Early project development and initial role of the NPO
The APIN NPO assumed a more active role than that which is generally provided by grant administrators. A team of representatives composed of NPO staff, a member of the APIN National Advisory Committee, and a CCNA staff member visited each of the selected sites. These visits were largely investigative, to allow NPO staff to fully understand each individual project. Early site visits also created an opportunity to assist grantees in organization and infrastructure, goal setting, and development of partnerships.
Strong and inclusive partnerships were critical for all projects. A few grantee states had excellent working relationships across academic institutions from the outset. In others, work was initially hampered by perceived competition and mistrust. In addition to relationships between schools, AONL and other Tri-Council members emphasized the importance of involvement from nursing employers and other stakeholders throughout the process. In most locations these relationships required outreach, development, and strengthening.
Creation or revision of academic progression programs required work far beyond that which could be directly supported by grant funds, and a great deal of volunteer effort was required. Project leaders identified a need for development of new skills in soliciting and managing this volunteer workforce.
Early work of the NPO included facilitating the needed outreach and team-building across multiple individuals and institutions. NPO staff provided assistance with intentional communication and skilled messaging. Because early work of the grantees was exploratory in nature, the NPO initially prioritized role modeling of concepts critical to work of that nature: flexible leadership, collaboration rather than competition, curiosity and creativity.
In addition to site visits and team building assistance, the NPO provided support to grantees through structured contact across the various projects. Although each project was unique, project leaders recognized shared challenges and opportunities to build on one another’s work. NPO staff convened the group in monthly conference calls and created a newsletter and private website to provide a central location for comments, questions, and shared review of work underway. Quarterly reports helped keep grantees on track and advancing.
Even with these supports in place, the challenge was daunting for many grantees, who began with substantial enthusiasm but were sometimes overwhelmed by challenges of transformative change within highly structured academic institutions. Grantees were charged with advancing bold agendas but the needed organizational culture for supporting transformative change was often not in place. From the early months of the project, NPO staff provided positive feedback and reinforcement for “starting where you are” and advancing even in the absence of enough data, enough personnel, or perfectly aligned organizations.
Identification of essential elements for success
Within the first year of funding, the NPO was able to identify essential elements for success across the varied APIN project sites. These were utilized to assess and build strength for each program, and will serve to guide future academic progression program development (Gerardi, 2015).
- Relationships: Strong relationships between AD and baccalaureate educators were critical to program development, and project sites with existing relationships demonstrated accelerated progress. Relationships between academia and practice partners were also essential and helped to drive change through hiring practices and elements of policy infrastructure detailed below. Other important relationships included those with legislative and regulatory bodies, hospital associations, nurse executives, business representatives, and practice partners across all settings.
- Leadership: Successful education redesign required significant resources and commitment from key stakeholders, especially academic institutions and practice partners. Dissemination of learning required leadership through presentation at nursing conferences, publication of articles, and provision of consultative services.
- Supporting infrastructures: Substantial infrastructure was required at the outset and throughout program development. Organization of participants through committees or work groups, clear goals and timelines, and the presence of an identified project coordinator were needed. Access to accurate data was a key determinant in the ability of program leaders to measure project impact.
- Scalability / Sustainability: From the outset of program development, it was clear that projects would need to be scalable in order to impact BSN numbers in a meaningful way. Successful programs required a mechanism to institutionalize change and maintain operational and financial support beyond the grant period.
- Competency: Education system redesign required demonstrated competencies in system thinking, innovation, complexity science, organizational behavior, risk taking, and change management. Intentional development of these skills served to accelerate progress.