Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.

In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.

This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.

Imani Baker is an alumna of Project L/EARN, a graduate education preparation program supported by the Robert Wood Johnson Foundation (RWJF). She recently earned her bachelor’s degree in public health from Rutgers, the State University of New Jersey, and plans to become a nurse practitioner.

The two words that I can use to describe my journey through Project L/EARN are: life changing. 

I learned about the RWJF-funded program from an advisor who referred me to its faculty program director, Jane Miller, PhD. Dr. Miller warned me that the program would be “intense” and “much more work than you are used to.”

However, there are no words that could have ever prepared me for what I was about to experience that summer. Before I was admitted to Project L/EARN, I was not confident in my abilities to compete outside of my comfort zone, which included subjects specifically related to the health sciences.

This program forced me to face many of my weaknesses and confront my worst fears head on. Each day, I was overwhelmed with self-doubt. I was not the best public speaker; I struggled in statistics; and there were times when I questioned why I was picked for the program.

I said to myself, “I want to be a nurse. I don’t want to sit behind a computer and look at numbers all day. What did I get myself into?” However, my mentor, Dr. Judith Lucas, EdD, RN, GCNS-BC, taught me why it was so important for nurses to be involved in research and to have advanced graduate degrees.

During the week of April 15, the United States faced several natural and man-made disasters: the Boston Marathon bombings, an explosion at a Texas fertilizer plant, and ricin-laced letters mailed to politicians. Federal and local officials—including Nicole Lurie, MD, MSPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1982-1984) and assistant secretary for preparedness and response at the U.S. Department of Health and Human Services—were ready, and quickly responded to these events.

In the second video in a series of RWJF Clinical Scholars Health Policy Podcasts, Clinical Scholar Chileshe Nkonde-Price, MD, interviews Lurie about that week and the state of the country’s disaster preparedness. They also explore the impact of budget cuts on public health jobs, and what aspects of disaster response are ripe for scholarly study.

The video is republished with permission from the Leonard Davis Institute.

Underrepresented students considering careers in medicine can talk to mentors and join discussions on the free, web-based mentoring site, DiverseMedicine.org. Launched in August 2012, the site now has 400 active users, American Medical News reports.

High school, college and medical school students can interact with mentors on the site in real time through instant messaging or video chat functions, and learn about admissions testing, residency applications, and more in discussion forums. The site also features podcasts, video lectures and other resources on topics important to aspiring physicians, and a feature that allows students to participate in a mock medical school interview.

“One of the main reasons why there are so few minorities in the field of medicine is because of the mentoring gap. If nobody’s there to tell you how to get into medical school, you’re not going to get in,” Dale O. Okorodudu, MD, the project’s founder, told American Medical News.

Read the American Medical News article.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

Getting less than six hours of sleep a night raises levels of inflammation among women with heart disease, and therefore increases the risk of a heart attack, according to a five-year study led by RWJF Health & Society Scholars alumnus Aric Prather, PhD. The findings did not hold true for men. United Press International and HealthDay are among the outlets to report on the findings.

RWJF Community Health Leader Darleen Reveille, RN, spoke to The Record about new community gardens in Garfield, New Jersey, and a program that will give 7th-graders and their families hands-on gardening experience as a way to learn healthy eating habits. “We’re trying to raise awareness in a fun way,” she said. “By creating these activities, you’re engaging the community, not just lecturing them on what they should do.”

“Nurses are particularly at risk for becoming overwhelmed and depleted,” RWJF Executive Nurse Fellows alumna Cynda Hylton Rushton, PhD, RN, FAAN, told the Washington Post about “compassion fatigue ” She said: “When the clinician suffers, so does the patient,” which is why many hospitals are using creative arts to help nurses manage stress and re-energize. Fierce Healthcare also picked up the story.

A study led by RWJF Physician Faculty Scholars alumnus Deverick J. Anderson, MD, MPH, finds that small community hospitals have higher rates of ventilator-associated pneumonia than larger hospitals, even though they use ventilators less frequently. The researchers hypothesize the disparity could result from limited familiarity with the equipment and the on-staff availability of fewer respiratory therapists and other specialty workers, News Medical and Fierce Healthcare report.

Efrain Talamantes, MD, MBA, is a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar at the University of California, Los Angeles. This is part of a series of posts looking at diversity in the health care workforce.

Diversity in health care is critical in providing quality health care to all Americans. As physicians, we care for patients from all walks of life and we strive to heal with our expertise, compassion and open-mindedness. Our health system and patients benefit greatly from health professionals who can speak and understand different languages, and who always strive to understand different backgrounds, cultures, practices, and beliefs. Research shows that diversity in the health care workforce enhances training for health professionals and improves access to quality health care.

There is an unprecedented demographic transformation happening in our country today; the majority of births are from Hispanics, Blacks, Asians and other racial and ethnic minorities. Since 1985, the number of underrepresented ethnic and racial minority medical school applicants, matriculates, and graduates has leveled off at about 15 percent, while their representation in the U.S. population has been nearly twice as high—and they are on pace to become the majority.

Deborah Gross, DNSc, RN, FAAN, is the Leonard and Helen Stulman Endowed Chair in Mental Health & Psychiatric Nursing at the Johns Hopkins University Schools of Nursing, Medicine, and Public Health. She is also an alumna of the Robert Wood Johnson Executive Nurse Fellows program (2006-2009).

As a child psychiatric nurse, my mission is to make a difference in the lives of families with young children, particularly those living in low-income, urban communities. 

There is now wide consensus that early childhood is the most cost-effective time for targeting prevention and early intervention. The foundation for children’s mental health is formed during the first five years of life, when 90 percent of brain development occurs. Since parents are the primary mediators of their young children’s earliest social and learning environments, any effort to promote mental health in young children must first and foremost engage parents and help them build up their strengths and caregiving capacities.

Nearly 20 years ago, I began searching the literature for parenting programs that had a strong evidence base and demonstrated substantial and enduring effects on parenting quality and children’s behavior. What I discovered is that the strongest programs available had been originally developed and tested on White, middle-class families. As a result, their content and delivery methods were often built on values and assumptions many families I knew could not relate to. 

This is part of the June 2013 issue of Sharing Nursing's Knowledge.

“Not a week goes by that I don’t receive at least one letter from a patient or family member grateful for the extraordinary care he or she received from a nurse. Using descriptions such as ‘tireless,’ ‘compassionate,’ ‘gentle’ and ‘efficient,’ these gifts from the heart speak volumes about a profession we celebrate throughout May that is the heart and soul of our nation’s health care delivery system. And while National Nurses Month is a time for gratitude and celebration, it is important to remember that the New Jersey nursing profession faces significant challenges that must be overcome … Sometime this month, thank a nurse. It means much more than you realize.”
-- Robert P. Wise, FACHE, president and chief executive officer, Hunterdon Healthcare, Take a Moment to Thank a Nurse During National Nurses Month, Times of Trenton, May 21, 2013

“Growing up, I thought I would become a doctor, but then I met my wife, an RN [registered nurse], and I fell in love with her—and with her career. I’m thrilled with my professional decisions; I find great joy in helping my patients recover and my students learn. I’m able to combine my love of nursing practice and education because NJNI [the New Jersey Nursing Initiative] put me on a fast track to a master’s degree in nursing ... NJNI helped me re-imagine my future. I now see myself as an emerging nurse leader and plan to enroll in a doctorate program in the fall to realize that vision.”
-- Marlin Gross, MSN, APN, NP-C, New Jersey Nursing Scholar, assistant professor, Cumberland County College and family nurse practitioner, Virtua Health Care System in Marlton, Remember What Nurses Do for Us Every Day, Daily Journal, May 15, 2013

Amal Trivedi, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholars program. He is an assistant professor of health services, policy and practice at Brown University and a hospitalist at the Providence VA Medical Center. His co-author, Danya Qato, PharmD, MPH, is a pharmacist and doctoral candidate in health services research at Brown University. They recently published a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South.

Human Capital Blog: Why did you decide to look at this particular topic? And why are some drugs considered high-risk for elderly patients?

Danya Qato and Amal Trivedi: Adverse drug events are an important public health problem. For the elderly, such events are often precipitated by use of potentially inappropriate or high-risk medications. Over the past several decades, clinicians and researchers have sought to identify medications that should be used with caution in the elderly. These high-risk medications should be avoided among people 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available. Elderly patients are susceptible to these medications because they have more chronic illness, greater frailty, and an altered ability to metabolize drugs. The Centers for Medicare and Medicaid Services now require all Medicare Advantage plans to report on the use of high-risk medications among their enrollees.

We undertook this study because successful efforts to reduce high-risk medication use in the elderly require knowledge of how prescribing of these agents varies geographically and the factors that predict their use. Half of persons aged 65 and older use three or more prescription medications a day. Therefore, potentially inappropriate use of medications in the elderly has important implications for health care spending and quality.

This is part of the June 2013 issue of Sharing Nursing's Knowledge.

Heart Failure Patients Benefit from Adequate, Stable Nurse Staffing

A new study suggests that rural hospitals may be better able to ensure high-quality care for heart failure patients if they have lower nursing turnover and better practice environments.

With funding from the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI), a team of researchers led by Robin Newhouse, PhD, RN, NEA-BC, FAAN, and Laura Morlock, PhD, tested a quality collaborative intervention in 23 rural hospitals in the eastern United States. The intervention included in-person meetings, an evidence-based toolkit, and monthly group teleconference calls between site coordinators and the team conducting the study. One group of hospitals used the intervention for six months while the other did not. Then the second group also began using the intervention.

Researchers used four metrics to assess how thoroughly the hospitals implemented the program: whether the hospitals provided smoking cessation counseling, provided adequate instructions to patients being discharged, assessed how well patients' hearts pumped, and made sure the patients received medication to help blood vessels relax. The researchers found that while there was no significant difference in implementation of the four core measures as a result of the intervention, the hospitals with lower nurse turnover and better practice environments implemented more of the measures.