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 critically important nursing issues.  These are some of the stories in the February issue:

RWJF Scholars Work to Strengthen Rural Nursing
Remote communities like Crawford, Colo. and Chokio, Minn. now have improved access to local health care, thanks to programs that are offering distance education and other innovative ways to educate nurses. Suzan Ulrich, DrPH, CNM, FACNM, associate dean of midwifery and women’s health at Frontier Nursing University and an RWJF Executive Nurse Fellow, is just one of the RWJF scholars working to increase access to high quality nursing care in underserved and hard-to-reach rural areas. Several Partners Investing in Nursing’s Future programs—from Alaska to Wyoming to North Carolina—also are focused on improving care in rural communities.

RWJF Nurse Scientist Discovers New Health Benefits of Tai Chi
During her 15 years studying and practicing nursing in Hong Kong, Ruth E. Taylor-Piliae, PhD, RN, FAHA, learned firsthand about the health benefits of Tai Chi, a Chinese martial art involving slow physical movements, extended concentration, and relaxed breathing. A cardiovascular nurse scientist and RWJF Nurse Faculty Scholar, Taylor-Piliae was well aware of the health benefits of Tai Chi and wondered if the practice carried similar benefits for stroke survivors, a population she studies in her research. She conducted a study on the effects of Tai Chi in adult stroke survivors, often prone to losing their balance, and found that the practice may reduce falls.

A report completed this month by the Congressional Research Service (CRS), which conducts analysis for members and committees of Congress, examines how the Affordable Care Act (ACA) will affect the nation’s supply of physicians. In particular, the report focuses on the workforce’s size, composition and geographic distribution.

Size
The health care system cannot work effectively or efficiently without a physician workforce of appropriate size. Too few physicians means delayed care, and too many physicians can mean unnecessary or duplicate care. But measuring the size of the physician workforce—and the future physician population—is challenging, and estimates vary. The CRS report notes that “predicting the timing, content, and effect of policy change is difficult, which adds to the uncertainty of the projections.”

The ACA authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. It requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents. It also includes provisions designed to increase physician productivity and the volume of physician services available. The law encourages care coordination—in medical homes and accountable care organizations, for example—and expands the non-physician workforce that can augment or substitute for physician services.

Eileene Shake, DNP, RN, NEA-BC, is CEO of the Foundation for Nursing Excellence. The Robert Wood Johnson Foundation Human Capital Blog asked scholars and experts to consider what the election results will mean for health and health care in the United States.

The 2012 election is over and now, as health care leaders, we are trying to figure out how to move forward with implementing the Affordable Health Care Act (ACA).  Yes, there will be an influx of Americans entering the health care system who did not have access to health care in the past. The impact on nursing will be significant as nurses are being recognized as important to providing care to the large number of new patients entering the system.  Nurses will be key players working on interdisciplinary teams to redesign how health care is delivered. Nurses and advanced practice nurses will need to practice to the full extent of their education in order to care for the increased number of citizens entering the health care system.

There will be less resistance to implementing the ACA and more emphasis will be placed on how to implement it.  Hospitals are already putting processes in place to reduce readmission rates for patients with chronic disease.  New programs are being implemented to manage health care after the patient is discharged to reduce readmission rates. Nurses are following up with patients to ensure they are taking their medications, checking their blood pressure, and following their therapeutic diets. It is important to note that there will still be some resistance to implementing the ACA from states that do not feel they can afford to pay for the health care program. 

Large population centers like Las Vegas and Detroit are feeling the effects of the nation’s physician shortage, Bloomberg News reports, which is no longer limited to rural areas. Patients in populous urban areas are waiting weeks—or even months—or traveling to find the care they need.

Many factors are contributing to the shortage, including an aging physician workforce that is reaching retirement, and not enough new doctors in the pipeline to replace them and care for an influx of patients with increasingly complex health care needs.

Doctors also tend to stay near where they train, the story reports, creating poor distribution in states like Nevada that don’t have large medical schools or training hospitals. Census Bureau data shows that Nevada has the fifth-lowest ratio of doctors to patients in the country, behind Wyoming, Mississippi, Oklahoma and Idaho.

One possible solution: other health care professionals. “In a bid to address the shortage, the medical community has embraced the greater use of nurse practitioners and physician assistants, who can prescribe medicines and diagnose and treat many illnesses,” the story reports.

What do you think? What steps will convince physicians to practice in underserved areas? Register below to leave a comment.

Read the Bloomberg News story.

Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.

The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”

He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.

Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.

A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.

The Department of Health & Human Services (HHS) has awarded $9.1 million to medical students participating in the National Health Service Corps’ Students to Service Loan Repayment Program. In exchange for funds to repay their medical school debts, the 77 students in the pilot program commit to provide primary care services in communities with shortages of health professionals and limited access to care.

After their residencies, participants will spend three years full-time, or six years half-time, working in clinical practice in underserved or rural communities. They can receive annual student loan repayment funds of up to $30,000 while in the program.

The pilot program, created by the Affordable Care Act—the health reform law—aims to help alleviate a shortage of primary care professionals. “This new program is an innovative approach to encouraging more medical students to work as primary care doctors," HHS Secretary Kathleen Sebelius said in a statement.

Read more about the shortage of primary care providers and efforts to recruit primary care physicians in underserved areas.

Convincing a medical student, sometimes tens of thousands of dollars in debt, to take a lower-paying job or move to a low-income, rural community can be a tough sell. So perhaps it’s not surprising that many new physicians gravitate toward high-paying specialties or urban sprawls with modern-day conveniences. But with an aging population and millions of people poised to gain insurance coverage under the health reform law, the nation is in desperate need of general primary care physicians, particularly in rural and underserved areas.

Last week, NPR reported on a technique that one rural community has used successfully to recruit primary care providers – “mission focused medicine.” At the Ashland Health Clinic in southwest Kansas, CEO Benjamin Anderson is recruiting primary care providers not by pointing to all the advantages the community offers, but by highlighting its most severe needs. And to further appeal to prospective providers’ desire to do meaningful work, Anderson offers candidates eight weeks off to do missionary or other service work overseas. Anderson hopes to find providers who are engaged and motivated by the challenges associated with providing care in a rural community.

“When you recruit a mission-focused provider…,” Anderson said, “they want to know that there's no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there's need and that by them coming there, they would fill a disparity that would otherwise not be filled.”

Specialization also poses a challenge to building the primary-care workforce, the Washington Post reports. A medical resident who chooses a specialty over general primary care has the potential to earn millions more over a lifetime, making it an attractive option to the often deeply in debt medical student.

Last summer the White House launched the Primary Care Residency Expansion, providing financial support for three-year primary care residency training programs at 82 hospitals around the country. Participating residents are required to work in underserved areas. All of the 172 slots funded in the first year of the program have been filled, the story reports.

What do you think? How can we recruit more primary care physicians for general practice or in underserved areas? Register below to leave a comment.

Listen to the NPR story.

Read the Washington Post story.

The University of Kansas last month opened a new medical school campus in the rural town of Salina, to teach students the complexities of rural health care and, university leaders hope, to encourage physicians to practice in small, underserved communities after graduation.

The new school, three hours from the University’s main campus in Kansas City, plans to accept only eight students a year, and has offered it first class free tuition and monthly stipends to study there and start their careers in rural communities. Students will attend virtual classes, with video and podcasts streamed from the school’s other campuses, and will receive training in local doctors’ offices and at the hospital in Salina.

“It just makes sense, and it’s great that it’s been put into practice,” Alan Morgan, the president of the National Rural Health Association, told the New York Times. “From a rural policy perspective, this is big news.”

What do you think? Will going to medical school in a rural setting help encourage physicians to practice there? What other options should medical schools and policy-makers consider to recruit and retain health care providers in rural and underserved communities? Register for a Disqus account below to leave a comment and let us know what you think.

Read more about the Salina medical campus. Read about nursing solutions to advancing health care in rural America.

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the fourth in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars share their thoughts on the ideas presented. The author, Elizabeth A. Kostas-Polston, Ph.D., A.P.R.N., W.H.N.P.-B.C., is an assistant professor at Saint Louis University School of Nursing. Find out more about the forum or view the archived webcast.

Nearly one in four Americans—70 million people—live in rural America. On average, they are older, poorer, more likely to be uninsured, and suffer from higher rates of chronic health conditions.1

For the past 15 years, I have lived in south central Missouri, in a small town—population ~12,000 rural Americans. I am a nationally, board certified Women’s Health Nurse Practitioner and Colposcopist. In this role I participate by providing primary and specialty health care to rural, underserved and uninsured women who are often the target of Healthy People 2020 indicators. What’s more, the women I care for are not just faces in the crowd. They are my children’s teachers, colleagues’ wives and daughters, the lady who waits on me at the post office, the woman who rings up my groceries, my children’s friends, and my friends’ daughters—all of whom make up our community. It is no surprise, then, that the primary aim of my practice is to improve the health of women and their families. Improving the health of women and their families, in turn, positively impacts the health of our community.

As I listened to nurses such as the Honorable Mary Wakefield and Gail Finley share their thoughts regarding the challenges and opportunities that simultaneously exist as Nursing purposely and strategically moves to make its mark on the improvement of health care in rural America, I could not help but reflect on the numerous barriers which continue to interfere with my ability to practice to the full extent of my education, training, and competence.

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the third in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars share their thoughts on the ideas presented. The author, Laurie Theeke, Ph.D., R.N., is an assistant professor of nursing at West Virginia University in Morgantown, West Virginia, and her research emphasizes the development of interventions that target loneliness as a psychosocial stressor that impacts overall health. Find out more about the forum or view the archived webcast.

I recently had the opportunity to listen to the AARP Solutions Forum, “Advancing Health in Rural America – Maximizing Nursing’s Impact.” I was thrilled to be able to hear about the continuing emphasis on rural health care. As a native of Appalachia, a long-term resident of West Virginia, and a Clinical Nurse Specialist in Gerontology, I often think about how we could better serve our older adults who are living in poverty with limited resources and complex chronic illness.

As I listened, I thought about how attached many of my patients are to rural living in Appalachia. Nearly everybody in the region knows the words to this popular song, “Take me Home, Country Roads” and I kept thinking that it would be wonderful if health care was available and affordable for all rural residents without having to take the long country road back to a more urban area, particularly in the winter months.