Julie A. Fairman, PhD, RN, FAAN, is Nightingale Professor of Nursing at the University of Pennsylvania School of Nursing, and director of the Barbara Bates Center for the Study of the History of Nursing. She is a predoctoral fellow at the Penn Nursing Center for Health Outcomes and Policy Research. Safiyyah Okoye, BSN, RN, and Jill Vanek, BSN, MSN, are students at the University of Pennsylvania School of Nursing.

The 2011 Institute of Medicine (IOM) report “Future of Nursing: Leading Change, Advancing Health” pointed out that because nursing scope of practice regulations vary across states, and because there is little rationale for these variations, the federal government, through the Federal Trade Commission (FTC) and the Antitrust Division of the Department of Justice, “is well situated to promote effective reforms [related to regulation of APRN scope of practice] by collecting and disseminating best practices from across the country and incentivizing their adoption.” 

The IOM recommended that the FTC and the Department of Justice review existing and proposed state regulations related to advanced practice registered nurses (APRNs) to identify those that limit competition without contributing to the health and safety of the public, and urge such states to allow APRNs to provide care to patients in all circumstances in which they are qualified to do so. 

Created in 1914 to promote consumer protection by eliminating and preventing anticompetitive, unsafe, or deceptive business practices, the FTC is the logical agency to address scope of practice laws. The FTC’s responsibility is to promote competition, inform consumer choice, and protect consumer safety. All are directly related to APRN scope of practice regulations, including those mandating physician supervision and oversight of APRNs when there is not “a compelling consumer protection rationale” for doing so. That includes evidence justifying restrictions on APRNs’ ability to provide health care services that could override the public interests with regard to choice, cost or competition.

Felix German Contreras, 22, of Atlantic City, N.J., credits his 2012 participation in the Robert Wood Johnson Foundation-funded Summer Medical and Dental Education Program (SMDEP), and his teachers at the Yale University site, for opening new doors to opportunities. A naturalized U.S. citizen, Contreras emigrated to the U.S. with his family at age 6. He will graduate from Atlantic Cape Community College next year and plans to attend Yale School of Medicine. Started in 1988, more than 21,000 alumni have completed SMDEP, which today sponsors 12 university sites with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Living as an immigrant and student with only part-time employment is a daily battle. But I will never allow these challenges to slay my dreams. With so many struggles, I am often asked: “Felix, how do you do it?”

I cannot help but smile when I reply, as it is not a secret; nor do I believe it is a talent—it is simply a strong work ethic. I have realized the best things in life are the hardest to obtain.

My doors to new unexpected opportunities were opened when a late-night online search in 2012 led me to the Summer Medical and Dental Education Program. I applied and was accepted at the six-week program’s Yale University site. It was there where I met mentors and students with similar aspirations to improve communities through medicine. Not only did the intensive program place me on a sure-footed path toward a health sciences career, my English improved tremendously through rigorous reading and writing. You can’t believe how much six weeks can give someone who is eager to receive. SMDEP exposed me to countless possibilities on the other side.

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

The Institute of Medicine (IOM) has called on nurses to take on more leadership positions so they can use their unique insights to help redesign the nation’s ailing health care system.

But some nurses are already there.

In its biennial list of the 25 most powerful women in the health care industry, Modern Healthcare, a leading health policy journal, included nine women with nursing backgrounds and two others who are vocal champions of nurses and nursing.

Nurses and nursing champions, in other words, comprised nearly half the list, which was released in April.

Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

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.

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”

On Monday, U.S. Department of Health & Human Services Secretary Kathleen Sebelius announced a program that will help military veterans who have health care experience or training pursue nursing careers. The Veterans’ Bachelor of Science in Nursing Program is expected to provide $3 million before the end of this fiscal year (September 30) to accredited schools of nursing to increase veterans’ enrollment, and provide mentorship and other support services.

“The Veterans’ Bachelor of Science in Nursing Program recognizes the skills, experience and sacrifices of our veterans, while helping to grow our nursing workforce,” Secretary Sebelius said in a news release.  “It helps veterans formalize their skills to get jobs, while strengthening Americans’ access to care.”

The funds will also be used to explore ways to award academic credit for prior military health care experience or training.

Read more about the new federal veterans/nursing program.

Elliott Fisher, MD, MPH, a health policy researcher and alumnus of the Robert Wood Johnson Foundation Clinical Scholars program (1983-1985), was recently named director of the Dartmouth Institute for Health Policy & Clinical Practice. Fisher coined the term “Accountable Care Organization” (ACO). In this Clinical Scholar Health Policy podcast, he discusses the origins of ACOs and the effort to develop them in the nation’s health care system. Watch his interview with RWJF Clinical Scholar Chileshe Nkonde-Price, MD, (2012-2014). The video is republished with permission from the Leonard Davis Institute.

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.