Author Archives: Beth Toner

Filling in the Cracks: The Fight for Mental Health

Jun 11, 2014, 3:11 PM, Posted by Beth Toner

In December 2009, I found myself in a narrow, cramped waiting room that looked, via one small window, into the locked psychiatric unit of a suburban Pennsylvania community hospital. On the other side was my oldest son, just a week shy of his 17th birthday. He was clad only in a thin hospital gown, perched in a wheelchair that was outfitted for restraints—although he wasn’t restrained. He looked tired, frightened, and overwhelmed. My husband, his stepfather, sat next to me as we waited for answers. Tears sprang to my eyes. Could my son—and our family—find our way back?

That moment was the culmination of six months of escalating anxiety and mood swings in my son’s life. He had always been, from a very young age, an intense child: bright, intensely focused, and articulate—which occasionally manifested itself in stubbornness and a reluctance to back down from an argument. But the fall of his junior year of high school had proved to be something very different. Suddenly, his occasional anxiety multiplied exponentially, completely out of proportion to the stressors in his life. Ten-point assignments in an advanced placement bio class turned into all-night crying and screaming sessions that ended with him sitting in a corner sobbing—and us all exhausted and at wit’s end. We tried therapy, with minimal effect. His school guidance counselor, not really understanding the depth of Wesley’s despair, encouraged him to “tough it out.”

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When Springtime Turns Ugly: Public Health and Disaster Preparedness

Jun 6, 2014, 11:24 AM, Posted by Beth Toner

MOYER_110506_13128 EMOTIONAL AFTERMATH: A resident of Alabama, overwhelmed by the sight of her ruined home after tornadoes struck at the end of April, 2011.

Ah, springtime: especially welcome for those of us who experienced a particularly harsh winter. Spring often conjures up images of blossoming trees and blue skies, freshly cut grass and picnics.

Yet in May, several anniversaries of devastating natural disasters reminded us that springtime can also bring with it some of nature’s most violent weather phenomena:

  • On May 20, Moore, Okla., marked the first anniversary of the devastating tornado that killed 24, including seven children at an elementary school. It was the second EF-5 tornado to strike the city in 15 years; the May 3, 1999, tornado left 46 dead.
  • In Joplin, Mo., residents remembered the May 22, 2011, EF-5 tornado that killed 161 people.
  • On May 31, Johnstown, Pa,., observed the 125th anniversary of the devastating flood that leveled the entire city and killed 2,209.

While improved warning systems and 21st century technology have certainly played a role in reducing the number of lives Mother Nature’s temper tantrums claim, the fact remains that these events have a substantial impact on our health as a nation.

We recently talked to Paul Kuehnert, director, Bridging Health and Health Care portfolio—as well as a pediatric nurse practitioner and longtime state and local health official—to get his thoughts about the role public health plays in helping us prepare for, cope with, and learn from natural disasters.

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We’re All in This Together: Let’s Bridge the Gap, Not Widen It

May 12, 2014, 4:14 PM, Posted by Beth Toner

Kathleen Hickey

At the end of April, the New York Times published an op-ed by Sandeep Jauhar, a cardiologist who—reacting to a New York bill granting nurse practitioners the right to provide primary care without physician oversight—argued that in primary care, “there will always be subtleties and complexities that demand a doctor’s judgment.”

His conclusion? “If we want more primary care providers, let’s have them be doctors”—and, he added, “let’s find a way to increase their pay.”

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What Would Melanie Do?

Jun 25, 2013, 11:20 AM, Posted by Beth Toner

 A critical response medical team walking in a hospital corridor.

The Robert Wood Johnson Foundation has long been committed to the improvement of nursing education—and to supporting academic progression in nursing. While nursing shortages may wax and wane, it’s clear that the baby boomers will need high-quality nursing care as they move into later life. Meanwhile, nursing schools turn away more than 75,000 qualified applicants each year.

In short, really good nurse educators have never been more necessary, yet they are increasingly in short supply. Last week, we lost one of the best I’ve ever known.

I heard about Melanie’s death, sadly, the way we sometimes do when we’ve lost touch with people—via a community college classmate on social media. Melanie had learned she had pancreatic cancer in January—and given a grim prognosis; in the end, she lived less than five months after diagnosis, dying far too young—at the age of 58. In the first awful moment, I felt a crush of regret that I’d learned of her death this way. And then I found myself smiling, thinking of when I’d first met Melanie on a warm August night in 2008—squeezed into a stuffy and cramped classroom with 31 other people in a room better suited for 15.

We were, all of us, first-year nursing students on our very first day of nursing school. We were, in many respects, a motley crew—ranging in age from our early 20s to our early 60s (I was somewhere in the middle). Stay-at-home moms rejoining the paid workforce, retired Army medics, and second-career students (like me) all shared one emotion that evening: fear. How would we manage full-time day jobs and evening/weekend classes and clinicals? From studying material that was completely foreign to me—with what felt (at the time) like a worthless master’s degree in journalism—to learning tasks that seemed incredibly complicated (how could I stick a needle in another human being?), I didn’t feel up to the task ahead. What the heck had I been thinking? Me? A nurse?

Melanie gave us an overview of the semester ahead. She calmly answered each agonized question we asked her. As she wrapped up her remarks, she smiled at her nervous charges and said, “I know you feel overwhelmed right now, and you feel like there’s so much to do. I’ll just remind you that you can do this the same way you’d eat an elephant: one piece at a time.”

It was exactly the right thing to say at exactly the right time. Melanie would repeat those words to me—often just saying “one piece at a time”—when she saw me in the hallway, agonizing over a clinical skill I hadn’t mastered or a lab value I couldn’t remember, more times than I can remember. I would often come to class exhausted and near tears from a grim day in corporate America, but Melanie would, with her real-life stories of patients to illustrate that night’s lecture, remind me why I had decided to become a nurse in the first place. We knew her for her pithy summary of the most obvious fact (“smoking is baaaaaaaaaaaaad!” she would say in a near-hiss), but also for her fierce love of, and advocacy for, each and every patient.

I made it through nursing school, passed the NCLEX, and thought of Melanie as I worked weekends in long-term care. If my patient had been Melanie’s mom, what would she have wanted me to do for her? When I felt as if I couldn’t make it through my first night shift alone, I remembered Melanie’s words of advice on that first day.

I thought of her again last week, and realized what a loss the world of nursing education suffered with her passing. It’s not only important to support our nurse educators—and to encourage others to join their ranks—but to thank them for sharing their love of nursing and their patients with us. I never got to say a proper “thanks” to Melanie. But you can bet that I’ll remind each nursing student I see that she (or he) can get there, one piece at a time.

Standing on the Shoulders of Angels

Jun 10, 2013, 9:37 AM, Posted by Beth Toner

nurse veterans 4

Sixty-nine years ago, on June 6, 1944, a 25-year-old Army captain from New Hampshire parachuted into the Normandy countryside outside the small French village of Sainte-Mère-Église as part of the Allied invasion known as D-Day. A member of the fledgling 82nd Airborne Division, he would count himself lucky to survive that jump,  three other World War II combat jumps, and the Battle of the Bulge. A self-described “career Army man,” he would go on to fight in both the Korean and Vietnam wars—and marry my mother in 1988. I was already living on my own when they married, so I had only occasional opportunities to get to know him.

While he could be curmudgeonly and opinionated, Colonel Robert M. Piper (I called him “The Colonel” throughout his life) was also brilliant and generous. My biggest regret is that I didn’t learn enough about the history in which he so actively participated until it was too late. The last time he set foot in that small village was in 2004, the 60th anniversary of the invasion. He passed away in 2007, and was buried at Arlington National Cemetery.

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A Big Week for Big Health Data

Jun 5, 2013, 4:30 PM, Posted by Beth Toner

Health Datapalooza Graphic

It’s been a great week to be a self-proclaimed “health data geek.” Here at the Foundation, we announced the launching of the Health Data Exploration Project at the California Institute for Telecommunications and Information Technology (housed at the University of California-San Diego). The project will explore how to bring individuals and companies who collect day-to-day health data (via smart phones and other tools) together with health researchers to uncover insights into personal and population health. You can read more about this project on RWJF’s Pioneering Ideas.

We also announced the $120,000 RWJF Hospital Price Transparency Challenge, which asks applicants to create data visualizations and applications to help people compare what different hospitals charge.

Finally, a number of Robert Wood Johnson Foundation staff came together at the fourth Health Datapalooza—the annual event put together by the Health Data Consortium, of which RWJF is a founding sponsor. The conference is a forum that features the newest and most innovative and effective uses of health data by companies, startups, academics, government agencies and individuals. Want to learn more about what went on there? Feel free to read our “Dispatches From Datapalooza,” starting here.

Want to learn more about health data?