Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

The Campaign for Action: Transforming the Nursing Profession

The Affordable Care Act and the changing landscape in health care are among the hot topics of the day. The pace of change requires nursing to be vigilant for the profession and engaged with policy makers, providers and boards who are instrumental in decision making that impacts health care. Education, workforce, and scope of practice are all part of the national conversation. These critical issues that are important to nursing warrant rapid dialogue among informed readers, and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook now offers an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession.

The Institute of Medicine (IOM) Report published in 2010 – THE FUTURE OF NURSING: LEADING CHANGE, ADVANCING HEALTH – set the stage for changing health care forever. This report kick-started national activities and awoke the nursing profession to organize toward maximizing the reach and opportunity for nurses in order to improve health of all citizens. Many of the recommendations launched organizations to begin to take action toward achieving goals by the year 2020. The Robert Wood Johnson Foundation (RWJF), mobilized by the Report with its key partner, the Center to Champion Nursing in America at AARP, were instrumental in creating the Campaign for Action.

Susan B. Hassmiller, Senior Adviser for Nursing with the Robert Wood Johnson Foundation, has been leading the charge from the IOM Report and speaks to the numerous activities underway with national organization partners and all 50 states and the District of Columbia in the “Campaign for Action.” According to the RWJF website, Dr. Hassmiller is shaping and leading the Foundation’s nursing strategies in an effort to create a higher quality of care in the United States for people, families and communities. Drawn to the Foundation’s “organizational advocacy for the less fortunate and underserved,” Dr. Hassmiller is helping to assure that RWJF’s commitments in nursing have a broad and lasting national impact. We asked her to elaborate on her recent article in NURSING OUTLOOK by answering 3 Questions! We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN Editor/Moderator

SueHassmillerSusan B. Hassmiller

Director, Future of Nursing: Campaign for Action

Senior Adviser for Nursing

Robert Wood Johnson Foundation




Question 1: The Robert Wood Johnson Foundation has generated nearly $18 million to date and others have supplemented activities of the Campaign for Action following the Future of Nursing release to move the recommendations and sustain the momentum of this historic IOM report. Can you describe the value of investment supporting a national agenda like this to catalyze change in health policy?

The Robert Wood Johnson Foundation has invested in nursing, really since the beginning of the foundation over 40 years ago. And even before that General Robert Wood Johnson was known for reaching into his very deep pockets. He of course was one of the founders of Johnson and Johnson so he used to reach into his very deep pockets to help both nurses and physicians with scholarships. That’s really where it started.

So why does the Robert Wood Johnson Foundation invest in nursing? Not really just for the sake of investing in nursing but because of nursing’s very close link to how we as nurses impact the overall health and healthcare for all Americans – and that’s really the Robert Wood Johnson Foundation mission, which is to improve the health and health care of all Americans. So investing in nursing is very important – it’s a very important means to an end for us. And ensuring that nurses are the most effective and efficient they can be helps with our own mission, and it helps with the triple aim which is what we are very concerned about too: cost, quality and access.

Our return on investment for everything we are putting into our nursing work … and remember it is not just the support for this IOM report and the campaign as I alluded to … we have been doing this for decades! We still have many investments going on: the Executive Nurse Fellows Program, Nurse Faculty Scholars and our investment in programs like QSEN (Quality and Safety Education in Nursing) and TCAB (Transforming Care at the Bedside). So our return on investment will come in the form of patients or consumers and their families having the most highly skilled and educated nurses available. Having nurses whenever they need them whether in schools or in primary care clinics or in places where they work. And that nurses will help in the equation of keeping our healthcare costs more reasonable! And because of this we will all be healthier and have better healthcare because of our nursing workforce.

Question 2: The Campaign for Action was intended to transform and diversify the nursing profession. With its powerful partners over the past 4 years, what do you consider the most profound changes that have been exemplars of an improved health care system?

Well, when you talk about partners, I think we are all on this journey together. There are so many health care partners, both individuals and organizations – partners with how we are helping to improve our health care system. Nursing can certainly help with that, and Robert Wood Johnson Foundation is betting on this equation. A few examples might include our work around insuring that all nurses practice to the top of their education and training. We care about this for all nurses. Yes. There are a lot of investments being made in ensuring that laws are modernized so that nurse practitioners can practice to the top of their education and training. You know, a recent piece that Nursing Outlook published and RWJF helped to fund called “Practice Characteristics of Primary Care Nurse Practitioners and Physicians” – it was a piece that Peter Buerhaus was involved in – and this research, published in Nursing Outlook found that more nurse practitioners as compared to physicians practice in rural, inner city, and more community health settings, and are much more willing to accept Medicaid patients. This is great news! This is really good news!

So working on advocacy efforts to modernize laws to assure that nurses practice to the top of their education and training, and then to have evidence that shows that nurse practitioners are making a difference for very important populations will really help to push this envelope further. And we really need a breakthrough in this area, don’t we?

And I would be remiss if I did not say, speaking of partners, what a key role AARP is playing in this scenario. They can, without RWJF funding, because we are not allowed to actually be on the ground promoting specific legislation. So AARP can be there supporting all of our 51 Action Coalitions – and we have Action Coalitions in 50 states and the District of Columbia. So they’re supporting our Action Coalitions and our Action Coalitions are crafting their own legislative language for these modernization efforts, and offer technical assistance with the legislative process.

In a last example I would use in talking about partners and how it takes everybody to do this is really our current effort around 10 KN – 10 KN – otherwise known as getting 10 thousand nurses on boards by 2020. So even with 51 Action Coalitions and our campaign headquarters which happens to be at AARP working on this, we can’t do this alone. So we formed a coalition starting with 19 other national nursing association to work on efforts to get 10,000 nurses on boards. And they’re doing this and they’re leveraging each other’s work – leadership training work, websites and the like.

So a final note, we can’t do any of what we’re doing alone. This is a campaign, this is a coalition. By its very definition, we use hundreds of partners. We have policy maker involvement, business involvement, national association involvement, consumer groups … it will take many to see this through.

Question 3: From your perspective, what needs to happen for the collective activities of the Campaign for action to reach a summit of widespread success?

One of the most important recommendations that many are working on (we’re working on at national headquarters at AARP, Robert Wood Johnson Foundation has a separate national program office working on this as well, spearheaded by our own tri-council) is really  the 80/20 recommendation. That means of course getting 80% of all nurses in the country to a BSN or higher. You know many people ask me if I think we will attain that goal but 2020 and I say “you know definitely in pockets we will get there!” But this is really, really hard because  as many new baccalaureate graduates as we have, community colleges are pumping  out just as many graduates on their own. So it’s almost like the dog chasing its tail. We’re getting … there we’re doing it! It’s unbelievable, but there’s just so much work. So by the 2020, we’ll certainly get there in pockets. But what we’re really doing in this campaign with this recommendation and other things is building the infrastructure. We are on a path to build an infrastructure. Community colleges – what do I mean by that? Community colleges are working with universities; memoranda of understandings are being formulated; acceptable transfer credits both in numbers and types are being agreed to; faculty at all sides are working with each other; employers are developing policies about hiring preferences; and continuing education (and who gets recognized and who can go on).

So this is all about building the infrastructure and this takes time. It’s just not simply a matter of counting numbers. The infrastructure must be built. This is about changing cultural and social norms. So in 2020, my goal would be that every nursing student coming out of a community college program, like I did, would fully know, understand, and have the wherewithal to continue his or her education. They would come out and they would say “OK … so this was my first step. This is where I’m gonna’ go now” …  Nursing students don’t have to think about whether they should go on – they just know they will, because the infrastructure is there. They would know that community colleges are only a first stop. That to be a nurse in the United States will take moving on to a BSN. And it’s the same with our 10 KN coalition (ten thousand nurses on boards).

It’s about changing social and cultural norms so that no decision makers, CEO, or persons asking for testimony on Capitol Hill will ever have to think about or wonder whether they should have a nurse on their board or providing testimony. They will just automatically have it because they know that nurses are on the front lines. They are the reality check to any decision that is being  made in this country.  We think it is wonderful that lawyers and doctors and other policy makers are there making decisions, but if we are not there, then those people are making decisions for us and for those we care for … and that’s unacceptable!

Follow-up Question: In closing, do you have anything else to add?

I’m really excited that Robert Wood Johnson Foundation has given me the opportunity and has given our country the opportunity to build this capacity in our nursing workforce. It’s so very important – but what that means is we all have to be involved. I talked about needing partners and that means everyone listening to this today – what does it mean to be involved? Go to the website campaignforaction.org and look up your state. There’s a place where you can click on your state – Alabama, Alaska, Minnesota – see what’s going on there. You can see who your leaders are and you can see how you can personally help make this nursing profession the best ever! This is history in the making and we need everyone.