This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

What policies optimize nurses' role in solving the shortage of primary care practitioners? What approaches will promote and incentivize interprofessional education and practice in health care so as to improve the quality and safety of care? What promising state and federal initiatives are likely to achieve the Institute of Medicine's recommendation to increase the proportion of nurses who hold a baccalaureate or higher degree to 80 percent by the year 2020?

These and other crucial issues confronting nursing and the health care system are the focus of the Robert Wood Johnson Foundation (RWJF) Charting Nursing’s Future policy briefs. Launched in 2005, the series now includes 20 briefs covering a range of topics, including:

• Unlocking the potential of school nursing;
• Expanding the nation’s capacity to educate nurses through state-level partnerships;
• Improving the recruitment and retention of older and experienced nurses as a way to stem the looming nursing shortage;
• Understanding the relationships among such issues as access, cost, payment systems,  and quality of care;
• Optimizing nurses’ role in closing the health care quality and safety “gap”;
• Addressing the nurse faculty shortage through public and private partnerships;
• Strengthening public health nursing;
• Driving policy change with data collected and analyzed by state nursing workforce centers;
• Easing the nursing shortage through government, school and employer collaborations; and more.

Cassandra Okechukwu, MSN, ScD, is an assistant professor in the department of social and behavioral sciences at the Harvard School of Public Health, and an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.

With the arresting title of “Why women can’t have it all,” Anne-Marie Slaughter’s Atlantic magazine article generated many discussions on the issues women face in balancing competing work and family demands. However, these discussions have not addressed the vast disparities in the types of work-family issues women face and the limited resources available to many working women. Also painfully missing from the discussion are the health implications of these competing work and family demands.

One group for which these issues cannot be separated is nursing home workers. Data from the Bureau of Labor Statistics (BLS) show that the majority of nursing home workers are drawn from racial/ethnic minority groups and low-income communities; as such, many face significant health disparities. For example, racial/ethnic minority and low-income populations have a disproportionate burden of diagnosis of several cancers that are related to adiposity—including cancers of the lung, esophagus, endometrium, colon and rectum, kidney, pancreas, gallbladder and thyroid.

Four in 10 physicians say their typical patient load “exceeds safe levels” at least once a month, causing the quality of care they provide to suffer, according to a study by researchers at Johns Hopkins University, published online in the Journal of the American Medical Association (JAMA). More than one-third of physicians (36%) reported their workloads exceeded safe levels at least weekly.

In the survey of more than 500 self-identified hospitalists in an online physician community, respondents said their workloads had caused patient care to suffer. Respondents reported that inadequate time with a patient had caused them to order potentially unnecessary tests or procedures, and that their workloads had “likely contributed” to a host of poor patient outcomes, including morbidity and mortality.

Among the other problems physicians attributed to excessive workloads: inability to fully discuss treatment options; delayed admissions and discharge; increased readmissions; worsened patient satisfaction; and worsened overall quality of care.

Read the study abstract.
Read more about the results in Medpage Today [free subscription required].

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. 

A survey of registered nurses by the health care staffing firm AMN Healthcare finds that roughly nine out of 10 nurses (91%) are satisfied with their career choice, up significantly from the firm’s 2011 survey.

Registered nurses’ job satisfaction has also increased in the last year. In the new survey, 66 percent said they plan to continue as they are (in career and job), compared to 55 percent who gave that answer in 2011.

Despite high levels of satisfaction, close to one-third of respondents plan to leave the profession or reduce their workload in the near future. Five percent of RNs say they are likely to retire now that the economy is beginning to recover (up from 3% in 2011).

The survey also finds that 40 percent of nurses plan to pursue further education in nursing in the next one to three years: 17 percent plan to pursue a BSN, 18 percent a master’s, and 5 percent a doctoral degree.

AMN Healthcare’s 2012 Survey of Registered Nurses was distributed via email to 88,288 RNs nationwide in April 2012.

Download the report here.

Twelve-hour nursing shifts cause higher levels of burnout and negatively affect patient care, according to a study published this month in Health Affairs.

Researchers from the University of Pennsylvania found that more than 80 percent of nurses working shifts of eight or more hours were satisfied with the scheduling practices at their hospitals, but “the percentages of nurses reporting burnout and an intention to leave the job increased incrementally as shift length increased.” Nurses who worked shifts longer than 8-9 hours were up to 2.5 times more likely to have burnout and job dissatisfaction.

Long nursing shifts also have consequences for patients. In hospitals with high proportions of nurses working long shifts, patients perceived worse care, both overall and in nursing-specific factors. Patients in these hospitals reported that nurses didn’t communicate well or respond quickly, and said their pain was not well controlled. For many patient outcomes, dissatisfaction increased as the proportion of nurses working longer shifts increased, the study says.

The researchers hypothesize that nurses may underestimate the impact of working long shifts because long shifts mean working fewer days a week, which may be appealing.

Accrediting bodies should consider policies for nurses—like those already in place for medical residents—limiting the number of hours they can work a week, the research team suggests, and boards of nursing and nursing management should monitor nurses’ hours and overtime, and promote a workplace culture that facilitates manageable work hours.

What do you think? Are long shifts good for nurses or patients? Is there a way to help nurses keep flexible schedules without compromising their job satisfaction and patient care? Register below to leave a comment.

Read the study abstract.

A report from the consulting firm Accenture finds a significant drop in physicians who practice independently, from 57 percent in 2000 to 39 percent in 2012. Business costs and expenses were the top concerns influencing physicians’ decision to seek employment (cited by 87 percent of survey respondents).

For those who remain independent, alternative business models are becoming more common. Accenture estimates that one-third of independent physicians will adopt subscription-based care models, like high-end concierge medicine and direct pay models.

“Doctors who convert to subscription-based models that shift the focus away from service volume will not only access greater financial rewards, but will also gain the flexibility to get back to the basics of patient care,” the report says. “Patients could also reap the rewards by gaining enhanced access to care at a service level they can afford.”

Accenture estimates that only 36 percent of physicians will be practicing independently by the end of 2013.  The survey of 204 physicians who represented an equal split of primary care and specialty physicians was conducted in May.

Read the report.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

Following the announcement of the 2012 RWJF Community Health Leaders, many media outlets have covered the awardees. Among them: Kay Branch, MA, in the Anchorage Daily News, Ifeanyi Anne Nwabukwu, RN, BSN, in the Washington Informer, and Fred Brason in the Winston-Salem Journal.

A 2004 Community Health Leader also was in the news: Rabbi Elimelech Goldberg was named one of People Magazine’s “Heroes Among Us” for his work with Kids Kicking Cancer, a nonprofit that uses martial arts therapy to empower young cancer patients and help them manage pain.

RWJF Physician Faculty Scholar Deverick J. Anderson, MD, MPH, and colleagues conducted a single-center pilot study that finds ultraviolet light kills more than 90 percent of pathogens, when hospital rooms are flooded with the light from a robotic device. "We are now performing a study to determine if use of the device can actually prevent patients from acquiring these infections in the hospital," Anderson told MedPage Today. The findings were presented at the IDWeek 2012 conference.

Ruchi S. Gupta, MD, MPH, also a Physician Faculty Scholar, did a Q&A with the Chicago Tribune offering guidance for parents of children with food allergies, especially on Halloween. Read a post Gupta wrote for the RWJF Human Capital Blog about her professional—and personal—experience with child food allergies.

Data from the Bureau of Labor Statistics shows that health care employment rose by 44,000 jobs in September.

Most of the gains were in ambulatory care services (+30,000 jobs), with much of the growth in outpatient care centers. Hospitals added 8,000 jobs, and nursing and residential care added 6,000 jobs. Over the past year, employment in health care has risen by 295,000 jobs.

September’s gains are the second largest for the health care industry in a decade, according to a brief from the Altarum Institute, and the strong showing drove the health sector share of total employment to a new high of 10.81 percent.

Read a news release from the Bureau of Labor Statistics.
Read the Altarum Institute brief.

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”