Category Archives: Nursing
Barbara Bricoli, MPA, is executive director of Nurses Improving Care for Healthsystem Elders (NICHE), an international program based at New York University’s College of Nursing that is designed to help improve the care of older adults. The program was developed by Terry Fulmer, PhD, RN, FAAN, chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
The rapid expansion of the aging population is a national concern. Nearly 20 percent of the U.S. population will be over age 65 by 2030, according to the U.S. Administration on Aging. And our aging population will place a heavy burden on our health care system; older adults, in fact, are hospitalized at three times the rate of the general population.
Yet health care providers lack adequate training in geriatrics and gerontology to care for older patients. Nurses Improving Care for Healthsystem Elders (NICHE) is working to change that.
Based at New York University’s College of Nursing, NICHE aims to better enable hospitals and health care facilities to meet the unique needs of older adults and embed evidence-based geriatric knowledge into health care practice. Hospitals and organizations that adopt NICHE report improved outcomes, decreased lengths of stay, better patient and staff satisfaction levels, and higher success in building systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
“I knew that if something were to go wrong, the nurse was just a phone call away. It made me feel so empowered to take care of my child myself.”
--Camille Wallace, LPN, How Nurses Can Help Low-Income Mothers and Kids, The Atlantic.com, January 14, 2015
“There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply. All the shortage of care at the bedside has to do with [is] how much hospitals want to pay nurses, and whether they want to use their resources on something else.”
--Linda Aiken, PhD, RN, FAAN, director, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, More Nurses are Better for Patients. Why is it so Hard to Get Hospitals to Hire Them?” The Washington Post, January 13, 2015
“Drivers of the shortage include an aging nursing workforce, increased number of people receiving health care via the Affordable Care Act along with increased number of people living with complex, chronic disease that requires care. Nursing provides a diverse array of opportunities from health care and bedside nursing to advanced practice nursing to positions for nurses in the business world.”
--Laura Rooney, DNP, APRN, director, UT Health Services, University of Texas Health Science Center, Outlook for Nursing Jobs Continues to Look Positive, Houston Chronicle, January 9, 2015
Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation (RWJF).
By 2050, as many as 84 million Americans will be 65 or older, and most of them will need some sort of help in maintaining their health and well-being. For them, and for the millions of younger Americans who will need similar assistance, it’s essential that we come to grips with the challenge of providing effective and affordable long-term services and supports (LTSS).
As it stands right now, we’ve got a long way to go. But the effort is under way, and nurses are at the forefront. At more than 3 million strong, the nursing workforce will be central to meeting growing demand for LTSS. In addition to providing clinical care, nurses can assess the long-term health prospects of individuals with physical and cognitive impairments, develop customized care plans, monitor individuals’ responses to care, coordinate care across providers and settings, and oversee the quality of the assistance older adults receive.
- Transitional Care. The Central New Jersey Care Transitions Program (CNJCTP) is one of a number of sites taking part in the Affordable Care Act-funded Community-Based Care Transitions Program. Six hospitals in the CNJCTP region work with registered nurses (RNs) and social workers, who together act as health coaches to teach self-care strategies to high-risk, chronically ill Medicare beneficiaries. Registered nurses (RNs) focus on beneficiaries’ symptoms and health care needs, including medication management, while social workers attend to socioeconomic needs that may lead beneficiaries to return to the hospital. Coaches visit patients in their homes within three days of discharge, facilitate a follow-up visit with a primary care provider, and follow up by phone for a month after discharge.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
Study: Night Shift Work Hazardous to Your Health?
A new study finds that female nurses working rotating night shifts for five or more years have a higher risk of death from cardiovascular disease and lung cancer than those who do not work such hours.
A team of researchers led by Eva Schernhammer, MD, DrPH, began with longitudinal data from the 1988 Nurses’ Health Study, a long-running data-collection project focused on women’s health. The 1988 iteration of the survey asked if respondents worked rotating night shifts at least three nights a month, in addition to day or evening shifts in that same month—and if so, for how many years they had been doing so. Some 75,000 respondents were included in follow-up research over the next 22 years, tracking the nurses’ personal health; researchers also examined death records, as needed.
Researchers found that women who’d worked three or more rotating night shifts a month for five years or more had higher all-cause mortality rates, as well as higher rates of death from cardiovascular disease. Women who worked such shifts for 15 or more years had elevated death rates from lung cancer.
In a news release, Schernhammer observes, “These results add to prior evidence of a potentially detrimental relation of rotating night shift work and health and longevity ... To derive practical implications for shift workers and their health, the role of duration and intensity of rotating night shift work and the interplay of shift schedules with individual traits ... warrant further exploration."
Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action. This piece is cross-posted with Off the Charts, the American Journal of Nursing Blog.
I spent the 2014 holiday season reading a book by Sarah Wildman called Paper Love. She describes how she, as a journalist, examined the fate of her Jewish predecessors, including her grandfather and his long lost love. I selected the book because my father was a Jew of Polish descent.
Wildman describes the horrific atrocities bestowed upon the Jews. Of course I knew of the Holocaust growing up, but as I get older, the connections between past and present seem to be more important. While I don’t know of any relative who was personally affected or killed, someone in my extended family very likely was. I pondered my own existence and how it may have depended on a relative escaping Europe and immigrating to the United States to escape the death camps. It is unspeakable how one man’s view of what is mainstream or normal sent so many others to their death.
I am not naive enough to believe that prejudice is a curse of the past. Stark data on health disparities continue to mount. The Centers for Disease Control and Prevention report on Health Disparities and Inequalities (2013) found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.
But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way, and that means lives that are, more often than not, very different than our own.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
A new kids’ movie is putting a positive spin on nursing—a profession that is routinely overlooked, and sometimes denigrated, in Hollywood.
Baymax, the lead character in Big Hero 6, Disney’s latest animated feature film, doesn’t look like your typical nurse in scrubs: The character is a male, futuristic balloon robot who brings to mind the Pillsbury doughboy, but on massive doses of steroids.
Baymax, nonetheless, carries out his role as a nurse and caregiver throughout the film and performs routine nursing care such as scanning for and diagnosing health conditions and prescribing treatments for various ailments. He even uses the pain scale, a classic nursing assessment tool, Harry Summers, co-author of Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk, points out in a review.
Malia Davis, MSN, RN, is a nurse practitioner and the director of nursing and clinical team development at Clinica Family Health Services in Lafayette, Colorado. She has cared for patients in the community, including those who are homeless, for more than a decade. She is a 2014 Robert Wood Johnson Foundation Executive Nurse Fellow.
Social and economic disparities define my work each day, and have provided powerful motivation for me to commit my professional life to attempts to minimize these disparities in the health care setting. Community health centers, which provide health care for the homeless, are where some of the sickest and poorest people in our communities seek medical and behavioral health care from people like me, a nurse practitioner who is honored to serve each of these individuals and families.
I believe one common misperception is that some of my patients fail to contribute to society. Working in community health care for 12 years—10 of them serving homeless people—I have found that most people are very hardworking. Many work at day labor and other low-wage, temporary jobs that are physically demanding and fraught with challenges of all kinds. I often hear of workers experiencing abuse, failing to get paid, and experiencing unsafe working conditions.
They have, of course, none of the benefits we usually associate with jobs. Instead, they face the stress of not knowing day to day if they will find work and be able to support their families—or not. This stress is often compounded by the personal experience of witnessing, surviving, and overcoming trauma or violence, often while in poverty and with very limited resources for healing physically or emotionally.
The Role of the Chief Nursing Officer in Bridging Gaps Among Health Systems and Communities to Improve Population Health
Jerry A. Mansfield, PhD, RN, is chief nursing officer at University Hospital and the Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing. He is an alumnus of the Robert Wood Johnson Foundation Executive Nurse Fellows program.
Since my doctoral work in public health, I have thought a great deal about the relationship of public health theory and practice and my acute care background. With more than 30 years of progressive leadership experience in a variety of for-profit/non-profit, inpatient and outpatient positions, I am trying to generate dialogue and discern a purposeful plan regarding the role of a Chief Nursing Officer in an academic medical center and the health of the populations we serve in our communities.
Based on earlier work in the 1990s and early 2000s, in 2007 the Health Research and Education Trust (HRET) engaged national experts to address the following question: How can hospitals engage their communities to improve the health of everyone? The report provides a framework and encourages hospital leaders and community members to envision health care in communities beyond the medical services offered by providers; it notes that the production of health is not only medical care, but also our environment, individual behavior, and genetic make-up.
Felesia Bowen, PhD, PCPNP-BC, is an assistant professor at Rutgers University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2014-2017). Her research focuses on community-based pediatric asthma care.
When I first began working as a pediatric nurse in New Jersey 20 years ago, I was committed to getting asthma care right. I worked hard to educate my young patients and their families about the disease, how to avoid the triggers that cause attacks, and how to use their medications. I wrote asthma action plans and prescribed the correct medications to control symptoms.
It wasn’t always enough. One Monday morning, one of my young patients experienced asthma symptoms. The family followed his asthma action plan, “stepping” his medications in an effort to relieve his asthma symptoms. On Tuesday, he wasn’t feeling better, and went to the nurse practitioner (NP) in his school’s health office, who appropriately modified his treatment plan and called the asthma specialist to get a next-day appointment for him.
She remembers the young man telling her that he really needed to feel better, because he was going to his middle school graduation dance Wednesday night. On Thursday morning, he visited the NP again, still with asthma symptoms. He told her that he had missed the appointment with the asthma specialist because his mom couldn’t make it—she had health issues of her own, and three other children to care for. But he’d gone to his dance and proudly showed her his middle school class ring.
Ten nurses who have done outstanding work to improve health for people in their communities were named Breakthrough Leaders in Nursing last month at the Future of Nursing: Campaign for Action summit in Arizona. These emerging leaders, who are helping medically fragile children, low-income mothers, women in rural communities, and many others, hail from ten different states.
The Campaign for Action, a joint initiative of AARP and the Robert Wood Johnson Foundation, created the Breakthrough Leaders in Nursing award to celebrate nurse leadership and the importance of efforts by nurses to improve health and health care.
“It’s amazing to see the difference that these 10 people are making in their communities and the health care system,” said Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing and director of the Campaign for Action. “The lives of the people they care for are better because they fearlessly tackled—or are tackling—daunting health care challenges.”
“These outstanding leaders truly represent the future of nursing,” said Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation.