AIM The purpose of this study was to determine gap areas where North Carolina should implement strategies to promote the Institute of Medicine’s recommendation of an 80 percent bachelor of science workforce. BACKGROUND The North Carolina Action Coalition sought information about the nursing BSN and higher degree workforce and about human resource policies/strategies that promote BSN and higher degree education. METHOD An electronic survey was used to query 120 acute care hospital chief nursing officers over a four-year period and 100 public health chief nursing officers over a two-year period. RESULTS A majority of acute care and a minority of public health institutions had policies promoting BSN education. Barriers included lack of tuition reimbursement, scheduling/staffing issues, lack of local universities, and a perceived lack of value for nurses. A minority of respondents reported an 80 percent BSN workforce. CONCLUSION Strategies are needed statewide to support nursing academic progression.

Carolina with the goals of improving access to cost-effective care, choice of treatment, and system accountability. Under the state reform plan, as described by Drs. Swartz and Morrissey in their article, Area mental health programs will become Local Management Entities (LMEs), will separate management and clinical functions, and will transition many clinicians to other independent or agency-based practice settings. Many services once provided directly by Area programs will be offered by qualified community-based providers contracting with the LMEs for patients who have been reliant on care at state facilities. Most clinical services will be provided by community-based programs, and state-funded treatment will be targeted to patients with severe mental illnesses and conditions. Less severely ill patients may seek care from primary care providers, human service agencies, and faith communities.The changes in the system brought on by mental health reform present unprecedented challenges to the mental health workforce. These challenges come at a time in which the mental health workforce is already under pressure to change the way care is delivered and is experiencing the effects of shortages in a number of fields. Mental health professionals are also pressed to deliver care in more efficient ways, utilizing best practices for community-based and institutional care.As system reform proceeds, several key workforce and education issues must be addressed to assure that the state has the appropriate supply and distribution of psychiatrists, social workers, and other mental health professionals, and that they are prepared to function effectively in a reformed system.

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In 1989, the General Assembly funded initiatives for the recruitment and retention of nurses, including two pilot "Institutes for Nursing Excellence" designed to develop, recognize, and reward excellent staff nurses. The Wake Area Health Education Center (AHEC) implemented the pilot projects. In 1991, additional funding was obtained to replicate the pilot projects. The grant was awarded to the Wake AHEC from the General Assembly, through the newly established Center for Nursing. This cooperative effort between the legislature and nursing is considered a model of its kind in this state and possibly the nation. The purpose of the Institute was to develop mentoring, role-modeling, change, and lifelong learning skills in an atmosphere of renewal, rejuvenation, and trust.

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