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.

The full analysis is available at HRSA's website.

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”

Health care employment accounted for 10.74 percent of total employment in the United States in March, according to a report by the Altarum Institute. One out of every nine jobs was in the health care sector—an all-time high, the report says.

Bureau of Labor Statistics (BLS) March 2013 employment data show that health care employment rose by 23,000 jobs in March, and most were in ambulatory care. Health care has added 1.4 million jobs since the start of the recession in December 2007, the report says, while non-health employment has fallen.

The Altarum Institute is a nonprofit health systems research and consulting organization.

Read the report here.

An annual Physician Retention Survey from Cejka Search and the American Medical Group Association (AMGA) finds that medical groups had an average physician turnover rate of 6.8 percent in 2012, up from 6.5 percent in 2011 and the highest rate since 2005. The increased turnover correlates with the nation’s economic recovery; improvements in the housing market and recovery in stock prices may have made physicians more likely to move or retire, experts say.

The survey, which drew responses from 80 medical organizations that collectively employ more than 19,000 physicians, also finds that medical groups expect an increase in turnover in the coming year due to accelerating retirement and competition to hire and retain top physicians. Seventy-six percent of respondents plan to hire more primary care physicians in the next 12 months.

“The survey findings provide evidence that recruitment and retention continue to be major challenges for health systems,” Donald W. Fisher, PhD, CAE, president and chief executive officer of AMGA, said in a news release about the survey. “To rise to these challenges, medical groups are demonstrating remarkable leadership by investing in new staffing and delivery models, building and nurturing their teams in a strategic way, and making accountable care work for their patients and their communities.”

For the second year, the survey also asked about turnover among advanced practice clinicians, including physician assistants and nurse practitioners. That turnover rate in 2012 was 11.5 percent, essentially unchanged from the previous year.

Read more about the survey.

Bonnie Zima, MD, MPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1989-1991), published a study this month that appeared in a special supplement of Pediatrics with articles by RWJF Clinical Scholars on child health quality. Pediatrics is the official journal of the American Academy of Pediatrics. Zima is a professor-in-residence in child and adolescent psychiatry at the University of California in Los Angeles (UCLA) and associate director of the UCLA Center for Health Services & Society.

Human Capital Blog: Why did you decide to review the new child mental health quality measures?

Bonnie Zima: This paper was written to stimulate discussion about the need for a paradigm shift for quality measurement for children that more closely aligns research with the accelerated pace of quality measure development. 

These are exciting times for those who believe that the quality of child health care can be improved through measurement and public reporting. However, this direction also raises questions about how to improve our methods and data infrastructure to monitor the quality of care received in real-time and to link adherence to quality indicators to clinical outcomes that are meaningful to parents, child advocates, providers, agency leaders and policy-makers.

HCB: Why did you focus on child mental health?

Zima: We focused on child mental health care because quality measurement poses additional challenges that can be used as a stimulus to improve future measure development.

Some of the areas for future research include development of a stronger evidence base to support nationally recommended care processes in community-based populations; models of care coordination across multiple care sectors that often have discrete funding streams, such as specialty mental health, public health, education, child welfare, and juvenile justice; and the development of interventions that more flexibly align service delivery with children’s clinical needs, especially for those with co-morbid mental and physical health conditions.

Lori Melichar, PhD, is a senior program officer at the Robert Wood Johnson Foundation (RWJF).

On February 12, the Robert Wood Johnson Foundation launched a new website that can serve as a long-awaited repository for work we have funded over the last 10 years that invests in advancing the science of quality improvement (QI) research and evaluation.  We hope the website also provides the opportunity for researchers and other health care professionals engaged in QI work to access resources and to connect with colleagues with mutual interests.

The launch coincided with a virtual meeting on Advancing the Science of QI Research and Evaluation (ASQUIRE).  The group convened to hear findings from grantees of the Foundation’s Evaluating QI Training Programs Initiative (PQI). 

Meeting participants were tasked with thinking about how the website can best disseminate their work as well as collect, house and spread tools, frameworks, methods and models to assist those doing QI and those evaluating QI efforts. Grantees were joined by experts in QI research, practice and evaluation and a lively discussion (sometimes a debate) ensued. 

The grantees of the Robert Wood Johnson Foundation (RWJF) conduct pioneering and influential research that makes remarkable contributions to the field, and to the research and evaluation community at large. Each year, RWJF identifies the 20 most popular pieces of research on its website, and invites the public to vote for the five Most Influential Research Articles.

After a record-breaking vote – the most since the poll was launched in 2008 – the 2012 “Final 5” have been announced.

“One of the most important things that bring all of these winners together is that they’ve hooked a research issue to a social issue that’s much bigger than the article itself,” RWJF Vice President of Research and Evaluation, David C. Colby, PhD, said in a Q&A about the finalists. “They helped solve a piece of that puzzle for people.”

One of the “Final 5,” a study on physician wages in states with expanded scope of practice for advanced practice registered nurses (APRNs), was funded by the RWJF Initiative on the Future of Nursing. The study found that physician wages are not depressed when APRNs practice independently.

“In 2010, the Institute of Medicine report on the future of nursing recommended that advanced practice registered nurses should be able to practice to the full extent of their education and training,” co-author Patricia Pittman, PhD, said in an interview. “As we looked at the issue as researchers, we scratched our heads and tried to understand what the dangers were for primary care physicians, and whether there were economic interests at stake… We viewed this study as a first step towards building an evidence base around the economics of these reforms.”

In addition to reading their research, this year you can read personal interviews with the grantees, where they share their motivation for the studies, key findings, examples of visibility and influence, and lessons that might be valuable to other researchers who want to maximize the impact and reach of their work.

Read more about the "Final 5."
Read the Q&A with David C. Colby.

Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.

I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.

Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.

The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.

Nicholas Stine, MD, and Dave Chokshi, MD, MSc, writing on behalf of the New York Academy of Medicine Primary Care and Population Health Working Group.

The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the fourth of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.

The Role of Primary Care and Clinical Incentives: Most discussants agreed that primary care and the patient-centered medical home (PCMH) movement are important foundations upon which to build broad-based population health activities. While acknowledging that these systems are already over-burdened with clinical responsibilities—and that current incentive structures are poorly aligned to accomplish this goal—many cited the degree of overlap in the missions of primary care and public health institutions as a starting point.

Community Care of North Carolina (CCNC), for example, evolved slowly and steadily over 25 years from a clinical quality network to a statewide multi-sectoral public-private partnership based on the PCMH. Allen Dobson, MD, described the key components as: the formation of cooperative provider networks; introduction of population management tools; case management; and data infrastructure with rapid feedback to providers. “Community Care is bottom-up and physician-led with respect to quality improvement…but because the collaboration includes the public health department, we are also looking at population metrics regardless of whether or not we’re managing that population.” Financing is organized using flexible per-member-per-month allotments that allow networks to put resources into quality measurement.  Dobson cited external evaluations demonstrating that the overall project is cost-saving, with CCNC responsible for nearly $1.5 billion in lower costs from 2007-09.

Lori Melichar, PhD, is a senior program officer at the Robert Wood Johnson Foundation (RWJF). 

The Robert Wood Johnson Foundation’s mission is to improve the health and health care of all Americans. In pursuit of this mission, we seek to improve the quality of care provided in hospitals, ambulatory care centers, public health departments, and other settings where health is enhanced or health care is delivered.

Within the past 15 years, Quality Improvement (QI)—the process-based data-driven approach to improving the quality of a product or service through iterative action-evaluation cycles—has emerged as a promising strategy to accomplish this goal, and RWJF funded several national programs to “demonstrate” the potential of QI to improve health care processes, staff engagement and patient outcomes.  The Foundation’s Pursuing Perfection Program, which had as its goal to help hospital and physician organizations improve patient outcomes dramatically by pursuing perfection in major care processes, employed QI tools such as Plan-Do-Study-Act cycles and improvement collaboratives to accomplish this goal.  Another program, Transforming Care at the Bedside, taught frontline nurses the skills and methods of QI and empowered these staff to engage in activities to transform hospital care.  Paths to Recovery is an RWJF program that used QI processes to improve the systems of care that provided substance abuse treatment. Aligning Forces for Quality  is RWJF’s signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities, and provide models for national reform.