Category Archives: Interprofessional collaboration
Linda H. Aiken, PhD, RN, FAAN, is the Claire Fagin Professor of Nursing, professor of sociology, director of the Center for Health Outcomes and Policy Research, and senior fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania. Olga Yakusheva, PhD, is an associate professor at the University of Michigan School of Nursing.
Four years ago the Institute of Medicine’s (IOM) landmark report on the future of nursing was released. The study was remarkable in multiple respects including the interdisciplinary perspectives of national experts comprising the study committee, the breadth and scope of the study, its actionable recommendations, and the commitment of the Robert Wood Johnson Foundation (RWJF) to provide philanthropic funds to help implement the study’s recommendations—a rarity. One net result of the IOM Report, as viewed on the 4th anniversary of its release, is its notable impact on the commitment of stakeholders to finally make the transition of the nation’s nurse workforce to BSN qualifications, after many decades of limited progress.
Changing trends in nurse employment and education: The IOM recommended that 80 percent of nurses in the United States hold at least a baccalaureate in nursing (BSN) by the year 2020. The recommendation was quite bold considering that two-thirds of new nurses still graduated with less than a BSN, despite numerous previous reports and commissions over decades recommending the BSN as the entry qualification for professional nurses.
While the percentage of nurses with bachelor’s and graduate education had been slowly increasing over time, when the IOM report was issued only about 49 percent of nurses held a BSN. However, the IOM’s recommendation, based upon a growing research base documenting that patient outcomes were better in settings that employed more BSN-qualified nurses, acted as a tipping point to mobilize responses from many stakeholders that together are impacting changes in nurses’ qualifications.
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. Summaries of the first two webinars in the series are available here and here. The third webinar in the series focused on building an effective primary care team. Speakers included leaders from three primary care sites around the country that the LEAP program has deemed exemplars.
LEAP Director Ed Wagner, MD, MPH, began the webinar by framing the question for participants: Patients need multiple forms of contact across a primary care team, he observed. Given that, how does an organization build an effective team? How does an organization go from a collection of employees to a coherent, high-functioning team?
Charles Burger, MD, Medical Director Emeritus at Martin’s Point Health Care in Bangor, Maine, discussed the importance of recruitment and training.
He began by describing the members of Martin’s Point’s teams: a medical provider, practice administrator, collaborative care nurses, medical assistants, and care team patient service representatives.
The recruiting process is quite rigorous, he explained. “We invite the whole team in reviewing and selecting new team members,” he said. “Really what we are looking for are certain behavioral characteristics.” He said training is similarly rigorous: a six- to eight-week competency-based training period for each new team member, working one-on-one with a trainer and moving steadily through a number of modules. Each new team member moves through each module at his or her own pace, and move on when they demonstrate competence with the material in each module.
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.
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 August issue.
More Nursing Schools Preparing Students to Provide Team-Based Care
Several of the nation’s top nursing schools now require students to participate in at least one interprofessional education course or activity, reports the Future of Nursing: Campaign for Action. Experts have called for interprofessional education for decades, but more health professions schools are responding now because requirements are being written into health professions accreditation standards, says Barbara Brandt, PhD, head of the National Center for Interprofessional Practice and Education, a public-private partnership supported by RWJF, the U.S. Health Resources and Services Administration, and other organizations.
Physical Work Environment in Hospitals Affects Nurses’ Job Satisfaction, With Implications for Patient Outcomes, Health Care Costs
A study conducted by RWJF’s RN Work Project finds that a physical work environment that facilitates registered nurses’ efficiency, teamwork and interprofessional communication relates to higher job satisfaction. The study revealed that physical environment affected whether nurses could complete tasks without interruptions, communicate easily with other nurses and physicians, and/or do their jobs efficiently.
Ann H. Cary, PhD, MPH, RN, is dean and professor at the School of Nursing and Health Studies at the University of Missouri-Kansas City. She was a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow from 2008 to 2011.
Human Capital Blog: Congratulations on the grant from the Centers for Disease Control and Prevention (CDC) to support the creation of a national resource center for HIV prevention at the School of Nursing and Health Studies at the University of Missouri-Kansas City! What will your role be at the center?
Ann H. Cary: My role is to ensure that the new center has the institutional resources it needs to succeed. This translates into procuring space reallocation and furnishings; supporting personnel hires; consulting with the CDC grant leadership team to remove organizational barriers; assisting in solving any challenges to the center’s rollout; and telling the story about this project through institutional messaging to our community, the discipline of nursing, and to other stakeholders and partners.
HCB: What is your vision for the center?
Cary: That the National HIV Prevention Coordinating Resource Center grant results in a center that leads and coordinates products for providers and the communities they serve to ultimately improve the prevention and treatment of people living with, or at risk of, acquiring HIV.
HCB: The center will be housed at a school of nursing and health studies. Why is that important?
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
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.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
“There has been tremendous growth in the nurse-managed health clinics, especially prior to the Affordable Care Act implementation, but certainly also now. I would go as far [as] to say that we won’t have a successful implementation of the Affordable Care Act if we don’t utilize nurse practitioners in primary care roles.”
--Tine Hansen-Turton, MGA, JD, CEO, National Nursing Centers Consortium, Nurse-Led Clinics: No Doctors Required, Marketplace Healthcare, March 5, 2014
“A lack of representative educators may send a signal to potential students that nursing does not value diversity. Students looking for academic role models to encourage and enrich their learning are often frustrated in their attempts to find mentors and a community of support. Clearly, we have a mandate to support and encourage nurses from minority groups in their quest to seek advanced degrees and to assume leadership roles in nursing education.”
--Jane Kirschling, PhD, RN, FAAN, president, American Association of Colleges of Nursing, Diversity in Nursing Education, Advance for Nurses, February 26, 2014
“The question for every nurse and every hospital board is how you go about promoting transformational change in which the emphasis is not on transitory, isolated performance improvements by individuals, but on sustained, assimilated, comprehensive change of the whole ... this report offers one answer: nurse leaders knowledgeable about how information technology can help redesign practices so that they are standardized, evidence-based and clinically integrated, and reinforce the values of a caring culture.”
--Angela Barron McBride, PhD, RN, FAAN, author of The Growth and Development of Nurse Leaders, TIGER Releases Study Aimed at Enhancing Nursing Informatics Education, Advanced Healthcare Network for Nurses, February 24, 2014
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
In a Huffington Post Latino Voices blog, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, discusses obesity among Hispanic Americans and how parents can influence children’s behavior, particularly regarding physical activity. She also flags influences that impede efforts to improve health for Hispanic youth: “In the U.S., food advertising on Spanish-language television is more likely to promote nutritionally-poor food than English-language advertising, hindering Hispanic children.”
During months when low-income individuals have access to Earned Income Tax Credit benefits, they spend more on healthy food, according to a study by RWJF Scholars in Health Policy Research alumna Diane Whitmore Schanzenbach, PhD. The study suggests that people with low incomes also buy more healthy food when their income increases, reports the Wall Street Journal Real Time Economics blog.
Health care professionals could make a vital contribution to educating children about the dangers of gun-related injuries, according to a study by RWFJ Clinical Scholar John Leventhal, PhD. He told Fox News: “Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.”
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.