Category Archives: National Nurses Week 2013
Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.
You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.
Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.
On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing.
What’s the answer to this decades’ old question? Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.
Lynne M. Dunphy, PhD, FNP, is the founding nurse co-lead of the Rhode Island Action Coalition and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. She is a professor and associate dean of external affairs at the University of Rhode Island’s College of Nursing, where she also holds the Routhier Chair of Practice. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
At the University of Rhode Island, I teach a graduate course in health care policy. Rhode Island Lt. Governor Elizabeth Roberts recently spoke to my class about health reform, and I showed her around our college of nursing. As we walked through rooms with high-tech simulation equipment and other labs that imitate real-life practice, she raised a question that resonated with me: Are your students getting out into the community? This is where our health care needs of the future will be.
So many of our nursing students want to go into acute care, and I am concerned that they have not had enough exposure to the entire health care system. The following questions keep coming to mind:
- Do they learn enough about all the settings they could work in?
- Do they understand what their responsibilities and day-to-day activities would be in various settings, such as in a community health center or long-term care facility?
- Do they understand how to implement population-based care?
- Are they ready for the challenging work of visiting patients in home care settings?
- Are they truly prepared?
In the more than two years since the launch of the Future of Nursing: Campaign for Action, state-based coalitions around the country have been working to strengthen the nursing profession to improve health and health care. These Action Coalitions have identified priorities and strategies specific to their states, and forged diverse partnerships to help reach their goals.
A new series of videos on RWJF.org features leaders from some of those Action Coalitions discussing their work and successes, and some of the unique challenges and opportunities they’ve faced.
Carolyn Hayes, PhD, RN, NEA-BC, is associate chief nurse for Adult Inpatient and Integrative Oncology at Dana-Farber Cancer Institute and Brigham & Women’s Hospital (BWH) in Boston, MA. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2012). Here, Hayes reflects on how nurses provided quality care to patients and others traumatized by the bombing at the Boston Marathon. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
I remember a brief report on television, just after the Newtown shootings, when an emergency department (ED) physician in Connecticut said his emotional pain started with his realization that his ED was not getting any victims. It clearly overwhelmed him not to be able to help. At the time I felt for him but on Monday, April 15, after the Boston Marathon bombing, I truly understood him. I, along with other highly-skilled members of the health care and support teams at Brigham & Women’s Hospital, had the privilege of making a difference for the victims of that tragic event.
That Monday, I was the operations section chief—the role designed to ensure staff, materials, supplies, and systems are in place to address whatever is occurring. On Friday the 19th, the day that Boston and surrounding towns were instructed to “shelter in place,” I was incident commander.
We saved lives and limbs in our ED that day. But we also tended to the anxiety, fear, and confusion created by an attack on our city. We addressed with patients, their families, family members of unidentified marathon victims, and ourselves, the existential gap created by the “why” of it all. We lived out what we had trained for, yet couldn’t comprehend. And we did it all as a community.
For National Nurses Week, the Human Capital Blog is highlighting some of the pioneering research covered on www.rwjf.org/nursing in the last few years. The nurse scientists who conducted this research are supported by the Robert Wood Johnson Foundation (RWJF) through its nursing programs. The following are examples of the many nurses who have made groundbreaking discoveries in health care quality and innovation.
RWJF Nurse Faculty Scholars program alumna Maren Coffman, PhD, RN (2009-2011) is working to improve health literacy among Latinas with diabetes, a disease that affects Latinos more often than non-Hispanic Whites, so they can better manage their disease. Lack of access to health care for people with diabetes can be devastating, as high blood sugar can lead to vein damage, vision loss, kidney disease, amputation, stroke, and heart disease. Read about Coffman’s project.
RWJF Executive Nurse Fellows program alumna Keela Herr, PhD, RN, FAAN, (2007-2010) is exploring ways to ensure research she and others conducted is put into practice, so fewer seniors will suffer from untreated pain. Even though research is providing new information about how best to manage pain among older patients, many health providers have yet to put that information into practice. Read more about her work.
Maja Djukic, PhD, RN, an RWJF Nurse Faculty Scholar (2012-2014) and a researcher with the RWJF-supported RN Work Project, is seeking ways to improve patient care by improving nurses’ work environments. Studies have shown that the ratio of nurses to patients affects patient care, but hospitals aren’t always able to hire more nurses to increase ratios. Djukic found that hospital administrators can make a number of other workplace changes that will improve the environment for nurses and, at the same time, improve nurses’ ratings of quality patient care. Read about the study.
Nancy Ryan-Wenger, PhD, RN, CPNP, FAAN, is the director of nursing research and an investigator at the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital in Columbus, Ohio. As a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), she was a lead investigator of the first-ever study to systematically elicit the views of hospitalized children and adolescents on the quality of their nursing care, and also the first to evaluate children’s perceptions of nurses’ behavior for evidence of any disparities across demographic groups. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
Have we asked the children?
That became a pressing question for me when I retired from academia after 30 years and joined the staff of Nationwide Children’s Hospital. I became aware of things that are highly important to hospitals, such as opinions of the quality of care. Yet when I saw the patient surveys at Nationwide, they were almost always completed by parents, and 80 percent of the questions were geared toward parents: Were they kept informed of their child’s condition? Did they have a comfortable place to sleep? Was their child treated kindly by staff member?
Those are important questions, certainly, but if you’re doing a patient survey, don’t you want to know what the patient thinks?
Have we asked the children?
In 2003, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation launched Transforming Care at the Bedside (TCAB), a nationwide, nurse-focused effort to improve health care delivery. TCAB recognized that nurses often hold the key to making hospital care more effective, patient-centered and efficient. David Harrington, RN, BSN, CMSRN, has been a nurse at Providence St. Vincent Medical Center since 2006 and a TCAB leader there for two years. Erin Hochstein, RN, BSN, PCCN has been a staff nurse at Providence since 2010 and a TCAB leader for two years. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
As nurses, we are with our patients and their families during some of the most pivotal moments in their lives, which is a true honor. Yet, with the ever-increasing demands of health care, the responsibilities of nurses have become greater, pulling us away from the bedside. To curb this trend we were given the opportunity, at Providence St. Vincent Medical Center, to adopt Transforming Care at the Bedside (TCAB), a program that gives bedside staff the chance to streamline care and improve patient outcomes.
By allowing us direct input on our workflow, we have the opportunity to develop rapid tests of change that we implement over the course of one shift. This adjustment in practice empowers frontline nurses to be catalysts of change for patient care, permitting us creative liberty in finding solutions to practice and system issues we face on a daily basis.
The Providence St. Vincent TCAB team began its journey in 2010 by visiting Prairie Lakes Hospital in Watertown, South Dakota, one of the original TCAB pilot sites, as part of an innovation grant provided by Providence Health & Services. Nurse representatives from three medical-surgical units along with hospital leaders were introduced to TCAB in action. As newly appointed TCAB leaders, we returned from the trip feeling motivated, inspired, and ready for change.
This is part of the May 2013 issue of Sharing Nursing's Knowledge.
“National Nurses Week gives us a chance to recognize the contribution of the health care providers at the heart of our health care system. Every day, nurses provide leadership, innovation and advocacy to meet the health care needs of Americans... The health care law’s emphasis on keeping people healthy, preventing illness, and managing chronic conditions, opens new opportunities for nurses to shape and lead the future delivery of healthcare and capitalizes on the expertise of the nursing profession... Please join me in thanking our nation’s nurses for the critical work they do in bringing better care and better health to all Americans.”
-- Health & Human Services Secretary Kathleen Sebelius, HHS Secretary Kathleen Sebelius on National Nurses Week, HHS.gov, May 6, 2013
“There are just over 180,000 APRNs [Advanced Practice Registered Nurses] in the United States, most of them in primary and long-term care ... extensive research finds they are able to handle 80 percent to 90 percent of primary care cases — and achieve outstanding results. APRNs can handle the vast majority of primary and preventive care needs and leave the more complex cases to physicians. This is a win-win situation, that frees nurses and physicians to spend more time with the patients who need them most. Utilizing APRNs provides the fastest and most cost-effective strategy for meeting the health and health care needs of millions more Americans ... Millions of Americans need help maintaining healthy lives or managing chronic conditions. Millions of older people need care in their homes. And millions of soon-to-be-insured patients need a health care provider with the time and training to listen, diagnose and educate. Unleashing the skills of nurse practitioners will improve health care. It is the right thing to do and it is the right time to act.”
-- Sheila Burke, Malcolm Wiener Center for Social Policy, Harvard University, and Future of Nursing: Campaign for Action strategic advisory committee (SAC); and Bill Novelli, McDonough School of Business, Georgetown University, and Future of Nursing: Campaign for Action SAC, Advanced Nurses Lower Costs, Improve Care, Politico, May 6, 2013
Tracey L. Yap, PhD, RN, CNE, WCC, is an assistant professor at the Duke University School of Nursing, a John A. Hartford Foundation Claire M. Fagin Fellow, and a senior fellow at the Duke University Center for Aging and Human Development. With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), Yap and her co-investigators developed a cost-effective, nurse-led intervention that aimed to reduce the prevalence of pressure ulcers in long-term care facilities by increasing resident mobility through a musical prompting system specifically tailored to each facility. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
It started with a boombox and the Byrds.
Those are hardly the first things that come to mind when you think about pressure ulcers, also referred to as bed sores—the wounds that are caused by continuous, unrelieved pressure on the skin and that often develop in people who have impaired mobility. Yet that’s just how my husband, a physician who has a large population of patients in long-term care, inspired this research by suggesting that I pursue a grant related to this serious issue.
At one long-term care facility, my husband had a maintenance person use a boombox over the public address system to play “Turn, Turn, Turn” at two-hour intervals. It was a creative, simple, and fun way to remind staff to move patients, and it appeared to be effective in preventing pressure ulcers.
We were in Kentucky at the time, and I was teaching at the University of Cincinnati College of Nursing. When I took my husband’s suggestion and applied for an INQRI grant, it radically changed my life—and the lives of many long-term care residents—for good. In my PhD studies, I’d focused on occupational health, and the INQRI grant helped me apply that knowledge in a new way and ultimately led to my current work at Duke University.