Nursing Leadership Survey (RN/LPN) Outcome Analysis. Nebraska Action Coalition

Transcription

1 Nursing Leadership Survey (RN/LPN) Outcome Analysis Nebraska Action Coalition Juan-Paulo Ramírez, Ph.D. Independent Consultant June 2013

2 Contents Summary... 3 Introduction... 5 Survey... 5 Survey Sample Size... 5 Response rate... 6 Margin of error... 6 Results... 6 Demographics... 6 Geography... 7 Items... 9 Recommendations...28 Building different scenarios to increase leadership participation by nurses...28 Main findings...35 Appendix...37 Nursing Leadership Survey (RN/LPN) sent to nurses...41 References...42 Page 2 of 43

3 Summary The Nursing Leadership Survey (RN/LPN) was analyzed using statistical and geomapping methods. A total of 1,140 nurses in the State of Nebraska responded to the survey, with a response rate of 57% (see Appendix for questionnaire). Respondents were mostly Registered Nurses, female, White, highly educated, living in cities over 2,500 inhabitants. Nurses with Bachelor degrees tend to concentrate in rural areas (< 2,500 inhabitants), and nurses with master/doctorate degrees tend to serve in larger cities. Results indicated that nearly half of respondents were serving in a decision-making body/ board, and six out of ten of them serve in Nursing Professional Associations (NPAs) or Health Care organizations. The lowest participation of nurses was in political offices (less than 1%), followed by businesses (2%), and community/civic organizations (5%). Nurses feel that NPAs are the mostly likely place where they can find open leadership opportunities. Results show that those nurses currently serving in organizations are more likely to become members of a decision-making body/board, they feel better prepared and are more likely to receive training support than those who do not serve. Nurses indicated that General training would be the most helpful assistance they would benefit from followed by Identify organization where to serve. In fact, when asked what kind of suggestions they might have in order to advance nurse leadership, the majority of nurses mentioned Information and Advertisement followed by being more involved in the Legislative process. Four out of ten nurses serve with two or more organizations. Those who serve in NPAs are more likely than any other group to serve with two or more organizations. Those serving in non-profits, community/civic organizations, and businesses tend to also serve in more than one organization. Three out of ten nurses are appointed/elected leaders of a decision-making body, and 60% of them belong to NPA/Health care organizations located in urbanized areas. Finally, three strategies are proposed to identify nurses who are the most likely to engage in active leadership. These strategies are built upon selecting specific questions of the survey, and through the use of geomapping techniques those Page 3 of 43

4 nurses responses are depicted on maps. As a result of this analysis, a total of 191 nurses are selected as potential candidates to become leaders in decision-making body/boards. Page 4 of 43

5 Introduction The Institute of Medicine s report titled The Future of Nursing: Leading Change, Advancing Health published in established four key messages as part of the recommendations for the future of nursing. Key message #3 indicated that Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. In order to fulfill this goal, the report calls for a strong leadership driven by nurses at all levels (i.e., hospitals, communities, schools, boards, and political business arenas) to redesign the healthcare system at the local and national level (pages xii and 8). In order to acquire information regarding leadership activities taken by nurses in Nebraska, the Nebraska Action Coalition ( designed an online survey, in which the primary objective was to measure the level of involvement that Nebraska nurses have in decision and policy-making leadership roles. A secondary objective was to measure what kind of training and skills nurses would like to acquire to become active and efficient role leaders. This report presents the analysis and outcomes of this survey. Survey A total of 16 items were included in the online survey (see Appendix for list of questions). Constant Contact online service ( was used to submit the survey to nurses across Nebraska. The survey was lunched on March 15, 2013, and closed on April 17, Survey Sample Size Calculations to estimate the survey sample size were based on a total population of 24,000 nurses, a margin of error of 4%, at a confidence level (α) of 95%. Thus, the number of respondents needed was 586. Additionally, a response rate of 50% was estimated (percent of participants who will actually respond to the survey), which gave a total number of potential participants of 1, Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. National Academies Press. Page 5 of 43

6 Response rate The survey was taken by 1,160 (2) participants, 20 of them were out of state, therefore a total of 1,140 valid surveys were analyzed. A total of 652 surveys were fully completed, which exceeded the minimum of 586, and 488 surveys were partial. The percentage of respondents who completed the survey was 57.19%. Margin of error Based on the total number of valid surveys received (n = 1,140) and the total population of nurses (n = 24,000), a 2.83% of margin of error was obtained. Results Demographics RNs and LPNs: The majority of respondents to the leadership survey were Registered Nurses (98%) and 2% were Licensed Practical Nurses. Gender: A total of 621 females (95%) and a total of 31 males (5%) indicated their gender in the survey. This percentage is similar to the ones obtained in the Nebraska nurse renewal surveys. Race/ethnicity: The majority of respondents were White (96.3%), followed by Hispanic (1.2%), African American (0.9%), Other (0.8%), Asian (0.6%), and Native American (0.3%). These percentages are also similar to the ones obtained in the Nebraska nurse renewal surveys. Education: 52% of respondents hold bachelor degrees, followed by master degrees (37%), and doctoral degrees (Ph.Ds, DNPs, and Ed.D.s) which represent 11% of the total sample. Figure 1 shows the distribution of nurses by educational degree. 2 A total of 1,161 surveys were collected but one of them was included for testing. Page 6 of 43

7 Doctorate 11% Bachelor 52% Master 37% Figure 1: Education degree of respondents Geography As indicated, 20 surveys were not included in the analysis as they were out of state (14 of them came from Iowa State). Those received from Nebraska (n = 652), encompasses 47 counties, representing a total of 80 cities; 48 classified as rural, three classified as urbanized areas (Bellevue, Lincoln, and Omaha), and 29 were classified as urban clusters 3. Three-fourths of respondents are from Madison, Douglas, Sarpy and Lancaster counties. Figure 2 shows the distribution of nurses according to this classification. 3 The U.S. Census Bureau classifies populated areas as follows: Urbanized Areas (UAs) of 50,000 or more people; Urban Clusters (UCs) of at least 2,500 and less than 50,000 people. Rural encompasses all population, housing, and territory not included within an urban area. Page 7 of 43

8 Figure 2: Geographic location of respondents Overall, 12% of respondents are from rural areas, 23% from urban clusters, and 65% from urban areas (Figure 3). Urban Clusters 23% Rural 12% Urban Areas 65% Figure 3: Location of respondents by geographic unit Page 8 of 43

9 Items Question 1: Do you currently serve on any decision-making bodies/boards (e.g., professional nursing organizations/boards, church, school, non-profit, city/county board, health care org, committee, political office)? Forty-nine percent of respondents (n = 551) serve on decision-making body/board and 51% do not (n = 584). When analyzing the geographic location of those who serve, sixty percent of nurses who serve live in urban areas (> 50,000 people), 26% live in urban clusters (> 25,000 < 50,000 people), and 14% in rural areas (<2,500 people). Figure 4 shows the level of involvement by nurses on decision-making body/boards by geographic location. Urban Clusters 26% Rural 14% Urban Areas 60% Figure 4: Geographic location of nurses who serve Education: When analyzing based on education level of those who serve, nearly three-fourths of doctorate respondents (78%) mentioned that they serve on a decision-making body/board, followed by nurses who hold a master degree (61%), and followed by nurses who hold a bachelor degree (50%). A higher proportion of nurses with bachelor degrees serve in rural areas than those who hold master and doctorate degrees (14%, in comparison to 7% and 2% respectively). This difference was statistically significant (Z = , p <.05). See Table 1 for details. Page 9 of 43

10 Table 1: Nurses serving on decision-making body/boards by level of education and geographic location Total # of nurses by Geographic location Q1. Serving (YES) Q1. Serving (NO) Doctorate Master Bachelor (n = 54) (n = 174) (n = 248) Rural 2 Rural 13 Rural 25 UA 41 UA 112 UA 185 UC 11 UC 49 UC (78%) Rural 1 UA 30 UC (22%) Rural 1 UA (61%) Rural: 8 UA: 62 UC: (39%) Rural: 5 UA: 50 UC: (50%) Rural 17 UA 82 UC (50%) Rural 8 UA 103 UC 13 Page 10 of 43

11 Question 2: What category best describes the decision-making bodies/boards on which you currently serve? (Check all that apply). Sixty percent (59.8%) of respondents who already serve, they do so on a decision making-board linked to a health organization (i.e., nursing association -35% 4 or health care organization -25%). Non-Profits is the third most important organization where nurses serve (11%), followed by Faithbased (10%), Community (5%), Business (2%), and Political (< 1%). Other category represents 11% of preferences. 60% Nursing/Health care org. 40% 35% 35% 30% 25% 25% 20% 15% 10% 5% 0% 11% 10% 5% 2% < 1% 11% Figure 5: Type of organization where respondents serve 4 Vandenhouten et al., (2011) reported 30% of nurses who were members of a nursing organization. Page 11 of 43

12 Number of organizations served by participant It was found that over one-third (37%, n = 193) of nurses serve on two or more organizations. Table 2 shows the number of organizations served, and the number and percentage of nurses who serve in one or more organizations. Table 2: Number and percentage of nurses serving in one or more organizations Number of Organizations Serving Frequency (number of nurses) Percentage 63% 24% 10% 2% 1% 0% Total % Those who serve in professional nursing associations (PNAs) are more likely to be members of more than one organization. In fact, one out of two nurses who serve in PNAs is also a member of other organizations, most likely a Health Care organization. When comparing with all other type of organizations, this difference was statistically significant (Z = 4.578, p <.0002). Nurses serving in non-profit, community/civic, and business organizations tend to be involved in two or more organizations. Those who are members of Faith-based organizations tend to serve proportionally less in other type of organizations. Faith-based organizations were mentioned as a second option for those serving in Health Care organizations, Non-profits, and Community/Civic organizations. See Table 3. Page 12 of 43

13 Table 3: Percentage of organizations served on by nurses Organization Professional Nursing Association (n = 183) Percentage of Organizations Served on 3 org 14% 4org 2% Second and third organization option 2 nd : Health Care (23%) 3 th : Faith-based (21%) 2 org 34% 1 org 50% Health Care Organizations (n = 133) 2 org 16% 3 org 6% 2 nd : Faith-based (12%) 3 th : Non-profits (6%) 1 org 78% Non Profit (n = 60) 3 org 4 org 2 nd : Faith-based (22%) 10% 3% 3 th : Health Care (18%) 2 org 25% 1 org 62% Faith-based (n = 52) 2 org 8% 3 org 9% 2 nd : tied between Health Care (8%) and non-profit (8%) 1 org 83% Community (n =29) 5 org 4 org 2 nd : Faith-based (38%) 10% 4% 3 th : Non-profit (21%) 3 org 14% 2 org 24% 1 org 48% Page 13 of 43

14 Organization Business (n =10) Percentage of Organizations Served on 4 org 20% Second and Third organization option 2 nd : tied between Health Care organization (30%) and non-profit (30%) 3 org 30% 1 org 50% Political (n = 4) 2 nd : community/civic group (all 4 respondents to political serve in 5 org this kind of setting as well) 25% 2 org 75% Other (n = 57) 4 org 5 org 2 nd : Community/Civic (12%) 2% 2% 3 th : Faith-based (11%) 3 org 2% 2 org 24% 1 org 70% Organizations served by geographic location As discussed previously, rural areas offer fewer opportunities for nurses to serve as members of bodies/boards organizations. Page 14 of 43

15 When analyzing the geographic location of organizations where nurses serve, nine out of 10 nurses who are members of NPAs/health care organizations live in cities over 2,500 inhabitants (urban areas + urban clusters). In comparison, eight out of 10 nurses who serve in non-health related organizations live in cities. This difference is statistically significant (Z = , p = ). See Table 4. Table 4: Distribution of nurses according to where they serve Serving in NPAs/Health Care (n = 206) Serving in non- NPAs/Health Care (n = 143) Geographic Location: Rural 18 (9%) 29 (20%) UA UC Total cities over 2,500 inhabitants (UA + UC) 188 (91%) 114 (80%) In terms of education, nurses with master degree tend to serve proportionally more in non-npas/health care organizations than in any other type of organizations (Z = , p < 0.05). No significant differences were found between Bachelor and Doctorate degrees. Table 5: Level of education and organization type where nurses serve Education: Serving in NPAs/Health Care (n = 171) Serving in non- NPAs/Health Care (n = 96) Bachelor 81 (47%) 40 (42%) Master 59 (35%) 45 (47%) Doctorate 31 (18%) 11 (11%) Page 15 of 43

16 Question 3: Do you serve as an appointed/elected leader on any of the following decisionmaking bodies/boards of which you are a member? Overall, 29% of respondents (n = 334) are appointed/elected leaders of a decision-making body. Results show that two-thirds of nurses who are appointed/elected members serve in NPAs/health care-type organizations, followed by Faith-based organizations, non-profit organizations, communities, other, and business. See Figure 6. 40% 38% 35% 30% 25% 20% 15% 28% 22% 20% 13% 10% 5% 3% 6% 0% Figure 6: Percentage of elected nurses by type of organization Analysis was conducted to evaluate whether the geographic locations of respondents were correlated with the type of organizations where they serve. Results indicate that urbanized areas attract a higher proportion of respondents who serve as elected leaders in NPAs/health care organizations in comparison to those who live in rural or urban clusters. Nearly two out of three nurses who serve in a Page 16 of 43

17 nursing professional association or health care organization live in an urban area of over 50,000 people. See Figure 7. URBAN CLUSTERS 29% RURAL 9% URBANIZED AREAS 62% Figure 7: Percentage of nurses serving in NPAs/Health care organizations by geographic location When comparing nurses who serve in Non-NPAs/Health care organizations (i.e., faith based group, non-profit, business), rural nurse participation increased to 26%, similar to nurses who live in urban clusters (27%). Still, 47% of nurses who serve in this kind of organization are located in urbanized areas. See Figure 8. URBAN CLUSTERS 27% RURAL 26% URBANIZED AREAS 47% Figure 8: Percentage of nurses serving in non-profit organizations, community civic group, faith-based group, business or other by geographic location Page 17 of 43

18 Question 4: Do you currently serve in an elected political office (ex: mayor, village board, county board)? Only five respondents (< 1%) indicated that they serve in a political office. Two of them are from rural areas, two from urban areas (Lincoln and Omaha), and one is unknown. Question 5: In what political office have you been elected to serve? Because of the low number of answer (n = 5), and to protect anonymity of the respondents, names of the political offices are not disclosed. Question 6: Have you ever been elected to a political office (ex: mayor, village board, county board)? Ten respondents (< 1%) have been elected to a political office. Four of them have been elected in rural areas, five in urban areas, and one is unknown. Question 7: In what office were you elected to serve? Because of the low number of answers (n = 8), and to protect anonymity of the respondents, names of the political offices where nurses were elected to serve are not disclosed. Page 18 of 43

19 Question 8: Are you interested in serving on a decision-making body/board? Overall, 52% of respondents (n = 581) mentioned that they would like to serve on a decision-making body/board. A total of 534 respondents (48%) mentioned that they were not interested in serving. See Figure 9. No 48% Yes 52% Figure 9: Would like to serve on a decision-making body/board From question # 1 in the survey (serve on a decision making body/board), nearly 50% of respondents indicated that they do participate in decisionmaking bodies/boards. When asked whether they would be interested in serving on a decision-making body/board (question #8), 58% answered they would. Those who answered that they do not currently participate in a decision-making body, 45% indicated that they would be interested in being part of a body/board. See Table 6 for details. This result shows that nurses who already serve at any capacity (church, school, non-profit, NPAs/health care organizations) are more likely to become members of a decision-making body/board in comparison to those who do not serve (Z = 4.221, p <.0002). Page 19 of 43

20 Question 9: Do you feel prepared to serve on a decision-making body/board? A total of 461 nurses (40%) indicated that they feel prepared to serve. In contrast a total of 115 nurses mentioned that they did not feel prepared (10%). Nearly 88% of those who already serve (question #1), are interested in serving on a decisionmaking body/board (question #8), and feel prepared to do so (question #8, n = 320 & question #9, n = 280). Thus, only 12% answered that they did not feel prepared. Those who already serve (question #1) feel much better prepared than those who do not and that difference was statistically significant (Z = 6.796, p <.0002). Question 10: Would you be interested in receiving support of some kind (i.e., mentoring, education) to help prepare you for serving on a decision-making body/board? Overall, 43% of nurses (n = 492) who answered the survey mentioned that they would like to receive some kind of support. This represents 83% of those who indicated that were interested in serving (question #8, n = 320 & question #10, n = 267). Most nurses (48%) who already serve would like to receive some kind of support, in comparison to only 9% who are not interested. Table 6 combines responses to question #1 (serving), question #8 (interested in serving), question #9 (feel prepared), and question #10 (interested in receiving support). Those who already serve are more likely to receive training support than those who do not and that difference was statistically significant (Z = 3.374, p = ). When combining question #8 (interested in serving) with question #10 (interested in receiving support), no significant differences were found between those who already serve and those who do not (question #1). In fact, 86% of those who do not serve but are interested in serving are open to Page 20 of 43

21 receive training, versus 83% of those who already serve (Z = , p = ). Therefore, those who are not serving (but are interested in serving), show a high interest in receiving training in comparison to those who already serve. See Table 6 for details. Table 6: Nurses serving and their level of involvement Q1: Serving YES (n = 551) Q2: Serving NO (n = 584) Q8: YES Q8: NO Q9: YES Q9: NO Q10: YES Q10: NO 320 (58%) 214 (39%) 280 (51%) 39 (7%) 267 (48%) 50 (9%) 261(45%) 320 (55%) 181 (31%) 76 (13%) 225 (39%) 31 (5%) Question 1: Do you currently serve on any decision-making bodies/boards (e.g., professional nursing organizations/boards, church, school, non-profit, city/county board, health care org, committee, political office)? Question 8: Are you interested in serving on a decision-making body/board? Question 9: Do you feel prepared to serve on a decision-making body/board? Question 10: Would you be interested in receiving support of some kind (i.e., mentoring, education) to help prepare you for serving on a decision-making body/board? Page 21 of 43

22 Question 11: What types of assistance would be helpful? (Check all that apply) Respondents identified General Training as the most helpful type of assistance they could receive (81% of preferences), followed by Identify organization on which to serve (69%), Learn what to offer as a professional nurse (57%), and Seek to be mentored by an experienced nurse (44%). See Table 7. Thirty-four comments were received and most were similar to the list of types of assistance. The need for training was the most mentioned (45%), followed by comments related to how their past or present experience serving on different organizations would help them to become effective leaders (19%). Need for mentoring was mentioned by13% of respondents. In terms of barriers for serving, 6% mentioned time limitations to serve due to family/work obligations. Table 7: Types of assistance to be helpful Types of Assistance Frequency Percentage Identify organization on which to serve % Learn what I have to offer as a professional nurse % General training re: expectations, roles, responsibilities % Seek to be mentored by an experienced nurse % Other 5 1% Total 389 Comments 34 I have served on committees in the past, I would need information and discussion on the issues at hand. I am very passionate about health care for underserved, and the disparities associated with this. I speak informally about this all the time. A respondent to the survey. Page 22 of 43

23 Question 12: Please list open leadership opportunities you are aware of in your community, health care organization, professional nursing organization, and etc. with a copied/pasted link and contact (or name and address). A total of 207 responses were analyzed and coded into eight categories: 1. Professional nursing association 2. Community/civic group 3. Health care organization 4. Business 5. Faith-based organization/group 6. Non-profit organization 7. Other 8. None Over 50% of nurses (n = 109) are unaware of any leadership opportunities in their professional/personal environment. Forty-three percent of them would be interested in serving on a decision-making body/board (question #8, n = 47). Professional nursing associations was the category where most nurses recognized opportunities for leadership (28%), followed by health care organizations (8%), other (5%), and political office (3%). The remaining categories (business, community/ civic group, and non-profit) received 1% or less replies. See Table 8. Table 8: Coded categories for leadership opportunities Category Frequency Percentage Business 1 < 1% Community/civic group 2 1% Faith-based organization/group 2 1% Health care organization 16 8% Non-profit organization 3 1% None % 43% are interested in serving Other 11 5% Political office 6 3% Professional nursing association 57 28% Total % Page 23 of 43

24 Hospital and agency boards present opportunities for rural nurses to advocate at the political level- however these boards continue to remain male and physician dominated- progress is needed to give voice to rural women and nurses. A respondent to the survey. Page 24 of 43

25 Question 13: Please offer any suggestions you might have to advance nurse leadership in Nebraska through political office or community/civic decision-making bodies: One-hundred forty-nine suggestions were received 5. Suggestions were coded in five categories: 1) Legislation, 2) Lobbying, 3) Information & advertisement, 4) Education & training, 5) Mentoring, and 6) Engagement. Legislation: 21 suggestions were related to encourage nurses to become more involved in the decision-making process affecting the nursing profession and the health care of citizens by being active in the legislative process. I believe we should put forth a candidate for the state unicameral who is a nurse. If we could identify someone willing to run, we could work to get that person elected. Nurses have much to offer government with their knowledge and understanding of health care and the role of advocacy. The understanding of the nursing process allows transfer of action to an elected position and facilitates the processes needed to make sound, collaborative decisions. Lobbying: five participants mentioned that lobbying was necessary to increase the presence and visibility of the nursing profession within communities and the general public. I think it would be great to understand the political process and how to have our voices heard. From lobbying, to how a bill is passed, and how to best reach your Senator. Information and Advertisement: 24 nurses mentioned that a broad information campaign (through advertisement, conferences, forums and s) was necessary to encourage nurses to become active role leaders. One nurse summarized the needed conditions to advance nurse leadership in Nebraska as follows: 5 Seventy-three responses were coded. The rest were either off topic or were too unique to group them into one category. Page 25 of 43

26 I think it would be very helpful to know: 1) Board vacancies 2) Expectations and requirements of board service 3) How to best serve on a board (i.e. how to create coalitions, when to speak and when to listen, how to communicate effectively to boards and community representatives, how to navigate political waters). Another nurse mentioned that lack of information is preventing more participation in leadership positions: Sometimes people are only waiting for a direct invitation and encouragement to get involved, and sometimes they don't realize they have the exact set of abilities needed. Education and Training: seven nurses mentioned that education and training were necessary actions to engage nurses in leadership positions: ( ) guidance to nurses who want to be in leadership roles or more secure in their practice with education so they can be a guidance to better care in the workforce. Mentoring: seven nurses mentioned that mentoring was an essential activity that may bring more nurses into leadership positions, especially for those young nurses who need guidance in their careers. We have excellent nurse leaders in Nebraska. Mentoring our new graduates and involving them in the long-term planning that will affect their careers and choices in health care will provide strong ongoing leadership for Nebraska nurses. We need to involve younger nurses in leadership positions. They are the future. I do not see many younger nurses involved in professional organizations, let alone leadership in any organizations. Page 26 of 43

27 Engagement: Nine nurses suggested that nurses should take the initiative and engage themselves in leader-role activities, participating in the design of new policies and advocating for the nursing profession. I think just by encouraging nurses to attend community meetings to see what it is all about might spark interest in nurse leadership in civic and community groups. Think about what organizations you really believe in and would like to support and improve. Think about what types of opportunities you need for professional networking, and experiences needed for your career and personal growth. Encourage people you know (who you think would be great in a certain role or position) to apply or run for that office. Page 27 of 43

28 Recommendations Building different scenarios to increase leadership participation by nurses Brief theoretical background: According to Besley et al. (2011) leaders are in general highly educated (i.e., post-graduate qualification). In particular, it is known that nurses with specializations tend to have more involvement in professional organizations (Gesse, 1991). Cramer (2002) found that nurses participation in nursing organizations is predictable if they show desire, motivation and they have the adequate resources. Vandenhouten et al., (2011) studied political participation of nurses showing that they engage in low cost activities (i.e., voting) but do not engage much in more active actions (i.e., speaking in public or being members of a nursing organization). Geographic location also plays a role in terms of leadership involvement, as those nurses practicing in rural areas are in general older and have lower education level than their counterparts practicing in urban settings (Dotson, Dave & Cazier, 2012). Further, studies have found that nurses are one of the least mobile professionals for reasons that are unclear (Kovner, Corcoran & Brewer, 2011). Based on the above premises, specific questions from the survey were selected to identify nurses who would be most likely to serve on a decision-making bodyboard. Selection of questions Questions #1 and #8 of the survey provide important information about serving status and nurse s desire to participate on a decision-making board. These two questions can be used as filters to make the first selection of highly interested nurses to pursue leadership roles and become active participants on board/body organizations. The third filter is based on geographic location. Urban clusters and urban areas offer the highest number of opportunities for nurses to become members of decision-making boards. The fourth filter is based on education: Those nurses with the highest educational level tend to be more active participants on boards than those with lower degrees. Based on these criteria, three strategies were developed to identify nurses with the highest likelihood to serve on a decisionmaking board. The only difference between strategies #1 and #2 is whether a nurse Page 28 of 43

29 serves or not. Strategy #3 only considered nurses who live in rural areas regardless of whether they are currently serving or not. After each filter was applied (questions #1, #8 and so on), the total number of nurses left is added between parentheses. The results are as follow: Strategy #1: Currently do serve on a decision-making body/board (question #1, n = 551) + would like to participate (question #8, n = 320) + would like to receive support (question #10, n = 267) + Live in Urban Areas/Urban Clusters (n = 211) + Master/Doctorate level education (n = 105). Thus, there are 105 nurses who met these criteria. Table 9 depicts the location of nurses by county, frequencies and cities. Figure 10 shows the geographic location of nurses. Table 9: Strategy #1 - Location and frequency of nurses by county and city County Frequencies Cities Adams 3 Hastings Buffalo 9 Kearney Cass 1 Plattsmouth Dawes 1 Chadron Douglas 51 Omaha (49) + Elkhorn (2) Gage 1 Beatrice Jefferson 1 Fairbury Lancaster 14 Lincoln Lincoln 3 North Platte Madison 6 Norfolk Platte 3 Columbus Red Willow 1 McCook Sarpy 2 Bellevue (1) + Papillion (1) Scotts Bluff 8 Scottsbluff Seward 1 Seward Total 105 Page 29 of 43

30 Figure 10: Strategy 1 - Geographic location of nurses by zip code Page 30 of 43

31 Strategy #2: Currently do not serve on a decision-making body/board (question #1, n = 584) + would like to participate (question #8, n = 261) + would like to receive support (question #10, n = 225) + Live in Urban Areas/Urban Clusters (n = 138) + Master/Doctorate level education (n = 46). Thus, there are 46 nurses who met these criteria. Table 10 depicts the location of nurses by county, frequencies and cities. Figure 11 shows the geographic location of nurses. Table 10: Strategy #2 - Location and Frequency of Nurses by County and City County Frequencies Cities Buffalo 1 Kearney Cass 1 Plattsmouth Colfax 1 Schuyler Douglas 24 Omaha Hall 2 Grand Island Lancaster 13 Lincoln Lincoln 1 North Platte Madison 1 Norfolk Scotts Bluff 2 Scottsbluff Total 46 Page 31 of 43

32 Figure 11: Strategy #2 - Geographic location of nurses by zip code Page 32 of 43

33 Strategy #3: Total nurses living in rural areas (n = 80) + would like to participate (question #8, n = 46) + would like to receive support (question #10, n = 40). Thus, there are 40 nurses who met these criteria. Table 11 depicts the location of nurses by county, frequencies and cities. Figure 12 shows the geographic location of nurses. Table 11: Strategy #3 - Location and frequency of nurses by county and city County Frequencies Cities Adams 1 Juniata Boone 1 Albion Brown 2 Ainsworth Buffalo 1 Gibbon Cass 1 Alvo Clay 1 Sutton Colfax 1 Clarkson Custer 1 Merna Dakota 1 Emerson Douglas 3 Bennington (2) + Whoville (1) Franklin 1 Franklin Garden 2 Lewellen (1) + Oshkosh (1) Harlan 3 Alma (2) + Rep. City (1) Holt 4 Atkinson (2) + Chambers (1) + Stuart (1) Kimball 2 Kimball Knox 5 Bloomfield (1) + Creighton (4) Lancaster 1 Roca Nance 1 Genoa Pierce 2 Pierce Rock 1 Bassett Saunders 1 Cedar Bluffs Washington 3 Arlington (1) + Fort Calhoun (1) + Kennard (1) Webster 1 Red Cloud Total 40 Page 33 of 43

34 Figure 12: Strategy #3 - Geographic location of nurses by zip code By adding strategies #1, #2 and #3, there is a total of 191 nurses who are likely interested in becoming members of a decision-making body/board. Page 34 of 43

35 Main findings Eight out of ten nurses who serve on decision-making body/board are located in urban settings over 2,500 people. Nurses who serve are highly educated (as research on this matter has shown), although geographic differences were found. Nurses holding bachelor degrees tend to serve in rural areas in higher proportion than nurses holding masters and doctorate degrees. Nurses holding master degrees are more likely to serve in NPAs/Health Care organizations than nurses holding doctorate or bachelor degrees. Six out of ten nurses who serve, do so with Nursing Professional Associations (NPAs) or Health Care organizations. One out of 10 nurses serve on Non-profit organizations and faith-based institutions. Community/civic organizations are served by 5% of nurses, and business by 2%. Less than one percent of nurses serve in Political offices. Nurses tend to serve in several organizations simultaneously: nearly four out of ten nurses serve in two or more organizations. Those who serve in NPAs are more likely to serve in more organizations than any other group. It was found that those serving in Non-profits, community/civic, and businesses tend to serve in two or more organizations. NPAs and Health care organizations are more likely to be served by nurses in cities over 2,500 people. Three out of ten nurses are appointed/elected leaders of a decision-making body. Most of them (over 60%) serve in NPAs/Health Care organizations and live in urbanized areas. Five out of 10 nurses mentioned that they would like to serve on a decisionmaking body/board. Nurses who serve with any type of organization are more likely to become members of a decision-making body/board in comparison to those who do not serve. Nine out of ten nurses who already serve feel prepared to become members of decision-making body/board. Those who already serve feel much better prepared than those who do not. Page 35 of 43

36 Eight out of ten nurses who are interested in serving on a decision-making body/board would like to receive some kind of support. Those who already serve are more likely to receive training support than those who do not. Those who are not serving (but are interested in serving), show the same high interest in receiving training in comparison to those who already serve. Respondents identified General training as the most helpful assistance that they could receive to become active members on a decision-making body/board. NPAs were identified as the type of organization where nurses could find open leadership opportunities. Most nurses mentioned that an information and advertisement campaign was necessary to promote leadership among nurses and that participation in the legislative body was fundamental to promote the nursing profession in Nebraska. There were 191 nurses found who are likely interested in becoming members and leaders of a decision-making body/board. See the Recommendations section. Literature research on nursing participation has shown that nurses increase their engagement when the following components are in place: o Taken Coursework re political affairs (Gesse, 1991) o Resources are available (Cramer, 2002) o Psychological engagement (Verba, Schlozman, & Brady, 1995; Cramer, 2002; Ritter, 2008) o Recruitment networks (Verba, Schlozman, & Brady, 1995) o Free time (Cramer, 2002) Page 36 of 43

37 Appendix Page 37 of 43

38 Nursing Leadership Survey (RN/LPN) 1. Do you currently serve on any decision-making bodies/boards (e.g., professional nursing organizations/boards, church, school, non-profit, city/county board, health care org, committee, political office)? Yes No 2. What category best describes the decision-making bodies/boards on which you currently serve? (check all that apply) Professional nursing association Community/civic group (ex: County Board) Health care organization Business Faith-based organization/group Non-profit organization Other 3. Do you serve as an appointed/elected leader on any of the following decision-making bodies/boards of which you are a member? (Check anywhere your answer is yes.) Professional nursing association Community/civic group (ex: County Board) Health care organization Business Faith-based organization/group Non-profit organization Other 4. Do you currently serve in an elected political office (ex: mayor, village board, county board)? Yes No 5. In what political office have you been elected to serve? 6. Have you ever been elected to a political office (ex: mayor, village board, county board)? Yes No Page 38 of 43

39 7. In what office were you elected to serve? 8. Are you interested in serving on a decision-making body/board? Yes No 9. Do you feel prepared to serve on a decision-making body/board? Yes No 10. Would you be interested in receiving support of some kind (i.e., mentoring, education) to help prepare you for serving on a decision-making body/board? Yes No 11. What types of assistance would be helpful? (check all that apply) Identify organization on which to serve Learn what I have to offer as a professional nurse General training re: expectations, roles, responsibilities Seek to be mentored by an experienced nurse Other 12. Please list open leadership opportunities you are aware of in your community, health care organization, professional nursing organization, and etc. with a copied/pasted link and contact (or name and address). 13. Please offer any suggestions you might have to advance nurse leadership in Nebraska through political office or community/civic decision-making bodies: 14. Please provide your contact information, necessary for baseline statistics First Name Last Name Company Name Address City Postal Code Credentials (eg.,rn, BSN) Gender (M or F) Page 39 of 43

40 15. Are you a Nebraska Action Coalition "40 Under 40" honoree? Yes No 16. Please provide your race/ethnicity (needed to assess diversity) White African American Hispanic Asian Native American Other Thank you for taking the time to participate in this survey. Your input will help us chart a more effective course towards transforming healthcare in Nebraska. Page 40 of 43

41 sent to nurses Dear (name), The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2010) report calls for nurses to become involved in decision-making bodies and boards at the community level and beyond in order to make a difference for healthcare within our communities and our nation. As the largest, most trusted health profession, our leadership is necessary for health care transformation that is patient-centered. Our goal is to position nurses to lead change; we need you to participate to obtain baseline data for our grant funded by the Robert Wood Johnson Foundation. The survey takes about 5 minutes and responses are confidential. The Nebraska Action Coalition will analyze results in aggregate only and use this information to establish goals for advancing nurse leadership in Nebraska. You may receive this survey from your organization. Please complete only once. Deadline April 5, Thank you for completing this survey. Your personal information will be kept confidential. The results will allow the NAC to establish a baseline on nurses' involvement in decision-making bodies and identify ways to bolster current levels with an eye toward diversity. To the Future of Nursing, Victoria Vinton, MSN, RN Director, Nebraska Action Coalition - Future of Nursing vvinton@neactioncoalition.org Page 41 of 43

42 References Besley, T., Montalvo, J. G., & Reynal Querol, M. (2011). Do educated leaders matter? The Economic Journal, 121(554), F Cramer, M. E. (2002). Factors influencing organized political participation in nursing. Policy, Politics, & Nursing Practice,3(2), Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the nursing shortage: A critical health care issue. Health marketing quarterly, 29(4), Gesse, T. (1991). Political participation behaviors of nurse-midwives. Journal of Nurse-Midwifery, 36(3), Kovner, C. T., Corcoran, S. P., & Brewer, C. S. (2011). The relative geographic immobility of new registered nurses calls for new strategies to augment that workforce. Health Affairs, 30(12), Vandenhouten, C. L., Malakar, C. L., Kubsch, S., Block, D. E., & Gallagher-Lepak, S. (2011). Political participation of registered nurses. Policy, Politics, & Nursing Practice, 12(3), Verba, S., Schlozman, K. L., & Brady, H. E. (1995). Voice and equality: Civic voluntarism in American politics. Cambridge, MA: Harvard University Press. Page 42 of 43

43 This Report was prepared by: Juan-Paulo Ramírez, Ph.D. GIS and Human Dimensions, LLC Lincoln, Nebraska June 2013 Page 43 of 43