Janice “Nisa” Bruce is the director of San Juan College Department of Nursing in Farmington, NM.  She has a BA from San Francisco State University, a BSN from East Central University Oklahoma, and an MS from the University of Oklahoma, College of Nursing.  She has been in nursing higher education since 1988, and is completing her 20th year at San Juan College.

We began our New Mexico community college-university collaboration in late 2009 with the publication of a university-generated white paper articulating the Institute of Medicine (IOM) recommendations citing the need for more baccalaureate nurses to meet the health care needs of the 21st century. Of course to community college associate degree educators, that proposal smacked of the old entry level into practice argument that has divided nursing educators for decades. We gnashed our teeth, we complained to each other, we argued that the literature was flawed. Then we got busy. And the New Mexico Nursing Education Consortium (NMNEC) was born.

Little by little, over time, the pieces have fallen into place. 

Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association.  D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.

Words Matter

The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds.  ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.

The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College will graduate six scholars with certificates in health policy during Meharry Medical College’s 138th Commencement Exercise this weekend. Having completed the Center’s health policy education program, the scholars are poised to join the nation's leading health policy experts, researchers, and analysts. They will focus on caring for minority and underserved communities in their careers.

The graduating scholars are:

• Kevin Blythe, MSPH, School of Medicine
• Lamercie Saint Hilaire, School of Medicine
• Ashley Huderson, School of Graduate Studies and Research
• Brandon Morgan, School of Dentistry
• Rebbie S. Timmons, School of Graduate Studies and Research
• Nadia Winston, School of Graduate Studies and Research
  

Learn more about the scholars and what lies ahead for each graduate in the health policy arena.
Learn more about the RWJF Center for Health Policy at Meharry Medical College.

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.

You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.

Lynne M. Dunphy, PhD, FNP, is the founding nurse co-lead of the Rhode Island Action Coalition and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. She is a professor and associate dean of external affairs at the University of Rhode Island’s College of Nursing, where she also holds the Routhier Chair of Practice. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

At the University of Rhode Island, I teach a graduate course in health care policy. Rhode Island Lt. Governor Elizabeth Roberts recently spoke to my class about health reform, and I showed her around our college of nursing. As we walked through rooms with high-tech simulation equipment and other labs that imitate real-life practice, she raised a question that resonated with me: Are your students getting out into the community? This is where our health care needs of the future will be.

So many of our nursing students want to go into acute care, and I am concerned that they have not had enough exposure to the entire health care system. The following questions keep coming to mind:

• Do they learn enough about all the settings they could work in?
• Do they understand what their responsibilities and day-to-day activities would be in various settings, such as in a community health center or long-term care facility?
• Do they understand how to implement population-based care?  
• Are they ready for the challenging work of visiting patients in home care settings?  
• Are they truly prepared?

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.

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.

President Obama’s Fiscal Year 2014 budget proposal recommends a $20 million increase over previous budget proposals for the Title VIII Nursing Workforce Development Programs, the primary source of federal funding for nursing education.

“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” American Nurses Association (ANA) President Karen A. Daley, PhD, RN, FAAN, said in a statement.

According to the Center to Champion Nursing in America (CCNA), the $20 million increase will expand the pool of primary care Advanced Practice Registered Nurses through the Advanced Education Nursing Traineeship Program.  If enacted, and if the funding is sustained, the increase will produce an additional 1,800 primary care nurses over five years.

“The President's proposal to train 1,800 more primary care nurse practitioners would provide a much needed shot in the arm to our health care workforce,” said Winifred Quinn, MA, PhD, director of legislation and field operations at CCNA. “These new health professionals are key to boosting consumer access to primary and preventive care, and other innovative delivery system reforms we are counting on to improve quality and hold down costs.”

The ANA also applauded other health care investments in the budget, including funding for community health centers, new mental health programs, health reform implementation, medical research, and more.

Read ANA’s statement about the budget.
Learn more about Title VIII Nursing Workforce Development Programs.

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 RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other critically important nursing issues.  These are some of the stories in the April issue:

More Nurses Climbing Education Ladder
Over the last century, nursing education has shifted from hospital-based diploma programs to colleges and universities, which offer associate’s, bachelor’s, master’s, and doctorate degrees in research and practice. Today, enrollment in higher degree nursing programs is on the rise, according to a 2012 survey by the American Association of Colleges of Nursing. Read about RWJF scholars who are continuing their education, and what the Institute of Medicine says about a more highly educated nursing workforce.

In Indiana, Physicians and Nurses Work Together to Transform Nursing
In the Indiana Action Coalition, the partnership between physicians and nurses runs deep. “Nursing can’t change health care alone,” co-lead Kimberly Harper says, and many doctors, pharmacists, and other professionals she works with agree—and are championing the effort to advance nursing because they believe it will ultimately benefit patients. Improving interprofessional education and collaboration is a top priority for the group.

RWJF Scholar Pioneers Innovative Program to Help Low-Income Elderly Age at Home
Sarah Szanton, PhD, CRNP, an associate professor at the Johns Hopkins School of Nursing and an RWJF Nurse Faculty Scholar, has developed a program that sends teams of nurses, occupational therapists, and “handymen” to the homes of low-income, frail elderly participants for 16 weeks. After an assessment of all functional areas, the participant decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure levels. The program is having extraordinary success, helping seniors age in place and saving taxpayers money.

See the entire April issue here. Sign up to receive Sharing Nursing’s Knowledge here.