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 the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the March issue.
Nurses Need Residency Programs Too, Experts Say
Health care experts, including the Institute of Medicine in its report on the future of nursing, tout nurse residency programs as a solution to high turnover among new graduate nurses. Now, more hospitals are finding that these programs reduce turnover, improve quality, and save money. Success stories include Seton Healthcare Family in Austin, Texas, which launched a residency program to help recent nursing school graduates transition into clinical practice. Now, three out of four new graduate nurses make it to the two-year point, and five or six new nurse graduates apply for each vacant position.
Iowa Nurses Build Affordable, Online Nurse Residency Program
Some smaller health care facilities, especially in rural areas, cannot afford to launch nurse residency programs to help new nurses transition into clinical practice. A nursing task force in Iowa has developed an innovative solution: an online nurse residency program that all health care facilities in the state—and potentially across the country—can use for a modest fee. The task force was organized by the Iowa Action Coalition and supported by an RWJF State Implementation Program grant.
One of the key recommendations in the landmark Institute of Medicine report on the future of nursing is to advance access to primary care by reducing barriers to practice for nurses. Implementation of this recommendation is now one step closer, thanks to a provision in President Obama’s budget proposal for fiscal year 2015, which was released this month.
Obama’s budget includes a provision that would extend an increase in Medicaid payments for primary care providers for one year at a cost of about $5.4 billion, according to an article in USA Today. The extension would, for the first time, apply to nurse practitioners (NPs) and physician assistants (PAs).
The Institute of Medicine recommended fixing this Medicaid “glitch” in its report on the future of nursing. The report is the foundation for the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform health care through nursing.
Obama’s budget proposal also calls for nearly $4 billion over six years to grow the National Health Services Corps (NHSC) from 8,900 primary care providers to at least 15,000 providers annually, starting in 2015, according to an analysis by the Campaign. Ten percent of the funding would be reserved for NPs and PAs.
Vanessa Grubbs, MD, MPH, is an assistant professor at the University of California, San Francisco, School of Medicine, and a scholar with the RWJF Harold Amos Medical Faculty Development Program. She is writing a book about what she calls the “sometimes irrational use of dialysis in America,” which will include a version of this narrative essay.
It is a Monday afternoon like any other and time to make my weekly rounds at the San Francisco General Hospital outpatient dialysis center. I push my cart of medical charts down the long aisle of our L-shaped dialysis unit and see Mr. Rojas, my dialysis patient for over a year now. He is in his mid-40s and slender, sitting in the burgundy-colored vinyl recliner. His blue-jeaned legs and sneakered feet are propped up on the extended leg rest. The top of his head shines through thinning salt and pepper hair. White earbud headphones peek through gray sideburns. He is looking intently at his Kindle, rarely glancing up at the activity around him.
I roll my cart up to his recliner, catching his eye. His right hand removes the earbuds as the left pauses his movie. He looks up at me, smiling. “Hola, Doctora. How are you?” he says with emphasis on the “are.”
“I am good. How are you doing?” I smile back at him as I grab his chart from the rack. I write down his blood pressure and pulse—both normal—and the excellent blood flow displayed on the dialysis machine. My eyes shift to his fistula, the surgically thickened vein robustly coursing halfway up his left forearm like a slithering garden snake. It is beautiful to me. Through it, Mr. Rojas is connected to the dialysis machine.
“I am good, Doctora. No problems. I feel healthy. Strong.” His brown eyes glint.
Nearly 450,000 new cancer patients are likely to have difficulty accessing oncology care in just over a decade, according to a report, “The State of Cancer Care in America: 2014,” released this month by the American Society of Clinical Oncology (ASCO).
The report is described by ASCO as the first-ever comprehensive assessment of challenges facing the U.S. cancer care system. It projects that new cancer cases could increase by 42 percent by 2025, but the number of oncologists will likely grow by only 28 percent, creating a deficit of nearly 1,500 physicians.
“We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals,” ASCO President Clifford A. Hudis, MD, FACP, said in a news release. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population.”
RWJF Scholars in the News: ADHD medication, reconstruction after mastectomy, care for returning veterans, and more.
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:
NBC News reports on a surge in the number of young adult women taking ADHD medication. An RWJF Investigator Award in Health Policy Research recipient, Stephen Hinshaw, PhD, explains that the rise in diagnoses among women in that age group may be evidence of failure to recognize the problem when the women were children. They may not have manifested symptoms as visibly as their male classmates with ADHD did, turning their distress inward rather than misbehaving in class, for example.
“How people with mental disorders are viewed by treatment providers and the general public can have a significant impact on treatment outcomes and the quality of life of clients,” Jennifer Stuber, PhD, and colleagues write in a study reported by Health Canal. The researchers presented vignettes about people with mental health problems to mental health providers and the general public, and compared their reactions. Providers had more positive attitudes, but some held views about the danger such patients might pose in the workplace that the researchers called “concerning.” Stuber is an RWJF Health & Society Scholars alumna.
More women are having breast reconstruction after mastectomies, USA Today reports. As a result of a 1998 federal law, most group insurance plans that cover mastectomies also cover breast reconstruction. Researchers found that the share of women who received reconstruction after mastectomy rose from 46 percent to 63 percent between 1998 and 2007. Author Reshma Jagsi, MD, DPhil, an RWJF Physician Faculty Scholars alumna, says the law could be contributing to the increase. The study was also covered by 9 News (Denver) and WKYC.com (Cleveland), among other outlets.
Ten years ago, a report from the Institute of Medicine (IOM) proposed a transformation of nurses’ workplaces, warning that “The typical work environment of nurses is characterized by many serious threats to patient safety.” The latest issue of the Charting Nursing’s Future policy brief series from the Robert Wood Johnson Foundation (RWJF) focuses on how much has changed in the intervening years, and how much remains to be done.
The new brief identifies a series of initiatives designed by and for nurses that have “spurred the creation of work environments that foster health care quality and patient safety.” Among them:
- The RWJF-backed Transforming Care at the Bedside (TCAB) initiative, developed in collaboration with the Institute for Healthcare Improvement, which seeks to empower frontline nurses to address quality and safety issues on their units, in contrast with more common, top-down improvement efforts. TCAB is now integrated with Aligning Forces for Quality (AF4Q), RWJF’s signature effort to improve the quality of health care and reduce disparities in targeted communities.
- Another RWJF-backed project, Quality and Safety Education for Nurses (QSEN), focuses on nursing school faculty, and has helped prepare thousands teaching in graduate and undergraduate programs to integrate quality and safety competencies into nursing school curricula.
- On the policy side, efforts have been made to further examine and improve the adequacy of nurse staffing. For example, a number of jurisdictions, including California, Illinois, Washington state, and Minnesota, have adopted standards that either require or encourage limits on how many patients a given nurse may be assigned to care for in acute care hospitals. Subsequent research has demonstrated an impact on hospital policies, but evidence of improvements in cost, quality, and safety is mixed so far.
- A number of institutions, including Vanderbilt University Medical Center in Nashville and The Johns Hopkins Hospital in Baltimore, have taken aim at disruptive behavior and professional discourtesy in the workplace, noting that, given the growing importance of teamwork and collaboration, the consequences of such misbehavior can be “monumental when patients’ lives are at stake.”
Robin Knobel, PhD, RN, is an associate professor at the Duke University School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2010-2013). The University of Carolina at Chapel Hill (UNC-CH) School of Nursing recently recognized her with its Distinguished Alumna award.
Human Capital Blog: Congratulations on the award! What does it mean for you and for your research?
Robin Knobel: I was truly honored to receive this award from UNC-CH because it recognizes my achievement thus far in my career in my area of research around improving thermal stability with premature infants. I was given great support as a doctoral student at UNC-CH through mentorship in research from faculty who are leaders as nurse scientists. To be recognized by alumni and faculty of the UNC-CH School of Nursing is a tremendous honor.
HCB: You received the award for your research into physiologic processes related to thermoregulation and perfusion in extremely premature infants. Can you explain what this means in lay terms?
Knobel: Yes. Premature infants are born too early to be able to keep themselves warm through the normal methods of heat production. Normally, infants up to one year of age do this through a metabolic production of heat, instead of shivering. Premature infants lack necessary components to accomplish efficient production of heat and consequently can become very cold if exposed to cold air after birth and through stabilization in the neonatal unit. They often experience hypothermic body temperatures during the early weeks after birth, which can lead to instability and possible lasting insults such as brain hemorrhage, infection, or even death. My research is studying the mechanisms around thermal stability in premature infants and ways to prevent bad outcomes from hypothermia.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
It took Arnold S. Relman, MD, one of the nation’s foremost medical thinkers, nine decades and a full-blown medical catastrophe to fully appreciate the value of nurses, according to an essay he penned in the Feb. 6 edition of the New York Review of Books.
Relman, 90, a doctor, a professor emeritus at Harvard Medical School, and a former editor of the New England Journal of Medicine, learned this lesson the hard way: as a patient. Last summer, Relman fell down the stairs and suffered life-threatening injuries—and discovered the critical role nurses play in health and health care during his lengthy recovery.
He shared his late-in-life epiphany in his recent essay: “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled,” he wrote. “This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”
Relman’s remarks spawned a surprise reaction from Lawrence K. Altman, MD, who begged the following question in a post on the New York Times Well Blog: “How is it that a leading medical professor like Dr. Relman—who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard—might not have known about the value of modern-day Florence Nightingales?”
What do you think? Do medical educators and scholars fully appreciate the contributions nurses make? Register and leave a comment.
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As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.
The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.
The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.