A Conversation with Associate Dean Dr. Scott Ziehm, newly elected President of the Board at the California Association of Colleges of Nursing (CACN)

Posted Thu, 09/20/2018 - 10:33

Congratulations Dr. Ziehm!

The California Association of Colleges of Nursing (CACN) represents colleges and universities offering baccalaureate and higher degree programs for California's nursing students. CACN began as a place for nursing deans and directors to network and discuss higher education issues and trends in the Nursing profession. While this continues to be relevant, members are increasingly interested in extending their influence as nursing leaders through public advocacy and collaborating with state legislators to advance the Nursing profession and the future of healthcare.

In a publication from January 2018, Statewide political activism for California academic nursing leaders, CACN leaders detailed the process they led to assist other state organizations to move toward political activism in support of the Nursing profession from the academic nursing leadership perspective. On September 15, 2018, we spoke with Scott R. Ziehm, DNP, RN, who was the lead author on this publication, to get his insights about some of the challenges and opportunities for CACN in the rapidly changing landscape of healthcare and Nursing education.

Dr. Ziehm, what has it taken to move CACN to this legislative advocacy role?

We began with very deliberate actions in 2011 during a strategic planning process. CACN members wanted to be more politically active to advance our discipline and higher education issues related to Nursing education. CACN members valued meeting twice a year in a conference format but realized our impact would be more significant if we collaborated with others within the state. We had been too isolated to have the level of impact we wanted in order to be an influential statewide nursing organization. California prides itself as being progressive and as the state that leads the nation - our members wanted CACN to be the voice for baccalaureate and graduate Nursing education.

We hired a legislative lobbyist back in 2011, who primarily told us that we needed to come together with a unified, one voice perspective on issues that were important to us.

Subsequently, CACN members decided to write position statements on topics that were of concern to the members, which include: Support for innovation and nursing academy; Support full academic privileges for doctorally prepared nurse-academics; Support for BSN for entry practice for professional nursing, among others. The development of these position statements reflect the mission and vision of CACN as an organization, and also gave members an opportunity to develop a unified voice on contemporary issues relevant to Nursing education.

What are some successes and challenges CACN faces going forward?

The State of California is quite diverse with large metropolitan and rural areas, each with its unique healthcare needs. The conflicting priorities of these geographic regions can at times divide us. It is not easy to intuitively understand the difference in nursing workforce needs in rural and urban areas. Additionally, the State of California has a large number of registered nurses and many different types of academic institutions with nursing schools. For instance, whether it is a private or public School of Nursing, or whether it is a part of the UC, Cal State or Community College system, they are defined by their respective charters. Furthermore, each school has its unique mission, vision, and ways of contributing to the Nursing profession. Given these differences, it can be challenging for nursing deans and directors to unify behind one-voice related to the complexities of higher education and healthcare policy.

CACN has been a place where we come together as a statewide nursing organization. We learn from each other and work to move the organization forward with one-unified-voice. Some issues we cannot all get behind as a unified front so we move on to something that will be productive. Staying focused on being impactful and relevant to the whole membership has been the avenue to support our greatest successes.

With that in mind, and as a response to the strategic plan created back in 2011, in 2017 CACN members made our first visit to Sacramento legislative offices; it was very successful. CACN members unanimously voted to continue to dedicate the CACN Spring conference to visits with Sacramento legislators. We’ve become more active on policy issues, raising a unified voice in support of policy matters about Nursing education, California’s healthcare workforce, and healthcare delivery.

Started in 2017, repeated in 2018, we are in the planning stages for our third visit to Sacramento in March of 2019. It is exciting to think about this history-defining where we were and where we are now, forecasting a productive journey forward.

What are your hopes for the future direction of CACN?

Regional Nursing Summit 2018 at Irvine, CACACN has been working in collaboration with the California Board of Registered Nursing (BRN) and other statewide organizations to plan the BRN Regional Summits. From September through October, the CA BRN, healthcare employers, union representatives and academic nursing leaders within each region will address issues related to clinical placements in pre-licensure nursing education. The goal is to identify better ways to sustain adequate clinical capacity and clinical placements for all types of pre-licensure nursing programs.

CACN is also focusing our efforts on the importance of masters and doctoral nursing education and meeting the full range of California’s nursing workforce needs. We recognized that CACN had been heavily focused on pre-licensure nursing education and clinical placement issues. However, CACN also represents the voice for nursing masters and doctoral education. Graduates from our nursing programs address a wide-range of California’s nursing workforce needs by meeting the demand but also shaping the future. We want Nursing to be well positioned to address academic workforce needs and healthcare delivery demands. Nursing deans and directors with our faculty are key drivers responding to California’s need for entry-level nurses and advanced practice registered nurses (APRN) who deliver primary care services throughout all regions of this state. CACN is the nursing organization with School of Nursing who graduate doctorally prepared nurses that become nursing faculty, and we are a vital part of the solution to the California nursing faculty shortage. We also have expertise related to caring for individuals and their families so CACN will continue to engage on legislative issues that address access to healthcare services and population health, including the opioid epidemic.

We need to strategically get behind legislation that will further our impact. Engaging in policy formation aligned with CACN’s mission and vision reinforces this organization is California’s voice for baccalaureate and graduate nursing education!

How will these changes affect the work of Advanced Nurse Practitioners?

Currently, in California, APRNs are required by existing legislation to practice under the supervision of physicians, thankfully the tide is changing. This is not the case in 21 other states including Washington, Oregon, New Mexico and Arizona where nurse practitioners and nurse midwives are independent health care providers (An Assessment of Physician Supervision of Nurse Practitioners. Rudner & Kung, 2017). California is unfortunately behind, and of greater urgency. Our rural regions have a significant need for access to primary care services. APRNs could address this need if they were independent of physician oversight. In California, a physician can only supervise four nurse practitioners, and in rural areas, there may not be a physician available to provide this supervision. There is data-based research confirming that nurse practitioners deliver high-quality services the public has valued for years, that they improve access to primary care services in rural areas, and they may favorably reduce healthcare delivery costs (The Graduate Nurse Education Demonstration - Implications for Medicare Policy . Aiken, et. al, 2018). During this last year, two California bills supporting greater independence for NPs and nurse midwives did not move to a vote, but both bills will be reintroduced in 2019. CACN is dedicated to helping pass legislation so that APRNs can be independent healthcare providers addressing the needs for all Californians, including those in rural regions.

This map shows that California is the only West Coast state that does not actually allow for independent practice of NPs.  This map image titled, "Scope of practice for nurse practitioners" shows that California is the only West Coast state that does not allow for independent practice of NPs.

Nursing deans and directors have a wide sphere of influence that can help mobilize legislative change and address issues facing healthcare delivery including access to care. With the support and input of the wider nursing community, we can become far more impactful to advance our discipline through the legislative process. It comes down to unifying a voice, public advocacy, education, and bringing stakeholders from all levels to the political process. CACN is already engaging in this kind of work, and we will succeed!

Congratulations Dr. Ziehm! We at University of San Francisco School of Nursing and Health Professions look forward to following you and CACN as it makes progress within the legislative advocacy journey.