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:

RWJF Clinical Scholar Alan Teo, MD, MS, is the lead author of a study that finds the quality of a person’s social relationships influences the person's risk of major depression, regardless of how frequently their social interactions take place. “The magnitude of these results is similar to the well-established relationship between biological risk factors and cardiovascular disease,” Teo told Health Canal. “What that means is that if we can teach people how to improve the quality of their relationships, we may be able to prevent or reduce the devastating effects of clinical depression.”

RWJF recently announced the selection of 30 primary care practices as exemplary models of workforce innovation. The practices will serve as the basis for a new project: The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP). Among them is CareSouth Carolina, the Hartsville Messenger reports. Learn more about the LEAP project and the practices selected for the program.

Low-income Oregonians who received access to Medicaid over the past two years used more health care services, and had higher rates of diabetes detection and management, lower rates of depression, and reduced financial strain than those without access to Medicaid, according to a study co-authored by RWJF Investigator Award in Health Policy Research recipient Amy N. Finkelstein, PhD, MPhil. The study found no significant effect, however, on the diagnosis or treatment rates of hypertension or high cholesterol levels.  Among the outlets to report on the findings: Forbes, the New York Times, the Washington Post Wonk blog, Health Day, and the Boston Globe Health Stew blog. Read more about Finkelstein’s research on the Oregon Medicaid system.

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

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.

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?

This is part of the May 2013 issue of Sharing Nursing's Knowledge.

Hospitals that have achieved "Magnet" recognition have lower mortality rates, according to new research led by Matthew D. McHugh, PhD, JD, MPH, RN, of the University of Pennsylvania School of Nursing, with support from the Robert Wood Johnson Foundation (RWJF).

McHugh and colleagues examined patient, nurse, and hospital data for 56 hospitals designated as Magnets by the American Nurses Credentialing Center, along with comparable data from 508 non-Magnet hospitals. They found that "Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification," and that "patients treated in Magnet hospitals had 14 percent lower odds of mortality and 12 percent lower odds of failure-to-rescue." They concluded that "lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes."

About 8 percent of hospitals in the United States have achieved Magnet designation. They are recognized for quality patient care, nursing excellence, and innovations in professional nursing practice.

The study was published in the May issue of Medical Care, a journal of the American Public Health Association. McHugh is an RWJF Nurse Faculty Scholar.

Learn more about the RWJF Nurse Faculty Scholars program.
Read the study.
Read a FierceHealthcare story about the study.

A report released Monday by the Health Resources and Services Administration (HRSA) indicate that efforts to grow and diversify the nursing workforce are showing results—a welcome finding given the looming shortage of nurses and primary care providers in general.

According to the data from HRSA's National Center for Health Workforce Analysis, the nursing profession grew substantially in the 2000s, adding 24 percent more registered nurses (RNs) and 15.5 percent more licensed practical nurses (LPNs). Significantly, the growth in the supply of nurses outpaced growth in the U.S. population, with the number of RNs per capita growing by about 14 percent and the number of LPNs per capita increasing by 6 percent.

The "pipeline" carrying nurses from school to the workforce also expanded during the past decade. The number of would-be nurses who passed national nurse licensing exams to become RNs more than doubled between 2001 and 2011, while the number of LPN test-passers grew by 80 percent. Significantly, the share of licensure candidates with bachelor's degrees increased during that time, as well.

The profession also is growing more diverse, according to the data. Non-white RNs are now 25 percent of the profession, up from 20 percent 10 years ago. Nine percent of RNs are men today, up slightly from 8 percent at the beginning of the decade.

Read more about the HRSA report.
The full analysis is available at HRSA's website.

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:

CBS Evening News profiled RWJF Community Health Leader Roseanna Means, MD, who founded the nonprofit Women of Means in 1988 to provide free medical care to homeless women in the Boston area. Today, 16 volunteer doctors and staff nurses provide care at the city’s shelters to women with unique sensitivities and needs. Read a post Means wrote about her nonprofit for the RWJF Human Capital Blog.

A study led by RWJF Clinical Scholars alumnus Matthew M. Davis, MD, MAPP, finds more than 40 percent of American parents give over-the-counter cough and cold medicines to children under age 4, despite product label warnings to the contrary. Health Day and the Examiner report on the findings.

Helena Hansen, MD, PhD, an alumna of the RWJF Health & Society Scholars program, is the lead author of an analysis that concludes social determinants—rather than changes in the environment or flawed diagnostic criteria—help explain the dramatic rise in the number of Americans diagnosed with mental disorders in recent years. Health Canal and MedPage Today report on the findings.

Forty-seven percent of children with cancer who receive part of their treatment at home have been exposed to at least one medication error, according to a study led by RWJF Physician Faculty Scholars alumna Kathleen E. Walsh, MD, MSc. Those errors had the potential to harm 36 per 100 patients, and actually did cause injury to four per 100, MedPage Today reports.

Kathleen J. Mullen, PhD, is an alumna of the Robert Wood Johnson Foundation Scholars in Health Policy Research program, and an economist and associate director of the RAND Center for Disability Research at the nonprofit, nonpartisan RAND Corporation.

Dementia, a chronic disease characterized by significant impairment of cognitive functioning, afflicts 15 of every 100 Americans over age 70 – and it is their caregivers who are perhaps most familiar with the disease’s effects.

Family members are often the ones who find themselves navigating the complex system of nursing homes, in-home health care, and health insurance (Medicare, Medicaid, and private insurance), all while dealing with heartbreaking changes in the physical and mental functioning of their spouses, siblings, parents or grandparents. Indeed, my own family is struggling to sort through an overwhelming number of options and decisions to help ensure that my 86-year old grandmother receives the best available care now that she is unable to live without daily assistance.

For many families, a significant barrier to that best available care is cost: Caring for someone with dementia is extremely expensive. A recent RAND study, the results of which were published in the New England Journal of Medicine, offers some of the most comprehensive and credible estimates to date of the monetary costs of dementia in the United States. These costs include both out-of-pocket spending and spending by Medicare, Medicaid, and other third parties on nursing home and hospital stays, medical visits, outpatient surgery, home health care, special services (such as outpatient rehabilitation), prescription drugs, dental services, and other needs.

Jason Houle, PhD, is a Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin. He recently published a study online in the journal Psychosomatic Medicine that finds association between depressive symptoms and mortality is due to later health problems, not prior physical health conditions.

Human Capital Blog: Why did you decide to look at this particular topic?

Jason Houle: I first started looking at this topic in graduate school, when I took a course on event history models (a quantitative method often used when studying mortality). Up to that point, most of my research focused on the social determinants of mental health, but I had become increasingly interested in the link between mental and physical health. While there’s a long literature on how depression influences physical health (and vice versa), as a demographer, I was really interested in the link between depression and mortality. When researching this topic, I discovered a rather large literature that showed that people who experience depression tend to die younger, on average, than those who do not. However, it wasn’t clear from prior research why, exactly, depressed people tend to die younger than those who are not. Though it makes sense that depression is linked with mortality, the reasons behind it remained a puzzle, and I thought it would make an interesting project.