create a culture of health in Kansas.

Campaign Vision – That all Americans have access to high-quality, patient-centered care in a health care system where nurses contribute as essential partners in achieving success.

Transforming health care through nursing

8 recommendations of FoN report 1.Remove scope of practice barriers 5.Double the number of nurses with a doctorate by Expand opportunities for nurses to lead & diffuse collaborative improvement efforts 6.Ensure that nurses engage in lifelong learning 3.Implement nurse residency programs 7.Prepare and enable nurses to lead change to advance health 4.Increase the proportion of nurses with a BSN to 80% by Build an infrastructure for collection & analysis of interprofessional health care workforce data

Health professionals Payers Consumer advocates Business Policy-makers Philanthropies Educators Hospitals and health systems Public health agencies Campaign supporters State Action Coalitions

KSAC promotion video

Kansas action steps Practice Working to full extent of Practice for RNs as well as APRNs Develop and sustain grassroots campaign for support of the changes to the KS Nurse Practice Act Develop and deliver an educational module to focus on what full scope of authority looks like for all nurses Education Development of standardized prerequisites Discuss and develop model for statewide academic progression Encourage lifelong learning- create webinar focused on importance of continuing education throughout the lifetime Leadership Based upon a needs assessment through the Leadership and Mentorship Survey work has begun to develop: Leadership Resources Mentorship Program Online Platform to create “Match.com” style website to match mentors with mentees Webinar series to help prepare nurses to serve on boards Advocacy Advance the health of Kansans by championing nursing’s capacity to transform health and healthcare Build capacity for advocacy; how to advocate for KSAC Create an elevator speech for nurse champions ID outside groups to connect with Interprofessional Collaboration Diversity Data #8 Build an infrastructure to collect & analyze interprofessional health care workforce data

KS Action Coalition Partners NURSE PARTNERSNURSE CHAMPIONS University of KansasUniversity of Kansas Hospital Pittsburg State UniversityKansas Dept of Commerce Fort Hays State UniversityKansas Dept of Health & Environment Wichita State UniversityKansas Dept of Labor Washburn UniversityREACH Healthcare Foundation KACN - Kansas Association of Colleges of Nursing Health Care Foundation of GKC KCADNE- Kansas Council of Associate Degree Nurse Educators Robert Wood Johnson Foundation KCPNE- Kansas Council of Practical Nursing Educators AARP, Inc. Kansas Organization of Nurse Leaders Kansas State Nurses Association Kansas State Board of Nursing KCCN – Kansas Council for Collaboration in Nursing

KSAC Data Collection Efforts

Completed and ongoing studies 1.RN Workforce Survey 2.Leadership & Mentor Survey 3.RN-BSN Program Survey 4.Cultural Competency Survey a.Individual nurses b.Pre-licensure & RN-BSN program curricula 5.KS Faculty Retirement Survey (new)

Kansas RN workforce survey Survey Development Promoting Nursing Education in Kansas (PNEK) KSBN, KS Department of Labor, & KansasWORKS Survey Distribution 11/2013 – 01/2014 Online survey link was sent to 44,568 RNs KS Nursing Newsletter ad; KC Nursing News article Survey Response n = 6, % response rate

Survey sample represents KS RN population 2012 Kansas RN Population Kansas RN Workforce Survey Sample GenderAgeRace 92 % Female92% White 31%< 40 yrs 53%41-60 yrs 16%> 61 yrs 92 % Female89% White 36%< 40 yrs 48%41-60 yrs 16%> 61 yrs

Who we are 80% are actively employed in position requiring a KS RN license For those working as RN, 84% are full time 82% have only 1 RN position > 60% licensed before year of 2000 ~ 50% have worked in current RN position > 5 years 7.5% (n = 440) plan to retire in next 2 years

Work setting, Clinical area, & Role Work Setting 48% work in hospital 16% work in ambulatory care 8% in academics Clinical Area (for the ~4,800 in direct care) 13% med/surg 11% ambulatory care 8% pediatrics 6% intensive/critical care Nursing Role 49% work in staff nurse role 11% work in nurse manager role

Education level at initial licensure = 46.3% BSN Current education level = 60.5% BSN Number of Registered Nurses Nursing Education Levels

Current nursing education levels among KS RNs were comparable to the national level *Based on Results from 2013 National Workforce Survey of RNs by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers

Comparisons with other states… KSMO 1,2 NE 3 IA 4 NM 5 OK 6 TX 7 National 8 Demographics Age, in years years29%35%42%34%30%-32.3% years52%45% 46%52%-51.0%- ≥ 60 years19%20%13%20%17%-16.7%- Gender Female92.1%-94.4%94.8%-91.1%88.3%93% Male7.9%-5.6%5.2%-8.9%11.7%7% Race/Ethnicity White/Caucasian91.9%90%94.4%-57%-63.0%83% Minority8.1%10%5.6%-43%-37.0%17% Education Initial Nursing Education Diploma14.1%-17.8%16%14.5%-10.8%23% ADN36.6%-28.5%55%50.4%-49.0%39% BSN or higher46.3%-53.7%29%35.1%-40.2%38% Current Nursing Education Diploma9% 16.0%10.5%-7.9%7.0%11% ADN31%35%25.6%44.5%-42.6%40.8%28% BSN or higher60%56%58.4%45.0%-49.5%52.2%61%

Note: KS, Kansas; MO, Missouri; NE, Nebraska; IA, Iowa; NM, New Mexico; OK, Oklahoma; TX, Texas; ADN, Associate Degree in Nursing; BSN, Bachelor of Science in Nursing; CRNA, Certified Registered Nurse Anesthetist.. 1. Data were retrieved from Missouri State Board of Nursing 2014 Annual Report Data were retrieved from Missouri Department of Health and Senior Services, Missouri’s Nursing Workforce 2014: & 3. Data were retrieved from Nebraska Center for Nursing, Nebraska RN Survey Report Data were retrieved from Iowa State Board of Nursing 2014 Annual Report Data were retrieved from 2013 Annual Report New Mexico Health Workforce Committee: 6. Data were retrieved from Oklahoma State Board of Nursing 2014 Annual Report Data were retrieved from Texas Department of State Health Service: 8. Data were retrieved from Budden, J.S., Zhong, E.H., Moulton, P., & Cimiotti, J.P. (2013). Highlights of the national workforce survey of registered nurses. Journal of Nursing Regulation,4 (2), data were not available to retrieved. Comparisons with other states… KSMO 1,2 NE 3 IA 4 NM 5 OK 6 TX 7 National 8 Licensing APRN Licensing Nurse Practitioner57.7%72%68%74.6%77%60%66.6%54% Clinical Nurse Specialist21.7%6%8%3.0%9.6%10%8.2%30% CRNA14.8%21%22%18.5%13.2%27%22.8%12% Certified Nurse Midwife2.6%1%2%3.9%-3%2.4%4% Employment Actively Employed in Nursing 90.6%-98.7%91.4%89.7%77%89.4%82% Full-time84.0%--77.0%78.4%-87.3%60% Employment Settings Academic setting8%2.7%5.4%-2.2%2.8%1.6%3% Ambulatory care setting16%1.9%13.9%21%12.5%5.5%7.3%9% Community/Public health5.7%2.1%6.6%-2.9%4.2%1.9%4% Hospital48%59%56.6%59%54.4%61.7%65.5%56% Nursing home/extended care/assisted living facilities 5.7%4.5%10.5%6%3.9%4.9%3.0%6%

Kansas RN-BSN Program survey Purpose describe the characteristics of current students enrolled in the RN-BSN programs in Kansas Survey sent to all RN-BSN programs in KS with 100% response rate each year programs programs programs

Kansas RN-BSN Programs survey

Leadership survey Purpose Inform workforce needs in formal & informal leadership roles Online 12-item survey through KSAC website 971 Kansas RNs completed survey Sample from all geographic areas of KS

Leadership roles 62% identified current leadership position Admin/Mgmt: Academics and practice Educator: Academics and practice Committee: Academics, practice, and community Professional Association Boards Mentor/Advisor/Preceptor

Leadership goals Desired Leadership Positionsn Healthcare organization volunteer206 Administrative leadership190 Community organization171 Hospital or other governance board146 Elected position in professional nursing organization144 Shared governance position98 Elected position at any level51 School board system47

What prevents leadership development? Barriersn Lack of time during work for participation as a leader339 Lack of time outside work for participation as a leader327 Would like more leadership development before serving157 Lack of supervisor support to participate in leadership roles137 Lack of colleague support to participate in leadership roles128 Leadership service not recognized by my organization109 Conflict of interest between organizations57

Leadership development needs Professional Development Programsn Personal Leadership Skill Development318 Understanding How to Influence Policy309 Networking Skill Development249 Understanding Budget and Finance250 Communication Skill Development231 Skill Development for HCO Board199 Other40 62% interested in Boardroom-focused leadership training

Cultural Competency study Purpose Evaluate nurses’ knowledge, skills, and attitudes of cultural competency according to 2014 Culturally Competent Nursing Care guideline Assess pre-licensure and RN-BSN programs’ curricular content on cultural competency using 2014 Culturally Competent Nursing Care guideline Data collected April-June nurses from across Kansas participated in the survey 34 pre-licensure nursing programs and 4 RN-BSN nursing programs completed survey (62% response rate).

2014 Culturally Competent Nursing Care guidelines 1Knowledge of Cultures: Nurses shall gain an understanding of the perspectives, traditions, values, practices, and family systems of the culturally diverse populations for whom they provide care, as well as knowledge of the complex variables that affect their achievement of health and well-being. 2Education and Training in Culturally Competent Care: Nurses shall be educationally prepared to provide culturally congruent health care. 3Critical Reflection: Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage in order to have an awareness of how these qualities and issues can influence culturally congruent nursing care. 4Cross-Cultural Communication: Nurses shall use culturally competent verbal and nonverbal communication skills to identify client’s values, beliefs, practices, perceptions, and unique health care needs. 5Culturally Competent Practice: Nurses shall use cross-cultural knowledge and culturally sensitive skills in implementing culturally congruent nursing care. 6Cultural Competence in Health Care Systems and Organizations: Health care organizations should provide the structure and resources necessary to evaluate and meet the cultural and language needs of their diverse clients. 7Patient Advocacy and Empowerment: Nurses shall recognize the effect of health care policies, delivery systems, and resources on their patient populations and shall empower and advocate for their patients as indicated. 8Multicultural Workforce: Nurses shall actively engage in the effort to ensure a multicultural workforce in health care settings. One measure to achieve a multicultural workforce is through strengthening of recruitment and retention efforts in the hospitals, clinics, and academic settings. 9Cross-Cultural Leadership: Nurses shall have the ability to influence individuals, groups, and systems to achieve positive outcomes of culturally competent nursing care for diverse and vulnerable populations. 10Evidence-Based Practice and Research: Nurses shall base their practice on interventions that have been systematically tested and shown to be the most effective for the culturally diverse populations that they serve.

Nurses’ knowledge, skills, & attitudes > 70% were Knowledgeable or Very knowledgeable about the 2014 guidelines > 60% felt Competent or Very Competent in their skills in using the 2014 guidelines > 80% thought the 2014 guidelines were Important or Very Important.

Guidelines focusing on the individual’s cultural competency (i.e., Guidelines 1-5) typically were reported as being integrated “A little” or “Quite a bit” into the program curricula (83% - 100%) More systems-focused guidelines (i.e., Guidelines 6- 10) were less likely to be integrated into the curricula, especially Guideline #9 (cross-cultural leadership) Integration of culturally competent content into curricula

KSAC Products

Resources for academic progression

Mentoring program

KSAC 2015 Summer Summit

Creating a Culture of Health in Kansas: Advancing Nursing Education and Leadership Acute Care Long- Term Care Public Health School Hays Pittsburg Kansas City Wichita Acute Care Long- Term Care Public Health School Acute Care Long- Term Care Public Health School Acute Care Long- Term Care Public Health School Northwest Region Southeast Region Northeast Region Southwest Region Final Meeting Location Topeka, KS

Key issue: increase nursing workforce diversity US minority populations currently = 37% Expected to = 50% by 2060 Kansas minority populations = 23% Currently, US nursing workforce 83% White and 93% female In KS, even less diversity in nursing 93% White and 93% females Diversity in Nursing

What can we do in our communities to build a culture of health? Creating a culture of Health in Kansas

Call to Action Education Team Seamless academic progression Practice Team Full scope of practice Leadership Team Leadership development Advocacy Team Advocacy/policy development

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