The Pilots
Practice-Ready Nurse Graduates
The RN Initiative seeks pilots to create a highly adept, diverse workforce where nursing schools, their clinical practice partners, employers, and licensure processes, deliver the best possible nurse into practice. New nurses will have greater satisfaction, productivity, competence, and confidence from the outset of their nursing career. This will increase nurse retention and reduce turnover costs. The RN Initiative believes expanding nurses' competencies will better equip them to improve patient care and satisfaction and eliminate health inequities.
The RN Initiative is seeking pilots that:
- Assess and validate demonstrated performance-based competencies;
- Maximize the real-world experiences of the student, including opportunities to prepare to practice outside of an acute care setting (e.g., community, home, long-term care, public health facility, etc.);
- Create a bridge between the academic and practice environments;
- Develop faculty skill in delivering competency-based education;
- Incorporate augmented reality, virtual reality, holography, and other technology-enabled learning tools to provide additional immersive clinical experience that will aid competency development; and/or
- Show evidence that the social determinants of health are grounded in the curriculum and are evidenced in the performance of the nurse.
Technology-Enabled Nursing Practice
The RN Initiative seeks pilots that demonstrate improved efficiency and clinical outcomes by having nurses engage directly with companies to design and implement technology-based tactics and tools. Solutions designed not just for nurses, but by nurses, will lead to better tools that meaningfully enhance the practice of nursing. Pilots must engage a diverse group of nurses to ensure solutions work across the profession.
The RN Initiative is seeking pilots where nurses, informaticists, computer scientists, and developers work together to apply design principles that:
- Enhance nurse competencies through AI-based clinical decision-making support;
- Automate task-oriented activities, increasing efficiencies and freeing nurses to focus on solution-based care of their patients;
- Expand access to care by leveraging telehealth and other technologies that make it possible for nurses to meet patients where the patients are;
- Expedite nurses’ competencies from novice to expert through decision support tools;
- Augment care through patient monitoring, symptom management, palliative care, care coordination, and operations;
- Evaluate the impact and value of nursing and improve the quality of patient outcomes in a cost-effective manner; and/or
- Improve interoperability, align technology better with actual nurse workflows to increase efficiencies, or other ideas that transform technology in ways that enhance the practice of nursing.
Pilots should be capable of deploying technology at the individual nurse, clinical practice, community, and/or health care system levels. Concepts must show the ability to scale and achieve widespread adoption. We also seek pilots that advance health equity using technology. Given the three-year window for pilot completion, we expect that pilots will focus on augmenting or expanding existing technology or bringing existing prototypes into practice settings as opposed to designing and deploying a completely new technology or process.
Direct-Reimbursement Nursing Models
The RN Initiative is seeking pilots that make the value of nursing more visible. Direct reimbursement to nurses for their work is a significant step toward this goal. These pilots must enable and empower nurses to take more leadership in decision making about patient care and well-being and provide entrepreneurial opportunities for nurse teams and advanced practice registered nurses. This includes the design and implementation of nurse-managed clinics as a comprehensive and holistic reimbursable model of care.
Pilots must focus on tests of change that apply or expand an integrated model of nursing practice in the community setting (e.g., home, neighborhood, workplace, telehealth/virtual, hospice, public health facility, long-term care, etc.) funded by direct reimbursement for nursing care delivery, management, and coordination. Care delivery needs to improve accessibility, reduce inequities, and provide value both in terms of lowering cost and improving or maintaining the quality of patient outcomes.
We also are looking for pilots that break down barriers that prevent direct reimbursement from flowing to nursing. This includes lack of billing and reimbursement codes, alternative payment models for value-based care, and models that measure the patient-level cost and quality of nursing care by the individual nurse. We also seek technology tools that support nursing delivery in a community setting.
Characteristics of the Ideas We Will Fund
The RN Initiative will fund bold ideas. We developed three criteria of “boldness” to ensure we focus on transformation and not incremental change:
- Future-oriented: To be truly bold, the idea must become an anchor of nursing in the future.
- Disruptive: To be truly bold, the idea must upset something that is happening today, whether it is a work process, a cultural norm, a billing system, etc.
- Risky (but not reckless): To be truly bold, there must be unknown factors and a chance at failure. If we believe an idea will work with very high levels of certainty, we are not pushing the envelope.
Characteristics of the Pilots We Will Fund
We are looking for pilots with the following characteristics:
- Sustainability: If successful, the pilot must be demonstrably sustainable beyond the pilot phase. By the end of year three, pilots need a framework for future implementation and grantees should have the capacity and/or partnerships to carry the work forward. A foundation for replication and scalability should be established.
- Replicability/Scalability: If successful, the pilot must have the potential for wide distribution or expansion by the grantee and/or replication by others. If an idea was already done as a pilot, you can submit the push to scale/replicate it as a bold idea.
- Timely Results: The pilot phase of the RN Initiative is for up to three years. Within that time, the pilots not only need to launch, but achieve enough results to determine which are successful and might have the ability to be adopted more broadly throughout nursing.
- Knowledge Creators: The design and execution of the pilot project needs to produce direct value for nursing and contribute to knowledge creation for the field. The RN Initiative will provide pilot sites technical assistance to identify and share learning from each site.
- Equity Focus: Systemic racism impacts nurses, patients, communities, and health care systems, aggravating disparities in access to and quality of care. Pilots need to demonstrate an understanding of the social determinants of health as well as an understanding of racism's role in creating today's education, regulation, and practice environment. Pilots should actively work to embed anti-racism strategies.
Characteristics of the Portfolio We Will Fund
When selecting individual pilots, we aim to build a portfolio of pilot grants that are:
- Diverse: Funded pilots will represent different geographic areas, including rural and medically underserved communities. Funded pilots will also represent diversity of approaches to transformational change, as well as a diversity of settings. We expect there will be pilots in acute care settings as well as in community settings; we will award at least one pilot grant for a home health setting.
- Synergistic: While we expect individual pilots will focus primarily on one of the three priority areas of change, we encourage change in the other priority areas, creating synergy across the portfolio.
Intended Outcomes
All RN Initiative funded pilots should contribute in some way to several of the following long-term outcomes that make the health care system more equitable and effective. Outcomes of interest include:
- Practice Outcomes
- Increased readiness for practice
- Decreased attrition from profession
- Increased efficiency
- Increased leadership opportunities for nurses
- Improved regulatory environment
- Academic Outcomes
- Increased ability to prepare nurses through competency-based education
- Increased diversity of students
- Patient Outcomes
- Increased quality of care
- Decreased disparities
- Increased access to care
- Decreased cost of care
Additional Initiative Components
Grantees chosen as pilot sites will be part of a larger effort to learn from and share the results of their bold new ideas. This will include:
Evaluation
Each applicant should plan and budget for an evaluation of the pilot that assesses to what extent the pilot activities were implemented as intended, how nurses were impacted, any preliminary impacts to patients and systems, and the pilot's effectiveness in achieving its goals. The evaluation should be designed so that annual progress can be reported and learning shared through the pilot term. In addition, the Foundation will be designing an evaluation of the RN Initiative as a whole, assessing the Initiative's impact on nursing and the potential for these pilot tests of change to become norms in nursing. The Foundation will provide technical assistance and consulting support beyond the grant to support this program evaluation.
Community of Learning
Pilot sites, Foundation staff, and health leaders will come together virtually and in person throughout the three years of the program in a learning community intended to provide support and foster shared learnings.
Reimagining Nursing Campaign
Only market forces have the power and resources to bring these bold ideas to scale to become common practices. To build interest in and momentum for change, we will launch a compelling and ongoing communications campaign that inspires others to test their own ideas and/or replicate the RN Initiative pilots. The campaign will be developed and led by the Foundation, featuring the voices and expertise of the pilot sites and other initiative stakeholders.