Category Archives: Nurses and Nursing
Laren Riesche, MSN, RN, is a nursing PhD student at the University of Illinois at Chicago. With clinical experience in neonatal nursing, her research focuses on the role of the placenta in fetal programming and its effect on health and disease throughout the life span. She is a Robert Wood Johnson Foundation (RWJF) New Careers in Nursing alumna and an RWJF Future of Nursing Scholar.
I have been extremely fortunate to have had great leadership development opportunities throughout my nursing education, thanks in part to the Robert Wood Johnson Foundation (RWJF). I have been privileged to be selected for two RWJF nursing education scholarship programs which are not only helping build my leadership skills, but also shaping my perspective on the importance of nurse leaders.
I am one of 16 nurses in the inaugural cohort of the Future of Nursing Scholars program, which supports nurses earning their PhDs. This August, we all participated in a leadership development workshop that was part of the very first scholars’ Boot Camp. The event was intended to help us prepare to complete our nursing PhDs in three years.
One of the activities involved choosing and then discussing a picture that represented our fears; we chose from more than 200 picture-cards that bore a wide range of images, from nature scenes to cityscapes, family events to individual athletes, and everything in between. I chose a picture of a koala bear hanging out in a tree. What I saw was a koala, all alone with nothing to hold onto but a single tree branch. It tapped into my fear that I was throwing everything I had into my PhD program, pushing my family and friends away, and losing myself in order to stay focused on finishing in three years—and maybe, in the end, the only thing I would have to hang onto was my degree.
If we want to create a Culture of Health in America, a 2015 priority must be to focus on ways to break down the barriers that separate us and keep us from being as effective and efficient as possible. Currently, health care systems, education, housing, and public health work in siloes; they are funded in siloes, and workers are trained in siloes. Yet, people’s concerns and lives are not siloed and a community health culture/system cannot be either. One of the places to begin coordinated cultural change is in schools.
Schools are a smart choice to target because nearly 98 percent of school-age children, in their formative years, attend school and schools provide access to families and neighborhood communities. The Department of Education’s Full-Service Community Schools Program and Whole School, Whole Child, Whole Community Initiative reminds us that, in order for children to be educated, they need to be healthy and there must be a connection between school and community.
There are many school health initiatives in place, such as healthy food choices, physical fitness, healthy policies, school health services, community support, and after-school programs. The potential is there—but so are the siloes. But when schools are appropriately staffed with school nurses, the nurses help break down the siloes; that is because school nurses are extensions of health care, education, and public health and thus can provide or coordinate efforts to ensure a holistic, resource efficient, healthy school community.
Tatiana Sadak, PhD, PMHNP, is an assistant professor at the University of Washington School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016). She is working to promote “dementia caregiver activation,” a process of preparing caregivers to become ready to manage the multiple needs of loved ones with dementia while caring for themselves.
The well-documented personal and societal burdens of dementia are the central focus of the National Alzheimer’s Plan, which calls for extensive reforms in the delivery of health care for patients with dementia and their family caregivers. RWJF answered this national call to action by funding several innovative dementia health services research projects and nurturing the careers of junior dementia researchers.
I was fortunate to receive RWJF Nurse Faculty Scholars funding. It will make it possible for me to focus a majority of my time on improving health services for people living with dementia and for their family care partners—or ‘caregivers.’
Dementia patients suffer brain failure that leads to progressive loss of autonomy and the inability to understand and meet personal health care needs. Clinicians conduct health assessments, create care plans, and treat symptoms, but it is dementia family caregivers who deliver the day-to-day care and health management these patients need. There is, however, considerable variation in their capacity to assist care recipients in making health care decisions, for providing daily care, and for navigating health care systems.
Barbara Bricoli, MPA, is executive director of Nurses Improving Care for Healthsystem Elders (NICHE), an international program based at New York University’s College of Nursing that is designed to help improve the care of older adults. The program was developed by Terry Fulmer, PhD, RN, FAAN, chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
The rapid expansion of the aging population is a national concern. Nearly 20 percent of the U.S. population will be over age 65 by 2030, according to the U.S. Administration on Aging. And our aging population will place a heavy burden on our health care system; older adults, in fact, are hospitalized at three times the rate of the general population.
Yet health care providers lack adequate training in geriatrics and gerontology to care for older patients. Nurses Improving Care for Healthsystem Elders (NICHE) is working to change that.
Based at New York University’s College of Nursing, NICHE aims to better enable hospitals and health care facilities to meet the unique needs of older adults and embed evidence-based geriatric knowledge into health care practice. Hospitals and organizations that adopt NICHE report improved outcomes, decreased lengths of stay, better patient and staff satisfaction levels, and higher success in building systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
“I knew that if something were to go wrong, the nurse was just a phone call away. It made me feel so empowered to take care of my child myself.”
--Camille Wallace, LPN, How Nurses Can Help Low-Income Mothers and Kids, The Atlantic.com, January 14, 2015
“There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply. All the shortage of care at the bedside has to do with [is] how much hospitals want to pay nurses, and whether they want to use their resources on something else.”
--Linda Aiken, PhD, RN, FAAN, director, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, More Nurses are Better for Patients. Why is it so Hard to Get Hospitals to Hire Them?” The Washington Post, January 13, 2015
“Drivers of the shortage include an aging nursing workforce, increased number of people receiving health care via the Affordable Care Act along with increased number of people living with complex, chronic disease that requires care. Nursing provides a diverse array of opportunities from health care and bedside nursing to advanced practice nursing to positions for nurses in the business world.”
--Laura Rooney, DNP, APRN, director, UT Health Services, University of Texas Health Science Center, Outlook for Nursing Jobs Continues to Look Positive, Houston Chronicle, January 9, 2015
Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation (RWJF).
By 2050, as many as 84 million Americans will be 65 or older, and most of them will need some sort of help in maintaining their health and well-being. For them, and for the millions of younger Americans who will need similar assistance, it’s essential that we come to grips with the challenge of providing effective and affordable long-term services and supports (LTSS).
As it stands right now, we’ve got a long way to go. But the effort is under way, and nurses are at the forefront. At more than 3 million strong, the nursing workforce will be central to meeting growing demand for LTSS. In addition to providing clinical care, nurses can assess the long-term health prospects of individuals with physical and cognitive impairments, develop customized care plans, monitor individuals’ responses to care, coordinate care across providers and settings, and oversee the quality of the assistance older adults receive.
- Transitional Care. The Central New Jersey Care Transitions Program (CNJCTP) is one of a number of sites taking part in the Affordable Care Act-funded Community-Based Care Transitions Program. Six hospitals in the CNJCTP region work with registered nurses (RNs) and social workers, who together act as health coaches to teach self-care strategies to high-risk, chronically ill Medicare beneficiaries. Registered nurses (RNs) focus on beneficiaries’ symptoms and health care needs, including medication management, while social workers attend to socioeconomic needs that may lead beneficiaries to return to the hospital. Coaches visit patients in their homes within three days of discharge, facilitate a follow-up visit with a primary care provider, and follow up by phone for a month after discharge.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
Study: Night Shift Work Hazardous to Your Health?
A new study finds that female nurses working rotating night shifts for five or more years have a higher risk of death from cardiovascular disease and lung cancer than those who do not work such hours.
A team of researchers led by Eva Schernhammer, MD, DrPH, began with longitudinal data from the 1988 Nurses’ Health Study, a long-running data-collection project focused on women’s health. The 1988 iteration of the survey asked if respondents worked rotating night shifts at least three nights a month, in addition to day or evening shifts in that same month—and if so, for how many years they had been doing so. Some 75,000 respondents were included in follow-up research over the next 22 years, tracking the nurses’ personal health; researchers also examined death records, as needed.
Researchers found that women who’d worked three or more rotating night shifts a month for five years or more had higher all-cause mortality rates, as well as higher rates of death from cardiovascular disease. Women who worked such shifts for 15 or more years had elevated death rates from lung cancer.
In a news release, Schernhammer observes, “These results add to prior evidence of a potentially detrimental relation of rotating night shift work and health and longevity ... To derive practical implications for shift workers and their health, the role of duration and intensity of rotating night shift work and the interplay of shift schedules with individual traits ... warrant further exploration."
Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action. This piece is cross-posted with Off the Charts, the American Journal of Nursing Blog.
I spent the 2014 holiday season reading a book by Sarah Wildman called Paper Love. She describes how she, as a journalist, examined the fate of her Jewish predecessors, including her grandfather and his long lost love. I selected the book because my father was a Jew of Polish descent.
Wildman describes the horrific atrocities bestowed upon the Jews. Of course I knew of the Holocaust growing up, but as I get older, the connections between past and present seem to be more important. While I don’t know of any relative who was personally affected or killed, someone in my extended family very likely was. I pondered my own existence and how it may have depended on a relative escaping Europe and immigrating to the United States to escape the death camps. It is unspeakable how one man’s view of what is mainstream or normal sent so many others to their death.
I am not naive enough to believe that prejudice is a curse of the past. Stark data on health disparities continue to mount. The Centers for Disease Control and Prevention report on Health Disparities and Inequalities (2013) found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.
But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way, and that means lives that are, more often than not, very different than our own.
This is part of the January 2015 issue of Sharing Nursing’s Knowledge.
A new kids’ movie is putting a positive spin on nursing—a profession that is routinely overlooked, and sometimes denigrated, in Hollywood.
Baymax, the lead character in Big Hero 6, Disney’s latest animated feature film, doesn’t look like your typical nurse in scrubs: The character is a male, futuristic balloon robot who brings to mind the Pillsbury doughboy, but on massive doses of steroids.
Baymax, nonetheless, carries out his role as a nurse and caregiver throughout the film and performs routine nursing care such as scanning for and diagnosing health conditions and prescribing treatments for various ailments. He even uses the pain scale, a classic nursing assessment tool, Harry Summers, co-author of Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk, points out in a review.
Cynda Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics and a professor of nursing and pediatrics at Johns Hopkins University. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2006-2009). In 2014, she was named a Hastings Center Fellow for her work in bioethics.
Human Capital Blog: Congratulations on being named a 2014 Hastings Center Fellow. What does this fellowship mean for you and your career?
Cynda Rushton: It’s a wonderful honor to be included in this interprofessional group of scholars of bioethics. It’s a terrific opportunity to cross-pollinate with great thinkers and leaders and to think about some of the most vexing ethical issues in health care. It’s going to be a rich container for dialogue, learning, and leadership.
HCB: How will the fellowship work?
Rushton: Fellows have the opportunity to help guide the direction of the Hastings Center, which is an independent, non-partisan and nonprofit bioethics research institute in New York. The center’s mission is to address fundamental ethical issues in the areas of health, medicine, and the environment, and we’ll be bringing up issues that we think deserve more in-depth scholarship and research. This summer, we’re having a retreat where we will be able to work together around issues of common concern, particularly in the area of bioethics.
HCB: What will you focus on as a fellow?
Rushton: My focus has been on how to create a culture of ethical practice in health care. I’m interested in what is required to create that culture and what kind of individual competencies need to be in place to support people to practice ethically and reduce moral distress.