Category Archives: Nursing

Sep 11 2014
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Recent Research About Nursing, September 2014

This is part of the September 2014 issue of Sharing Nursing’s Knowledge.

Lower Hospitalization Rates Linked to Broader NP Scope of Practice

New research correlating state-by-state hospitalization rates with state policies on nurse practitioner (NP) scope of practice offers a revealing conclusion: Medicare and Medicaid patients are less likely to require hospitalization in states that allow NPs a broader scope of practice.

A team of researchers from the University of Missouri Sinclair School of Nursing examined hospitalization data from a range of sources that sorted data by state, and then compared it with American Association of Nurse Practitioners data on state laws and regulations governing NP scope of practice. They found “a significant relationship between full practice of NPs and decreased hospitalization rates of Medicare and Medicaid beneficiaries in the United States and improved health outcomes of states.”

The researchers caution that the data do not prove a causal relationship between scope of practice and hospitalization rates, but write, “Our findings support the increasing call of facilitating Advanced Practice Registered Nurses [APRNs] to fulfill their full scope of practice in providing access and care to patients without direct or indirect supervision from physicians. The outcomes support the Institute of Medicine recommendation that APRNs practice to their full scope of practice including functioning as primary care providers.”

The study was published online by Nursing Outlook on August 4, 2014.

Read an abstract of the study or a news article on it in McKnight’s.

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Sep 11 2014
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RWJF Scholars in the News: Mental health and returning service members, children of incarcerated parents, nurse turnover, more.

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:

When reserve service members return to civilian life, such stresses as marriage and health care problems are more likely to trigger drinking problems than traumatic events that occurred during deployment, according to a study reported by Fox News. When it comes to the “long-term mental health for National Guard members, what matters is what happens after they come home,” said lead author Magdalena Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna. “Financial difficulties, re-integrating, difficulties accessing quality health care, all of those seem to matter.” But deployment stress also has an impact. “[T]he more traumatic events they are exposed to during or after combat, the more problems they have in daily life when they come home,” she said. RWJF Investigator Award in Health Policy Research recipient Sandro Galea, MD, MPH, DrPH, co-authored the study. Health Canal also reported on it.

An estimated 17.5 percent of newly licensed RNs leave their first nursing job within the first year, and one in three leave within two years, according to research conducted by RWJF’s RN Work Project. Advance for Nurses quotes co-directors Christine T. Kovner, PhD, RN, FAAN, and Carol Brewer, PhD, RN, FAAN. “One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “A high rate of turnover at a hospital, if it's voluntary, could be problematic,” Brewer added, “but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” Nurse.com also covered the study.

Having incarcerated parents is associated with significant health problems and behavioral issues, and may be more harmful to children’s health than divorce or the death of a parent, USA Today reports. “These kids are saddled with disadvantages,” said Kristin Turney, PhD, author of the study that reached those conclusions. She is an RWJF Health & Society Scholars program alumna. “They’re not only dealing with parental incarceration, but also mental health issues.” The study found that having a parent in prison was associated with such conditions as attention deficit hyperactivity disorder, learning disabilities, speech or language problems, and developmental delays. Turney’s study was also covered by US News and World Report, Salon, Psych Central, Healthline and Mother Jones, among other outlets. 

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Sep 10 2014
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I Am Who I Am Because of You

Faith Ikarede Atte, RN, MSN, is a Future of Nursing Scholar studying for her PhD at Villanova University, supported by Independence Blue Cross Foundation. The Future of Nursing program is a project of the Robert Wood Johnson Foundation.

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There are things in life so personal and private that when one vocalizes them, there is fear of being judged. It was eleven years ago that I had a personal encounter with myself. It is admittedly odd to look back at the path that I have walked on, now overgrown and distant—yet still so close to my heart.

Eleven years ago is when I lost a sense of who I was in the eyes of society, and I had to look within myself to find my footing. It is during this time that I had arrived from Kenya, full of vigor, light spirited and quick to laughter. I was hungry for knowledge and the sky was the limit.

Little did I know that life was about to teach me a lesson. It became obvious to me that my accent was different. Most immigrants can identify with the situation of being different. The more I spoke, be it in class or in a group of people, the more I felt isolated due to reactions like, “What did you say? Speak up.  Your accent is too thick. I don’t know what you are saying.”

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Sep 9 2014
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Quotable Quotes About Nursing, September 2014

This is part of the September 2014 issue of Sharing Nursing’s Knowledge.

“Changing cultural norms within the nursing profession will require efforts from all parties: from nursing graduates, in treating their colleagues with respect and raising awareness by reporting incidents; from nursing leaders, in leading by example to foster supportive behaviors and promote a healthy work environment; from health care institutions, in setting zero tolerance disciplinary policies and empowering staff to report on issues without fear of retaliation; and from academic institutions, in preparing students with conflict management skills to address situations as they arise.”
--Susan Sanders, DNP, RN, NEA-BC, vice president, Kaplan Nursing, Bullying a Rising Concern for New Nurses, U.S. News & World Report, September 3, 2014

“It is time to stop wringing our hands that there are inadequate MDs wanting to provide primary care service. There is a very synergistic way that medicine and advanced practice nursing can work together, capitalize on the strengths that each discipline brings to the table, and maximize the patient experience and the outcomes. This is a new model.”
--Rosemary Dale, EdD, professor of nursing, University of Vermont, New Health Care Model Tested in BurlingtonBurlington Free Press, August 30, 2014

“The numbers speak for themselves. As the demographics change and more ethnically and racially diverse populations grow, there will definitely continue to be a need for health care providers who mirror these patients.”
--Eva Gomez, MSN, RN-BC, CPN, staff development specialist, Children’s Hospital in Boston, Push to Recruit Black, Latino Nurses, Washington Informer, August 27, 2014

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Sep 9 2014
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In the Media: TV Show Zooms in on Birthplace of Midwifery in America

This is part of the September 2014 issue of Sharing Nursing’s Knowledge.

Nurse-midwifery took a turn in the media spotlight last month during a television talk show in Kentucky, the “birthplace” of midwifery and family nursing practice in America.

In a half-hour segment on Kentucky Educational Television, TV host Renee Shaw interviewed officials from Frontier Nursing University, the longest continuously operating and largest midwifery program in the country. The university will mark its 75th anniversary in October.

Nurse midwives and nurse practitioners “really want to make their community a better place, and they know from working in the system that, as nurses, they can do that,” said Julie Marfell, DNP, APRN, FAANP, dean of nursing at Frontier Nursing University.

Midwifery got its official start in America thanks to Mary Breckenridge, a nurse from a prominent political family who was born in the 1880s. After the deaths of her first husband and both of her children, Breckinridge decided to devote her life to improving health and health care. In 1925, she founded the Frontier Nursing Service in Hyden, Ky., a remote and unserved part of the country, so she could bring British midwifery practices to the United States. The Frontier Nursing Service later added the nation’s first schools of midwifery and family nurse practice.

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Sep 5 2014
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RWJF Alum Takes on New Role as CEO of Nurse Education Organization

Deborah E. Trautman, PhD, RN, is the new chief executive officer of the American Association of Colleges of Nursing (AACN) and executive director of the Center for Health Policy and Healthcare Transformation at Johns Hopkins Hospital. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program (2007-2008).

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Human Capital Blog: Congratulations on your new position as CEO of AACN! What are your priorities as CEO?

Deborah Trautman: AACN is highly regarded in health care and higher education circles for advancing excellence in nursing education, research, and practice. I am honored to have this unique opportunity to support the organization’s mission and move AACN in strategic new directions. As CEO, I will place a high priority on continuing to increase nursing’s visibility, participation, and leadership in national efforts to improve health and health care. I look forward to working closely with the AACN board, staff, and stakeholders to advocate for programs that support advanced education and leadership development for all nurses, particularly those from underrepresented groups.

HCB: What are the biggest challenges facing nurse education today, and how will AACN address those challenges?

Trautman: Nurse educators today must meet the challenge of preparing a highly competent nursing workforce that is able to navigate a rapidly changing health care environment. As the implementation of the Affordable Care Act continues, health care is moving to adopt new care delivery models that emphasize team-based care, including the medical (health care) home and accountable care organizations.

These care models require closer collaboration among the full spectrum of providers and will impact how health care professionals are prepared for contemporary practice. Nursing needs to re-envision traditional approaches to nursing education and explore how best to leverage the latest research and technology to prepare future registered nurses (RNs) and advanced practice registered nurses (APRNs). Greater emphasis should be placed on advancing interprofessional education, uncovering the benefits of competency-based learning, identifying alternatives to traditional clinical-based education, and instilling a commitment to lifelong learning in all new nursing professionals.

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Sep 4 2014
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RWJF Scholars in the News: The nursing shortage, ADHD, meaningful online communications and more.

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:

NBC 2 (Buffalo, New York) interviewed Carol S. Brewer, PhD, RN, FAAN, co-director of RWJF’s RN Work Project, for a story about the nursing shortage and job prospects for nurses early in their careers. “We are not seeing as much demand for brand new graduates,” Brewer said. However, the anticipated retirement of many older nurses and the increasing demand for health care as a result of the Affordable Care Act could combine to create a 19-percent increase in demand for nurses in the near future, Brewer said. In the meantime, she suggests that new nurses be willing to relocate and look for nursing jobs in rural communities, where demand is greater.

It is important to keep media and public focus on the Affordable Care Act, Jake Haselswerdt, PhD, an RWJF Scholar in Health Policy Research, tells the Independent Voters Network website, because some states are still blocking full implementation of the law. “In order for the more stubborn states to move forward with implementation and expanding care, there may need to be some continued pressure,” he said. “That’s going to require the media to pay attention to the big disparities that are emerging between states that tried to implement the law and those that resisted.”

Tina Bloom, PhD, RN, an RWJF Nurse Faculty Scholar, led training for nurses in Columbia, Missouri, aimed at helping them identify the risk factors and symptoms of domestic violence, and then to support victims, ABC17 News reports. The training is consistent with preventive care provisions in the Affordable Care Act, the article says. Among other things, Bloom teaches nurses to look for certain types of injuries and for issues in patients’ medical histories that do not make sense.

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Sep 3 2014
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Accepting the Challenge: What the ALS Ice Bucket Challenge Can Teach Us About Public Health

Elizabeth Gross Cohn, PhD, RN, is director of the Center for Health Innovation at Adelphi University, an adjunct professor at the Columbia University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.

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It only took 24 hours for the hospital unit where I work to complete the Ice Bucket Challenge. My colleagues and I were quick to dump ice water on our heads and publicly post a video of it to YouTube. Compare that to the speed at which we adapt other initiatives—even those that benefit our own health.

Why the difference? What is prompting people to action and, more importantly, what can RWJF learn from this campaign as it works to advance a Culture of Health?

In case you’ve been unplugged over the past several weeks, the Ice Bucket Challenge started in golf and baseball but has spread virally. As of today, it has raised $100 million for Amyotrophic Lateral Sclerosis (ALS).  Participation begins when you are challenged on social media to—within 24 hours—publicly accept, acknowledge the challenger by name, pour ice water over your head in as dramatic a method as you can imagine or afford, challenge two or three others to participate, and post the results to YouTube.  This campaign has been embraced by the general public, celebrities, grandmothers, babies, and teams of teachers, firefighters, nurses, teachers and others.  

We public health professionals can learn some important lessons about delivering information and impelling action from this extraordinary cultural phenomenon. Here are five factors that seem most potent to me. Do you see others?

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Aug 28 2014
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RWJF Scholars in the News: Medical marijuana’s unanticipated benefits, infant sleep pods, and more.

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:

States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.

An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.

Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.

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Aug 27 2014
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Team-Based Interdisciplinary Care

The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. (Read a post summarizing the first of the six webinars.) The second of the webinars in the series focused on team-based care for complex cases. Presenters included leaders from four primary care sites around the country that the LEAP program has deemed exemplars.

Managing Care for the Most Complex Patients

Kathy Bragdon, RN, director of care management at Penobscot Community Health Center in Bangor, Maine, discussed the rapid growth of the health center, and went on to describe its system of care management for the most complex patients.

The center relies on a transitions care manager, who shares information back and forth with the hospital and with patients’ medical homes. In addition, the manager meets with patients when they are in the hospital, looking to identify potential barriers to recovery and to provide any needed referrals.

“One of the big roles—we didn’t realize how big—was that a tremendous number of patients had no primary care at the time of admission,” she said. “We worked really closely with the hospitals trying to provide those services and make that linkage to those patients who needed primary care providers.”

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