Category Archives: Health Care Workforce
This is part of the September 2014 issue of Sharing Nursing’s Knowledge.
“Changing cultural norms within the nursing profession will require efforts from all parties: from nursing graduates, in treating their colleagues with respect and raising awareness by reporting incidents; from nursing leaders, in leading by example to foster supportive behaviors and promote a healthy work environment; from health care institutions, in setting zero tolerance disciplinary policies and empowering staff to report on issues without fear of retaliation; and from academic institutions, in preparing students with conflict management skills to address situations as they arise.”
--Susan Sanders, DNP, RN, NEA-BC, vice president, Kaplan Nursing, Bullying a Rising Concern for New Nurses, U.S. News & World Report, September 3, 2014
“It is time to stop wringing our hands that there are inadequate MDs wanting to provide primary care service. There is a very synergistic way that medicine and advanced practice nursing can work together, capitalize on the strengths that each discipline brings to the table, and maximize the patient experience and the outcomes. This is a new model.”
--Rosemary Dale, EdD, professor of nursing, University of Vermont, New Health Care Model Tested in Burlington, Burlington Free Press, August 30, 2014
“The numbers speak for themselves. As the demographics change and more ethnically and racially diverse populations grow, there will definitely continue to be a need for health care providers who mirror these patients.”
--Eva Gomez, MSN, RN-BC, CPN, staff development specialist, Children’s Hospital in Boston, Push to Recruit Black, Latino Nurses, Washington Informer, August 27, 2014
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.
More than half of recently graduated physician assistants (PAs) had three or more job offers upon completion of their training, according to a report from the National Commission on Certification of Physician Assistants. The commission, which gathered data on 80 percent of the nearly 96,000 PAs working in the United States, calls the report—its first statistical profile of certified PAs—“the most comprehensive workforce data available anywhere about the PA profession.”
The 76,000 PAs surveyed are predominantly female (66%) and white (86%), with a median age of 38 in 2013. Three-quarters of the PAs practice in an office-based private practice or a hospital setting.
“It is not surprising to see that demand is high for certified PAs in the era of health care reform,” Dawn Morton-Rias, EdD, PA-C, the commission’s president and CEO, said in a news release. “The PAs who responded cumulatively see over 5 million patients a week and are well entrenched in the delivery of health care to patients across the nation. As newly insured patients increase and more baby boomers enter the Medicare system, demand for PAs will continue to surge as proven providers of quality care.”
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.
Health care workers who have not attained bachelor’s degrees will have an opportunity for expanded roles and upward mobility in the changing health care landscape, which emphasizes increased efficiency and lower costs, according to a new Brookings Institution report. Less educated workers can take on more responsibility for screening, patient education, health coaching and care navigation, the report says, freeing up physicians and other advanced practitioners to focus on more complex medical issues.
The report examines health care occupations with high concentrations of pre-baccalaureate workers in the nation’s top 100 metropolitan areas. Those workers in the 10 largest occupations—including nursing aides, associate-degree registered nurses, personal care aides, licensed practical and licensed vocational nurses, medical assistants, and paramedics—number 3.8 million, accounting for nearly half of the total health care workforce in those metro areas. (The report notes that, “in the near future, the registered nurse may not be considered a ‘pre-baccalaureate’ occupation, given the Institute of Medicine’s recommendation that 80 percent of RNs have bachelor’s degrees by 2020.)
Adefemi Betiku was a junior at Rutgers University when he noticed that he wasn’t like the other students.
During a physics class, he raised his hand to answer a question. “Something told me to look around the lab,” he remembers. “When I did, I realized that I was the only black male in the room.”
In fact, he was one of the few black men in his entire junior class of 300.
“There’s a huge problem with black males getting into higher education,” says Betiku, currently a Doctor of Physical Therapy (DPT) student at New York University (NYU). “That has a lot to do not just with being marginalized but with how black men perceive themselves and their role in society.”
U.S. Department of Education statistics show that black men represent 7.9 percent of 18-to-24-year-olds in America but only 2.8 percent of undergraduates at public flagship universities. According to the Pew Research Center, 69 percent of black female high school graduates in 2012 enrolled in college by October of that year. For black male high school graduates, the college participation rate was 57 percent—a gap of 12 percent.
Betiku’s interest in the issues black men face, especially in education, deepened at Project L/EARN, a Robert Wood Johnson Foundation-funded initiative with the goal of increasing the number of students from underrepresented groups in the fields of health, mental health and health policy research.
Peter Buerhaus, PhD, RN, is the Valere Potter Distinguished Professor of Nursing, director of the Center for Interdisciplinary Health Workforce Studies, and professor of health policy at Vanderbilt University Medical Center. He co-authored a new study in Health Affairs that found more nurses are delaying retirement, which is adding to the supply of nurses at a time when shortages had been projected.
Human Capital Blog: A decade ago, you forecast large shortages of nurses by the middle of this decade. That isn’t panning out yet. Why?
Peter Buerhaus: When we did the original research, which was published in 2000 in the Journal of the American Medical Association, we were using data that was available at that time, which was up to about 1997 or 1998. At the time, we observed that enrollment in nursing schools had dropped nearly 5 percent each year over the previous five years. Based on that and some other factors, our projections suggested that unless something big happened—namely that we would get a lot of new people to enter nursing to replace the aging and large number of retiring Baby Boomer registered nurses (RNs)—we would run into large shortages and the RN workforce would stop growing by around 2014 or 2015.
Now we’re seeing two new phenomena: First, there has been a great surge of interest in nursing since the mid-2000s, and this has been reflected in a dramatic increase in the number of graduates from associate- and baccalaureate-degree nursing programs. And second, RNs are, on average, spending more time in the workforce—about 2.5 more years than did their peers back in the 1980s and 1990s.
This is part of the August 2014 issue of Sharing Nursing’s Knowledge.
The TV is a funhouse mirror—at least when it comes to its portrayals of nurses.
That’s the view of Leah Binder, MA, MGA, president and CEO of the Leapfrog Group, a national organization that promotes quality and safety in hospitals, and a member of the Future of Nursing: Campaign for Action’s Champion Nursing Coalition.
In a recent essay in the Wall Street Journal’s The Experts blog, Binder says television medical shows badly distort everyday life in hospitals and health care facilities. “Tune to your favorite hospital drama and count how many characters are nurses and how many are doctors,” she writes. “More likely than not, you will find about 10 doctors for every one nurse. The reality is roughly the opposite: There are about 10 times more nurses than physicians in the hospital down the street from you. Most of what hospitals do is deliver expert nursing care.”
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:
RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.
In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.
A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.
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 July issue.
Nurses Lead Innovations in Geriatrics and Gerontology
As the nation becomes older and more diverse, and more people are living with chronic health problems, nurses are developing innovations in geriatric care. They are finding new ways to improve the quality of care for older adults; increase access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more. Nurse-led innovations are underway across the nation to improve care for older Americans.
Improving Care for the Growing Number of Americans with Dementia
By 2050, 16 million Americans—more than triple the current number—will have Alzheimer’s disease. RWJF Nurse Faculty Scholars are working now to get ahead of the problem. “We’re all well aware of our aging population and how we’re going to see more individuals with Alzheimer’s disease or some other form of dementia,” says alumna Elizabeth Galik, PhD, CRNP, who is researching ways to improve functional and physical activity among older adults with dementia.