Palliative Education and Mentorship Needed for Clinicians

Changes are needed in how nurses and physicians are educated and trained about providing palliative care to older adults with serious illnesses, according to a Health Affairs blog written by Charles von Gunten and Betty Ferrell.

The authors contend that the fundamental approach to decision-making for elderly patients with serious illnesses should shift from the standard approach of “fixing” every biological issue, to the palliative care approach in which overall goals of care are established for the patient. However, for that to happen, clinicians need to start learning about palliative care early in their education and training. A clear standard and widely-adopted curricula for graduate and undergraduate training is needed, according to the blog:

“Although some medical schools have curricula on death and dying, the education is provided predominately through scattered didactic courses during the preclinical years. The effectiveness of the curricula is limited by the absence of immediate clinical application of the material, and hence, no opportunity to develop the necessary skills to alleviate the suffering of the patient and their loved ones.”

Efforts are underway to develop such materials, including some among nursing organizations and consortiums. The End-of-Life Nursing Education Consortium (ELNEC) project was formed to develop educational tools on core skills in palliative care. For the last 14 years the American Association of Colleges of Nursing has provided palliative care education through ELNEC, providing training to more than 17,500 nurses. However, this education needs to be reinforced in clinical settings with structured mentoring of nurses on palliative care, according to Gunten and Ferrell.

An INQRI study, Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice, explored the relationships between quality palliative nursing care delivered in intensive care units and patient and family outcomes. The study also explored how to measure and to improve these outcomes. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

The Importance of Nursing in Achieving the "Best Care at Lower Cost"

by Richard C Lindrooth and Olga Yakusheva

The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America"[1] in early September, 2013.  The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with:

(1) rapidly expanding diagnostic and treatment options; and
(2) the increasingly complex and chronic clinical condition of patients.

Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how "a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations."   Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands.  The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.

The recommendations highlight the critical importance of continuing investments in the human capital necessary to enable clinicians' (nurses) to thrive in the dynamic health care market.  Bachelors of Science in Nursing (BSN) programs teach nurses the critical communication skills and analytical tools and that can be harnessed by a well-managed organization in creating an environment that fosters and rewards continuous learning. 

The good news is that employers will increasingly recognize the value of a BSN and reward staff for the additional cost and effort required for the degree.  The IOM Future of Nursing report documents the value of an advanced degree and knowledge of the value of a BSN is reflected in recent hiring trends.  Standard economic theory predicts that the value of a BSN - and human capital in general - depends upon the ability of an organization to put those skills to productive use.  Well-managed organizations will be apt to reward advanced training precisely because the organization can harness the human capital to increase productivity. 

The IOM report documents the experiences of many organizations that have successfully fostered the skills and experience if their staff to improve outcomes and productivity.  While the case studies are encouraging, there are even more organizations that still have not adopted the management practices necessary to facilitate continuous learning.  An organization's future success hinges on its ability to keep up with rapidly changing treatments and the increasingly complex needs of patients. Those organizations that are successful in doing so will thrive and grow market share at the expense of organizations that fail to keep up. 

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[1] Smith, M; R. Saunders, L. Stuckhardt, and J.M. McGinnis, Editors. 2013. ""Best Care at Lower Cost: The Path to Continuously Learning Health Care in America." Available at: http://www.nap.edu/catalog.php?record_id=13444, accessed on September 20, 2013.

HRSA Grant Funds Interprofessional Educational Experiences

The University of Texas at Austin School of Nursing (SON) received a three-year, $1 million grant from the Health Resources and Services Administration to help integrate interprofessional education experiences with medicine, pharmacy, and social work into the curriculum, Nurse.com reports.

The expanded curriculum will be for students in the graduate level adult-gerontology clinical nurse specialist program.

“In many cases, physicians, nurses, pharmacists and other allied health practitioners have struggled to find ways to work together for the good of the patient,” said Alexa Stuifbergen, dean of SON. “Because learning how to work in teams with other health care providers shouldn’t begin on the job, several years ago we began to incorporate collaborative educational experiences into all levels of the nursing curricula.”

Research Brief: Quality of Nursing Care on Acute Inpatient Units

Does the composition of hospital nurse staffing levels matter when it comes to preventing costly complications and death following those complications? A team at the University of California, led by Mary Blegen, Tom Vaughn (from the University of Iowa) and Colleen Goode (from the University of Colorado), examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Innovative Educational Models

Sixty nursing students pursuing their bachelor of science in nursing at Washington State University recently completed their part in a national study of simulated patient use in education. The program was held for two years and featured 480 hours of simulation with 105 simulated patients. The students were part of the second phase of the National Council of State Boards of Nursing (NCSBN) National Simulation Study, which involves five associate and five baccalaureate programs nationwide. The purpose of the study is to investigate the ideal mix of simulation and clinical training needed to best prepare nurses. The national study is now moving into its last phase. NCSBN will follow up with nursing graduates in the workplace who participated in simulation study groups to evaluate their clinical competency.

Use of simulations in nursing education are among the recommended educational initiatives suggested by the Institute of Medicine in the report, The Future of Nursing: Leading Change, Advancing Health. For more details on similar research recommendations included in the report, please click here.

New Brief Makes the Case for Baccalaureate-Prepped Nurses

A new policy brief authored by Ann Kutney-Lee and Linda Aiken and distributed by the Leonard Davis Institute of Health Economics at the University of Pennsylvania makes the case for baccalaureate-prepared nurses.

Researchers found that increases in the percentage of nurses with baccalaureate degrees were associated with significant reductions in surgical mortality rates and failure-to-rescue rates.  They also found that a ten-point increase in a hospital’s percentage of baccalaureate-prepared nurses was associated with an average reduction of 2.12 deaths for every 1,000 patients. (The average reduction was 7.47 deaths per 1,000 patients in the subset of patients with complications.)

These results suggest that if all the hospitals in the study had increased their percentage of baccalaureate nurses by ten points, about 500 deaths might have been prevented.  This is an incredibly important finding, given the recommendation made in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health to increase the number of nurses holding a baccalaureate degree to 80% by the year 2020.

The brief also explains that in addition to improving patient outcomes, higher numbers of baccalaureate-prepared nurses could also lead to an increased number of graduate-level nurses prepared to either become nurse faculty or accept advanced-practice positions in primary care.  Aiken found that nurses with initial associate's degrees were less likely than those with an initial baccalaureate degree to earn a master's degree.

This brief is based on the following articles: 

1. A. Kutney-Lee, D.M. Sloane, L.H. Aiken. An increase in the number of nurses with baccalaureate degrees is linked to lower rates of post-surgery mortality, Health Affairs, March 2013, vol. 32, pp. 579-586;
2. L.H. Aiken. Nurses for the future. New England Journal of Medicine, January 20, 2011, vol. 364, pp. 196-198.

Need for Advanced Nursing Education Rising

The INQRI blog recently came across another article regarding the rising need for advanced nursing education on nurse.com. 

In its 2010 report, "The Future of Nursing: Leading Change, Advancing Health," the Institute of Medicine called for doubling the number of doctorate-level nurses by 2020, and the Affordable Care Act’s sweeping changes demand a heavy influx of nurses in leadership roles.

The article continues the discussion of cost containment, and notes that the percentage of nurses  obtaining master’s and research-focused doctorate degrees has increased 67% and 25% respectively between 2006 through 2011. 

Baccalaureate Prepared Nurses Save Lives

A newly published study suggestss that hospitals can save lives by hiring more nurses with bachelor’s degrees. University of Pennsylvania researchers Ann Kutney-Lee, Douglas M. Sloane and Linda H. Aiken found that about 500 deaths among general, orthopedic, and vascular surgery patients in Pennsylvania might have been avoided during the 1999-2005 study period if the number of bachelor’s-level nurses had been 10 percentage points higher.

Click here for the abstract.

This area of research is familiar to INQRI grantees Dr. Mary Blegen and Dr. Tom Vaughn, who sought to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. The results of the study showed that hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay.

Click here to learn more about INQRI and baccalaureate education in nursing and patient outcomes.

Missed Last Week's Webinar?

Did you miss the session on the Creation of a Nurse Manager Development Program to Increase Patient Safety? Well, you can catch up right here! This presentation is the third in a series providing the study findings from INQRI's final cohort of grantees. Their work focused on translating research into practice. This video features Drs. Linda Flynn and Joel Cantor presenting study findings from the design and implementation of a nurse manager development program to positively effect patient safety.

 

To view past sessions in the translation series or register for upcoming events, please visit www.inqri.org.

INQRI Grantees' Article Supports Future of Nursing Recommendation

INQRI grantees Mary Blegen and Tom Vaughn and their team recently published a new article, "Baccalaureate education in nursing and patient outcomes" which examined the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees.

The Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes.

This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay.

The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

Click here to access the article via PubMed.

New Videos on Education Progression

The Center to Champion Nursing in America (CCNA) has launched a new video series on education progression and the implementation of the four promising models identified in the Future of Nursing: Campaign for Action Action Coalitions' Learning Collaborative. The CCNA asked nurse expert consultants to provide additional insights in a video series and make themselves available for further discussion on the web.

Click here to access these videos.

Please NOTE: Videos best viewed in Firefox or Google Chrome.

Opinion Piece on Addressing the New Jersey Nursing Shortage

John R. Lumpkin, senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation and chair of the Robert Wood Johnson University Hospital board of directors, and Susan Bakewell-Sachs, program director of the New Jersey Nursing Initiative (NJNI) and interim provost of the College of New Jersey, recently authored a piece for the Star-Ledger which provides some details about the way that NJNI tries to address the potential of a nursing shortage in New Jersey.

As noted in the blog post, since launching in 2009, NJNI has supported 61 New Jersey Nursing Scholars, providing tuition and other support while they pursue master’s or doctoral degrees that qualify them for faculty positions. Thirty-eight scholars have already graduated, with many now teaching in the state.

Click here to read the post.

Virginia Nursing Program Allows Students to Obtain BSN for Under $17,000

A recent partnership between the Virginia Community College System and Western Governors University will allow for nursing students to obtain a BSN for less than $17,000. With the Affordable Care Act expanding coverage and the nursing workforce continuing to age, this step will be important in filling the gap of qualified nurses to provide care to the United States' population.

To read more about this partnership, click here.

Nursing Schools Brace For Faculty Shortage

Earlier this morning, National Public Radio's Morning Edition program discussed the looming faculty shortage facing nursing schools nationwide. The nurse faculty shortage issue was highlighted in the Institute of Medicine's report "The Future of Nursing: Leading Change, Advancing Health" and has been a major focus of the Campaign for Action and other organization's efforts to bolster nursing faculty numbers. With nearly 8% of all nursing school faculty positions remaining vacant, continued efforts are needed to ensure that there will be educators for tomorrow's nurses.

To listen to the story as heard on Morning Edition or read the transcript, click here.

Nursing Certificate Program Available for High School Students

An innovative education program that allows for high school students to start certified nurse assistance (CNA) training while still in school is being promoted in Hillsboro, North Carolina. Ben Kleine, reporting for the Hillsboro Star-Journal, detailed how local high school students can integrate the CNA certificate coursework into their high school class schedule. This program may be very useful for individuals who want to get an early start to their nursing career.

To read more about this program, click here.

Inside an Award-winning ED's Nursing Department

Yesterday, Alexandra Wilson Pecci, reporting for HealthLeaders Media, gave a glimpse of specific programs and initiatives being implemented in one of the most innovative nursing department within an emergency department at Boston Children's hospital. One such program focuses on improving the assessment of pain among children, a topic area that has also been focused on in previous INQRI research.

To read more of Ms. Pecci's description of the fabulous care being provided at Boston Children's hospital, click here.

New Partnerships Spurs Innovation in Nursing Education

The Cincinnati State Technical and Community College's innovative nursing education program, which integrates new nurses into the workforce, was recently highlighted by Dr. Jill Biden during her "Community College to Career" bus tour. The hierarchical program trains students for entry-level positions, then coordinates and collaborates with employers to continue educational efforts in order to expand the skill-set of these students. By partnering with employers, the program provides entry level workers with the flexibility, support and coaching they needed to continue their education.

To read more about this program, click here.

Significant Rise in Ohio Nurses Seeking 4-year Degrees

In response to growing demands by hospital systems and ambulatory practices, more Ohio registered nurses are enrolling in bachelors of science programs to enhance their skill-set and improve their desirability in the touch job market. Many of these nurses are seeking to obtain their BSN as part of their job requirements, which require nurses without a bachelors degree to obtain one within five years of employment. These efforts support one of the recommendations made by the Institute of Medicine (IOM) report, "The Future of Nursing: Leading Change, Advancing Health" which seeks to improve the number of registered nurses with BSNs to 80% by 2020.

To read more about Ohio's efforts to improve its nursing workforce, click here.

To read more blogposts relating to the IOM's "Future of Nursing" report, click here.

RWJF Program Debuts Tool to Answer Questions about Nurse Faculty Members

How do nurse faculty members spend their time? How do they assess key aspects of their work-life? How do faculty at your school compare to those at similar schools around the country?

A new tool created by the Robert Wood Johnson Foundation's Evaluating Innovations in Nursing Education (EIN) program can help you to answer these and many more questions about full-time nurse faculty in the U.S.

To see a brief demonstration and begin using the tool, click here.

With this web-based interactive tool, you can easily create customized views of data from the 2011 National Survey of Nurse Faculty, a study of a nationally representative sample of full-time faculty at prelicensure nursing programs. NuFAQs guides you in exploring over 60 characteristics of workload and attitudes toward work-life and seeing how they differ among faculty subgroups of interest to you.

Background: The National Survey of Nurse Faculty was conducted during the 2010-2011 academic year by the national program office of Evaluating Innovations in Nursing Education (EIN), at the Rutgers University Center for State Health Policy. The survey was funded by the Robert Wood Johnson Foundation. Results were compiled from responses from a nationally representative sample of all full-time nurse faculty members teaching in over 270 nursing programs that were selected to be representative of all pre-licensure ADN and BSN programs in the United States. Completed questionnaires were received from 3,120 faculty members, a response rate of 79% A copy of the survey questionnaire is posted on the web site for your use. Ask your colleagues to complete it, and you’ll be able to assess how their workload and attitudes toward work compare to faculty members similar to them throughout the country. 

 For questions and more details on the study design, contact the EIN National Program Office at: info@EvaluatingInnovationsInNursing.org.

Nursing Schools Seek to Improve Training on Veteran Care

Earlier this spring, we shared a story with all of you regarding an initiative led by First Lady, Michelle Obama, and Second Lady, Dr. Jill Biden focused on improving education for the treatment of PTSD and other mental illnesses affecting military families. The program, better known as the Joint Forces Initiative, continues to be expanded upon by nursing schools around the country. Kate Thayer, of the Chicago Tribune, detailed how Chicago area educational institutions have pledged to enhance training for maladies commonly seen in veterans.

To read more about the Chicago area initiatives, click here.