President Obama’s Fiscal Year 2014 budget proposal recommends a $20 million increase over previous budget proposals for the Title VIII Nursing Workforce Development Programs, the primary source of federal funding for nursing education.

“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” American Nurses Association (ANA) President Karen A. Daley, PhD, RN, FAAN, said in a statement.

According to the Center to Champion Nursing in America (CCNA), the $20 million increase will expand the pool of primary care Advanced Practice Registered Nurses through the Advanced Education Nursing Traineeship Program.  If enacted, and if the funding is sustained, the increase will produce an additional 1,800 primary care nurses over five years.

“The President's proposal to train 1,800 more primary care nurse practitioners would provide a much needed shot in the arm to our health care workforce,” said Winifred Quinn, MA, PhD, director of legislation and field operations at CCNA. “These new health professionals are key to boosting consumer access to primary and preventive care, and other innovative delivery system reforms we are counting on to improve quality and hold down costs.”

The ANA also applauded other health care investments in the budget, including funding for community health centers, new mental health programs, health reform implementation, medical research, and more.

Read ANA’s statement about the budget.
Learn more about Title VIII Nursing Workforce Development Programs.

Health care employment accounted for 10.74 percent of total employment in the United States in March, according to a report by the Altarum Institute. One out of every nine jobs was in the health care sector—an all-time high, the report says.

Bureau of Labor Statistics (BLS) March 2013 employment data show that health care employment rose by 23,000 jobs in March, and most were in ambulatory care. Health care has added 1.4 million jobs since the start of the recession in December 2007, the report says, while non-health employment has fallen.

The Altarum Institute is a nonprofit health systems research and consulting organization.

Read the report here.

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

What policies optimize nurses' role in solving the shortage of primary care practitioners? What approaches will promote and incentivize interprofessional education and practice in health care so as to improve the quality and safety of care? What promising state and federal initiatives are likely to achieve the Institute of Medicine's recommendation to increase the proportion of nurses who hold a baccalaureate or higher degree to 80 percent by the year 2020?

These and other crucial issues confronting nursing and the health care system are the focus of the Robert Wood Johnson Foundation (RWJF) Charting Nursing’s Future policy briefs. Launched in 2005, the series now includes 20 briefs covering a range of topics, including:

• Unlocking the potential of school nursing;
• Expanding the nation’s capacity to educate nurses through state-level partnerships;
• Improving the recruitment and retention of older and experienced nurses as a way to stem the looming nursing shortage;
• Understanding the relationships among such issues as access, cost, payment systems,  and quality of care;
• Optimizing nurses’ role in closing the health care quality and safety “gap”;
• Addressing the nurse faculty shortage through public and private partnerships;
• Strengthening public health nursing;
• Driving policy change with data collected and analyzed by state nursing workforce centers;
• Easing the nursing shortage through government, school and employer collaborations; and more.

Margaret Wainwright Henbest, RN, MSN, CPNP, is executive director of the Idaho Alliance of Leaders in Nursing and co-lead of the Idaho Nursing Action Coalition. She served in the Idaho state Legislature from 1996-2008.

I stumbled into politics in the midst of my nursing career. After serving as a nurse practitioner (NP) for two years in California and Oregon, I moved to Idaho in 1986. But it wasn’t until after the move that I discovered that I could not practice in my new home state unless a physician recommended me to the Idaho Board of Medicine (IBM) for licensure. That was not the only barrier to practice: To get my license, I had to interview with the IBM and win its approval.

I took a faculty position instead. But I soon met NPs all across the state who were seeking a change to this restrictive licensing requirement. I somehow wound up as the spokesperson for our eventual legislative effort, which was defeated after its first Senate hearing in the early 1990s.

That experience taught me that if something needs to be done, if a law needs to be changed, no one is going to do it for you; you have to do it yourself. Since I had a part-time job, I had the time to get active in local nursing organizations, and one thing led to another. I was approached to run for office and, after deliberating with family and friends, decided to make the leap. I won by seven votes in 1996. Every vote counts!

When I arrived at the state Capitol, I found that my perspective as a nurse was extremely valuable, especially during health care debates. I recognized prior to running that nurses were educationally and intellectually prepared for public office, and that we had little if any self-serving agenda in health care reform debates. We had a legitimate altruistic interest in patient and community health. This was readily apparent to policy-makers and the public.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other critically important nursing issues.  These are some of the stories in the April issue:

More Nurses Climbing Education Ladder
Over the last century, nursing education has shifted from hospital-based diploma programs to colleges and universities, which offer associate’s, bachelor’s, master’s, and doctorate degrees in research and practice. Today, enrollment in higher degree nursing programs is on the rise, according to a 2012 survey by the American Association of Colleges of Nursing. Read about RWJF scholars who are continuing their education, and what the Institute of Medicine says about a more highly educated nursing workforce.

In Indiana, Physicians and Nurses Work Together to Transform Nursing
In the Indiana Action Coalition, the partnership between physicians and nurses runs deep. “Nursing can’t change health care alone,” co-lead Kimberly Harper says, and many doctors, pharmacists, and other professionals she works with agree—and are championing the effort to advance nursing because they believe it will ultimately benefit patients. Improving interprofessional education and collaboration is a top priority for the group.

RWJF Scholar Pioneers Innovative Program to Help Low-Income Elderly Age at Home
Sarah Szanton, PhD, CRNP, an associate professor at the Johns Hopkins School of Nursing and an RWJF Nurse Faculty Scholar, has developed a program that sends teams of nurses, occupational therapists, and “handymen” to the homes of low-income, frail elderly participants for 16 weeks. After an assessment of all functional areas, the participant decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure levels. The program is having extraordinary success, helping seniors age in place and saving taxpayers money.

See the entire April issue here. Sign up to receive Sharing Nursing’s Knowledge here.

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/U.S. Department of Veterans Affairs Physician Faculty Scholars alumnus Amal Trivedi, MD, MPH, is co-author of a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South. Although the specific reasons for the regional differences are unknown, the researchers hypothesize factors like education, socioeconomic status, and access to quality medical care might be to blame, the New York Times Well Blog reports. NPR and Nurse.com are among the other outlets to report on the findings.

Fierce Healthcare reports on a study led by RWJF/U.S. Department of Veterans Affairs Clinical Scholar Kelly Doran, MD, that finds frequent use of the emergency department at Veterans Health Administration facilities is often due to “severely compromised life circumstances,” rather than poor access to outpatient health care. The study raises questions about the degree to which increasing access to outpatient care, as the Affordable Care Act aims to do, will reduce emergency department use.

Manish K. Sethi, MD, a health policy associate at the RWJF Center for Health Policy at Meharry Medical College, spoke to the Leaf Chronicle about a program he started at Cameron College Prep Middle School in Nashville to teach teens conflict resolution strategies in an effort to reduce violence in the Nashville area. Read a Q&A with Sethi about the program.

The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni.

The Chicago Parenting Program, an innovative program that supports healthy parenting and reduces behavioral problems among children, was recently added to the National Registry of Evidence-Based Programs and Practices, run by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. RWJF Executive Nurse Fellow alumna Deborah Gross, DNSc, RN, FAAN, was a driving force behind the program, which is used by Head Start centers in Chicago and New York City, among others.  RWJF Nurse Faculty Scholar Susan Breitenstein, PhD, RN, PMHCNS-BC, and Executive Nurse Fellow alumna Sharon Tucker, PhD, RN, joined with Gross and others to conduct a study on the program, published in Research in Nursing & Health. It was recently named the journal’s Best Research Article award for 2012.

David Kindig, MD, PhD, RWJF Health & Society Scholars program director at the University of Wisconsin, and Health & Society Scholars program National Advisory Committee (NAC) member George Isham, MD, MS, co-chaired the Institute of Medicine’s Roundtable on Population Health Improvement, which is exploring factors beyond medical care that affect people's health. Among other participants in the Roundtable: RWJF Senior Program Officer Pamela Russo, MD, MPH, and Health & Society Scholars NAC Member James Knickman, PhD.

RWJF Health Policy Fellows alumna Carmen R. Green, MD, was appointed the University of Michigan Health System’s inaugural Associate Vice President and Associate Dean for Health Equity and Inclusion. In the position, Green will find and address inequalities in care, education and research, and promote health care careers to those from groups that are underrepresented in the field.

Sylvia Garcia, JD, a member of the RWJF Community Health Leaders program NAC, was elected to the Texas State Senate (District 6) in a run-off election to fill the seat previously held by the late state Sen. Mario Gallegos.

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Michael R. Bleich, PhD, RN, FAAN, is Maxine Clark and Bob Fox dean and professor at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2000-2002).

With help from co-authors Brent MacWilliams, PhD, ANP, and Bonnie Schmidt, PhD(c), RN, in our recent American Journal of Nursing article summarizing research on men in nursing—and further inspired by a manuscript by Dena Hassouneh, PhD, ANP, entitled Anti-Racist Pedagogy: Challenges Faced by Faculty of Color in Predominantly White Schools of Nursing in the July 2006 issue of the Journal of Nursing Education—I am in a reflective place. After a nearly 40-year journey as a male in nursing, I now realize the discipline was never designed for me.

"Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?"

That is not to say that I have not had a fabulous career, worked with the finest colleagues one could imagine, or had opportunities that provided continuous challenge and opportunity. But as a discipline, nursing has had its broad shifts.  Florence Nightingale was a master of evidence-based practice and spent a lifetime elevating nursing to a discipline in a world that was political, gender-biased against women, scientifically evolving, caste-oriented, and more. The gift of structure, process, and outcomes she gave nursing are irreplaceable.

Noting that “online technologies present both opportunities and challenges to professionalism,” the American College of Physicians and the Federation of State Medical Boards recently issued a position paper offering guidance to physicians looking to “strike the proper balance” between harnessing opportunities and navigating challenges inherent to technology.

The paper takes five positions:

1. Standards for professional interactions should be consistent across all forms of communication between physician and patient, and care should be taken to preserve the relationship, and maintain confidentiality, privacy and respect. “Friending” or Googling patients can result in providers observing “risk-taking or health-adverse behaviors,” and can compromise trust between the two parties. The paper urges physicians to avoid using online forums to “vent” or air frustrations.

2. Physicians should make an effort to keep professional and social spheres separate and behave professionally and cautiously in both. They should be aware that information posted online can quickly be widely disseminated or taken out of context.

3. Electronic communications should only be used by physicians in an established patient–physician relationship and with patient consent. Documentation of these communications should be included in patient’s medical records, and physicians should be aware of legal and state medical board requirements for these communications in their state.