Nursing advocates in Oregon are hard at work combating the nurse and nursing faculty shortages that threaten access to health care and the quality of care in the state. Eight years into a focused coalition effort, they've made great progress, along the way developing new and innovative tools that other states are taking advantage of with help from the Center to Champion Nursing in America, a partnership between the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation.

The coalition effort began in 2001, soon after the release of a report by the Northwest Health Foundation which underscored the scope of the coming shortages in nurses and nursing faculty. The Oregon Nursing Leadership Council, a collaboration of the Oregon State Board of Nursing, Oregon Nurses Association, Oregon Council of Associate Degree Programs, Oregon Council of Deans and the Northwest Organization of Nurse Executives, worked to develop a comprehensive, strategic response. Together, the organizations identified five key strategies:

• Doubling enrollment in schools of nursing;
• Transforming nursing education to meet current health care and practice needs; 
• Recruiting nurses and keeping them in the profession;
• Developing staffing models to make the best use of the nursing workforce; and
• Creating an entity-the Oregon Center for Nursing-to execute the plan.

The Tide Turns

In the eight years since, the plan has begun to turn the tide in the state. Early on, the coalition brought nursing leaders together with educators from private nursing schools and community colleges and nurse leaders from hospitals, long-term care and public health for a series of retreats and conferences on how to expand enrollment. Schools responded, partnering with members of the healthcare industry in the state, whose nurses stepped up to help support enrollment increases by taking on instructional duties.

At the same time, the coalition created the Oregon Simulation Alliance to help create and manage simulation labs across the state—now 24 in all, equipped with high-tech mannequins for use in training students.

The coalition began working to draw students to the profession as well, reaching out to high school guidance counselors to acquaint them with the opportunities available in the profession and to encourage them to share that information with students. The relationship with counselors also gave shape to a marketing campaign launched by the Oregon Center for Nursing, aimed at drawing young men into the profession. The cornerstone of the effort was an award-winning poster under the headline, "Are you man enough for nursing?" The poster  featured nine men, dressed for a variety of activities—snowboard gear, rugby clothes, a coat and tie, surgical scrubs, a martial arts robe and more. All of the men are identified as nurses or nursing faculty.

"The counselors told us that if we want more men in nursing, young men have to be able to identify with the profession," says Kristine Campbell, Ph.D., R.N., executive director of the Oregon Center for Nursing. Two years later, a follow-up poster featured a cross-section of Oregon nurses under the headline, "Caring Knows No Boundaries. Be a Nurse." The message, picture and poster text all highlighted the need for nurses from a variety of cultural backgrounds.

The Center has also developed a Nursing Leadership Development Initiative, now in its third year, and a Nursing Workforce Diversity Initiative, supported by  RWJF, focused on diversifying the nursing workforce and increasing cultural competency in the delivery of care.

Measurable Progress

The effort is working. Overall enrollment in nursing programs in the state has doubled since 2001, Campbell says. The University of Portland has tripled enrollment, and it has partnered with Providence Health & Services, a statewide provider, to develop a scholarship program.

"Providence took a look at their nursing work force and decided to direct some of their recruitment funds toward scholarships," Campbell says. The scholarships cover tuition for students' final two years, while the University contributes separately to room and board. In exchange, students agree to a three-year commitment to nursing.

Graduates from the program tend to stay in nursing, Campbell says, noting that 85 percent of the first group of graduates from the program stayed after their three-year commitment was completed. "So it saves Providence money they would otherwise spend on recruitment efforts, and brings more nurses into the profession," she explains.

In addition, Campbell says, Oregon nursing students have a 92 percent success rate on National Council Licensure Examination (NCLEX) tests, leading the nation.

The Center has also developed an innovative system, backed by a web-based software package of their own design, to support students in clinical settings. Working with participation of all the hospitals in the Portland region, the Center has centralized student placement and tracking at clinics, saving considerable time for students, faculty and clinicians. The system allows clinics to fill student slots more efficiently, shrinking the unfilled positions by 25 percent, Campbell estimates. The Center is now selling the software, called StudentMAX, to other states, and the licensing fees are helping to support the Center's work.

Over the years, the Oregon Center for Nursing has expanded to bring in other voices-among them, the state AARP, as part of the national organization's Center to Champion Nursing in America collaboration with the Robert Wood Johnson Foundation. "It's an amazing group of people, very collegial and very effective with leadership from Kristine Campbell," says Joyce DeMonnin, M.P.H., C.H.E.S., director of public outreach for AARP Oregon. "It's important to our members to have quality health care available where and when they need it, because they understand that a well-trained nurse is critical across all care settings. So we're proud to lend our consumer voice to the effort."

Significant challenges remain-including stabilizing funding for the Center and working to continue growing nursing faculties at schools around the state. But progress to date has made a big difference, while also identifying important tools for future work.

In early February, the Oregon Center for Nursing, along with organizations from 17 other states that work with the Center to Champion Nursing in America, will participate in a Nursing Education Capacity Summit in Baltimore, Md., to share ideas and experiences, as well as hands-on strategies for addressing the nurse and nursing faculty shortages, with leaders from additional states.