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Health Care Employment Rose in September

Oct 9, 2012, 12:59 PM

Data from the Bureau of Labor Statistics shows that health care employment rose by 44,000 jobs in September.

Most of the gains were in ambulatory care services (+30,000 jobs), with much of the growth in outpatient care centers. Hospitals added 8,000 jobs, and nursing and residential care added 6,000 jobs. Over the past year, employment in health care has risen by 295,000 jobs.

September’s gains are the second largest for the health care industry in a decade, according to a brief from the Altarum Institute, and the strong showing drove the health sector share of total employment to a new high of 10.81 percent.

Read a news release from the Bureau of Labor Statistics.
Read the Altarum Institute brief.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

HRSA Names New Center for Interprofessional Education and Collaborative Practice

Sep 19, 2012, 9:00 AM

The Health Resources and Services Administration (HRSA) last week announced that the University of Minnesota Academic Health Center will lead its new Coordinating Center for Interprofessional Education and Collaborative Practice. The Center will have a mission to accelerate teamwork and collaboration among nurses, doctors and other health professionals, with a particular focus on medically underserved areas.

“Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers,” said HRSA Administrator Mary K. Wakefield, PhD, RN, in a news release issued Friday.  “We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care.  This coordinating center will help us move forward to achieve that goal.”

The Robert Wood Johnson Foundation (RWJF) and three other leading foundations this summer announced their support for the Center and committed up to $8.6 million over five years. RWJF, the Josiah Macy Jr. Foundation, the Gordon and Betty Moore Foundation, and The John A. Hartford Foundation aim to help make the Center the “go to” coordinating and connecting body for efforts to promote interprofessional education and collaborative practice, as well as a place to convene key stakeholders, develop interprofessional education programs, and identify and disseminate best practices and lessons learned.

“Interest in interprofessional education and team-based care has increased in recent years but we need to move faster,” Maryjoan Ladden, PhD, RN, FAAN, senior program officer at RWJF, said in announcing support from the four foundations. “We hope this Center will foster collaborations between educators and practice organizations to advance the field and improve how care is delivered to patients and families.”

Read the news release from the four foundations.
Read the news release from HRSA.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Oral Health: Putting Teeth Into the Health Care System

Aug 22, 2012, 9:00 AM

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

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AAMN Supports RWJF's Mission to Diversify the Nursing Profession

Aug 15, 2012, 9:00 AM, Posted by Brent MacWilliams


The Robert Wood Johnson Foundation (RWJF) values diversity and inclusion, which includes historically underrepresented populations like men. The population of the United States is becoming more diverse, and the best way to increase cultural competence in the health care system is to increase the diversity of health care providers.

Medicine, pharmacy and other allied professions have increased gender diversity to near equitable levels. Nearly half—or 48 percent—of 2010 medical school graduates were women, according to the Association of American Medical Colleges. Yet men account for less than 10 percent of the nursing profession. 

It is time for nursing to recalibrate to meet the needs of a 21st century health care workforce through sustainable metrics. RWJF and the American Assembly for Men in Nursing (AAMN) share a vision for measurable change to take place in the nursing workforce through cultural change, greater diversity in health care leadership and evidence-based change.

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Increasing Life Expectancy Could Undercut Social Security Viability, Scholar Finds

Aug 10, 2012, 9:00 AM, Posted by Samir Soneji

Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.


Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?

Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later.  One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.

HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.

Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.

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Explore Findings from Survey on Nurse Faculty Work-Life

Aug 7, 2012, 9:00 AM

How do nurse faculty members spend their time?  How do they assess key aspects of their work-life?
In 2010 the Robert Wood Johnson Foundation’s Evaluating Innovations in Nursing Education program (EIN) conducted a nationwide survey of full-time nurse faculty focusing on their employment characteristics, workloads and attitudes toward work-life. More than 3,000 respondents completed the survey, answering questions about more than 60 characteristics of work-life.
Now, using an online tool—the Nurse Faculty Query (NuFAQs)—you can search the survey results. The interactive tool allows you to customize the findings to suit your interests in faculty with particular backgrounds or rank, in specific settings or circumstances.
To see a brief demonstration and begin using this resource, click here.
Read more about NuFAQs in the latest issue of Sharing Nursing’s Knowledge.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Executive Nurse Fellow "On Cloud Nine" After Bearing Olympic Torch

Aug 2, 2012, 9:30 AM, Posted by Debra Toney

Robert Wood Johnson Foundation Executive Nurse Fellows program alumna Debra Toney, PhD, MS, BSN, FAAN, was one of 22 people selected by the Coca-Cola Company to carry the Olympic torch in Kirtlington, England, in a relay across the country leading up to the opening ceremonies for the 2012 Olympics. Here, Toney, director of nursing for Nevada Health Centers and immediate past president of the National Black Nurses Association, writes about the experience.


Have you ever done something that changes your life? Have you met people who inspire you to do more? These are just a few of the many feelings I have experienced after participating as an Olympic Torchbearer! They are certainly great feelings to have and I have been on cloud nine since returning home.


The opportunity to participate in this international event which celebrated the accomplishments of some very amazing people was a proud and humbling moment. Humbling because I never expected something this significant would happen to me. However, it is an experience that could happen to anyone.

While flying home I had plenty of time to pinch myself to wake up, but I was awake. Did this really just happen to me? The opportunity to spend time with people from different parts of the country and hear their stories of giving has given me the drive to do more. We came from different cultures, spoke different languages and enjoyed different food, yet we had a lot in common. We want to make the world a better place to live.

The Flame was finally delivered to London, after being transferred from one Torchbearer to another, spreading the message of peace, unity and friendship. It ended its journey as the last Torchbearer lit the cauldron at the opening of the Olympic Games. I experienced a feeling of honor and joy as I watched in awe the opening on television, knowing I played a role in this great history making event.

Read more about Toney’s experience as a torchbearer in the latest issue of Sharing Nursing’s Knowledge.
Learn more about the RWJF Executive Nurse Fellows program.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Make What the Supreme Court Upheld a Reality by Empowering All Providers

Jul 17, 2012, 4:11 PM, Posted by Matthew McHugh

This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, is an assistant professor of nursing at the Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, and an RWJF Nurse Faculty Scholar.


By upholding the Affordable Care Act, the Supreme Court’s landmark ruling has allowed health reform to continue to move forward. But the promise and potential of health reform depends on having a robust, well-trained workforce that can meet the demands of a changing health care system, an aging population, and newly insured Americans with increasingly complex health care needs.

More than ever, the recommendations from the Institute of Medicine’s (IOM’s) report The Future of Nursing: Leading Change, Advancing Health will be critical to achieving the goals of health reform. For example, this defining moment provides an opportunity to redefine roles to take advantage of the fullest extent of all providers’ capabilities to improve health system efficiency and meet the health care needs of the population.


The first recommendation from the IOM report is that nurses should practice to the full extent of their education and training. Many of the Affordable Care Act’s provisions rely on the health care workforce, particularly the primary care workforce, working in new and expanded roles.  Whether it is implementing new models of integrated care, providing much needed care to previously uninsured Americans, or delivering guaranteed preventive services and essential benefits, meeting the coming demand for primary care will require “all hands on deck”—every provider working at their fullest capacity. Although advanced practice nurses are one way to grow the primary care workforce, their ability to fully participate has been limited by legal barriers that restrict them from practicing up to the level they have been trained and often requiring physician oversight.

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It is Time to Engage in Conversations with People Who Have Ideas We Don't Like

Jul 9, 2012, 9:00 AM, Posted by Andru Ziwasimon Zeller

This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act.  Andru Ziwasimon Zeller, MD, is co-founder of the Casa de Salud family medical office and the Community Coalition for Health Care Access in Albuquerque, and a 2010 RWJF Community Health Leader.

Andru Ziwasimon-Zeller

I’m a doctor and supporter of health care for all and happy that we as a nation have achieved almost universal health care.  The Affordable Care Act has flaws and areas of disagreement.  It was forged from 100 years of argument and compromise, bringing together liberal universal health care with conservative personal responsibility

I don’t love every detail of the law but I love that we as a nation, through the leadership of President Barack Obama, have removed a massive injustice in our society which has contributed significantly to stress, disease, death, medical debt and household bankruptcy.  These have been “silent killers" since those affected tend to keep their suffering to themselves.  Many of us have born witness to that suffering.  I am so glad it is coming to an end.


Yet I feel the fear and anger of those in our nation who oppose this new law and see in it an assault on individual freedom, a government invasion of health care, and a grand plan to destroy what is perceived to be our founding principles.

I resonate emotionally with the first point—no one likes to be told what to do.  Seat belts, car insurance, driver’s license to vote, passport to travel, taxes, and now health insurance?  Why not let the hospitals eat that cost?  Or drop it on the county health fund?  Is this a slippery slope to dreaded socialism or an evolution towards health and personal accountability?

Facts are hard to come by.  Trust is next to impossible.  We are a nation of belief against belief in search of the ultimate political power to create a singular vision of the future—Republican vs. Democrat, and who knows what either of those really mean.  This battle, more than anything, is the greatest threat to the vision and political prowess of our founding fathers.  Democracy is conversation, compromise and decision-making for solutions that help us take care of each other and improve our place in this world.

This is our democracy in action.  I give thanks that we fight the ‘war’ between liberals and conservatives with words and election ballots.

The decline of our schools, health care system, manufacturing, and prestige internationally stems from and contributes to our inability to care for each other.  We are squandering our resources, fighting for control instead of forging a better society.  This criticism is not about “hating” America.  I’m saying that we Americans are wasting the equity that all of our forebears gave us.  All of them.  Native Americans and all of the immigrants who come to these shores by force, or hope for a better future.  This hope and equity are not owned by any one segment of our society, they are our shared birthright as Americans.  

It is time we each take a deep breath, do an internal inventory of our emotional tenor, and start to engage in perhaps stressful, but important conversations with people who have ideas that we don’t like.  Passion is a beautiful thing when it can be restrained by reason and respect.  Let’s embrace this challenge as a nation, hear what we each have to offer, and live better lives together.

Read more about Ziwasimon Zeller’s work, visit the Casa de Salud website, and learn about the Robert Wood Johnson Foundation Community Health Leaders.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

A Tale of Two Emergency Rooms

Jul 6, 2012, 6:00 PM, Posted by Julia Lynch

This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Julia Lynch, PhD, is an associate professor at the University of Pennsylvania. Lynch is a recipient of a 2006 RWJF Investigator Award in Health Policy Research at the University of Pennsylvania and an alumna of the RWJF Scholars in Health Policy Research program (2003-2005).

Julia Lynch

The first emergency room is one you know: the ED in your nearest inner-city or rural hospital. There you’ll find trauma cases, heart failures, emergency appendectomies, heroic rescues by doctors and nurses working through the night, just like on TV. But also, waiting in chairs (lots of chairs), the frequent fliers, the preventable complications of asthma and diabetes, the people awaiting primary care in the worst possible medical environment for it. These are America’s emergency rooms.

And then there are Italian emergency rooms. As an expat living in Italy, I’ve navigated hundreds of miles of red tape to get a car registered, a telephone line installed, a tax ID number. I’ve paid notaries hundred upon hundreds of Euro for the stamps and forms needed to make the transactions of daily life (renting an apartment, selling a car) legal. Just imagine the emergency room. Better yet, don’t. I’ll tell you about it.

Some years ago, just after my husband and I had moved to Italy for my research, he cut his finger while preparing dinner. It looked bad, but it was Saturday night, and the one doctor we knew of who accepted our weird Belgian insurance policy for expats wasn’t in his office. So when the cut failed to stop bleeding overnight, we reluctantly made our way to the city hospital, asked for directions to the pronto soccorso (literally “immediate aid”), and prepared ourselves for a very long wait.

In the area to which the hospital greeter had directed us, we found a closed door, and three empty chairs in the hallway. After some confused wandering around, we knocked on the door, and once again asked for directions to the elusive ER waiting room. A doctor poked his head out, pointed to the three chairs, and said he’d be with us as soon as he finished patching up a motorcycle accident.

How long would that take, we wondered? And how many heart attacks, asthma attacks, and gunshot wounds would come in while we were waiting?

But the remaining chair in the hallway remained empty; and within ten minutes, the very same doctor who had answered our knock glued my husband’s finger back together and sent us on our way. Minimal wait, one doctor, no paperwork, and no charge—despite the fact that neither of us had an Italian National Health Service (NHS) card. Our Belgian insurance policy would not be billed. The doctor explained proudly that Italy’s NHS looked after everyone, even visitors.

And that’s not all: we didn’t know at the time that there is a designated doctor for every quartiere (neighborhood) in Italy, called the guardia medica, on call for minor nighttime emergencies. The doctors of the guardia medica, which I’ve also since had the occasion to call, are paid by the Italian state. They make house calls, with a little black bag and everything. The doctor for our quartiere could have glued my husband up on a Saturday night, in the comfort of our own home, again at no charge.

I know you must be thinking “But all this must be terribly expensive!” It’s true. Since our visit to the Italian ER, many patients of the NHS have been subjected to new out-of-pocket charges for medicines and specialist visits, and lines have grown longer in emergency departments as regional health budgets have come under pressure. But primary and emergency care is still free at the point of service. And Italy still spends considerably less than its neighbors do on health care: $2,870 per capita in 2008, compared to $3,129 in the UK, $3,696 in France, $4,063 in the Netherlands—and $7,538 in the U.S. Even so, income disparities in both access to care and health outcomes remain small in Italy, and most readers of this blog will know that Italy outperforms the U.S. on virtually every indicator of health and well-being.

Where does this tale of two emergency rooms leave us? The Affordable Care Act (ACA) brings us nowhere near a National Health Service on the Italian or British model. And not even the most ardent advocates of cost-effective medicine can imagine a way, under the ACA, to reduce our health care budget by 60 percent to bring us in line with what Italy spends on a per capita basis.

What the ACA does do is bring us one step closer to being able to say -- as that Italian ER doctor could -- that our health care system “looks after everyone.” It may even bring us nearer to the day when the waiting rooms of our emergency departments aren’t packed with patients seeking primary care, and care for complications resulting from a lack of primary care. Perhaps even a day when our emergency departments look a little more like three empty chairs in a hallway.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.