Category Archives: Careers
With all the changes in the country’s health care system, one thing has remained constant: nurses remain the nation’s most trusted profession.
Nurses topped Gallup’s annual survey as the profession most trusted by the public again last year. It was the 12th year in a row—and the 14th time in the 15-year history of the survey—that the public rated nurses as the most trusted profession.
Gallup conducted the survey in December. More than four in five respondents (82%) said “high” or “very high” when asked: How would you rate the honesty and ethical standards of people in these different fields – very high, high, average, low, or very low?
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.
The website Physicians Practice has released its annual Physician Compensation Survey, which for the third straight year shows that a majority of U.S. physicians view the income from their medical practice as “disappointing.” In 2013, 54 percent defined their net income this way, the same number as a year earlier, but 5 percent more than those who took the survey in 2011.
Physicians Practice surveyed 1,474 physicians and staff for the survey, asking about personal income, practice overhead, practice outlook, and other financial issues. For the first time, the survey acknowledged the shift from volume-based reimbursement to value-based reimbursement, asking respondents to share how much of their income is tied to factors other than the number of patients they see.
Thirty-three percent of respondents said a portion of their compensation is tied to value (quality and cost of care provided), with 8.5 percent of that group saying this was the only factor in their pay. Furthermore, 24 percent of respondents said a portion of their compensation was tied specifically to patient satisfaction.
However, productivity remained the dominant factor in physician compensation, with 28 percent of survey respondents saying that their entire compensation package was factored on productivity alone. Another 37 percent said it made up a portion of their annual pay.
This is part of the November 2013 issue of Sharing Nursing's Knowledge.
Creating Healthy Workspaces for Older Nurses
The nursing workforce is aging, in part because the nation's economic difficulties have prompted some nurses to delay retirement. A new literature review by Jaynelle Stichler, DNSc, NEA-BC, FACHE, of the San Diego State University School of Nursing, examines ways hospital work environments might be fine-tuned to help older nurses navigate the health challenges associated with their physically demanding work. The article was published online on October 17 by the Journal of Nursing Management.
Noting that Centers for Disease Control & Prevention data indicate that older workers' on-the-job injuries tend to be more severe than those suffered by younger workers, Stichler offers recommendations culled from 25 separate studies conducted since 2002. They include:
- Ergonomic seating and countertops with the correct height for charting tables, and adequate space for keyboards, in order to prevent strains caused by working in improper body positions;
- Adequate lighting and non-slip floor surfaces to reduce the risk of falling;
- Decentralized linen, equipment, and supply storage in or near patient rooms, and decentralized nursing stations, in order to diminish walking distances;
- Electrical and medical gas outlets placed on either side of the patients' beds and at an easily accessible height, rather than behind or above the head of the bed, so that nurses won't have to strain to plug in equipment;
- Enhanced task lighting options over beds or on swing arms to ease eye strain and help nurses with visual acuity problems; and
- Barrier-free patient bathroom and shower designs, with floor drains and shower curtains, so nurses needn't use towels to mop up water.
Clyde Evans, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program and president of CE Consulting in Needham, Massachusetts.
In 1995 I was getting “media training” with another colleague, consisting mostly of being interviewed on camera and then critiquing the tape. At one point the consultant stopped the taping of my colleague (a medical school dean) and said “we know you’re smart; we want to know what you’re passionate about.” Though I wasn’t asked at the time, I realized I couldn’t say (or didn’t know) what I was passionate about. I figured I’d better find out.
"It is not important what your particular mission is. It’s only important that you have one."
In pretty short order I came up with this: “I want to help ensure that every man, woman and child in the U.S. has a chance to live a healthy life.” That “personal mission statement” subsequently led me to the RWJF Health Policy Fellows program and guided me as a fellow, becoming a kind of “litmus test” for me: “How does (or could) X help to give people a shot at a healthy life?” If I could see that connection, I could care about whatever X was. While this dynamic was admittedly personal and idiosyncratic, it still helped me navigate several key decisions during my fellowship year.
One in three health care workers say they are likely to look for a new job in the next 12 months, according to a survey by Harris Interactive on behalf of the human resources and staffing company, Randstad Healthcare.
Among other findings from the survey:
- Fifty-four percent of health care workers believe they could find a new job in the next 12 months.
- About six in 10 health care workers “feel confident in the future of their employer,” and 81 percent feel secure in their jobs.
- More than a quarter of health care workers (26%) say the economy is getting stronger—a four percentage point increase from last quarter.
The survey includes online responses from 188 health care workers who are 18 or older.
The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni.
Arthur L. Kellermann, MD, MPH, has been named dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He comes to the U.S. Military Medical School from the RAND Corporation, where he was the Paul O’Neill-Alcoa Chair in Health Policy Analysis. Before that, Kellermann was at the Emory School of Medicine. Kellermann is an alumnus of both the RWJF Health Policy Fellows program and the RWJF Clinical Scholars program.
The American Academy of Nursing will induct 12 RWJF Executive Nurse Fellows and four RWJF Nurse Faculty Scholars into its 2013 “Class of Fellows,” which is among the most prestigious honors in the nursing profession. The Executive Nurse Fellows are: Margaret Baker, PhD, RN; Susan Bakewell-Sachs, PhD, RN; Gaurdia Banister, PhD, RN; Suzanne Boyle, DNSc, RN; Janie Canty-Mitchell, PhD, RN; Stephen J. Cavanagh, PhD, MS, MPA, RN; Margaret Flinter, PhD, APRN; Mary Ellen Glasgow, PhD, RN, ACNS-BC; Mary Lou Manning, PhD, RN, CPNP; Sandra Festa Ryan, MSN, CPNP, FCPP, FAANP; Sharon A. R. Stanley, PhD, RN; and Danuta M. Wojnar, PhD, RN. The Nurse Faculty Scholars are: Robert Atkins, PhD, RN; Jason Farley, PhD, MPH, CRNP; Joachim Voss, PhD, RN; and Shannon Zenk, PhD, MPH, RN.
The American Red Cross awarded two RWJF Executive Nurse Fellows its Florence Nightingale Medal: fellow Sharon Stanley, PhD, RN, and alumna Tener Goodwin Veenema, PhD, MPH, RN, CPNP, FNAP, FAAN. The award is the highest international distinction given to those in nursing and is given to “nurses who distinguish themselves in time of peace or war by their exceptional courage and devotion to victims of a conflict or disaster or exemplary service in the areas of public health or nursing education.”
Harold Amos Medical Faculty Development Program alumna Deidra Crews, MD, ScM, was named the 2013-2015 Gilbert S. Omenn Anniversary Fellow at the prestigious Institute of Medicine. Among her previous research is a study examining the association between unhealthy diet and kidney disease among low-income individuals.
Lynne Holden, MD, is president and chief executive officer of Mentoring in Medicine, Inc and a 2009 Robert Wood Johnson Foundation Community Health Leader. Based in the Bronx, N.Y., she has established an all-volunteer organization that encourages and nurtures disadvantaged students to enter the health professions. Mentoring in Medicine introduces students as young as first grade to a wide range of health professions and provides mentoring, academic enrichment, and leadership development to set them on the path toward health careers. In addition to personal contact with health professionals, students have opportunities to deliver health education in their communities. The movement Holden created motivates and supports nearly 6,000 students and engages nearly 500 health care professional volunteers.
As an Emergency Department physician, I owe all of my success to a number of mentors who were there to encourage, challenge, and remind me of what’s possible with a high degree of dedication and sacrifice.
Oddly, my first mentor was a television character: Marcus Welby, MD. I would rush home from school to see what types of patients Dr. Welby had to deal during the latest TV episode. I wanted to be just like him—smart, caring, and helpful.
Constant discussions about becoming a doctor led my father to give me a copy of “Gray's Anatomy”—a standard medical school textbook on human anatomy—for Christmas when I was 10. Constant talk at family gatherings led my aunt, who was a nurse, to allow me to meet a black female physician for the very first time. I met Dr. Muriel Petioni at the age of 12 and that began a lifelong mentoring relationship until her death in 2012 at the age of 96.
Gary H. Gibbons, MD, is director of the National Heart, Lung, and Blood Institute at the National Institutes of Health. He is an alumnus of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. This is part of a series of posts looking at diversity in the health care workforce.
Growing up in a predominantly African American neighborhood in Philadelphia, high blood pressure, strokes, and heart attacks were common. When I got to medical school, I asked one of my professors why the African American community tended to have a higher prevalence of these medical conditions. He introduced me to biomedical science for the first time and challenged me to pursue that question on my own. I've continued to look for the answer to that provocative question ever since.
Similar to that early experience, mentorship has been a determining factor in my career trajectory. I might not have pursued a research career at all if it hadn't been for Harvard Medical School professor A. Clifford Barger who inspired me to ask and answer difficult research questions. The Robert Wood Johnson Foundation’s Harold Amos Program pushed me further with their emphasis on mentorship, which gave me a sense of community with the many scholars interested in the same research problems. It was my experience with a National Institutes of Health T32 training grant when I was starting out as an investigator that inspired me to give back to a younger set of minority researchers by becoming a K Award mentor and leading a T32 program at Morehouse School of Medicine.
Felix German Contreras, 22, of Atlantic City, N.J., credits his 2012 participation in the Robert Wood Johnson Foundation-funded Summer Medical and Dental Education Program (SMDEP), and his teachers at the Yale University site, for opening new doors to opportunities. A naturalized U.S. citizen, Contreras emigrated to the U.S. with his family at age 6. He will graduate from Atlantic Cape Community College next year and plans to attend Yale School of Medicine. Started in 1988, more than 21,000 alumni have completed SMDEP, which today sponsors 12 university sites with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.
Living as an immigrant and student with only part-time employment is a daily battle. But I will never allow these challenges to slay my dreams. With so many struggles, I am often asked: “Felix, how do you do it?”
I cannot help but smile when I reply, as it is not a secret; nor do I believe it is a talent—it is simply a strong work ethic. I have realized the best things in life are the hardest to obtain.
My doors to new unexpected opportunities were opened when a late-night online search in 2012 led me to the Summer Medical and Dental Education Program. I applied and was accepted at the six-week program’s Yale University site. It was there where I met mentors and students with similar aspirations to improve communities through medicine. Not only did the intensive program place me on a sure-footed path toward a health sciences career, my English improved tremendously through rigorous reading and writing. You can’t believe how much six weeks can give someone who is eager to receive. SMDEP exposed me to countless possibilities on the other side.