Category Archives: Advanced practice nurses
Nurses truly run the front lines of hospitals. Their leadership oversees every hospital quality initiative essential to improving care—from reducing hospital-acquired infections, to cutting unnecessary readmissions, to preventing patient falls.
Poor scores in these quality measures now result in government penalties that can hit hospitals hard.
And as health care evolves and hospitals stretch beyond their own walls, nurses are leading the programs that bring health care into communities. They are critical to the success of health reform as more Americans obtain health insurance and seek primary care.
So tell me something? Why is the highest level of hospital leadership in our nation nearly devoid of nurses?
Surveys find the number of nurses with voting positions on hospital boards is about 4 to 6 percent — an unfathomable statistic for anyone who understands, even a little, how hospitals work.
We need the leadership of nurses on every hospital board.
This week marks the 4th anniversary of the Institute of Medicine’s future of nursing report. Fran Roberts, PhD, RN, FAAN, is owner and executive leader of the Fran Roberts Group, a consulting and contracting practice providing expertise on health care leadership, higher education, governance, regulation and patient safety. The Kate Aurelius Visiting Professor for the University of Arizona College of Medicine–Phoenix, Roberts serves on the boards of directors of several health care organizations, including the Presbyterian Central New Mexico Health System. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive News Fellows program.
“Leadership from nurses is needed at every level and across all settings.” That’s what the Institute of Medicine’s (IOM) Future of Nursing panel wrote in its 2011 report—a message I’ve taken to heart. Here’s why the IOM was exactly right.
I’ve served (and still serve) on several health-related boards, in most cases as the only nurse in a group dominated by physicians, local business leaders, and administrators. My experience on the Presbyterian Central New Mexico Healthcare Services board, which I now chair, is both representative and instructive. I joined the board about eight years ago, recruited by one of my colleagues in the RWJF Executive Nurse Fellows program, Kathy Davis, RN, the senior vice president and chief nursing officer at Presbyterian.
It was an honor to be asked, doubly so because I live and work out of state. But Presbyterian had concluded that it needed a nurse with executive experience on its board, so I got the call.
I started my first term on the board determined not to pigeon-hole myself as “the nurse on the board.” I didn’t want my fellow board members to think I had tunnel vision, unable to see beyond the need to advocate for nurses. That’s not to say I didn’t intend to advocate for nurses when that was called for, but I didn’t want to be limited to that, either in my colleagues’ estimation or in reality.
The Robert Wood Johnson Foundation (RWJF) has announced the first 14 schools of nursing selected to receive grants to support nurses as they pursue their PhDs. Each of the inaugural grantees of the Future of Nursing Scholars program will select one or more students to receive financial support, mentoring, and leadership development over the three years during which they pursue their PhDs.
The Future of Nursing Scholars program is a multi-funder initiative. In addition to RWJF, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting grants this year.
The program plans to support up to 100 PhD nursing candidates over its first two years.
In its landmark future of nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates in order to support more nurse leaders, promote nurse-led science and discovery, and address the nurse faculty shortage. Right now, fewer than 30,000 nurses in the United States have doctoral degrees in nursing or a related field.
In addition to the National Nurses Week carnival on this blog, there is a lot of other information available online this year. Following are just a few examples:
- The Robert Wood Johnson Foundation (RWJF) Culture of Health Blog features a moving post by Brent Thompson, RWJF communications officer, who writes about the nurse whose intervention allowed his family to gather at his grandmother’s side for her final moments.
- The National Nurses Association offers a variety of resources, including a history of National Nurses Week and suggestions on how to celebrate it.
- Elsevier Publishing has prepared a three-minute video marking the week.
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 April issue.
Consumers Benefit from Expanded APRN Practice, FTC Says
In March, the Federal Trade Commission (FTC)—the government agency that works to protect consumers and prevent anti-competitive business practices—released Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses. It warns that barriers to advanced practice registered nurse (APRN) practice could reduce the kind of free-market competition in the health care industry that benefits consumers. The report also says APRNs play a “critical role” in alleviating shortages of primary care providers.
Building a Community of Nurse Scientists
Ann Cashion, PhD, RN, FAAN, has been hooked on the promise and potential of genetics and genomics in nursing since the first survey of the human genome was completed in 2000. She participated in the inaugural cohort of the Summer Genetics Institute at the National Institute of Nursing Research (NINR), and it changed the trajectory of her career. Now, 14 years later, Cashion is NINR’s newly appointed scientific director. She is also an alumna of the RWJF Executive Nurse Fellows program.
Margo Brooks Carthon, PhD, APRN, is an assistant professor in the School of Nursing at the University of Pennsylvania and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
The Federal Trade Commission (FTC) created quite a stir when it released a recent report in support of expanded scope-of-practice (SOP) regulations for advanced practice registered nurses (APRNs)1. Why after all, would the FTC—an agency charged with protecting consumers—take an interest in the regulatory woes of nurses?
Because unnecessary restrictions on APRN practice have the potential to undermine competition in the health care market and impede consumer access to care. That, at least, is the conclusion of the FTC, which released a policy paper making that argument in March entitled Competition and the Regulation of Advanced Practice Nurses.
The FTC aims to prevent unfair methods of competition and unfair, deceptive acts or practices in (or affecting) commerce. Overly restrictive SOP regulations on APRNs may be an example of anti-competitive conduct, the FTC argues, because they may prevent nurse practitioners (NPs) and other APRNs from entering the health care market as providers of care that patients need.
The report also argues that while SOP policies may be intended as a form of consumer protection, they may have the opposite effect. Decades of research link APRNs to safe, high-quality, and cost-effective care. That extensive body of evidence makes it difficult to support the many restrictive SOP regulations that are in place in many states.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
Nearly 450,000 new cancer patients are likely to have difficulty accessing oncology care in just over a decade, according to a report, “The State of Cancer Care in America: 2014,” released this month by the American Society of Clinical Oncology (ASCO).
The report is described by ASCO as the first-ever comprehensive assessment of challenges facing the U.S. cancer care system. It projects that new cancer cases could increase by 42 percent by 2025, but the number of oncologists will likely grow by only 28 percent, creating a deficit of nearly 1,500 physicians.
“We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals,” ASCO President Clifford A. Hudis, MD, FACP, said in a news release. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population.”
This is part of the February 2014 issue of Sharing Nursing’s Knowledge.
“As an ADN-prepared nurse returning to school, I have been confronted with the formidable gap between the current reality of professional nursing and the push to elevate the level and scope of practice in the face of a projected nursing shortage. I have no doubt that higher levels of education, certification, and experience have the potential to create better nurses and in turn safer environments for our patients, but I do have to question whether the infrastructure necessary to support these changes is in place.”
--Eric Deane, RN, Charlottesville, Va., Thoughts on Entry to Practice, Nurse.com, February 10, 2014
“As medical professionals we are recognizing that on a national level, advanced practice nurses [APNs] are part of the solution to the health care access crisis. The only way that patients are going to get the care they need is if all parts of the medical team, including APNs, midwives, physician’s assistants, physicians, and others, come together as partners. It’s not that nurse practitioners are going to replace any other clinicians. That’s not our goal. But advanced practice nurses are extraordinarily well prepared to provide primary care. They are trained in managing multiple types of health problems and in promoting a healthy lifestyle. With the current challenges in patient care, I can only see the role of the nurse practitioner increasing.”
--Ivy Alexander, PhD, APRN, FAAN, clinical professor and director of advanced practice programs, University of Connecticut School of Nursing, An Expanding Role for Nurse Practitioners, Medical Xpress, February 5, 2014
“More needs to be done to help spread awareness [about the Affordable Care Act]. This is one of the things nurses do best. They educate.”
--Mary Wakefield, PhD, RN, FAAN, administrator, Health Resources & Services Administration, Nurses Step Out to Help with ACA Enrollment, Nursezone.com, January 31, 2014
Kentucky Gov. Steve Beshear signed legislation last week that lifts a key limitation on advanced practice registered nurses (APRNs) and increases consumer access to health care.
The new law “allows more flexibility for nurse practitioners to provide accessible health care to Kentuckians,” Beshear said. “Nurse practitioners are a critical part of helping more Kentuckians get the medical care they need quickly and efficiently, and I am proud of the bipartisan effort to serve Kentucky’s health needs.”
In the past, APRNs were only allowed to prescribe medication with a physician’s written consent. The new law removes that requirement for APRNs who have four or more years of experience prescribing medication under a collaborative agreement with a physician or as an independent practitioner in another state, according to the Future of Nursing: Campaign for Action.