Human Capital Blog RWJF’s Human Capital portfolio created its blog to serve as a forum for sharing information and stimulating discussion about the challenges of building a health care workforce that meets the nation’s current and emerging health care needs. Fri, 24 Oct 2014 09:00:00 -0400 en-us Copyright 2000- 2014 RWJF (RWJF) <![CDATA[Working Together to Draw More Nurses to Public Health]]>

Patricia Drehobl, MPH, RN, is associate director for program development at the Centers for Disease Control & Prevention (CDC). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2007-2010).

Patricia Drehobl

Human Capital Blog: CDC is engaging in new partnerships with the American Association of Colleges of Nursing (AACN) to promote public health nursing. How did the new collaboration come about?

Pat Drehobl: CDC has funded some national academic associations for many years, including the Association of Schools of Public Health, the Association of Prevention Teaching and Research, and the Association of American Medical Colleges. We recognized the need to include nursing representation because nursing is the largest discipline in the public health workforce. We added AACN as a partner in 2012 when we developed our funding opportunity announcement to work with academic partners.

HCB: Why did CDC decide to reach out to the nursing community in 2012?

Drehobl: With such a strong emphasis on public health and health care collaboration in our country as well as emphasis on interprofessional practice, we thought the time was right to strengthen our relationship with the nursing community. Although some CDC programs have worked with various nursing organizations over the years, this collaboration with AACN is the first formal collaboration to serve the entire agency. This means that all of CDC’s centers and programs have the opportunity to engage with AACN and its 750 member schools through the mechanism we have established. 

HCB: What are some of the projects the CDC is working on with AACN?

Drehobl: CDC has provided funding to AACN so that it can enhance the teaching of population health concepts at all levels of nursing education. It has also focused on faculty development to enhance faculty understanding of how to integrate population health concepts into professional nursing education.

Last year, AACN created a population health supplement to “The Essentials of Baccalaureate Education for Professional Nursing Practice.” This year, it is working on a toolkit to accompany the supplement. We have also worked with AACN to establish a new service-learning fellowship program for nurse fellows to spend a year or two working in a CDC program; currently, two nurse fellows are at CDC. These activities exemplify the four aims of the AACN project: to support faculty, help students, evaluate impacts, and engage with other health professions to support population health.

HCB: One of your goals is to build the capacity of the public health nursing workforce. Why is that important?

Drehobl: CDC and AACN believe it is important for all nurses (and other health professionals) to get a good grounding in concepts of public health and population health during their academic preparation. Then, regardless of the practice setting, they can carry forward and apply concepts, such as prevention, to improve the health of individuals, families and communities.

Due to budget cuts, local health departments across the country have had to significantly cut staff, and public health nurse positions have been a big part of those cuts. This sometimes makes it difficult for schools of nursing to find enough opportunities for all students to have a public health nursing experience as a part of their educational program.  That is another reason why AACN’s work to make sure population health concepts are incorporated throughout the curriculum is so important to the future of public health nursing.

HCB: Why don’t more nurses choose to go into public health? 

Drehobl: Public health careers are not as well-known as clinical careers. Also, there is typically higher compensation in clinical settings than in public health settings. We hope the collaboration between CDC and AACN will make more nurses aware that public health is an exciting career choice. Additionally, as the collaboration between public health and primary care increases, all nurses are using the principles of public health practice regardless of where they work. You might say public health is choosing them!

HCB: Can you also describe the Academic/Public Health Partnership Impact Evaluation Projects Pilot Grants? What are these, who is eligible to apply, and what do you hope they will accomplish? 

Drehobl: These are small grants available to AACN member schools that have established academic-practice partnerships with communities or public health agencies. The grants support small impact evaluation projects that will provide evidence of what is working or what can be improved in these partnerships. The modest funding available allows recipients to develop evaluation methods, tools and impact analysis projects. The goal is to support a culture of evidence-based practice in these partnerships and add to the available evidence of what works for community and education partners.   

Fri, 24 Oct 2014 09:00:00 -0400 Patricia Drehobl Nurses Public health Education and training Human Capital Nursing Executive Nurse Fellows Voices from the Field <![CDATA[RWJF Scholars in the News: CPR for Ebola patients, freezing women’s eggs, the inevitability of failure, and more.]]>

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

The New York Times reports on remarks by medical ethicist Joseph J. Fins, MD, in which he calls for clearer guidance on whether clinicians should administer cardiopulmonary resuscitation (CPR) to Ebola patients whose hearts stop beating. In a commentary published on the Hastings Center Report website, and cited by the Times, Fins argues against administering CPR because of the danger of transmission of the virus to clinicians, the slim likelihood that Ebola patients will recover, and other clinical factors. Fins, an RWJF  Investigator Award in Health Policy Research recipient, urges a dialogue on the question leading to clear guidelines from hospitals and government officials.

In an article for CNN, Rene Almeling, PhD, and co-authors say that while Apple and Facebook made headlines last week for offering to cover costs for their female employees to freeze their eggs, people should be suspicious of egg-freezing as a “solution.” The technology carries risk and has high rates of failure, they write. “But even if the technology were perfect, the proposal to help women put motherhood on ice so they can focus on their jobs is shortsighted,” they add. “[R]ather than making fundamental changes to the structure of work in our society to accommodate women’s reproductive years, technological optimists reach for an engineering solution. ... Instead, the goal should be to build systems of production that allow us to live our lives without constantly watching the clock.” Almeling is an RWJF Scholars in Health Policy Research alumna.

The consumption of sugar-sweetened soda might be promoting disease independent of its role in obesity, according to a study co-authored by RWJF Health & Society Scholars program alumni Belinda Needham, PhD, MA, and David Rehkopf, ScD, MPH. The study shows that telomeres—the protective units of DNA that cap the ends of chromosomes in cells—were shorter in the white blood cells of survey participants who reported drinking more soda, Science Blog reports. Shorter telomeres have been linked to a number of chronic diseases, including heart disease, diabetes and some types of cancer.

The number of children medicated for attention deficit hyperactivity disorder (ADHD) varies by season and could be affected by academic pressure, the Huffington Post reports. The research, co-authored by RWJF Health & Society Scholars alumni Jennifer Jennings, PhD, and Jason Fletcher, PhD, shows that middle and high school students are 30 percent more likely to have a prescription filled for stimulant medication during the school year than they are during the summer. “If it’s the case that kids only need their medication during school, perhaps we should look at what's happening at school as opposed to the kid,” said Jennings. “Another way to look at it would be, ‘Actually, these kids need to be on these medicines continuously. Doctors and parents are doing these kids a disservice.’”

In a blog post co-written for David Grande, MD, MPA, discusses why the 149 million Americans who have employer-sponsored insurance (ESI) should still care about the Affordable Care Act (ACA). He notes that, over time, fewer employers are offering coverage—a trend that pre-dates the ACA. In addition, he writes, benefits offered as part of employer coverage may eventually start to resemble the more limited designs of some plans available on state and federal insurance exchanges, with higher deductibles and more limited provider networks. Finally, the ACA’s requirement that employers with 50 or more full-time employees offer health insurance or pay a penalty could induce some employers to shift some workers to part-time status. Grande is an RWJF Health & Society Scholars program alumnus.

Reforming malpractice laws and including patients in medical decision-making may help reduce overdiagnosis and overtreatment, according to a study co-authored by Hemal K. Kanzaria, MD, an RWJF Clinical Scholar. The research considers the need to change professional and public attitudes toward uncertainty and medical errors, Health Day reports. “We need to go beyond these ideas and start to change the culture of medicine, and even the wider culture,” the authors write. “This will require us to be more open about the inevitability of failure, and even of error.” This story was republished by Doctor’s Lounge.

A study by RWJF Health & Society Scholars program alumnus Haslyn E. R. Hunte, PhD, covered by Medical Xpress, finds a correlation between housing discrimination and drug abuse. “Mental health and substance abuse providers should consider treating experiences of unfair treatment/discrimination as a risk factor for drug use, as they do other experiences of stress, such as the death of a love[d] one,” Hunte says.

A report from the National Research Center on Hispanic Children and Families provides a snapshot of Hispanic families in the United States, NBC News reports. Among other things, the study finds that 67 percent of Hispanic women are either living with a partner or married when their first child is born, and that foreign-born Hispanics are more likely to be married than U.S.-born Hispanics. "[F]amily structure can look so different by nativity status," says study co-author Elizabeth Wildsmith, PhD, an RWJF Health & Society Scholars program alumna.

A Los Angeles Times opinion piece co-authored by RWJF Clinical Scholar Adam Schickedanz, MD, asks whether having children will soon be out of economic reach for many American families. He writes that the most striking cost increase is in child care, which now consumes one of every five dollars in a family’s budget, exceeding the typical cost of rent. “We should be reinvesting in working families and modernizing our public infrastructure,” he writes. “Not only would this make parenthood more feasible, it also makes good economic sense.”

Investments in early childhood education can pay for themselves because they substantially boost students’ chances of educational and economic achievement over the course of their lives, according to a study co-authored by RWJF Investigator Award in Health Policy Research recipient Greg Duncan, PhD. The paper argues that strong educational guidance early in life has huge long-term payoffs, the Wall Street Journal reports. “The benefits of even a moderately effective early childhood education program are likely to be substantial enough to offset the costs of program expansion,” the study says. Duncan’s work is also covered by the Washington Post.

The National Science Foundation has awarded more than $10 million to researchers at the University of Michigan and Stanford University to conduct a series of surveys on political participation and vote choice in the 2016 presidential election, the Business Journal reports. University of Michigan political scientist Vincent Hutchings, PhD, an RWJF Scholars in Health Policy Research alumnus, is co-principal investigator for the study. Researchers plan to look at the possible effect of income inequality, the role of gender attitudes, and partisan polarization among voters.

Thu, 23 Oct 2014 13:00:00 -0400 Human Capital Blog Infectious diseases Scholars and fellows Research Nutrition Affordable Care Act (ACA) Human Capital Investigator Awards in Health Policy Research Scholars in Health Policy Research Health & Society Scholars Media Coverage Research & Analysis HC Website Feature <![CDATA[New RWJF Podcast Episode Features Keith Wailoo]]>
Keith Wailoo Keith Wailoo, PhD

Tune in to the sixth episode of RWJF’s Pioneering Ideas podcast to hear from RWJF  Investigator Award in Health Policy Research recipient, premier medical historian and Princeton educator Keith Wailoo, PhD. RWJF’s Steve Downs, SM, joins Keith to discuss how deeply held cultural narratives influence our perceptions of health, and how today’s wild ideas are often tomorrow’s cutting edge innovations.

Visit iTunes to download this episode and subscribe to future episodes.

In this episode, we also look at innovations that ask, “What if?” and explore simple shifts in perspective:

  • OpenNotes’ Tom Delbanco and Jan Walker talk to RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation—and where their work is headed next.
  • Founder and CEO of LIFT Kirsten Lodal talks to RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being.
Thu, 23 Oct 2014 09:00:00 -0400 Human Capital Blog Barriers to care: cultural, gender and racial Research Human Capital Voices from the Field <![CDATA[It’s About More than Money]]>

Heather J. Kelley, MA, is deputy director of the Robert Wood Johnson Foundation (RWJF) Future of Nursing Scholars program.

Healther Kelley Heather Kelley

“Being selected as a Robert Wood Johnson Foundation Future of Nursing Scholar was such an honor!  I was already excited about starting my PhD program, but this took that excitement to another level.  I wasn't sure what to expect from the boot camp, but it was truly transformative.”  - Laren Riesche, a Future of Nursing Scholar attending the University of Illinois at Chicago.

Riesche was one of the 16 new scholars I was privileged to meet on August 5 and 6 at our program’s first-ever scholars’ event.  In addition to providing financial support to nurses to complete their PhDs in three years, the Future of Nursing Scholars program will also provide a series of leadership development activities.  One of these activities is a boot camp which will be held for each cohort prior to the start of their doctoral programs. 

Future of Nursing Scholars Bootcamp Future of Nursing Scholars Boot Camp

The first-ever boot camp was a two-day event at which the scholars were able to meet and connect with one another, and begin the work of developing skills that will serve them well as they pursue their PhDs.  Sessions addressed crucial issues, including developing strategies for peer coaching, and identifying and understanding one’s own approach to change and exerting influence.  The new scholars met with current doctoral students to discuss a variety of issues and were given time to network with program leaders, guest speakers, and each other.  A workshop served as an introduction to scholarly writing and the event closed with a panel on selecting and working with mentors.

Pam McCue, RN, MS, an RWJF Future of Nursing Scholar at the Rhode Island Foundation, who is attending the University of Rhode Island, said that the event demonstrated the investment that RWJF is making in each scholar.

“Boot camp provided me insight into my own personal attributes, and gave me tools and tips that I know will help me as I begin my scholarly work.  It also became quite evident that RWJF is investing not only in my education but in the resources that will make me successful as a nurse leader far beyond graduation,” McCue said.

At the end of a very busy two days together, program leaders asked the scholars to reflect on some of their biggest “take aways” from the event.  Among them:

·         Riesche said the “peer coaching sessions about challenges we foresee and approaches to working through those challenges were not only helpful because we were able to discuss our concerns and how we plan to address them, but the safe environment allowed us to express our vulnerabilities which ultimately brought all of us closer together.” 

·         Alexis Chettiar, an RWJF Future of Nursing Scholar attending the University of California, San Francisco, said she felt empowered to “think big” when it comes to selecting mentors and shared that she now has more specific ideas about what a successful mentor-mentee relationship involves.

·         Stephen Perez, an RWJF Future of Nursing Scholar at the Independence Blue Cross Foundation at the University of Pennsylvania, said he knows the program will provide support throughout his journey.

·         Latia Wade Hickerson, an RWJF Future of Nursing Scholar attending the University of Texas Health Science Center at Houston, said she understood the importance of building networks and was inspired by the writing workshop to master use of one electronic database prior to starting her doctoral program.

·         Millicent De Jesus, an RWJF Future of Nursing Scholar at Cedars-Sinai Medical Center, attending the University of San Diego, said she appreciated the discussion centered around influencing styles, noting that the boot camp has encouraged her to think about how to interact with groups outside of the network she has developed over the last 17 years in nursing. The guided activity with her RWJF colleagues also helped to validate the importance of aligning her research focus and doctoral studies to influence for positive outcomes, she said.

At the end of our time together, I left Princeton excited about the wonderful group of nurses in the Future of Nursing Scholars program’s first cohort.  We are looking to this inaugural cohort with great anticipation not only for the work they will contribute to the science, but because their experiences and responses will help shape this program for future scholars.  With that in mind, we are thrilled to welcome them to the RWJF family.  And they made it clear that they are delighted to be here.

As Riesche recently wrote to me: “The hard-work and seriousness of the boot camp was balanced with plenty of laughs and being warmly welcomed into the RWJF family ... what an amazing family!  I'm really looking forward to seeing everyone again next summer at what will undoubtedly be another great event.”

Wed, 22 Oct 2014 09:00:00 -0400 Heather Kelley Nurses Leadership development Continuing education Human Capital Future of Nursing Scholars Nursing <![CDATA[Getting Medical Residents Ready for Real Life]]>

New guidelines from the American Association of Medical Colleges (AAMC) are intended to close the gap between expectations and the reality of what medical students are prepared to do at the start of their residencies.

Known as the Core Entrustable Professional Activities for Entering Residency, the guidelines include 13 activities—such as performing physical exams, forming clinical questions, and handing off patients to other physicians when residents go off duty—that all medical students should be able to perform, regardless of specialty, in order to be better prepared for their roles as clinicians. In August, AAMC launched a five-year implementation pilot with 10 institutions.

Ensuring that the nation’s medical school graduates “have the confidence to perform these activities is critical for clinical quality and safety,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release earlier this year. “These guidelines take medical education from the theoretical to the practical as students think about some of the real-life professional activities they will be performing as physicians.”

A recent U.S. News & World Report article, “Medical Schools Change How Students Prepare for Work,” highlighted AAMC’s work on the guidelines, with a particular focus on the implementation pilot schools that are finding simulation to be a useful tool. 

Tue, 21 Oct 2014 11:00:00 -0400 Human Capital Blog Medical schools Practice guidelines Medical students and residents Education and training Human Capital <![CDATA[Sharing Nursing’s Knowledge: The October 2014 Issue]]>

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 October issue.

Campaign Helps Advance Institute of Medicine's Call for More Nurse Leaders
On the fourth anniversary of the release of the Institute of Medicine’s (IOM) landmark report on the future of the nursing profession, more nurse leaders are stepping into positions of power and influence—and efforts to prepare even more nurses for leadership are gaining ground. Today, the Future of Nursing: Campaign for Action is putting new emphasis on the report’s leadership recommendation, and nurses and their employers in government and other sectors are responding. The Campaign is a joint initiative of RWJF and AARP.

Nursing Improvements Could Boost Outcomes for 7 Out of 10 Critically Ill Black Babies
A new study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research provides insight into the issue of very low birth weight (VLBW) infants, who are disproportionately black. Researchers found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for VLBW infants born in those facilities.

California has “Well-Educated” Nurse Force, Study Finds
While California has a “well-educated” nurse force, a survey published by the state’s Board of Registered Nursing shows that there is a long way to go toward meeting the goal set forth by the Institute of Medicine’s landmark report on the future of nursing that 80 percent of nurses hold bachelor’s degrees or higher by 2020. About 60 percent of the state’s registered nurses have earned a bachelor’s or graduate degree in nursing or another field, the survey found. Nearly 40 percent of respondents—and nearly 80 percent of those under 35—said they are considering or seriously considering additional education.

RWJF Fellow Educates Nurses About New Medicare Payment Rule
Nicole Adams
, RN, MSN, is working to educate nurses about a new Medicare payment rule so that they can better protect their patients’ financial health. A fellow at the RWJF Nursing and Health Policy Collaborative at the University of New Mexico, Adams is focused on a 2013 Centers for Medicare & Medicaid Services rule designed to reduce the number of long “outpatient” stays. This rule can create financial hardship for some patients, she says.

Economist Charts New Ground in Studies of Nursing Labor Market
When Joanne Spetz, PhD, FAAN, enrolled in a doctoral program in economics in the 1990s, few economists were specializing in health care and fewer still in the nursing labor market. But Spetz, the daughter of a nurse, was drawn to the inchoate field. She is now director of the University of California, San Francisco Health Workforce Research Center and a consultant to the Future of Nursing: Campaign for Action. Health economics has grown into a major specialty, but there is still a lot more research to be done, Spetz says. “There’s so much we don’t know about how nurses can fully contribute to health care.”

Tue, 21 Oct 2014 09:00:00 -0400 Human Capital Blog Nurses Education and training Leadership development Human Capital Sharing Nursing's Knowledge Nursing Future of Nursing Campaign for Action Interdisciplinary Nursing Quality Research Initiative Center for Health Policy at the University of New Mexico <![CDATA[Thoughts on Mentoring]]>

For 23 years, Project L/EARN has created stronger candidates for admission to graduate programs. The intensive, 10-week summer internship 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. In this post, interns and mentors share their insights on the value of mentoring in general, and on Project L/EARN in particular. For more, check out an accompanying Infographic: Project L/EARN: Milestones.

“Project L/EARN mentoring has been incredibly instrumental in my career path and has contributed greatly to my professional success. The program was my first major introduction to research, and helped me to apply and reinforce research methods and statistical analysis skills throughout my undergraduate and graduate years.” — Anuli Uzoaru Njoku, 1999 Intern

“Mentoring means allowing me to experience how someone else sees me—someone who believes in me and sees my potential, someone who can set my sights higher and in the right direction.” — Tamarie Macon, 2006 Intern

“Project L/EARN mentoring, then and now, has been the difference between the summer program being a one-time experience, and the beginning of an educational and professional career that will undoubtedly contribute to the story of my life. The mentoring was the avenue by which my truest potential, of which I had no real awareness, was discovered and cultivated. That cultivation has resulted, and is still resulting, in opportunities and accomplishments that are beyond my imagination.” — David Fakunle, 2008 Intern

“The success I have had and my goals of working with the underprivileged would not have been possible without the extensive engagement of the Project L/EARN mentors.” — Dakota Cintron, 2011 Intern

“Project L/EARN mentoring gave me the support and one-on-one attention I needed while developing the essential research and professional skills that I used to work in a clinical laboratory, to complete my honors thesis, and to be a competitive candidate for my current research position.” — Patricia Calixte-Civil, 2012 Intern

“The mentoring provided by Project L/EARN empowered and gave me confidence to pursue my dreams by connecting me with other minorities pursuing this field and showing me the importance of seeking out mentors to guide me.” — Giselle Colorado, 2006 Intern

“Project L/EARN is the model example of what mentoring to diverse populations in higher education should be.” — Kimele Gray Persaud, 2011 Intern

“The passion and creativity of Project L/EARN students in using research tools to ask and answer innovative questions inspires me to continue learning from members of our academic community who may have very different life experiences from my own. I have become a better researcher and mentor by helping these students to find their own paths to success in academics, professional life, and community service. They nudge us all in new directions and keep us engaged in challenging work.” — Dorothy Gaboda, MSW, PhD, Mentor

“Being a Project L/EARN mentor has helped me both professionally and personally. I have become a better data analyst and a better writer through teaching my interns, and my research has benefitted from the interns’ academic year participation, following their Project L/EARN summer.” — Susan Brownlee, PhD, Mentor

“As a Project L/EARN mentor, I truly enjoy helping deserving students persevere, learn, and flourish. In addition to that personal fulfillment, mentoring these bright students from backgrounds very different from my own also teaches me new perspectives on the issues I study. Their openness, idealism, and curiosity refreshes my own determination to do meaningful research.” — Kristen Lloyd, MPH, Mentor

“As someone who has mentored several students from minority and/or disadvantaged backgrounds, these students struggle with a diversity of challenges—financial, family, class/race issues—that impact their academic functioning or their views of themselves and their futures. I allow for space in the relationship to discuss these issues, provide support and share my own experiences. Being a mentor has become a core part of my professional identity, and I try to foster this type of professional identity in my current mentees.” — Ayorkor Gaba, PsyD, Mentor

“One of my greatest challenges as a mentor was to learn the importance of ‘tough love.’ Our many successes in Project L/EARN have come because we have very high expectations for our students, make them clear, and hold them to them. They also come because students realize and really believe that we care deeply about them, that we are there for them not just while they are formally in the program, but for the long haul, and that we mean and live up to that commitment.” — Peter Guarnaccia, PhD, former Project L/EARN Faculty Director

“As Faculty Director, I devote a lot of time to training mentors for Project L/EARN. From the get-go, we make it clear that our program is very different from many undergraduate research training programs in terms of what it expects from its mentors. Mentoring the mentors is one of my favorite professional roles because it helps increase the pipeline of researchers who are prepared and committed to developing the next generation of health researchers from groups that have been underrepresented in the profession.” — Jane Miller, PhD, Project L/EARN Faculty Director

Project LEARN Infographic
Mon, 20 Oct 2014 09:00:00 -0400 Human Capital Blog Mentoring Scholars and fellows Project L/EARN Voices from the Field <![CDATA[RWJF’s Lavizzo-Mourey, Nursing Grantees Honored by American Academy of Nursing]]>

Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation (RWJF), was honored by the American Academy of Nursing (AAN) yesterday, receiving the President’s Award from the venerable institution.


The presentation was made by AAN President Diana Mason, PhD, RN, FAAN, at its conference, Transforming Health, Driving Policy Conference. Lavizzo-Mourey, MD, MBA, spoke to the assembled conference participants via video. “At the Robert Wood Johnson Foundation, we like to say that nursing is in our DNA. That’s because we believe to our core that nurses are the glue that holds together our health care system across the entire continuum of an individual’s lifespan ... We envision a future where all Americans realize a new and robust Culture of Health ... We cannot and we will not ever achieve a Culture of Health without the support, help and the leadership of nurses.”

“I am grateful to be honored with this award,” Lavizzo-Mourey continued. “And know that you are all committed to transforming health, leading change, influencing policy, and ultimately improving the nation’s health ... And I am humbled to be in the company of this year’s FAAN inductees and the Living Legend honorees who will be recognized tonight. Congratulations to everyone – and a shout-out to those who are RWJF scholars, fellows and alumni.”

Some 170 people will be inducted as fellows of AAN (FAANs) tomorrow. They include four RWJF Executive Nurse Fellows, eight RWJF Nurse Faculty Scholars, two RWJF Interdisciplinary Nursing Quality Research Initiative investigators, and Mary Dickow, MPA, the statewide director of the California Action Coalition of the Future of Nursing: Campaign for Action.

Dickson is one of only two “non-nurses” who will be inducted as Honorary Fellows. She is being honored for her work building “momentum to build bridges and empower nurses throughout California.”

“It’s a very special honor to be named a fellow of this revered academy and to join the ranks of so many dedicated, talented and remarkable nurses,” Dickow said. “I have had the pleasure of working alongside many FAANs and I am deeply touched to be inducted this year and be able to count myself as a fellow, too.”

The Executive Nurse Fellows who will be inducted are:  

·         Rita Adeniran ,DrNP, RN, CMAC, NEA-BC , president and CEO of Innovative and Inclusive Global Solutions, a consulting firm that specializes in helping health care organizations leverage the total capacity of their workforce for enhanced productivity and optimal patient outcomes;

·         Kate Malliarakis, PhD, ANP-BC, MAC, associate professor at the George Washington University School of Nursing, and director of its MSN Nursing Leadership and Management Program and the Executive Leadership Program for the Doctor of Nursing Practice Program;

·         Susanne Prevost, PhD, RN, COI, professor and associate dean for practice and community engagement at the University of Kentucky, College of Nursing; and

·         Sharon Tucker, PhD, RN, senior associate director for research and evidence-based practice in the Department of Nursing at the University of Iowa Hospitals & Clinics (UIHC) in Iowa City, IA.

The Nurse Faculty Scholars who will be inducted are:

·         Rosa Gonzalez-Guarda, PhD, MPH, RN, assistant professor at the University of Miami School of Nursing and Health Studies;

·         Robin Knobel, PhD, RN, assistant professor at Duke University School of Nursing;

·         Versie Johnson-Mallard, PhD, ARNP-BC, associate professors at University of South Florida College of Nursing;

·         Lusine Poghosyan, PhD, MPH, RN, assistant professor at Columbia University School of Nursing;

·         Karin Reuter-Rice, PhD, RN, assistant professor at the Duke University School of Nursing, School of Medicine, and the Duke Institute for Brain Sciences;

·         Sarah Szanton, PhD, RN, assistant professor at the Johns Hopkins University School of Nursing;

·         Tami Thomas, PhD, CPNP, FAANP, assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University; and

·         Diane Von Ah, PhD, RN, assistant professor in adult health at the School of Nursing at Indiana University in Indianapolis.

The two INQRI principal investigators  being inducted are:

·         Ann Kutney-Lee, PhD, RN, assistant professor at the University of Pennsylvania School of Nursing; and

·         John M. Welton, PhD, RN, director of the PhD program at the University of Colorado Anschutz Medical Campus College of Nursing.

Criteria for induction as a fellow include having made significant contributions to nursing and health care, and having a career that has influenced health policies and the health and well-being of all. Each nominee must be sponsored by two current Academy fellows; a panel comprised of elected and appointed fellows reviews all applications.

Fri, 17 Oct 2014 14:00:00 -0400 Human Capital Blog Nurses Scholars and fellows Registered nurses Human Capital Nursing Executive Nurse Fellows Nurse Faculty Scholars Interdisciplinary Nursing Quality Research Initiative Campaign for Action <![CDATA[Stay Up to Date with RWJF!]]>

Want to stay on top of the latest news from RWJF? Check out all the ways you can get the latest news delivered to you:

·         Sign up for Content Alerts, newsletters, and funding alerts

·         Read the Sharing Nursing’s Knowledge e-newsletter, then subscribe

·         Sign up to receive Charting Nursing’s Future policy briefs

·         Stay up to date on the Future of Nursing: Campaign for Action

Fri, 17 Oct 2014 09:00:00 -0400 Human Capital Blog Nurses Physicians Research Human Capital Nursing Sharing Nursing's Knowledge Charting Nursing's Future Future of Nursing <![CDATA[RWJF’s Clinical Scholars Program: A Proud Legacy of Creating Change]]>

Encouraging physicians to be not only agents of care, but agents of change: That’s the challenge the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program has embraced for 45 years, and it’s a challenge the Foundation has met with “great success,” writes Bharat Kumar, MD, in an article in the American Medical Association’s ethics journal, Virtual Mentor.

In an era of increased activism and access to health care as evidenced by the creation of Medicare and Medicaid, a group of medical school professors envisioned the Clinical Scholars Program as a way to move beyond “the detached and passive model of medical practice” and instead “train physicians to become agents of change, not only in the clinic and in the hospital, but also in communities, in classrooms, and the halls of power,” Kumar writes. Three years after the program was launched in 1969 at five universities, with support from the Carnegie Corporation and the Commonwealth Fund, it came under the auspices of RWJF.

The article describes the program’s current objective—to provide post-doctoral training for young physicians in health services research, community-based participatory research and health policy research—and its current structure: training sites at the University of Michigan, the University of Pennsylvania, Yale University, and the University of California, Los Angeles; a national program office at the University of North Carolina; and a longtime collaboration with the U.S. Department of Veterans Affairs that supports positions for Clinical Scholars via affiliated Veterans Affairs medical centers.

The program’s final cohort of scholars, selected this year, will follow in the footsteps of more than 1,200 alumni, many of whom “have become leaders in health care policy and delivery,” Kumar writes, with roles in all levels of government and notable advancements in the fields of pediatrics, internal medicine, and emergency medicine.

Alumna Stacey Lindau, MD, says in the article that the program’s “traditions of promoting excellence, critical thinking, and service extend beyond the two to three years of training, effectively creating a pipeline of alumni dedicated to service.”

Read “The Robert Wood Johnson Clinical Scholars Program: Four Decades of Training Physicians as Agents of Change.”

Thu, 16 Oct 2014 12:00:00 -0400 Human Capital Blog Scholars and fellows Research Human Capital Clinical Scholars <![CDATA[RWJF Scholars in the News: Ebola safeguards, pay-for-performance, brain development and more.]]>

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

PBS NewsHour interviews Howard Markel, MD, PhD, FAAP, on whether hospitals, doctors and nurses are sufficiently prepared to handle Ebola cases in the United States, and what measures should be taken to increase safety. “As someone who studies epidemics, there’s always lots of fear, scapegoating and blame,” Markel, an RWJF Investigator Award in Health Policy Research recipient, said. “American tolerance for anything less than perfection has only shortened. The incredible thing to focus on is that so little has happened, so few cases have spread here.” The video is available here and an accompanying article is available here. Markel is also quoted in an Ebola story in the New Republic and wrote a blog for the Huffington Post.

In an article for Forbes magazine, RWJF Investigator Award in Health Policy Research recipient Peter Ubel, MD, discusses whether pay-for-performance health care models can lead to overdiagnosis and overuse of antibiotics. He cites recent journal articles suggesting that sepsis may be over diagnosed in hospitals because the institutions receive higher reimbursements for sepsis patients than for those with milder infections. “In other words, it pays not to miss sepsis diagnoses,” Ubel writes. “Because of the inherent subjectivity of medical diagnoses, those groups that assess health care quality need to remain on the alert for the unintended consequences of their measures. And those insurers and regulators eager to establish clinical care mandates? They need to slow down and make sure their administrative fixes do not create undue side effects.” Ubel also wrote a separate Forbes article on health insurance turnover.

Recent research on children who began life in overcrowded Romanian orphanages shows that early childhood neglect is associated with changes in brain structure, Science Times reports. A study co-authored by RWJF Health & Society Scholars program alumna Margaret Sheridan, PhD, finds that children who spent their early years in Romanian orphanages have thinner brain tissue in cortical areas that correspond to impulse control and attention, providing support for a link between the early environment and Attention Deficit Hyperactivity Disorder (ADHD). Researchers compared brain scans from 58 children who spent at least some time in institutions with scans of 22 non-institutionalized children from nearby communities, all between the ages of 8 and 10. The article notes that the study is among the first to document how social deprivation in early life affects the thickness of the cortex.

A team of researchers at George Washington University, including RWJF Health & Society Scholars program alumnus Jeffrey Bingenheimer, PhD, has been awarded a grant from the Centers for Medicare & Medicaid Services to study a new model that aims to improve HIV-prevention and care while lowering health care costs, News Medical reports. The funding will support testing of a system that relies on mobile technologies, home testing, and integrated care to prevent HIV infection and to care for those who already have the virus.

RWJF Health & Society Scholar Merlin Chowkwanyun, PhD, is interviewed by Philadelphia radio station WURD about the role of race in medicine, discussing racial disparities in treatment and outcomes. The interview addresses race as a biological concept, the relevance of race in genetics, and more. In 2013, Chowkwanyun wrote “Race is Not Biology: How unthinking racial essentialism finds its way into scientific research” for The Atlantic.  The WURD radio broadcast is available here.

NPR covers research by RWJF Health & Society Scholars program alumni Christopher Wildeman, PhD, and Andrew Papachristos, PhD, revealing that homicide victims in Chicago are concentrated among a tiny social network. Papachristos is interviewed about the study, in which he notes that tracing the networks of people involved in violent crime could lead to public health measures to protect potential victims. The radio broadcast and transcript are available here.

RWJF Scholars in Health Policy Research alumnus Michael Greenstone, PhD, participated in a discussion on free-market economics and climate change at the University of Chicago, where he advocated a price on carbon to address climate change, Forbes magazine reports. “What’s happening when we turn on the lights, when the power is derived from a coal plant, or when we drive our car, is that carbon dioxide is emitted into the air, and that’s sprinkling around damages in Bangladesh, London, Houston,” Greenstone said. “And those costs are real, and they’re not being reflected in the costs of that electricity or the tank of gas. Emitting carbon dioxide into the atmosphere does allow you to produce electricity more cheaply, but there’s a whole other set of people who are being punished or penalized.”  Greenstone was also recently quoted by The Hill.

Thu, 16 Oct 2014 09:00:00 -0400 Human Capital Blog Pay for performance Infectious diseases Child welfare Research Scholars and fellows Human Capital Health & Society Scholars Investigator Awards in Health Policy Research Scholars in Health Policy Research Research & Analysis HC Website Feature Media Coverage <![CDATA[Let’s Have a Conversation about Food that Goes Beyond Restriction and Restraint—and Resonates with Real People]]>

Sonya Grier, PhD, MBA, is an associate professor of marketing at the Kogod School of Business at American University in Washington, D.C., and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005).

Sonya Grier Sonya Grier, PhD, MBA

Human Capital Blog: Congratulations on receiving the Thomas C. Kinnear award for your 2011 article in the Journal of Public Policy & Marketing on food well-being! Please tell us about the award.

Sonya Grier: The award honors articles published in the Journal of Public Policy & Marketing (JPP&M) that have made a significant contribution to the understanding of marketing and public policy issues. This year, eligible articles needed to have been published between 2010 and 2012. The marketing community was called upon to nominate articles for the award. JPP&M editorial review board members and associate editors then voted among the nominees.

Generously funded by Thomas C. Kinnear, his colleagues, friends and former students, and administered through the American Marketing Association  Foundation, the award’s purpose is to recognize authors who have produced particularly high-quality and impactful research in marketing and public policy.

HCB: How did your article do that?

Grier: Our research changes the conversation about food and health. We call for a departure from the prevailing paradigm driving research and recommendations for fighting our obesogenic society. That paradigm is that “food = nutrients = health.” But that is not how consumers see it. As we say in the article:  “No one sits down to eat a plate of nutrients. Rather, when we sit down for a meal, we are seeking physical as well as emotional and psychological nourishment: comfort, pleasure, love and community.” 

A marketing lens on health must prioritize how consumers see food, because any effective intervention has to fit within the way consumers see and live their lives. Our food well-being (FWB) framework shifts the discussion from an emphasis on restraint and restriction toward a more positive, holistic understanding of the role of food in a person’s overall well-being. Our article identifies and integrates key domains relevant to food that are central to understanding how marketing-related public policy can help to move people toward healthier, more sustainable food consumption.

HCB: How do you define FWB?

Grier: We define food well-being as “a positive psychological, physical, emotional and social relationship with food at both the individual and societal levels.” This definition is richer than the way we think of food, and emphasizes the multidimensional role that food plays in our lives. We identify five key domains that are encompassed in FWB: food socialization, food literacy, food marketing, food availability, and food policy.

The FWB framework highlights the need for research related to food to consider multiple disciplines and paradigms both within marketing (e.g. managerial, consumer, public policy) and outside of marketing (e.g. public health, psychology, sociology, etc.).  Each dimension of FWB incorporates a broad range of influences that together help us to better organize the complexity of food decisions and food’s ability to contribute to our social, psychological and physical well-being.

HCB: Why do you call for a shift to the food well-being concept?

Grier: The paper evolved from the “Food and Health” track of the first “Transformative Consumer Research (TCR)” conference. This is a dialogical conference; there were no presentations, just discussions over a two-day period about how to develop new research ideas. It was the first conference with this type of focus in the marketing and consumer research fields.

I was a co-chair of the track. Prior to the conference, we reviewed applications and selected a diverse group of 10 people to include in the track. Many didn’t know each other, and participants were conducting many different kinds of research (for example, managerial, consumer-oriented, and policy research) from different theoretical and methodological perspectives (including experimental, qualitative, economic, and other approaches). We also invited an “out-of-field” (that is, a non-marketing) participant, and that was Shiriki Kumanyika, PhD, MPH, a professor of epidemiology and my mentor in the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of Pennsylvania.

So, we had all of these people in one room discussing the question: “How can we move the research on food and health forward, in a way that is transformative?” And through our discussions, it became clear that research and intervention approaches to health issues related to food consumption do not typically consider the multi-dimensional role of food in people’s lives.

The traditional emphasis on restriction and restraint focuses on what you shouldn't do. It's really a negative framing. And people like food! Most people do not see it as a negative. So we wanted to look at the role of food and health in the way that people do in their daily lives and frame it in a way that reflects how food contributes positively to peoples’ lives.

HCB: How can we make that shift as a country?

Grier: As a country, taking this positive approach toward food, and understanding how we can contribute to our well-being—as opposed to solely focusing on how it can be detrimental to our health—would help move the conversation forward for us all. The FWB framework identifies key areas at both the individual and societal levels. A focus on these factors, such as the way we socialize children about food, food literacy among the population, our food policies, and food marketing and availability, at the aggregate societal level will help us make the shift as a country.  I believe this can lead to healthier, more sustainable consumer lifestyles with regard to food.   

I already see the shift taking place in terms of the way people are talking about food. There have been conversations around these different dimensions of food, but now I'm seeing them linked together more frequently, and related to the notion of food as well-being, as opposed to just food as health.

HCB: How do you plan to spur the shift as a health researcher, and are you confident the shift will take place?

Grier: I continue research in this area and work to support the evolution of the concept in marketing, as well as in other disciplines. At the doctoral student/faculty consortium prior to the marketing and public policy conference three years ago, we held a workshop on food well-being. We had a group of doctoral students and junior faculty develop research proposals related to the food well-being concept, and then resident faculty provided commentary and assistance to further develop the proposals. In this way we are exposing new researchers to the concept and helping them develop relevant research.

In addition, subsequent to our Transformative Consumer Research track, other conference tracks at TCR Conferences have taken on the topic and extended it. There have been two additional research articles focused on the concept from these conferences. 

And finally, along with my co-chair from the conference and another colleague who was in a subsequent TCR group, we are in the process of publishing an article that integrates food well-being with social marketing, which is a key framework for designing health interventions. This will be published in a forthcoming “Handbook of Consumer Persuasion.”* This further helps to extend our thinking.

HCB: You were an RWJF Health & Society Scholar. What did you study during this period, and how has it influenced your current work?

Grier: I came into the program wanting to understand how marketing influences consumer behavior and health. My application to the program was built on a desire to understand how marketing—and by that, I mean the entirety of the marketing process, including the product, promotion, price, place and distribution— influences health.

That desire grew from my observation at the time that public health really seemed to emphasize advertising. But advertising is only one small part of marketing strategy and tactics and only one of the many ways in which the marketing system influences consumer attitudes, preferences, beliefs and actions.

At Penn, I worked primarily with Shiriki Kumanyika on issues related to obesity among African-Americans. A key outcome of this work was a systematic review in the American Journal of Public Health** that investigates the marketing environment that African-Americans face. There was such limited research on African-Americans that it was important to understand what they were exposed to as a result of aggregate marketing strategies. 

My subsequent research has evolved from this initial project, and seeks a more detailed understanding of the food marketing environment and how consumers respond to it, as well as what types of shifts might be needed to promote healthier eating and FWB among African-Americans in the context of the obesity epidemic.

In addition, the program really expanded and stretched my research. I came in primarily as a traditional experimental consumer researcher focused on target marketing. I aimed to understand the social-psychological processes underlying consumer responses with an emphasis on the role of cultural categories, especially those defined by ethnicity, age and gender. 

In the last 10 years I have expanded my research from a focus on individual consumer behavior to encompass the macro-societal dimensions of target marketing. In addition to examining consumers’ psychological processes, my research now also examines managerial strategies, public policy and ethical dimensions of target marketing. I look not only at obesity, but also other conditions such as breast cancer, and disparities in health more generally. The RWJF Health & Society Scholars program was a big part of the evolution of my research and the research topics I now undertake.


*Bublitz, M.G., L.G. Block and S.A. Grier. (Forthcoming),”Social Marketing to Advance Food Well-Being”, in Handbook of Persuasion and Social Marketing, Praeger Publishing, p. 39-76.

**Grier, S. A. and S.K. Kumanyika (2008), “The Context for Choice:  Health Implications of Targeted Food and Beverage Marketing to African-Americans,” American Journal of Public Health, 98:9 (September), 1616-1629.

Wed, 15 Oct 2014 09:00:00 -0400 Human Capital Blog Scholars and fellows Public policy Research Obesity policy Human Capital Health & Society Scholars Voices from the Field <![CDATA[Crusader Against Cancer]]>

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 Jacqueline Barrientos, MD, a member of the 1994 class.

Jacqueline Barrientos Jacqueline Barrientos, MD

As far back as Ancient Egypt, cancer has frustrated medical practice. Papyri written around 1600 BC describe various cases, with one concluding that “there is no treatment.”

But there’s hope for patients diagnosed with chronic lymphocytic leukemia (CLL)—a cancer that attacks the blood and bone marrow—thanks to Jacqueline Barrientos, MD, who isn’t intimidated by the history surrounding the disease.

She’s busy helping to rewrite it.

Barrientos is part of a team researching new CLL therapies at the North Shore-LIJ Cancer Institute’s CLL Research and Treatment Center on Long Island. In clinical trials, the pioneering drug treatments produced unprecedented results—considerably better than those achieved with chemotherapy, and minus the brutal side effects.

“We’ve never seen response rates like this before,” says Barrientos. “It’s astonishing.” When the FDA approved the use of the new treatments earlier this year, she and her team were elated. “We’re giving life to patients who once had no hope of surviving because the cancer was so aggressive.”

To those patients, Barrientos and her colleagues are saviors. “You have given us hope where there wasn’t any,” wrote one. “I thank you, my children thank you, and my eight grandchildren thank you.”

Journey of a Thousand Miles

For Barrientos, the newly approved CLL therapy is the zenith of a long journey. “I always wanted to treat cancer,” she says.

Her passion for the work is personal: when she was 6 years old, her mother was diagnosed with refractory lymphoma, a form of cancer that is resistant to treatment.

“We didn’t have good cancer doctors in Peru,” explains Barrientos, who was born in that country’s Chincha Province. Her father, a general practitioner and surgeon, took her mother to Houston’s MD Anderson Cancer Center seeking more advanced therapies, which also were unsuccessful. “She didn’t respond, ever. She suffered a lot.”

Although she couldn’t know it at the time, her mother’s illness set Barrientos on the path she travels today. “I felt we needed to find better ways to treat the disease. We treat infections with antibiotics...why couldn’t we do the same with cancer?”

As an undergraduate in Puerto Rico, where Barrientos moved with half of her family in the wake of Peru’s political turmoil in the 1980s, she joined a pre-med club and began to explore the possibilities. That’s where she saw an ad for the University of Virginia (UVA) Medical Academic Advancement Program (MAAP), which later became the Robert Wood Johnson Foundation’s Minority Medical Education Program (MMEP, now SMDEP).

“When I was accepted to MAAP, I was jumping for joy!” she exclaims. Getting there was logistically taxing—she had to take a plane from Puerto Rico to New York City and then a Greyhound bus to UVA’s campus in Charlottesville, Va.—but once she arrived, she was introduced to like-minded people, including doctors who had once participated in the program.

“They talked about their experiences and how they made it, and I thought, ‘Oh, my God, I hope that will be me one day,'” she says. “And about 10 years ago, I was invited to go back and speak to the new students.”

Entering the Promised Land

Although she was determined to become a doctor, Barrientos felt an equally strong pull toward research. Back home, there was a line of demarcation between the two disciplines: “In Puerto Rico, most MDs are clinicians only, while the people who want to do research are PhDs.” But at MAAP, Barrientos partnered with a black physician who was a researcher as well. “I was surprised to learn I could do both.”

It’s hard when you know that there is a drug that could save someone’s life, but you’re unable to offer it because it hasn’t been approved yet.

She also found a mentor who, two decades on, continues to influence her: Moses Woode, PhD, who led MAAP and then MMEP at UVA for 25 years.

“Jacquie is an intelligent, highly motivated individual with great determination and perseverance,” says Woode. “She will continue to make outstanding contributions to health care and is a wonderful role model.”

Barrientos says Woode told the students, “Medicine is the Promised Land. You have to study a lot. You cannot slack off. You have to make an effort.”

She adds, laughing, “I just realized: his name is Moses, and he told us about getting to the Promised Land. It took me 20 years to put that together!”

Over the years, there have been many other mentors who have helped Barrientos pursue her goals. One of them, Kanti R. Rai, MD, invited her to interview four years ago for her current position at the CLL Research and Treatment Center. But Rai is no run-of-the-mill researcher; when it comes to CLL, he’s a veritable rock star. The main system used to classify stages of the disease is named for him, and he has received numerous awards in recognition of his groundbreaking clinical research and contributions to oncology.

Breakthrough Treatment

With Rai’s support, Barrientos opened up clinical trials of two new drugs, ibrutinib and idelalisib, that she believed had the potential to change the lives of their CLL patients.

“The moment that I opened up those clinical trials, we couldn’t stop people from banging on our doors to get into the trials,” she says. The drugs worked immediately, without many of the side effects of chemotherapy.

“These are targeted drugs that essentially put you into remission without the toxicity that you usually think of with chemotherapy—none of the usual vomiting or tiredness,” she explains, adding that even patients who hadn’t responded to other therapies went into remission.

When the program began to grow, Rai made sure that Barrientos had the patients and staffing she needed to continue her research. “I don’t think I could be here without his support,” she says. “I’ve been very blessed.”

The success of the trials were accompanied by disappointments. “In one of the studies, the FDA allowed crossover to the new drug only after some time, even if the patients had progressed,” says Barrientos. “People died waiting for the miracle drug.”

We’re giving life to patients who once had no hope of surviving.

“I do understand the need for clinical trials and comparisons to ensure patient safety,” she adds. “It’s just hard when you know that there is a drug that could save someone’s life, but you’re unable to offer it because it hasn’t been approved yet.”

The results of the trials were published in a series of articles in the prestigious New England Journal of Medicine, and the FDA eventually approved both drugs to treat patients with CLL.

Making Dreams a Reality

One of those patients, Ronald E. Tolkin, was diagnosed in March 2007. Although chemotherapy had lowered his white blood cell (WBC) count from a high of 264,000—the normal range is between 4,500 and 10,000—he suffered serious side effects. Then, in late 2012, his WBC count began to rise again.

“The night before I was scheduled to go into the hospital for more chemotherapy, Dr. Barrientos called me to find out if I wanted to participate in a new study,” says Tolkin. Instead of chemotherapy, he would take three pills a day of ibrutinib—a welcome change in light of his previous experience with chemo.

Tolkin began taking ibrutinib in January 2013. Within months, his WBC count started to fall, and CAT scans showed improvement in his spleen and lymph glands. “At my last visit my white blood count was 9,000, which is within the normal range,” he says. “My CAT scan shows that there is no sign of CLL.”

Ever the scientist, Barrientos is careful to note that the treatment’s longest follow-up so far is three years. “But to me, it’s very encouraging,” she says. “The hope is that we can make this cancer a chronic, treatable illness, like HIV.”

Ronald Tolkin is less reserved about her accomplishments.

“This was a life-altering event for me and my wife,” he says. “We can now plan for our future. We have eight beautiful grandchildren, ages 4 to 12. It’s our hope and desire to be able to dance at all of their weddings.

“Dr. Barrientos has made that dream a reality for us.”

Tue, 14 Oct 2014 09:00:00 -0400 Human Capital Blog Scholars and fellows Cancer Clinical research Human Capital Summer Medical and Dental Education Program <![CDATA[BSN Qualifications Recommended for the Nation’s Nurses: Four Years of Progress]]>

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.

Linda Aiken Linda H. Aiken

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.

Olga Yakusheva - medium enlarge Olga Yakusheva

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.

Employers have become engaged for the first time in meaningful ways, taking actions to move to a largely BSN workforce through preferential hiring of BSN-qualified nurses and support of their employees to pursue RN to BSN education. The Magnet Recognition Program, a form of voluntary accreditation for nursing excellence to which many institutions aspire, now requires evidence from applicants documenting progress toward achieving a nursing workforce of at least 80 percent BSNs. More than 100,000 nurses are pursuing bachelors in nursing degrees, up from only 35,000 in 2004. The Future of Nursing: Campaign for Actiona joint initiative of AARP and RWJF—is helping promote more efficient articulation between associate degree and baccalaureate nursing programs and helping state Action Coalitions develop local and regional strategies to increase the number of nurses with BSNs.

Agenda-setting research: The IOM report’s recommendation on baccalaureate education for nurses also stimulated additional research on the outcomes of baccalaureate nursing.  At least three agenda-setting papers documenting better patient outcomes associated with more BSN qualified nurses have been published since the IOM Report.

Among the top 15 most read papers in Health Affairs in 2013 was the first large scale longitudinal study of the impact of increased employment of BSNs by hospitals (Kutney-Lee, Sloane, Aiken, 2013). The panel study of Pennsylvania hospitals showed that that those increasing their percentage of bedside care nurses with BSN qualifications between 1999 and 2006-07 experienced significantly greater declines in hospital mortality than hospitals that had not hired more BSNs over the period. Researchers estimated if all hospitals in Pennsylvania had increased to 80 percent BSNs, some 2,100 lives might have been saved in the one state over the seven-year period, showing the great potential for preventing unnecessary deaths if the whole country transitioned to 80 percent BSN nurses. This study is one of the first to establish a causal linkage between more BSN nurses and better patient outcomes—information that is needed to convince employers that increased investments in BSN nurses is likely to yield the expected result of better patient outcomes.

Earlier this year, The Lancet published the results of the first comprehensive study on the effect on hospital mortality of more baccalaureate nurses at the hospital bedside in nine European countries (Aiken et al., 2014). Independent of the effects of patient-to-nurse workloads and characteristics of hospitals such as teaching status and technology availability, each 10 percent increase in the percent of baccalaureate qualified bedside care nurses in European hospitals was associated with 7 percent lower in-hospital mortality following common surgical procedures. This research in Europe in differently organized, financed, and resourced health systems closely mirrors similar research in the United States and Canada, and thus strengthens the case that baccalaureate education for nurses really matters in improving patient outcomes. As a result of the study, the European Parliament recommended for the first time a bachelor’s pathway for nursing education in European Union countries.

Most recently, an important economic analysis published in Medical Care (Yakusheva, Lindrooth, Weiss, 2014) documented the value of a nurse workforce in which most nursing care (80%) was delivered by BSN-qualified nurses. An editorial (Aiken, 2014) accompanying the publication of this paper lauds its innovative design which examines the dose response relationship between the percent of BSN care for individual patients and these patients’ outcomes. The paper adds significantly to our understanding of the improved patient outcomes that can be expected when the nation reaches the target of 80 percent BSN nurses. The new study documents the outcomes for individual patients depending upon the percent of their care that is provided by BSN nurses.

Previous studies have estimated the impact of BSN-qualified nurses on patient outcomes by the percent of all nurses in an institution qualified at the BSN level. Both are reliable and valid methods for assessing the impact of BSN care but the advantage of examining the dose of BSN care for individual patients is that many patients are already receiving 80 percent or more of their care from BSN nurses, whereas few hospitals have yet to employ 80 percent or more BSN nurses. The new paper documents the same relationship between more BSN care and lower mortality, as found in the European study and previous research in the United States. But the study ploughs new ground by showing that once patients receive a threshold level of 80 percent BSN care, other important outcomes like readmission rates and average length of stay are significantly reduced. Thus even if BSN nurses are compensated at a higher level, the savings they achieve for hospitals in better outcomes for patients more than offset their higher compensation.

The Affordable Care Act:  The IOM recommendations on nursing education were issued in the same year that the Affordable Care Act was passed—timing that was fortuitous for pressures to change nursing education. Millions of previously uninsured patients are expected to seek medical care resulting in an exacerbation of an existing national shortage of primary care. The IOM Report pointed to advanced practice nurses as safe and effective primary care providers who needed to be fully mobilized to meet national demands for primary care. Yet producing enough advanced practice nurses would require a larger pool of nurses with bachelor’s degrees because advanced practice nurses are required to obtain at least Master’s level education.

Historically, only 20 percent of nurses have gotten even one additional degree after their basic nursing education. If two-thirds of nurses continue to get their initial nursing education in associate-degree programs, the stream of nurses likely to enter graduate programs preparing nurse practitioners will be too small to meet national primary care capacity requirements. Thus national efforts to ameliorate the shortage of primary care put additional pressure on nursing education programs to graduate fully qualified BSN nurses from basic pre-licensure programs to produce a larger pool of nurses who qualify to enter nurse practitioner education programs.

Challenges ahead: In setting sustainable growth targets for the baccalaureate-educated nursing workforce, the economics of the nursing market can no longer be ignored. While accurate nationwide estimates of the cost of a BSN degree are difficult to find, the average cost (not including room and board) of a 4-year college degree in 2013-14 was $9,000 to $30,000 per year (Trends in College Pricing, 2013). Given that a diploma-prepared nurse earns, on average, $65,000 per year, the decision to transition to a BSN can come with a hefty price tag in tuition costs and lost wages—as high as $138,000-$180,000 for ADN-to-BSN, and twice as high for Diploma-to-BSN transitions. Yet, the salary premium for having a BSN is currently a miniscule $6,400 a year (IOM, 2011), which means that nurses embarking on a BSN education are generally not expected to even begin earning a positive return on their educational investment until 20 to 30 years into their careers.

As a point of comparison, the earnings premiums for having a 4-year college degree in fields other than nursing is about $25,000 annually. If we are to generate a sustainable transition to BSN-educated nursing workforce, policymakers, employers and payers need to understand the necessity of aligning the wage premium for BSN-prepared nurses with the rest of the labor market. Evidence of the value-added of nurse education to patient outcomes and organizational economic viability is key to growing this momentum.

The transition to a national BSN nurse workforce:  Market forces are in greater alignment than ever before to support transition to a BSN-qualified nurse workforce in the United States. The IOM report recommending the transition helped immensely in garnering the attention and participation of important stakeholders, including, most importantly, employers.

Investments by RWJF in helping stakeholders problem solve to make the transition feasible have helped tremendously. Renewed national interest in BSN education has stimulated research to inform decisions that will further motivate the transition. The nation’s continuing challenges to provide safe, effective, patient-centered, affordable care and prevent a widespread shortage of primary care providers will coalesce to support the long awaited standardization of nursing education at the bachelor’s level, comparable to the minimum educational standard of all other health professionals.     


Institute of Medicine.  The Future of Nursing: Leading Change, Advancing Health.  Washington, DC: National Academies Press, 2011.

National Advisory Council on Nurse Education and Practice, Report to the Secretary of DHHS on the Basic RN Workforce.  Rockville, MD:DHHS, 1996.

Kutney Lee, A, Sloane, DM, Aiken, LH.  2013.  Increases in nurses with baccalaureate degrees associated with lower rates of post-surgery mortality.  Health Affairs 32(3):579-586.

Aiken LH, et al.  2014.  Association of nurse staffing and education with hospital mortality in 9 European countries.  The Lancet 383:1824-30.

Yakusheva O, Lindrooth R, Weiss, M.  2014.  Economic evaluation of the 80% baccalaureate workforce recommendation: A patient-level analysis.  Medical Care 52:864-869.

Aiken LH.  2014.  Baccalaureate nurses and hospital outcomes: More evidence.  Medical Care.  52:861-863.    

Fri, 10 Oct 2014 09:00:00 -0400 Olga Yakusheva Nurses Research Interprofessional collaboration Affordable Care Act (ACA) Education and training Workforce issues Human Capital Nursing Future of Nursing Future of Nursing: Four Years Later Voices from the Field <![CDATA[Hospitals Must Recruit Nurses to Their Leadership Boards]]>

This week marks the 4th anniversary of the Institute of Medicine’s future of nursing report. David L. Knowlton is president and CEO of the New Jersey Health Care Quality Institute.

David Knowlton

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.

As Chairman of the Board of St. Francis Medical Center in Trenton, one of my first actions was to recruit a nurse as a full member of the board. Nurses bring a patient-centric view of health care and a clinical background critical to the far-reaching and complex issues the board must address.

I mean no disrespect to the attorneys, business leaders and other committed people on hospital boards when I say the perspective of nurses is invaluable. Nurses understand the day-to-day workings of a hospital better than any other profession—yes, even doctors.

I must say that I am mystified at the lack of nurses on boards. Why the waste of talent? I hear the argument that putting nurses on boards can be a conflict because they might put the needs of fellow nurses above the overall needs of the hospital.

Every nurse I have ever met put the needs of patients first. Regardless, a board must seek and can easily find a nurse who is not a hospital employee—perhaps a nursing professor or advanced practice nurse with a private practice. The ethical requirements for any board member would apply to any nurse on the board.

We know the push for quality is stronger than ever. Any hospital that wants to avoid the Medicare penalties or—just as harmful—the bad publicity that can follow low quality ratings needs a nurse on its board. When I became chair of The Leapfrog Group, a non-profit organization promoting safety, quality and affordability of health care, I recruited a nurse to the board. It seemed foolish to even talk about safety and quality without a nurse at the table.

And today hospital patient satisfaction surveys are public. No medical profession is more closely connected to patient satisfaction than the nursing profession. If you have ever been in a hospital—and I have—you know that nurses are the folks most responsible for all of your day-to-day care.

I believe the leaders in hospitals recognize the value of nurses. They know nurses are essential to everyday patient care. But I suspect too many hospital board members fail to see nurses as leaders. The nursing role has changed as nurses today run private practices, obtain advanced degrees and prescribing privileges, and run many hospitals as CEOs.

The role of nurses has changed faster than the perception of nurses held by too many people on hospital boards. That needs to change, not for the sake of nurses but for the sake of hospitals and all of us as patients.

Thu, 9 Oct 2014 11:00:00 -0400 David L. Knowlton Nurses Nurse practitioners Advanced practice nurses Human Capital Future of Nursing: Four Years Later Nursing Voices from the Field RWJF Leaders Future of Nursing Campaign for Action <![CDATA[RWJF Scholars in the News: The nurse faculty shortage, teaching empathy, a link between overtime and diabetes, and more.]]>

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

ABC News explores the nation’s nursing workforce shortage, focusing specifically on the faculty shortage at nursing schools. “Suddenly, we turned around and realized we’re not attracting enough nurses to go into teaching,” said Kimberly Glassman, PhD, RN, chief nursing officer at NYU Langone Medical Center. “The fear is we will have to shrink the number of nurses we can prepare for the future at a time when we need to prepare more.” Glassman is an RWJF Executive Nurse Fellow. The article was republished by Yahoo News and ABC News Radio.

RWJF Health & Society Scholars program alumnus Allison Aiello, PhD, MS, is interviewed for an NBC News story on Enterovirus D-68. She recommends that parents consider getting flu shots for their children, noting that preventing children from getting the flu should help make Enterovirus less complicated to diagnose and treat. The video is available here.

RWJF Harold Amos Medical Faculty Development Program scholar Paloma Toledo, MD, co-authors a Huffington Post blog entry on the need for medical schools to teach students to be empathetic. Over the course of their training, they become less empathetic, as opposed to more empathetic, and the reasons for this are unclear,” Toledo writes, recommending lectures on active listening and communication skills, among other measures. 

Erin E. Krebs, MD, MPH, will conduct a four-year project that will track more than 3,000 Iraq and Afghanistan veterans to learn about the development of chronic pain following their tours of duty, the Star Tribune (Minneapolis) reports. The project is part of Krebs’ work at the Minneapolis Veterans Affairs (VA) Medical Center—where the RWJF/U.S. Department of Veterans Affairs Physician Faculty Scholars program alumna is women’s health medical director. Nationwide, the VA launched the Opioid Safety Initiative in 2012 to reduce opioid use for chronic pain by focusing on patient education, close patient monitoring and such alternative treatment practices as acupuncture, yoga and meditation.

A recent analysis of several studies finds that low-income people doing manual work were much more likely to develop type 2 diabetes if they worked more than 55 hours per week, the Daily RX reports. Published in The Lancet Diabetes & Endocrinology, the study is accompanied by an editorial, co-written by Cassandra Okechukwu, ScD, in which she suggests that “work factors affecting health behaviors and stress might need to be addressed as part of diabetes prevention.” Okechukwu is an RWJF Health & Society Scholars program alumna. The editorial was also covered by FARS news agency, the Diabetes News Journal and the Nigerian Tribune, among other outlets.

In a guest column for the Seattle Times, Jennifer Stuber, PhD, writes that the debate in Washington state over background checks for gun buyers should be expanded to address the misuse of guns to prevent suicides. “The sad reality is 78 percent of all firearm deaths in Washington state are suicides,” Stuber writes. She recommends embarking on a robust public-health initiative focused on firearm suicides, including gun safety and storage. Stuber is an RWJF Health & Society Scholars program alumna. Read more about Stuber’s experiences.

FiveThirtyEight reports on a not-yet-peer-reviewed working paper posted online by Jason M. Fletcher, PhD, MS. In “Estimating the Value Added of Attending Physicians on Patient Outcomes,” Fletcher and co-authors create a method to measure a doctor’s “value added”—a risk-adjusted measure to link patient-health outcomes to doctor performance. Doctors with a value added score at the 75th percentile had patients whose health outcomes were 8 percent better than patients of doctors with a score at the 25th percentile, according to the story. Fletcher is an RWJF Health & Society Scholars program alumnus.

Politico features recommendations from 15 health scholars on how to revise the Affordable Care Act in 2015 and beyond. RWJF Investigator Award in Health Policy Research recipient and Scholars in Health Policy Research alumnus Harold Pollack, PhD, is among the 15. He writes that the law is working better than expected, citing the declining number of uninsured Americans and evidence that growth in spending is below expectations and quality indicators are improving. Pollack laments the Supreme Court’s narrowing of the law’s Medicaid expansion, arguing for allowing near-retirees to buy into Medicare.

Overall government spending on child welfare declined from 2010 to 2012, even as the number of youths entering foster care increased, according to research led by Christopher Wildeman, PhD, an RWJF Health & Society Scholars program alumnus. Total federal, state and local spending dropped by $2.3 billion during those years, reports the Chronicle of Social Change. Some but not all of the decline can be attributed to the 2009 economic stimulus legislation but “additional factors are at play,” the report said.

The School of Nursing at the University of Texas in Austin is one of two institutions in the country to receive a multimillion-dollar grant from the National Institutes of Health to build a new research center dedicated to advancing health care for individuals, families and communities, reports BioNews Texas. The $2.4-million grant will help fund completion of the Center for Trans-Disciplinary Collaborative Research in Self-Management Science. RWJF Executive Nurse Fellows alumna Miyong Kim, PhD, RN, FAAN, is director of the new research center.

Births of multiple babies cost more and pose greater risks of complications and death than singleton births, according to a study that suggests limiting embryo transfers for couples undergoing in vitro fertilization, HealthDay reports. An editorial accompanying the study in JAMA Pediatrics, co-authored by RWJF Clinical Scholar Pooja Mehta, MD, notes that research has shown insurance coverage plays a role in embryo-transfer decisions. “We must recognize the dangerous and potentially discriminatory ways in which even educated reproductive decision-making seems to be constrained by a restrictive coverage environment.” The research and editorial were covered by the Los Angeles Times, US News and World Report, and Medical Daily.

Propeller Health, a startup company founded by David Van Sickle, PhD, MA, an RWJF Health & Society Scholars program alumnus, has landed $14.5 million in new financing, the Wisconsin State Journal reports. The new funds will let Propeller speed development and bring its products to a wider audience, the article says. Propeller uses sensors on asthma inhalers, along with mobile apps and analytics, to monitor when and where an asthma patient uses an inhaler and transmit that data to doctors. Mobile Health News also recently covered Propeller Health.

Thu, 9 Oct 2014 09:35:00 -0400 Human Capital Blog Scholars and fellows Research Epidemiology Nurses Workforce issues Human Capital HC Website Feature Media Coverage Executive Nurse Fellows Health & Society Scholars Harold Amos Medical Faculty Development Program Physician Faculty Scholars Investigator Awards in Health Policy Research Scholars in Health Policy Research <![CDATA[Proud to be ‘The Nurse on the 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.

Fran Roberts

“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.

"[Nurses] see how the full life of a hospital unfolds, how its departments interact, where the seams are, where the stitchery is frayed."

Within six months, I concluded that I was pigeon-holing my profession! My fellow board members’ contributions to the board all reflected their professional experiences. Physicians on the board examined issues through the lens of their own practices. Business leaders on the board thought in terms of financial implications.

Nurses deserved to be represented in those discussions. But more than that, as a nurse, I felt I had a broader range of experiences to bring to the table. With due respect to physicians, nurses are the ones who actually live in hospitals. We’re there 365 days a year, holidays and weekends, 24 hours a day. We see how the full life of a hospital unfolds, how its departments interact, where the seams are, where the stitchery is frayed. We see hospital care through the eyes of our patients, because we’re with them at all phases of their care—those who come to the emergency room for a broken bone and are gone within a few hours, and those who come with more serious, life-threatening conditions who are with us for days and weeks. We help them heal, and we see them through the transition to rehab or back home. We understand the risks involved in those transitions. We meet their families, understand how their home environment affects their recovery, and how their cultural background comes into play.

Along the way, we live the experience of what it means to a hospital to be short-staffed. We see what it means in terms of patient care and safety, and its impact on the nursing staff. We experience the impact of staff cuts in ways doctors or business leaders usually don’t.

In short, we understand hospital care from the inside out, with a perspective unique to the system.

So my role isn’t just to stick up for what nurses want and need, it’s to stick up for what the whole system needs, along with its patients, families and communities.

The other role I’ve learned that nurses can play on a board is to translate medical-ese for the non-medical board members. In the same way that nurses routinely explain to patients and their families what doctors said earlier that day, then take time to answer their questions, I find that I can be helpful to my fellow board members breaking down some of the jargon from my physician colleagues on the board.

So after six months on the board, I met with the board chair and told him that I was coming out of the closet and intended to be the nurse on the board, and that I was going to be proud and articulate about it!

Since then, I’ve been a stronger board member, and rather than bringing a narrow, nurses-first-last-and-always perspective to the board’s deliberations, I’ve been able to bring a broader perspective, connecting the dots between financial issues and quality of care, staffing and more. My colleagues with a business background are trained to examine issues from a financial perspective. But as a nurse, I can see how staffing issues affect quality of care, and how that affects readmissions and the increased use of expensive contract labor and that, in turn, is reflected in bottom line costs. I can articulate every link in that chain to my fellow board members.

Before too long, I’ll cycle off of the Presbyterian board. I’m glad to say that my colleagues need no convincing that they need to find a nurse to take my seat. They’re right to think that, of course. But I think they’d do better to recruit two...or three...or...!

Wed, 8 Oct 2014 09:00:00 -0400 Fran Roberts Nurses Leadership development Advanced practice nurses Human Capital Future of Nursing Future of Nursing: Four Years Later Nursing Voices from the Field Executive Nurse Fellows <![CDATA[A Business Community Board Role Broadens a Nurse Leader’s Horizons]]>

This week marks the 4th anniversary of the Institute of Medicine’s future of nursing report. Sandra McDermott, DNP, RN, NEA-BC, is an assistant professor of nursing and the director of health and service related professions at Tarleton State University in Fort Worth, Texas. A member of the Texas Team Action Coalition, which recently launched the Nurses On Board training program, she is a newly appointed member of the board of directors for the Fort Worth Chamber of Commerce South Area Council.

Sandra McDermott

I have been in my university director position for about six months now, and I knew that before I started teaching classes this fall, I had an opportunity to really get involved in the Fort Worth community. I wanted to get my name out there, because when I do that, I am getting my school’s name out there, too. I started attending Chamber events and enjoyed them, and I realized that the South Area Council is the one that encompasses the hospital district, which is where I want to have a lot of my connections.

If my role is to draw nursing students and build awareness for our nursing programs, then clearly, focusing on the hospital district makes a lot of sense. I had made a strong connection with a South Area Council board member, so I lobbied the Chamber to join the board, and they ultimately added a new spot and appointed me to it, which was very humbling. They did not have a university represented on the Council, and they saw value in having a nurse and an educator join them.

The main campus for my school is about 90 miles away. Everyone knows about our presence there, where there are around 8,600 students. But in Fort Worth, we have around 1,600 students, and the nursing programs are relatively new and very small. I knew I needed to be out in the community as we build up our programs, and what better way to do it than to be at multiple Chamber functions? And as a board member, I knew I could influence a lot more people. In the hospital district, I can go in as not only a nurse and an educator, but a Chamber leader as well. That is a great platform to advocate for my school programs and for wellness and health care as community priorities.

"[Board service] is a great platform to advocate for my school programs and for wellness and health care as community priorities."

You hope you are bringing something to the table that is meaningful to the people you are joining, and I have tried to show that I am driven by passion and compassion, which are things that can be hard to write into a board job description. I have already connected with a fellow board member who does great work with Catholic Charities, and we are encouraging the board to make a bigger investment in scholarships for community residents, and the board has been very supportive.

My background has been very broad, and I have been fortunate enough to have been a nursing administrator at both the VP level and at an associate chief nursing officer level, so I had to have that 30,000-foot view for several years of my career. That has caused me to really look at the big picture, and what I see in the business community, and in my education role, is how people often focus on their own silos. I have never been able to do that as a nurse leader, and that background has been a great match for a board role.

I also serve on the board for an organization called the Dallas Fort Worth Great 100 Nurses, and I was its first board president. The Chamber community, of course, is much different, and I really enjoy interacting with the different kinds of businesses and different kinds of people. The issues are very interesting, and I love broadening my horizons this way. There are so many good things that can happen through my Chamber board service that will benefit my community and my campus, so I am thrilled with this opportunity and eager to see where it takes me.    

Tue, 7 Oct 2014 09:00:00 -0400 Sandra McDermott Nurses Leadership development Nurse practitioners Human Capital Campaign for Action Nursing Voices from the Field Future of Nursing: Four Years Later Future of Nursing RWJF Leaders <![CDATA[Celebrating Four Years of Nurses Leading Change to Advance Health]]>

Susan B. Hassmiller, PhD, RN, FAAN, directs the Future of Nursing: Campaign for Action, which is implementing recommendations from that report. Hassmiller also is senior adviser for nursing for the Robert Wood Johnson Foundation.

Susan Hassmiller

This week marks the fourth anniversary of The Future of Nursing: Leading Change, Advancing Health, the landmark Institute of Medicine (IOM) report that galvanized the nursing field and partners to participate in health system transformation. Nurses nationwide are heeding the report’s call to prepare for leadership roles at the national, state and community levels. Why?  Simply put, nurses coordinate and provide care across every setting, and they can represent the voices of patients, their families and communities. Nurses are the reality check on committees and in boardrooms.

The Future of Nursing: Campaign for Action, a national initiative led by the Robert Wood Johnson Foundation (RWJF) and AARP to implement recommendations from the future of nursing report, is promoting nursing leadership—and I’m thrilled by our progress.

To date, Action Coalitions report that 268 nurses have been appointed to boards. Virginia has implemented an innovative program to recognize outstanding nurse leaders under age 40, and several other states including Arkansas, Nebraska and Tennessee are offering similar programs. New Jersey has set a goal of placing a nurse leader on every hospital board. Texas has partnered with the Texas Healthcare Trustees to provide its nurses with governance and leadership education to prepare them for board leadership. Even better, other states are fostering nursing leadership by adopting these best practices.

Fundraising is an important aspect of leadership, and state action coalitions have raised more than $10 million so far to advance the future of nursing recommendations—that’s in addition to receiving RWJF financial support!

Next month, the Campaign will recognize 10 emerging national nursing leaders with its Breakthrough Leaders in Nursing awards at our “Leadership and Legacy: The Future Is Now” summit in Phoenix. Each leader will receive a Leadership Development Program scholarship package from the Center for Creative Leadership, funded by RWJF. This interprofessional experience is designed to maximize their leadership potential. The selected leaders will be the future leaders of this Campaign, and the leaders needed to transform health through nursing.

I’m excited that the major national nursing associations recently set the audacious goal of placing 10,000 nurses on boards by 2020. The associations will combine their best practices, including board and leadership development training programs, to place a record number of nurses on boards. Many of the associations have done a stellar job in promoting nursing leadership, and combining resources will ensure that more nurses join influential boards.

As we ramp up efforts to promote nursing leadership, the Campaign needs more nurses to commit to being leaders in their communities and states, and the nation. Nurses need to be represented as decision-makers on hospital and health care boards, public health commissions, community oversight boards, advocacy groups, and other boards. When nurses are not on committees and boards making decisions, others make decisions for them.

I recently asked four leadership experts how nurses can prepare for nurse leadership.  They are Angela McBride, PhD, RN, FAAN, distinguished professor and university dean emerita, Indiana University School of Nursing; Melanie Dreher, RN, PhD, dean emeritus, College of Nursing, Rush University, Chicago, Illinois; Connie Curran, RN, EdD, president, Curran Associates; and Larry Prybil, PhD, Norton professor of health care leadership and associate dean, College of Public Health, University of Kentucky, Lexington.  They said that nurses should:

  1. Have broad knowledge, including an ability to speak about health care, politics, the economy, business and finance.
  2. Develop their expertise, so they can make contributions regarding clinical care, IT, administration or quality improvement methods.
  3. Join community and municipal organizations such as the Rotary or the Economic Club or the Governmental Affairs Group, and be visible within interdisciplinary circles, so other influencers value their expertise. (Individuals in other fields are likely to nominate nurses to board positions.)
  4. Analyze the board to determine what it needs to reach its goals. Nurses should read recent financial and annual reports prior to the interview so they can ask relevant questions and identify areas of the organization in which they can be useful. 
  5. Tell their network they want to be on a board and use their influential contacts to secure a position.
  6. Start small, joining committees within their organizations or local organizations.

Four years ago, the IOM deliberately called on nurses to lead change to advance health.  I’m proud that the nursing field is answering the call for the expressed purpose of improving the health of all people wherever they live, learn, work and play. By engaging in leadership to improve health, nurses are helping to fulfill RWJF’s vision of building a Culture of Health -- to enable all in our society to lead healthy lives, now and for generations to come.

If you are a nurse, I hope you’ll prepare for board—or committee or commission—leadership so that you can be one of the 10,000 nurses serving on boards by 2020. You can contact the co-leads of the state Action Coalition where you live and let them know you are interested in serving. If you’re a leader of a health organization, I urge you to place a nurse on your board to ensure that the perspectives of patients, their families, and the professionals who coordinate and provide care across every setting are included.  

Let’s work together to promote nurse leadership to improve health for all. 

Mon, 6 Oct 2014 09:00:00 -0400 Susan Hassmiller Nurses Leadership development Human Capital Nursing Campaign for Action RWJF Leaders Future of Nursing Future of Nursing: Four Years Later <![CDATA[Meeting the Needs of Children in Partnership with Nurses and Nurse Practitioners]]>

Sunny G. Hallowell, PhD, APRN, is a postdoctoral fellow, and Danielle Altares Sarik, MSN, APRN, a predoctoral fellow, at the Robert Wood Johnson Foundation-funded Center for Health Outcomes and Policy Research at the School of Nursing at the University of Pennsylvania. Hallowell is also a Leonard Davis Institute Fellow. Both are pediatric nurse practitioners serving on the executive board of the National Association of Pediatric Nurse Practitioners, Pennsylvania Delaware Valley Chapter. Monday, October 6, is National Child Health Day.

Sunny G. Hallowell Sunny G. Hallowell

Many Americans may not know that children born in the United States are less likely to survive to their fifth birthday than children born in other high-income peer countries. The United States falls at the bottom of the Commonwealth Fund’s recently released “Mirror, Mirror” report, ranking last out of 11 countries for infant mortality.  

As children hold the greatest potential to achieve good health, high infant and child mortality may be particularly surprising.  Early lifestyle and health care decisions can set children on a trajectory that determines their health for a lifetime.  

Danielle Altares Sarik Danielle Altares Sarik

As a country, we can do more to ensure the health of our youngest and most vulnerable population. Using nurses and nurse practitioners (NP) to the highest level of their education and training is one strategy. Robust use of nurses and NPs can offer solutions to improve infant and child survival rates through prenatal, postnatal and early childhood health surveillance. 

Nurses a Part of the Solution          

Below, we highlight four areas where research has shown that nurses make a difference in the lives of children and their families: early and adequate prenatal care, supporting transition from hospital to home, providing increased access to care, and childhood support and health surveillance.

For children, access to health care is important even before they are born. Early prenatal care and ongoing support throughout pregnancy are imperative to successful maternal-infant outcomes.  An increasing number of women in the United States receive prenatal care from a midwife, NP or physician assistant, indicating a growing reliance on and acceptance of these providers. 1  Additionally, studies have shown improved pregnancy and birth outcomes in models that use NPs to provide care to pregnant adolescents2—a population at high risk for infant and maternal complications.

Programs that send a nursing professional to provide transitional care for mothers and infants in the postnatal period have demonstrated a decrease in all-cause mortality for mothers and preventable cause mortality in firstborn children in disadvantaged settings.3  In addition, these programs decrease emergency room visits and hospitalizations by 50 percent in the first year of life,4 and are associated with higher 12-month infant mental development scores5 and increased receptive language skills at 2, 4 and 6 years.6  These nurse-led interventions have the potential to improve under-five mortality and the early care of U.S. infants. The Affordable Care Act recognizes the success and importance of nurse visiting and transition programs and has allocated more than $1.5 billion to continue these cost-effective programs through 2015.

Almost one in every ten children in this country is uninsured. Thirty-five percent of children with insurance are covered through Medicaid programs.  NPs often work in settings such as federally qualified health centers and nurse-managed health clinics where many patients who are uninsured or under-insured seek care, including women and children. NPs also are more likely than other providers to work in rural and remote areas, which may increase access to healthcare.  

The American Association of Pediatrics recommends seven preventative appointments during the first year of life and children are often seen many more times for coughs, colds, rashes and bumps during that same time period.  Each of these appointments offers an opportunity for health surveillance and is an ideal time for teaching. NPs are trained to provide holistic, comprehensive health care services, with a special emphasis on education, health promotion and disease prevention. Therefore, NP care is ideal for the ongoing guidance, developmental monitoring, and lifestyle support needed by young children and their parents.

Moving Forward and Growing Up

The leadership of nurses and NPs in collaboration with all health care professionals will be key to improving the health of future generations. While we still have room for health care improvement in the United States, many of our existing programs and established systems of care may offer solutions that improve children’s health. It is important to continue to support these evidence-based models of care.



1.            Kozhimannil KB, Avery MD, Terrell CA. Recent trends in clinicians providing care to pregnant women in the United States. J Midwifery Womens Health. Sep-Oct 2012;57(5):433-438.

2.            Neeson JD, Patterson KA, Mercer RT, May KA. Pregnancy outcome for adolescents receiving prenatal care by nurse practitioners in extended roles. Journal of Adolescent Health Care. 6// 1983;4(2):94-99.

3.            Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA pediatrics. Jul 7 2014.

4.            Dodge KA, Goodman WB, Murphy RA, O'Donnell K, Sato J. Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care. Pediatrics. Nov 2013;132 Suppl 2:S140-146.

5.            Norr KF, Crittenden KS, Lehrer EL, et al. Maternal and infant outcomes at one year for a nurse-health advocate home visiting program serving African Americans and Mexican Americans. Public health nursing (Boston, Mass.). May-Jun 2003;20(3):190-203.

6.            Olds DL, Holmberg JR, Donelan-McCall N, Luckey DW, Knudtson MD, Robinson J. Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years. JAMA pediatrics. Feb 2014;168(2):114-121.

Fri, 3 Oct 2014 12:00:00 -0400 Sunny G. Hallowell Nurses Nurse practitioners Scope of practice Child welfare Early childhood Prenatal and neonatal care Human Capital Nursing Voices from the Field <![CDATA[Recent Research About Nursing, October 2014]]>

This is part of the October 2014 issue of Sharing Nursing’s Knowledge.

Study: California’s Mandatory Nurse-Patient Ratio Law Reduces Work-Related Injuries

A 2004 California law mandating specific nurse-to-patient staffing standards in acute care hospitals has significantly reduced job-related injuries and illnesses for nurses, according to a study published online by the International Archives of Occupational and Environmental Health.

A team of researchers from the Schools of Medicine and Nursing at the University of California, Davis used data from the U.S. Bureau of Labor Statistics to compare illness and injury rates in California and other states before and after the law’s implementation. The data documented a downward trend nationwide, but also found that California’s workplace injury and illness rate declined even faster than the national rate.

In California, the researchers estimated that the law resulted in an average decline from 176 to 120 injuries and illnesses per 10,000 registered nurses—a 32-percent reduction. For licensed practical nurses, the rate went from 244 injuries to 161 per 10,000—a 34-percent reduction.

Lead author J. Paul Leigh, PhD, speculated in a news release that having more nurses available to help with repositioning patients in bed could help prevent back and shoulder injuries. Similarly, needle-stick injuries could be less common because nurses now conduct blood draws and other procedures in a less time-pressured manner.

“We were surprised to discover such a large reduction in injuries as a result of the California law,” says Leigh. “These findings should contribute to the national debate about enacting similar laws in other states.”

The research was funded by the National Institute for Occupational Safety and Health and the California Department of Public Health.

Read an abstract of the study and a news release about it.

Research Links Extended Nursing Shifts to Safety and Quality Problems

A survey of more than 30,000 medical/surgical nurses across Europe finds that those who work shifts of 12 hours or longer or who work overtime are more likely to describe the quality of care in their units as poor or fair, and more likely to describe safety on the unit as poor or failing.

A British research team led by Peter Griffiths, PhD, RN, of the University of Southampton, surveyed 31,627 nurses in 488 hospitals across 12 European countries. Results varied by country but, overall, half of the nurses reported that their most recent shift was eight hours or shorter, while 15 percent reported that their most recent shift lasted 12 hours or longer. In addition, slightly more than a quarter reported that their last shift had involved overtime.

The nurses working longer shifts and those working overtime reported care and safety problems. The researchers write that for European nurses, “Shifts of [greater than or equal to] 12 hours and working overtime (beyond contracted hours) on a shift were independently associated with nurses’ reports of lower quality of care, poorer patient safety, and increasing rates of care left undone.”

“Although eight-hour shifts are still common, a lot of nurses are working these longer shifts, but this study shows that this could be counterproductive,” said Griffiths. “Additionally, the increased flexibility associated with working overtime may not deliver the desired goals for employers.”

The study was published in the September 15, 2014 issue of Medical Care.

Read news stories on the study in MedicalXpress and Nursing Times, or read the full study or an abstract.

More Recent Research About Nursing on the RWJF Human Capital Blog:

Fri, 3 Oct 2014 09:00:00 -0400 Human Capital Blog Nurses Research Patients Human Capital Nursing Sharing Nursing's Knowledge <![CDATA[In the Media: New Annual Event Honors Federal Nurses]]>

This is part of the October 2014 issue of Sharing Nursing’s Knowledge.

Every May, the news media zooms in on nurses during National Nurses Week, held the second week of the month in honor of Florence Nightingale’s birthday.

Now, nurses are getting another turn in the media spotlight—but this time in September.

Or at least that’s the goal of Federal Nurses Week, a new annual event held in recognition of the nation’s 100,000 federally employed nurses. The event, held this year between Sept. 22 and Sept. 28, is sponsored by the American Federation of Government Employees (AFGE). J. David Cox, RN, national president of AFGE, is a nurse and also serves on the national executive board of the AFL-CIO.

During the week, supporters were encouraged to host an event to recognize a federal nurse or nurses and spread the word about the importance of federal nurses through posts to social media sites or letters to the editor of newspapers or other publications. AFGE is also urging Congress to pass a resolution recognizing the federal nurse workforce.

“Nurses in the federal sector are often overlooked, and we’re advocating to change that,” Cox said in a Washington Post blog post. “We proudly champion this important new annual celebration of these dedicated caregivers by establishing an annual week of recognition for their crucial role.”

Learn more here.

Thu, 2 Oct 2014 13:00:00 -0400 Human Capital Blog Nurses Federal government Health care delivery system Human Capital Nursing Media Coverage Sharing Nursing's Knowledge <![CDATA[RWJF Scholars in the News: Autism and birth order, nurse staffing and underweight infants, long-term care insurance, and more.]]>

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

There is an increased risk of Autism Spectrum Disorders (ASD) among children born less than one year or more than five years after the birth of their next oldest sibling, Forbes reports. The study, led by RWJF Health & Society Scholars program alumna Keely Cheslack-Postava, PhD, MSPH, analyzed the records of 7,371 children born between 1987 and 2005, using data from the Finnish Prenatal Study of Autism. About a third of the children had been diagnosed with ASD by 2007. Researchers found that the risk of ASD for children born less than 12 months after their prior sibling was 50 percent higher than it was for children born two to five years after their prior sibling. “The theory is that the timing between pregnancies changes the prenatal environment for the developing fetus,” Cheslack-Postava said. 

The health outcomes and quality of care for underweight black infants could greatly improve with more nurses on staff at hospitals with higher concentrations of black patients, according to a study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The study, led by Eileen Lake, PhD, RN, FAAN, found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for very low birthweight babies born in those facilities, reports Health Canal. More information is available on the INQRI Blog. The study was covered by Advance Healthcare Network for Nurses, among other outlets.

Because of a “medical-industrial complex” that provides financial incentives to overuse and fragment health care, patients nearing the end of their lives need an advocate to fight for their interests, Joan Teno, MD, MS, writes in an opinion piece for the New York Times. Teno encourages readers to “find a family member or friend who can advocate for the health care that you want and need. Find someone to ask the hard questions: What is your prognosis? What are the benefits and risks of treatments? Find someone not afraid of white coats.” Teno is an RWJF Investigator Award in Health Policy Research recipient. 

Last summer, 26 nurses gathered in Dallas for a one-day immersion in governance training with the Texas Team, Trustee Magazine reports. The gathering was the launch of the Nurses on Boards project, which by the end of 2015 seeks to develop 400 nurse prospects with the skills and confidence to serve on a variety of health-related boards, said Texas Team co-lead Cole Edmonson, DNP, RN, FACHE. The Texas Team is one of 50 state Action Coalitions launched by The Future of Nursing: Campaign for Action, a national initiative of RWJF and AARP.

The recently released National Study on University Admissions in the Health Professions, led by Greer Glazer, PhD, RN, CNP, FAAN, is the first to examine the use and impact of “holistic review” nationwide. It is a university admissions process that assesses an applicant’s unique experiences alongside traditional measures of academic achievement for students pursuing a health profession, News Medical reports. Glazer is an RWJF Executive Nurse Fellows alumna.

Universal health insurance for long-term care could prevent families from falling into poverty, Andrea Louise Campbell, PhD, writes for Time magazine, provided it does not cap recipients’ total assets, as Medicaid does. Campbell writes that Medicaid often forces families to spend down their meager savings in order to qualify for coverage; as a result, many families find themselves with no funds for emergencies and no ability to save for retirement. Under the Affordable Care Act, patients newly eligible for expanded Medicaid face no asset test. However, those in the original eligibility categories, such as someone who is disabled, are still subject to the old rule. “It’s bad enough that America’s system of social supports is so limited,” Campbell writes. “That the government also forces some of its citizens to get poor to get the help they need is an abomination.” Campbell is an RWJF Scholars in Health Policy Research alumna and Investigator Award in Health Policy Research recipient.  

RWJF Investigator Award in Health Policy Research recipient Amy Dockser Marcus, AB, writes about the consequences for clinical trials when patients not participating in a trial have an adverse reaction to the drug being tested. The piece is published in the Wall Street Journal Pharmalot blog. At the recent meeting of the National Niemann-Pick Disease Foundation, researchers reported that a patient taking the drug cyclodextrin for the fatal genetic disease Niemann-Pick Type C suffered significant hearing loss. The patient was not part of a clinical trial being conducted by the National Institutes of Health (NIH). Nevertheless, the NIH institutional review board asked researchers not to increase participants’ doses or enroll new patients in the study until the board could meet on the issue.

The Arkansas Insurance Department will soon release 2015 rates for the Arkansas Health Insurance Marketplace, created under the Affordable Care Act. The release will allow consumers to begin looking at their options for the coming year, the Arkansas Times reports. Marketplace Director Cindy Crone, MNSc, APRN, CPNP, recently testified at a joint meeting of the state legislature’s Public Health Committees, saying,We’re confident that you and your constituents will be pleased with the way the rates have come in for this year.” Crone is an RWJF Executive Nurse Fellows alumna. Politico Pro also reported on Crone’s testimony. (Subscription required.)

As the new CEO of Lafayette, Indiana’s Riggs Community Health Center, Bambi McQuade-Jones, DNP, APRN, FNP-BC, is expanding the Center’s focus so that it goes beyond caring principally for patients with chronic illnesses, reports the Lafayette Journal & Courier. “My mission is [to] make sure we take care of everybody,” says McQuade-Jones, an RWJF Executive Nurse Fellows alumna. “We are seeing everybody, not just throwing them in the ER because they have nowhere else to go.” McQuade-Jones hopes the new mission, together with other reforms, will allow the Center to be more efficient while reaching more patients, many of whom are low-income and uninsured.

Fifty years after the Freedom Summer campaign for voting rights, labor activists are joining with students to fight for economic justice on behalf of low-paid workers in the “Summer for Respect” program. Organizers hope the program will help inspire a new generation of student labor activism and deepen the links between labor unions and academia, In These Times reports. RWJF Health & Society Scholar Adam Reich, PhD, led this summer’s initiative, which involved compiling oral histories and related materials on workers for use by activists, students, historians and others.

Inside Higher Education features a podcast with RWJF Health & Society Scholars program alumna Jennie Brand, PhD, MS, in which she discusses the effects of job loss on single mothers. A transcript of this podcast can be found here and audio is available here

Thu, 2 Oct 2014 09:00:00 -0400 Human Capital Blog Scholars and fellows Clinical research Leadership development Social determinants of health Affordable Care Act (ACA) Black (incl. African American) Human Capital Health & Society Scholars Media Coverage HC Website Feature Interdisciplinary Nursing Quality Research Initiative Investigator Awards in Health Policy Research Campaign for Action Executive Nurse Fellows Scholars in Health Policy Research <![CDATA[New Journal Covers Emerging Field of Health Economics]]>

Deborah Haas-Wilson, PhD, is a visiting professor of public policy at the John F. Kennedy School of Government at Harvard University and a member of the editorial board of the forthcoming American Journal of Health Economics. In 1994, she received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research to study antitrust policy and the transformation of health care markets.

Deborah Haas-Wilson

Human Capital Blog: Congratulations on your appointment to the editorial board of the American Journal of Health Economics. Can you tell us about the journal’s mission?

Deborah Haas-Wilson: I am very pleased to be serving on the editorial board of the American Journal of Health Economics (AJHE), along with many distinguished health economists, including Frank Sloan, PhD, who is the editor-in-chief.

A little about the AJHE: The plan is to publish quarterly with the first issue scheduled for the winter of 2015. The mission of the AJHE is to provide a forum for theoretical and empirical analyses of health care systems and health behaviors.

HCB: What topics will the AJHE cover?          

Haas-Wilson: Topics of particular interest include the impact of the Accountable Care Act, pharmaceutical regulation, the supply of medical devices, the increasing obesity rate, the influence of an aging and more diverse population on health care systems, and competition and competition policy in the markets for hospital services, physician services, pharmaceuticals and health care financing.

HCB: Why is this kind of journal needed, and why doesn’t it already exist?

Haas-Wilson: There is growing demand for high-quality research in health economics. Add to that a growing supply of really smart scholars who focus their research on health economics, and you will understand the reason for this new journal. The field of health economics has changed dramatically. I earned my PhD in economics at the University of California-Berkeley in the 1980s when, unlike today, there were no health economists in the department of economics. I had to walk down the hill to the School of Public Health to find a health economist.

HCB: In 1994, you received an RWJF Investigator Award in Health Policy Research, which you used to study antitrust policy and the transformation of health care markets. How did that experience affect your career, and will it have any kind of impact on your role on the editorial board of the new journal?

Haas-Wilson: The RWJF Investigator Award in Health Policy Research facilitated my career in many ways. It provided the funding to spend more time on my scholarship and thus, publish more, including multiple articles with Martin Gaynor, PhD, a 1994 recipient of the RWJF Investigator Awards in Health Policy Research and a member of the AJHE board, and a book that was published by Harvard University Press.

This, in turn, allowed me to branch into the world of antitrust consulting and work as a proponent of market competition. For example, I had the privilege of working as the testifying economic expert in the Federal Trade Commission’s successful challenge to the merger of two hospitals in the Chicago area. More recently, I had the privilege of working as one of the testifying economic experts in the successful challenge to the St. Luke’s hospital system’s acquisition of the largest practice of primary care physicians in the Boise, Idaho, area.  It is a huge understatement to say I am very grateful to RWJF.

Wed, 1 Oct 2014 13:00:00 -0400 Deborah Haas-Wilson Health care delivery system Health policy Behavioral economics Scholars and fellows Human Capital Voices from the Field Investigator Awards in Health Policy Research <![CDATA[You’re Invited to 'Flipping' the Medical School Classroom]]>

Please join the Robert Wood Johnson Foundation (RWJF) this Friday, October 3 from 12 p.m. – 1 p.m. ET for a First Friday Google+ Hangout. Panelists will discuss a new approach to medical education in which much basic content is delivered online, thus freeing up classroom time for more interactive sessions and learning what really “sticks” with students.

Susan Dentzer, senior policy adviser to the Foundation, will lead the discussion, sharing visions for the present and future of medical education that better serve emerging physicians and patients.  This event is the ninth in the #RWJF1stFri series—a platform to inform RWJF audiences about lessons our partners are learning as we all work to create a Culture of Health.

Speakers will be:

  • Michael Painter, MD, JD, Robert Wood Johnson Foundation
  • Charles Prober, MD, Stanford School of Medicine 
  • Rishi Desai, MD, MPH, Khan Academy  
  • Jennifer DeCoste-Lopez, Stanford School of Medicine
  • Shiv Gaglani, Osmosis and Medgadget 

Prior to the Hangout, you can join the conversation and ask questions on Twitter at #RWJF1stFri. RSVP and learn more.  

Wed, 1 Oct 2014 11:00:00 -0400 Human Capital Blog Medical schools Clinical care Human Capital <![CDATA[Quotable Quotes About Nursing, October 2014]]>

This is part of the October 2014 issue of Sharing Nursing’s Knowledge.

“I’ve learned over the last couple of years, as my mother came to rely more on nursing assistance at home for daily tasks, that health care is all about what happens between people. It’s the relationship of trust between the patient and family members and a universe of medical professionals. Nowhere is the relationship more vital than between patient and nurse.

Nurses are the front line of care. Doctors parachute into our world and we into theirs, but nurses stay on the ground from crucial moment to moment.”
--Marsha Mercer, independent journalist, They Put the ‘Care’ in Health Care, The (Lynchburg, Va.) News & Advance, Sept. 28, 2014

“Unfortunately, due to the culture of the health care industry, nurses have usually taken a back seat to physicians and administrators when it comes to changing the policies and practices of optimizing care. However, there is a wealth of evidence that points to the vital and increasing leadership role nurses are taking in health care practices around the country.  ... The message to hospital administrators should be clear—if you’re looking to improve the quality of care and reduce costs, try talking to the people working on the front lines every day—talk to a nurse.”
--Rob Szczerba, PhD, MS, CEO of X Tech Ventures, Looking to Transform Healthcare? Ask a Nurse, Forbes, September 23, 2014

“I’ve been a nurse for 25 years and love what I do. But when we are forced to work overtime, it adds unnecessary stress, frustration and fatigue that can impair your ability to function at your best. You can’t think straight when you’ve been working 16 hours.”
--Terri Menichelli, Nurse., State Auditor Will Look into Health Care Overtime Law, The Citizen’s Voice (Wilkes-Barre, Pennsylvania), Sept. 19, 2014 

“The issue is that it doesn’t make sense to prevent NPs from doing everything they are trained to do, especially in a system where they are struggling to have enough doctors. NPs are currently one of the fastest growing professions out there. We could help the recruiting effort and help the veterans.”
--Ken Miller, PhD, RN, FAAN, president, American Association of Nurse Practitioners, Nurse practitioners say they can help VA with staffing shortages, Washington Post, Sept. 18, 2014

“As we think about what we need for the future, with the number of patients that are demanding and needing quality services and with the changes that health care reform has provided, there’s just an urgent need to use our entire health care workforce to the highest level possible.”
--Phyllis Zimmer, MN, NP, FAAN, president of the Nurse Practitioner Healthcare Foundation, Nurse Practitioners: The Cure for Primary Care Shortages, KBIA, Sept. 17, 2014

“Good leadership is needed at all levels of nursing, from staff nurse to high-level management. Now that so much inter-professional work happens both at the bedside and in the boardroom, nurses need a special skill set. It’s important to note that the qualities paramount in good leaders are also required of good team players.”
--Sylvia Brown, EdD, RN, CNE, dean and professor, College of Nursing at East Carolina University,  Bedsides and Boardrooms, East: The Magazine of East Carolina University, Fall 2014

Wed, 1 Oct 2014 09:00:00 -0400 Human Capital Blog Nurses Registered nurses Research Nursing Media Coverage Sharing Nursing's Knowledge <![CDATA[Building the Optimal Primary Care Team]]>

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. 

Burger also stressed the importance of communication. “We engage everyone in the practice,” he said, and “that requires a fair number of meetings.... Everyone is responsible for system improvement. That’s why we have morning huddles, so that we have quick learnings; and if we have a major process improvement, we have a structured way for moving that structure along and having everyone participate.”

Burger went on to note that the function of organizational leaders is to communicate a vision, and then to keep that vision in focus. In addition, he observed that individual staff members have personal visions, and career goals, and that leaders should work to help them achieve those goals.

Communicating to Solve Problems

Audrey Lum, RN, MPA, chief clinical officer at Union Health Center in New York City, then discussed her organization’s experience with team-based, multi-disciplinary care. Key to the approach is the teams’ semi-monthly team meetings, which include medical providers, nurses, health coaches, floor coordinators, patient care assistants and patient support specialists. Over the course of the two-hour meetings, staff members discuss what’s working and what’s not, and offer kudos to recognize and encourage each other’s accomplishments. The teams also break into smaller groups to work through specific issues and quality improvement projects.

“The team finds that it allows members to develop new ways to work with each other, and brainstorm new and creative ways to solve issues,” she said. “They also work on smaller projects like updating education display-boards for patients. The team strives to incorporate a team-building exercise in all of their meetings. The overarching goal for the meeting is to move toward improving together and to measure what they are improving.”

She said that recruiting for teams begins with the interview process, as leaders seek to hire staff members who are interested in working in team-based practices. 

Echoing Burger’s remarks, she said that “Communication is key to keeping the teams motivated and working on the same page. And looking to the next step of their goals.”

Management strongly supports the team approach, and works to be sure that everyone is empowered to have a say in helping to improve work processes via their teams.

She said patients have developed relationships with their teams, and not just their providers. “On any given day, our patients call to talk with medical assistants who are working with them or health coaches who are providing care,” she said.

In addition to the primary care teams, the organization also has a medical home support team, made up of representatives from management, senior support staff, and team leaders. As an example of how the team functions, she pointed to a recently resolved problem with a backup in registering new patients. The team “figured out how to register patients before they come in,” she said. “They added more ID-card scanners at the front desk, and proposed a separate area for new registration vs. established patients. So, now there is a new area for new patient registration.”

Expanding Team Members’ Roles

Dana Valley and Jason Cunningham, DO, of West County Health Centers (WCHC) in Sebastopol, California, spoke next. Valley is the associate director of quality management; Cunningham is the agency medical director.

Valley began by describing WCHS’s system of assigning each patient to a primary care team that includes a provider, a nurse, a front office member and a medical assistant (MA).

WCHC also has patient navigators/health coaches, who undergo specific training for the role. Their charge, she said, is to spend time with patients and figure out what their needs are.  WCHC also has nurses who serve as health educators, as well as mental health providers, and addiction counselors.

She said that when the organization moved to a care team model, it “took the time to look at everyone’s role and define what they were responsible for and expert at, and at what the highest responsibility we could give them [would be,] according to their skills.” As a result, the front office team members are in charge of health information, customer service, and helping the patient navigate through the system. MAs are expected to manage the patient experience, and manage the provider’s day — in addition to their responsibilities to their patients, which include ordering lab diagnostics, immunizations, and providing referrals. Nurses focus on complex care management, and also conduct home visits and oversee hospital transitions. Providers manage the whole system and manage the relationship with the patient.

Cunningham noted the importance of communication systems to the model. He said that each team has “the ability to communicate by whatever method they want to use at that time. So we enabled an agency-wide instant messaging and communications platform called WebEx Connect that allows staff to quickly communicate with one another and escalate that to a video communication or WebEx meeting if necessary. All staff and nurses have web cams on their desktops, and we have implemented iPads now in the rooms. That even allows us to do some communication when our nurses are at home using an iPad or when we have to communicate with specialty staff.”

Tue, 30 Sep 2014 11:00:00 -0400 Human Capital Blog Primary care Nurses Interprofessional collaboration Human Capital LEAP Project <![CDATA[Sharing Nursing’s Knowledge: The September 2014 Issue]]>

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 September issue.

Advocates Work to Recruit Latinos to Nursing
Latinos comprised only 3 percent of the nation’s nursing workforce in 2013, according to a survey by the National Council of State Boards of Nursing and the National Forum of State Workforce Centers, and 17 percent of the nation’s population, according to the U.S. Census Bureau. More Latino nurses can help narrow health disparities, experts say. “Having a culturally competent nurse really makes a difference in terms of compliance and patient outcomes,” said Elias Provencio-Vasquez, PhD, RN, FAAN, FAANP, an RWJF Executive Nurse Fellows program alumnus. “Patients really respond when they have a provider who understands their culture.”

New Careers in Nursing Program Helps Minnesota College Expand and Diversify While Improving Care in Rural Communities
Since its 2008 launch, the RWJF New Careers in Nursing program (NCIN) has kept a tight focus on attracting a diverse group of “second-career” students to nursing. Along the way, NCIN has had a profound effect on many of the institutions themselves. One such school, the College of St. Scholastica (CSS), saw its overall program change and grow substantially, in great measure because of its participation. NCIN has supported scholarships to 40 CSS accelerated-degree nursing students over the last seven years.

Nearly One in Five Nurses Leaves First Job Within a Year
A study in the current issue of Policy, Politics & Nursing Practice reveals that an estimated 17.5 percent of newly licensed registered nurses (RNs) leave their first nursing job within the first year, and one in three (33.5%) leave within two years. Researchers found that turnover for this group is lower at hospitals than at other health care settings. The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, which is funded by RWJF. RN turnover is costly for hospitals and also affects quality of care.

Latina Nurse Takes Helm of One of Nation’s Premier Nursing Schools
In July, Antonia Villarruel, PhD, RN, FAAN, became dean of the University of Pennsylvania School of Nursing. Villarruel first came to the University in the 1980s to earn her master’s degree. Now back as dean, she aims to continue her work to diversify the nursing workforce—increasingly important work as the country grows more diverse. She also serves as co-chair of the diversity steering committee of the Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP to transform health care through nursing. “I think we have a ways to go to fully diversify the nursing workforce,” she says, “but I’m excited by what I see happening.”

Tue, 30 Sep 2014 09:00:00 -0400 Human Capital Blog Nurses Research Scholars and fellows Human Capital Nursing Sharing Nursing's Knowledge <![CDATA[Intimate Partner Violence: What We Tell Our Children Can Make a Difference]]>

A. Monique Clinton-Sherrod, PhD, is a 2008 alumna of the Robert Wood Johnson Foundation’s New Connections program. She is an RTI research psychologist with extensive experience in prevention research associated with a variety of psychosocial issues.

Monique Clinton-Sherrod

Recently while watching ESPN with my two children, we saw nonstop coverage of the Ray Rice incident, including the video of Mr. Rice violently assaulting Janay Palmer, his then-fiancée. I was peppered with questions from my children. 

“Did he get arrested? Why did he do that? What did she do? Is that something they shouldn’t show on television because it’s private?”

The recurring images and my children’s questions were all the more jarring because I recently lost a sorority sister in a murder-suicide by her former husband. These experiences have served as an unfortunate but teachable moment for my daughter and son, and reinforced the importance of my life’s work—both for my children and for society as a whole. 

Our children must continuously hear the message that violence within relationships, whether platonic or romantic, is unacceptable. Intimate partner violence (IPV) is not a private matter but one that we all must confront directly.

IPV is widely recognized as a significant public health problem in the United States, with the Centers for Disease Control and Prevention (CDC) reporting lifetime prevalence estimates of physical violence by an intimate partner of 31.5 percent among women and 27.5 percent for men. This results in deleterious consequences to individuals, families and society in general. Despite growing evidence of the multiple impacts of IPV, sustained public outcry against this crisis is often limited to violence-against-women advocacy groups and a narrow pocket of supporters. Typically, there are upsurges of mobilization around the issue when highly publicized cases occur, such as the recent incidents of professional athletes physically and violently assaulting their partners.

Our society must not only move toward a zero-tolerance policy for physical, sexual and emotional violence against women, men and children, but also enforce it. However, ameliorating these forms of violence can only be achieved through shifts in policies and norms within our society and sustained investment in primary prevention. As a research psychologist at RTI International and a member of its Global Gender Research Center, I have had the privilege of collaborating on two comprehensive teen-dating violence (TDV) prevention initiatives focused on primary prevention: the Robert Wood Johnson Foundation’s Start Strong: Building Healthy Relationships©; and the CDC’s Dating Matters: Strategies to Promote Healthy Relationships™.

These initiatives emphasized the importance of TDV prevention by not only equipping middle school youth with the knowledge and skills to build and sustain healthy relationships through curricula and communications campaigns, but also engaging parents, near-peers, educators and community members, and informing TDV and TDV-related policies. These types of multilevel comprehensive approaches, and similar efforts with even younger children, are critical in ensuring that our children can build futures without violence.

We have to establish new norms through advocacy and policy change that dispel any tolerance or acceptance of intimate partner violence. This is a critical public health issue—one that is impacting far too many individuals and families every day. The heightened awareness around the harmful health impacts of cigarette smoking did not come to full fruition until increased taxes, restrictions on public smoking, and other policies and practices influenced knowledge, attitudes and beliefs about smoking behavior, resulting in change for many. My children are staunch opponents of smoking and, in fact, have become their grandfather’s constant reminder that smoking is not good for him and they do not want to lose him because of it. They and all other children should have the same norms, attitudes and beliefs around the lack of acceptance of intimate partner violence and the expectation of healthy relationships.

We are long overdue for the enactment and enforcement of laws, policies and practices that place intimate partner violence and its amelioration at the forefront of our minds all the time—and not just when it is a popular media story.


Afifi, T. O., MacMillan, H., Cox, B. J., Asmundson, G. J. G., Stein, M. B., & Sareen, J. (2009). Mental Health Correlates of Intimate Partner Violence in Marital Relationships in a Nationally Representative Sample of Males and Females. J Interpers Violence, 24(8), 1398-1417. doi: 10.1177/0886260508322192

Breiding, M.J., Smith, S.G., Basile, K.C., Walters, M.L., Chen, J., and Merrick, M.T. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimizaion—National Intimate Partner and Sexual Violence Survey, United States, 2011. Mortality and Morbidity Weekly Report Surveillance Summaries, 63(SSO8), 1-18.

Breiding, M. J., Black, M. C., & Ryan, G. W. (2008). Chronic Disease and Health Risk Behaviors Associated with Intimate Partner Violence—18 U.S. States/Territories, 2005. Annals of Epidemiology, 18(7), 538-544. doi:

Bonomi, A. E., Thompson, R. S., Anderson, M., Reid, R. J., Carrell, D., Dimer, J. A., & Rivara, F. P. (2006). Intimate Partner Violence and Women’s Physical, Mental, and Social Functioning. Am J Prev Med, 30(6), 458-466. doi:

Mon, 29 Sep 2014 09:45:00 -0400 A. Monique Clinton-Sherrod Behavior change Public health Public policy Human Capital New Connections Voices from the Field <![CDATA[Lack of Coverage for Undocumented Patients Puts Pressure on the Health Care Safety Net]]>

Michael K. Gusmano is a research scholar at the Hastings Center in Garrison, New York and former president of the American Political Science Association’s Organized Section on Health Politics and Policy. After completing his PhD in political science at the University of Maryland at College Park, Gusmano was a Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research at Yale University from 1995 to 1997.

Michael Gusmano

The nation’s 11 million undocumented immigrants constitute a “medical underclass” in American society. [1,2] Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA) of 2010, because they are not “lawfully present” in the United States. [3] Federal health policy does provide undocumented immigrants with access to safety-net settings, such as an acute-care hospital’s emergency department (ED), or a community health center (CHC). Since 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) has required that all patients who present in an ED receive an appropriate medical screening and, if found to be in need of emergency medical treatment (or in active labor), to be treated until their condition stabilizes. CHCs such as Federally Qualified Health Centers and other nonprofit or public primary care clinics serving low-income and other vulnerable populations trace their origins to health policy that includes the Migrant Health Act of 1962. [4]

"The health care safety net is crucial for maintaining access to care for low-income patients, including undocumented immigrants. But the net is unraveling."

Because it is imprudent to project that undocumented immigrants will be able to defer the need for affordable health care for the next decade or longer, one measure of the long-term success of health care reform will be whether and how it can intersect with local and regional efforts to provide undocumented immigrants with better access to health care and related public services. The health care safety net is one of the locations in which undocumented immigrants and their children encounter public services that can help or hinder their ability to live, work and flourish in a community and in this nation. Changes include ACA-mandated cuts in “disproportionate share hospital” (DSH) payments to safety-net institutions, based on the assumption that these hospitals will recoup this funding through reimbursements from newly insured patients. Because DSH funds have helped cover care for uninsured patients who are undocumented, safety-net providers are concerned that the differences between the care available to formerly-uninsured low-income patients, and to still-uninsurable undocumented low-income patients, will become pronounced. [5]

Without access to insurance or federal benefits, they will continue to rely heavily on safety-net health care even while ACA implementation expands options for other currently uninsured populations. The health care safety net is crucial for maintaining access to care for low-income patients, including undocumented immigrants. But the net is unraveling. The costs of providing care to undocumented immigrants are disproportionately borne by health care organizations and physicians in communities and states with large populations of undocumented immigrants. [6] Requiring professionals, organizations and taxpayers in these communities to take on the disproportionate burden of unresolved immigration policy problems is unfair. A national policy is called for on both ethical and economic grounds.

More information is available at the web site for the Hastings Center Project on Undocumented Patients.


[1] Sommers, Benjamin D., “Stuck Between Health and Immigration Reform - Care for Undocumented Immigrants,” New England Journal of Medicine (2013): 1-3, doi: 10.1056/NEJMp1306636

[2] Passel, Jeffrey S. and D’Vera Cohn, ‘“Unauthorized Immigrant Population: National and State Trends, 2010,” Pew Hispanic Center (February 2011): 1-32, at 1. Estimates are based on the U.S. Census Bureau’s Current Population Surveys, March 2010 Supplement, available at:; accessed August 10, 2013.

[3] 62 Fed. Reg. 61344, November 17, 1997. The public benefits category “Persons Residing Under Color of Law” (PRUCOL) permits some undocumented patients, such as asylum seekers, to obtain Medicaid coverage if they meet exacting conditions.

[4] Section 330 of the Public Health Service Act (42 USCS § 254b)

[5] Iverac, Mirela, “Hospitals Treating Immigrants Here Illegally Worry About Upcoming Cuts,” WNYC, June 10, 2013, Accessed June 10, 2013; Salimah Ebrahim, “Health Reform May Expose Immigrant Status of Millions,” Reuters, August 9, 2012,, accessed May 24, 2013.     

[6] Breen JO. Lost in translation - ¿Cómo se dice, "Patient Protection and Affordable Care Act"? N Engl J Med 2012; May 16. DOI: 10.1056/NEJMp1202039.

Fri, 26 Sep 2014 09:00:00 -0400 Michael K. Gusmano Affordable Care Act (ACA) Access and barriers to care At-risk and vulnerable people Health insurance Immigrants and refugees Underinsured Underserved populations Uninsured Human Capital Scholars in Health Policy Research