As the largest number of health care providers in the US, nurses are critical to the public's health. Without sufficient numbers of nurses, the quality and safety of the health care system are in jeopardy. Nurses provide the front-line care to hospitalized patients 24 hours a day, 365 days a year. By their continual surveillance and attention to patients' needs, they help patients improve more quickly and with fewer complications. Through their guidance and education, nurses help people stay well, have successful pregnancies, deal with illness of family members, and manage lives with chronic health conditions.

Like other health care workers, nurses are in short supply, and projections indicate that the supply will continue to decrease even as the demand for health care will increase with the aging population. Unless short- and long-term measures are put into effect, the nation will be faced with a severe crisis in health care delivery that will decrease access and quality of health care.

The Colleagues in Caring Forum is the successor to Colleagues in Caring: Regional Collaboratives for Nursing Workforce Development, a national program funded by The Robert Wood Johnson Foundation, which created regional and statewide coalitions of stakeholders in nursing and nursing education around the US. The coalitions, now numbering over 40, have evolved into nursing workforce centers (funded) and other entities (volunteer, primarily unfunded) that have conducted analyses of the supply and demand data about the nursing workforce; developed initiatives to address the long-term, intransigent structural issues at the root of the US shortage of nurses; created educational mobility arrangements to assure that nurses have access to an educational system that promotes career progression, and influenced public policy debates and decisions regarding nursing workforce issues.

In addition, the coalitions have joined together to create a new, locally based, but nationally linked Internet "rapid response" system that links community-based nursing care stakeholders with statewide and national organizations, that include the entire continuum of employers and educators of nurses. Through this network, the centers/entities have learned and borrowed from one another, thus streamlining their responses to local nursing workforce issues and concerns. All 50 states have in one way or another been part of or accessed the CIC network. The linchpin for the network has been the National Program Office housed at the American Association of Colleges of Nursing in Washington, DC.

Demographic data about the nursing workforce indicate that the current gap between supply and demand is expected to widen, all other things being equal, until 2020. Therefore, these statewide and regional efforts are critical links to narrowing the gap. Sustaining the CIC Forum is pivotal to work of the centers/entities.

Statewide nursing center/entity leaders have indicated that they want the following services:

• Nursing workforce information gleaned from regular systemic environmental scanning. These provide ideas for replication and expansion to the state-based nursing workforce entities.
  
  
• A nexus where nursing care stakeholders can ask for answers to issues with which they are dealing. This activity can be accomplished through a mixture of direct person-to-person dialogue as well as interactive virtual communities of interest.
  
  
• Technical assistance and consultation on such matters as educational mobility arrangements, strategies for expanding educational capacity, recruitment activities, and initiatives that promote healthy work environments for nurses. This can be provided by the cadre of nursing leaders involved in this work.
  
  
• Distributing data and information about the nursing workforce. This can be provided by web-based posting of nursing workforce information and an annual gathering of nursing leaders involved in nursing workforce development activities.
  
  
• Broker for innovative partnerships. Where mutual interests coalesce among the stakeholders, the Forum can continue to serve as the broker among various entities, both state-based and national in origin.
  
  
• Shared development and maintenance of a national nursing supply database. The CIC minimum supply data set has been adopted by the majority of CIC sites, and there is a mutual understanding that a national database of unduplicated licensees would serve to inform policymakers and be useful for other issues, like homeland security.

If funded, the Forum will be the focal point for state-based nursing workforce centers/entities to share their work, learn from one another, and develop and test initiatives that transcend state boundaries. In its broadest sense, the Forum's goal will be to assure that the nation's needs for nursing care will be met through the synergistic work and further development of state-based nursing workforce centers aimed at meeting their jurisdictions' needs for nursing care. Through the Forum, stakeholders will access tools that have been successful in other regions, eliminating the "reinvention of the wheel" syndrome; learn from others' successes and challenges, and more rapidly develop a nurse workforce capable of meeting demand. Furthermore, the Forum model can be replicated by other allied health professions that are facing similar workforce challenges.

Once fully operational, the following will serve as guiding principles underpinning the success of the Forum:

• Environmental scanning: focusing the attention of the nursing community on issues of shared importance: the only factor becoming scarce in the information age is attention.
  
  
• Communities of interest: People inhabit places, but nursing networks inhabit spaces. In networks, self-reinforcing circles add value, which attracts more members, which increases value, which attracts more members in a virtuous circle of growth.
  
  
• Archiving of information: Networks are nurtured by making it as easy as possible to participate in them. The more diverse the players, the more you must facilitate connection easily.
  
  
• Status reports of activities: The sum value of a network increases exponentially by adding a few new members with diverse insights/opinions/networks of their own). Sharing projects and outcomes enhances opportunities for others in the network.
  
  
• Searchable databases: As more of the economy migrates to intangibles, more standardization will be required. .Capturing, collating and contrasting data lead to eventual standardization of promising practices.
  
  
• Tools for nursing leaders: The abundance upon which a network economy is built is one of opportunity: the more interconnected the technology is (i.e., in the Forum), the more opportunities it spawns, giving leadership benefits to anyone with the vision, information, and initiative to pursue the issue under consideration. These tools maximize innovation.
  
  
• Documented interface between the Forum and its constituents and products and public policy agencies, governmental entities, hospital and other trade and professional associations: The number of new opportunities increases exponentially as existing opportunities are seized. Sharing progress and initiatives is reciprocally beneficial-from the grassroots and the national perspectives.
  
  
• A sustainability plan that spawns continual legacy work: The nursing shortage will be with us for the long term, and changes in nursing and health care dictate that the stakeholders must be committed at all levels-local, regional, statewide, national, and international-to working together in assuring that the health care needs of people are met. Sustainability is not just a dream, but a necessity.