Frequently Asked Questions about the Campaign for Action Dashboard

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1 Frequently Asked Questions about the Campaign for Action Dashboard General questions How were the indicators for the Dashboard chosen? A team of people from the Robert Wood Johnson Foundation, AARP, and the University of California, San Francisco, reviewed the recommendations of the Institute of Medicine and brainstormed ways that progress toward the recommendations could be measured. Some of these ideas were quickly ruled out because they were hard to define clearly, too difficult to collect data about, or not closely related to the efforts of the Campaign for Action. Once the set of candidate indicators was narrowed, the team at the University of California systematically reviewed potential data sources and determined which could be accessed annually to ensure regular updates of the Dashboard. This research led to a revised set of candidate indicators. The candidate indicators were then discussed with an Advisory Committee composed of data experts and leaders from state Action Coalitions and the National Council of State Boards of Nursing. They provided guidance and advice to identify additional indicators and improve the definition of the ones already under consideration. Other experts also provided important guidance. Continuing review of the indicators led to agreement of a final set, which were continuously refined as data were collected and the team developed a better understanding of the data available and its limitations. Finally, the Dashboard team worked closely with graphic and web designers to ensure the final Dashboard is easy to understand and accurate. Is this the only way you are going to measure the success of the Campaign for Action? No. This is only part of a set of activities to evaluate the progress of the Campaign for Action in implementing the recommendations of the Institute of Medicine Committee on the Future of Nursing. The Foundation and CCNA are monitoring progress of action coalitions through several evaluation activities and is planning a summative evaluation to assess its impact. The Foundation also will evaluate the success of specific programs such as Academic Progression in Nursing. Can we get a state-level Dashboard? State Action Coalitions are encouraged to develop Dashboards that are consistent with the National Dashboard. Many states already have data available through state nursing boards, employment departments, and nursing workforce centers. The Campaign for Action has some reports and guidance for collecting data at the state level.

2 Questions regarding Indicator 1: Percentage of employed nurses with baccalaureate degrees in nursing or higher degrees What is the American Community Survey? The American Community Survey is a large-scale national survey administered by the U.S. Census Bureau. Roughly 65,000 households are surveyed every month over the course of a year, representing about 2.5% of the population. The full set of data is published annually in a series of pre-tabulated profiles, tables and maps. In addition to these pre-tabulated products, ACS data is available as a 1% public use microdata sample (PUMS) file. Why does Indicator 1 include only employed nurses? In the American Community Survey (ACS), people are identified as registered nurses if they report that their occupation is registered nursing. Advanced Practice Registered Nurses are included in the occupation category of registered nursing. People who identify their occupation as registered nursing but are currently unemployed can thus be identified as registered nurses, but If their current occupation is not in nursing, registered nursing or they consider themselves retired (or otherwise out of the workforce), there is no way in the ACS to know that they are licensed as a nurse. We limited this indicator to nurses who are currently employed to make it easier to compare these data with other datasets that might identify registered nurses differently. For example, the National Sample Survey of Registered Nurses (NSSRN) identifies nurses as those licensed as an RN. There is no way to tell from the NSSRN who would say their occupation is nursing, but you can tell who is employed. Thus, the only way to see how the data in the NSSRN differ from the ACS is by focusing on people employed as nurses. Why didn t you use the National Sample Survey of Registered Nurses to measure the educational attainment of nurses? The NSSRN has historically been conducted every four years. We wanted the Dashboard to be updated annually, so the interval of the NSSRN is too long. Moreover, the NSSRN was not conducted in 2012 and it is uncertain whether it will be collected in the future. The ACS is collected annually and it is highly likely that is will continue to be collected. Why does this indicator include only a bachelor s degree in nursing and not bachelor s degrees in other fields? The Campaign for Action is focused on advancing the progression of nurses in their nursing education, so this indicator was selected to align with this focus. Why does this indicator include graduate degrees in non-nursing fields? The American Community Survey (ACS) asks about the major field of study for a baccalaureate degree, but not for graduate degrees. For people whose highest degree is a baccalaureate degree, we counted the number with a registered nursing major field of study. We counted all people with a graduate degree, regardless of their major field of study for their bachelor s degree. People who entered nursing through a master s-entry program thus will be counted, as will people whose highest nursing degree is an associate degree but who have a master s degree in another field such as public health. 2

3 Why are you not using state-collected data on nursing education? For National indicators, it is important to use a source of data that provides consistent information across states. State-level data on education of nurses varies substantially in how it is collected, who is included in the statistics, and frequency of data collection. States are encouraged to use their own data to evaluate their statewide efforts in the Campaign for Action. To the extent possible, it will be ideal for states to follow the data collection guidelines recommended by the National Forum of State Nursing Workforce Centers so that data across states will be consistent. Questions regarding Indicator 2: Total fall enrollment in nursing doctorate programs The IOM Recommendation is that the total numbers of nurses with doctorates double. Why is the indicator only the enrollment in nursing doctorate programs? There are a small number of nurses with doctoral degrees, and national surveys like the American Community Survey (ACS) do not include enough nurses to accurately measure yearto-year changes in the number with doctorates. The NSSRN has a larger sample, but is collected only every four years, and may not be collected in the future. The number of enrollments can be tracked accurately and growth in this measure portends growth in the total number with doctorates. Why does this indicator measure enrollment in doctoral programs rather than graduations? Doctoral programs can require years of study and research. By measuring growth in enrollments, we can see whether the Campaign for Action is making progress during the years before enrolled students complete their degrees. Later we will convert this indicator to track the number of graduations. What doctoral degrees are included? Any degrees in nursing offered by the programs that report to the American Association of Colleges of Nursing are included in this indicator. Nursing schools that do not provide data to the American Association of Colleges of Nursing are not included. Doctoral programs that are not based in nursing schools are not included. Why are you not counting the doctorates in other fields received by nurses, such as public health, epidemiology, and sociology? Non-nursing doctoral programs do not report data that include information about the educational background of their students to any national organization or data repository. The only national survey with a large sample size that includes data about nurses who have nursing and nonnursing doctorates is the NSSRN, but this survey is conducted only every four years and may not be conducted in the future. The American Community Survey also has information about whether employed nurses have doctoral degrees, but the number of nurses in this survey is small so the data are not precise. We recognize that these doctoral degrees are important, thus represent an important gap in the data available. 3

4 Is the goal of the Campaign for Action that the number of both research-focused doctorates and practice-focused doctorates double? The goal is that the total number with doctorates double, and does not specify any target ratio of practice-based versus research-based doctorates. Both types of doctorates will be tracked. Questions regarding Indicator 3: State progress in removing regulatory barriers to care by Advanced Practice Registered Nurses (APRNs) Can you explain what the different levels of barriers are ( many, few )? States differ in how APRNs are licensed and regulated. The Campaign for Action supports the APRN Consensus Model, which is a set of regulatory standards that improves access to safe, high-quality APRN care. States that have achieved APRN consensus or are nearing consensus have removed major barriers to APRN care. Refer to for more information. Does this indicator include all types of advanced practice registered nurses (APRNs)? Yes, the National Council of State Boards of Nursing assessment of progress toward the APRN Consensus Model includes all APRNs: Nurse Practitioners, Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists. What about other barriers to APRN practice like the lower payments from Medicare, Medicaid, and private insurance companies not treating APRNs as primary providers? Because reimbursement for APRN practice varies widely between federal, state, and private payers, collecting data to measure the degree to which there are barriers is complicated. These are important issues and will constitute future work for the Campaign for Action. Questions regarding Indicator 4: Number of required clinical courses and experiences at top nursing schools that include both RN students and other graduate health professional students Why did you pick this measure and not some other measure more aligned with collaboration in clinical practice? There are no consistent standards for interprofessional collaboration in practice, nor are there agreed-upon measures to determine the extent to which such collaboration takes place. How did you identify top nursing schools? The schools are the highest-ranked graduate nursing schools, as reported by U.S. News and World Reports that have entry-level nursing education and also have other graduate health professions education programs. The top 10 schools meeting these criteria were invited to share information for the Dashboard. 4

5 Why did you limit this indicator to only top nursing schools? There is no single place where data on the curricula of all nursing schools is compiled. All these data are collected through direct contact with each nursing school. Only a limited number of schools could be feasibly included in the data collection. It would be ideal if such data were collected more widely. Why does this indicator focus on RN students and not graduate nursing students? We wanted this measure to reflect progress toward interprofessional collaboration and education among the greatest number of nurses. Over 80 percent of registered nurses are not in advanced practice, and most nurses do not have graduate degrees. Entry-level nursing education is where nurses should learn best practices, including interprofessional collaboration. Why does this indicator include only educational experiences that directly involve other health professional students, and not curricula that focus on the process of collaboration? There is a significant difference between talking about how to work with other professionals and having the experience of working with other professionals. The most innovative curricula in this area provide real, in-person collaborative experiences, and the Campaign for Action encourages this. Why does this indicator focus on graduate health professional students and not other types of health professional students such as associate-degree level technicians? Nursing care nearly always involves collaboration with physicians and pharmacists, and excellent care requires collaboration with these and other highly-trained health professionals. Questions regarding Indicator 5: Percent of hospital boards with RN members Why did you limit this measure to hospital boards? Many different areas of nursing leadership were considered. We decided to focus on an area where nurses have some presence, have a clear role in leadership, and there is a history of consistent data collection. Why are you not tracking nurses in government leadership positions? Nurses hold leadership roles in many federal government agencies, but we could find no standardized database to track them. Why are you not including corporate boards? There are no nurses on the Boards of Directors of the top five pharmaceutical companies, top five health system corporations, or top five insurance companies. 5

6 Questions regarding Indicator 6: Number of states collecting nurse supply data Where did the 14 items that you tracked come from? The Forum of State Nursing Workforce Centers developed recommendations for data collection about the nursing workforce. They have provided clear specifications for how surveys should be worded and data can be collected to measure nurse supply, demand, and education. For more information about the Minimum Data Set recommendations, you can link to: Do all these states collect data when nurses renew their licenses? The Forum of State Nursing Workforce Centers recommends that states collect data when nurses apply to renew their nursing licenses, but some states conduct periodic sample surveys instead. 6