current resident or

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Special Points of Interest:

• PoliticsTrumpsScienceOnceAgain-page 4

• NursingStudentinSacramentoInternship(NSSI)-page 6

• StudyShowsTransitiontoPracticeProgramsGetNursesEmployed-page 9

ANA\C is AN AffiliAte ChApter of the AmeriCAN Nurses’ AssoCiAtioN

Volume 17 • Issue 3July, August, September 2012

President’s Perspective

Elissa Brown

Join theANA\C Today!Information on

page 10

Elissa BrownPresident, ANA\California

HappySpringandsoontobeSummer….

Well, here we are—stillin a major election year. SoI shall repeat my plea to youall—consider that votingis a duty, an obligation,and whatever your politicalleanings, please exercise thatright to vote. Stay informedon the issues. Make your owndecisions based on informationyou have received and haveanalyzed.And,asIhavesaidbefore:respectoneanother’sdiffering viewpoints and agree to disagree. There maybe some tough times ahead—politically, professionally,organizationally.

From a John F. Kennedy quote: “We shall needcompromisesinthedaysahead,tobesure.Butthesewillbe,orshouldbe,compromisesofissuesnotprinciples.”

Principles...guessweallhavethem—thoughsometimesIwonder.Or is it that our principlesmaybe sodifferentfrom those of others, that theirs sometimes seem not toexist. Perhaps what we need to do is try to understand.Problems arise when people are not sure of their ownvalues and principles, and in what they believe. As aresult, they may be too easily swayed to just do whatsomeone tells them to do—it just feels easier. Especiallywhenpeoplearetoldthatsomeoneorsomegroupwilltakecareofeverything,“just joinusand leave the ‘driving tous’”….theimplicationbeingthatyoudonotneedtoknowanythingorbeable to (orallowed to)makeupyourownmind.Although this seems to be the easy route…it is sodisempowering!

Myassumptionandhopeisthatnurseswanttobetheirownpersons,andanythingweandtheycandotofacilitatethat is positive.Never give up your choice to dowhat isright.Again I ask you to become involved!There are somanycurrentopportunitiesatworkandinthecommunity.Join committees, become active in community groups,teach,joinemailliststhatreflectyourinterests,andworkonCaliforniaActionCoalitionactivities.

Ithascometomyattentionthat therearesomenursesout there who are saying they do not support the IOMreport and Future of Nursing activities through the stateactioncoalitions.

Whatisnottosupport?Progress? Chances to make a difference in

improving the quality of health care? Improvingeducationalopportunitiesforournursecolleagues?Usingandimprovingyourskillsinnewtechnologyand communication? Moving the NursingprofessionforwardandassuringNurseshaveaseatat themany tableswhere healthcare decisions aremade?

As a colleague of mine has said: ‘If you arenot at the table, then you are on themenu!”Onehas little to complain about if he or she has noteventriedtomakeadifference!Thisholdstrueineverythingonedoes—work,professionalactivities,life!

Withover360,000nursesinCalifornia—Nursesareinapositiontobeadrivingforceinimprovinghealthcareatthe local, state, national and international levels…pleasegetonboard.

Reminder: coming up in June, the American NursesAssociation House of Delegates and convention willbe in the Washington, D.C. area. Our elected delegatesfromCaliforniawill bringknowledge fromourmembersand other Nurses as we address the issues and tend tothebusinessof theassociation.Afterwe return,we shallinclude reports and articles about the happenings at theANA House, to keep California Nurses informed. Weare all available through the ANA\California office forquestionsatanytime.

Ongoing: A Future of Nursing Update:MembersofANA\Candothernursesare involvedwith theCaliforniaAction Coalition—the Statewide CAC and local groups,continue working together to address nursing’s futurein California. ANA\California continues to be veryinvolved on committees and coalitions, and has strongrepresentative leadership in the CACs, regionally andstatewide.AstheregionalCo-LeaderfortheLosAngelesarea, along with Dr. Rosie Curtis we are working onactivities in the L.A. area. Please check our website forupdated information, links and opportunities to becomeactive participants. {Reference: The Future of Nursing: Leading Change, Advancing Health, by the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; (2011)}.

Please also check the American Nurses Association\Californiawebsite and theAmericanNursesAssociationwebsite,aswellastheCaliforniaActionCoalition.

PleasegotothenationalANAsite:www.nursingworld.org for the latest information about healthcare reform,healthcareissuesandnursingissues;alsoavideolinkto:‘NursesHavePower:Let’sUseItforChange.’Pleasealsosee on the nursingworld.org link to the “Key ProvisionsRelatedtoNursingandHealthCareReform.”

Ongoing national: many healthcare reform issuescontinue being discussed; including the future of nursinginitiatives.IcontinueasViceChairpersonoftheExecutiveCommittee of the ANA Constituent Assembly (CA; thegroup of the Presidents and Executive Directors of allof thestatesplusanumberofotherconstituents). I try toshare with you updates on the issues. We have regularcallswiththeANAPresident,andwithregionalgroups.

ANA\California continues to be open to hearing fromourmembersaboutwhatmoreyouwouldlikeinthewayofprograms,outreach,andopportunitiesforinvolvement.

Please maintain your membership in ANA\C or joinif you have not. We are a growing organization thanksto the nurses in California. ANA\C is the professionalnurses association in California open for all RNs, in alltypes of roles at all types of places. I encourage you asalways to join your professional nursing associations;perhaps join at least two associations—your professionalgeneral organization,ANA\California, andyour specialtyorganization. The networking opportunities alone areworthit.

ANA\C has 4 elected officers with clearresponsibilities, and4electedBoardDirectors, eachwitha specific focus, i.e.,Practice,Education,LegislationandMembership.We all work together, making for a strong

President’s Perspective continued on page 3

Page 2 • ANA\C The Nursing Voice July, August, September 2012

Published by:Arthur L. Davis

Publishing Agency, Inc.

www.anacalifornia.org

ANA\C Wants To See You….IN THE NEWS

Have you or one of your colleagues been recognizedfor an accomplishment, elected to office, won an award,received a grant or scholarship, launched a new venture?Tell us about it!Sendname, address, phonenumber, andaccomplishment—

E-mailto: TheNursingVoice@yahoo.comMailto: ANA\CaliforniaINTHENEWS 1121LStreet,Suite409 Sacramento,CA95814

Article Submittal to ‘The Nursing Voice’

ANA\California accepts and encourages manuscriptsand editorials be submitted for publication in theassociation’squarterlynewsletter,TheNursing Voice.Wewill determine which letters and articles are printed bythe availability of publication space and appropriatenessof the material. When there is space available, ANA\Cmemberswillbegivenfirstconsiderationforpublication.Wewelcomesignedlettersof300wordsorless,typedanddoublespacedandarticlesof1,500wordsorless.ArticlesprintedinTheNursing VoicedonotnecessarilyreflecttheviewsofANA\C,itsmembership,theboardofdirectorsoritsstaff.

ANA\California’sofficialpublication,‘TheNursing Voice’ editorial guidelines and due dates for articlesubmittalisasfollows.

1. Manuscripts should be word processed anddouble-spacedonone sideof8½x11 inchwhitepaper.Manuscripts should be emailed toEditor atTheNursingVoice@yahoo.com

a. Manuscripts should include a cover page withtheauthor’sname,credentials,presentposition,address and telephone number. In case ofmultiple authors, list the names in order inwhichtheyshouldappear.

b. The Nursing Voice reserves one-timepublication rights. Articles for reprint willbe accepted if accompanied with writtenpermission.

c. The Nursing Voice reserves the right to editmanuscriptstomeetstyleandspacelimitations.

d. Manuscriptsmay be reviewed by the EditorialStaff.

e. Articlessubmittedbymembers’ofANA\Cwillbe given first consideration when there is anavailabilityofspaceinthenewsletter.

2. Photographs should be of clear quality. Writethe correct name(s) on the back of each photo.Photographs will be returned if accompaniedby a self-addressed, stamped envelope. Mailphotographs to: Samantha Hunter, Editor, TheNursing Voice c/o ANA\California, 1121 L StreetSuite 409, Sacramento CA 95814. Or emailphotographs in jpeg format to thenursingvoice@yahoo.com

3. E-mailallnarrativetoTheNursingVoice@yahoo.com

AmericanNursesAssociation/CaliforniaisanAffiliateChapterMemberoftheAmericanNursesAssociation.

The Nursing Voice istheofficialpublicationoftheAmericanNurses’Association\California.

ANA\Cislocatedat1121L.Street,Suite409Sacramento,CA95814,

Office916-447-0225-Fax916-442-4394AssociationE-mailanac@anacalifornia.org

TheNursing VoiceEditorE-mailthenursingvoice@anacalifornia.org

ANA\CBOARDOFDIRECTORSOfficers:ElissaBrown,MSN,PMHCNS-BC,President;Elizabeth“Liz”Dietz,EdD,RN,CS-HP,VicePresident;NicoleMarcy,BPH,BSN,RN,Secretary; Cathy Melter, RN, MSN, CWOCN, Treasurer.Directors; Monica Weisbrich, BSN, RN, Legislative andProfessional; Donna Dolinar, RN, BSN, MPA(c), Practice;Dianne Moore, PhD, RN, CNM, MN, MPH, Education;Arlene R. Hady, BSN, RN, PHN, Membership andCommunication.

ANA\CaliforniaExecutiveDirector: Hon.TriciaHunter,MN,RN

ANA\CaliforniaLobbyingFirm: GovernmentRelations Group,Inc.

ANA\CDirectorofMemberServices SamanthaHunter

ANA\CMerchandiseDevelopment&Sales MicheleTownsend

EditorialCommittee:Chairperson LouiseF.Timmer,EdD,RNStaff Hon.TriciaHunter,MN,RN SamanthaHunter

The official publication of the ANA\C shall be The Nursing Voice. The purpose of this publication shall be to support the mission of ANA\C through the communication of nursing issues, continuing education and significant events of interest. The statements and opinions expressed herein are those of the individual authors and do not necessarily represent the opinion or views of ANA\C, it’s staff, the Board of Directors, our Affiliates or the publications editors. Likewise, the appearance of advertisers, and/or their views and opinions, do not constitute an endorsement of products or services featured in this, past or subsequent issues of this publication. Copyright by theAmericanNursesAssociation\California.

TheNursing Voice ispublishedquarterlyeveryJanuary,April,July and October and is complimentary to ANA\C members,schools of nursing and their nursing students, affiliates of theassociationandtheirmemberships.Ifyouwouldliketosubmitanarticleforpublication,pleasesee‘ArticleSubmissionforTheNursingVoice’inthisissuefordeadlinesandsubmissiondetails.

Ifyouwouldliketoreceivethis publicationoryouwouldliketostop receivingthis publicationpleasewriteorcalltheANA\Cat (916) 447-0225 or fax to (916) 442-4394. Please leave yourfullname,completeaddressoraddresscorrectionandaphonenumbershouldweneedtocontactyou.Or,filloutandmailintheUpdateRequestFormfoundinthisnewsletter.

Reprints and Submissions: ANA\C allows reprinting ofnewslettermaterial. Permission requests should be directed totheANA\ChomeofficeinSacramento.(916)447-0225

Advertising: Advertising Rates Contact—Arthur L. DavisPublishingAgency,Inc.517WashingtonSt.,POBox216,CedarFalls,IA50613,800-626-4081,sales@aldpub.com.ANA\CandtheArthurL.DavisPublishingAgency,Inc.reservetherighttorejectanyadvertisement.Responsibilityforerrorsinadvertisingis limited tocorrections in thenext issueor refundofpriceofadvertisement. Acceptance of advertising does not implyendorsementorapprovalbyANA\Cofproductsadvertised,theadvertisers, or the claimsmade.Rejectionof an advertisementdoesnotimplyaproductofferedforadvertisingiswithoutmerit,or that themanufacturer lacksintegrity,or that thisassociationdisapprovesoftheproductoritsuse.ANA\CandtheArthurL.Davis PublishingAgency, Inc. shall not be held liable for anyconsequences resulting frompurchaseoruseofanadvertiser’sproduct.

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association dedicated to nursing. Nurses can be involvedeitheroncommitteeswiththeDirectorsoratleastontheire-mail groups.SomegroupshaveonlyANA\Cmembers,others include nonmember nurses. Those who vote mustbeANA\Cmembers.

PleasecontactusatANA\C,abouthowyouwouldliketobeinvolvedinANA\Cactivities.

Other issues: BRN updates; ongoing issues, stateand national, continue with Health Care Reform; withbills related to nursing practice, and more. Please seeourwebsite, formore information.ANA\Cwill keepyouupdated.

My enduring thanks to our ANA\California Boardmembers and staff,who continue their excellentwork topromote quality healthcare, to, participate in healthcare

President’s Perspective continued from page 1

Some of the past “CNS of the Year Award” winners at NACNS Convention in Chicago, March 2012.

reform, to support theNursing profession and to supportANA\CandANA.

Andthankyoutoallnursesforwhatyoudo.Begoodtoeachotherandtoyourselves!

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Page 4 • ANA\C The Nursing Voice July, August, September 2012

Politics Trumps Science Once Again…But From An Unexpected Place

Diana Taylor RNP, PhD, FAANProfessor Emerita, UCSF School of Nursing

Faculty, Advancing New Standards in Reproductive Health Program (ANSIRH)

UCSF Bixby Center for Global Reproductive Health

In late February, California Sen. Christine Kehoe(D-San Diego) introduced a bill in the state Senate(SB1338) that would remove the restriction on nursepractitioners (NPs), physician assistants (PAs), and nursemidwives (CNMs) performing first trimester aspirationabortion care and allow women to obtain safe, earlyabortion care in their communities, from their currenthealthcareproviders.

At first glance, California Senate Bill 1338 (SenatorKehoe’s Safe & Early Access Bill) should have easilymovedthroughthe legislativeprocess. Itwasco-authoredbylegislativeleadersinthestatesenateandtheassembly,itwas based on evidence regarding need and safety, andwassupportedbyallprofessionalnursingorganizations—The American Nurses Association of California, theCalifornia Association of Nurse Practitioners, and theCalifornia Nurse-Midwives Association as well asmultiplemedicalgroupsincludingtheCaliforniaMedicalAssociation, the Association of Reproductive HealthProfessionals and Physicians for Reproductive Choice &Health.

Because half of allCalifornia counties arewithout anaccessible abortion provider, these health professionalorganizations, along with many others, recognize thepublic health imperative to increase access to earlyand therefore safer services. Opposition was expectedfrom groups that oppose abortion rights. But what wasunexpected was the aggressive opposition of the nurses’union (California Nurses Association) which identifiespublically as supportive of abortion rights. Because oftheunion’soppositionand theirpressureonSenator JuanVargas (D-San Diego) whose vote was the tie breakeron the Business & Professions Committee, Sen. Kehoewithdrewthebill(5/4/12).

Whatwas the stated rationale forCNAandVargas tooppose SB1338? Their claimwas that the study was notcomplete and that study results needed to be publishedin a peer-reviewed journal. Solid evidence from amulti-year study conducted under a transparent process bythe California Office of Statewide Health Planning andDevelopmentwasbrushedaside.

What does the evidence tell us?Modernabortionpracticehasmadeabortionincredibly

safe. The widespread use of aspiration abortion as thepreferredmethod for terminatingapregnancy in the firsttrimester is part of that advancement. The question of

who should be able to perform those aspiration abortionprocedures is one that can be answered by scientificevidence.

For the last four years,mycolleagues and I (from theUCSFSchoolsofNursingandMedicine)have ledaverylargeandcomprehensivestudy,underalegalwaiverfromtheHealthWorkforcePilotProjectProgramoftheOfficeof Statewide Health Planning and Development. HWPP#171 was designed to answer two questions: can nursepractitioners, certified nurse midwives and physicianassistants (NP/CNM/PAs) be trained to competencein aspiration abortion? And can they perform thoseprocedures with comparable outcomes as their physiciancolleagues? The study was required not because uterineaspiration is outside of the scope of advanced nurse(APRN) practice, but because of the restriction placedonAPRNsby the2003ReproductivePrivacyAct,whichlimited surgical abortions to physicians. In fall 2011, wehadsufficientdatatoconducttheanalysestoanswerthesequestions.

Byfall2011,41clinicianswere trained tocompetenceand they performed almost 8,000 aspiration abortionprocedures. Their safety outcomes were equivalent tophysicians who performed almost 7,000 procedures.Fewerthan2%ofallpatientsrequiredanyadditionalcareandonly7patients(lessthan0.05%)neededanyhospital-based care, what is deemed by the Centers for DiseaseControl andPrevention (CDC)asa“major”complicationofabortion.Fourofthosepatientswereseenbyphysiciansand3bytheNP/CNM/PAgroup.Andallofthesewomenrecovered without any long-term harm to their physicalhealth.Women in the study reported satisfaction rates ofover 9 on a 10 point scale for both provider groups.Ourscientific conclusion is that NP/CNM/PAs should beallowedtoperformaspirationabortioninCalifornia.

Why is legislation needed?Legislativechangeisnecessarytoremovethecriminal

penalties associated with “physician-only language”for this procedure to be performed under California’sReproductive PrivacyAct. TheHWPP-171 (and the legalwaiver from OSHPD that allowed us to conduct thestudy) will end this year and without legislative change,the clinicians in theHWPP-171 studywill be at risk forcriminal charges if they continue performing aspirationabortion services. Although California NPs and CNMscanperformmedicationabortionsandproceduresthataremuchmorecomplicatedundertheStandardizedProceduremechanismintheNursePracticeAct,“surgicalabortion”(anoutdatedtermforearlyaspirationprocedures)canonlybeperformedbyphysicianswithoutcriminalpenalty.

Legislation should not be necessary to allow APRNsto practice within their legally defined scope of care,but in this unique situation (and abortion is often treated

as a unique exception within health care regulation), itis the only way to ensure that qualified clinicians areable to support an important element ofwomen’s health.California is a state in which half of all counties haveno accessible abortion provider. The removal of legalrestrictions to aspiration abortion holds promise forincreasing access to care for women seeking pregnancytermination, and restores regulation of APRN practiceto the jurisdiction of the California Board of RegisteredNursing.

Is legislation premature?The legislation is not premature because the Pilot

Project,whichanticipates legislativeaction, requiresonlythat the findings from the Project regarding safety andefficacy be provided to the Legislature when legislativechangeisbeingconsidered.AcademicjournalpublicationofHWPPprojectresultsisnotarequirementofthewaivermechanism. Numerous prior HWPP projects have beenthe basis for legislative change and academic publicationofstudyresultsdidnotoccurinthosecases.Thedirectorof the California Office of State Health Planning andDevelopmenthaspubliclystatedthattheHWPP-171studyiscompleteandtheresultsarehighlypositive.

After decades of experience, we know there are twothings that make abortion safer: making it legal andperforming it early in pregnancy. Unfortunately, acrossthecountryand inCalifornia,womenwith lessaccess toroutine health care have higher rates of abortions afterthe first trimester. Therefore, we have a public healthimperativetoincreaseaccesstoearlyservicesandreducethis health care disparity. Expanding the eligible healthcareteamwill improvethelivesandhealthofallwomenin California who find themselves making the difficultpersonaldecisiontoterminateapregnancy.

The California Nurses Association—a unionaffiliated with the Teamsters—chose not to stand withprofessional nursing1, medicine and the reproductivehealthcommunities to improve the livesandhealthofallwomeninCaliforniaonthebasisthattheyareopposedtoanylegislationthatadvancesthescopeofnursingpractice.This union applied its political influence with SenatorVargas to defeat evidence-based legislationmuch neededfor the benefit of California women.Whowill hold thisgroupaccountable foropposingoneof theonlypiecesofstatelegislationintheU.S.thisyearthatimprovesaccesstoearlyabortionandreproductivehealthservices?

Taylor D, Safriet B, Weitz T (2009). When politics trumpsevidence:Legislativeorregulatoryexclusionofabortionfromadvanced practice clinician scope of practice. J. MidwiferyandWomen’sHealth,54:4-7.

Related linkshttp://jezebel.com/5905701/california-abortion-access-bill-

already-stalled-in-senatehttp://www.utsandiego.com/news/2012/apr/26/vargas-blocks-

abortion-bill/http://www.rhrealitycheck.org/article/2012/05/06/california-

bill-to-expand-access-officially-killedht tp: //anaca l i forn ia .org /newslet ters /TNV%202009/

NVDec08JanFeb09.pdf (an excellent history of the need fora strong PROFESSIONAL nursing organization by LouiseTimmer,pastpresidentofANA-C)

1ThankyoutoANA-C,CNMAandCANPforbeingpro-nurseand pro-patient access by supporting SB1338. A big handgoestoANA-Cfor takingtheearlyleadas thefirstnursingorganizationtosignonasasupporterofSB1338.

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Nursing Student in Sacramento Internship (NSSI)John E. Lyon

LVN–BSN Class of 2012California State University San Marcos,

School of NursingCSUSM Student Nurses’ Association Rep –

National Informant 2011-2012

We as nurses have the most respected profession,and represent the face of healthcare. Together, weneed to acknowledge and embrace the power we hold.As a representative selected for the Nursing Studentin Sacramento Internship (NSSI), I had the amazingopportunitytoplayanactiveroleinthelegislativeprocessandlearnwaystoutilizethepowerandesteemthatcomesalongwithbeinganurse.Tobegin thefirstdayofNSSI,TriciaHunter,ExecutiveDirectorof theANA\C,gaveanintroduction to the political arena, a roadmap to passinglegislature, and an inspiring presentation regarding thefutureofnursing.ThiswasjustthestarttoRNLobbyDayandajam-packed3dayinternship.

The two NSSI interns and our advisor and CNSALegislative Director had the honor of meeting membersof the ANA\C board. We were invited to share mealswith these strong nurse leaders and participate inthe meetings at the ANA\C headquarters with otherhealthcare professionals. The intent of the meetingswere to advocate for patient safety and quality of careby improving collaboration with other stakeholders.Discussions included current legislation and where eachparty stands on particular issues. Tricia Hunter, as anexperienced nurse leader and former politician, gaveus advice on how to approach the appointments we hadeach day to meet with our local representatives or their

staffmembers.Wediscussed thebillsas theygo throughthe legislative process from committees to the floor.Dependingon thesubject,we lobbied togainsupport fororinoppositiontothebillwiththerepresentativeswemet.Thedynamicsweredifferentwitheachmemberdependingontheawarenessoftheissueandpoliticalaffiliationofthelegislator.Sometimes,thisposedachallengetocreatingaconnectionwithsomerepresentatives,yetwemaintainedapositivedemeanorandahopetoplantaseedforsupportofthenursingprofessionandtheadvancementofhealthcare.

Other internship activities included touring theCapitolBuilding and attending the Senate andAssemblyCommittee meetings. These more intimate settingsallowed us to hear both sides of the argument oncontroversial issues and then observe the voting processin which they voted to kill the bill or pass it to theSenateorAssembly floor tobeheard.Somebills passedunanimously, while others had opposition related toimproper wording in the bill, not enough information tomake an educated decision or the bill infringing on thescopeofotherhealthcareprofessionals.

Attheendofourdays,wewouldreturntotheANA\Cheadquarters to debrief about our interactions throughoutthe day and to talk about expectations for the week andourobservationsfromattendingmeetings.Wefocusedourattention on bills related to healthcare, patient advocacy,and removing barriers to practice for Advanced PracticeRegisteredNurses(APRNs).

An area of personal interest is to allow APRNs topractice to their fullest extent and expand opportunitiesfor nurses to actively change the face of healthcarethrough research, higher education, policymaking, andhealthcare technology systems development. Currently,

the emphasis of the health care system is to branchout into the community and away from the hospitalsetting. We need to improve preventative medicine andchronic care management by striving for wellness and acontinuumofcare.Amajorroadblocktomovingforwardis the individualization and specificity of the bills fordifferent types of APRNs, particularly addressing thescope of practice issues for nurse practitioners, CRNAs,clinical nurse specialists, and certified nurse-midwives.By enacting the umbrella term of Advanced PracticeRegistered Nurses (APRNs) to remove all barriers toadvance nursing practice and allow greater autonomyto practice independently, we can expedite the flow andpassing of legislature on the state and federal levels.I’m passionate about this topic. It is crucial we promotemore nurses, patients, students, and other healthcaremembers to become involved by joining the CaliforniaActionCoalition towork together collectively tomake adifference.

Aspecial thankyougoesout toTriciaHunterand theANA\CBoardofDirectors,CNSA,especially,NicoleandJessica, and ACNL for selecting me for this prestigiousand eye-opening opportunity to represent my schooland state as an advocate formy fellownurses. I stronglyencouragemorestudents toapplynextyear forNSSIandto make the student nursing voice heard. I have learneda great deal, discovering the impact I can make in thelegislativesphereasaregisterednurse.Let’schallengeourpeerstorespectandsupportoneanotherinthemissiontotransformhealthcare for future generations by improvingthe quality, safety and accessibility for patients, familiesand providers. Congrats to the graduating senior nursesandgoodluckinyournursingendeavors.Cheers!

July, August, September 2012 ANA\C The Nursing Voice • Page 7

2010 – 2011 California New Graduate Hiring SurveyFebruary 2012—The difficulty of newly graduated

RNs to find employment remains a pressing workforceissue in California. After several years of investing inbuilding the workforce and increasing nursing programeducational capacity, the current economy continues toimpacthiringintheshortterm,threateningtounderminetheprogress thathasbeenmade.This isoccurringas thenursingworkforcecontinues toage, thestate’spopulationagesandgrows,andchangesresultingfromhealthreformare anticipated. These factors will dramatically escalatethe demand for nursing care in the near future, andCaliforniawillagainfaceasignificantnursingshortage.

To better understand the employment experience ofnewlylicensedRNs,astatewidesurveywasconductedinfall2011throughtheeffortsoftheCaliforniaInstituteforNursing & Health Care (CINHC), the California Boardof RegisteredNursing (BRN), California Student NursesAssociation (CSNA), Association of California NurseLeaders(ACNL),andtheUCLASchoolofNursing.

Design and Sample: A random selection of 7,890(50%) out of the 15,780 nurseswhowere newly licensedby exam in California from April 2010 through August2011were invited tovoluntarilyparticipate in thesurvey.Each received a letter from the BRN in October 2011inviting them to access and complete an on-line survey.Nopersonal informationwasgathered and the all resultsreportedwereaggregated.Wereceived1,492responsesfora19%surveyresponserateoverall.

Results:RespondentProfile:• 91%graduated fromnursing schools inCalifornia

fromApril2010throughAugustof2011.• 58%graduatedin2010,and42%graduatedin

2011• The sample reflects 57% of respondents had

associate degrees, 40% bachelors, and 3% weremasters prepared. The percent responding differsfrom the actual distribution of new graduatesin the state with 10% fewer responses fromassociate degree graduates, 13% more responsesfrom bachelors degree graduates, and 3% fewerresponsesfrommastersdegreegraduatescomparedtothedistributionofnewgraduatesinthestate

• 27%of respondents live in theSanFranciscoBayarea; 24% in the Los Angeles/Ventura area; 15%inOrange/RiversideandSanBernardinocounties;10%intheSanDiegoarea,7%intheSanJoaquinValley, 6% in the greater Sacramento area, andsmaller numbers represented from other regionsofthestate.Thisdatareflectsagreaterpercentageof newly licensed nurses responded to the surveyfrom theSanFranciscoBayareacompared to thepercent of new graduates in the region (21% newgraduates), and a smaller percentage respondedfrom the Los Angeles/Ventura area compared tonewgraduates in the region (30%newgraduates).Responsesfromotherregionsaremorecomparableto the percent of newly licensed nurses residingin each area.As theSanFranciscoBayArea andthe Los Angeles/Ventura areas, have the highestnumber of new graduates in the state, it is notedthat the statewide survey results also reflect thismisdistribution.

• 36% of respondents were between the ages of25-30; 21% were less than 25 years of age, and16% were between 31-35 years of age, indicatingthat the entry into practice is consistent with thenational trend of nursing as a younger, careerorientedprofession.

• The majority of survey respondents were White,non-Hispanic (49%) followed by 16% Filipino,13%Asian/nonFilipino,13%Hispanic,4%Black/African American, and <1%Native American. AgreaternumberofWhite,non-Hispanic(5%more)and Filipino (4% more) nurses responded to thesurveycompared to theactualdistributionofnewgraduatesinCalifornia,andfewerAsian(4%less)Hispanic (4% less), and Black/African (2% less)Americannewgraduatesresponded.

• 87%ofrespondentswerefemale,and13%male.

Work/RN Job Experience:• 57% of respondents are working in their first job

as a registered nurse and 43% are notworking asaregisterednurse.TheseresultsarecomparabletoprioryearsurveyfindingsforJanuary2009-March2010graduates.

• Dataindicates54%(N=458)ofADNnursesreportworking in their first RN job, 62% (N=364) ofBSNnurses,and60%(N=22)ofnursesgraduatingfromanELMprogram.Whilethesurveyindicates

a greater percent of BSN graduates are working,a larger number of ADN graduates report havingbeenhired,reflectingthestatewidedistributionbytypeofprogramoverall.

• Of the respondents who are currently working asnurses,62%areworkinginanacutecarehospital;the remainder working in long term care/skillednursingfacility(13%),homehealthorhospice(5%),communityclinicorpublichealth(4%),behavioralhealth(1%),andcorrections(1%).

• The majority of those working as an RN areworking full-time (77%), with 14% working parttime,and9%workingoncall.

• 62%ofrespondentsindicatedtheywereworkingina“jobofchoice”

• When asked how long it took to find their firstnursing job, 40% of respondents indicated lessthan three months; 30% responded that it took3-6 months to find their first nursing job, 15%indicated taking 6-9 months, 10% taking 9-12months,with6%takinggreaterthan12months.

• Jobswerefoundinavarietyofways:32%indicatedthat they knew someone at the hospital or healthfacility where they eventually went to work; 30%indicated that they used the hospital or healthfacility Website; 23% had a referral; 19% hadclinicalexperienceatthehealthfacilitywheretheywerehired;18%responded that theyhadpreviousemployment at the hospital or health facility in anon-RNposition,and3%werehiredthroughajobfair. (some respondents indicated more than oneanswer)

• Among respondents who indicated that they werenotworking as anRN, 13%had been looking forlessthan3months,39%hadbeenlookingforaRNposition 3-6 months; 18% had been looking, 6-9months; 14% for 9-12 months and 15% had beenlookingforlongerthan12months.

Reasons for Difficulty in Finding Employment and Internship Attitudes:

• The reasons thatwere given for not finding a jobwere either no experience (92%) or no positionsavailable (54%).42%were toldaBSNdegreewaspreferredor required,and6%were told theywereoutofschooltoolong.

• Data from those not yet working as an RNindicated 28% are working in non nursing jobswith 21% working part time, and 7% full time.12% indicated working in a health care job as anonRN,and13%indicatedtheywerevolunteeringin a health related service. 47% of respondentsindicated “other” options with narrativeexplanations written in. While these open endedresponses are not able to be quantified, the mostfrequent categories indicated new graduates wereworkingasRNsinshortterm,temporaryoroncalljobs, several of which were in seasonal and nonacute care settings such as a flu clinic. The nextmost frequententrywasvolunteering, followedbythose continuing towork in prior non health carejobs,thosecontinuinginschoolforaBSNorMSNdegree,andthosecontinuingtoworkasanLVN.

• When asked about interest in participating in anon-paying internship, themajorityof respondents(80%)indicatedtheywouldbeinterested.

• The opportunity to increase skills andcompetencies was the overwhelming incentive toparticipateinaninternshipasindicatedby95%oftherespondents.Otherincentivesreportedwere:• Exposuretoemployers(91%)• Improvingonesresume(86%)• Obtaining college credit applicable toBSNor

MSNdegree(58%)• Defermentofstudentloans(42%)

• 80%would bewilling to participate in an unpaidinternship and 43% would be willing to pay atuitionfeetoparticipate.

• 76% indicated that if given the opportunity toworkinanon-acutehealthcarefacilitytheywouldconsiderthisopportunity.

ThissurveywasasnapshotofthehiringdilemmanewRN graduates are facing in California and its findingsare a resource for nurse leaders seeking creative waysto employ recently graduated nurses. The low responserate (19%) is a possible concern and the results shouldbe interpreted with caution as representative of allnewly licensed graduates. Nurses who have not foundemployment may have been more likely to answer thesurvey, and if so, the actual employment rate may behigherthanreported.

The results reflect thedemographicsofnewgraduates

from the annual BRN school survey and their regionaldistribution,with someover responding from theSFBayArea, and also mirror data from prior employer surveysof nurses. In 2009, a survey conducted by CINHC andtheHospital Association of Southern California (HASC)indicated that 40% of new graduates may not able tofind jobs in California hospitals because of a lack ofavailablepositions,andtheSurveyofNurseEmployersinCalifornia conducted by theUniversity ofCaliforniaSanFrancisco in fall 2010 also indicating up to 50% of newgraduatesmaynotfindemploymentinhospitalsettings.

The first survey of new graduates completed in fall2010 indicated that 42% were not yet employed. Datafrom this most recent survey indicate no change in theemploymentrateofnewlylicensedRNswhorespondedtothesurveyfromtheprioryear.Newgraduateemploymentdata has also been collected annually since 2008 by theNational StudentNurses’Association (NSNA). Their fall2011 survey of members indicates 54% of nurses wereemployedapproximatelyfourmonthsfollowinggraduationwhich is a 10% increase in national employment fromtheir prior year survey. When this national employmentdatawasbrokendownby region,a rangeof55% to72%was reported with theWestern region having the lowestemployment rate of 55%, and employment in Californiareportedtobe47%.(Mancino,D.(2011)InactionisNotanOption.Dean’sNotes,33(1),1-3)

California needs to keepnewly licensedRNs engagedand in the nursing workforce as they are the criticalresource for ensuring the state has the nurses to providecare to the people of California. It is evident from thesurvey that newly licensed nurses are working hard toobtain employment, often working a combination oftemporary or part time jobs, and considering optionsoutside traditional hospital settings. As the economyimproves and the expected exodus of experienced nursesoccurs, the demand for new nurses will dramaticallyincrease. This demand will be further impacted by theincreased demand resulting from health care reform.Hospitals have historically been the largest employer ofnurses and new graduates, and hospital vacancy rates inCaliforniawere reported tobe3.7%in the3rdquarterof2011.Nurseleadersfromacademiaandservicemustbegintosharebestpracticesand innovativestrategies toensurethatnewRNsmaintainandgaincompetenciesduringthistemporaryemploymenthiringlull,asthenurseshortageisnotover.

This current survey also indicates that the use ofunpaid internships may be a way to keep the newlylicensed RN engaged in the work force, providing anopportunity to increase skills and competencies, whilethey seek employment. Community-based RN TransitionProgramsconductedby schoolsofnursing inpartnershipwith service partners have been successful in providingadditional education and clinical experience to newlylicensed nurses in the state, with 20 schools conductingprograms for over 750 newly licensedRNs over the past2 years. Preliminary hiring results from these programsindicatedthatwellover70%ofparticipantsfoundjobsasRNs.

Theresearchteamthanksallofthenewgraduateswhotooktimetosharetheirhiringexperienceswithus.Theseresults will be shared with others concerned about thedifficultynewgraduatesarehavingfindingRNpositions.

Study Team:Louise Bailey, MEd, RN, Executive Officer, California

BoardofRegisteredNursingSuzette Cardin, DNSc, RN, FAAN, Assistant Dean,

UniversityofCaliforniaLosAngelesSchoolofNursingandPrincipalInvestigatorforthesurvey

Deloras Jones, MS, RN, Executive Director CaliforniaInstituteforNursing&HealthCare

Patricia McFarland, MS, RN, FAAN, Executive Officerfor Association of California Nurse Leaders andCaliforniaStudentNursesAssociation

Carolyn Orlowski, MSN, RN, Southern CaliforniaRegionalCoordinatorCINHCandSurveyProjectLead

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July, August, September 2012 ANA\C The Nursing Voice • Page 9

Study Shows Transition to Practice Programs Get Nurses Employed

CINHC’s New Graduate Nurse Transition to Practice Programs Increase Community Collaboration and

Innovation While Getting Nurses JobsOAKLAND—The California Institute for Nursing &

Health Care (CINHC) released its Evaluation Report offour San Francisco Bay Area pilot NewGraduate NurseTransitiontoPracticePrograms(RNTransitionPrograms).The evaluation, led by the University of San Francisco,found that the programs are making a difference in theconfidence and competence of new nurse graduates andincreasing their employment opportunities in hospitalsand out-of-hospital settings. As ofMay 2012, 79 percentof thenurseswhoparticipated in the fourprogramshavesecured jobs. “These RN Transition Programs improvednew graduates’ hiring eligibility,” said CINHC’s ProjectManagerNikkiWest.“Andalthoughtheseprogramswerelaunchedinadifficulteconomicclimatewithahighstateunemployment rate, they can enhance the preparation ofnursesforemploymentatanytime.”

In2011,CINHCconductedasurveyofnewlylicensedRNs and found that 43 percent of the 1,492 respondentswho had been licensed between April 2010 and August2011 had not found positions. Through innovation andcollaboration among nursing schools, hospitals andcommunity-based agencies, the 12- to 18-week pilot RNTransitionProgramsweredevelopedandhousedinschoolsof nursing and opened up to newRNsnot yet employed.Threehundred forty-fivenewnursegraduatesenrolled inthepilotprograms.

Theprogramsintegratedbestpracticesfromemployer-based residencymodels andused standardizedevaluationand confidence tools adapted from the six Quality andSafety Education for Nurses (QSEN) competencies andthe 2006 revisedCasey-FinkGraduateNurse ExperienceSurvey.Theprogramswereflexiblydesignedforeachsiteto provide the best experience for nurse participants andfocused on building generalist, acute care and non-acutecare skills. Key components of the Transition Programs

included ongoing assessments of participants’ criticalthinking and competency skills; individualized learningplanswithassignedfaculty;preceptedclinicalhours;andclassroomeducationonmultipletopics.

The pilot programs were based at schools of nursingatSamuelMerrittUniversity;CaliforniaStateUniversity,EastBay;UniversityofSanFrancisco;andacollaborationofSouthBayschools,includingSanJoseStateUniversity,Samuel Merritt University’s San Mateo Learning Centerand San Jose/Evergreen Community College DistrictthroughtheWorkforceInstitute.

“Themaingoalof thepilotprogramswas toestablishregional collaboratives to enhance skill development andconfidenceofRNgraduatesunabletosecurejobsbecauseof thecurrenteconomy,”saidCINHCExecutiveDirectorDeloras Jones. “The RNswanted to continue developingcompetencies to increase their value as nurses andprospectiveemployees.”

“The Transition Programs are in sync withrecommendations from the InstituteofMedicine’s report,The Future of Nursing,” said Jones. “They providetransitionalsupportfromclassroomtoclinicalpracticeandareanecessaryeducationalcomponentinpreparingnursesforpracticetodayandtomorrow.”

The four pilot RN Transition Programs were fundedby the Gordon and Betty Moore Foundation, KaiserPermanente Fund for Health Education at the EastBay Community Foundation and the Alameda CountyWorkforceInvestmentBoard.Theevaluationstudycanbefoundatwww.cinhc.org.

The California Institute for Nursing & Health Care is a non-profit 501(c)(3)organization that transforms the capacity of nurses to meet the evolving health needs of Californians by partnering with nurse leaders, educators, providers, payers, policy leaders and consumers.

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Page 10 • ANA\C The Nursing Voice July, August, September 2012

Membership and Communication

Help us stay in touch: Do you have a new address or e-mail address?

You can helpAmericanNurses Association\California ‘stay in touch’ by updatingyour contact information. Call ANA\C at 916-447-0225, e-mail us a anac@anacalifornia.orgorreturnthisformto:

The‘Nursing Voice’c/oANA\C1121LStreet,Suite409Sacramento,CA95814

ANA\CMemberIdentificationNo.(ifapplicable)

___________________________________________________________________

Name: _____________________________________________________________

NewAddress:_______________________________________________________

___________________________________________________________________

OldAddress:________________________________________________________

___________________________________________________________________

NewE-mailAddress:_________________________________________________

*** This is not to update your license information with the Board of Registered Nursing. Go to www.rn.ca.gov

AMERICANNURSESASSOCIATION\CALIFORNIAANAFFILIATEOFTHE

AMERICANNURSESASSOCIATION

American Nurses Association \ CaliforniaMembership Application

_________________________________________________ ______________________ _____________________Last Name/First Name/Middle Initial Credentials Date of Application

_________________________________________________ ______________________ _____________________Mailing Address Apt. / Unit Number Home Phone Number

_________________________________________________ ______________________ _____________________City / State Postal Code ‘Zip’ Home Fax Number

_________________________________________________ ______________________ _____________________Basic School of Nursing Year Graduated License Number / State

_________________________________________________ ______________________Employer Name Business Phone _________________________________________________ ______________________Title/Building/Department Business Fax _________________________________________________ ______________________Address Postal Code

_________________________________________________ _____________________________________________Employer City / State E-mail Address

_________________________________________________ Referred By:

MEMBERSHIP DUES VARY BY STATE

Membership Category (Check one) Payment Plan (Check One) Payment Plan (continued)M Full Membership Dues–$255 ❍ Full Annual Payment ❍ Electronic Dues Payment Plan (EDPP) ❍ Employed–Full Time ❍ Check Read, sign the authorization, and enclose a ❍ Employed–Part Time ❍ Master Card or VISA Bank Card check for first month’s EDPP payment (Available for Annual payment only) (contact your SNA/DNA for appropriate rate). 1/12 of your annual dues will beR Reduced Membership Dues–$127.50 _______________________________ withdrawn from your checking account ❍ Not Employed Bank Card Number and Expiration Date each month in addition to a monthly ❍ Full Time Student service fee. ❍ New graduate from basic nursing _______________________________ education program, within six months Signature of Card Holder AUTHORIZATION to provide monthly after graduation (first membership electronic payments to American Nurses year only) Association (ANA) Grad. Date _______________________ This is to authorize ANA to withdraw 1/12 ❍ 62 years of age or over and not earning of my annual dues and any additional more than Social Security allows service fees from my checking account designated by the enclosed check forS Special Membership Dues–$63.75 the first month’s payment. ANA is ❍ 62 years of age or over and not employed authorized to change the amount by ❍ Totally Disabled giving the undersigned thirty (30) days written notice. The undersigned mayNote: cancel this authorization upon receipt by$7.50 of the SNA member dues is for ANA of written notification of terminationsubscription to The American Nurse. A twenty (20) days prior to the deduction datepercentage of your dues may or may not as designated above. ANA will charge abe applied to an SNA/DNA subscription. $5.00 fee for any return drafts.State nurses association dues are notdeductible as charitable contributions ________________________________for tax purposes, but may be deductible Mail with payment to: Signature for EDPP Authorizationas a business expense. However, that American Nurses Association\Californiapercentage of dues used for lobbying by 1121 L Street, Suite 409 the SNA is not deductible as a business Sacramento, CA 95814expense. Please check with your SNAfor the correct amount.

TO BE COMPLETED BY SNA Employer Code ____________________________

_______ _______ _______STATE DIST REG Approved by ___________ Date ______ Sponsor, if applicable ____________ Expiration Date ______ / _______ $ _______________________________ SNA membership # ______________ Month Year AMOUNT ENCLOSED CHECK #

Membership Form for the Golden State Nursing Foundation

Yes,IwouldliketobecomeaFriendoftheGSNFandreceiveemailedandmailedupdatesastothefoundationsprojectsandevents.

Individual Sponsorship

Name:_____________________________________________________________________________________

Address: __________________________________________________________________________________

City/State/Zip:______________________________________________________________________________

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❏ Pleaseacceptthisone-timedonationof____________________________________________________

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__________________________________________________________________________________________Pleasemakecheckspayableto:

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CreditCard#:______________________________________Ex.Date: ____________________________

SignatureofCardHolder:_____________________________________________________________________

❏ Iwouldpreferthatmydonationbeusedfor__________________________________________________

Contributions to the Golden State Nursing Foundation, a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code, are deductible for computing income and estate taxes.

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Page 12 • ANA\C The Nursing Voice July, August, September 2012