Reimagining Nursing Initiative Seeks to Scale Up 10 Pilots

The American Nurses Foundation’s Reimagining Nursing Initiative (RN Initiative) has granted $14 million to 10 three-year pilot programs in 29 states to test nursing-led innovative solutions. In a recent interview, Kate Judge, ANF’s executive director, spoke with Healthcare Innovation about the impetus for the initiative and the goal of scaling up the pilots as widely as possible.

Judge said that the idea for the initiative goes back to a conversation she had before the pandemic with board member Greg Adams, who's now the CEO of Kaiser Permanente and is also a nurse. He told her he often sits at the table with companies like Google and Amazon and nursing really is not at the table. He challenged her team to come up with an idea to change that. AFN brought together 20 nurses, engineers, venture capitalists, and physicians, to brainstorm.

“We ended up with what we thought were three areas that we called accelerants,” Judge said. One was to focus on practice-ready graduates; another is nursing-led technology; and the third involves new models of care.

“Kaiser gave us $14.5 million, and we raised another $5 million. We did this national call, and we had 347 proposals from all over the country,” Judge said. “What we challenged them to do involved three things: to be bold in their thinking, to build equity into the project, and to create something that can be scaled. Philanthropy does such good work, but given the preciousness of dollars, we should all be challenged to make those investments last.”

Healthcare Innovation has actually already written about two of the RN Initiative projects. A few weeks ago, we detailed how several health systems, led by the Columbia University Irving Medical Center (CUIMC), are seeking to combine the expertise of nurses with artificial intelligence to create prediction models that can improve patient outcomes.

Nurse expertise includes the ability to pick up cues about patients’ health from subtle changes in behavior and appearance.

CONCERN (COmmunicating Narrative Concerns Entered by RNs) is a predictive tool that extracts nurses’ expert and knowledge-driven behaviors within patient health records and transforms them into observable data that support early prediction of organ failure or other critical conditions in hospitalized patients.

CUIMC is partnering with three hospital systems — Mass General Brigham (MA), Vanderbilt University Medical Center (TN), and Washington University School of Medicine/Barnes-Jewish Hospital (MO) — to test the effectiveness of the CONCERN implementation toolkit, developed to support large-scale adoption of the tool.

In another project we wrote about, Delaware-based health system ChristianaCare is piloting a collaborative robot — or “cobot”— that can make deliveries and perform other non-clinical tasks so that nurses and other clinical staff can spend more time caring for patients.

With a $1.5 million grant from the American Nurses Foundation, ChristianaCare is deploying five “Moxi” cobots at Christiana Hospital in Newark.

ChristinaCare cited research published in the Journal of Nursing Management  that found that nurses spend up to 33 percent of their shifts on time-consuming but simple tasks such as dropping off lab specimens, collecting supplies or picking up medications from the pharmacy. Moxi can take over these time-consuming but simple tasks.

“There is so much research that says when the nurses have the right working environment, patient morbidity and mortality decrease,” Judge said. “That’s absolutely what we believe in, so ChristianaCare is a great model of thinking about, in this time of a nursing shortage, what is essential for a person to do? We have to think more broadly and creatively and stop fighting about who does what, and think about what needs to get done and what's the best way to do it, and then, where does technology fit in?”

Several of the pilots do focus on new practice models. In one, OHSU in partnership with Adventist Health is working to create and build the reimbursement infrastructure for Adventist’s Community-Based Nursing Service (CBNS). CBNS delivers nursing care outside the walls of medical clinics, focusing on people living in the rural communities in Tillamook County and Columbia County, Oregon.

“I was out in in Oregon this summer, and one of the care providers is really doing street medicine. He's walking into restaurants and seeing people where they are and that is exactly the kind of care that people need,” Judge said, “but it doesn't fit into the highly regulated structure of who gets paid for what. But in the end, it is highly collaborative with physician partners, and it is maximizing what people need.”

In another pilot that Judge highlighted, Navi Nurses uses an on-demand technology allowing people to request and pay for nursing care directly, so nurses can assist people in need. Connecting patients and nurses upon hospital discharge has several benefits, from preventing readmissions, to catching medication errors, to providing peace of mind to people and their caregivers. Navi Nurses also helps people get home a few hours to a few days sooner.

In yet another pilot focused on practice models, Boston College and its partners, Brandeis University, and the National Nurse Practitioner Entrepreneur Network, are seeking to reduce barriers to value-based payment arrangements for NP-owned practices. The pilot is developing an NP Practice Risk Readiness Development Model, which includes a tool to identify areas to improve practice risk readiness and a learning collaborative program.

As these initial projects wind down, the goal is to have more than just reports that sit on a shelf, Judge said. “This is outcome-oriented, and part of our job is to really use the whole three years of the granting program to help build excitement for what we call phase three, which is another and a larger investment into these solutions, but more than just a report and the outcomes,” she added. “Some of this goes to the scalability. It's creating things that can be plug and play. How easily can someone hand over CONCERN to another institution that doesn't use Epic and they understand all the things that the Columbia team have learned about? How do you build it? How do you engage you’re your physicians and your nurses in it? How do you evaluate it? So that's our ideal goal is that we come out with a comprehensive evaluation of the work, but also a translation to the next place because for us it is all about scalability.”

Judge closed by saying that the single greatest issue in healthcare right now is workforce “and the workforce is nursing,” she stressed. “People write about strikes and things like that. But I think the whole idea around innovation is: how do you innovate so that the nursing population is empowered to create solutions? I think we're just so short-sighted that we're missing this huge opportunity to do things better by inviting people to sit around the table up front, which goes back to your very first question about why we decided to do this. It’s because nursing hasn't been given the resources and hasn't been included at the front end.

“We're going to have to use innovation, technology, process change and better communication and better engagement, because I am sincerely worried about the workforce,” Judge said. “Nurses are more burned out and less engaged than they were two years ago.”