Culture of Health Blog

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action. This piece is cross-posted with Off the Charts, the American Journal of Nursing Blog.

I spent the 2014 holiday season reading a book by Sarah Wildman called Paper Love. She describes how she, as a journalist, examined the fate of her Jewish predecessors, including her grandfather and his long lost love. I selected the book because my father was a Jew of Polish descent.

Wildman describes the horrific atrocities bestowed upon the Jews. Of course I knew of the Holocaust growing up, but as I get older, the connections between past and present seem to be more important. While I don’t know of any relative who was personally affected or killed, someone in my extended family very likely was. I pondered my own existence and how it may have depended on a relative escaping Europe and immigrating to the United States to escape the death camps. It is unspeakable how one man’s view of what is mainstream or normal sent so many others to their death.

I am not naive enough to believe that prejudice is a curse of the past. Stark data on health disparities continue to mount. The Centers for Disease Control and Prevention report on Health Disparities and Inequalities (2013) found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.

But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way, and that means lives that are, more often than not, very different than our own.

This week marks the 4^th 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.

Nurses truly run the front lines of hospitals. Their leadership oversees every hospital quality initiative essential to improving care—from reducing hospital-acquired infections, to cutting unnecessary readmissions, to preventing patient falls.

Poor scores in these quality measures now result in government penalties that can hit hospitals hard.

And as health care evolves and hospitals stretch beyond their own walls, nurses are leading the programs that bring health care into communities. They are critical to the success of health reform as more Americans obtain health insurance and seek primary care.

So tell me something? Why is the highest level of hospital leadership in our nation nearly devoid of nurses?

Surveys find the number of nurses with voting positions on hospital boards is about 4 to 6 percent — an unfathomable statistic for anyone who understands, even a little, how hospitals work.

We need the leadership of nurses on every hospital board.

This week marks the 4^th anniversary of the Institute of Medicine’s future of nursing report. Fran Roberts, PhD, RN, FAAN, is owner and executive leader of the Fran Roberts Group, a consulting and contracting practice providing expertise on health care leadership, higher education, governance, regulation and patient safety. The Kate Aurelius Visiting Professor for the University of Arizona College of Medicine–Phoenix, Roberts serves on the boards of directors of several health care organizations, including the Presbyterian Central New Mexico Health System. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive News Fellows program.

“Leadership from nurses is needed at every level and across all settings.” That’s what the Institute of Medicine’s (IOM) Future of Nursing panel wrote in its 2011 report—a message I’ve taken to heart. Here’s why the IOM was exactly right.

I’ve served (and still serve) on several health-related boards, in most cases as the only nurse in a group dominated by physicians, local business leaders, and administrators. My experience on the Presbyterian Central New Mexico Healthcare Services board, which I now chair, is both representative and instructive. I joined the board about eight years ago, recruited by one of my colleagues in the RWJF Executive Nurse Fellows program, Kathy Davis, RN, the senior vice president and chief nursing officer at Presbyterian.

It was an honor to be asked, doubly so because I live and work out of state. But Presbyterian had concluded that it needed a nurse with executive experience on its board, so I got the call.

I started my first term on the board determined not to pigeon-hole myself as “the nurse on the board.” I didn’t want my fellow board members to think I had tunnel vision, unable to see beyond the need to advocate for nurses. That’s not to say I didn’t intend to advocate for nurses when that was called for, but I didn’t want to be limited to that, either in my colleagues’ estimation or in reality.

This week marks the 4^th 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.

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.

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.

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.

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.

I flew to Florida years ago to be with my father at the end of his life. He lay in a hospital bed, at times conscious of the family members gathered at his side and other times unaware of his loved ones surrounding him. I watched a nurse I didn’t know lean over and kiss his forehead.

At another hospital bed years later, I watched a nurse comfort my daughter as she labored to bring my first granddaughter into the world. “You’ll be okay,” she whispered to my daughter, giving her a hug.

The end of life and the beginning of life, marked by a compassionate nurse keeping vigil and offering comfort.  In the midst of machines, a nurse provides a human touch and caring to patients and their family members.

The essence of caring is what first attracted me to the nursing profession. Now, more than 35 years later, the essence of caring still propels me in my work as the director of the Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP to transform health through nursing. One of the Campaign’s major focus areas is promoting nursing leadership. 

A year ago this week, the Robert Wood Johnson Foundation (RWJF) convened an unprecedented meeting that brought together diverse leaders from community colleges around the country, the Tri-Council for Nursing, and RWJF’s Academic Progression in Nursing (APIN) initiative, which is fostering collaboration between community colleges and four-year university nursing programs to promote seamless academic progression for nurses. The meeting was organized to address concerns in the community college community about the recommendation in the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, that 80 percent of the nation’s nurses attain bachelor of science in nursing or higher degrees by the year 2020.

A paper, released today, reports on the proceedings of that meeting, including participants’ shared goal to ensure that community colleges continue their invaluable work to educate a new generation of nurses and diversify the nursing workforce; and to give all nurses opportunities to be lifelong learners who are well-prepared to provide high-quality care and promote health.

The paper includes an addendum that provides news and information about how nursing, health, education, government, business, and other leaders in nine states have made exciting progress in the last year in support of seamless progression for nursing students, as well as for nurses already in the workforce who wish to continue their education.

“While we did not solve every concern, the meeting was tremendously constructive, opening a dialogue, identifying numerous areas of strong agreement, and illuminating issues yet to be resolved,” said John Lumpkin, MD, MPH, senior vice president at RWJF. The Foundation “is determined that last year’s meeting be a beginning for a continuing, constructive dialogue that will advance the goals we all share.”

One of the key recommendations in the landmark Institute of Medicine report on the future of nursing is to advance access to primary care by reducing barriers to practice for nurses. Implementation of this recommendation is now one step closer, thanks to a provision in President Obama’s budget proposal for fiscal year 2015, which was released this month.

Obama’s budget includes a provision that would extend an increase in Medicaid payments for primary care providers for one year at a cost of about $5.4 billion, according to an article in USA Today. The extension would, for the first time, apply to nurse practitioners (NPs) and physician assistants (PAs).

The Institute of Medicine recommended fixing this Medicaid “glitch” in its report on the future of nursing. The report is the foundation for the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform health care through nursing.

Obama’s budget proposal also calls for nearly $4 billion over six years to grow the National Health Services Corps (NHSC) from 8,900 primary care providers to at least 15,000 providers annually, starting in 2015, according to an analysis by the Campaign. Ten percent of the funding would be reserved for NPs and PAs.

Jane Kirschling, PhD, RN, FAAN, is president of the American Association of Colleges of Nursing and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This post is part of the “Health Care in 2014” series, in which health leaders, as well as Robert Wood Johnson Foundation scholars, grantees, and alumni, share their New Year’s resolutions for our health care system and their priorities for action this year.

2014 marks the 10^th anniversary of the landmark study conducted by Linda Aiken, PhD, FAAN, FRCN, RN, and colleagues, which showed a strong connection between nursing education and patient outcomes. Published in the September 2004 issue of the Journal of the American Medical Association (JAMA), the study’s researchers found that patients experienced significantly lower mortality and failure to rescue rates in hospitals with higher proportions of baccalaureate-prepared nurses. In her analysis, Dr. Aiken stated that the study’s results “suggest that employers’ efforts to recruit and retain baccalaureate-prepared nurses in bedside care and their investments in further education for nurses may lead to substantial improvements in the quality of care.”

The federal government announced late last year it would deliver $55.5 million in fiscal 2013 to programs designed to strengthen, diversify, and grow the health care workforce.

The bulk of the funds—82 percent, or $45.4 million—are targeted at nurses, the largest segment of the health care workforce.

The announcement came as welcome news to supporters of a national campaign backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform the nursing profession to improve health and health care.

Many of the grants support the Future of Nursing: Campaign for Action’s call for a more highly educated and more diverse nursing workforce and for more interprofessional collaboration among nurses and other health care professionals, according to Winifred Quinn, PhD, co-director of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF.