Category Archives: Education and training
In the last 15 years, the availability of high-fidelity simulation has slowly begun to transform the clinical education of the nation’s nursing students. Schools that once relied on the combination of classroom education and hands-on experience in a clinical environment began to mix in time in a simulation lab, where nursing students could work with highly sophisticated mannequins able to display a range of symptoms and react in real-time to treatment.
Such simulation labs offer many advantages to nurse educators, including the ability to replicate a range of patient situations, thus allowing students to practice specific nursing skills without having to practice their budding skills on actual patients.
But how effective are simulators at training the next generation of nurses? That’s a question that the National Council of State Boards of Nursing (NCSBN) has a particular interest in answering, because the state boards it represents are asked with increasing frequency to permit nursing schools to replace on-the-ground clinical time with simulation.
In pursuit of an answer, NCSBN conducted a full-scale study, tracking 666 nursing students for two academic years, beginning in Fall 2011, and then for six months longer as they began their work in the nursing profession. During their nursing school experience, one-quarter of the students had traditional clinical experiences with no simulation, another quarter had 25 percent of their clinical hours replaced by simulation, and the remaining half had 50 percent of their clinical hours replaced by simulation. At various points during their training and subsequent work as nurses, all study participants were assessed for clinical competency and nursing knowledge.
The new Future of Nursing Scholars program has announced its first cohort of 16 nurse scholars who are receiving scholarships and other support as they pursue PhDs in nursing. The students were selected by schools of nursing that have received grants to provide those scholarships.
Each Future of Nursing Scholar will receive financial support, mentoring and leadership development over the three years of her or his PhD program. They are in the initial stages of selecting the topics for their doctoral research, which range from infection control in the elderly population to the impact of stigma on people with mental illness to the quality of life of children with implanted defibrillators.
In addition to the Robert Wood Johnson Foundation, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center and the Rhode Island Foundation are supporting the Future of Nursing Scholars grants to schools of nursing this year. The program is located at the University of Pennsylvania School of Nursing.
Deborah E. Trautman, PhD, RN, is the new chief executive officer of the American Association of Colleges of Nursing (AACN) and executive director of the Center for Health Policy and Healthcare Transformation at Johns Hopkins Hospital. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program (2007-2008).
Human Capital Blog: Congratulations on your new position as CEO of AACN! What are your priorities as CEO?
Deborah Trautman: AACN is highly regarded in health care and higher education circles for advancing excellence in nursing education, research, and practice. I am honored to have this unique opportunity to support the organization’s mission and move AACN in strategic new directions. As CEO, I will place a high priority on continuing to increase nursing’s visibility, participation, and leadership in national efforts to improve health and health care. I look forward to working closely with the AACN board, staff, and stakeholders to advocate for programs that support advanced education and leadership development for all nurses, particularly those from underrepresented groups.
HCB: What are the biggest challenges facing nurse education today, and how will AACN address those challenges?
Trautman: Nurse educators today must meet the challenge of preparing a highly competent nursing workforce that is able to navigate a rapidly changing health care environment. As the implementation of the Affordable Care Act continues, health care is moving to adopt new care delivery models that emphasize team-based care, including the medical (health care) home and accountable care organizations.
These care models require closer collaboration among the full spectrum of providers and will impact how health care professionals are prepared for contemporary practice. Nursing needs to re-envision traditional approaches to nursing education and explore how best to leverage the latest research and technology to prepare future registered nurses (RNs) and advanced practice registered nurses (APRNs). Greater emphasis should be placed on advancing interprofessional education, uncovering the benefits of competency-based learning, identifying alternatives to traditional clinical-based education, and instilling a commitment to lifelong learning in all new nursing professionals.
Carolyn Montoya, PhD, PNP, is associate professor and interim practice chair at the University of New Mexico College of Nursing and a recent graduate of the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing.
Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?
Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.
HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.
Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.
Health care workers who have not attained bachelor’s degrees will have an opportunity for expanded roles and upward mobility in the changing health care landscape, which emphasizes increased efficiency and lower costs, according to a new Brookings Institution report. Less educated workers can take on more responsibility for screening, patient education, health coaching and care navigation, the report says, freeing up physicians and other advanced practitioners to focus on more complex medical issues.
The report examines health care occupations with high concentrations of pre-baccalaureate workers in the nation’s top 100 metropolitan areas. Those workers in the 10 largest occupations—including nursing aides, associate-degree registered nurses, personal care aides, licensed practical and licensed vocational nurses, medical assistants, and paramedics—number 3.8 million, accounting for nearly half of the total health care workforce in those metro areas. (The report notes that, “in the near future, the registered nurse may not be considered a ‘pre-baccalaureate’ occupation, given the Institute of Medicine’s recommendation that 80 percent of RNs have bachelor’s degrees by 2020.)
A new report from the Institute of Medicine (IOM) criticizes an absence of transparency and accountability in the nation’s graduate medical education (GME) financing system, which was created in conjunction with the Medicare and Medicaid programs nearly five decades ago. The 21-member IOM committee behind the report says there is “an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME,” and it recommends “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
Because the majority of public financing for GME comes from Medicare and is rooted in statutes and regulations from 1965 that don’t reflect the state of health care today, the committee’s recommendations include a modernization of payment methods to “reward performance, ensure accountability, and incentivize innovation in the content and financing of GME,” with a gradual phase-out of the current Medicare GME payment system.
Charles D. Scales Jr., MD, MSHS, an alumnus of the Robert Wood Johnson Foundation/VA Clinical Scholars program (UCLA 2011-2013), is a health services researcher at the Duke Clinical Research Institute and assistant professor in the division of urologic surgery at Duke University School of Medicine. He is also assistant program director for quality improvement and patient safety for the urology residency training program at Duke University Hospital.
Young doctors training to become surgeons, also called surgical residents, are increasingly caring for patients in an environment that links quality, safety, and value to patient outcomes. Over a decade ago, the Institute of Medicine highlighted the need for improving care delivery in the landmark report, Crossing the Quality Chasm, suggesting that high-quality care should be safe, effective, patient-centered, timely, efficient (e.g., high value), and equitable. Just this week, the Institute of Medicine followed with a clarion call for training new physicians to participate in and lead efforts to continually improve both care delivery and the health of the population, while simultaneously lowering costs of care.
To support this imperative, the Accreditation Council for Graduate Medical Education, which accredits all residency training programs in the United States, mandates that all doctors-in-training receive education in quality improvement. Despite this directive, a number of substantial barriers challenge delivery of educational programs around quality improvement. Health care is increasing complex, driving residents to focus on learning the medical knowledge and surgical skills for their field. Patient care demands time and attention, which can limit opportunities to learn about quality improvement within the context of 80-hour duty limits. This barrier particularly challenges surgeons-in-training, who often spend 12 or more hours daily learning surgical skills in the operating room, leaving little time for a traditional lecture-format session about quality improvement. Finally, many surgical training programs lack faculty with expertise in the skills required to systematically improve the quality, safety, and value of patient care, since these skills were simply not taught to prior generations of surgeons.
The Robert Wood Johnson Foundation (RWJF) has announced the nine state “Action Coalitions” that will share $2.7 million to advance strategies aimed at creating a more highly educated, diverse nursing workforce. The nine states that are receiving two-year, $300,000 grants through RWJF’s Academic Progression in Nursing (APIN) program are California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington state. For each, this is the second two-year APIN grant and it will be used to continue encouraging strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees.
In its groundbreaking 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020. Right now, about half the nurses in the United States have baccalaureate or higher degrees.
Physicians who have both doctor of medicine (MD) and master of business administration (MBA) degrees reported that their dual training had a positive professional impact, according to a study published online by Academic Medicine. The study, one of the first to assess MD/MBA graduates’ perceptions of how their training has affected their careers, focused on physician graduates from the MBA program in health care management at the University of Pennsylvania.
The MD was more often cited as conveying professional credibility, while 40 to 50 percent of respondents said the MBA conveyed leadership, management, and business skills. Respondents also cited multidisciplinary experience and improved communication between the medical and business worlds as benefits of the two degrees.
“Our findings may have significant implications for current and future physician-managers as the landscape of health care continues to change,” lead author Mitesh S. Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, said in a news release. “A study published in 2009 found that among 6,500 hospitals in the United States, only 235 were run by physicians. Moving forward, changing dynamics triggered by national health care reform will likely require leaders to have a better balance between clinical care and business savvy. Graduates with MD and MBA training could potentially fill this growing need within the sector.”
The Robert Wood Johnson Foundation (RWJF) has announced the first 14 schools of nursing selected to receive grants to support nurses as they pursue their PhDs. Each of the inaugural grantees of the Future of Nursing Scholars program will select one or more students to receive financial support, mentoring, and leadership development over the three years during which they pursue their PhDs.
The Future of Nursing Scholars program is a multi-funder initiative. In addition to RWJF, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting grants this year.
The program plans to support up to 100 PhD nursing candidates over its first two years.
In its landmark future of nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates in order to support more nurse leaders, promote nurse-led science and discovery, and address the nurse faculty shortage. Right now, fewer than 30,000 nurses in the United States have doctoral degrees in nursing or a related field.