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Assessing the American Association of Neuroscience Nurses' progress on the Institute of Medicine report.

ABSTRACT

The American Association of Neuroscience Nurses (AANN) has worked toward meeting the challenges and addressing the key messages from the 2010 Institute of Medicine report on the future of nursing. In 2012, AANN developed an article summarizing how the association has addressed key issues. Since that time, new recommendations have been made to advance nursing, and AANN has updated its strategic plan. The AANN has assessed organizational progress in these initiatives in a 2017 white paper. This process included review of plans since the initial report and proposal of further efforts the organization can make in shaping the future of neuroscience nursing. The purpose of this manuscript is to provide an overview of the AANN white paper.

Keywords: future of nursing, healthcare leadership, neuroscience nursing, nursing practice, professional organization

The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, presented calls for action-oriented plans for the future of nursing. (1) The American Association of Neuroscience Nurses (AANN) published a white paper in 2012, which identified strategies and recommendations to integrate the 4 key messages of the IOM report: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; (3) nurses should be full partners, with physicians and other healthcare professionals, in redesigning US healthcare; and (4) effective workforce planning and policy making require better data collection and an improved information infrastructure. (2) Since that time, the IOM has become known as the National Academies of Sciences, Engineering and Medicine (NASEM), and the Robert Wood Johnson Foundation has asked NASEM to convene a committee to assess the progress of recommendations. The NASEM report, "Assessing Progress on the IOM Report: The Future of Nursing," was released in December 2015. (3)

The AANN has continually worked toward meeting the challenges. In 2012, AANN published a white paper with recommendations to address the IOM call to action. (2) In response to the NASEM report, AANN completed an updated strategic planning process, revising the organizational mission and vision and selecting key initiatives in 2015. In May 2016, the AANN Board of Directors (BOD) updated the 2012 AANN IOM white paper to (1) assess organizational progress toward achieving the 2012 AANN white paper recommendations and (2) address the recommendations in the NASEM report. (3) Being indispensable to nurses and neuroscience health, AANN developed a strategic plan that aligns with the 2010 IOM report and ensures AANN's support of the future of neuroscience nursing. This white paper is a summary of AANN's progress in implementing the 4 key messages of the IOM report and proposal for initiatives to address the 10 recommendations from the NASEM report. This article summarizes the 2017 AANN white paper. (4)

This summary is organized according to the original 4 IOM key messages and an additional key message focused on diversity. Within each of these 5 sections, the 10 associated NASEM recommendations are noted. A table of AANN's progress can be found in the AANN white paper. (4)

Key Message 1: Nurses Should Practice to the Full Extent of Their Education and Training

The AANN has progressed toward this goal on 2 major fronts: (1) scope of practice and (2) transition to practice. The AANN strategic plan calls for regular updates to the scope and standards. The AANN collaborates and is an organizational affiliate with the American Nurses Association. In 2012, a task force was formed to align the scope and standards of AANN with the American Nurses Association by integrating advanced practice registered nurses' (APRNs) scope of practice with bedside nurses. The AANN has disseminated their scope and standards (5) and will update this document in 2017. Members of the AANN have been given a forum at the AANN annual meeting to present their efforts regarding scope of practice and experiences with policy makers. The 2017 AANN Annual Meeting will provide these forums through the AANN Advocacy Committee Session and a leadership educational track focused on policy change.

The AANN supports graduate nurse residency programs but has not formally contributed directly to the formation of a transition-to-practice neuroscience nurse residency program or curricula. However, several approaches to offering resources for, and collaboration with, training to develop competency-based programs are being actively considered by AANN, and a position statement is being developed. This statement will be available on the AANN Web site in 2017. (6) The 2017 white paper now includes a recommendation for creating and funding transition-to-practice neuroscience programs that may be delivered in a variety of models. (4)

Key Message 2: Nurses Should Achieve Higher Levels of Education and Training Through an Improved Education System That Promotes Seamless Academic Progression

As of August 22, 2016, 51.3% of AANN membership attained their Bachelors of Science in Nursing as their highest degree earned, which was comparable with national registered nurse (RN) rates, and 33% achieved higher degrees. (3) To date, there is a lack of conclusive evidence regarding the direct benefit of lifelong learning via certification or credentialing to patient outcomes. (1,7-10) As a member of the American Board of Nursing Specialties, the American Board of Neuroscience Nursing supports research efforts identifying concrete measures that demonstrate the impact of nursing certification on patient outcomes.

The AANN has progressed toward this goal by securing a learning management system (LMS). The first LMS project is a stroke-certified RN review course. Future plans include a certified neuroscience RN review course and a basic "Neuro 101 Essentials" course to enhance training for new neuroscience RNs. (11) The AANN continues to be an accredited provider of continuing education units, and major educational efforts include a stroke conference, annual meetings, and continuing education units through the Journal of Neuroscience Nursing. In addition, publications such as AANN's Clinical Practice Guidelines (12) and the AANN Core Curriculum for Neuroscience Nurses, AANN Comprehensive Review for Stroke Nursing, social media, and special focus groups help to disseminate best practice. (13,14) The 2017 white paper addresses the importance of creating entrepreneurial professional development education, as well as a comprehensive core of clinical performance competencies. In the 2017 white paper, AANN added a recommendation that AANN partner with Agnes Marshall Walker Foundation (AMWF) in offering support for academic and educational pursuits inclusive of focused content for APRNs at face-to-face meetings.

Key Message 3: Nurses Should be Full Partners With Physicians and Other Healthcare Professionals in Redesigning US Healthcare

The AANN has made progress toward addressing the recommendations made in the NASEM report by creating multilevel leadership programs and including in the strategic plan a focus that includes a mentoring program. (3) The AANN has partnered with many professional organizations (Supplemental Digital Content 1, available at http://links.lww.com/JNN/A87). Members of the AANN also serve on executive boards with allied organizations representing AANN on key initiatives. Leadership programming is offered annually at meetings. Leadership opportunities are also offered in board positions, chapter and committee roles, and advocacy program opportunities. Although AANN has not implemented the recommendation to solicit input from strategic partners such as chief executive officers, government, and corporate entities, an additional recommendation in the 2017 white paper addresses the importance of AANN offering interdisciplinary development programs that focus on leadership to prepare the membership for leadership positions in not only AANN, American Board of Neuroscience Nursing, and AMWF but also outside healthcare organizations.

The 2017 white paper addressed expansion of the scope of communication strategies through increased communication efforts to the public and consumers. Messages would focus on improving neuroscience health and healthcare through the development of materials published in collaboration with industry partners.

Key Message 4: Effective Workforce Planning and Policy Making Require Better Data Collection and an Improved Information Infrastructure

Limited data have been collected on neuroscience APRNs, RNs, and licensed vocational nurses regarding educational level, area of practice, and scope. The AANN collects data about members, but these data elements are limited and proprietary. The purchase of a new LMS represents an investment in information systems and technology. This facilitates data collection and data mining for data-driven decision making. Refining the mission and vision of the organization with strategic planning in 2015 has clarified the organizational messaging and has facilitated partnership development with memoranda of understanding identifying relationship details (SDC 1).

Surveys are used as a tool to engage membership regarding a variety of issues and to help inform program planning. A variety of liaisons have been established with mission-similar organizations providing opportunities for discussion regarding effective workforce and organizational planning.

The AANN strategic plan calls for the organization to explore a mechanism to collect and analyze data to report neuroscience nursing-specific quality outcomes. The AANN should consider aligning member data collection with the data elements suggested by the National Forum of State Nursing Workforce Centers. The 2017 white paper calls for AANN to engage with the Campaign for Action and fellow specialty nursing organizations to identify whether any collaborated efforts for workforce-related data may be initiated. This should include consideration of sharing membership workforce data.

With regard to policy making, the AANN has secured memoranda of understanding with multidisciplinary healthcare liaison organizations. The AANN solicits membership opinion and participation in advocacy activity such as the development of measurement sets. An initiative of the 2015 strategic plan calls for AANN to expand the efforts of the Advocacy

Committee by considering the need for and development of position statements from the organization (Value of Certification in Neuroscience Nursing (15) and the Impact of Neuroscience Nursing on Quality of Care and Health Outcomes (16)). Since 2012, the Advocacy Committee has received more than 55 requests for support or review. The AANN leadership participates in the Nursing Organizations Alliance, which provides the opportunity to learn about health policy. The Advocacy Committee sends 1 committee member annually to the Nurse in Washington Internship. An advocacy toolkit has been developed and is available to members. (6)

The recommendation to monitor healthcare polices is partially addressed in board meetings via an "environmental scan" to identify external opportunities and threats that influence healthcare and AANN. This is also accomplished in Advocacy Committee activities. Although the recommendation to assess the transformative effect of policies has not yet been implemented, the 2017 AANN white paper recommendations support that AANN should evaluate the value of developing an advocacy Webpage so that members can readily learn about and participate in advocacy efforts. The AANN should also consider LMS or Webinar resource development regarding advocacy or partnership with other organizations with existing materials. Although the 2012 paper advocated for AANN to assess the actual or potential transformative effect of policies on neuroscience nursing practice and the organization overall, this is limited by lack of data and support. The 2017 white paper supports efforts to target funding via an AMWF grant.

Key Message 5: Diversity

The "Future of Nursing: Campaign for Action" (the Campaign) was formed by the American Association of Retired Persons and the Robert Wood Johnson Foundation soon after the release of the original IOM report in 2010. Their purpose, in partnership with the Center to Champion Nursing in America, is to shepherd the implementation of IOM recommendations. The efforts of the Campaign focus on 6 areas, in which one promotes diversity. The AANN data show that the organization lags behind national data related to diversity (Table 1). According to a 2013 survey conducted by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers, 55% of the national RN workforce are 50 years or older, (17) whereas 33% of the surveyed AANN membership reported their age as 50 to 59 years. Neuroscience nursing by nature includes a diversity of subspecialties. Furthermore, there are many educational levels within the membership. It is with this knowledge that AANN has added age, specialty, area of practice, and level of education within the operational definition of diversity and seeks to address these factors within the most current strategic plan.

During the fall 2015 strategic planning session, the AANN board identified goals with initiatives and tactics addressing diversity. These include (1) recruitment and engagement, (2) creation of a board-level role focused on diversity, and (3) offering of diverse education options (LMS, in person, Webinar, print) to address a variety of educational needs (specially and level of practice). The BOD has noted that increased diversity on committees feeds into a diverse BOD. The strategic plan calls for the creation of a virtual chapter to meet the needs of geographically diverse membership that may have no local chapters or have barriers to travel. The annual meeting is held in different "destination cities" within the United States so that travel may be less of a burden for attendees from a variety of locales. Communication with members is accomplished electronically via newsletters and calls for opportunities to apply for board positions, as well as other work groups, such as the clinical practice guideline group. This strategy allows members from all locations, ages, and specialties to participate in a variety of professional activities.

The 5 new AANN recommendations for diversity are as follows: (1) the most effective way to increase nursing workforce diversity is to increase nursing student diversity. The AANN should encourage members to participate in career days and job fairs at their local schools of nursing and high schools to highlight neuro-science nursing. (2) Given that socioeconomic status is a large barrier for many pursuing advanced degrees in nursing, (3) AANN should partner with AMWF to consider targeted scholarship programs. (3) The AANN should continue to explore the needs of all members for educational programs to include novice-to-expert and advanced practice offerings. (4) The AANN should explore the availability and feasibility of partnering with more minority nursing organizations. (5) The AANN should continue to improve and expand the collection of data related to membership demographics to ensure that the organization is as inclusive as possible.

Conclusions

The future of neuroscience nursing is strong. The AANN seeks to connect, educate, and inspire nurses as leaders who influence comprehensive neuroscience health. As the leading authority in neuroscience nursing, AANN seeks to continually assess our progress in moving forward the initiatives first proposed with 2010 IOM report on the future of nursing. The AANN has made significant progress since 2012 but has additional opportunities to move our profession and specialty forward. The 2017 white paper provides a proposal for further change by tethering our organizational efforts to the broad vision in the 2010 and 2015 recommendations. It is hoped that dissemination of the 2017 white paper will not only educate key stakeholders of AANN's involvement but also serve as an impetus for membership to engage in developing programs and implementing the key messages at local levels.

References

(1.) Institute of Medicine (IOM). The Future of Nursing: Leading Change, Advancing Health. 2010. Washington, DC: National Academies Press.

(2.) Hinkle JL, Sullivan C, Villanueva N, Hickey JV. Integrating the Institute of Medicine future of nursing report into the American Association of Neuroscience Nurses strategic plan. J Neurosci Nurs. 2012;44(3):164-167.

(3.) National Academies of Science Engineering and Medicine (NASEM). Assessing Progress on the Institute of Medicine Report: The Future of Nursing. 2015. Washington, DC: National Academies Press.

(4.) Madden LK, Hundley L, Summers D, Villanueva N, Walter SM. Assessing Neuroscience Nursing Progress Toward the Future of Nursing. 2017. American Association of Neuroscience Nurses. http://aann.org/IOM

(5.) American Association of Neuroscience Nurses. Neuroscience Nursing: Scope and Standards of Practice. Silver Spring, MD: American Nurses Association; 2013.

(6.) American Association of Neuroscience Nurses (AANN). Advocacy committee. 2016. http://aann.org/about/advocacy. Accessed December 27, 2016.

(7.) Hickey JV, Unruh LY, Newhouse RP, et al. Credentialing: the need for a national research agenda. Nurs Outlook. 2014; 62(2):119-127.

(8.) Johantgen M. Overview of the State of the Research. Paper presented at: IOM Standing Committee on Credentialing Research in Nursing; January 14, 2013, Washington, DC.

(9.) Newhouse R. Understanding the Landscape and State of Science in Credentialing Research in Nursing. Paper presented at: IOM Future Directions of Credentialing Research in Nursing: A Workshop; September 3, 2014, Washington, DC.

(10.) Institute of Medicine (IOM). Future Directions of Credentialing Research in Nursing: Workshop Summary.

(2015.) Washington, DC: National Academies Press.

(11.) American Association of Neuroscience Nurses (AANN).

(2016.) http://aann.org/. Accessed December 27, 2016.

(12.) American Association of Neuroscience Nurses (AANN). Clinical practice guidelines. 2016. http://aann.org/publications/clinical-practice-guidelines.

(13.) Bader MK, Littlejohns LR, Olson DM. AANN Core Curriculum for Neuroscience Nursing. 6th ed. Glenview, IL: American Association of Neuroscience Nurses; 2016.

(14.) Livesay S, American Association of Neuroscience Nurses. Comprehensive review for stroke nursing. 2014.

(15.) American Association of Neuroscience Nurses (AANN).

A position statement on the value of certification in neuroscience nursing. 2015.

(16.) American Association of Neuroscience Nurses (AANN). A position statement on the impact of neuroscience nursing on quality of care and health outcomes. 2015.

(17.) American Association of Colleges of Nursing. Nursing faculty shortage fact sheet. 2015. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage. Accessed December 13, 2016.

Questions or comments about this article may be directed to Lori Kennedy Madden, PhD RN ACNP-BC CCRN CNRN, at lkmadden@ucdavis.edu. She is a Clinical Nurse Scientist, UC Davis Health, Sacramento, CA; Associate Clinical Professor, UCSF School of Nursing, San Francisco, CA; and a member of the AANN Board of Directors.

Lynn Hundley, MSN RN CNRN CCNSANVP, is Director, Clinical Effectiveness - Stroke Care, Norton Healthcare, Louisville, KY.

Deborah Summers, MSN RN ACNS-BC CNRN SCRN, is Advanced Practice Nurse, CV and Stroke Outcomes, St. Luke's Hospital, Kansas City, MO.

Nancy Villanueva, PhD CRNP BC CNRN, is Neurosurgical Nurse Practitioner, Temple University, Philadelphia, PA.

Suzy Mascaro Walter, PhD APRN FNP-BC CNRN, is Assistant Professor, West Virginia University, School of Nursing, Morgantown, WV.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jnnonline.com).

Copyright [c] 2017 American Association of Neuroscience Nurses
TABLE 1. Reported IOM and AANN Membership Diversity

Group             NASEM        AANN Membership
                  Data, (1) %  Poll, (a) %

African           10.70        3.59
American
Hispanic/Latinos   5.60        3.98
Men                9.20        6.93

Note. AANN = American Association of Neuroscience Nurses; IOM =
Institute of Medicine; NASEM = National Academies of Sciences,
Engineering and Medicine.
(a) Internal data from AANN (2016).
COPYRIGHT 2017 American Association of Neuroscience Nurses
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

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Title Annotation:EXECUTIVE SUMMARY
Author:Madden, Lori Kennedy; Hundley, Lynn; Summers, Deborah; Villanueva, Nancy; Walter, Suzy Mascaro
Publication:Journal of Neuroscience Nursing
Article Type:Report
Date:Jun 1, 2017
Words:3073
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