Culture of Health Blog

Adejoke B. Ayoola, PhD, RN, is an assistant professor of nursing in the Department of Nursing at Calvin College and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar. Mary Molewyk Doornbos, PhD, RN, is a professor of nursing, also in the Department of Nursing at Calvin College in Grand Rapids, Michigan.

It is important to deliver high-quality care to improve health outcomes in the United States. This level of care can only be delivered by well-trained health professionals. Nurses are the single group of health professionals who have the most contact with clients, and are on the forefront of promoting delivery of high-quality care.

One means of addressing the increasing demand to deliver the high-quality care proposed by the Initiative on the Future of Nursing, supported by RWJF and the Institute of Medicine (IOM), is the recommendation to increase the percentage of nurses prepared to enter masters and doctoral level education. Graduate studies prepare nurses to produce and use the best evidence in client care, which will improve health outcomes.

Calvin College Department of Nursing (CCDON), a private liberal arts college, and Michigan State University College of Nursing (MSUCON), a public academic institution, began a partnership program in 2012 to address this initiative of the Future of Nursing. This partnership provides opportunity for eligible students from the undergraduate baccalaureate nursing program to enroll in the accelerated BSN to PhD nursing program at MSUCON.

Sammy Zahran, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2012 - 2014). He is assistant professor of demography in the Department of Economics at Colorado State University, assistant professor in the Department of Epidemiology in the Colorado School of Public Health, and co-director of the Center for Disaster and Risk Analysis at Colorado State University. This blog is based on his study: "Linking Source and Effect: Resuspended Soil Lead, Air Lead, and Children's Blood Lead Levels in Detroit, Michigan."

RWJF Health & Society Scholars lead the field of environmental health. This is part of a series highlighting their 2013 research.

Human Capital Blog: Tell us about your recent study, published in Environmental Science and Technology. What questions did you set out to answer? And what did you find?

Sammy Zahran: We sought to understand a mysterious statistical regularity in blood lead (Pb) data obtained from the Michigan Department of Community Health.  The dataset contained information on the dates of blood sample collection for 367,800 children (<10 years of age) in Detroit. By graphing the average monthly blood Pb levels (μg/dL) of sampled children, we found a striking seasonal pattern (see Figure 1). Child blood Pb levels behaved cyclically. Compared to the reference month of January, blood Pb levels were 11-14 percent higher in the summer months of July, August, and September.

In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.

A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.

Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.

Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:

- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.

- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.

- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.

- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.

- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.

- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.

- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.

- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Sarah Burgard, PhD, MS, MA, is an alumna of the RWJF Health & Society Scholars program, and an associate professor of sociology and epidemiology and research associate professor at the Population Studies Center at the University of Michigan. Burgard recently co-authored a study that finds perceived job insecurity is linked with significantly higher odds of fair or poor self-reported health, symptoms of depression, and anxiety attacks.

Human Capital Blog: What got you interested in researching the working lives and health outcomes of adults? Was there anything in particular that sparked your curiosity about job insecurity?

Sarah Burgard: I was interested in the excellent research being done by health disparities researchers that focused on socioeconomic position and its strong and persistent relationship with health. My dissertation looked at race and socioeconomic position and how they shaped children's health in different societies. When I started looking at the lives of adults in wealthy economies and focusing on health disparities in these groups, it struck me that most scholars were focused on education and income as stratifying factors, but not looking deeply at what connected them: paid employment.

Careers characterized by stimulating and satisfying work versus dangerous, monotonous or insecure work are of considerable interest in their own right to sociologists of stratification, but they could also be important for understanding divergence in health, as considerable research in occupational psychology and epidemiology has suggested. Many of the projects I've done have been aimed at bringing together the strong work in each of these fields to build even stronger explanations of the way work (or lack of work) influence health. I've been interested in less explored aspects of work, such as perceptions of job insecurity among those still employed, and in taking better account of the multitude of psychosocial aspects of work that affect individuals at a given point in time and the ways these could change over the career.

Partners Investing in Nursing’s Future (PIN), a partnership between the Robert Wood Johnson Foundation (RWJF) and the Northwest Health Foundation, devoted the latest issue of its PIN Point newsletter to the topic of leadership and featured the Leading Toward Tomorrow Project, which cultivates nurse leaders in southeast Michigan, with a primary focus on geriatric care. Below, three project leaders weigh in on what led them to tackle leadership development and what they’ve learned along the way.

Why does your organization see nursing leadership as an area worthy of investment?

Elizabeth Sullivan, MPA, vice president for community investment at the Community Foundation for Southeast Michigan: We felt it was important to build the nursing workforce and to do it in a way, in this particular project, that supports retention and mobility of nurses. We knew that the need was significant in southeast Michigan, and we knew it was important to do this with nurses in acute and long-term care settings. Our interest was working with novice nurses who found themselves in management positions and were working in care settings that serve a lot of older adults.

Carole Stacy, MA, MSN, RN, director of the Michigan Center for Nursing: On one of our nursing surveys several years ago, one of the questions was: If you’ve left a nursing job in the last two years, what was the reason? One of the answers they could select was that they had difficulty with their nurse manager or with administration. Over the course of several surveys, we kept seeing that particular response chosen in large numbers. Then we really started going out and looking at what the problem was. We found that in Michigan, we do not do a very good job of preparing people to be in nursing management. Just because they’re a good nurse, we assume they’ll have the skills needed to be a good manager. And that’s frequently not the case.

Nora Maloy, DrPH, senior program officer at the Blue Cross Blue Shield of Michigan Foundation: The Foundation has been supporting the profession of nursing since 2003, when we developed an initiative addressing the nursing shortage. That put us in touch with nurse leaders from around the state. Since then, through our nurse leader colleagues, we have seen the impact of nursing on all aspects of health care, including access, policy and quality of care.