Advancing Healthcare Transformation: A New Era for Academic

Advancing Healthcare

Transformation

A NEW ERA FOR ACADEMIC NURSING

Advancing Healthcare

Transformation

A NEW ERA FOR ACADEMIC NURSING

Manatt Health Project Team:

Tom Enders, MBA

Senior Managing Director

Alex Morin, MA

Manager

Brenda Pawlak

Managing Director

Special Advisors:

Margaret Grey, DrPH, RN, FAAN

Annie Goodrich Professor

Yale University School of Nursing

Arthur Rubenstein, MBBCh

Professor of Medicine

University of Pennsylvania Raymond

and Ruth Perelman School of Medicine

MARCH 1, 2016

Dear Colleagues and Stakeholders,

ransforming health care is a formidable challenge that can only be met through a coordinated response

from academic and practice leaders from across the health professions. Nursing recognizes its important

role in steering this critical work and maintaining a laser focus on what is best for the public.

Advancing Healthcare Transformation: A New Era for Academic Nursing was conceived from a desire to

maximize nursing’s contribution to ushering in healthcare reform. Since 2013, AACN member deans from

Academic Health Centers (AHCs) have engaged in robust discussions about the evolving role of schools of

nursing in this unprecedented time of accelerating change. These forward thinking leaders were so passionate

about this topic that they issued a call to action to the AACN Board of Directors. The deans formally asked the

board to conduct a national study to better understand the possibilities and challenges ahead for academic

nursing. In February 2015, AACN commissioned a comprehensive study on how to highlight nursing’s role in

AHCs. Soon after, Manatt Health was selected to work with us in preparing this report on how to best position

nursing schools for long-term success and sustainability.

From the onset of this project, AACN was committed to ensuring that the scope of research would be

comprehensive, discussions would be interprofessional, and ﬁnal recommendations would be achievable. To

commence this work, interviews were conducted with a variety of stakeholders in AHC and non-AHC afﬁliated

institutions to uncover the issues and the opportunities facing academic nursing. Findings from the interviews

were used as discussion points for a national summit of AHC leaders convened by AACN and Manatt in

Washington, DC in August 2015. Following the summit, two surveys to AHC leaders were issued to better

determine how academic nursing could make a greater contribution to the larger health enterprise.

Armed with a fresh understanding of today’s landscape, this report identiﬁes a path for achieving an enhanced

partnership between academic nursing and academic health centers around the imperative to advance

integrated systems of health care, achieve improved health outcomes, and foster new models for innovation.

AACN is conﬁdent that lessons learned from this study will be important to the full universe of baccalaureate

and higher degree nursing programs. The work initiated with those located in AHCs will continue. The dialogue

has started. Academic nursing must play a signiﬁcant role in advancing healthcare transformation at the local,

state, and national levels.

All those connected with this bellwether report, including dozens of academic and practice leaders who

contributed insights and recommendations, are excited by its potential to magnify nursing’s impact on

improving health and health care. AACN is looking forward to working with the full community of stakeholders

to disseminate this report broadly, assess its long-term outcomes, and assist schools as they implement the

recommendations. We invite you to join us as we move to meet the challenges ahead and reap the rewards that

come with meaningful change.

Eileen T. Breslin, PhD, RN, FAAN

Chair, AACN Board of Directors

Deborah E. Trautman, PhD, RN, FAAN

AACN President and Chief Executive Ofﬁcer

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

This report was commissioned by the

American Association of Colleges of Nursing

and overseen by a Project Oversight Committee:

**Eileen Breslin, PhD, RN, FAAN

Dean, School of Nursing

University of Texas Health Science Center,

San Antonio

**Juliann Sebastian, PhD, RN, FAAN

Dean, College of Nursing

University of Nebraska Medical Center

Teri Murray, PhD, APHN-BC, RN, FAAN

Dean, School of Nursing

Saint Louis University

Judy Beal, DNSc, RN, FNAP, FAAN

Dean, School of Nursing and Health Sciences

Simmons College

Susan Bakewell-Sachs, PhD,

PNP-BC, RN, FAAN

Dean and Vice President for Nursing Affairs

Oregon Health and Science University

**Ann Cary, PhD, MPH, RN, FNAP

Dean, School of Nursing & Health Studies

University of Missouri-Kansas City

Harriet Feldman, PhD, RN, FAAN

Dean, College of Health Professions and

the Lienhard School of Nursing

Pace University

Greer Glazer, PhD, CNP, RN, FAAN

Dean, College of Nursing and Associate Vice

President for Health Affairs

University of Cincinnati

Anita Hufft, PhD, RN

Dean, College of Nursing

Texas Woman’s University

Kristen Swanson, PhD, RN, FAAN

Dean, College of Nursing

Seattle University

**David Vlahov, PhD, RN, FAAN

Dean, School of Nursing

University of California, San Francisco

**Deborah Trautman, PhD, RN, FAAN

President and Chief Executive Ofﬁcer

American Association of Colleges of Nursing

** Denotes Members of the Project

Oversight Committee

The authors acknowledge the invaluable assistance of Kathy McGuinn, MSN, RN, CPHQ, Director of Special

Projects, AACN, and Shelley McKearney, Program Manager, AACN. The authors also wish to thank the many

participants in this study including those interviewed, those who traveled to Washington for the Leadership

Summit, and those who responded to the surveys. All were generous with their time and insights, and we

gratefully acknowledge their contributions.

AACN Board of Directors

American Association of Colleges of Nursing

Contents

EXECUTIVE SUMMARY .................................................................................................................................................. 2

SUMMARY OF FINDINGS .............................................................................................................................................. 2

SUMMARY OF RECOMMENDATIONS ......................................................................................................................... 3

DEFINITIONS OF MAJOR TERMS USED IN THIS REPORT ....................................................................................... 5

A NEW ERA FOR ACADEMIC NURSING ..................................................................................................................... 6

THE STATE OF ALIGNMENT OF ACADEMIC NURSING WITHIN ACADEMIC HEALTH CENTERS ...................... 8

Report Findings .............................................................................................................................................................. 9

Academic Nursing Leadership Summit ....................................................................................................................... 16

BUILDING A STRONG PARTNERSHIP ........................................................................................................................ 17

Recommendation 1: Embrace a New Vision for Academic Nursing ........................................................................... 19

Recommendation 2: Enhance the Clinical Practice of Academic Nursing .................................................................. 20

Recommendation 3: Partner in Preparing the Nurses of the Future ........................................................................... 23

Recommendation 4: Partner in the Implementation of Accountable Care ................................................................. 26

Recommendation 5: Invest in Nursing Research Programs and Better Integrate Research into Clinical Practice ..... 28

Recommendation 6: Implement an Advocacy Agenda in Support of a New Era for Academic Nursing .................. 31

IMPLEMENTATION STRATEGIES ................................................................................................................................32

Recommendations for Deans of Nursing ..................................................................................................................... 33

Recommendations for Deans of Medicine ................................................................................................................... 34

Recommendations for Health System Executives ....................................................................................................... 35

Recommendations for University Presidents, Chancellors, and Vice Chancellors ...................................................... 35

CONCLUDING PERSPECTIVES .................................................................................................................................... 36

APPENDICES .................................................................................................................................................................. 37

Appendix A – Organizational Self-Assessment ........................................................................................................... 37

Appendix B – Participating Institutions and Leaders .................................................................................................. 44

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Executive Summary

Advancing Healthcare Transformation: A New Era for

Academic Nursing, commissioned by the American

Association of Colleges of Nursing (AACN), provides

a deeper examination of the potential for enhanced

partnership between academic nursing and academic

health centers (AHCs) around the imperative to

advance integrated systems of health care, achieve

improved health outcomes, and foster new models for

innovation. It is intended as a guide for nursing and

AHC leaders in implementing organizational change

that will bring the assets and talents of their schools of

nursing to bear on the challenge of transforming health

care in their region.

Academic health centers have long been at the apex of

American health care and pivotal to its vibrancy. Health

reform imperatives are compelling AHCs to broaden

their focus to community settings and to deliver care

across the continuum of patient needs. Coupled

with changing economics, market consolidation,

generational changes in the healthcare workforce, and

an increasing focus on chronic disease prevention and

management, these market dynamics are requiring

AHCs to transform their operating models and to

evolve into more integrated and efﬁcient systems

of care.

In addition to providing the largest professional

workforce in the health system, nurses serve a central

role in the management of AHC’s patients and their

families. Nurses are often the primary interface point

and advocate for patients. Patients desire to be

well—and nurses have a critical role in making health

care better. As academic health systems develop and

increasingly implement value-based reimbursement

programs and assume responsibilities for populations

of patients, health system leaders should look to

nurses to lead and support prevention and wellness

programs, new models of care delivery, continuity

across transitions in care settings, and integration with

home and community based services and resources.

At the same time, academic nursing is advancing

higher levels of preparation and developing pathways

for deeper specialization, which can help AHCs expand

access to care and address the primary care shortages

in many communities. To date, the potential and

opportunity for academic nursing in the transformation

of AHCs into health systems has not been considered

thoroughly.

Summary of Findings

The ﬁndings presented in this report regarding the

current state of alignment of academic nursing with

AHCs are sobering.

● Finding 1: Academic nursing is not positioned as

a partner in healthcare transformation.

Signiﬁcant organizational limitations prevent

academic nursing from functioning as a true

partner in AHC transformation. These include

minimal meaningful participation in health system

governance, lack of integration of nursing faculty

into health system leadership roles, marginal

integration of nursing faculty into clinical

services, and siloed nurse-scientist research.

● Finding 2: Institutional leaders recognize

the missed opportunity for alignment with

academic nursing and are seeking a new

approach.

Preparation of this report entailed numerous

interviews, surveys of deans of nursing, university

presidents, and a summit that convened

institutional leaders for candid dialogue.

A theme that ran consistently throughout these

discussions was one of missed opportunity

for partnership and a strong desire to reset

relationships around a dynamic vision for

academic nursing.

● Finding 3: Insufﬁcient resources are a barrier

to supporting a signiﬁcantly enhanced role for

academic nursing.

The tuition-dependent funding structure of

academic nursing severely limits the ability of

schools of nursing to participate in healthcare

transformation initiatives and to provide the

institutional leadership of which they are capable.

Most schools of nursing do not have faculty

practices and therefore no clinical income, nor

do they generally receive funding from their

American Association of Colleges of Nursing

afﬁliated health systems. Despite unique research

capacity (in particular, related to patient-oriented

research), schools of nursing received $133 million

(0.4%) in NIH funding from an approximately $30

billion total budget.

Summary of

Recommendations

An enhanced partnership between AHCs and

academic nursing will beneﬁt all parties and,

above all, enhance the ability of academic health

systems to transform health care. Achieving a new

partnership requires that nursing faculty have a deeper

involvement in clinical practice and greater opportunity

to engage in the clinical innovation needed by evolving

academic health systems. Stronger partnerships

also entail fostering enhanced nurse-scientist based

patient and community-oriented research. This report,

therefore, recommends six actions for

institutional leaders:

1. Embrace a New Vision

for Academic Nursing

The report recommends that institutions adopt the

following vision: Academic nursing is a full partner

in healthcare delivery, education, and research

that is integrated and funded across all professions

and missions in the Academic Health System. The

elements of this vision include:

▪ Nursing participation in health system governance

▪ Expanded academic nursing leadership in clinical

practice and care delivery

▪ Growth and evolution of academic nursing

research programs in partnership with the medical

school, health system, and other professional

schools

▪ Collaborative workforce plans and training

programs in partnership with the health system

▪ Integration of academic nursing into population

health initiatives

▪ System-wide commitment to leadership

development to prepare and support future

nurse leaders

Enhance the

Clinical

Practice of

Academic

Nursing

Partner in

Preparing

the Nurses

of the Future

Invest in

Nursing

Research

Programs and

Better

Integrate

Research

into Clinical

Practice

Implement an

Advocacy

Agenda to

Support a New

Era for

Academic

Nursing

Partner in

the

Implement-

ation of

Accountable

Care

Embrace a New Vision

for Academic Nursing

2 3 4 5 6

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

2. Enhance the Clinical Practice of

Academic Nursing

Initiatives should be implemented that more fully bring

nursing faculty into the clinical practice of the health

system and connect the clinical service more closely to

the academic mission of the school of nursing.

3. Partner in Preparing the Nurses

of the Future

Build a pipeline of nurses at multiple levels (BSN, MSN,

DNP, PhD) so as to meet the clinical requirements of

the extended AHC system. Create nursing leadership

development programs for faculty and practicing

nurses that are jointly managed by the school of

nursing and clinical practice.

4. Partner in the Implementation

of Accountable Care

Strategies include joint clinical planning, having

academic nursing provide leadership in developing

linkages between acute care and post-acute, home-

based and long- term care services, and expanding

nurse-led community programs under the leadership

of academic nursing faculty in partnership with health

system leaders and clinicians.

5. Invest in Nursing Research Programs

and Better Integrate Research into

Clinical Practice

A true, research-grounded and evidence-based

nursing service will enrich the life of the AHC and

beneﬁt the community. Strategies include creating

mechanisms to coordinate research projects and

activities across academic nursing and AHCs;

developing joint research programs between academic

nursing and health system nurse-scientists; integrating

nurse researchers into developing informatics

programs; strengthening the training programs for

nurse clinical trial coordinators and clinical research

nurses; providing leadership in establishing linkages

to other professional schools; and expanding nursing

faculty development and recruitment to include PhD

investigators across multiple disciplines in targeted

research areas.

6. Implement an advocacy

agenda in support of a new era

for academic nursing

This recommendation is directed toward AACN,

institutional leaders, and kindred associations

interested in and committed to the alignment and

integration of nursing more broadly with the goals of

the Triple Aim. Planks of the recommended agenda

include: seeking growth in NIH budget to support

nursing-led research, especially at NINR; increased

funding support for the training of nurse-scientists;

advancing a national nursing agenda that links to the

Triple Aim, including expansion of the Graduate Nurse

Education (GNE) Demonstration; heightened advocacy

for scope of practice changes to enable nurses to take

on the clinical roles they are trained to perform; and

support for academic nursing leadership in clinical

care delivery.

Achieving the potential for academic nursing as

described in this report requires a change in culture

that can only be accomplished by the collaborative

leadership of university presidents, deans of nursing

and medicine, and health system chief executives.

All parties must embrace a new vision for academic

nursing, and by doing so deal directly with the cultural

and structural issues that are impeding the ﬂowering of

potential that indeed all perceive. Leaders committed

to a new vision for academic nursing will challenge

the status quo and seek to unharness the potential

of their nursing colleagues. Participatory governance

structures that cross-populate, as appropriate,

leaders of the academic and clinical practices will

help to ensure mission integration and proper insights

from a diverse set of constituencies. Participatory

governance will be immeasurably enhanced by

collaborative strategic and ﬁnancial decision making

around academic and clinical programs, workforce

development, and research programs. Further

alignment of medicine, nursing, and health system

organizations may also prove beneﬁcial for certain

institutions.

American Association of Colleges of Nursing

Denitions of Major Terms

Used in This Report

Academic Nursing: Academic Nursing

encompasses the integration of practice,

education, and research within baccalaureate

and graduate schools of nursing. Faculty engaged

in academic nursing demonstrate a commitment to

inquiry, generate new knowledge for the discipline,

connect practice with education, and lead scholarly

pursuits that improve health and health care.

School of Nursing: An accredited degree-

granting school and/or college that educates

nurses at the baccalaureate and/or graduate level.

Academic Health Center (AHC): Accredited,

degree granting institution of higher education

that consists of: an allopathic or osteopathic

medical school, a school of nursing, and other health

professional schools (dentistry, pharmacy, public

health, veterinary medicine, allied health sciences,

public health) and an owned or afﬁliated relationship

with a teaching hospital, health system, or other

organized healthcare provider.

Academic Health System: The clinical operations

of an academic health center, owned/afﬁliated

hospitals, community practices, faculty practice

organizations, and other clinical services, organized as a

multi-site system of care and oriented towards population

health as a deﬁning strategic objective.

Deﬁnition taken from the Association of Academic Health Centers (2014)

“Nurses’ regular, close proximity

to patients and scientiﬁc

understanding of care process

across the continuum of care

give them a unique ability to act

as partners with other health

professionals and to lead in the

improvement and redesign of the

healthcare system and its many

practice environments, including

hospitals, schools, homes, retail

health clinics, long-term care

facilities, battleﬁelds, and

community and public health centers.”

–Institute of Medicine

The Future of Nursing: Leading Change and Advancing Health (2010)

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

A New Era

for Academic Nursing

In 2010, the Institute of Medicine (IOM) and the

Committee on the Robert Wood Johnson Foundation

Initiative on the Future of Nursing released the

seminal report, The Future of Nursing: Leading

Change, Advancing Health,’ which articulated the

critical role the nursing profession plays in the delivery

of health care and the imperative for nursing to

provide signiﬁcant leadership in the transformation

of healthcare delivery in the U.S. The culmination

of a two-year initiative, the report examined the

opportunities and the barriers for the over 3 million

members of the nursing profession—the largest

segment of our nation’s healthcare workforce—to

be able to respond effectively to rapidly changing

healthcare settings and an evolving health care system

as change leaders in advancing health. The IOM report

delivered four action-oriented messages as a blueprint

for the future of nursing:

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 professionals, in redesigning health

care in the United States.

4. Effective workforce planning and policy making

require better data collection and an improved

information infrastructure.

This report, commissioned by the American

Association of Colleges of Nursing (AACN), provides

a deeper examination of the potential for enhanced

partnership between academic nursing and academic

health centers (AHCs) around the imperative to

advance integrated systems of health care, achieve

improved health outcomes, and foster new models

of ﬁnancial sustainability for the tripartite academic

mission of clinical care delivery, research, and

education. It is intended as a guide for university

and AHC leaders in planning for and implementing

organizational change that will bring the assets and

talents of academic nursing to bear in the challenge of

transforming health care in their region.

Nurses are on the frontlines of care delivery. Nurses

practice in a wide variety of settings, including the

hospital, the clinic, the classroom, community health

settings, the business sector, home health care, and

the laboratory but in all cases, the primary goal of

the nursing professional is to advocate for the patient

and to provide optimal care based on evidence-

based guidelines. As the nation’s largest professional

healthcare workforce, registered nurses are not only

vital members of the patient care team and often the

patient’s and/or family’s primary interface with the

healthcare system, they also are critical partners for

physicians and health system leaders in advancing

patient-centered care models, improving access to

primary and preventative care, and achieving success

in new payment models centered around quality

and value.

The Patient Protection and Affordable Care Act of

2010 (ACA) has served as a catalyst for the shift to

value-based reimbursement on the part of the federal

government (the nation’s largest healthcare payer)

and commercial insurers. In order to succeed in a

value-based model, where providers are rewarded for

increased efﬁciency, improved health outcomes and

prevention and management of chronic conditions

before they require hospitalization, the U.S. healthcare

delivery model must transform to one that fosters

more effective systems of high quality care that are

oriented around the needs of the patient. The IOM

recommended in Crossing the Quality Chasm: A

New Health System for the 21st Century (2001)

that

healthcare providers adopt patient-centered care

models, which the IOM deﬁned as providing care that

is respectful of and responsive to individual patient

preferences, needs and values, and ensuring that

patient values guide all clinical decisions.

Academic nursing and the nurses they educate

are essential to this healthcare transformation. The

healthcare workforce faces signiﬁcant provider

American Association of Colleges of Nursing

shortages—including of nurses—at the same time

that approximately one quarter of the U.S. population

is passing the retirement age and projected to

impose increased demand for access to healthcare

services, particularly chronic disease management.

As healthcare systems pursue population health

approaches and seek to provide care in lower cost

outpatient settings, there is an increasing demand

for nurses to ﬁll this need. Academic nursing is the

vehicle for preparing these needed nurses—including

baccalaureate and graduate degree prepared nurses

and PhD-prepared nurse-scientists—who operate in

every clinical care setting from primary care ofﬁces

to specialty clinics to inpatient settings to hospice

andhome.

Academic nursing also is developing new education

models designed to prepare nurses for future

healthcare delivery within a population health

orientation. Interprofessional education, where nurses,

physicians, and other clinicians learn and train together

in a collaborative environment to improve health

outcomes is becoming more widely adopted and

becoming more prevalent in curricula. Nurses are often

leaders in the development of these programs.

Further, academic nursing is involved in pioneering

research focused on population health, chronic

disease management models, and collaborative care

approaches translated into new care models that

improve the health of patients and the population.

Yet despite its potentially integral role within AHCs,

academic nursing has largely operated with only a

minimal level of alignment with the health system

and/or their peers in academic medicine. While

academic medicine tends to be tightly integrated in

health system decision-making, it is the exception for

academic nursing to be similarly involved. In certain

By 2029, when the last cohort of “baby boomers” (individuals born between 1946 and 1964) reaches retirement age, the number of Americans

65 or older will climb to more than 71 million, up from about 41 million in 2011, a 73 percent increase, according to Census Bureau estimates.

Patients over 65 years of age typically have more than one chronic healthcare condition. The American Hospital Association projects that more

than 37 million boomers will be managing more than one chronic condition by 2030.

RESEARCH

LEADERSHIP

PATIENT-CARE

LEADERSHIP

WORKFORCE

DEVELOPMENT

LEADERSHIP

▪ Science of quality and

patient safety

▪ Optimal care delivery

models

▪ Science of self-management

▪ Symptom management

▪ Chronic condition

management

▪ Informatics (Emerging)

▪ Science of Leadership

▪ Community based care

(ofﬁce care, retail care,

home care)

▪ Nurse-managed clinics

▪ School-based programs and

University student/employee

clinics

▪ Health system inpatient

program leadership

▪ Patient engagement

programs

▪ Pallative care/end of life care

▪ Growth in advanced nursing

practice curricula producing

doctoral prepared nurses

▪ Interprofessional education

programs in nascent stages

▪ Training curricula preparing

clinicians for the future care

delivery system

▪ Growth in research training

to produce nurse scientists

Figure 1: Areas Where Academic Nursing Provides Leadership

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

cases this is an artifact of the reporting relationships

of the professional schools, with medicine and the

health system having grown over time into a uniﬁed

organization and academic nursing remaining in a

separate professional silo, resulting in barriers to

collaboration. The development of clinical leadership

roles such as the chief nursing ofﬁcer (CNO) has

provided a stronger voice for nursing in decision-

making in the health system; however, in most cases,

there remains a lack of alignment between academic

nursing and the broader health system as well as AHC

governance and management.

A particularly acute challenge being faced by many

AHCs is the disruption of their traditional specialty

services-focused business model by the shift towards

value-based payment and the formation of mega-

systems of care and “narrow network” insurance

offerings, which increasingly limit specialty referrals.

This report asserts that academic nursing can serve

a vital function for health systems attempting to

become expert in population health and thus diversify

from their specialty care roots. This potential is due

to nursing having the interest and the expertise

related to critical components of population health—

including the provision of primary and preventive

care, community engagement, deployment of multi-

disciplinary and interprofessional care teams, the

training of advanced practice registered nurses,

understanding the impact and intervention points

related to social determinants of health, management

of care across the continuum of care, and patient and

family/caregiver engagement.

This report ﬁrst considers the present state of

alignment between academic nursing and AHCs,

describing three major issues that will shape the

path forward for an enhanced partnership. We

then describe a future vision for academic nursing

and a framework for implementation intended to

guide leaders in the formation of a new partnership.

Throughout, we highlight examples of innovative

and successful initiatives. Lastly, we provide

recommendations for university presidents, nursing

and medical school deans, and chief executives of

health systems. These leaders—deans of medicine

and health system leaders in particular—are critical

to the success of the recommendations contained in

this report, and the report seeks to provide guidance

for them in beginning to align more closely with their

partner schools of nursing.

The State of Alignment

of Academic Nursing

within Academic

Health Centers

In the preparation of this report, Manatt Health

conducted 48 interviews at 25 institutions. Interviews

were conducted with 25 nursing school deans, 5

medical school deans, 16 health system CNOs and

CEOs, and 8 university chancellors / vice chancellors.

During these interviews, the project team sought

to understand the perspective of a diverse set of

academic and clinical leaders on how the evolving

AHC intersects with academic nursing, and how

different points of integration can be better leveraged.

The interviews addressed the following areas:

▪ Vision for academic nursing;

▪ Major points of integration with the health system

(governance, management, strategic, ﬁnancial,

mission);

▪ Level of alignment between academic nursing and

the nursing clinical practice in the health system,

including the role and responsibilities of the dean

of nursing and nursing faculty;

▪ Primary challenges in advancing the shared goals

of the school of nursing and health system and

potential points of intersection;

▪ Academic nursing ﬁnancial issues, particularly

those related to research and education and

inter-entity (between academic nursing and health

system) issues.

In addition to interviews, two surveys were completed

during December 2015 to collect additional data from

Interviewees listed in the Appendix.

American Association of Colleges of Nursing

102 leading academic institutions and academic health

systems. One survey was completed by nursing deans

and a second by university presidents and chancellors.

In the section that follows, three major ﬁndings are

presented that are based in large measure on these

interviews, and the two leadership surveys. Additional

highlights from the interviews and the surveys are

included throughout.

REPORT FINDINGS

● Finding 1: Academic nursing is not positioned

as a partner in healthcare transformation

Signiﬁcant organizational limitations prevent

academic nursing from functioning as a true

partner in AHC transformation, and as a

result, in many institutions it is largely conﬁned

to a marginal role. Manifestations of these

organizational limitations include:

1) Governance Structures. It is widely known and

discussed that nurses are not well represented

on hospital boards—despite their importance in

the clinical workforce and their trusted role with

patients. According to a 2010 survey from the

American Hospital Association, only 6% of hospital

boards have nurses represented compared to 20%

with physicians.

iii

A national study of University

HealthSystem Consortium hospital members

suggested that “high-performing boards were

more likely to have nurses as voting members”

than were low-performers.

In the survey of

nursing deans, most health systems were reported

as not being inclusive of either the dean of nursing

or an associate dean on their governing boards,

and overall, nearly half of respondents indicated

no nursing participation on the health system

board at all.

Note: Full results from both surveys are included as supplemental materials from AACN.

Select survey results are included in the body of this report.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Current nursing participation on health system

boards contrasts sharply with the views of many of

the university presidents we surveyed, with 73%

of respondents strongly or most strongly agreeing

that schools of nursing should have representation

on health system boards.

2) Organization Structures. The differing

reporting structures that pertain in most

universities for nursing, medicine, and in some

cases the health system can become a barrier

to the enhanced partnership and collaboration

described in this report. In many universities,

the faculty professional services and the health

system increasingly are in close alignment as a

clinical enterprise. It is rare to ﬁnd the school

of nursing being included in these evolving

structures, some of which are more formal

and include new governance and reporting

structures, and others that are focused on

the integration of operational and ﬁnancial

processes. In a few instances all the health

sciences and the health system have uniﬁed

governance and/or reporting structure, and this

can facilitate the collaboration across disciplines

that is increasingly valued.

3) Leadership Structures. Based on our

interviews and understanding of AHC

organizational structures, most nursing deans

and faculty do not hold signiﬁcant health system

leadership positions, either as members of the

health system executive team or as leaders of the

clinical nursing enterprise. This ﬁnding contrasts

sharply with academic medicine, where the

dean is often a key member of the health system

executive team. While there are many variants

of reporting structures amongst AHC’s, it has

SURVEY OF DEANS OF NURSING SURVEY OF UNIVERSITY LEADERSHIP

Survey Goal: Establish a baseline understanding

of how schools of nursing and their academic and

clinical partners are approaching the development

of a new alignment model for academic nursing in

the context of evolving academic health centers.

Survey Participants: This survey was completed by

Deans of Nursing at schools that are a part of or are

afﬁliated with AHCs.

▪ 102 survey participants were invited to

complete the survey.

▪ 55 responses were collected for a response rate

of 54%. 74% of respondents were from public

university settings.

▪ The survey was blinded; however a list of

invited institutions is in the appendix.

▪ Select questions asked for “free-response”

follow ups. Pertinent summaries of those

comments are included throughout.

Timeline: This survey was launched on December 9,

2015 and closed on December 23, 2015.

Survey Goal: Understand the perspective of

university leaders regarding the role of their Schools

of Nursing.

Survey Participants: This survey was completed

by University Presidents, Provosts, Health Science

Chancellors, or their equivalents that have or are

afﬁliated with academic health systems.

▪ 102 survey participants were invited to

participate.

▪ 50 responses were collected for a response

rate of 49%.

▪ The survey was blinded however a list of invited

institutions is listed in the appendix.

▪ Select questions asked for “free-response”

follow ups. Pertinent summaries of those

comments are included throughout.

Timeline: This survey was launched on December 9,

2015 and closed on December 23, 2015.

American Association of Colleges of Nursing

become widely accepted that the Dean and the

CEO must work intimately and closely together,

with highly aligned organization structures

amongst schools of medicine and health

systems rapidly becoming the norm.

Clinical department chairs often lead the

clinical services of the health system, holding

appointments in both the school of medicine

and the health system.

From the survey of nursing deans, many

reported that they or a member of their

leadership team hold appointments in the

health system and the health system CNO

holds an appointment in the school, however,

in many cases it was reported that these

cross-institution appointments lack the

strength and level of responsibility needed

to foster innovation and a higher degree of

collaboration.

Perceived limitations exist within the academic

nursing community with respect to the

incorporation of the perspectives of schools of

nursing into the strategic

decision-making of both their

afﬁliated health systems and

afﬁliated medical schools—

areas where universal

endorsement for closer

alignment was noted by

interviewees.

University presidents largely

support a closer strategic

relationship between

schools of nursing and their

partner health systems and

medical schools, with 89%

endorsing a school of nursing

role in the development of

university strategic plans, 79%

endorsing a role in health

system strategic plans, and

49% endorsing a role in the

school of medicine’s strategic

plans. Of the university

president respondents, 88%

strongly or most strongly hold the expectation that

their “school of nursing should be an innovator and

major contributor to the transformation of health

care in our region”, reinforcing the expectation that

their schools of nursing should serve an enhanced

institutional role.

4) Integration of Nursing Faculty into the

Health System. Although nurse training

programs originated within hospitals in the late

19th century—the “Nightingale schools”—today

there is relatively modest clinical integration

between academic nursing and their afﬁliated

health systems. As one measure, a majority of

nursing deans reported low/minimal integration

of school of nursing faculty into the clinical

practice of the health system in the survey of

nursing deans.

Few nursing clinical faculty members practice

in their partner health systems. Many deans of

nursing report difﬁculty securing appointments

for clinical faculty, and in many cases, faculty

71%

29%

90%

10%

Dean of Nursing Survey

Does the Dean of Nursing hold a seat on

the governing body of the health system?

Dean of Nursing Survey

Does an associate/assistant dean of

nursing hold a seat on the governing

body of the health system?

Dean of Nursing Survey

How many governing body seats, if any, are held by Directors with a nursing background?

Yes

60%

40%

20%

Zero One TwoThree Four Five

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

must seek clinical placements outside of their

partner health system to maintain certiﬁcation.

This lack of clinical integration has several effects:

▪ School of nursing faculty are not viewed as

full partners by the clinical practice and its

leadership;

▪ Preceptorships and teaching roles for nursing

students and residents are often ﬁlled by non-

faculty nurse leaders from the health system;

▪ A limited integration of faculty-led and

student-led research projects that can lead to

a stronger “culture of learning;”

▪ Academic nursing participation in the

development of clinical and research strategic

plans remains minimal.

The appetite in academic nursing for maintaining

a robust clinical faculty that spends signiﬁcant

portions of their time in patient care also has

been minimal. In our view,

this is largely due to a lack of

funding for this role.

5) Integration and

Collaboration in Nurse-

Scientist Research. Nurse-

led research is carried out

daily both within academic

nursing and also in the

health system by faculty and

non-faculty nurse scientists.

In many instances, these

research activities and projects

operate independently of their

associated school of nursing,

despite opportunities for

collaboration. Barriers also exist

between academic nursing and

the health system to facilitate

nurse-led projects across

institutions, which inhibits

potentially innovative research

projects. Further integration

and collaboration is needed

across the different health

sciences schools.

Overall according to the survey of nursing

deans, low levels of research collaboration were

reported between schools of nursing and partner

health systems, medical schools, and other

professional schools

Transdisciplinary research programs can and

should be supported to integrate investigators

and foster “university-wide” research leadership

and programs. University president respondents

strongly supported the notion that nursing

research programs should be developed and

better integrated across multiple dimensions

– in particular within the critically important

domain of population health science research.

Over three-quarters of university president

respondents ranked growing academic programs

as a high or highest priority, particularly with

respect to population health science.

Dean of Nursing Survey

Does the heath system CNO have a faculty appointment?

Does the Dean of Nursing or an Associate Dean of Nursing

have an appointment within the health system?

Yes – 61% No – 39%

Yes – 73% No – 27%

Dean of Nursing Survey

On a scale of 1 (lowest) to 5 (highest), how would you rate the integration of perspectives

from the school of nursing into the strategic decision making of (average score):

Affiliated Medical School

2.40

2.33

0 12345

Affiliated Heath System

American Association of Colleges of Nursing

● Finding 2: Institutional leaders recognize

the missed opportunity from alignment with

academic nursing and are seeking a new

approach.

Themes that ran consistently throughout the

interviews conducted were missed opportunity

for partnership; frustration at the lack of

alignment amongst academic nursing, medicine,

and the health system; and a strong desire to

reset relationships around a dynamic vision for

academic nursing.

▪ Deans of nursing report that they often

are omitted from AHC decision-making and

efforts to advance important AHC clinical

redesign, despite attempts at integration

and offering what they perceive as signiﬁcant

value in areas including transitions of

care, chronic care management, design of

informatics projects, patient engagement,

and primary care. Despite notable advances

in nursing-led research, they report a sense

of being on the margin of enterprise research

initiatives focused on population health.

Deans of nursing believe that they – through

their faculty, students, and

academic programs – have

much to contribute to the

future success of AHCs and

that they historically have

been undervalued at best,

and ignored at worst.

▪ The health system

chief executives and

chief nursing ofﬁcers

interviewed recognize

that academic nursing

generally has not

been involved in major

leadership roles and are

not often involved in

health system strategic

initiatives. Several

interviewees remarked

that their afﬁliated school

of nursing seemed more

interested in education

and research portfolios than clinical practice.

We also heard the comment that nursing faculty

are insufﬁciently engaged in the clinical delivery

processes to practically contribute what they

will readily agree are valuable insights. There

also was a concern that nursing faculty are

insufﬁciently focused on the issue of total cost

management, and that proposed solutions

for care coordination and transitions which

enhance the role of nursing may increase

costs as an unintended consequence. On the

other hand, we were advised of “the critical

importance of academic nursing to achieving

a patient-centered approach to clinical care,”

as well as the critical need for the school of

nursing to graduate nurses prepared to care

for patients in a 21st century context. Several of

the interviewees also indicated that academic

nursing “needs a seat at the table” of health

system management and were interested in the

potential for leadership training programs to

prepare nurse faculty for this responsibility.

Dean of Nursing Survey

Do the nursing faculty primarily maintain their clinical certification by practice

within the health system?

Yes – 33% No – 67%

Dean of Nursing Survey

On a scale of 1 (low) to 5 (high), how would you rate the integration of school nursing

faculty into clinical practice in the health system?

12345

10%

20%

30%

40%

50%

43%

Rating (1-5)

Percent of Respondents

24%

22%

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

▪ Deans of medicine reported signiﬁcant interest

in evolving institutional research agendas

that are transdisciplinary and that increasingly

share resources and faculty. They also are

strongly interested in pursuing an agenda on

interprofessional education—particularly with

master’s and doctoral degree nurses in the

graduate education realm and are seeking

partnership from nursing in this regard.

▪ Finally, university presidents / chancellors see

a strong need for academic nursing to rethink

their approach to their own development as

leaders in the advancement of science and

clinical innovation. They value contributions

to the nursing profession and the health

sciences more broadly and are

supportive of schools of nursing

rethinking approaches in this

regard—from the selection of

deans to program development

to individual faculty recruitment.

They are interested in ﬁnding

opportunities for synergy

among the entire research

enterprise and recognize that

the future of research—as in

clinical care—increasingly will

be transdisciplinary, particularly

for clinical and translational

research. By a wide margin

(81%), the university presidents

surveyed endorsed the notion that “the school

of nursing should have signiﬁcant depth in each

of the missions of teaching, clinical care, and

research.”

● Finding 3: Insufﬁcient resources are a barrier

to supporting a signiﬁcantly enhanced role for

academic nursing

All the deans of nursing interviewed for this

report brought up the challenge they face in

realizing higher aspirations given their current

funding model, which is highly dependent

on tuition. They perceive a major disconnect

between the expectations for an increasingly

participatory role in AHCs, expanded to all

missions, with a funding model

based primarily on the educational

mission.

Academic nursing is largely

funded by tuition dollars and does

not beneﬁt signiﬁcantly either

from funds that ﬂow from their

afﬁliated health systems or from

robust grant support from federal

agencies. Deans of nursing report

that, on average, over 60% of their

funding is from tuition, and trace

amounts are from clinical income

and AHC support. Given that total

budgets reported ranged from $5

Percent of Respondents

The School of Nursing should have significant

depth in each of the missions of teaching, clinical

care, and research.

The School of Nursing should combine its teaching

mission with a very significant role in research.

The School of Nursing should have as its primary

mission the education of future nurses.

The School of Nursing should combine its teaching

mission with a very significant role in clinical care

innovation and delivery.

50%

University President Survey

Which of the following best represents your perspective (choose 1):

100%

Dean of Nursing Survey

On a scale of 0 (none) to 5 (extensive), describe the extent of research collaboration

between the school,of nursing and:

Affiliated Medical School

2.42

2.59

0123

Affiliated Heath System

American Association of Colleges of Nursing

to $30 million, one can appreciate the limited

ﬂexibility that the deans have for investment.

Academic nursing for the most part does not

have its own clinical income (on average, school

of nursing budgets in our survey only contained

4% in clinical support), such as with a “dean’s

tax”

comparable to those that often exist in

medical schools.

For those institutions that do receive ﬁnancial

support from their partner health systems, deans

of nursing report arrangements for purchased

services, in kind services,

and education support,

with recruitment support

and research support

being the exception in

some schools. Recruitment

and research support

may be most needed by

academicnursing.

Research programs in

particular should be noted as

signiﬁcantly under-resourced

in academic nursing. The

dedicated arm of the National

Institutes of Health (NIH)

institute that funds nursing

research directly—the

National Institute for Nursing

Research (NINR)—constituted

just 0.4% of the total NIH

budget of $30 billion in 2015.

While it is true that many of

the other NIH Institutes also

fund academic nursing, these

funding amounts are quite

limited. Academic nursing

received just over $133 million

in total NIH funding in 2014,

compared to signiﬁcant

amounts awarded to their

colleagues in academic

medicine ($11.4 billion),

public health ($821 million),

pharmacy ($252 million), dentistry ($179 million),

and veterinary medicine ($158 million).

vii

Furthermore, of the total 9,000-plus NIH funded

scientists in the healthcare workforce between

2008-2012, only 341 (3.7%) were nurse-scientists,

despite the recognized need for capacity building

in nursing science.

viii

However, the paucity of

nurse-scientists is not solely a result of limited

funding but also represents the traditional focus of

academic nursing on training clinical practitioners.

Foundation

Support

Tuition OtherResearch

Grants -

NIH

Research

Grants -

HRSA

Research

Grants -

Other

Clinical

Income

AHC

Support

10%

20%

30%

40%

50%

60%

70%

63%

22%

5% 5%

Average Percentage of

Total SON Budget

Dean of Nursing Survey

What percent of the School of Nursing budget is comprised from each of the following:

Compensated

services support

for clinical

responsibilities

In kind

(infrastructure)

services

provided

Educational

support for

graduate

training,

preceptorships

Recruitment

support for

School of

Nursing faculty

positions

Research

funding support

45%

40%

35%

30%

25%

20%

15%

10%

42%

37%

31%

16%

11%

Percent of Respondents

Dean of Nursing Survey

Does the School of Nursing receive any of the following types of financial support

from the health system?

A dean’s tax is a common ﬁnancial mechanism used by schools of medicine to assess the faculty’s collective professional income and thus

provide academic support funds for the school. In effect, a cross-subsidization for supporting the school’s missions.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

ACADEMIC NURSING LEADERSHIP SUMMIT

On August 25, 2015, AACN hosted a leadership summit

with deans from academic nursing and medicine,

university leaders, health system CEOs and CNOs,

AACN and Association of American Medical Colleges

leaders, and nursing leadership from the Veterans Health

Administration.

The objective of the summit was to

engage a thorough discussion on health reform, the need

for academic nursing leadership, and the intersection

with academic health system transformation.

Manatt Health facilitated this gathering of invited

leaders and prepared the following summary of the

major takeaways.

1. The traditional ways of doing business

within AHCs must evolve, which will

necessitate signiﬁcant culture change across

all three missions. Of particular importance

will be enhanced communication, a focus on

“we,” and a commitment to mutual support.

Participants recognized that this change in

culture will be difﬁcult, given that schools of

nursing, other professional schools, health

systems, and schools of medicine have become

increasingly siloed from each other.

2. New organizational structures that more

closely couple academic nursing with health

systems will be important to facilitate

the kind of successful integration that is a

precursor to effective collaboration. There

is no one “correct” structure, but rather, the

broad principle of alignment of interests along

strategic, cultural, programmatic, economic,

and governance dimensions should be pursued.

Partnership needs to mean: “If I succeed, you

succeed, and if you fail, I fail.”

3. The ﬁnancial model of tuition driving

academic nursing inhibits the strategic and

aspirational role participants believe is

possible. Nursing faculty typically focus ﬁrst

and foremost on teaching. To some degree this

accounts for the reluctance of nursing faculty

to take on positions of clinical responsibility,

particularly without a ﬁnancial support model

for doing so. If academic nursing is to serve

a transformative role, then the economic

model must be put in place that provides the

resources—through clinical, research, and

educational support—to do so.

2015 Academic Nursing

Leadership Summit

Attendees listed in Appendix B

Figure 3: Leadership Summit Participating Institutions

American Association of Colleges of Nursing

4. Within academic nursing there is a strong

perception that physicians are overly dominant

and that independence is necessary for nurses

to achieve their true potential. Contemplating

the pivotal role for nursing in the future, the

issues of cultural, organizational, discipline, and

gender bias that persist in our organizations

must be addressed, fostering partnership and

alignment across the professional schools and

the AHC.

5. Nursing needs to be at the table as AHCs

develop their population-health strategies

and accountable care organizations. Many

health systems are lacking data scientists and

implementation scientists. Leaders should be

seeking new opportunities to connect the dean

of nursing to other initiatives in their enterprise.

6. Leadership development is a key long-

term success factor for AHCs given trends in

interprofessional, team-based clinical care,

and in multi-professional research programs

that seek to translate discovery and innovation

into practice. Approaches that identify and

foster the development of future leaders—

both through informal mentorship and formal

programs to equip future leaders with skills

needed for leadership—in the clinical, research,

and administrative realms are essential.

7. Workforce planning efforts within AHCs

through partnerships with the health system

and its afﬁliated schools represent a major

opportunity for collaboration:

a. Signiﬁcant opportunity exists within AHCs

to link clinical enterprise workforce needs and

planning to the various academic programs to

create a robust pipeline of clinicians prepared

for the future of care delivery. Most institutions

have failed to realize the power of a true

partnership around training and workforce

development.

b. There is a shortage of clinicians to support

clinical trials and data integrity/analytics roles

in AHCs, as well as shortages of researchers

in data science and implementation science.

Solutions will require collaboration among all

the disciplines and the health system.

8. Research program capacity-building within

academic nursing present an important

opportunity for alignment. Academic nursing

should consider recruiting PhD investigators

in emerging areas including informatics,

implementation science, health services research,

and patient safety/quality, which can increase the

number of grant dollars.

9. The recommendations set forth are

not without risks to those schools of

nursing that operate in silos—strategically,

programmatically, and ﬁnancially. With

integration, shared leadership and shared

governance comes shared accountability for

success and failure.

10. Policy issues at the federal and state level,

and possibly within professional societies that

oversee the various stakeholder groups are

limiting. Speciﬁcally we need to consider:

a. Scope of practice

b. Reimbursement for advanced practice

registered nurse (APRN) professional services

c. NIH and other public programs to support

nursing-focused and multi-professional research

Building a Strong

Partnership

The ﬁndings from the interviews, the surveys, and the

leadership summit are unambiguous: an enhanced

partnership with academic nursing will beneﬁt all

parties. On the one hand, AHCs are in the midst of

signiﬁcant transformation in clinical care delivery

and in the evolution and integration of research and

education programs. Academic nursing can contribute

materially to the success of this transformation. On the

other hand, academic nursing has unrealized potential

to grow as centers for research and clinical innovation

as the role of nurses expands and develops in health

care, positively contributing to the ultimate goal of

advancing health.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

To achieve a new partnership the following challenges

must be met:

▪ Academic nursing faculty must have a deeper

involvement in clinical practice and more

opportunity to engage in the clinical innovation

IMPERATIVES FOR AHCS

INTERSECTION WITH ACADEMIC

NURSING INTERESTS

1. Developing population health competence

necessary to successfully manage

beneﬁciaries—a new paradigm for AHCs. This

development must occur alongside continued

focus on core business of complex tertiary/

quaternary care services.

▪ Strong population health science research

and leadership

▪ Opportunity for significant role in health

system innovation around population health

capability development

2. Continuum-of-care development and integration

that links acute, post-acute, and community-

based care, built on a foundation of transitional

care and care management capabilities.

▪ Nursing leadership in emerging clinical

roles critical to population health including

transitional care nurses, care coordinators,

care managers

▪ Leadership in new care model design and

implementation

3. Development of a foundation of primary care

and enhanced patient access off the traditional

main campus to the community, with growing

networks of employed and afﬁliated non-

faculty nurses, physicians, physician assistants

(PA), and other allied health professionals

“closer to home.”

▪ APRNs critical element of a growing network of

primary care

▪ Nursing leadership on care teams as front-line

partners with patients in self-management, etc.

4. Priority focus on quality, patient safety, and

outcomes within the delivery system to meet

both a national imperative on quality but also

an internal imperative to lower the overall

AHC cost-structure to compete with lower-

cost community systems, particularly for less-

acute care.

▪ Long tradition of academic nursing leadership

in the science of quality and safety

▪ Opportunity for enhanced academic nursing

role in implementation of quality and safety

initiatives in the clinical system and in

community-based settings

5. Innovation with patient-oriented research

that connects basic science discovery to new

clinical interventions, drugs, therapies, and

procedures and broader population/public

health interventions.

▪ Long tradition of academic nursing leadership

in patient and community-oriented research

▪ Opportunity for transdisciplinary research

teams focused on implementation science and

population health interventions

American Association of Colleges of Nursing

needed by evolving academic health systems—

which has signiﬁcant implications for both

schools of nursing and AHCs.

▪ Research programs across academic nursing,

health systems, academic medicine, and

other professional schools must be fostered,

particularly around patient and community-

oriented research.

Overcoming these challenges will require a paradigm

shift in how academic and clinical programs across

health science schools and the clinical enterprise

organize and align themselves. Academic nursing

needs to reﬂect on its aspirations and reorient to these

themes, and a business case for investment in the

evolution of academic nursing must be compellingly

made both nationally and within each institution.

Most, if not all, AHCs are focused on regional system

development that will enable them to deliver the

scope of services necessary to compete with their

community-system competitors and better manage

the total cost of care. They are seeking to redesign

their services and offerings and move away from

operating exclusively as “destination-centers” for

tertiary and quaternary care to systems-of-care that

offer a full range of services along the continuum

through a combination of owned assets and aligned

partners. These imperatives intersect with the interests

of academic nursing leaders, suggesting signiﬁcant

potential for an enhanced partnership.

The following six recommendations are designed to

assist institutional leaders as they consider how best to

achieve the promise and potential of a full partnership

with academic nursing. The sections that follow

provide detail on each of these recommendations, as

well as highlight exemplar activity from institutions

across the country where academic and clinical leaders

have been successful in aligning and integrating

academic nursing in a true “transformation agenda.”

RECOMMENDATION 1: EMBRACE A NEW

VISION FOR ACADEMIC NURSING

AHCs are traditionally organized within the context

of the relationship between academic medicine and

the health system, with academic nursing playing a

secondary role in clinical decision making and strategic

planning for long-term sustainability.

Enhance the

Clinical

Practice of

Academic

Nursing

Partner in

Preparing

the Nurses

of the Future

Invest in

Nursing

Research

Programs and

Better

Integrate

Research

into Clinical

Practice

Implement an

Advocacy

Agenda to

Support a new

Era for

Academic

Nursing

Partner in

the

Implement-

ation of

Accountable

Care

Embrace a New Vision

for Academic Nursing

2 3 4 5 6

Figure 4: Building A Strong Partnership–Recommendations

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

RECOMMENDATION 2:

ENHANCE THE CLINICAL PRACTICE OF

ACADEMIC NURSING

We recommend that academic nursing and their

partner AHCs develop mechanisms to more fully

bring nursing faculty into the clinical practice of the

health system and seek to connect the

clinical service more closely to the mission of

academic nursing.

Though signiﬁcant gains have been achieved by

nursing since the publication of the IOM Future of

Nursing report in 2010, real support now needs to

be put behind engaging the nursing enterprise in

a number of transformative practices and concepts

gaining traction within AHCs, including team practice,

evidence-based health care, population health, and

patient engagement.

To achieve a new model of interprofessional

engagement within AHCs, institutional leaders must

embrace a new vision for academic nursing. Nursing

is integral to the success of the health system, and

the impact of a well-positioned school of nursing will

bring material beneﬁts to the larger enterprise. These

can include, among others: achieving and sustaining

magnet designation status; successfully meeting

the requirements for accountable care organization

(ACO) programs; broadening the foundation of

primary care; preparing the clinical workforce for

the future; realizing clinical and ﬁnancial beneﬁts

from value-based payment; transitioning to patient-

centered care; and leading in clinical informatics and

patient-oriented research. A recommended starting

point for the future of academic nursing is found

in the following vision statement, which we urge all

institutional leaders to embrace:

ACADEMIC NURSING IS A FULL PARTNER IN HEALTHCARE DELIVERY, EDUCATION, AND RESEARCH

THAT IS INTEGRATED AND FUNDED ACROSS ALL PROFESSIONS AND MISSIONS IN THE ACADEMIC

HEALTH SYSTEM. ELEMENTS OF THIS VISION INCLUDE:

▪ Nursing participation in health system governance

▪ Expanded academic nursing leadership in clinical practice and care delivery

▪ Growth and evolution of academic nursing research programs in partnership with academic medicine,

the health system, and other professional schools

▪ Collaborative workforce plans and training programs in partnership with the health system

▪ Integration of academic nursing into population health initiatives

▪ System-wide commitment to leadership development to prepare and support future nurse leaders

UNIVERSITY OF

PENNSYLVANIA

The University of

Pennsylvania School of

Nursing, in partnership with the Hospital of the

University of Pennsylvania (HUP), established two

roles aimed at facilitating greater linkages between

the activities of the clinical practice and the school

of nursing faculty. First, a Clinician Educator (CE)

role has been developed. CEs are full-time faculty

members appointed with responsibility for delivery

of services within the practice setting, based on the

premise that practice, research, and education are

interrelated and should be integrated. The health

system has agreed to fund part of the CE salary

based on the percentage of clinical time provided

(variable). In addition to clinical responsibilities, CEs

have research programs that are often carried out in

the health system in partnership with other faculty,

students, and non-faculty nurses. Promotion and

American Association of Colleges of Nursing

Strategies that academic nursing and AHC

leadership should consider in adopting this

recommendation include:

1. Establish clinical leadership positions to link

academic nursing faculty to clinical practice

leadership and vice-versa. A recommendation

from several health system executives interviewed

for this report is for nursing faculty to take on

greater responsibility for direct clinical care.

This recommendation is made in the spirit

of enhancing the ability of nursing faculty to

provide clinical leadership, in a model akin to

how physician chiefs of division serve as leaders

in AHCs. With regard to nursing, as an example,

a director of critical care nursing might also have

an academic nursing faculty appointment. Having

nursing faculty in clinical roles also will beneﬁt

the education of nurses in the clinical setting,

with more of an integrated approach between

faculty and hospital-employed preceptors.

Deans of nursing and health system CEOs must

develop appropriate ﬁnancing models that

recognize potential contributions to health system

operations and innovation in clinical care.

tenure requirements are as vigorous as non-CE

faculty within the school.

Second, an Associate Dean for Practice and

Community role has been developed jointly between

the Dean of Nursing and the Chief Nursing Ofﬁcer at

HUP. The position was designed to support clinical

research development and the strengthening of

collaboration between the school and the health

system. The position is jointly funded and reports

both to the Dean of Nursing and the CNO of HUP.

2. Facilitate joint clinical program development

between academic nursing faculty and clinical

practice leaders, with particular emphasis on

ambulatory care and population health. In

effect, such an effort will facilitate a more robust

approach to designing and improving clinical

service delivery in support of the transition to new

models of care. Development of a joint committee

or inclusion of academic nursing faculty into

existing clinical service committees should be

considered as a mechanism to support broader

engagement related to care redesign.

3. Grow academic nursing clinical practice as a

means of meeting several goals described in this

report: broadening the involvement of nursing

faculty in clinical care; creating a practice home

for APRNs; and generating clinical income support

for the school of nursing. Nursing clinical practice

is likely to expand in the years ahead as APRNs

increase in number and scope of practice laws

continue to evolve to recognize the advancement

of the profession and its centrality for patient

care. Therefore, institutions should anticipate

and plan for expanded nursing clinical practice.

Broadly, there are two paths for schools of

nursing to follow, depending on their institutional

context. One path includes the development

leverage where possible the leadership of School of

Nursing faculty in strategic and operational decision-

making. The Dean is a Vice President of the Medical

Center, sitting at the senior leadership table with the

Dean/CEO, COO, Hospital CEO, and CMO of the

faculty practice. The Dean also sits on the Medical

Center Executive Team and the Nursing Practice

Executive Council. This structure allows for the

collaborative thinking, planning, developing, and

evaluating of initiatives that support and enhance

the functioning of the AHC. The participation of the

school of nursing on this senior team broadens the

sphere of inﬂuence that our faculty/school can have

in high level discussions and decisions. For example,

the SON is highly visible in the URMC Strategic Plan—

highlighting the school’s contributions to creating a

highly educated, diverse workforce and in increasing

the capacity of the institution’s primary care agenda.

UNIVERSITY OF

ROCHESTER

The University of

Rochester/University

of Rochester Medical Center has developed

an integrated leadership structure to facilitate

integration of the School of Nursing faculty and

leaders into the activities of the broader AHC, and

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

of a nursing faculty practice organization. This

organization may contract for billing and/or

management services from the medical faculty

practice or health system. Organizations that

have successfully taken this path in some form

include University of Utah, University of Texas

Health Science Center at San Antonio, and

Columbia University School of Nursing. Another

path is to build a nurse faculty division integrated

with the medical faculty plan and/or the health

system employed practice, using a “lease”

mechanism for the provision of clinical time.

4. Expand clinical integration with joint

appointments and practice integration.

Nursing clinical faculty need to maintain

certiﬁcation and a priority should be for the

health system to provide clinical settings, both

inpatient and outpatient, and compensation

models that permit them to do so. Joint

appointments – such as with a clinician-educator

track or equivalent – also will be important

to create more points of linkage. Further, the

integration of nursing faculty into internal

medicine, family medicine, and pediatrics

practices will expand capacity and create

new opportunity for team-based practice and

potentially research and educational synergy.

5. Promote and expand nurse-managed

health clinics. Nurse-managed clinics have the

potential to increase the primary care workforce

nationally

and thereby provide an approach

that AHCs can utilize to strengthen their primary

care foundations. As AHCs become focused

on a population-health model designed to

meet the needs of multiple beneﬁciary cohorts

(notably Medicaid), the ability to expand up

nurse-managed clinics will provide them with

a complementary and more rapid approach

to meet these burgeoning needs for access.

Specialist Program. She is a certiﬁed ACNP and

works in the Cardiac Intensive Care Unit (CICU), and

serves as a lead NP over the NPs working in the CICU.

Recently, she completed a research study evaluating

a new model of care in which ACNPs manage 7 CICU

beds providing 24/7 patient coverage. The expansion

of these CICU beds addressed the increased volume

of patients with cardiac diagnoses from the emergency

department who needed acute, intensive care beds.

She also spearheaded the development of an NP led

Heart Failure Admission Reduction Program (HARP).

In this program the CICU NPs followed patients

discharged from the CICU for 30 days in collaboration

with a home health agency. In a 3 month pilot study,

the HARP patients had an 11% readmission rate

compared to a 66% readmission rate for heart failure

patients discharged from the CCIU who did not enroll

in HARP.

RUSH UNIVERSITY

Rush University/Rush

University Medical

Center has an integrated

model of clinical, teaching, and research service that

starts with a shared academic / clinical leadership

model, and extends down to the faculty. Indeed, the

College of Nursing mission statement states, “The

uniﬁcation of education, research, and practice is

the learning model of this college…faculty have

the opportunity to function in one of three roles:

teacher-practitioner, teacher-researcher, or researcher-

practitioner”. From a leadership perspective, there

is cross pollination across the academic and clinical

organizations, with the Dean of the College of Nursing

acting as a Vice President of the Medical Center and

the Chief Nursing Ofﬁcer acting as an Associate

Dean in the school of nursing. The College of Nursing

faculty all operate within a “teacher-practitioner

model”, participating in and leading multiple aspects

of the College and Medical Center’s missions.

Today, the unit-based teacher-practitioner role is

typically a 0.5 FTE appointment in the medical

center and a 0.5 FTE appointment in the College

of Nursing. In this role, the teacher-practitioner has

teaching responsibilities in coursework and clinical

experiences for nursing students in the College while

having a signiﬁcant service-based role in the medical

center. Clinical responsibilities include consultation,

patient care, nursing education, quality improvement,

and project support. As an example, an Assistant

Professor in the College of Nursing serves as the

Director of the Adult Gerontology Acute Care Nurse

Practitioner (ACNP) and Acute Care Clinical Nurse

American Association of Colleges of Nursing

Nurse-managed clinics also can provide needed

settings for the placement of nursing students

and the opportunity to gain required outpatient

services exposure. One dean of nursing indicated

interest in establishing a nurse-managed clinic

in the physician outpatient building after-hours

and on weekends. However, the concept was

derailed by a lack of consensus as to how the

nurse-managed clinic would ﬁt with the center’s

other primary care clinics. During multiple

interviews we also perceived the strong bias

toward “physician leaders of the team,” which

mitigates pushing the envelope on nursing-led

primary care. About 51% of respondents in the

survey of nursing deans reported having nurse-

managed clinics managed by their schools of

nursing, though many clariﬁed in free-responses

that the clinics were small in scale and in some

cases were limited to narrow populations such as

employees/students.

6. Expand participation of academic nursing

in next-generation payment arrangements. In

those institutions where there is willingness by

both the health system and the school of nursing

to collaboratively advance with population-

health innovation, we recommend exploring

shared efforts to achieve clinical and ﬁnancial

results. These efforts may include the health

system contracting with the school to provide

care coordination services; have the school’s

faculty participate as clinical leaders in ACO

efforts; participation in shared savings efforts;

collaboration on stafﬁng the ACO’s primary care

with clinics with APRNS; and direct contracting

with nursing faculty for the provision of services.

RECOMMENDATION 3: PARTNER IN

PREPARING THE NURSES OF THE FUTURE

One of the most critical challenges facing AHCs is

the development of the leadership of the future—

both the leadership of health science schools within

universities and the leadership of clinical systems.

Indeed, one of the core recommendations from the

IOM Future of Nursing report focused on leadership

development. According to the survey of university

presidents, “expanding leadership development to

train and support future nurse leaders” ranked second

in terms of priority for schools of nursing in terms of

opportunities to support the evolution of AHCs.

The time to begin planning is now, and given the

transformation of AHCs and their partner universities

UNIVERSITY OF

VIRGINIA

The University of

Virginia has developed a

joint appointment model to support collaboration

and integration between the full-time faculty of

the school of nursing and the clinical practice.

One faculty member serves as the Associate

Dean for Strategic Partnerships & Innovation

and holds a joint appointment (supported 20%

ﬁnancially) with the health system. In that capacity,

the Associate Dean works with the palliative care

service, and assists clinicians and students to

foster quality patient care, education and research.

Many of these joint appointments —some funded,

others volunteer—at UVA have been a critical

element of their collaborative model.

UNIVERSITY OF

COLORADO

The University of

Colorado College of

Nursing launched a nurse-managed and 100%

nurse-staffed clinic, “Healthcare Partners at

Bellview” operated out of the College. The clinic

will provide mostly preventive and primary care

services as well as basic laboratory services

and some in-ofﬁce procedures. The Clinic takes

insurance, but also charges a monthly ﬂat fee for

access to all services with no additional co-pays or

cost-sharing requirements for patients.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

and health science schools to prosper in healthcare

reform, new proﬁles of leaders are emerging that

academic nursing and AHCs must consider.

Strategies to consider include:

1. Develop a long-term workforce plan that

leverages redesigned academic nursing

educational programs combined with re-

training to prepare nurses for the future.

In a reconﬁgured system of health care organized

around whole-person care, nurses will have

a critical role as “boundary spanners” linking

patients with disparate parts of the health system

and coordinating transitions of care. Academic

nursing must rapidly adapt their curricula and work

closely with their afﬁliated health systems to train

the next generation of nurses adept at population

health management, especially for the chronically

ill, encompassing a myriad of new skills including

patient coaching, informatics, care transitions, and

geriatric case management.

There also is the need

to provide continuous re-training for the existing

nursing workforce in these new techniques.

2. AHCs and academic nursing should

collaborate to develop both a pipeline of new

nurses at multiple levels (BSN, MSN, PhD, DNP)

to meet current and future workforce needs, as

well as programs that advance selected high-

performing nurses to higher levels of education

and specialized training to further meet internal

workforce needs in a more cost-effective

way. Health systems and academic nursing

must jointly recognize the need for graduate

preceptorships and collaborate to provide

the programmatic incentives needed for their

expansion.

xii

The Graduate Nursing Education

(GNE) Demonstration—a Centers for Medicare

and Medicaid Services (CMS) program that tests

providing reimbursement to a select number of

hospitals for the reasonable cost of providing

clinical training to APRN students—should be

built upon as a model for collaboration between

AHCs, academic nursing, and community-based

training sites in supporting the training of APRNs,

speciﬁcally in community settings.

xiii

ELMS COLLEGE

Elms College has

developed an innovative

academic-practice

partnership with two separate health systems in

Massachusetts (Berkshire Health Systems and

Baystate Health) to prepare APRNs to assist in

meeting their future workforce needs, speciﬁcally

in the acute care adult setting and in primary

care. Formalized by agreement, the partnerships

include a discounted tuition package from the

College for each cohort that the health systems

sponsor; collaboration in the selection of qualiﬁed,

high-performing nurses for the organizational

funded DNP scholarships; provision of clinical

preceptors and clinical practice sites; joint faculty

appointments; support of scholarly DNP capstone

projects to contribute to advancing the systems’

goals for quality practice and healthcare delivery;

and evaluation of student and program outcomes

including the program model’s impact on the time

and resources related to transition and orientation

into practice of the new DNP graduate.

Eight (8) RNs from each organization (total of 16

funded students) received full scholarships in 2014

(ﬁrst cohort) and in 2015 (second cohort). The

Elms DNP APRN program is also open to non-

organizationally funded students within the region.

3. Create nursing leadership development

programs for faculty and clinical practice

nurses that are jointly managed by the school

of nursing and clinical practice. Identifying,

mentoring, and supporting promising nurses for

leadership positions—both within the faculty

and nursing clinical practice—but also within the

broader university and AHC leadership—is critical

for academic and clinical leaders. The leaders of

AHCs and health science schools of the future will

require new proﬁles—proﬁles of deans, faculty

leaders, clinical leaders, and AHC administrative

leaders that speak to the complexity of evolving

AHCs. Academic nursing and AHCs must act now to

start developing the next generation of leadership.

American Association of Colleges of Nursing

4. Lead the development of interprofessional

education efforts institution-wide. We found

near universal agreement that the future of

healthcare education is interprofessional

and, according to the survey conducted of

deans of nursing, 80% of deans report that

interprofessional education programs are in

place at their institutions. We found in direct

discussions, however, few clear examples of a real

and meaningful approach to interprofessional

education (both in didactic education and clinical

training) at most institutions. Many organizations

are in the early phases of establishing programs

in this regard that cut across the different

health sciences schools within an AHC including

University of Colorado and the University of

Rochester as well as others, but much work is to

be done to realize their full potential. Academic

nursing should take the lead in driving

interprofessional education development in

partnership with university presidents and their

health science college dean counterparts.

UNIVERSITY OF

COLORADO

The University of

Colorado has developed

a medical-campus speciﬁc interprofessional

education program. The current Interprofessional

Education Program is overseen by the IPE Council.

Representation on the council comes from each

of the schools/colleges. The representative, an

Assistant Director for Interprofessional Education,

serves as an advisor, consultant and collaborator

within the IPE council. The council oversees

the IPE program across campus. The students

participate in two eight-week courses, using team-

based learning.

There are three components of the program:

▪ The Interprofessional Education and

Development (IPED) Course focuses on team

dynamics and communication which are

shared across all AHC-afﬁliated schools and

programs.

UNIVERSITY OF

ROCHESTER

The University of

Rochester Medical

Center Institute for Innovative Education (IIE)

was created to identify and facilitate common

medical center educational priorities and to

support and promote interprofessional education

initiatives. The institute has a dedicated board

that includes the Dean of Nursing, and is currently

developing a URMC-wide educational strategic

plan that will emphasize inter-professional tram

training. After the plan is adopted, the IIE will

develop and drive speciﬁc educational initiatives

for the medical center as well as its community

clinicians. The Board and the institute are also

acting as a vehicle to seek out and apply for

funding to support programs and initiatives within

the interprofessional education space. The IIE

has supported the successful application of an

Assistant Dean for Interprofessional Education

for a Macy’s Faculty Scholar grant. This grant has

allowed URMC to study the impact of the use of

the electronic medical record on patient/family

centered care and communication and to develop

ways to enhance these processes. The IIE has

also supported the third annual Collaborative

▪ Clinical Transformations (CT) Simulations,

which provides an opportunity for students

to work together in a simulated environment

focused on teamwork and communication.

▪ Clinical Integrations (CI), which allows

students to practice interprofessional

health care in clinical situations. The Dawn

Clinic is an interprofessional clinic serving

underserved and uninsured clients within the

local community.

The IPE program essentially sits with the

Vice Chancellor for Health Affairs. There is a

Coordinating Council composed of the Deans

and the Vice Chancellor who review and provide

support for the IPE. program.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

of community-health programs and community-

engagement models, extending to primary care and

nurse-managed clinics.

Strategies that academic nursing and AHC

leadership should consider in adopting this

recommendation include:

1. Engage in joint clinical planning as part of a

larger, integrated strategic planning process

that incorporates all academic and clinical

entities. Many of the organizations identiﬁed

with stronger partnership between academic

nursing and the health system began with a

more integrated strategic planning process that

incorporated school of nursing leaders in clinical

system planning and vice versa. In particular,

academic nursing has contributed to the long-

term planning for new population health models

of care, including linking to evolving clinical

training programs both within schools of nursing

and, more broadly, across health science schools.

RECOMMENDATION 4:

PARTNER IN THE IMPLEMENTATION OF

ACCOUNTABLE CARE

Most AHCs are seeking to form systems of care and

prepare for accountable care. Some are seeking to

be leaders in this regard. The early experience of

AHCs with accountable care programs including

the Physician Group Practice demonstration and

the Medicare Shared Savings Program (MSSP) and

Pioneer ACOs indicates several deﬁning success

factors, including having a primary care foundation,

experience with risk-bearing products, building close

relationships with post-acute and long-term care,

signiﬁcant data and analytics expertise, and patient

and community engagement.

xiv

According to a 2015

article in Nursing Outlook, 18 of 32 original Pioneer

ACOs were developing new and enhanced roles for

registered nurses across the continuum of care, with

many enhancing roles for RNs in the various clinical

activities of the ACO.

Medicaid programs nationally are undergoing

signiﬁcant transformation as well, as states respond

to signiﬁcant budgetary issues, Medicaid program

growth (now the single biggest payer nationally), and a

need to re-orient services for an increasingly complex

population. AHCs in many markets care for high

numbers of Medicaid beneﬁciaries and in some states

are sole-providers of complex care services. As a

result, AHCs often care for signiﬁcantly more complex

patients who fall through the cracks of a fragmented

delivery system and who may require signiﬁcantly

higher levels of care.

As a result of the Medicaid imperative for a population

health model, AHCs increasingly are developing

networks of services in the community, moving off

campus and out of the hospital to meet patients in

their neighborhoods with new kinds of services.

Nurses, including academic nursing clinical faculty,

are vital contributors to developing these types

THE UNIVERSITY

OF FLORIDA

University of Florida

Health has established

a uniﬁed strategic plan that brought together

all of the clinical and academic units within

the academic health center. UF Health, which

encompasses several hospitals and physician

practices, the health professional colleges and

numerous research institutes, is now operating

within one strategic framework and set of

organizational goals around its three missions

that can only be achieved through functional

integration and collaboration.

In keeping with national recommendations to

improve nursing practice and help nurses become

well-positioned to lead change and advance

health, the College of Nursing and the UF Health

Shands Hospital division of nursing began to

strategically collaborate in education, research,

and patient care. As part of this partnership,

both Anna McDaniel, PhD, RN, FAAN, dean of

Care Symposium bringing nationally recognized

experts to URMC to discuss issues related to

collaborative practice and interprofessional

education and team training.

American Association of Colleges of Nursing

2. Play a leadership role in developing

linkages between acute care and post-acute,

home-based, and long-term care services.

Accountable care approaches are emphasizing

transitions in care to reduce hospital readmissions

and because transitions are often where patients

can “fall through the cracks.” Academic nursing

can play an important role in the development of

and training around next-generation care models,

developing communication and care protocols

that extend care team continuity across settings of

care, and focusing on nursing excellence in non-

acute settings.

3. Expand nurse-led community programs

under the leadership of academic nursing

faculty in partnership with health system

leaders and clinicians. Developing a community

presence and set of services for speciﬁc

populations is a key imperative for AHCs. In

addition to providing healthcare services closer

to home through a new network of community

practices, AHCs are seeking to develop an

approach to connect to community-based and

social resources to support prevention and

non-medical needs of patients. Further, nursing

students at multiple levels are playing an essential

role in prevention and community wellness

outreach efforts, which could be linked more

formally to AHC population health strategies.

Academic nursing—both through direct provision

of services and through research programs on

these topics—can be strong partners to AHCs.

the UF College of Nursing, and Irene Alexaitis,

DNP, RN, NEA-BC, chief nursing ofﬁcer and vice

president for nursing and patient services at UF

Health Shands Hospital, now hold positions and

active roles within the hospital system and college,

respectively. In addition to serving as dean, Dr.

McDaniel serves as the UF Health assistant vice

president for academic-practice partnerships,

and Dr. Alexaitis serves as the College of Nursing

associate dean for academic-practice partnerships.

As part of a stronger partnership, several new

initiatives emerged. The Academic Partnership

Unit, or APU, is a new model of clinical education

that places nursing students in units to shadow and

learn from staff nurses who hold courtesy faculty

appointments. The program, which started in fall

2014, is a joint effort between leaders in the UF

College of Nursing and UF Health Shands Nursing

to enhance education and integration between

students and nursing staff. The APU model ensures

a low faculty-to-student ratio — two students per

faculty member — and allows for more two-way

dialogue and interaction and a hands-on patient

care experience.

In 2015, the College established a RN-to-BSN

program exclusively for UF Health registered nurses

to obtain their bachelor’s degree online from UF,

thus helping the hospital system reach the strategic

goal of increasing its pool of BSN-educated

nurses. This successful program recently has been

expanded for nurses across the state of Florida.

UNIVERSITY

OF TEXAS

HEALTH SCIENCE

CENTER,

SAN ANTONIO

UTHSCSA faculty developed a nursing faculty

practice plan, the Nursing Services Research &

Development Plan (NSRDP) approved by the

Board of Regents, led by the Vice Dean for

Practice and Engagement that is a separate and

distinct clinical practice entity from the Schools of

Medicine and Dentistry. The plan represents all

faculty that are 50% time or more. The practice

plan purchases certain MSO services from the

School of Medicine (speciﬁcally billing support).

The plan focuses strongly on providing care for

the underserved, recently being recognized by

the city for its efforts in support of the UTHSCSA

employee health and wellness clinic. The plan

runs several different clinics in partnership with

community agencies, as well as a student health

center, and the UTHSCSA employee health

clinic. In addition to billing for services, the plan

has been successful at securing other sources

of funding such as foundations and community-

based projects focused on Medicaid beneﬁciaries.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

4. Advance innovative evidence-based care

models and interventions focused on improving

the health status of underserved members

of the community linked to an overall AHC

clinical strategy. Faculty research programs

around community health, social determinants

of health, population, and public health should

be supported and tested in the ever-expanding

network of community clinics, particularly in

communities that are typically underserved.

As AHCs seek to take leadership positions

within state-wide Medicaid reform, a need for

innovative approaches to community-based

care for the underserved with a focus that

moves beyond medical needs will be needed.

Academic nursing faculty can be vital partners in

developing and executing a strategy to meet the

needs of communities.

5. Encourage leadership roles for academic

nursing faculty and leaders outside the AHC in

the community. Academic nursing leaders and

nurses more generally should seek to expand

their role as community leaders, seeking key

board positions and partners with community

organizations that can help to raise their proﬁle,

and the visibility of the work that they do.

RECOMMENDATION 5:

INVEST IN NURSING RESEARCH

PROGRAMS AND BETTER INTEGRATE

RESEARCH INTO CLINICAL PRACTICE

One CNO commented: “When you work in an

academic environment, you need to elevate

the practice of nursing through that academic

connectivity—through cutting edge research—and

make it part of the daily life and practice of the nursing

clinical practice.” Echoing this comment, a university

president said “any dean is more credible if they hire

and mentor faculty who are successful in securing NIH

funding.” Indeed, research should be a foundational and

vibrant dimension of academic nursing and of the nursing

clinical practice of the academic health system.

Yet academic nursing does not hold the same stature

as other health professional schools in terms of

large, resource-rich research programs. As indicated

previously, overall NIH funding is miniscule compared

to other health professional schools, and other sources

of research funding fail to provide adequate support.

This despite the reality that nurse-scientist-led

research is steeped in patient-oriented research and

research focused on improvements in quality, safety,

outcomes, and patient engagement—the types of

research critical to the pressing need to transform care

delivery nationally. University presidents in the survey

conducted for this report indicated this as the number

one priority in their view for academic nursing.

In addition to overall limited resources, there

often exist poor linkages between academic nurse

investigators and their research programs, and those

being led by hospital or health system-based nurses

in the AHC. Nursing units led by hospital-employed

nurses also conduct research projects, far too often

with little linkages to academic nursing faculty.

Institutional barriers are often to blame for these silos

– through the lack of joint appointments for nurse-

researchers and regulatory barriers that prevent faculty

from utilizing health system resources for conducting

research and vice versa. A true, research-grounded

and evidence-based nursing service that contributes

to the overall academic mission of the AHC, the

advancement of knowledge, and improvements in the

health and lives of patients is critical.

Strategies to consider include:

1. Create mechanisms to coordinate research

projects and activities across academic nursing

and the AHC with a shared leadership structure

and resources. For those schools of nursing

that have extensive research aspirations, closer

ties to their afﬁliated medical school and health

system will be mutually beneﬁcial. Organizational

integration may be realized by linking deans

of research; research and/or program councils;

and by involving nurse scientists in developing

clinical research initiatives. We recommend a

process be established to support broader access

by nurse scientists to core services within the

medical school and across the university- such

as data sets, informatics, and clinical research

infrastructure. Where not already in place, joint

IRB or coordinated IRBs should be put into place.

American Association of Colleges of Nursing

2. Develop joint research programs between

academic nursing and health system nurse-

scientists. Many clinical research projects will

beneﬁt from teams of faculty and clinical practice

nurses working collaboratively in and out of

nursing units. Jointly submitted grants should

be considered, and academic nursing and AHCs

should work to limit administrative and regulatory

barriers to collaboration across entities.

3. Integrate nurse researchers into developing

informatics programs. Vast investment by

medical schools and health systems is ﬂowing into

developing informatics programs, many of which

emphasize clinical informatics. As these programs

are planned, organized, and resourced, they

should incorporate the perspectives and talents of

academic nursing. Nurses trained as informaticians

will be invaluable complements to developing an

informatics initiative, extending to the development

of graduate training programs and other resources.

Achieving meaningful results with “big data” will

require nursing involvement to overcome, including

establishing standard data deﬁnitions, patient

engagement applications, decision support, and

security, to name just a few.

xvi

4. Strengthen clinical research nursing. The

continuing growth of clinical research, combined

with emphasis on T1 through T4 translational

research, requires an ever larger and more adept

cohort of nurse clinical trial coordinators and

clinical research nurses, a specialized and valued

position. The emphasis on patient assessment

and coordination, clinical observation, “deep”

phenotyping, and broader patient engagement

requirements make nursing involvement more and

more critical. Despite this impetus, the ﬁeld of

clinical research nursing remains undeveloped, and

there is a need for more detailed role deﬁnition

combined with enhanced training by academic

nursing combined with career progression and

opportunities with afﬁliated health systems and

schools of medicine.

• Community-Based Participatory Research

• Cost Effectiveness / Comparative Effectiveness

• Health Disparities

• Public Policy

• Observational Studies

• Personalized Medicine

• Guideline Development

• Systematic Reviews / Meta-Analysis

Clinical and Translational Research Spectrum

Basic

Scientific

Discovery

Examples Include:



Preclinical and Animal

studies

 Human Physiology

 First in Humans

 Proof of Concept

 Phase 1 Clinical Trials

Examples Include:



T3 Studies in the

Community

 Population Outcome

Studies

 Studies Beyond

Clinical Care That

Affect Health

Examples Include:



Phase 4 Clinical Trials

 Health Services

Research

(Dissemination,

Communication,

Implementation)

Examples Include:



Phase 2 Clinical Trials

 Phase 3 Clinical Trials

Transition to

Humans

Model SON Research:

Epigenetics of Pain

Control of

Experimental

Conditions

Sample

Size

Model SON Research:

Hypertension Epigenetics in

African American Families

Model SON Research:

Nursing Workforce Devel. in

Systems of Care

Model SON Research:

School - Based Obesity

Prevention

Transition to

Patients

Transition to

Practice

Transition to

Population

Health

Clinical

Insights

Implications

for Practice

Implications for

Population Health

Improved

Global Health

Figure 5: Translational Research Spectrum

Source: Harvard Clinical and Translational Science Center (updated by Manatt Health)

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

5. Lead in the establishment of linkages to

other schools for multi-disciplinary research

programs and approaches. The convergence

of disciplines in the conduct of biomedical and

health services research will continue at a rapid

pace. Academic nursing should help lead the

development of transdisciplinary research projects

in partnership with schools of medicine, pharmacy,

dentistry, public health, allied health, and non-

health science schools as well.

THE UNIVERSITY

OF FLORIDA

University of Florida is

seeking to enhance the

research proﬁle of its College of Nursing as part of

UF’s preeminence initiative. UF Preeminence is the

university’s effort to become a national and international

leader in more than two dozen areas, including health

care and the sciences, fueled by an investment from

the Florida legislature. Through this initiative, two

preeminent nurse researchers are now at UF and will

enhance the UF College of Nursing and UF Health

Shands shared research agenda, especially in nursing

informatics and palliative care.

The College of Nursing and UF Health Shands also have

developed a director of clinical research role to foster

integration between the nurse faculty-led research

programs and those of the hospital system. This director

serves as a bridge between faculty members at the

college and nurses in the hospital to facilitate research

and assists the nurses at UF Health Shands hospitals with

formulating clinical research projects.

Among success stories are collaborations between

expert faculty at the college and key clinical care teams

at the hospitals, including efforts focused on bone

marrow transplant, sickle cell, and wound ostomy. These

collaborations include Doctor of Nursing Practice

students actively working with clinical units at the

hospitals as part of their ﬁnal projects and clinical faculty

members providing expertise to both the hospital staff

and researchers.

The College of Nursing had a large and active presence

at UF Health Shands Nursing Research Day. In addition,

a robust Journal Club brings faculty members and

clinical nurses together to discuss clinical issues, which

promotes evidence-based practice and research.

THE UNIVERSITY

OF PENNSYLVANIA

Penn Medicine has

established and fully funded

a Director of Nursing Research and Science position

tasked with providing leadership for the development

of nursing research within the Hospital of the University

of Pennsylvania, the primary academic hospital of Penn

Medicine. This position reports directly to the CNO. The

Director chairs a Shared Governance Research Core

Council and is charged with advancing a culture of

scholarship and inquiry as well as developing strategies

speciﬁcally to integrate with the school of nursing.

6. Expand nursing faculty development and

recruitment to include PhD investigators across

multiple disciplines in targeted research areas.

The aspirations for nurse-scientist research, which

can underpin many of the promised innovations

from population health, will never be realized

without a signiﬁcant increment in the number

of nurse PhDs. The traditional route for nurse-

scientists which includes multiple decades in

clinical practice results in nurses receiving their

doctorates at a median age of 47, resulting

in a research work-force with far more limited

time to build scientiﬁc programs.

xviii

There is a

rapidly developing shortage of clinically trained

investigators—including veterinarian-scientists,

dentist-scientists, and nurse-scientists—to carry

out the next generation of clinically focused

research and to develop the next generation of

clinician scientists.

xix

Given the shortage of nurse-

scientists, academic nursing should expand faster-

track training programs for nurses interested in a

science career, particularly if successful advocacy

can increase the NINR budget and therefore funds

available for graduate training support. However,

research conducted by schools of nursing need not

be conﬁned to nurse-scientists alone.

Today, academic nursing faculty rosters heavily

favor faculty with PhDs in nursing and those with a

clinical certiﬁcation due to state and accreditation

requirements for faculty. Speciﬁcally, AACN data

shows that of the 50% of nursing faculty with

doctoral degrees, 10.7% of full-time faculty have

American Association of Colleges of Nursing

RUSH UNIVERSITY

In 2007, the Center for

Clinical Research and

Scholarship was formed at

Rush University Medical Center to serve as a formal

mechanism to help further advance research and

evidence based projects. Two teacher-practitioners

serve to mentor clinical staff to develop formal

research proposals. Pilot funding is available for

clinical teams to propose research ideas. Teams are

formed to join clinical staff with a faculty mentor for

the project along with a graduate nursing student to

facilitate their exposure to the research process. Over

50 clinical projects have been facilitated under the

direction and assistance of the teacher practitioners

including quality improvement projects, education-

based projects, pilot study initiatives and research

studies. The Center also sponsors clinical grand

rounds with internal and invited researchers, applies

for and obtains research funding for clinical projects,

provides mentorship for abstract and manuscript

preparation, and facilitates a journal recycling

initiative for faculty to donate their monthly journal

issues that has resulted in distribution of over 1000

clinical and research journal issues to the clinical units

to promote dissemination of research and evidence-

based practice resources for clinical staff.

non-nursing doctoral degrees. In order to expand

their research capacity, schools of nursing should

consider recruiting faculty with masters’ degrees

and PhDs in other disciplines such as informatics,

clinical and translational research, biology, public

health, epidemiology, and other related ﬁelds. This

recruitment should be considered in coordination

and partnership with their afﬁliated AHC and health

professional schools (including public health).

RECOMMENDATION 6: IMPLEMENT AN

ADVOCACY AGENDA IN SUPPORT OF A

NEW ERA FOR ACADEMIC NURSING

Critical to the success of many of the recommendations

and strategies in this report, as well as to the elevation

of the profession more generally as “true full partners

with physicians and other health professionals in

redesigning health care in the United States,” are

signiﬁcant changes to various policies at the state and

federal levels. Issues related to nursing’s role in care

delivery have been at the top of the agenda; however,

there are several other areas speciﬁcally related to

academic nursing and to academic nursing’s role in

healthcare transformation that should be considered.

Strategies to consider include:

1. Seek growth in the NINR budget to support

nursing-led research projects and nurse-

scientist training. The NINR budget represents

less than 1% of the total NIH budget, yet supports

nurse-led research in key transformation areas

that has the potential to transform patient care,

including with respect to patient outcomes. The

NINR is also a leading sponsor for nurse-scientist

training through the Graduate Partnership

Program and also a variety of extra-mural awards.

2. Support the recommendations made to the

NIH director for increased support for clinician-

scientists and initiate a dialogue to deﬁne how

to increase the numbers of nurse-scientists in the

future clinician-scientist workforce.

3. Develop a coalition of stakeholders to

advocate for increased public funding to

support a national nursing agenda that

links to the Triple Aim. This should include

advocacy for increased funding targeted toward

UNIVERSITY OF

CALIFORNIA,

SAN FRANCISCO

University of California,

San Francisco (UCSF) facilitates transdisciplinary

research approaches across its health science

schools. The school of nursing looks to include

relevant school of medicine faculty in faculty

and leadership search committees and where

appropriate contribute to percent efforts to facilitate

collaborations for the new hire. Further, UCSF has

in place other mechanisms to integrate research

programs. At UCSF, faculty conducting research

collaborate easily across departments and schools

based on research resonance. School of nursing

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

transdisciplinary research questions and projects

around key health issues ranging from basic

science to the population science. Advocacy

should also extend to the realm of education,

including expansion of the current GNE

Demonstration and enhanced federal support for

graduate training of nurses in critical areas, similar

to that of support for medical GME funding.

4. Continue to advocate for scope of practice

changes to enable nurses to take on the clinical

roles they are trained to perform and support

academic nursing leadership in clinical care

delivery. Academic nursing should contribute to

the conversation related to restrictions on scope

of practice. As AHCs increasingly look to academic

nursing and its faculty for clinical innovation, having

the ability to easily translate these advances into

clinical practice will require nurses to function at

the top of their license and education. Indeed, the

AACN Futures Task Force recently recommended

that AACN position nursing as a leading partner

in advancing systemic improvements in health

and health care.

Additional advocacy is required

to accompany scope of practice changes with

changes in reimbursement for APRNs so that

reimbursement and practice align.

5. Position AACN, a leading advocate in

partnership with other organizations, to

communicate the importance of nursing-

led research programs to federal, state, and

private funders. The AACN Futures Task Force

also recommended that AACN be a leader

in information curation and synthesis related

to nursing education, research, and practice.

AACN should ﬁll a critical void in the national

conversation on funding for nurse-led research.

Collectively, these recommendations advance the

shared missions of AHCs and academic nursing in

signiﬁcant, tangible, and beneﬁcial ways. During

the development of these recommendations and

this report, the Institute of Medicine released

an update on their 2010 Future of Nursing

Report that indeed conﬁrms the importance

and timeliness of the recommendations in our

report. The update, Assessing Progress on the

IOM Report—The Future of Nursing

xxi

, provides

an updated set of 10 recommendations to the

healthcare community within the spirit of the

original report. The recommendations contained

in the report further push for an enhanced role

for nursing in the redesign of care delivery

and payment systems, a commitment to the

development of nurses to advanced practice,

and for a renewed focus on interprofessional

education and clinical practice models. Our

recommendations ﬁt squarely within the spirit of

both the original IOM report and this important

update, and our hope is that as AHC leaders

consider implementing our own series of speciﬁc

academic nursing alignment recommendations in

their own organizations, the promise of the IOM

report will be more fully realized.

Implementation

Strategies

Achieving the potential for academic nursing as

described in this report requires a change in culture

that can only be accomplished by the collaborative

leadership of university presidents, deans of nursing

and medicine, and health system chief executives.

All parties must embrace a new vision for academic

nursing, and by doing so deal directly with the cultural

and structural issues that are impeding the ﬂowering of

potential that indeed all perceive.

Leaders committed to a new vision for academic

nursing will challenge the status quo and seek to

unharness the potential of their nursing colleagues.

Participatory governance structures that cross-

populate, as appropriate, leaders of the academic and

faculty investigators have faculty from other

professional schools and the other schools have

school of nursing faculty on their grants as co-

investigators. This is a longstanding relationship

that reﬂects the deﬁnition of UCSF as a research

intensive institution.

American Association of Colleges of Nursing

clinical practices will help to ensure mission integration

and proper insights from a diverse set of constituencies.

In particular, nursing representation on AHC boards

can bring forth expertise in magnet certiﬁcation,

wellness initiatives, patient safety initiations, EHR

adoption, trauma certiﬁcation, workforce development,

APRN deployment, patient education initiatives,

and evidence-based clinical decision-making. In

addition, nurses typically represent the lion’s share of

healthcare organization budgets, provide the majority

of in-patient care, and train the clinical workforce in

schools of nursing. Participatory governance will be

enhanced immeasurably by collaborative strategic

and ﬁnancial decision-making around academic and

clinical programs, workforce development, and research

programs. Further alignment of medicine, nursing, and

health system organizations may also prove beneﬁcial

for certain institutions.

The following recommendations for deans of nursing,

deans of medicine, health system executives, and

university presidents/chancellors are intended to

help leaders in AHCs achieve the potential from an

enhanced role for academic nursing in the continuing

evolution of their institutions.

CURRENT STATE FUTURE STATE

▪ Few nursing “clinical faculty” relative to School

of Medicine faculty

▪ Limited shared leadership positions/roles

▪ Limited cross-entity governance participation

• Narrow mission focus

• School leads didactic education

and research

▪ Health system leads clinical practice

▪ Entity-speciﬁc strategic planning

▪ Limited ﬁnancial integration

▪ Participatory governance and aligned

organization model

▪ Increased joint appointments to lead

academic and clinical programs

▪ Growing clinical faculty in School of Nursing

that maintain practice within the health

system

▪ Joint strategic planning

▪ Financial support model to facilitate School

of Nursing investment

▪ Growth and integration of research

programs into clinical practice

Figure 6: An Aspirational View of Academic Nursing

RECOMMENDATIONS FOR DEANS

OF NURSING

The challenge—and opportunity—for academic

nursing and its leadership rests primarily in preparing

for an enhanced role in clinical service delivery and

a renewed focus on growth in size and stature of

research programs. It is, as many of the deans of

nursing interviewed for this project indicated, a

“paradigm shift” for academic nursing leaders in

developing the right mix of faculty, and the right

partnerships with health system and academic

medicine leaders so as to become full partners in the

health enterprise. Deans of nursing must develop the

business case for a new partnership model with AHCs,

one that demonstrates clearly the beneﬁts academic

nursing can bring to the complex environment of

academic clinical care delivery and make the case for

the resources and investment needed.

The following strategies will begin to help deans of

nursing push their organizations forward:

Enhance clinical practice opportunities for

clinically focused faculty to ensure that a robust

clinical faculty exists to carry out the teaching

mission of the school in the health system, and tie

important clinical advances and innovations back into

the academic environment in the school of nursing.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Engage health system CNO/CEO to create

clinical leadership/administrative/practice roles

for select school of nursing faculty through

shared appointments and other means, including

potentially jointly funded positions charged with

facilitating alignment and integration of the academic

and clinical missions.

Propose a nursing enterprise workforce

development program to help mitigate health

system shortages for nurses prepared at all

levels, developing promising nurses for leadership

roles and enhanced education opportunities, and

developing the faculty of the future to lead academic

nursing and the academic mission.

Establish a strategic agenda for research

incorporating themes of relevance to the region

such as chronic illness management. Expand the

academic nursing faculty roster to include both nursing

and non-nursing PhD investigators in critical research

areas that are funded and can help grow the portfolio

(in size and scope) of research conducted in academic

nursing. Develop and expand scientiﬁc research training

programs and build a cadre of nurse-scientist faculty.

Review promotion and tenure policies for their

alignment with academic nursing’s achievement

of the tripartite mission, allowing for faculty to

maintain strong clinical practices in the health system

alongside their academic responsibilities

As one indicator of expectations, of various

characteristics valued in a Dean of Nursing, University

president respondents rated “ability to partner with

the Dean of Medicine” as the highest.

RECOMMENDATIONS FOR DEANS

OF MEDICINE

Deans of medicine have long beneﬁted from close

alignment and in most cases fairly full integration

with their partner AHCs. Deans of medicine have

maintained key leadership positions both from a

governance and management perspective in AHCs,

and leading faculty (department chairs, division chiefs,

etc.) typically run the various clinical departments in

the hospital, with further responsibility for growing

AHC service lines a new theme and responsibility. This

alignment gives added stature and weight when it

comes to AHC and university decision-making. There

are several areas where the leadership of deans of

medicine is critical to advancing many of the interests

discussed in this report. Ultimately, the success of

schools of medicine is contingent upon a robust, high-

performing clinical partner and school of medicine

leadership should be keenly aware of opportunities

to advance them. This leadership also can extend to

academic nursing to achieve a level of alignment and

integration that beneﬁts the entirety of the academic

and clinical enterprises. Given the scale of academic

medicine in the overall ﬁnancial portrait of universities,

academic medicine and its leadership carry signiﬁcant

weight and can champion approaches to alignment

with schools of nursing.

The following strategies will begin to help deans of

medicine achieve this potential:

Facilitate linkages between academic nursing

and academic medicine research and increase

interprofessional research programs and funding

through leadership of the dean’s ofﬁce and in some

cases through shared investment in key areas.

Integrate research programs that are in

high demand such as informatics, patient

engagement, outcomes and effectiveness, and

population health across the professional schools again

through the leadership of the dean’s ofﬁce and by

leading faculty, with the potential for shared centers/

research programs that are transdisciplinary and share

critical research infrastructure and core services.

Advance programs for enhancing nursing

professional billing within the faculty practice

where possible and appropriate to facilitate

the integration of APRNs as part of a broader clinical

network strategy.

Address issues of culture between nurses and

physicians in the same spirit as increasing

diversity. Encourage team science integrating

clinicians and bio-medical researchers.

Strengthen interprofessional HHS and NIH-

supported programs. For instance, by

incorporating nurse-scientists within the CTSA

renewal awards.

American Association of Colleges of Nursing

RECOMMENDATIONS FOR HEALTH

SYSTEMS EXECUTIVES

AHC CEOs and CNOs are critical to the adoption

and ultimate success of this strategic framework and

its recommendations. They run and are responsible

for the entirety of the clinical nursing services and

the broader AHC enterprise, and they have needs

and challenges with which nursing (academic nursing

in particular) may help meet and solve. CEOs and

CNOs can facilitate the development of the right

organizational mechanisms to link academic nursing

faculty and leaders into the operations of the health

system in a way that allows them to contribute to

innovative solutions.

The following strategies will begin to help CEOs and

CNOs realize a new partnership model with academic

nursing:

Establish participation for academic nursing

on governing bodies and within health system

leadership through appointment of school

of nursing leaders on key governing boards and

committees.

Integrate the school of

nursing into applied

programs for clinical

innovation where possible,

particularly in areas of patient

safety, quality, population health

science, and patient experience,

with appropriate ﬁnancial support

in place to sponsor services

provided by school of nursing

faculty and leaders.

Enhance academic nursing’s

role in primary care/

community clinic network

development and workforce

preparation.

Advance programs

for enhancing nursing

professional billing within

developing practice models that

combine academic and community

based clinicians in a growing, distributed network model.

Facilitate academic nursing faculty meeting its

certiﬁcation requirements for clinical practice

through the health system by way of expanded

positions available for clinical faculty.

RECOMMENDATIONS FOR UNIVERSITY

PRESIDENTS, CHANCELLORS, AND VICE

CHANCELLORS

In both university-based and university-afﬁliated

AHCs, presidents/chancellors (and in some cases vice

chancellors for health affairs) should be engaged in

support of the alignment between academic nursing

and AHCs. University leaders can be powerful

forces in organizing academic leaders in integrated

strategic planning efforts to ensure optimal utilization

of resources, and they can organize leaders around

discreet initiatives with respect to research and

academic programs. They also can support schools

of nursing more directly in recruiting deans of

nursing for the future and in some cases can provide

needed investment for academic nursing to begin

transformation efforts contained in this report. Lastly,

where it makes sense they can create organizational

alignment by unifying the differing reporting

1. Ability to partner with Dean of Medicine

2. Educational Leader

3. Proven Innovator

4. Ability to partner with CEO of health system

5. Change Agent

6. Research Leader

7. Clinical Care Leader

8. Ability to serve as CNO of health system

4.50

4.44

4.36

4.35

4.28

3.98

3.51

3.04

Rank Order of Importance based on Average Score Avg. Score (1-5)

University President Survey

On a scale of 1 (least) to 5 (most), please rate the importance of each of the

following characteristics of Deans of Nursing (responses ranked;

average scores reported)

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

relationships amongst deans of the health science

schools within the university and potentially through

supporting aligned governance with the health system.

Facilitate integrated strategic planning processes

for health science schools to ensure appropriate

alignment and integration between the schools

and where possible facilitate trans-disciplinary research

and education approaches.

Recruit deans of nursing with the leadership ability

to partner in the transformation of health systems

and deans that can navigate an increasingly

complex and demanding research environment in

partnership with other health science school leaders.

Strengthen roles for academic nursing in

university governance positions including

relevant committees. Align organization

structures where value can be created.

Lead and facilitate inter-professional education

program development.

Increase university investment in nursing programs

and support a national advocacy agenda to

increase institutional funding for nursing research

and nursing involvement in research activities.

Concluding Perspectives

The core of this investigation has been to answer the

question, “How can academic nursing leaders partner

with AHCs to transform health care?” We propose

that academic nursing has a signiﬁcant role to play in

transforming health care, and indeed is a necessary

partner for AHCs as they seek to become patient and

community-centered.

We believe that the vision and strategic framework for

action we set forth in this report is transformational,

and different components will be appealing based

on institutional context. We recognize that numerous

factors will impact the ultimate adoption of the

recommendations contained in this report – existing

organizational structures and governance models,

current leadership and cultures between schools of

nursing and AHCs, ﬁnancial resources, the clinical

services market around AHCs, competition, current

pace of change, current academic and clinical strength,

among many other factors. However, all organizations

can beneﬁt from a candid assessment of where they are

today with respect to the recommendations we make in

this report – and to what extent there are opportunities

for alignment between schools of nursing and AHCs.

What is clear from our investigation is that success in

adopting this vision and the elements of the strategic

framework we set forth is ﬁrst and foremost, the

development of a shared vision among all academic

and clinical leaders. This vision entails commitment to a

transformative role for academic nursing in the evolving

academic health system. It requires an approach to

integration and alignment among schools of nursing

and their colleagues in all health science schools. And

we believe this shared vision is essential so as to achieve

the aspirations described by the IOM in The Future of

Nursing: Leading Change, Advancing Health (2010).

We wish to acknowledge the signiﬁcant barriers to

moving our recommendations forward. These include

resistance to change by the leaders of the various

entities involved, organizations and ﬁnancial systems

that encourage siloed approaches to various healthcare

entities and academic programs, and a lack of conviction

that the changes we have outlined will be necessary or

important for transforming an AHC’s clinical delivery

system. In this regard, it may be necessary to move

forward incrementally in terms of our recommendations,

so that the value of each new program can be evaluated

and appreciated gradually and the leadership of the

various entities can gain conﬁdence. In some institutions

a more rapid transformation may be possible, but this

may not be feasible in many, where a forceful approach

could potentially backﬁre.

The authors have designed this report, and the

accompanying assessment in the Appendix to facilitate

the process of evaluating the partnership role of

academic nursing in your organization. The framework

for action, its associated recommendations, and the

implementation strategies for deans of nursing, deans

of medicine, CEOs/CNOs, and university leaders are

intended to encourage your own thinking about the

current state of alignment and integration and to

stimulate initial conversations about approaches you

can take today to advance discussions regarding the

future of academic nursing in your institution.

American Association of Colleges of Nursing

Appendices

APPENDIX A – ORGANIZATIONAL

SELF-ASSESSMENT

Overview

A candid assessment of where your organization is

today with respect to the recommendations contained

in this report is a critical ﬁrst step to achieving

the vision of academic nursing as a full partner in

healthcare delivery, education, and research integrated

and funded across all professions and missions in

academic health systems. This assessment will walk

through each of the report’s recommendations

and help you to understand how your organization

performs today and how important each is in your

organization to strategically focus on in the near term.

The recommendations in this report are collectively

ambitious and will require leaders across nursing,

medicine, and academic health systems to carefully

evaluate and prioritize strategic initiatives and develop

a long-term implementation approach that is tailored

to each organization’s unique circumstances.

This assessment can be completed by any AHC leader

including health science school deans, university

presidents, and health system leadership and can be

used to compare perspectives of different leaders as a

starting place for developing a plan to implement the

recommendations in this report.

Instructions

Please consider the recommendations contained on

pages 32-52 of the report. For each recommendation

and sub-recommendation, we ask you to ﬁrst evaluate:

1. Criticality of Recommendation – How critical is

this recommendation to me and my organization to

achieve? Can we succeed long-term without it?

2. Current Organizational Performance – Has

this recommendation been implemented in my

organization in any way? If so, to what degree has it

been implanted? How well have we performed?

We then ask you to provide a score for each of the

two evaluation criteria that will be used to calculate

the results of this assessment. Please use the following

scoring methodology:

1. Criticality of Recommendation – How critical is

this recommendation to my organization?

● [5] Very critical to my organization’s success

● [4] Critical to my organization’s success

● [3] Somewhat critical to my organization’s success

● [2] Not very critical to my organization’s success

● [1] Not critical to my organization’s success at all

2. Current Organizational Performance:

● Strong

● Moderate

● Weak

● Not Possible/Not Applicable

At the end of the assessment there is a score sheet

that should be used to tabulate the results of the

assessment.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Report

Recommendation

Sub-Recommendation

Criticality of

Recommendation

(Scale: 1-5)

Current

Organizational

Performance

(Strong,

Moderate, Weak,

NA)

Recommendation #1

Embrace a New Vision

for Academic Nursing

a) Establish the formal commitment of

academic and clinical leaders to schools

of nursing as full partners in healthcare

delivery, education, and research that is

integrated and funded across all professions

and missions in the AHC (e.g., leadership

resolution, directive from respective

governing entities, etc.).

Recommendation #2

Enhance the Clinical

Practice of the School

of Nursing

a) Establish clinical leadership positions to

link school of nursing faculty to clinical

practice leadership in the health system and

vice-versa (e.g., Associate Dean for Clinical

Practice)

b) Facilitate joint clinical program development

between school of nursing faculty and

clinical practice leaders (e.g.., ambulatory

service development, population

health development, inpatient service

improvement).

c) Grow school of nursing clinical practice

through development of nursing faculty

practice plan activity either independently

or as part of a broader academic clinical

practice (e.g., through medical school

practice plan or health-system clinician

employment group).

d) Expand clinical integration with joint

appointments and practice integration

between faculty and clinical practice nurses

in the health system.

Self-Assessment Worksheet

American Association of Colleges of Nursing

Report

Recommendation

Sub-Recommendation

Criticality of

Recommendation

(Scale: 1-5)

Current

Organizational

Performance

(Strong,

Moderate, Weak,

NA)

Recommendation #2

Enhance the Clinical

Practice of the School

of Nursing

e) Promote and expand nurse-managed health

clinics as part of a broader clinical strategy

and community engagement strategy within

the AHC.

f) Expand participation of academic nursing in

next-generation payment arrangements.

Recommendation #3

Partner in Preparing

the Nurses of the

Future

a) Develop a long-term workforce plan that

leverages redesigned school of nursing

educational programs combined with re-

training to prepare nurses for the future.

b) Collaboration between the School of

Nursing and the health system to create

formal “pipeline” programs to facilitate

employment of nurses in AHCs at all levels

(BSN, MSN, PhD, DNP)

c) Create nursing leadership development

programs for faculty and clinical practice

nurses that are jointly managed by the

school of nursing and clinical practice

leadership.

d) Lead the development of interprofessional

education efforts institution-wide in

partnership with other health science school

leaders to prepare the clinical workforce of

the future.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Report

Recommendation

Sub-Recommendation

Criticality of

Recommendation

(Scale: 1-5)

Current

Organizational

Performance

(Strong,

Moderate, Weak,

NA)

Recommendation #4

Partner in the

Implementation of

Accountable Care

a) Engage in joint clinical planning as part of a

larger, integrated strategic planning process

that incorporates all academic and clinical

entities.

b) Incorporate school of nursing faculty

in health system programs aimed at

developing linkages between acute care

and post-acute care, home-based, and

long-term care services.

c) Expand nurse-led community programs

under the leadership of school of nursing

faculty in partnership with health system

leaders and clinicians.

d) Advance innovative evidence-based care

models and interventions developed by

school of nursing and health-system based

investigators focused on improving the

health status of underserved members of

the community linked to an overall AHC

clinical strategy.

e) Encourage leadership roles for school of

nursing faculty and leaders outside the

AHC in the community (e.g., board seats,

community leadership positions).

American Association of Colleges of Nursing

Report

Recommendation

Sub-Recommendation

Criticality of

Recommendation

(Scale: 1-5)

Current

Organizational

Performance

(Strong,

Moderate, Weak,

NA)

Recommendation #5

Invest in Nursing

Research Programs

and Better Integrate

Research into Clinical

Practice

a) Create mechanisms to coordinate research

projects and activities across the School of

Nursing and Academic Health Center with

a shared leadership structure and resources

(e.g., nursing research council, Director of

Nursing Research position).

b) Develop joint research programs between

school of nursing and health system nurse-

scientists and seek grant funding to support.

c) Integrate nurse researchers into developing

informatics programs across health science

schools.

d) Strengthen clinical research nursing through

growth and development of programs to

support nurse clinical trial coordinators and

clinical research nurses.

e) Lead in the establishment of linkages

to other schools for multi-disciplinary

research programs and approaches and

the development of multi-school, multi-

disciplinary grants and centers/institutes to

conduct targeted research.

f) Expand nursing faculty development and

recruitment to include PhD investigators

across multiple disciplines in targeted

research areas.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Assessment Scoring

Use the following worksheet to track your criticality and organizational performance scores.

Report Recommendation Sub-Recommendation

Criticality Score

(Scale: 1-5)

Organizational

Performance

(Strong, Moderate,

Weak, NA)

Recommendation #1

Embrace a New Vision for

Academic Nursing

Recommendation #2

Enhance the Clinical

Practice of the School of

Nursing

Recommendation #3

Partner in Preparing the

Nurses of the Future

Recommendation #4

Partner in the

Implementation of

Accountable Care

Recommendation #5

Invest in Nursing Research

Programs and Better

Integrate Research into

Clinical Practice

American Association of Colleges of Nursing

WHAT YOUR SCORES MEAN

These scores will help you rank which recommendations

you should focus on developing and implementing in

your organizations, and will help academic and clinical

leadership teams understand where there is agreement

on major initiatives to pursue with the school of nursing.

The matched pairs of criticality scores and

organizational performance scores will help you

develop your strategic approach going forward:

● A high criticality score matched with a low

organizational importance score is indicative of a

recommendation that should be prioritized.

● A high criticality score matched with a

high performance score is indicative of a

recommendation that should be supported

ongoing, and an area where learnings can be

shared across the community of academic nursing

and AHCs.

● Recommendations with low criticality scores should

be prioritized last.

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

APPENDIX B – PARTICIPATING INSTITUTIONS AND LEADERS

Interviews

Name Title / Institution

Irene Alexaitis, DNP, RN, NEA-BC Vice President, Nursing and Patient Services, University of Florida Health

Shands Hospital

Cynthia Barginere, DNP, RN,

FACHE

Vice President for Clinical Nursing and Chief Nursing Ofﬁcer,

Rush University Medical Center & Associate Dean for Practice, College of

Nursing, Rush University

Judy A. Beal, DNSc, RN, FNAP,

FAAN

Dean, School of Nursing and Health Sciences, Simmons College

Bobbie Berkowitz, PhD, RN, FAAN Dean, School of Nursing, Columbia University & Senior Vice President,

Columbia University Medical Center

Robert Berne, PhD, MBA Executive Vice President for Health, New York University

Bradley Britigan, MD Dean, College of Medicine, University of Nebraska Medical Center &

President, Nebraska Medicine

Eileen Breslin, PhD, RN, FAAN Dean, School of Nursing, University of Texas Health Science Center,

San Antonio

Marion E. Broome, PhD, RN, FAAN Dean, School of Nursing, Vice Chancellor for Nursing Affairs, Duke

University & Associate Vice President for Academic Affairs for Nursing,

Duke University Health System

Margaret M. Calarco, PhD, RN Senior Associate Director, Patient Care Services and Chief of Nursing

Services, University of Michigan Health System & Associate Dean for

Clinical Affairs, School of Nursing, University of Michigan

Ann Cary, PhD, MPH, RN, FNAP Dean, School of Nursing and Health Studies, University of

Missouri-Kansas City

S. Wright Caughman, MD Executive Vice President for Health Affairs, Emory University, Chief

Executive Ofﬁcer, Woodruff Health Science Center & Chairman,

Emory Healthcare

Regina Cunningham, PhD, RN,

AOCN

Chief Nurse Executive, Hospital of the University of Pennsylvania

Patricia M. Davidson, PhD, MEd,

Dean, School of Nursing, Johns Hopkins University

Mary Ann Donohue, PhD, RN, APN,

NEA-BC

Chief of Patient Care Services, Stony Brook University Hospital

Azita Emami, PhD, RN, MSN, RNT,

RN, FAAN

Dean, School of Nursing, University of Washington

Dorrie Fontaine, PhD, RN, FAAN Dean, School of Nursing, University of Virginia & Associate Chief Nursing

Ofﬁcer, University of Virginia Health Systems

Marquis D. Foreman, PhD, RN,

FAAN

John L. and Helen Kellogg Dean, College of Nursing, Rush University

Mary Ann Fuchs, DNP, RN, NEA-

BC, FAAN

Vice President, Patient Care and System Chief Nursing Executive,

Duke University Health System

American Association of Colleges of Nursing

Susan M. Grant, DNP, RN, FAAN,

NEA-BC

Executive Vice President, Chief Nursing Ofﬁcer, Beaumont Health

Robert I. Grossman, MD Saul J. Farber Dean, School of Medicine, New York University & Chief

Executive Ofﬁcer, New York University-Langone Medical Center

David S. Guzick, MD, PhD Senior Vice President, Health Affairs, University of Florida & President,

University of Florida Health

Doreen C. Harper, PhD, RN, FAAN Dean, School of Nursing, University of Alabama at Birmingham

J. Larry Jameson, MD, PhD Dean, Raymond and Ruth Perelman School of Medicine, University of

Pennsylvania & Executive Vice President, University of Pennsylvania for the

Health System

Kevin Mahoney, MBA Vice Dean for Integrative Services, Raymond and Ruth Perelman School

of Medicine, University of Pennsylvania, Senior Vice President & Chief

Administrative Ofﬁcer, University of Pennsylvania Health System

Linda A. McCauley, PhD, RN,

FAAN, FAAOHN

Dean, Nell Hodgson Woodruff School of Nursing, Emory University

Lilly Marks Vice President for Health Affairs, University of Colorado

Anna M. McDaniel, PhD, RN, FAAN Dean, College of Nursing, University of Florida

Rosanna Morris, MBA, RN, NE-BC Interim Chief Executive Ofﬁcer, University of Nebraska Medicine

Ralph W. Muller, MA Chief Executive Ofﬁcer, University of Pennsylvania Health System

Kathleen Potempa, PhD, RN, FAAN Dean, School of Nursing, University of Michigan

Kathy Rideout, EdD, PNP-BC,

FNAP

Dean, School of Nursing, University of Rochester

Marschall S. Runge, MD, PhD Executive Vice President for Medical Affairs and Dean, University of

Michigan Medical School

Linda Sarna, PhD, RN, FAAN Interim Dean, School of Nursing, University of California Los Angeles

Juliann G. Sebastian, PhD, RN,

FAAN

Dean, College of Nursing, University of Nebraska Medical Center

Kathleen B. Scoble, EdD, RN Dean, School of Nursing, Elms College

Eileen Sullivan-Marx, PhD, RN,

FAAN

Dean, School of Nursing, New York University

Sarah A. Thompson, PhD, RN,

FAAN

Dean, College of Nursing, University of Colorado,

Anshutz Medical Campus

Deborah Trautman, PhD, RN, FAAN President & Chief Executive Ofﬁcer, American Association of

Colleges of Nursing

Selwyn M. Vickers, MD Senior Vice President for Medicine & Dean, School of Medicine,

University of Alabama at Birmingham

Antonia M. Villarruel, PhD, RN,

FAAN

Dean, School of Nursing, University of Pennsylvania

David Vlahov, PhD, RN, FAAN Dean, School of Nursing, University of California San Francisco

A. Eugene Washington, MD, MPH,

MSc

Chancellor for Health Affairs, Duke University & President & Chief

Executive Ofﬁcer, Duke University Health System

Ray L. Watts, MD President, University of Alabama at Birmingham

Michael T. Weaver, PhD, RN, FAAN Interim Dean, School of Nursing, Indiana University

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

Name Title / Institution

Michael R. Bleich, PhD, RN,

FAAN

Maxine Clark and Bob Fox Dean and President, Goldfarb School of Nursing,

Barnes-Jewish College

Margaret Faut Callahan, CRNA,

PhD, FNAP, FAAN

Provost, Health Sciences Division, Loyola University Chicago

Regina Cunningham, PhD, RN,

AOCN

Chief Nurse Executive, Associate Executive Director, Hospital of the

University of Pennsylvania & Assistant Dean for Clinical Practice, School of

Nursing, University of Pennsylvania

David Entwistle, MS Chief Executive Ofﬁcer, University of Utah Hospitals and Clinics

Will Ferniany, PhD Chief Executive Ofﬁcer, University of Alabama at Birmingham Health System

Donna Gage, PhD, RN, NE-BC Chief Nursing Ofﬁcer, Veterans Health Administration

Larry Goodman, MD Chief Executive Ofﬁcer, Rush University Medical Center & President,

Rush University

Maryellen Gusic, MD Chief Medical Education Ofﬁcer, Association of American Medical Colleges

David Guzick, MD, PhD Senior Vice President for Health Affairs, University of Florida & President,

University of Florida Health

Doreen Harper, PhD, RN Dean, School of Nursing, University of Alabama at Birmingham

Darrell Kirch, MD President and Chief Executive Ofﬁcer, Association of American

Medical Colleges

Kevin Mahoney, MBA Executive Vice President and Chief Administrative Ofﬁcer, University of

Pennsylvania Health System & Executive Vice Dean, Integrative Services,

School of Medicine, University of Pennsylvania

Janis Orlowski, MD Chief Health Care Ofﬁcer, Association of American Medical Colleges

Kathy Rideout, EdD, PNP-BC Dean, School of Nursing, University of Rochester

Kevin Sowers, MSN, RN, FAAN Chief Executive Ofﬁcer, Duke University Hospital

Maureen Swick, PhD, RN Senior Vice President and Chief Nurse Executive, Inova Health System &

President-Elect, American Organization of Nurse Executives

Board of Directors

Mark Taubman, MD Dean, School of Medicine, and Vice President for Health Sciences, University

of Rochester & Chief Executive Ofﬁcer, University of Rochester

Medical Center

Oversight Committee

Eileen Breslin, PhD, RN, FAAN Dean, School of Nursing, University of Texas Health Science Center

San Antonio

Ann Cary, PhD, MPH, RN, FNAP Dean, School of Nursing and Health Studies, University of Missouri,

Kansas City

Juliann G. Sebastian, PhD, RN,

FAAN

Dean, College of Nursing, University of Nebraska Medical Center

Deborah Trautman, PhD, RN,

FAAN

President and Chief Executive Ofﬁcer, American Association of

Colleges of Nursing

David Vlahov, PhD, RN, FAAN Dean, School of Nursing, University of California San Francisco

2015 Academic Nursing Leadership Summit – Attendees

American Association of Colleges of Nursing

Project Staff

Tom Enders, MBA Senior Managing Director, Manatt Health

Margaret Grey, DrPh, RN, FAAN Annie Goodrich Professor, School of Nursing, Yale University

Kathy McGuinn, MSN, RN,

CPHQ

Director, Special Projects, American Association of Colleges of Nursing

Shelley McKearney Program Manager, American Association of Colleges of Nursing

Alex Morin, MA Manager, Manatt Health

Brenda Pawlak Managing Director, Manatt Health

Arthur Rubenstein, MBBCh Professor of Medicine, Raymond and Ruth Perelman School of Medicine,

University of Pennsylvania

Institutions Invited to Participate in the Dean of Nursing / University President Survey

Case Western Reserve University

Charles R. Drew University of

Medicine and Science

Columbia University

Creighton University

Drexel University

Duke University

East Carolina University

East Tennessee State University

Emory University

Florida International University

George Washington University

Georgetown University

Georgia Baptist College of Nursing of

Mercer University

Georgia Regents University

Howard University

Indiana University-Purdue University

(Indianapolis)

Johns Hopkins University

Loma Linda University

Louisiana State University Health

Sciences Center

Loyola University Chicago

Marshall University

Medical University of South Carolina

Michigan State University

New York Institute of Technology

New York University

Northwestern College

Nova Southeastern University

Ohio State University, The

Ohio University

Oregon Health and Science University

Pennsylvania State University

Rush University

Rutgers, The State University

of New Jersey

Saint Louis University

Stony Brook University

SUNY Downstate Medical Center

SUNY Upstate Medical University

Temple University

Texas A&M Health Science Center

Texas Tech University Health

Sciences Center

Texas Tech University Health Sciences

Center-El Paso

Thomas Jefferson University

Uniformed Services University of the

Health Sciences

Universidad de Puerto Rico

University at Buffalo-SUNY

University of Alabama at Birmingham

University of Arizona

University of Arkansas for

Medical Sciences

University of California-Davis

University of California-Irvine

University of California-Los Angeles

University of California- San Francisco

University of Central Florida

University of Cincinnati

University of Colorado

University of Connecticut

University of Florida

University of Hawaii at Hilo

University of Hawaii at Manoa

University of Illinois at Chicago

University of Iowa

University of Kansas

University of Kentucky

University of Louisville

University of Maryland

University of Massachusetts

Medical School

University of Miami

University of Michigan

University of Minnesota

University of Mississippi

Medical Center

University of Missouri-Columbia

University of Missouri-Kansas City

University of Nebraska

Medical Center

University of Nevada-Las Vegas

University of New Mexico

University of North Carolina-

Chapel Hill

University of North Dakota

University of Oklahoma

University of Pennsylvania

University of Pittsburgh

University of Rochester

University of South Alabama

University of South Carolina

University of South Dakota

University of South Florida

University of Tennessee Health

Science Center

University of Texas Health Science

Center-Houston

University of Texas Health Science

Center-San Antonio

University of Texas Medical Branch

University of Toledo

University of Utah

University of Vermont

University of Virginia

University of Washington

University of Wisconsin-Madison

Vanderbilt University

Virginia Commonwealth University

Wayne State University

West Virginia University

Western University of Health Sciences

Wright State University

Yale University

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

i. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from

http://books.nap.edu/openbook.php?record_id=12956&page=R1

ii. National Institutes of Health. (2011). Crossing the quality chasm: A new health system for the 21st century.

Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK22857/

iii. Van Dyke, K., Combes, J., & Joshi, M. (2011). 2011 Health Care Governance Survey Report.

Chicago, IL: American Hospital Association. Retrieved from: http://ams.aha.org/eweb/DynamicPage.

aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=05bbee68-3be7-4930-ab7a-2b0855064f4e.

iv. Szekendi, M., Prybil, L., Cohen, D., Godsey, B., Fardo, D., & Cerese, J. (2015). Governance practices and

performance in US academic medical centers. American Journal of Medical Quality, 30(6): 520-525. doi:

10.1177/1062860614547260

v. Enders, T., & Conroy, J. (2014). Advancing the academic health system for the future: A report from the

AAMC advisory panel on health care. Washington, DC: Association of American Medical Colleges.

Retrieved from https://www.aamc.org/download/370550/data/advancing.pdf.

vi. National Institutes of Health. (2014). Research Portfolio Online Reporting Tool.

vii. National Institutes of Health. (2014). Research Portfolio Online Reporting Tool.

viii. National Institutes of Health. (2014). Physician-scientist workforce working group report. Retrieved from

http://acd.od.nih.gov/reports/psw_report_acd_06042014.pdf.

ix. Auerbach, D., Chen, P., Friedberg, M., Reid, R., Lau, C., Buerhaus, P., & Mehrotra, A. (2013). Nurse-

managed health centers and patient-centered medical homes could mitigate expected primary care

physician shortage. Health Affairs, 32(11): 1933-1941. doi: 10.1377/hlthaff.2013.0596.

x. Denver Business Journal Staff. (2015, January 18). CU nursing opening Aurora clinic with no physicians.

Denver Business Journal. Retrieved from http://www.bizjournals.com/denver/news/2016/01/18/cu-nursing-

opening-aurora-clinic-with-no.html.

xi. Fraher, E., Spetz, J., & Naylor, M. (2015). Nursing in a transformed health care system: New roles, new

rules. Penn Interdisciplinary Nursing Quality Research Initiative Research Brief. Retrieved from

http://ldi.upenn.edu/brief/nursing-transformed-health-care-system-new-roles-new-rules.

xii. Donley, R., Flaherty, M., Sarsﬁeld, E., Burkhard, A., O’Brien, S., & Anderson, K. (2014). Graduate clinical

nurse preceptors: Implications for improved intra-professional collaboration. The Online Journal of Issues

in Nursing, 19(3). DOI: 10.3912/OJIN.Vol19No03PPT01.

xiii. Quinn, W., Reinhard, S., Thornhill, L., & Reinecke, P. (2015). Improving access to high quality care:

Medicare’s program for graduate nursing education. Washington, DC: AARP. Retrieved from http://www.

aarp.org/content/dam/aarp/ppi/2015/improving-access-to-high-quality-care-revised.pdf.

xiv. Berkowitz, S., & Pahira, J. (2014). Accountable care organization readiness and academic medical centers.

Academic Medicine, 89(9): 1210-1215. doi: 10.1097/ACM.0000000000000365

REFERENCES

American Association of Colleges of Nursing

xv. Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in pioneer accountable care

organizations. Nursing Outlook, 63(5): 554-565. Doi: http://dx.doi.org/10.1016/j.outlook.2015.05.008.

xvi. McCormick, K. et al. (2007). Guideposts to the future—an agenda for nursing informatics. Journal of the

American Medical Informatics Association. 14(1): 19–24. doi: 10.1197/jamia.M1996.

xvii. Hastings, C., Fisher, C. A.& McCabe, M. A. (2012). Clinical research nursing: A critical resource in the

national research enterprise. Nursing Outlook, 60(3): 149-156. doi: 10.1016/j.outlook.2011.10.003.

xviii. American Association of Colleges of Nursing. (2005). Faculty shortages in baccalaureate and graduate

nursing programs: Scope of the problem and strategies for expanding the supply. Washington, DC

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http://acd.od.nih.gov/reports/psw_report_acd_06042014.pdf.

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from https://www.aacn.nche.edu/about-aacn/committees-task-force/futures-task-force.

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Nursing.aspx.

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END NOTES

Association of Academic Health Centers. Retrieved from http://www.aahcdc.org/About.aspx (2014).

U.S. Bureau of the Census. Retrieved from http://www.census.gov/population/international/ﬁles/97agewc.pdf

American Hospital Association; First Consulting Group. When I’m 64: How boomers will change health care.

Chicago: American Hospital Association; 2007. p. 23

Advancing Healthcare Transformation

A NEW ERA FOR ACADEMIC NURSING

AMERICAN ASSOCIATION OF COLLEGES OF NURSING

The American Association of Colleges of Nursing (AACN) is the national voice for university and four-year

college education programs in nursing. Representing more than 780 member schools of nursing at public

and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection,

publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing

education, assist deans and directors to implement those standards, inﬂuence the nursing profession to improve

health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

www.aacn.nche.edu

MANATT HEALTH

Manatt Health is the interdisciplinary health policy and health care strategy advisory division of Manatt, Phelps,

and Phillips, a premier law and consulting ﬁrm. Manatt has one of the leading health strategy practices in the

country, with more than 80 professionals (consultants, policy advisors, project managers, analysts and health care

attorneys) providing knowledge and expertise to a wide range of health care clients, including children’s hospitals,

academic medical centers, health care systems and other institutional providers; post-acute care providers;

national and regional payers; pharmaceutical manufacturers; philanthropic foundations; health care trade

associations; and state and federal agencies and policymakers.

Manatt’s expertise and client engagements involve all aspects of health care, including delivery systems,

processes, ﬁnancing and payment, and health information technology. We differentiate by being keenly attuned

to the organizational dynamics of the organization – and many of our assignments include issues relating to

governance, organization structure, and capacity building.

AUTHOR CONTACT INFORMATION

TOM ENDERS

Senior Managing Director

Manatt Health

tenders@manatt.com

212-790-4508

917-882-6791

BRENDA PAWLAK

Managing Director

Manatt Health

bpawlak@manatt.com

202-585-6523

ALEX MORIN

Manager

Manatt Health

[email protected]

202-585-6506

American Association of Colleges of Nursing

III

One Dupont Circle, Suite 530

Washington, DC 20036

202-463-6930