The Journal of Continuing Education in Nursing

Original Article 

Identifying Gaps in Population Health Nursing Educational Resources Through a Culture of Health Initiative Project

Boniface C. Stegman, PhD, MSN, RN; Rachelle A. Collinge, BSN, MPH, RN; Christina M. Lear, MHA; Heather K. Gilchrist, DNP, MEd, MS, RN

Abstract

Background:

To meet the health care challenges and increasing population health demands of today and the future, the Missouri Center for Nursing developed the Culture of Health Initiative Project (CHIP).

Method:

Phase one surveys examined 33 nurse leaders' responses to the population health knowledge and training needs of nurses in their organizations. In phase two, 71 nurse leaders' and practicing nurses' responses from the Population Health Nursing Skills Survey provided insight into the education needs of Missouri nurses.

Results:

Findings identified a lack of available education and resources related to nursing, limited knowledge of concepts among nursing leaders, and a need for flexibility in the format and content to educate nurses in all types of nursing practice.

Conclusion:

Professional development practitioners must collaborate with nurses and nurse leaders, in all settings, to meet the learning needs necessary for Culture of Health competence. [J Contin Educ Nurs. 2020;51(12):568–573.]

Abstract

Background:

To meet the health care challenges and increasing population health demands of today and the future, the Missouri Center for Nursing developed the Culture of Health Initiative Project (CHIP).

Method:

Phase one surveys examined 33 nurse leaders' responses to the population health knowledge and training needs of nurses in their organizations. In phase two, 71 nurse leaders' and practicing nurses' responses from the Population Health Nursing Skills Survey provided insight into the education needs of Missouri nurses.

Results:

Findings identified a lack of available education and resources related to nursing, limited knowledge of concepts among nursing leaders, and a need for flexibility in the format and content to educate nurses in all types of nursing practice.

Conclusion:

Professional development practitioners must collaborate with nurses and nurse leaders, in all settings, to meet the learning needs necessary for Culture of Health competence. [J Contin Educ Nurs. 2020;51(12):568–573.]

Improved population health is a desired outcome of the Robert Wood Johnson Foundation (RWJF), as described in the Culture of Health (COH) Action Framework (RWJF, 2015). Sharing the outcome of improved population health, well-being, and equity, the framework emphasizes four action areas: (a) making health a shared value; (b) fostering cross-sector collaboration to improve well-being; (c) creating healthier, more equitable communities; and (d) strengthening integration of health services and systems (RWJF, 2015). In their 2017 executive summary, Catalysts for Change: Harnessing the Power of Nurses to Build Population Health in the 21st Century, Storfjell et al. brought attention to nursing and its role in developing a COH through identification of factors that impact health, ability to develop clinical interventions, and the delivery of these interventions to advance health throughout the population. Possessing strong nursing assessment skills, along with a comprehension of health policy and the environment's impact upon health, can contribute to improved patient outcomes. Therefore, nurses are in a unique position to make system changes and to take a proactive approach in transforming health care.

The call for nursing innovators as leaders of system change was recognized by the Institute of Medicine in their 2010 report, The Future of Nursing: Leading Change, Advancing Health. In that report, nurses are called upon to be “full partners, with physicians and other health professionals, in redesign of health care in the United States” (p. 7). Nurses are a critical part of health care system transformation, and nursing's patient-centered focus has proven to play a role in driving innovation in the health care environment. Learning opportunities should reflect rapidly changing health trends and must shift from a disease-based medical model to an integrated model of care, focusing on the whole person and community. The purpose of this project is to identify the knowledge and skills needed by nurses in community health and clinical practice settings to effectively meet increasing population health demands.

Theoretical Framework

The theoretical framework for this study is the RWJF (2015) COH Action Framework. The COH Action Framework contains four action areas: (a) making health a shared value; (b) fostering cross-sector collaboration to improve well-being; (c) creating healthier, more equitable communities; (d) and strengthening integration of health services and systems. Progress in these action areas will approach an outcome of improved population health, well-being, and equity (RWJF, 2015).

Literature Review

Nurses are in a key position to affect change and influence the health care system toward a structure with the natural outcome of healthy individuals and communities (National Advisory Council on Nurse Education and Practice, 2016). Incorporating population health nursing concepts into daily practice is one of the key skills nurses can use to change health outcomes and influence change in their work environment (Association of Public Health Nurses, 2016).

As a result of the increasing movement from public health to population-based services, many health care organizations, including hospitals, have increased their efforts toward improving the health of their communities (Association of Public Health Nurses, 2016). The emergence of the concept of population health is requiring academic institutions to contemplate building curriculums that will prepare nursing students to practice as part of this workforce (Harris et al., 2016).

The United States is seeing a significant shift from a patient-based focus to a population-based focus in our health care systems. This project proposes that all areas of health-focused industry are still working to understand the skills needed and desired in a workforce to ensure population-based health outcomes. Nursing already has strong population health skills, which are often underused. By equipping the current nursing workforce with tools to implement population-based interventions in their work environments, we are setting up nurses as leaders in establishing a COH in their communities (Hassmiller, 2014). Nurses represent the largest part of the health care profession and can be found working in all sectors of health care and health-related jobs. By focusing education efforts on nurses, we are broadening our impact on the entire health system (Buerhaus et al., 2012; Harris et al., 2016).

Method

Culture of Health Initiative Project

As part of the collaboration between the RWJF Missouri Public Health Nurse Leader (PHNL) and the Missouri Center for Nursing, the Culture of Health Initiative Project was created through a partnership with the RWJF Missouri PHNL, the Missouri Center for Nursing, and Maryville University. The purpose of this project was to understand both educational and skills development gaps of nurses in community health and all practice settings to identify key concepts applicable toward expanding a COH. Phase one of the COH Initiative Project was initiated in July 2017, following approval from the Maryville University Institutional Review Board. Phase two began in December 2017 with the validation of a quantitative survey, followed by the distribution of a final survey beginning in March 2018.

Phase One

Phase one examined Missouri's nurse leaders of health care industries comprehension of population health and potential training needs of staff nurses to lead COH initiatives in their workplaces and communities. Preinterview survey questions considered the nurse leaders' perceptions of the ability of their nursing staff to incorporate the nursing skills as they pertain to building a COH. The survey demographic questions included the respondent's name, primary degree or certification, number of years with current employer, number of years in the health care industry, current organization of employment, type of organization, organization's or unit's mission, and if nurses are required to hold a Bachelor of Science in Nursing degree (BSN), if not, percentage of nurses with a BSN or higher degree. Additionally, nurse leaders were asked to assess their nurses' ability to incorporate the following competencies in their practice and identify those areas they would be interested in having additional resources and education:

  • Ability to apply the nursing process to populations, organizations, and systems
  • Understanding and applying social determinates of health to individuals and populations
  • Understanding and applying principles that ensure health equity
  • Collaboration with interprofessional teams, stakeholders, community partners, organizations, and the client
  • Leading diverse teams
  • Conducting community assessments
  • Identifying and implementing evidence-based strategies
  • Resource identification, creation, and utilization
  • Understanding of systems including health care, public health, government, and organizations
  • Development of policies and procedures at the organizational, community, and government levels
  • Understanding the impact of policy on individual and community health
  • Focus on prevention
  • Providing culturally competent care and communications in a diversity of settings
  • Applying health literacy principles

The interviews served as vehicles to articulate the COH framework, nursing's roles in a COH, the intersection with the health care environment, and addressed any questions the nurse leaders may have about the preinterview survey. This discussion was followed by the distribution of a quantitative, nine-question postinterview survey that was emailed to 33 nurse leaders to identify the current educational needs of organizations and nurses in Missouri, as they relate to building a COH. In addition to asking the participants to identify what education, training, and support was needed in relation to the above stated competencies in the preinterview survey, the following questions were posed:

  • How does your organization define population health?
  • What education, training, and support do you currently provide for your nurses related to their role in population health and value-based care?
  • What kind of additional leadership-building skills would you like to have available to your nurses?
  • If education, training, and support were offered, would you be interested in having your nurses participate? If yes, specify which classifications of nurses.
  • What format of training works best for your organization (e.g., web-based, online, in-person)?
  • Are there specific topics that would be most valuable to your organization?
  • What kind of topics would you like to see as interdisciplinary training versus nursing specific?
  • Would you provide paid time for nurses to attend these education sessions?

Phase Two

In December 2017, the Missouri Center for Nursing sought validation of the quantitative Population Health Nursing Skills Survey that would be directed toward practicing nurses and nurse leaders regarding population health nurse education. The Population Health Nursing Skills Survey was piloted as a paper version with the Missouri Center for Nursing board members (n = 13) and consisted of a diverse set of nurses and nurse advocates from across Missouri. Upon validation of clarity and consistency of the questions, the final Population Health Nursing Skills Survey was distributed in March 2018 over the course of 2 months. The survey was distributed to Missouri nurses and nurse leaders in all clinical settings, specialties, and positions through the Missouri Center for Nursing newsletter, LISTSERV®, Facebook®, and Twitter™. The purpose of the survey was to assess nurse leaders and practice nurses understanding of population health nurse education and the necessary resources needed to take the lead as catalysts in changing the health of Missouri. Six demographic questions that encompassed education, years of practice, and current work environment were included. The definitions of the four RWJF population health competencies were provided: (a) holistic approach, (b) coordination of care, (c) collaboration, and (d) advocacy (Table 1). Thirty-six additional questions asked nurses to rate their opinion of the importance of each competency to successful nursing practice, as well as their comfort level with its implementation (Table A; available in the online version of this article). Space was provided for additional comments. Participants were asked to rate the importance of each question as it pertains to population health and how they felt about its implementation in their nursing practice. The last part of the survey listed 17 educational opportunity types, and participants were requested to rate if they would “definitely attend,” “attend if convenient,” or “send staff.”

Key Competencies for Population Health Nursing Practice

Table 1:

Key Competencies for Population Health Nursing Practice

Population Health Nursing Skills SurveyPopulation Health Nursing Skills SurveyPopulation Health Nursing Skills SurveyPopulation Health Nursing Skills Survey

Table A:

Population Health Nursing Skills Survey

Ethical Considerations

The Maryville University Institutional Review Board reviewed and approved the project for human subjects' considerations. The Missouri Center for Nursing also provided a letter of support for the project. Implied consent was obtained at the beginning of each survey.

Results

Phase One

The preinterview survey (n = 33) gathered baseline demographics of 33 nurse leaders in Missouri and included education level, employment history, and role in their current organization. Most nurse leaders held a BSN degree (42.4%), compared with those who had a Master of Science in Nursing (MSN) degree (24.2%). Most respondents (27.3%) have worked with their current employer for 6 to 10 years. Preinterview survey responses to a 14-item 5-point Likert scale (1 = no/low proficiency, and 5 = high proficiency) asked how well they believed nurses in their organization were able to incorporate population health nursing skills into practice. Twenty-nine percent of leaders identified their nurses as highly proficient in two categories: (a) applying the nursing process to populations, organizations, and systems; and (b) collaboration with interprofessional teams, stakeholders, community partners, organizations, and the client. The postinterview survey (n = 9) questions considered current educational needs of organizations and nurses, as they pertain to building a COH. The option to check a box alongside each ranking provided an opportunity to indicate areas they would be interested in having available as additional resources and education for their teams. Focusing on prevention and identifying and implementing evidence-based strategies were identified as the primary population health nurse training requested.

Phase Two

This survey examined four areas that provided insight into the population health education needs of Missouri nurses: competencies, daily practice, nursing leadership, and delivery methods for training (Table A). Seventy-seven nurses responded to the survey. Thirty percent of nurses possessed a BSN degree, with 20% holding an MSN degree. The primary work environment of most nurses was in public health (55%), followed by the next highest percentage in the outpatient setting (8.3%).

Competencies

Results identified that more than half of nurses are very comfortable with implementing the competencies of the holistic approach (50%), coordination of care (51.4%), collaboration (54.3%), and advocacy (50%). The importance of these competencies to successful nursing practice were 67.1%, 81.4%, 74.3%, and 77.1%, respectively. Those who preferred to participate in education addressing coordination of care was 52.9%, compared with 45.7% who prioritized participation of education in the holistic approach. Delivery methods preferred were varied, with the online approach preferred for education of all competencies.

Daily Practice

Ensuring that nursing roles and specialties in all practice settings included population-focused concepts as an integral part of practice was considered extremely important by 54.8% of respondents. This varied significantly from those who considered it very important (38.7%). Because nurses considered population-focused concepts to be extremely important, 38.7% felt adequately equipped to apply them into daily practice. In the survey conducted, 71% of respondents found it extremely important to provide nurses in all practice settings with the tools needed to promote learning and behavior changes.

Nursing Leadership

Of the nurses surveyed, 57.4% responded it is extremely important to promote and support nurses in new population-focused executive and managerial roles in health systems, public health agencies, and payers as systems shift focus from volume to value. More than 70% of nurses responded that it is extremely important to encourage inclusion of nurse leaders on decision-making committees, councils, and boards, and nurture nurses and nurse leaders who advocate for individuals, families, and communities, taking into consideration the context of their environment.

Delivery Methods for Training

Onsite employer-sponsored training had the highest response at 50.8%, followed by live online webinar training, with 46.7% of respondents very likely to participate. Although 33.9% would very likely attend a conference in person, this method of training also had the largest response (5.1%) who would not attend.

Discussion

Both phase one and phase two surveys revealed a gap in available education and resources in the health care setting, as related to population health. The most sought-after education topics identified by nurse leaders included the identification and implementation of evidence-based strategies, prevention focus, and applying nursing practice to social determinants of health to individuals and populations. Interview questions provided a glimpse into how nurse leaders defined population health in their organizations and what education, training, and support they currently provide for their nurses related to their role in population health and value-based care.

Nursing Competence in Population Health

Population health nursing competence has a role in improving health across the United States. As the largest health care profession, “nurses are essential to reversing the decline in health status and the increasing costs of health care” (Storfjell et al., 2017, p. 29). Recognizing the need for organizational experts and clinically competent population health nurses, organizations and nursing schools need to provide the learning opportunities necessary to bring appropriate, evidence-based health care to the populations they serve. Learning opportunities should reflect rapidly changing health trends and shift from a disease-based medical model to an integrated model of care, focusing on the whole person and community. As a change agent for population-focused health care, the Missouri Center for Nursing recognized a gap in the education and training of population health practices. As the nation's health care system moves toward a more value-based approach, health care organizations must take a closer look at their strategies for meeting the demands of high-risk communities. Nurses contribute to this partnership through their roles as leaders, innovators, and advocates for the population health needs of our communities.

These results support Denham's (2017) assertion that a culture of health “requires nurses prepared to think and practice differently” (p. 357). Recognizing the significance of leadership for the advancement of population health practices is addressed by the Institute of Medicine (2010) in the Future of Nursing: Leading Change, Advancing Health. As nurse leaders continue to take on ever-expanding roles at the executive level, they are well-positioned to promote a COH Action Framework (Grob, 2018) that supports improved population health, well-being, and equity. To move forward with the expansion of population health awareness and education, nurses must have a proactive approach to learning and an acceptance and understanding of their role in the advancement of patient health, both inside and outside of the clinical setting.

Study Limitations

Generalization to the national population is limited due to all surveys being conducted in Missouri, the small sample size of the nurse leader presurvey (n = 33), and poor response rate of the postsurvey (n = 9) in phase one of the study. These surveys were not meant to be a comparison study, but rather to gain insight from nurse leaders to identify nurse proficiency with incorporating population health skills into their practice, and to identify the training and support needed for such skill development.

Implications for Continuing Education and Staff Development

For nurses to benefit from the findings of the Population Health Nursing Skills Survey, we must examine how nurse leaders and educators can create an environment supportive of nursing enthusiasm and engagement in the current health care climate of scarce resources. The following list suggests some constructive actions:

  • Expand nursing access to information regarding population health evidence-based research and best practices.
  • Increase the number of organizational experts in population health knowledge and skills.
  • Provide learning opportunities for nurses to expand their knowledge about population health.
  • Recognize that current cultural climates in most clinical settings do not place a sense of urgency/importance for population health competence.
  • Be astute to the financial resources needed for education and training that will bring about effective change to the organization.

Conclusion

Population health skills should have a place in every nursing education program—in both academic and organizational settings. This study surveyed nurse leaders, community health and clinical practice nurses to identify the current population health education needs of organizations and nurses, as they relate to a COH. Results revealed nurse leaders identified a gap in knowledge, skills, and available resources related to population health nursing. Nurse leaders were particularly interested in the areas of evidence-based strategies, prevention focus, and the application of nursing practice to the social determinants of health. At least half of the nurse leaders, community health, and clinical practice nurses surveyed were very comfortable with applying each of the four key population health competencies and thought such competencies were extremely important to their practice. Nurses in Missouri recognize the need for population health knowledge and skills. The information collected supports recognition of the need for population health nurse education in the academic and organizational settings. All providers should consider using a flexible format and content that address the eight subject areas of population health.

Storfjell et al. (2017) recognized that population-focused nursing is a cultural change for all nurses. Nurse educators play a significant role in changing the perception of population health nurse competence in the organization. As they align with nurse leadership to bring about this shift in culture, they must be steadfast and articulate in creating an environment that supports the development and implementation of population health skills into practice. Nurse leaders can create an environment that promotes a culture of health and enthusiasm for population health–focused learning. Recognizing that a lack of nurses with population health knowledge and skills can negatively impact an organization's ability to reach the goals of the Triple Aim (Berwick et al., 2008). Both leaders and educators should seek out opportunities to develop these aspects in nurses at all levels, with a goal to lead the organization from a health care focus to an improved individual and population focus.

References

Key Competencies for Population Health Nursing Practice

CompetencyDefinition
Holistic approachConsidered the physical, mental, social, and spiritual aspects in the context of an environment. (Socioeconomic model of meeting the individual where they are [e.g., considering language, culture, reading level, socioeconomic factors, and readiness for change in care plan and education].)
Coordination of careAcross providers and sites of care. (Ensuring individuals receive all health care and health supporting services needed before, during, and after acute illness where they live. Health supporting services include things such as access to medications and food, safe housing, and transportation to medical appointments.)
CollaborationCollaboration with other professionals and community stakeholders. (Bringing both health and nonhealth partners together for the good of the individual or population [i.e., medical teams, social workers, housing, transportation, economic partners]. This includes for the patient, as well as larger issues in the organization or community, such as addressing how to reduce complications from neonatal abstinence through or decreasing readmissions for diabetics.)
AdvocacyFor the individual and the community. (Ensuring the voice of the individual[s] being affected by the policy or action is being heard.) This includes:

Individual advocacy, such as ensuring a patient has adequate translation services during a visit.

Organizational advocacy, such as ensuring your organization has an adequate staffing ratio.

Community advocacy, such as supporting a “No Smoking” ordinance in your community.

Population Health Nursing Skills Survey

Your current comfort level in implementing the competency in your nursing practice.Very comfortable Frequency (% of Respondents)Comfortable Frequency (% of Respondents)Some comfort Frequency (% of Respondents)Uncomfortable Frequency (% of Respondents)
Holistic approachN = 35 (50%)N =27 (38.6%)N =7 (10%)N =1 (1.4%)
Coordination of careN =36 (51.4%)N =26 (37.1%)N =8 (11.4%)N =0 (0%)
CollaborationN =38 (54.3%)N =23 (32.9%)N =8 (11.4%)N =1 (1.4%)
AdvocacyN =35 (50%)N =25 (35.7%)N =9 (12.9%)N =1 (1.4%)
How important is this competency to successful nursing practice?Extremely important Frequency (% of Respondents)Very important Frequency (% of Respondents)Moderately important Frequency (% of Respondents)Slightly or Not at all important Frequency (% of Respondents)
Holistic approachN =47 (67.1%)N =19 (27.1%)N =3 (4.3%)N =1 (1.4%)
Coordination of careN =57 (81.4%)N =12 (17.1%)N =1 (1.4%)N =0 (0%)
CollaborationN =52 (74.3%)N =16 (22.9%)N =2 (2.9%)N =0 (0%)
AdvocacyN =54 (77.1%)N =13 (18.6%)N =2 (2.9%)N =1 (1.4%)
How likely are you to participate in education on this competency?Definitely Frequency (% of Respondents)Very Likely Frequency (% of Respondents)Somewhat Likely Frequency (% of Respondents)Not at all Likely Frequency (% of Respondents)
Holistic approachN =32 (45.7%)N =22 (31.4%)N =11 (15.7%)N =5 (7.1%)
Coordination of careN =37 (52.9%)N =23 (32.9%)N =9 (12.9%)N =1 (1.4%)
CollaborationN =35 (50%)N =25 (35.7%)N =8 (15.7%)N =2 (2.9%)
AdvocacyN =32 (47.6%)N =25 (36.8%)N =9 (13.2%)N =2 (2.9%)
Delivery method preferred for this topic.In personOnlineConference
Holistic approachN =21 (30%)N =29 (41.4%)N =20 (28.6%)
Coordination of careN =22 (31.4%)N =28 (40%)N =20 (28.6%)
CollaborationN =24 (34.8%)N =29 (34.8%)N =21 (30.4%)
AdvocacyN =22 (31.9%)N =28 (40.6%)N =19 (27.5%)
In order for nursing to transform our practice to meet the current health issues, the Robert Wood Johnson Foundation issued the following recommendations. Please rate a) how important you feel each is [importance] and b) how equipped to you feel in implementing this recommendation in your practice [daily practice]?
Daily Practice
Extremely important Frequency (% of Respondents)Very important Frequency (% of Respondents)Somewhat important Frequency (% of Respondents)Not important Frequency (% of Respondents)Very equipped Frequency (% of Respondents)Adequately equipped Frequency (% of Respondents)Somewhat equipped Frequency (% of Respondents)Not at all equipped Frequency (% of Respondents)Not applicable to my practice
Ensure that all nursing roles and specialties, in all practice settings, include population-focused concepts as an integral component of practice.N =34 (54.8%)N =24 (38.7%)N =4 (6.4%)N =0 (0%)N =16 (25.8%)N =24 (38.7%)N =19 (30.7%)N =3 (4.8%)
Foster true collaboration between nursing and other health care professions, as well as with other disciplines, to promote coordination of care, reduce fragmentation of health and social services, and support cross-sector collaboration to promote well-being.N =45 (72.6%)N =17 (27.4%)N =0 (0%)N =0 (0%)N =17 (27.4%)N =22 (35.5%)N =21 (33.9%)N =2 (3.2%)
Provide nurses in all practice settings with the tools to promote learning and behavior change and connect patients and families with local resources that promote health and meet social and emotional needs.N =44 (71%)N =18 (29%)N =0 (0%)N =0 (0%)N =14 (22.6%)N =21 (33.9%)N =23 (37.1%)N =4 (6.4%)
Support and promote access to population-focused nurses for all schools. (i.e., a school nurse in every school.)N =40 (64.5%)N =18 (29%)N =4 (6.4%)N =0 (0%)N =14 (24.1%)N =14 (24.1%)N =22 (37.9%)N =8 (13.8%)
Promote increased data fluency and data-based decision-making regarding population needs and trends. (i.e., ability to find and utilize new best practices and current health issue trends).N =34 (54.8%)N =26 (41.9%)N =2 (3.2%)N =0 (0%)N =11 (18%)N =21 (34.4%)N =24 (39.3%)N =5 (8.2%)
Promote interprofessional teams that include nurses as leaders and equal partners in improving the efficiency and effectiveness of health care systems and process.N =38 (61.3%)N =24 (38.7%)N =0 (0%)N =0 (0%)N =14 (23%)N =24 (39.3%)N =16 (26.2%)N =7 (11.5%)
Nursing Leadership
Extremely important Frequency (% of Respondents)Very important Frequency (% of Respondents)Somewhat important Frequency (% of Respondents)Not important Frequency (% of Respondents)Very equipped Frequency (% of Respondents)Adequately equipped Frequency (% of Respondents)Somewhat equipped Frequency (% of Respondents)Not at all equipped Frequency (% of Respondents)Not applicable to my practice
Promote and support nurses in new population focused executive and managerial roles in health systems, public health agencies, and payers as systems shift focus from volume to value.N =35 (57.4%)N =25 (41%)N =1 (1.6%)N =0 (0%)N =13 (21.3%)N =17 (27.9%)N =24 (39.3%)N =7 (11.5%)
Encourage inclusion of nurse leaders on decision-making committees, advisory councils, and boards.N =47 (75.8%)N =14 (22.6%)N =1 (1.6%)N =0 (0%)N =15 (24.6%)N =16 (26.2%)N =26 (42.6%)N =4 (6.6%)
Nurture nurses and nurse leaders who consider individuals and families in the context of their environment.N =44 (72.1%)N =16 (26.2%)N =1 (1.6%)N =0 (0%)N =16 (26.7%)N =19 (31.7%)N =22 (36.7%)N =3 (5%)
Advocate for individuals, families, and communities accordingly.N =50 (80.6%)N =11 (17.7%)N =1 (1.6%)N =0 (0%)N =15 (24.2%)N =22 (35.5%)N =21 (33.9%)N =4 (6.4%)
Promote and support the development of a pipeline of population-focused nursing leaders with population-focused nurse leadership residencies, lifelong learning, and mentoring strategies.N =34 (54.8%)N =19 (30.1%)N =9 (14.5%)N =0 (0%)N =11 (18.3%)N =11 (18.3%)N =26 (43.3%)N =12 (20%)
Authors

Dr. Stegman is Associate Professor and Coordinator of RN-to-BSN and Community Paramedic Programs, Catherine McAuley School of Nursing, Maryville University, St. Louis, Ms. Collinge is Nurse Case Manager, Anthem, Jefferson City, Missouri; Ms. Lear is National Program Director, National Education Progression in Nursing, Edwardsville, Illinois; and Dr. Gilchrist is Adjunct Nursing Instructor, MidAmerica Nazarene University, Olathe, Kansas.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank the following Culture of Health Initiative Project team contributors: Lisa Sitler, PhD, RN, PHNA-BC, SANE; Gloria Solis, MSN, MBA, RN, NEA-BC; Carol Ellis, DNP, RN, NEA-BC; Julie Clawson, PhD, RN; Ann H. Cary, PhD, MPH, RN, FNAP, FAAN; Kristine Strong, RN, BSN, MHA; Stacy Farr, PhD, MPH.

Address correspondence to Boniface C. Stegman, PhD, MSN, RN, 6775 China Lake Drive, St. Louis, MO 63129; email: bstegman@maryville.edu.

Received: June 25, 2019
Accepted: July 15, 2020

10.3928/00220124-20201113-07

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