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Linda H. Aiken, PhD, RN, FAAN, is the Claire Fagin Professor of Nursing, professor of sociology, director of the Center for Health Outcomes and Policy Research, and senior fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania. Olga Yakusheva, PhD, is an associate professor at the University of Michigan School of Nursing.
Four years ago the Institute of Medicine’s (IOM) landmark report on the future of nursing was released. The study was remarkable in multiple respects including the interdisciplinary perspectives of national experts comprising the study committee, the breadth and scope of the study, its actionable recommendations, and the commitment of the Robert Wood Johnson Foundation (RWJF) to provide philanthropic funds to help implement the study’s recommendations—a rarity. One net result of the IOM Report, as viewed on the 4th anniversary of its release, is its notable impact on the commitment of stakeholders to finally make the transition of the nation’s nurse workforce to BSN qualifications, after many decades of limited progress.
Changing trends in nurse employment and education: The IOM recommended that 80 percent of nurses in the United States hold at least a baccalaureate in nursing (BSN) by the year 2020. The recommendation was quite bold considering that two-thirds of new nurses still graduated with less than a BSN, despite numerous previous reports and commissions over decades recommending the BSN as the entry qualification for professional nurses.
While the percentage of nurses with bachelor’s and graduate education had been slowly increasing over time, when the IOM report was issued only about 49 percent of nurses held a BSN. However, the IOM’s recommendation, based upon a growing research base documenting that patient outcomes were better in settings that employed more BSN-qualified nurses, acted as a tipping point to mobilize responses from many stakeholders that together are impacting changes in nurses’ qualifications.
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 related to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the June 2014 issue.
Campaign for Action Is Chalking Up Successes that Will Improve Patient Care
Three years after it launched, the Future of Nursing: Campaign for Action is making steady progress on nurse education, practice, interprofessional collaboration, data collection, and diversity, according to a series of indicators released last month. Led by RWJF and AARP, the Campaign has created Action Coalitions in all 50 states and the District of Columbia that are working to implement recommendations from the Institute of Medicine. “Because of the Campaign, there’s more awareness about the importance of preparing the nursing workforce to address our nation’s most pressing health care challenges: access, quality, and cost,” says RWJF Senior Program Officer Nancy Fishman, MPH.
Pioneering Nurse Scientist Addresses Asthma-Related Disparities
Kamal Eldeirawi, PhD, RN, a pioneering scientist with expertise in immigrant health, was born in the Gaza Strip in Palestine, where he saw the profound impact of poverty and disadvantage on health in his own community. A career in nursing, the RWJF Nurse Faculty Scholar believed, would allow him to make a difference at both the individual and population-wide levels. Today, Eldeirawi, is researching risk factors that contribute to asthma in Mexican American children living in the United States, and the effects of immigration and acculturation on children’s health.
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 April issue.
Consumers Benefit from Expanded APRN Practice, FTC Says
In March, the Federal Trade Commission (FTC)—the government agency that works to protect consumers and prevent anti-competitive business practices—released Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses. It warns that barriers to advanced practice registered nurse (APRN) practice could reduce the kind of free-market competition in the health care industry that benefits consumers. The report also says APRNs play a “critical role” in alleviating shortages of primary care providers.
Building a Community of Nurse Scientists
Ann Cashion, PhD, RN, FAAN, has been hooked on the promise and potential of genetics and genomics in nursing since the first survey of the human genome was completed in 2000. She participated in the inaugural cohort of the Summer Genetics Institute at the National Institute of Nursing Research (NINR), and it changed the trajectory of her career. Now, 14 years later, Cashion is NINR’s newly appointed scientific director. She is also an alumna of the RWJF Executive Nurse Fellows program.
Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America”[i] in September, 2012. The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with (1) rapidly expanding diagnostic and treatment options and (2) the increasingly complex and chronic clinical condition of patients. Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how “a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations.”
Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands. The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.
Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.
"We suggest that nurses should embrace rather than fear these innovations."
This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases. The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.
Here’s a sampling of recent news coverage of the work of Robert Wood Johnson Foundation (RWJF) Scholars and Fellows:
Craig Pollack, MD, MHS, an RWJF Clinical Scholars program alumnus, and Julia Lynch, PhD, an RWJF Investigator Award in Health Policy Research recipient and alumna of the RWJF Scholars in Health Policy Research program, coauthored an op-ed in the New York Times titled “Foreclosures Are Killing Us.” They write: “Foreclosure is not just a metaphorical epidemic, but a bona fide public health crisis. When breadwinners become ill, they miss work, lose their jobs, face daunting medical bills — and have trouble making mortgage payments as a result. But that is only part of the story. A growing body of research shows that foreclosure itself harms the health of families and communities.”
Craig Pollack was also one of several guests to join California Attorney General Kamala Harris on Southern California Public Radio to discuss a state investigation of banks accused of wrongdoing in the foreclosure crisis.
RWJF Scholars in Health Policy Research alumna Rene Almeling, PhD, is the author of a new study of the fertility market called “Sex Cells,” which has gotten significant media coverage. Most recently the research was noted by Proud Parenting and the Daily Beast. Almeling was also a guest on The Morning Buzz on WORT- FM.
RWJF Executive Nurse Fellows alumna Laura Anderko, PhD, RN, was interviewed by the Associated Press for a story about tainted food outbreaks, in light of the recent listeria outbreak in cantaloupe. Food Science Chef is among the outlets that printed the story, and Anderson’s comments made the Associated Press’ “Quotations of the Day.”
RWJF Harold Amos Medical Faculty Development Scholar Alfredo Quinones-Hinojosa appeared recently on C-SPAN, participating in a U.S. Chamber of Commerce-sponsored briefing on immigration policy.