Category Archives: Nursing
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?
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.
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.
Adejoke Ayoola, PhD, RN, is an assistant professor with the Calvin College Department of Nursing in Grand Rapids, Michigan, and a Robert Wood Johnson Foundation Nurse Faculty Scholar. This is part of a series of posts looking at diversity in the health care workforce.
Nurses in the United States are caring for a progressively more diverse population. In 2008, ethnic and racial minority groups accounted for about one third of the United States population. According to the United States Census Bureau, people from ethnic and racial minority groups— namely Hispanic, black, Asian, American Indian, Native Hawaiian and Pacific Islander—will together outnumber non-Hispanics over the next four decades. Minorities, now 37 percent of the U.S. population, are projected to comprise 57 percent of the population in 2060. The total minority population would more than double, from 116.2 million to 241.3 million over the period (U.S. Census Bureau, 2012). So it is essential to have a nursing workforce that will reflect the population of the United States so as to deliver cost-effective, quality care and improve patients’ satisfaction and health outcomes, especially among ethnic and racial minorities.
The importance of promoting diversity in the nursing workforce is acknowledged by various nursing agencies and health organizations, including the American Association of Colleges of Nursing (AACN, 2013). Diversity in the nursing workforce provides opportunities to deliver quality care which promotes patient satisfaction and emotional well-being.
When I take my students to the hospital for their clinical rotations in acute care, I often assign those who are Spanish-speakers to Spanish-speaking patients. It has often been a win-win situation for both my students and the patients. Recently we cared for a Hispanic patient who did not speak English and had just given birth to her first baby. Her face lit up when my student spoke to her in Spanish! There was no one else with the woman, so the student’s ability to interact with her in a language she understood made a big difference. We noticed positive progress in the patient’s emotional and physical state as a result of her interaction with the student during the shift.
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.
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.
National Nurses Week begins today, May 6, and runs through Sunday, May 12, which is Florence Nightingale’s birthday. The theme for the week this year is: delivering quality and innovation in patient care.
It’s a wonderful theme, because nurses do even more than deliver high-quality patient care. Nurses conduct groundbreaking science and discovery, develop innovations that improve the quality of care, provide primary care, help patients and their families avoid and manage illness, teach at community colleges and universities, shape public policies, serve in the military, help when there are disasters, run large health organizations, and much more.
Since it opened its doors 40 years ago, the Robert Wood Johnson Foundation has recognized that, which is why it has invested more than $580 million in nursing over the last four decades. That investment continues today, with support to our programs that prepare the next generation of nurse faculty, support nurse research, promote nursing leaders, and more.
The Institute of Medicine, too, recognized nurses’ many contributions to improving health care in this country in its groundbreaking 2010 report. That is why the report called for a more highly educated nursing workforce, more support for nurse-led research, and more nurses in leadership roles of all kinds, from the front lines to the board room. The Future of Nursing: Campaign for Action is working to implement those and other recommendations from that report.
This week on this blog, you will be able to learn more about it and read about some of the innovative work that nurses around the country are doing. This is one of my favorite weeks of the year, because it provides us an opportunity to really showcase nurses’ work. Enjoy!