Category Archives: Health Care Workforce
Lori Escallier, PhD, RN, CPNP, is a professor and associate dean for evaluation and outcomes at the State University of New York at Stony Brook School of Nursing. She is her university’s project director for a program that helps veterans earn baccalaureate degrees in nursing (VBSN) and for New Careers in Nursing, a program supported by the Robert Wood Johnson Foundation (RWJF) and the American Association of Colleges of Nursing (AACN) that supports second-career nurses in accelerated master’s and baccalaureate nursing programs.
Human Capital Blog: Please tell us about your university’s program for nursing students who are veterans.
Lori Escallier: The project is entitled Enhancing the Nursing Workforce: Career Ladder Opportunities for Veterans. The purpose is to increase the enrollment, retention and educational success of veterans in the baccalaureate nursing program at Stony Brook. Our program operationalizes the collaborative efforts of the Health Resources and Services Administration, the Department of Defense, and the Department of Veterans Affairs (VA) by providing opportunities for veterans to transition into nursing careers.
HCB: How is the VBSN program helping to build a Culture of Health that more effectively serves veterans?
Escallier: One of the project’s aims is to enhance the nursing workforce with veterans. Veterans certainly have a good understanding of the needs of other veterans and their families. Who better to promote a Culture of Health for veterans than those who have “walked the walk?”
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
DNP Programs Increasing
New research by the RAND Corporation, conducted for the American Association of Colleges of Nursing (AACN), finds that the percentage and number of nursing schools offering doctorates in nursing practice (DNPs) has increased dramatically in recent years, but that some schools still face barriers to adopting programs that confer the degree.
Ten years ago, AACN member schools endorsed a call for moving the level of preparation necessary for advanced nursing practice from the masters to doctoral level, establishing a target of 2015. More recently, the Institute of Medicine’s landmark report on the future of nursing called for doubling the number of doctorally prepared nurses in order to help meet the demands of an ever more complex health care system.
According to RAND’s data, nursing schools are following through. Since 2006, the number of schools offering DNP degrees has grown by more than 1,000 percent, from 20 schools in 2006 to 251 in 2013.
The report finds that approximately 30 percent of nursing schools with Advanced Practice Registered Nursing (APRN) programs now offer degree paths in which baccalaureate-prepared nurses move directly to DNP programs, and that such BSN-DNP programs will likely be in another fifth of nursing schools with APRN programs in a few years.
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
“As a nurse, I understand the risk that I take every day to go to work, and he’s no different than any other patient that I’ve provided care for. So I wasn’t going to say, ‘No, I’m not going to provide care for him. I didn’t allow fear to paralyze me. I got myself together. I’d done what I needed to get myself prepared mentally, emotionally, physically, and went in there.”
--Sidia Rose, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“...I grabbed a tissue and I wiped his eyes and I said, ‘You’re going to be okay. You just get the rest that you need. Let us do the rest for you.’ And it wasn’t 15 minutes later I couldn’t find a pulse. And I lost him. And it was the worst day of my life. This man that we cared for, that fought just as hard with us, lost his fight. And his family couldn’t be there. And we were the last three people to see him alive. And I was the last to leave the room. And I held him in my arms. He was alone.”
--John Mulligan, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“Someone asked a nurse, what do you make? I make sure your seriously ill father is cared for. I make sure that when you’re incontinent you’re cared for. It’s this everyday, profound yet intimate work that people do. People don’t understand it. It requires incredible cognitive and emotional intellect to do it. You are with someone at the most difficult and challenging and joyous moments of their lives.”
--Diana Mason, PhD, RN, FAAN, professor, Hunter-Bellevue School of Nursing and president, American Academy of Nursing, Nurses Want to Know How Safe is Safe Enough With Ebola, NPR.org, Oct. 14, 2014
With so many aspects of the nation’s health care system undergoing significant change, many of the nation’s nursing schools have implemented curricular innovations aimed at ensuring that new nursing graduates are fully prepared for the challenges they’ll face in practice. These include working collaboratively in teams, providing evidence-based care, managing chronic conditions, coordinating complex care, and promoting a culture of health—and much more transformation lies ahead.
According to the latest issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation’s (RWJF) issue brief series focused on the future of nursing, most clinical nursing education programs still emphasize hospital-based care, as they have for decades, even though much care has shifted to community settings. This results in a widening gap between clinical nursing education and the 21st-century competencies nurses need.
The brief highlights curricular innovations at a number of nursing schools around the nation, including re-sequencing of the curriculum, using a “concept-based” approach, a “coach model” supporting an online baccalaureate (BSN) degree, new types of academic/practice partnerships, and more. Increasingly, nursing schools are restructuring their students’ clinical experiences, embracing:
- Simulation, using actors posing as patients, complex high-fidelity mannequins, or virtual reality. A newly released and eagerly awaited study by the National Council of State Boards of Nursing (NCSBN) offers powerful support for the trend toward simulation. It found no differences in licensure pass rates or other measures of overall readiness for practice between new graduates who had traditional clinical experiences and those who spent up to 50 percent of their clinical hours in simulation.
Physician assistants (PAs) received high marks from patients in a recent survey conducted by Harris Poll for the American Academy of Physician Assistants (AAPA). Among 680 Americans (out of more than 1,500 surveyed) who have interacted with a PA in the past year, 93 percent see PAs as part of the solution to the nation’s shortage of health care providers; 93 percent regard PAs as trusted health care providers; and 91 percent agree that PAs improve health outcomes for patients.
“The survey results prove what we have known to be true for years: PAs are an essential element in the health care equation and America needs PAs now more than ever,” AAPA President John McGinnity, MS, PA-C, DFAAPA, said in a news release. “When PAs are on the health care team, patients know they can count on receiving high-quality care, which is particularly important as the system moves toward a fee-for-value structure.”
The AAPA points out that more than 100,000 PAs practice medicine in the United States and on U.S. military bases worldwide. A typical PA will treat 3,500 patients in a year, the association says, conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, prescribing medication, and assisting in surgery.
Swet Patel is a sophomore at the College of New Jersey, majoring in psychology. He is a graduate of Project L/EARN, a 10-week summer internship that provides training, experience and mentoring to undergraduate college students from socioeconomic, ethnic and cultural groups that traditionally have been underrepresented in graduate education. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
On May 27, 2014, I finally ended my teens and entered my 20s. But I will forever remember this date as more than just my birthday. This was the first day of Project L/EARN.
Like my peers entering the program, I expected to gain research exposure that would be a great résumé booster. Little did I know I would gain so much more than just research experience. Although the 10-week program was intensive, and at some points it made me question why I was doing it, I never imagined I would be able to achieve so much in such a short period of time. I realized after seeing the fruits of my labor—the poster, the oral presentation, and the paper—that this program was beyond worth it.
Project L/EARN boosted my confidence. I actually feel like a researcher. And it was truly remarkable that I was able to meet such diverse individuals from a wide range of fields during the guest lecture series. I learned a great deal from these esteemed professionals regarding the different aspects of health care. The networking the program provided gave me lifelong relationships that I will forever cherish.
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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.
For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Sam Willis, MD, a member of the 1995 class.
After completing medical school, Sam Willis decided his residency could wait. He wanted to see the world.
So he joined the Peace Corps and spent two years working as a health volunteer in Burkina Faso, one of Africa’s poorest countries. Living among the Burkinabé, in a mud-and-brick house with no running water, Willis learned the native language along with French. Every day, he hauled water back from a well so he could take a bath outdoors.
He talked to the villagers about sanitation, HIV/AIDS prevention, and ways to fight malnutrition. He helped set up a food bank to tide residents over during the summer dry seasons, when the rains stopped and they couldn’t plant crops.
When he came back to the United States, it was with a different worldview.
“Learning to speak another language opened up my mind to understanding how the world works,” says Willis, who today is an assistant professor at Baylor College of Medicine and practices family medicine in Houston, Texas, treating patients from disadvantaged communities.