Category Archives: Education and training
A year ago this week, the Robert Wood Johnson Foundation (RWJF) convened an unprecedented meeting that brought together diverse leaders from community colleges around the country, the Tri-Council for Nursing, and RWJF’s Academic Progression in Nursing (APIN) initiative, which is fostering collaboration between community colleges and four-year university nursing programs to promote seamless academic progression for nurses. The meeting was organized to address concerns in the community college community about the recommendation in the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, that 80 percent of the nation’s nurses attain bachelor of science in nursing or higher degrees by the year 2020.
A paper, released today, reports on the proceedings of that meeting, including participants’ shared goal to ensure that community colleges continue their invaluable work to educate a new generation of nurses and diversify the nursing workforce; and to give all nurses opportunities to be lifelong learners who are well-prepared to provide high-quality care and promote health.
The paper includes an addendum that provides news and information about how nursing, health, education, government, business, and other leaders in nine states have made exciting progress in the last year in support of seamless progression for nursing students, as well as for nurses already in the workforce who wish to continue their education.
“While we did not solve every concern, the meeting was tremendously constructive, opening a dialogue, identifying numerous areas of strong agreement, and illuminating issues yet to be resolved,” said John Lumpkin, MD, MPH, senior vice president at RWJF. The Foundation “is determined that last year’s meeting be a beginning for a continuing, constructive dialogue that will advance the goals we all share.”
For the fifth consecutive year, the number of U.S. medical school seniors choosing internal medicine residencies has increased, according to 2014 data released by the National Resident Matching Program. However, at 3,167, the number is well below the 3,884 medical school seniors who chose internal medicine three decades ago, the internist-focused American College of Physicians (ACP) pointed out in a news release.
“While the number of U.S. medical students choosing internal medicine residencies continues in an upward trend, the exorbitant cost of medical education with the resulting financial burden on medical students and residents, along with problematic payment models and administrative hassles, are barriers to a career in general internal medicine and primary care,” ACP’s senior vice president for medical education, Patrick Alguire, MD, FACP, said in the release. “General internists and other primary care physicians are the heart of a high-performing, accessible, and high-quality health care system.”
Susan B. Hassmiller, PhD, RN, FAAN, is co-director of the Future of Nursing Scholars Program and senior adviser for nursing for the Robert Wood Johnson Foundation (RWJF). The Future of Nursing Scholars program’s call for proposals will close on April 15. It is open to schools of nursing with research-focused PhD programs. The schools that receive awards will select the scholars to support.
I started my nursing career at a community college. It was a terrific experience that left me as prepared as I could be for my beginning staff nurse role. I quickly discovered that I wanted and needed to know more, however, so I returned to school. Over the next several years, I earned a PhD in nursing administration and health policy. It was difficult but incredibly rewarding and has led to a career I could never have imagined when I started out, including serving as a faculty member at the University of Nebraska and George Mason University. That experience has made me want to “pay it forward”—to pay homage to the nurses who mentored and encouraged me on my journey.
Serving as co-director of the Future of Nursing Scholars program is part of my personal mission to help other nurses who want to follow the same path. It also is a big part of RWJF’s extraordinary, long-term support for the nursing profession, which advances the Foundation’s mission to improve health and health care, and build a culture of health in this country.
Supporting nurses seeking PhD degrees is tremendously important. Because nurses have vast experience working directly with patients and families, we are positioned to help make care safer, more accessible, and higher quality. In particular, PhD-prepared nurse scientists and researchers are in a unique position to identify solutions that make a real difference to patients and families. But, as the Institute of Medicine (IOM) noted in its landmark report, The Future of Nursing: Leading Change, Advancing Health, the country will need many more PhD-prepared nurses in coming years.
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.
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.
Adopting best practices from home-based hospice care in the inpatient environment can reduce suffering at the end of life, according to a study published in the Journal of General Internal Medicine. Researchers at the Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham said the study is the first to show that palliative care techniques usually used in home settings can have an impact on those who die in hospitals.
The Best Practices for End-of-Life Care for Our Nation’s Veterans (BEACON) trial was conducted at six Veterans Affairs Medical Centers from 2005 to 2011 and involved training more than 1,620 staff members in aspects of care for more than 6,000 dying patients. Although focused on veterans, the study can have a wider impact, researchers said, because most Americans will die in the inpatient setting of a hospital or nursing home.
“We only die once, and therefore there is only one opportunity to provide excellent care to a patient in the last days of life,” wrote lead author F. Amos Bailey, MD, director of the Safe Harbor Palliative Care Program at the Birmingham Veterans Affairs Medical Center, professor in the Division of Gerontology, Geriatrics and Palliative Care at the University of Alabama at Birmingham School of Medicine, and a 2000 Robert Wood Johnson Foundation Community Health Leader. “The keys to excellent end-of-life care are recognizing the imminently dying patient, communicating the prognosis, identifying goals of care, and anticipating and palliating symptoms. Since it is not possible to predict with certainty which symptoms will arise, it is prudent to have a flexible plan ready.”
Brenda Zierler, PhD, RN, FAAN, is a professor of behavioral nursing and health systems at the University of Washington in Seattle, where she focuses on interprofessional education in the health professions. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2008-2011). This post is part of the “Health Care in 2014” series, in which health leaders, as well as Robert Wood Johnson Foundation scholars, grantees, and alumni, share their New Year’s resolutions for our health care system and their priorities for action this year.
Over the last several years, health professional students at the University of Washington (UW) in Seattle have had numerous opportunities to participate in interprofessional education (IPE) events using a variety of pedagogical approaches, experiences, and technologies such as unfolding web-based cases, team-building exercises, simulated scenarios, mock codes, joint quality improvement placements, shadowing health professionals, and service learning in the community.
These activities are highly rated, and students typically provide positive testimonials about the importance of working together early in their training. Although the feedback provided by the students is overwhelmingly positive, I was concerned that the students were not fully understanding the rationale for these numerous IPE activities, which are logistically challenging to develop, implement, and evaluate.
I was recently invited to give a lecture to describe local and national IPE initiatives to pre-licensure students in a UW leadership class. These students had participated in two IPE events during one academic quarter. While standing outside of the classroom waiting for the first guest speaker to finish his PowerPoint lecture, I decided to abandon the lecture and instead to facilitate a discussion on the rationale for the IPE events.
Jane Kirschling, PhD, RN, FAAN, is president of the American Association of Colleges of Nursing and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This post is part of the “Health Care in 2014” series, in which health leaders, as well as Robert Wood Johnson Foundation scholars, grantees, and alumni, share their New Year’s resolutions for our health care system and their priorities for action this year.
2014 marks the 10th anniversary of the landmark study conducted by Linda Aiken, PhD, FAAN, FRCN, RN, and colleagues, which showed a strong connection between nursing education and patient outcomes. Published in the September 2004 issue of the Journal of the American Medical Association (JAMA), the study’s researchers found that patients experienced significantly lower mortality and failure to rescue rates in hospitals with higher proportions of baccalaureate-prepared nurses. In her analysis, Dr. Aiken stated that the study’s results “suggest that employers’ efforts to recruit and retain baccalaureate-prepared nurses in bedside care and their investments in further education for nurses may lead to substantial improvements in the quality of care.”
A High Priority for Action in 2014
Marsha Howell Adams, PhD, RN, CNE, ANEF, is president of the National League for Nursing (NLN), and senior associate dean of academic programs and professor at The University of Alabama Capstone College of Nursing. This post is part of the “Health Care in 2014” series, in which health leaders, as well as Robert Wood Johnson Foundation scholars, grantees, and alumni, share their New Year’s resolutions for our health care system and their priorities for action this year.
This past December, I was lucky to attend a holiday reception at the White House with Judith Halstead, PhD, RN, FAAN, ANEF, my immediate predecessor as president of the NLN. It’s one of the nice benefits of being president.
I have experienced the White House via public tours many times throughout the years, but this visit was very different. We were able to explore rooms that those on White House tours can only glimpse from the hallways. We could study the art on the walls and absorb a sense of the purpose, power, and passion of past and present leaders. The prospect of meeting the president and first lady created such an excitement in me that it almost took my breath away. No matter one’s political point of view, meeting our nation’s president, especially in the White House, is truly an honor and a privilege.
Given near-universal concern over rising health care costs, are new physicians being taught to keep costs in check?
Not enough of them, according to a research letter published in JAMA Internal Medicine in December. Lead author Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, and his research team analyzed survey responses from nearly 300 U.S. internal medicine residency programs. They found that fewer than 15 percent have curricula designed to teach residents to be more cost-conscious.
“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and his team wrote. Among 295 programs that responded to a questionnaire on cost-conscious care in a 2012 survey from the Association of Program Directors in Internal Medicine, 14.9 percent indicated that they had a formal curriculum in cost-conscious care; another 49.8 percent responded that they did not, but were working on it.