Read the Full Report by clicking here.
 

The New Jersey Collaborating Center for Nursing (the Center) recently presented current data in an educational forum about the New Jersey nurse and faculty shortage at the State House. The event was sponsored by the Office of Legislative Services and was well received. Geri L. Dickson, PhD., RN, Executive Director, and Linda R. Flynn, PhD, RN, Research Director, graphically described the present and future critical nurse shortage that is compounded by the shortage of nurse faculty. The shortage is global in nature, but the predicted New Jersey shortage is more severe than in many other U.S. states.

Three Shortage Factors

Since its inception, the Center staff has systematically collected data through annual educational capacity surveys of all New Jersey nursing schools, random sample surveys of RNs/LPNs in 2002 and 2006, and a survey of nurses who did not renew their licenses in the 2002/2003 cycle, as well developed and updated the New Jersey Nurse Demand Forecasting Model.  

Meeting their mission to measure, monitor, and forecast the demand for the nurse workforce, the Center has identified three shortage factors that play a major role in the current and projected shortages, which can be used to develop a series of public policy initiatives.

Shortage factor #1 is the aging population, both of the nurse workforce and the population at large. Data from the Center’s most recent research in 2006 indicate that the average age of a New Jersey RN is close to 52 years of age. At the same time the general population is living longer and the fastest growing segment of the general population is those over the age of 85. Taken together, the increasing age of the nurse workforce and the growing demand for healthcare by the general population results in a growing shortage of nurses reaching massive proportions by 2020, unless concerted, deliberate, and well-thought out policies are put into place.

Shortage factor #2 grew out of the current Center study, funded by a grant from the Robert Wood Johnson Foundation and in collaboration with the New Jersey Board of Nursing. The study, conducted under the direction of Dr. Flynn, documents the dissatisfaction of New Jersey nurses with their jobs and, for some, with nursing. The major reasons related to nurses’ dissatisfaction revolve around retirement benefits, salaries, job opportunities, and the work environment. Nurse workload is a crucial factor in their dissatisfaction with more than 50% of the direct care RNs reporting that there were too few RNs and support staff to complete their work. Further, almost 40% reported that because of their workload their ability to identify important changes in patients’ conditions was diminished. Care left undone, such as patient surveillance, documentation of care and patient teaching, are predictors of New Jersey nurses’ job dissatisfaction, burnout and intent to leave their nursing positions.

Nurse burnout is reported by New Jersey nurse respondents to be a growing epidemic. Burnout was measured by a valid and reliable tool developed for other professionals such as firefighters and police officers. Using this tool, more that one/fourth of New Jersey RNs suffer from high burnout, which is identified as emotional exhaustion.  Those respondents who reported burnout were four times more likely to leave their current positions (hospitals and nursing homes reported highest burnout rates).

Shortage factor #3 is the lack of the capacity of New Jersey schools of nursing to meet the growing demand for education by qualified potential nursing students. The schools lack the resources to hire additional faculty and RNs with a graduate degree are in great demand; also, there is a serious disparity between academic salaries and healthcare industry salaries. The salary disparities are further compounded by disparities within universities between such schools as business or engineering and nursing. Adequate clinical placements, laboratory, and classroom space also are problematic for some schools.

Although enrollments and graduations have increased steadily each year since 2002, more that 1,400 qualified students have been denied admission for each of the past three years because of the lack of capacity of New Jersey schools to educate them. In 2005, 1,898 graduates (90% of 2,110 BSN, AD, Diploma graduates) passed the NCLEX RN licensing exam. RNs coming into New Jersey (2,439) surpassed those leaving the state (1,282), with a net gain of over 1,100 new RNs. Schools reported 2,218 openings for new students in New Jersey.  However, 2,979 applicants were enrolled indicating that schools are operating above capacity resulting in an increased workload for faculty.  In spite of steady growth in the capacity to educate RNs, the number of new graduates would have to triple to prevent the 2020 scenario predicted by the U.S. Department of Health and Human Services for New Jersey (42,200 unfilled RN FTEs).

Expert Panel Dialogue

An expert panel responded to the presentations by Dickson and Flynn. Sharon Rainer, RN, MSN, New Jersey State Nurses Association (NJSNA) Associate Director and lobbyist, led a panel that offered testimony that reinforced the presentations and identified the need for action. The panel included Dean Susan Bakewell-Sachs, PhD, RN, President, Association of  Baccalaureate and Higher Degree Programs in New Jersey; Linda Gural, RN, NJSNA President; Robyn Begley, MSN, RN, President, Organization of Nurse Executives/New Jersey; Ann Twomey, RN, President, Health Professionals and Allied Employees; and James Moore,  PhD., Assistant Commissioner, New Jersey Department of Labor. Each, from their own perspective, predicted an ever increasing, serious challenge to New Jersey’s healthcare delivery system and negative outcomes for all of New Jersey’s patients and families.

The panel discussion was followed by audience participation. The dialogue validated the problems identified and some solutions were presented. The downside is that most solutions will require additional funding and public funds are in short supply right now.

In summary, there is a severe shortage of nurses now and in the foreseeable future in New Jersey. Many members of the New Jersey nurse workforce and faculty are aging and will soon retire in 5 to 10 years, thereby, exacerbating the problems  Further, since many nurses are leaving the profession because of the work environment, patient safety, and quality of care concerns, and with educational resources preventing hundreds of qualified students from entering New Jersey nursing schools, immediate legislative and workplace action is vital to ensure that there will be the right nurse, with the right education and work experience, to care for New Jersey patients and aging population.

The New Jersey Collaborating Center for Nursing

The Center was established by legislation on December 12, 2002, but without an appropriation. However, 2003 funding from the Robert Wood Johnson Foundation (RWJF) created a public/private funding partnership between the State of New Jersey and the RWJF. The Center is a future-oriented research and development organization created to develop and disseminate objective information about nurses and the workforce to the Governor, Legislators, and the public at large (NJ P.L 2002, c116). The Center is located in Rutgers University, the State University of New Jersey, College of Nursing, on the Newark Campus.

In addition, the Center has developed several projects designed (a) to ease the transition from one educational level of nurse education to another; (b) inductively developed a competency-based nursing practice model with four levels of practice; and (c) enhanced the image and profession of nurses by distributing a series of posters and CDs to all New Jersey schools that depict the wide variety of workplace options for nurses.

All of the Center’s work is based on the foundational values of: visibility, credibility, and neutrality through a collaborative made up of nurses and other healthcare stakeholders.

Watch for our column in every issue of the Institute for Nursing Newsletter and check out our Web site at http://njccn.org.

The 4th National Conference of State Nursing Workforce Leaders was held at the Hyatt Regency Jersey City on the Hudson on April 27-28, 2006. This national conference was designed for leaders and stakeholders of state-based nursing workforce centers that focus on measures to address long term nursing workforce solutions at the grass roots level. The conference was attended by 155 nursing workforce leaders, nurse educators, and other stakeholders representing all regions of the country with a total of 30 states plus the District. A comprehensive picture of nursing workforce issues was offered with participants and presenters working on providing evidence about education, retention, funding, and public policy. By the conclusion of the two day session, the many facets of nursing practice were addressed through presentation of current evidence and formulation of research and policy questions for the future.

Among the key issues addressed on the agenda were critical analyses of the national nursing shortage both in workforce and faculty settings, the methods and strategies to accurately measure nursing supply and demand, work satisfaction, and the impact of nursing practice on health outcomes. Other topics addressed the development of effective workforce centers, the formulation of public policy and funding to support nursing workforce education and professional development of nurses, and the provision of qualified nursing faculty through nursing education and retention strategies. Presentations also focused on more global issues such as the development of change in nursing practice and work design, national and local health care policy, and the mastery of those skills necessary to communicate the most important needs of nursing practice and education to legislators, foundations, employers, and other stakeholder communities.

Although the details of the current and future nursing shortage have been well established, the conference presentations raised the issues from a variety of provocative viewpoints. Conference participants had the opportunity to hear presentations from nationally recognized researchers in nurse workforce issues. The Thursday keynote was delivered by Sean Clarke, PhD, RN, CRNP, Assistant Professor, and Deputy Director the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, who discussed the current state of research on nurse staffing and work environment and its link to patient safety and stability of the nursing workforce. Dr. Clarke stressed the importance of developing a body of evidence that would support improved patient outcomes and drive health policy reform. A patient safety climate and culture was promoted as a key contributor to reaching desirable levels of nurse satisfaction, competency and staffing.

The Friday keynote was delivered by Julie Sochalski, PhD, RN, FAAN, Associate Professor, University of Pennsylavania School of Nursing, who challenged attendees to critically analyze the nursing shortage as a perception and function of inadequacy of nursing role design in relation to the structure of health care, the relationship to other health care provider roles, and the care needs imposed by trends in aging, chronic illness and health risk factors. Dr. Sochalski discussed the impact of nursing on patient outcome by analyzing the public health need in relation to the capacity of the current infrastructure of our health care system.

Nursing leaders also considered innovative approaches to defining nursing's primary role in the creation of more effective health care delivery and the commitment evidence based practice that will lead to improved patient outcomes. In spite of regulatory trends in the collection of outcome data according to evidence based indicators, the value of nursing practice in addressing our most prevalent diseases and in managing our current health risks has not been utilized in the current health care infrastructure. The nursing shortage will remain in crisis proportions unless strategic change of roles and integration with a more patient centered health care delivery system can be established. Workforce leaders accepted the call to drive change in order to preserve the valuable components of nursing practice.

To further the understanding of nursing shortage and future design requirements, discussions addressed the issues with inconsistent and inaccurate data available to determine the actual number of nurses in the workforce by region and by work setting. Workforce centers are challenged to collect accurate data and to direct policy that will streamline, consolidate, and standardize information on the number of working licensed registered nurses across the country. Variations in data collection practices by State Boards of Nursing have made research and survey activities time consuming and expensive. Accurate data on local, regional, and national nursing workforce trends is vital to educating lawmakers on the nursing role and impact in effectively meeting the national health care needs. Workforce leaders expressed their commitment to collaboration and consolidation efforts to achieve consistency and standardization of nursing workforce data. This unified network will design methods to gather nursing data at the point of licensure and to maintain current records that can be utilized in local and regional research and planning.

Nursing leaders discussed ways to more accurately survey the current workforce and to seek funding from government agencies and private foundations to further the study of student enrollment, nurse retention, and work redesign strategies. Presentations were conducted by a number of leaders outside the nursing profession who were active in the administration of workforce programs, funding, or research. Researchers and executive leaders in the fields of law, sociology, and public health presented their research and program models in areas of survey research, work satisfaction studies, creative funding designs, and workforce center projects.

A common thread throughout all presentations was the expressed need for additional research in all issues related to workforce. Colleagues from large funding sources such as AHRQ and the Robert Wood Johnson Foundation expressed their strong organizational commitment to funding the study of nursing roles, their relationship to other health care providers, work redesign, and the linking of nursing practice to positive health outcomes.

Workforce leaders were invited to partner with large scale funding sources combined with smaller local resources to target studies that will impact populations segmented by health risk, disease, age, or disability. They were encouraged to tap funding resources to support innovative models. Ideas presented ranged from sophisticated virtual clinical learning labs to small consortium of rural hospitals working to improve work environment and outcomes of care in their own organizations. Other models presented ideas such as a community -based collaborative, partnerships offering unique approaches at the local level in targeted funding, support of specific initiatives, and primary involvement of local nursing leadership. Funding opportunities were described in areas of advocacy, policy development, and grant pilot programs.

Workforce leaders and other stakeholders gained insight into the skills and strategies of large scale survey techniques. A panel of experts offered model approaches and their experience in surveys designed to achieve desirable response rates. Discussion included the importance of using findings to create concise and focused information tailored for educating lawmakers and other interested supporters. Successful approaches were evidenced in presentations and in the many posters displayed for review. The efforts of the nursing workforce centers throughout the states included a concerted resolve to support the growth of additional workforce centers nationally while leveraging the current impact with continued collaboration and communication.

All is all, the conference was a success and participants gleaned information to take home as well as the opportunity to network with colleagues with similar interest and experience. Geri Dickson, PhD, RN, Executive Director of the New Jersey Collaborating Center, closed with the idea that the time has come for nurses to play an active role in shaping their future as Victor Hugo emphasized: "Mightier than the tread of armies is an idea whose time has come."

Large Study of Nursing Care and Outcomes Underway in New Jersey!
Reprinted with permission from the Institute for Nursing Newsletter, February 2006.

The second Annual conference of the New Jersey Collaborating Center for Nursing was held on October 24th at the Woodbridge Hilton. The title was "Improving Quality Through Nursing." Approximately 160 persons attended the conference.

Opening remarks and welcome was given by Dr. Judith Mathews, Chair of the NJCCN Board. Dr. Mathews stressed the need to chart new paths but maintain the good from the past.

Dr. Linda Flynn, Research Director at the Center, was unable to attend the conference due to a family emergency. Dr. Geri Dickson presented the research and the nursing education programs that are ongoing at the Center. The research activities at the Center during the past year include a survey of RNs/LPNs in nursing facilities about the important factors in their work environments.

The New Jersey Nurse Survey 2005 being done in collaboration with the University of Pennsylvania and funded by grants from Robert Wood Johnson Foundation and the NJ State Board of Nursing was introduced. One half of all registered nurses in NJ will receive this survey and the importance of responding promptly, either by returning it by mail or on the internet was stressed. The purpose of the study is to identify specific work environment traits across practice settings that contribute to nurses' job satisfaction, patient safety and good patient outcomes.

Dr. Dickson presented the Center's work that clarifies the existing situation for nursing education in New Jersey: programs that produce nurses as well as programs that enhance nursing preparation. Enrollments in diploma, AD and BSN programs have all increased in the past year and the diploma and AD programs are operating well above their capacity. This information regarding the State's ability to produce a supply of nurses is vital for policy development. The Center has formed a partnership with the National League for Nursing. This collaboration will ensure that one educational survey will be developed that will simplify and consolidate information for all nursing schools in the State. This effort will provide one set of numbers to be used by all organizations and will potentially strengthen nursing's voice at policy levels.

Dr. Dianne Cooney –Miner presented the New York State initiative to advance the profession of nursing. The proposed legislation would require that all registered nurses would be required to have a Bachelor's degree within 10 years of being licensed in the State. She discussed education and entry levels for many professions in the US such as social workers, art therapists, athletic trainers and physician's assistants, all who require a college degree. She presented an international perspective on nursing education levels. There was animated dialogue and many interesting questions following this presentation.

Transforming Care at the Bedside" was the topic for the afternoon session. This is a Robert Wood Johnson Foundation project involving 15 sites throughout the country. The purpose of these projects is to change the culture of care for the patient. Dan O'Neal from the James Haley Veteran's Hospital and Maureen White of the North Shore/Long Island Jewish Health System gave excellent presentations regarding their progress to date on this project. One of the main themes from both experiences is the importance of communication—among nursing staff members, with patients and their families, with other health team members and with hospital administration. The main themes for the project are patient centered care, teamwork, patient safety and reliability within a value-added care process.

The evaluation of the conference provided by the participants was excellent. Many nurses expressed appreciation for the new ideas and innovations that they could bring to their own practices. Dr. Cooney –Miner's presentation provided an innovative approach to strengthening the nursing profession within her State and a stimulus for all of us to develop creative approaches to improve the quality of care for our patients.

Read the full press release here: http://www.nln.org/newsreleases/njdataalliance05.pdf

The staff at the Center continues to work on the results of our successful November 1st Conference. Dr. Rice introduced the session, "How to Get There from Here." Many suggestions were made during this participant dialogue. Dr. Rice asked for three pertinent areas for which the Center might develop innovative strategies to reach the desired future of nursing.

After much sorting and sifting of ideas four main areas of concentration evolved that are consistent with the mission and visions of the Center. . The areas that the Center will focus on for the next year are:

RESEARCH

Data collection and analysis Create a research advisory group

INFORMATION

Public information programs on role and value of nurses Maintain a website for nursing information

COLLABORATION

Facilitate collaboration among AD, diploma and BSN programs Assist in creating service and education partnerships Promote Competency-Based Practice Model as a mechanism to mesh quality education and practice

ADVOCACY

Seek funding to stabilize and guarantee the future of the Center Develop a strategy to influence the allocation of State resources for nursing

Volunteers: Many of the participants offered to work with the Center to achieve these objectives. We have attempted to reach all those who volunteered and hopefully they all have been contacted. Several advisory councils are being created to address particular issues.

The staff of the Center currently work in all of these arenas. If you are interested in working on a particular topic, please contact Allison Creary, the administrative assistant, so that we can include you in our communications.

The first Annual Conference of the New Jersey Collaborating Center for Nursing, Strategies for the Future of Nursing," was held on November 1st at the Woodbridge Hilton. Two hundred thirty-eight people registered for the conference.

Following opening remarks by Julia Plotnick, Geri Dickson reviewed the journey of the Center, from Colleagues in Caring to its present configuration as the Center.

Geri raised an essential question: "How do we respond to this nursing shortage?" She suggested that when facilities work with nurses as valued assets and collaborative partners, there are realistic and possible solutions. She presented several new ideas suggested for future solutions, as well as ones that are already being tested in some locations.

Linda Flynn presented data collected from the Educational Capacity Study in 2003 at all schools of nursing in New Jersey. Based on the findings of that study and other survey data, the 2005 NJ Nurse Survey is in the works, in collaboration with Linda Aiken at the University of Pennsylvania. Phase I encompasses data collection while Phase II will link survey data with existing patient databases.

Pamela Thompson, CEO of the American Organization of Nurse Executives, posed the question to the group: What are the principles that can guide us as we try to define our future delivery models and the nurses who will be providing care to our patients? Thompson envisions our guiding principles to fit like puzzle pieces, with one piece connecting to the next. Central to the puzzle is the patient. Pieces that are needed to complete the puzzle are nursing knowledge and caring, user-based care, access-based and synthesized knowledge, the relationships of care and then how we manage the journey.

Nancy Langston, dean and professor of the School of Nursing at Virginia Commonwealth University, captivated her audience at the start by her phrase: TOGETHER WE CAN! THE WORLD AWAITS US! NOW GO! She talked about preferred futures, where nurses can transform words into action. She presented several ideas such as to include adjunct faculty in clinical experiences, surround the nurse with every resource she or he needs to work effectively and efficiently and increase the technology in learning.

Becky Rice summarized the day's presentations and asked each table of nurses to discuss what they had gleaned from the presentations and chose three issues affecting nursing that they felt the Collaborating Center could address in the future.

Evaluations were collected and were very positive. Becky is categorizing the suggestions and will list them according to priorities in relation to our mission. The results will be posted on our website: http://njccn.org

All in all, a very successful 1st conference.

State nursing workforce groups and interested health stakeholders from around the country met in Orlando, Florida, April 29 and 30 for the 2nd Annual Conference of State Nursing Workforce Centers to discuss what is being done at the various state levels to address the current nursing shortage and the chronic, underlying issues that attend it.

The keynote speaker, Dr. Edward O'Neil, Director of the University of California Center for Health Professions, emphasized the need for nurses to own the continuum of service. He advocated that a strengthened nursing leadership needs to "articulate, differentiate, and integrate a full range of nursing service, declare victory, and push ahead." Dr. O'Neil believes that nursing has hampered its development into one strong, unified, respected voice because of fragmentation in the areas of education and timidity in taking hold of the profession and asserting its rightful place in the medical hierarchy.

Dr Geri Dickson, Executive Director of the NJ Collaborative Center for Nursing (NJCCN), presented a poster exhibition showing the development of the Center and the models that were created collaboratively with other NJ healthcare stakeholders. These models included the NJ Forecasting Model, the education Articulation Model, and the NJ Competency-Based Nursing Model. Elementary through high school recruitment posters and DVDs promoting nursing as a profession were also available at the display table.

Nursing Workforce groups from Iowa, North Carolina, North Dakota, Illinois, Vermont, Mississippi, Oregon, California, Wisconsin, and Missouri presented their research or programs that have been conducted in addressing the nursing shortages in their states. Topics centered on education and retention practices and offered a glimpse at the variety of ideas and strategies that are being used to resolve the current and future shortages.

The education speakers looked at funding issues, seamless nursing education curricula, legislative pre-requisites for nursing courses, standardization of admission policies, regional articulation agreements across a state, and model curricula.

Retention Practices included several awards programs that celebrate nursing excellence and strive to encourage and inspire the pursuit of advanced education; a pilot program that actively addressed the four major areas of nursing discontent, i.e., time with patients, intellectual stimulation, healthy workplace cultures and teams, and ergonomics and safety; research that looked at "Nurse's Perception of Workload"; and a second presentation that described a tool to measure the gap between the importance employees place on organizational issues and their perception of organizational performance.

The 3rd Annual Conference of Nursing Workforce Centers will meet in Oregon in the spring of 2005.

The NJ Collaborating Center for Nursing hosted a festive reception on the evening of April 1, 2004 from 5-7 PM during the NJSNA Convention in Atlantic City. The event was well attended with sixty nurses stopping by the beautiful suite at the Tropicana Hotel and Resort. Materials and information about the Center and the Articulation Model for Nursing Education were distributed to the attendees and an opportunity was provided to meet the Center's Executive Director, Dr. Geri Dickson, RN, Ph.D. Lovely refreshments were provided for all to enjoy.

Also present at the reception were several NJCCN Board members. Mimi Cappelli, Interim Board Chair, Sharon Rainer, Barbra Tofani, and Louise DeBlois were on hand to greet the nurses and speak with them informally. Gay Lutton, MSN, MS, RN, who recently joined the NJ Collaborating Center as its Associate Director served as co-hostess for the event.

Ms. Lutton brings a knowledge base in recruitment and retention issues gathered over many years at the bedside and fine tuned at the NJ Department of Human Services where she was the Director of Nursing Recruitment and Retention for four of its Divisions. She is looking forward to and eager to participate in the Center's activities as it discusses and studies the current and future nursing issues that shape nursing's role in the 21st century.

NJCCN made its presence known again on Friday morning when Carolyn Tuella, Ed. D, RN, Chairperson, Division of Nursing, Bloomfield College and Co-chair of the Center's Competency Advisory Group presented the competency nursing practice model that was developed at the Colleagues In Caring and the NJCCN. Her presentation at the NJSNA Convention was entitled "An Integrated Competency Based Nursing Practice Model". A full text describing this model can be accessed on the NJCCN website. The Competency model will soon be published for distribution as well.

The NJ Collaborating Center For Nursing is a primary source for data based evidence to formulate reliable health policy that has a positive impact on nursing care, nursing education, and patient outcomes. The next Board meeting for the NJCCN will be held on May 14, 2004 in the Center's office at Rutgers-Newark. For more information about NJCCN, please visit our website.

   
Richard Aughenbaugh and Barbara Wright                              Guests at the NJCCN Reception        

Hanna Tracy and Maureen Clark-Gallagher

The New Jersey Collaborating Center for Nursing hosted an open house on the afternoon of January 23, 2004. The event was attended by 45 people, who met the Center's board of directors and staff and heard a brief overview of the Center's activities by Executive Director Geri Dickson, RN, Ph.D. and Board Chair Mimi Cappelli.

Assemblywoman Linda Greenstein (D -15th District) spoke to the group about the importance of nursing in health care and of the nursing shortage. Laverne Parish, RN, Acting Supervisor, Newark Department of Health and Human Services, represented the Honorable Sharpe James, Mayor of Newark, and relayed his greetings to those assembled.

Twelve members representing different areas of nursing are currently appointed to the 17-member board. They are: Ms. Mimi Cappelli (NJSNA), Ms. Marianne Duffy NJ-ONE), Dr. Lucille A. Joel (NJSNA), Dr. Judith Mathews (ADSPN), Ms. Kathleen Pavalkis (LPN Educational Council), Ms. Sharon Rainer (NJSNA), Ms. Faith Scott (Home Health Assembly), Dr. Kathi Kendall Sengin (Council of Teaching Hospitals) Ms. Janice Testa (NJ Association of Health Care Facilities), Ms. Barbara Tofani (NJHA), and Ms. Connie Wilson (LPN Nurse Association of NJ). Board members yet to be appointed are the representatives from: the Council of Baccalaureate and Higher Degree Nursing Programs, NJ Council of Associate Degree Programs, the New Jersey League for Nursing, and two public members.

 
                                                                                   Geri Dickson and Assembly woman Linda Greenstein         

 
Annette Hubbard and Lavern Parish.                             Gay Lutton and Sharon Rainer.

 
         Luz Ramos and Bernie Gerard                               Julia Plotnick and Laverne Parish         

 
Linda Greenstin addressing the guests at the open house.

To keep up with our activities, visit our website from time-to-time. Thanks.