Category Archives: Interprofessional collaboration
The federal government announced late last year it would deliver $55.5 million in fiscal 2013 to programs designed to strengthen, diversify, and grow the health care workforce.
The bulk of the funds—82 percent, or $45.4 million—are targeted at nurses, the largest segment of the health care workforce.
The announcement came as welcome news to supporters of a national campaign backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform the nursing profession to improve health and health care.
Many of the grants support the Future of Nursing: Campaign for Action’s call for a more highly educated and more diverse nursing workforce and for more interprofessional collaboration among nurses and other health care professionals, according to Winifred Quinn, PhD, co-director of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF.
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.
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.
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.
Promoting Rigorous Interdisciplinary Research and Building an Evidence Base to Inform Health Care Learning, Practice, and Policy
By Mary D. Naylor, PhD, RN, FAAN, Marian S. Ware Professor in Gerontology, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing, and co-director of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative. This commentary originally appeared on the Institute of Medicine website.
The Institute of Medicine (IOM) established the Roundtable on Value & Science-Driven Health Care to accelerate the advancement and application of science to achieve the best possible health and health care outcomes and value for Americans. The work of the roundtable is predicated on the notion that our health care system must continuously learn from rigorous evidence in order to innovate and improve. To that end, it acknowledges and promotes the importance of identifying best practices in health and health care, developing and testing innovations, and—most importantly— promoting collaborative efforts.
This vision for improving health and health care is shared by the Robert Wood Johnson Foundation, which funds an innovative and unique initiative to improve patient care by examining the role nurses play in improving care quality: the Interdisciplinary Nursing Quality Research Initiative (INQRI). Mark Pauly of the University of Pennsylvania and I have had the great privilege of serving as co-directors of this program since its inception in 2005.
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.
Tracey L. Yap, PhD, RN, CNE, WCC, is an assistant professor at the Duke University School of Nursing, a John A. Hartford Foundation Claire M. Fagin Fellow, and a senior fellow at the Duke University Center for Aging and Human Development. With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), Yap and her co-investigators developed a cost-effective, nurse-led intervention that aimed to reduce the prevalence of pressure ulcers in long-term care facilities by increasing resident mobility through a musical prompting system specifically tailored to each facility. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
It started with a boombox and the Byrds.
Those are hardly the first things that come to mind when you think about pressure ulcers, also referred to as bed sores—the wounds that are caused by continuous, unrelieved pressure on the skin and that often develop in people who have impaired mobility. Yet that’s just how my husband, a physician who has a large population of patients in long-term care, inspired this research by suggesting that I pursue a grant related to this serious issue.
At one long-term care facility, my husband had a maintenance person use a boombox over the public address system to play “Turn, Turn, Turn” at two-hour intervals. It was a creative, simple, and fun way to remind staff to move patients, and it appeared to be effective in preventing pressure ulcers.
We were in Kentucky at the time, and I was teaching at the University of Cincinnati College of Nursing. When I took my husband’s suggestion and applied for an INQRI grant, it radically changed my life—and the lives of many long-term care residents—for good. In my PhD studies, I’d focused on occupational health, and the INQRI grant helped me apply that knowledge in a new way and ultimately led to my current work at Duke University.
This is part of the April 2013 issue of Sharing Nursing's Knowledge.
“A nurse practitioner may be in your future — if he or she is not already in your present. This is a kind of super-nurse, who’s gone through four years of nursing school plus at least two more years of training in diagnosing and treating disease. Nurse practitioners may specialize in women’s health, pediatrics or cardiac care ... I went to a superb nurse practitioner for years... When I had a complaint she considered beyond her expertise, out came her pad and the name of a specialist to call. Her accessibility was a big plus... Cutting health-care costs—and making health-care services more convenient for consumers—demands moving basic medical services away from hospitals and, in many cases, doctors’ offices. Sometimes we need a doctor; sometimes we don’t. A well-trained nurse practitioner can help point us in the right direction.”
-- Froma Harrop, Nurse Practitioners Can Help Save Big Health-Care Dollars, Columbus Dispatch, March 30, 2013
“I have watched my daughter, Sam, in action several times. She has volunteered for several years during the flu shot clinics at the health department. But her finest moments were the ones taking care of her dad while he was dying. The tenderness and careful attention she gave him was indescribable ... I imagine she gives that kind of care to all her patients. She has sat with families while they waited on their loved one to pass. She has encouraged dying people to go with confidence and poise. Going through it with her dad has given her a special love for helping the dying to die peacefully. Going the extra mile is important in any professional field. In the nursing field, it is the difference between being a nurse and being a great nurse. It just doesn’t hurt to do everything you can for a patient. And it could be the difference between life and death. Appreciate those hard working nurses. They have tough jobs.”
-- Anita Goza, Those Hardworking Nurses, Waurika News-Democrat, March 27, 2013
The impact and influence of INQRI’s work is explored in a special supplement of the journal Medical Care which published online this month. A blog carnival related to the supplement is now on the INQRI blog.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
A deceptively simple intervention has dramatically reduced the incidence of painful pressure ulcers among nursing home residents in Signature Healthcare facilities in Kentucky. Every two hours, music is played throughout the nursing homes, prompting staff to go and check on residents and either ensure that they move or help them to move. This effective and easy intervention is the result of a study funded by the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI), which has provided funding to 40 interdisciplinary teams of researchers to investigate the link between nursing and the quality of patient care.
INQRI is the first effort of this size and scope to identify both the ways in which nurses improve the quality of patient care and keep patients safe, and the contributions nurses make to saving lives and keeping patients safer and healthier. INQRI research teams have examined such issues as: depression in nurses; the impact of nurse-to-patient staffing ratios on infection rates and on patient mortality; children’s assessments of hospital nursing care; fall prevention; differences in patient outcomes between Magnet and non-Magnet hospitals; and more. Each team includes a nurse researcher and at least one researcher from another field, such as business, economics, medicine, social work, pharmacy, and psychiatry.