Building Bridges: The Journey of Alabama's Health Action Coalition

One month after the Institute of Medicine, released The Future of Nursing (FON) report (IOM, 2011), the Campaign for Action was founded by the Robert Wood Johnson Foundation (RWJF), AARP, and AARP Foundation. Building on the report's recommendations and the longtime efforts of nurse leaders and nursing organizations, the Campaign for Action has taken bold moves at the national, state, and local levels. In 2012, Alabama became an Action Coalition state, and the Alabama Health Action Coalition (ALHAC) was formed. AL-HAC is a nonpartisan, voluntary collaboration of leaders from health care, education, business, public offices, and the community (see Supplemental Digital Content 1, available at http://links.lww.com/NEP/A21).The coalition was established following a yearlong conversation involving key nursing organizations, nurse leaders in academia and practice, and the major health care leaders and organizations across the state. Member organizations include the Alabama Board of Nursing (ABN), Alabama Hospital Association, Blue Cross and Blue Shield of Alabama, and the Medical Association of the State of Alabama. AARP Alabama has also become a key stakeholder. Along with four coleaders representing the Alabama Hospital Association, the Alabama Organization of Nurse Executives, and Blue Cross and Blue Shield of Alabama, these stakeholders are focused broadly on addressing the future health status of Alabamians through the implementation of recommendations identified in the FON report and endorsement of the RWJF focus on creating a culture of health.AL-HAC activities are geared toward improving the large number of poor health rankings in Alabama. Alabama has a consistently low overall health ranking (currently 47 of 50) and consistently low rankings in obesity, diabetes, cardiovascular deaths, and infant mortality (United Health Foundation, 2016). To advance the health of the state population, AL-HAC determined four focus areas to drive its work: 1) advancing nursing education, with a primary focus on RN to BSN academic progression; 2) improving nursing workforce data; 3) promoting diversity among nursing and health care professionals; and 4) fostering a culture of health.ADVANCING NURSING EDUCATION IN ALABAMAIn Alabama, as in many rural states, entry into nursing practice for the majority of nurses is at the license practical nurse (LPN) and/or associate degree nurse (ADN) level. The state has a strong community college system that is affordable and conveniently located in rural communities. More than half of the RNs in Alabama are initially licensed as ADNs.In 2011, in response to the recommendation to increase the proportion of BSN-prepared RNs to 80 percent by 2020, the state formed the Alabama 80 x 20 Taskforce, whose primary goal is to address seamless academic progression for RNto BSN students.Once AL-HAC formed in 2012, the work of the taskforce, renamed the Advancing Education Taskforce (AET), became part of the organizational structure of the state coalition. The AET retained the original taskforce membership, consisting of nurse educators from two- and four-year institutions and representatives from all types of health care agencies, including the Alabama Department of Public Health.Some states have chosen to meet the 2020 goal by promoting the BSN degree as the basic entry level to practice. In Alabama, the AET has focused primarily on improving the nursing education system by creating seamless academic articulation for RNs seeking to obtain a BSN.Alabama is a rural state, with all 67 counties containing federally designated medically underserved areas or medically underserved populations (Health Resources Service Administration [HRSA], 2016). There is a shortage of all levels of health care providers, and this shortage is magnified in rural areas. However, the nursing shortage is partially addressed because the vast majority of RN to BSN and graduate programs in the state are offered online. …