Category Archives: Education and training
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.
Efforts to increase the percentage of baccalaureate-educated nurses in West Virginia are getting a boost from a new online RN-to-BSN program at the University of Charleston (UC) in the state capital. The program, which will begin in the spring, will allow registered nurses (RNs) to complete requirements for a bachelor of science in nursing (BSN) degree in as little as 18 months.
The university’s president, Ed Welch, PhD, said in a news release that the program “answers an immediate need of West Virginia’s health care facilities. By completing their bachelor’s degree at UC in just 18 months, and continuing to work full time, nurses are able to advance their careers and better serve patients in the field.”
Robert Wood Johnson Foundation Executive Nurse Fellows program alumnus Duane Napier, MSN, RN-BC, formerly executive director of the West Virginia Center for Nursing, is the UC RN-BSN program coordinator. “We’ve had a great response since announcing the program,” Napier said in an interview. “It's the state's first online program that doesn't require any campus sessions, so it's truly designed for the working nurse.”
Newly minted physicians who train in underserved health facilities are much more likely to continue practicing in such facilities after completing their residency training, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, an independent research unit of the American Academy of Family Physicians (AAFP).
The study, “Do Residents Who Train in Safety Net Settings Return for Practice?,” found that up to half of medical residents who trained in rural health clinics, critical access hospitals, and federally qualified health centers—which serve most of the nation's uninsured and underinsured patients—returned to practice in those settings. The study is published in the December issue of Academic Medicine.
“Overall, between one-third and one-half of the residents we identified in any of these settings during training were also identified as practicing in these same settings after training,” writes Robert Phillips, MD, MSPH, and his co-authors.
This is part of the December 2013 issue of Sharing Nursing’s Knowledge.
Americans Favor Increased Access to Nurse Practitioners
A new telephone survey commissioned by the American Association of Nurse Practitioners (AANP) shows strong support for increased access to care provided by nurse practitioners (NPs).
Among the survey's findings:
- A large majority favors removal of requirements that NPs work only under the supervision of physicians. Sixty-two percent of respondents support allowing NPs to prescribe medications and order diagnostic tests without such supervision. Just 17 states and the District of Columbia currently grant NPs full-practice authority, according to AANP.
- An overwhelming majority of Americans back legislation making it easier to choose NPs as their health care providers. Seventy percent of respondents favor legislation to eliminate barriers preventing patients from choosing NPs.
- There is widespread familiarity with NPs. Eighty percent of respondents have either seen an NP or know someone who has. More than half (53 percent) say a family member has seen one.
"These results clearly confirm what we have known anecdotally for years: American health care consumers trust NPs and want greater access to the safe, effective services they provide," AANP Co-President Ken Miller said in a news release.
The telephone survey was conducted by The Mellman Group, a Washington, D.C.-based polling firm. Its margin of error is +/-3.1 percent at the 95-percent level of confidence.
This is part of the December 2013 issue of Sharing Nursing's Knowledge.
“Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future. The rise of nonphysician providers will enable more team care. Skilled health aides will monitor patients at home and alert a doctor if certain medical parameters decline. Nurses will provide wound care to diabetic patients, adjust medications like blood thinners and provide the initial management of chemotherapy side effects for cancer patients. ... Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care ... Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.”
-- Scott Gottlieb, MD, American Enterprise Institute, and Ezekiel J. Emanuel, MD, PhD, University of Pennsylvania, No, There Won’t Be a Doctor Shortage, New York Times, December 4, 2013.
“Let me put it this way, we have over 1,200 pre-nursing students. I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
-- Dwight Sweeney, PhD, California State University, San Bernardino, Nursing Students Being Turned Away Amid Faculty Shortage in Cal State System, Los Angeles Daily News, December 1, 2013
Mirroring national trends, the California State University (CSU) system is turning away qualified nursing school applicants due to faculty shortages, reports the Los Angeles Daily News, and CSU officials fear that the situation will worsen the nurse shortage in a state that already has one of the country’s lowest numbers of nurses per capita.
This fall, CSU Long Beach had a nursing program acceptance rate of 18 percent, having received 450 applications for 82 slots. CSU Northridge had a “very highly qualified” pool of 300 applicants but could only accept 60. CSU Chico had to turn down 86 percent of its fully qualified applicants, while CSU San Marcos turned away nearly 89 percent.
“Let me put it this way, we have over 1,200 pre-nursing students,” Dwight Sweeney, interim chairman of nursing at CSU San Bernardino, told the Daily News. “I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
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.
Beverly Malone, PhD, RN, FAAN, is chief executive officer of the National League for Nursing (NLN). She was recently elected to the Institute of Medicine. Last month, the NLN announced the launch of Accelerating to Practice, a new program designed to help new nurses move more seamlessly from education to practice. It is the inaugural program of the NLN's Center for Academic and Clinical Transitions.
Human Capital Blog (HCB): Why is Accelerating to Practice needed?
Beverly Malone: We've always known that there is a difference between how nurse educators view graduates of nursing programs and how nursing directors view graduates. But we never knew how deep the divide was. A recent survey showed that 90 percent of educators thought that nurse graduates were doing just fine, but almost 90 percent of directors felt that nurse graduates did not have the skills that were needed to practice. That kind of a divide is not a small one. It has so much to do with how care is delivered, and the League felt compelled to do something about it.
HCB: What explains the divide?
Malone: We don't talk enough to one another. There are some exemplars out there where educators and administrators are on the same wavelength, and they have worked very hard to ensure that graduates are prepared in a way to move quality patient care forward. But overall, that's not the picture throughout the United States.
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 essential nursing issues. These are some of the stories in the November issue:
For decades, experts have called for more team-based care but the movement has gained traction in recent years with more health professions schools incorporating interprofessional education into their coursework. Proponents say this kind of education will prepare students to practice in coordinated, well-functioning health care teams, which in turn will help meet increasing, and increasingly complex, patient needs. Officials in several professions are considering making interprofessional education and training a requirement for accreditation for health professions colleges and universities.