Annual Report 2022-2023
365 Stout Drive, Johnson City, TN 37614 July 2023
2Appalachian Highlands Center for Nursing Advancement
Executive Summary
Welcome to the ETSU Appalachian Highlands Center for Nursing Advancement!
We are delighted to have you join us on this journey to enhance and elevate the nursing
profession in our region and throughout the state of Tennessee. As a dynamic hub of
knowledge and innovation, our center is dedicated to collecting and sharing crucial data
and crafting a comprehensive strategic plan. This plan will play a pivotal role in addressing
the evolving needs of our nursing workforce, ensuring its growth, sustainability, and
excellence.
Our collaborative efforts will not only shape the future of nursing but will also positively
impact the health and well-being of the communities we serve. Together, we will continue
to make a difference by fostering a strong nursing community, supporting professional
development, and driving advancements that resonate far beyond our Center’s walls.
Once again, a warm welcome to the ETSU Appalachian Highlands Center for Nursing
Advancement. We’re excited to have you as a part of our dedicated team, and we look
forward to the positive change we can achieve together.
Best regards,
Debbie C. Byrd, PharmD, MBA
Interim Dean, College of Nursing
Dean and Professor, Gatton College of Pharmacy
Holly Wei, PhD, RN, CPN, NEA-BC, FAAN
Professor
Interim Executive Associate Dean and Chief Nursing Administrator
Associate Dean for Research and Scholarship
Interim Executive Director for East Tennessee State University (ETSU) Appalachian Highlands
Center for Nursing Advancement
Carolyn S. Harmon, PhD, DNP, RN-BC
Nurse Scientist, ETSU Appalachian Highlands Center for Nursing Advancement
Kathryn Wilhoit, PhD, RN
Interim Executive Director for ETSU Appalachian Highlands Center for Nursing Advancement
Dana Hoehenberger
Oce Coordinator, ETSU Appalachian Highlands Center for Nursing Advancement
July 2023ANNUAL REPORT 2022-2023 3
Table of Contents
PART I: INTRODUCTION
1.1 Service Regions and the Four Primary Foci of the Center ..........................................................4
1.2 Center’s Service Region .................................................................................................................5
PART II: STRUCTURAL FORMATION
2.1 Joint Forces ...................................................................................................................................8
2.2 Center’s Organizational Structure .................................................................................................8
2.3 Advisory Boards Formation...........................................................................................................9
2.3.1 Appalachian Highlands Center for Nursing Advancement Advisory Board Members ...........9
2.3.2 Tennessee Center for Nursing Advancement Advisory Board Members ...............................9
2.4 Workgroup Formation ....................................................................................................................9
2.4.1 Workgroup Guidelines ..............................................................................................................11
PART III: ACTIVITIES AND EVENTS
3.1 Visioning Session, May 18, 2022 ................................................................................................12
3.2 AHCNA Advisory Board Meeting, December 8, 2022 ................................................................14
3.3 TCNA Advisory Board Meeting, December 13, 2022 .................................................................14
3.4 Listening Sessions Across the State, September 12 – 29, 2022 .............................................. 14
3.4.1 Listening Sessions’ Main Findings and Recommendations ..................................................16
3.4.2 News Report of the Listening Sessions ..................................................................................17
3.5 Lecture Series and Sharing Sessions .........................................................................................19
3.5.1 Research Grand Rounds, November 18, 2022 ........................................................................19
3.5.2 Distinguished Leadership Lecture Series, December 2022 ...................................................19
3.5.3 Best Practice and Information Sharing Sessions, November 21, 2022 ................................21
3.6 National Presence and Collaborations ....................................................................................... 22
3.7 Data Analysis of the Tennessee Board of Nursing, December 2022 ........................................22
3.8 Workforce-Related Grants ...........................................................................................................24
3.9 2023 Quarter 4 Ballad Health New Grad Hiring Data ................................................................26
PART IV: FUTURE DIRECTIONS AND PLANS
4.1 Pipeline ......................................................................................................................................... 27
4.2 Innovative Clinical and Academic Teaching Models .................................................................28
4.3 Nurse Well-Being ..........................................................................................................................29
4.4 Data ..............................................................................................................................................30
PART V: ACKNOWLEDGMENTs
5.1 Conclusions .................................................................................................................................32
5.2 Acknowledgments .......................................................................................................................32
REFERENCES ....................................................................................................................................34
4Appalachian Highlands Center for Nursing Advancement
Healthcare professionals have faced the
overwhelming stress of acute and ongoing nursing
shortages, which threatens the health of nurses and
patients. The United States (US) Surgeon General
issued a new Surgeon General’s Advisory (2022),
highlighting the pressing need to address the
healthcare workers’ burnout crisis across the nation.
Health workers, including nurses, physicians, and
community and public health workers, have been
facing healthcare system challenges even before the
COVID-19 pandemic, and the COVID-19 pandemic
further exacerbated the growing shortfall of nurses.
Clinicians of all disciplines, specialties, and
care settings are experiencing alarming rates of
burnout (National Academy of Medicine [NAM],
2022). American Nurses Association (ANA, 2022)
conducted four surveys on nurses’ mental health in
the summer of 2020, December 2020, September
2021, and November 2022. During the pandemic,
nurses’ mental health symptoms worsened, such as
stress, frustration, and anxiety. The third ANA survey
(2022) showed high percentages of nurses feeling
stressed (75%), frustrated (68%), exhausted (67%),
overwhelmed (62%), and anxious (58%). Research
shows similar ndings about nurses’ high burnout
rate – over 70% of participating nurses reported
high-level burnout during the pandemic (Wei et al.,
2022). When feeling burnout, individuals report
feeling overwhelmed and emotionally exhausted,
becoming cynical and detached from their job,
and having a sense of ineffectiveness and lack of
accomplishment (Maslach, 2018). Clinician burnout
can have serious, wide-ranging consequences
on individual clinicians and learners, healthcare
organizations, and patient care.
Promoting nurse well-being is a signicant endeavor
of healthcare leaders. Clinician well-being improves
patient-clinician relationships, enhances healthcare
teamwork, and fosters workforce engagement and
effectiveness (NAM, 2022). However, promoting
clinician well-being requires continued efforts at the
organization, state, and national levels and support
in research and information-sharing to improve
evidence-based interventions.
Nursing is among the fastest-growing professions
in the US, yet the nation still faces severe
shortages of qualified and experienced nurses.
The nursing shortageand its negative impacts
comprise a significant concern and uncertainty
for healthcare organizations. The ongoing nursing
shortage has substantial undesirable effects on
nurses and organizations and, more so, on patient
safety and care. Healthcare organizations and
leadership play a significant role in promoting
nurse well-being and workforce development (Wei
& Horton-Deutsch, 2022).
As nursing jobs grow and hospital resources dwindle,
the traditional practice models and routines may
not work. Thus, healthcare and academic leaders
attempt to identify and implement innovative ways
to alleviate the distress caused by the nursing
shortage. This annual report described the formation
of the Appalachian Highlands Center for Nursing
Advancement (AHCNA) and the Tennessee Center
for Nursing Advancement (TCNA), which are referred
to as “the Center” in this report, describes and
summarizes the events and activities conducted in
2022, and called on actions for 2023 and beyond.
1.1 SERVICE REGIONS AND THE FOUR PRIMARY
FOCI OF THE CENTER
The four major foci for the Center include:
1. Building the pipeline to becoming a registered
nurse and nursing faculty.
2. Developing innovative clinical and academic
teaching models that facilitate learning,
retention, and success for nursing students on
the journey to becoming a registered nurse or
licensed practical nurse.
3. Improving the well-being of the nurse in all
settings through recognition, valuing the work
that they do and the impact they have on care
outcomes.
4. Mining and developing data related to the
nursing workforce and sharing that data
through an interactive dashboard housed on
an attractive and user-friendly website.
part I: Introduction
July 2023ANNUAL REPORT 2022-2023 5
These four foci encompass the current critical need
to increase the nursing workforce. These areas can
improve clinical-academic innovation and partnership,
promote nurse well-being, and develop data as a
reference point for stakeholders, including nurses,
leaders, students, healthcare leaders, and state
legislators. These focus areas are consistent with the
strategic direction of East Tennessee State University
(ETSU), and the development of the Center. With the
Center, nurses can be involved, pull in resources,
collaborate, research, communicate, and plan the
future of nursing in our region.
1.2 CENTER’S SERVICE REGION
The ETSU Appalachian Highlands Center for Nursing
Advancement serves the region and the state of
Tennessee by collecting and disseminating data and
developing a strategic statewide plan to address
nursing workforce needs.
Appalachia has 423 counties across 13 states and
spans 206,000 square miles. The Center’s area of
focus includes parts of Appalachia’s Central and
South-Central subregions, and the state of Tennessee.
6Appalachian Highlands Center for Nursing Advancement
part I: Introduction
FIGURE 2. BALLAD HOSPITALS
FIGURE 1. SUBREGION MAP
The Ballad Health service area below depicts
the targeted Appalachian region for focus. The
counties included are, in Tennessee (Carter,
Cocke, Greene, Hamblen, Hancock, Hawkins,
Johnson, Sullivan, Unicoi, and Washington
counties), in Virginia (Buchanan, Dickenson,
Grayson, Lee, Russell, Scott, Smyth, Tazewell,
Washington, Wise, and Wythe counties), in North
Caroline (Ashe, Avery, Madison, Mitchell, Yancey,
and Watauga counties), and the Kentucky
counties of Harlan and Letcher. Figure 1 shows
the subregion map, and Figure 2 displays the
areas of Ballad hospitals.