In Texas, Strategic Alliances and Legislative Champion Key to Success

In 30 states around the country, teams of experts in nurse education, practice and workforce development are collaborating with the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation, to address the looming nursing shortage in ways that make sense locally. Unprecedented levels of collaboration and untold hours of strategic planning and implementing are creating smart solutions to ensure each state’s residents get the health care they need from highly skilled nurses. These efforts succeed best with the support of diverse coalitions and elected officials. In Texas, it was precisely this combination that secured nearly $50 million in state funds for the Professional Nursing Shortage Reduction Program for 2010-2011. This program allows Texas nursing schools to hire more faculty and create educational efficiencies to prepare more nurses and grow the state’s nursing workforce.

When Governor Rick Perry of Texas first learned about the Champion Nursing initiative, he immediately recognized its value, perhaps in part because his First Lady, Anita Perry, is herself a nurse – and an energetic advocate for the nursing profession. The Governor decided the fastest way to get Texas up and running was to create a team himself, then let them get to work. He appointed a mix of leaders from nursing, workforce development, hospital management, education, consumer advocacy and even a state legislator who is a professional nurse. To lead the team, he appointed Alexia Green RN, PhD, FAAN who is a dean and professor at Texas Tech University Health Sciences Center in Lubbock and was already serving on the Governor’s Health Policy Council.

For Green and her team, a high priority is reversing some daunting statistics. In Texas, the need for new nurses in the workforce is projected to rise 86 percent by 2020 even as the supply of new nurses, at current rates, will rise only 53 percent. In 2008, nearly 9,000 Texans who wanted to enter nurse education programs were turned away simply because there were not enough faculty and other resources to educate them. To meet that demand, Texas needs to hire 265 additional full-time and 159 part-time faculty statewide.

In Texas and elsewhere, the shortage of nurses is fast becoming a public health challenge because of aging baby boomers and the specialized health care they will need. Texas already has more than three million residents over age 60, with higher numbers of them living in the state’s rural communities. Those numbers are multiplying each decade, and projections are that by 2040, one quarter of all Texans will be above age 60. The current nursing workforce in Texas, like any state, does not have the specialized skills to meet the changing and often complex health care needs of these older Americans, and to do so in the non-hospital settings where many of these patients will receive care. Legions of new, well-educated nurses will be needed to provide the primary and preventive care, chronic care management, and care coordination that will improve access and quality while still reducing waste and lowering costs.

A few short months after the Texas team was assembled, they published a strategic plan with annual goals and concrete benchmarks to address the nursing shortage. “Goal number one,” says Green “was funding from the state legislature to expand education capacity and double the number of RN graduates by 2013.” However, because most of the team members were state employees working in universities or government, they themselves were unable to lobby for the needed funding; so they turned to allied groups who were seeking solutions to expand the state’s workforce, including the Texas Nurses Association, the Texas Hospital Association, the Texas Association of Business and 13 local Texas Chambers of Commerce.

“The business groups were instrumental in making our plan solidly outcome based and building in a level of accountability that is improving our entire effort,” recounts Green. In particular, at the time funding was being considered, Texas had 98 nursing schools with wide variation in graduation rates. The groups all agreed that directing money to schools with a mediocre record of graduating nurses was the wrong use of resources, so they built mechanisms into the funding bill that would tie dollars to graduation rates and ensure accountability: the schools with rates above 70 percent received funding, but only on condition that they give back the per-student allotment for each graduate short of a promised an 18 percent increase in graduation rates over two years. As for the remaining 50 some schools with lower rates, each was invited to submit an action plan for graduating more nurses and seek approval by the Texas Higher Education Coordinating Board, which is administering the funds. According to Clair Jordan, Executive Director of the Texas Nurses Association and a member of the Champion Nursing team, this uniquely constructive frame from the Texas Association of Business and the local Chambers was invaluable. “They helped us to see the schools as production units that should qualify for funds based on performance,” says Jordan. “Their conviction that precious state dollars should go only to known producers really helped sell our legislative ‘ask’.”

Green and her team also knew a regional model would benefit the sprawling state of Texas. They secured $1 million in American Recovery and Reinvestment Act funds through the Texas Workforce Commission and are currently reviewing regional proposals to put the money to work.

As one of 30 state Champion Nursing teams committed to increasing nursing education capacity to address the looming nursing shortage and educate, build and deploy the nurse workforce of the future, Texas offers an important example of how support from lawmakers and allies is fundamental to any success. This is why all the teams are comprised of representatives from nursing education, state workforce offices, state departments of labor, consumers (often AARP state offices), local business, philanthropies, and others. Through strategic collaborations, they implement changes to nursing education, advocate for policy changes, and address faculty shortages all to increase nursing school enrollment and bring more highly-skilled nurses into the workforce. The Center to Champion Nursing in America provides ongoing technical assistance to help the teams accomplish these critical activities and fosters collaborative learning experiences that link the teams and allow them to share best practices and lessons learned with their peers in other states. The Texas team’s resourcefulness in securing support to advance their goals is a success story they are happy to share