Author Archives: mtomlinson

Are Young People the Cure for the Nursing Shortage?

Dec 14, 2011, 3:37 PM, Posted by mtomlinson

A study in the December issue of Health Affairs finds that the number of women ages 23 to 26 entering the nursing profession increased by 62 percent between 2002 and 2009, causing faster growth than previously anticipated in the nursing workforce. If this trend continues, the study says, the nursing workforce will grow at roughly the same rate as the population through 2030.

While this data offers hope, experts caution that a nursing shortage still looms and it could undermine patient care. The trend identified in the Health Affairs study will only continue if young people continue to flock to nursing jobs, and nobody knows if that will be the case. Further, there remains a bottleneck in nursing education that could narrow the pipeline of nurses.

Read more about this critically important new study here.

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

Action Coalitions at Work: Florida

Dec 14, 2011, 2:54 PM, Posted by mtomlinson

Watch Michael Hutton, PhD, discuss progress by the Florida Action Coalition, which is working to advance recommendations from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. The state’s Action Coalition is led by the Florida Center for Nursing and the Blue Cross Blue Shield of Florida Foundation.

This video is part of a series released by The Future of Nursing: Campaign for Action highlighting the goals and the ongoing work of some of its state-based collaborations, called Action Coalitions.

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

Health Leads Helps Fill Gap Between Unmet Social Needs and Good Health

Dec 8, 2011, 12:00 PM, Posted by mtomlinson

Four out of five physicians say unmet social needs are directly leading to worse health for Americans, according to a new Robert Wood Johnson Foundation survey conducted in fall 2011. Health Leads, a grantee of the Robert Wood Johnson Foundation, has pioneered a model for enabling physicians and other clinicians to “prescribe” the basic resources their patients need to be healthy. Health Leads Co-founder and Chief Executive Officer Rebecca Onie discusses the poll findings.

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Human Capital Blog: According to the survey, doctors believe unmet social needs are directly leading to worse health for Americans, and within the current health care system, they are not confident they have the capacity to address those social needs. How does Health Leads help to address this gap?

Rebecca Onie: For Health Leads, this survey validates and quantifies what we’ve been hearing from doctors anecdotally for years. Every day in America, doctors prescribe medications to patients who might have no food at home or are living in a car—many of these patients will return with more serious and often more costly illnesses. This survey documents physicians’ frustrations with this reality on the front lines of our health care system.

Health Leads envisions a new model for health care delivery that addresses those very frustrations in which patients’ basic resource needs — such as food, housing, and heating assistance — are addressed as a standard part of patient care. In the clinics where we work, Health Leads enables physicians and other health care providers to “prescribe” such resources just as they do medication. Patients take their “prescriptions” to the clinic waiting room, where Health Leads’ college volunteers work with patients to help “fill” them by connecting patients to resources.

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Action Coalitions at Work: New Jersey

Dec 2, 2011, 1:47 PM, Posted by mtomlinson

New Jersey is working to advance the four main pillars of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, by working to advance academic progression and to increase the number of nurses with baccalaureate and advanced degrees.

The state is home to the New Jersey Nursing Initiative, a program of the Robert Wood Johnson Foundation and the New Jersey Chamber of Commerce Foundation, which is already working to increase the number of doctoral nurses and nurse faculty in the state. The New Jersey Chamber of Commerce is also a partner in the New Jersey Action Coalition.

Watch Susan W. Salmond, EdD, RN, discuss the work of the New Jersey Action Coalition and why it’s important for nurses to pursue advanced degrees. This video is part of a series released by The Future of Nursing: Campaign for Action highlighting the goals and the ongoing work of some of its state-based collaborations, called Action Coalitions.

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

Medicare's Move to Bundled Payments

Nov 17, 2011, 4:20 PM, Posted by mtomlinson

By Gail R. Wilensky, Senior Fellow, Project HOPE

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Medicare has been moving away from reimbursing providers using fee for service payments and toward the use of bundled payments since the introduction of DRGs in 1983. The initial impetus for the change in reimbursement was the recognition that reimbursing hospitals on the basis of number of days spent in the hospital encouraged the use of additional days during a stay, especially since reimbursements had been based on the average cost per day even though most hospital stays are “front-loaded” in terms of their costs—with early days being much more expensive than last days in a stay.

Since 1983, the use of bundled payments by Medicare has been extended to outpatient hospital visits, home care and to a limited extent, to nursing home reimbursement. The major exception has been the way physician services are paid which has remained based on the use of a disaggregated fee for service schedule where physicians bill Medicare on the basis of 8,000 billing codes. Due to concerns about uncontrolled spending with a disaggregated fee schedule, it was combined with a spending limit that attempts to regulate fees per unit of service based on aggregate spending on physician services. The continued use of this reimbursement system has caused enormous frustration among physicians while doing little to slow the actual rate of growth of spending on physician services since the spending limit has been ignored every year it was breached except for 2002. Creating the appropriate bundle of payments to use for physician services has apparently not been possible, although it is not obvious that much effort has been directed to developing an alternative system of payments for physicians.

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Be Careful What We Ask For...

Nov 10, 2011, 6:00 PM, Posted by mtomlinson

By Kathy Harris, MS, RN, CENP, FACHE, Regional Vice President, Clinical Services, Banner Health

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Within the professional lifetimes of many practicing nurses there have been episodic efforts to establish the BSN as entry into professional practice and licensure. It might be argued that these efforts succeeded in “moving the dial” to a greater or lesser extent but there is no argument about the fact that today only 50% of nurses in this country have been educated at the BSN level or higher1.

Concomitant with, and for many years prior to, these efforts, the nation’s health care industry has experienced fluctuations in the availability of licensed nurses with whom to staff sites of care. Consequences of these variations include the establishment of multiple points of entry into practice (AD, Diploma, LPN, BSN, ND, some MSN programs) making it difficult for many to understand and fully appreciate the professional differences among the preparational levels as well as the value each brings to the delivery of patient care.

Today the evidence points quite clearly to the benefits of preparation at the baccalaureate level. The educational requirements of preparation for practice will need to be even more demanding than at present as the complexity of acute care grows and new sites for care are identified.

As more aspiring and practicing nurses begin working toward baccalaureate degrees, academic settings will be stressed to extremes as they attempt to meet the growing demand for nurses prepared at the BSN level while utilizing fewer faculty, enjoying less physical and clinical space, and experiencing growing demands for nurses trained differently than in the past.

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Impact of Bundled Payments: Opportunities and Threats to Nurses

Nov 3, 2011, 2:00 PM, Posted by mtomlinson

By Ellen T. Kurtzman, MPH, RN, FAAN, Assistant Research Professor, School of Nursing, The George Washington University

While any restructuring of the payment system will create incentives that alter providers’ behaviors, bundled payments—single, all-inclusive payments for multiple services across an episode of care—are likely to have profound influences on the health care workforce. Here I contend that the impact of these new payment methodologies will present unique opportunities and threats to nurses—the single largest segment of this workforce. Though the profession’s traditional roles and historical strengths are in care management and coordination, patient education and self-care management, public health and wellness, patient safety and surveillance, and transitional care (IOM, 2011), these contributions have not been typically recognized, measured, reported or rewarded. A bundled payment system could elevate the importance of these roles.

Under bundled payments, interventions that produce cost savings and reduce waste— practices for which nurses are expert—become profitable. Economic theory suggests this will result in providers placing new value and respect on the contributions nurses make. Recognizing that each bundled payment reflects an inclusive rate, hospital executives and practice administrators may choose to substitute lower cost practitioners (Advanced Practice Registered Nurses or APRNs and Registered Nurses or RNs) for those who command a higher wage (MDs) whenever possible. Where these substitutes can achieve equivalent outcomes (“Quality of Care,” 2011), combining payments across settings and providers could inspire creative and more efficient use of the nation’s health care workforce. Certainly, the “patchwork-like” state scope of practice laws (Center to Champion Nurses in America, 2010) which have kept APRNs from practicing to the full extent of their education and training may hinder such workforce efficiencies and constrain innovation that would be otherwise stimulated under bundled care.

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Action Coalitions at Work: Wyoming

Nov 2, 2011, 2:07 PM, Posted by mtomlinson

In a state with fewer than a dozen doctoral nurses, the Wyoming Center for Nursing and Health Care Partnership is working to revitalize nursing education programs as part of its effort to implement recommendations from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. This video is part of a series released by The Future of Nursing: Campaign for Action highlighting the goals and the ongoing work of some of its state-based collaborations, called Action Coalitions.

Watch Veronica Taylor, RN, MS, and Brad Westby discuss the unique challenges in their state and how they’re working to implement change.

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

Technology: Key to Transforming Nursing Education

Oct 27, 2011, 1:04 PM, Posted by mtomlinson

By Roy L. Simpson, RN, C, FAAN, DPNAP, Vice President, Nursing, Cerner Corporation

Technology erases the traditional boundaries of space and time, which allows nurses to access innovations in care, proven best practices and insights from academic research on the fly at the patient’s bedside—whether the patient is in a hospital, an outpatient facility, a rehabilitation center or even a private home.

Preparing nurses to lead in this technology-enabled health care system requires sweeping reform in nurse education, utilization and advancement.

The Institute of Medicine’s (IOM’s) landmark study, “The Future of Nursing: Leading Change, Advancing Care,” recommends the nursing profession move immediately to:

  • Institute residency training for nurses,
  • Increase the percentage of nurses who attain a bachelor’s degree to 80 percent by 2020, and
  • Double the number of nurses pursuing doctorates.

To complement this trio of action items, the report also points to the need to remove regulatory and institutional obstacles, such as current limits on nurses’ scope of practice, to allow patients to reap the full benefit of nurses’ education, skills and knowledge.

Technology can accelerate the success of each of the above-named initiatives. For example, replacing traditional residency, which is based on the “see one, do one” medical model, with learning in virtual environments substantially expands the number of nurses who gain new competencies and the depth of their skills. In a virtual environment, nurses can repeat skills-based lessons as often as they need with absolutely no impact on actual patients. Additionally, the “always on” component of virtual learning lends itself nicely to the model of employed nurses working during off hours to advance their education.

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Medical School Enrollment Climbs

Oct 26, 2011, 1:11 PM, Posted by mtomlinson

The number of first-time medical school applicants reached an all-time high this year, according to the Association of American Medical Colleges (AAMC). The number of students applying to medical school for the first time in 2011 increased 2.6 percent over the previous year.

The data also show improvements in recruitment of traditionally underrepresented groups. There were gains among most major racial and ethnic groups for the second year in a row, both in the pool of applicants and in medical school enrollees. African American applicants increased by 4.8 percent, and Hispanic/Latino enrollment increased by 5.8 percent.

“At the same time the number of applicants is on the rise, we also are encouraged that the pool of medical school applicants and enrollees continues to be more diverse. This diversity will be important as these new doctors go out into communities across the country to meet the health care needs of all Americans,” Darrell G. Kirch, MD, AAMC president and CEO, said in a statement.

Total enrollment also increased by 3 percent, as medical schools increase their class sizes to educate more physicians in anticipation of a workforce shortage.

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