Change of Shift

The INQRI program is excited to partner with the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing, at the IOM to present the February 18 edition of Change of Shift. In anticipation of the upcoming forum on the Future of Nursing: Education, we have selected nursing education as our theme.

The goal of the INQRI program is to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care. In a recent article, NursingZone.com reported that new nurses are entering the field feeling poorly prepared by their education to implement quality improvement measures. We see this eye-opening research as an important opportunity for nurse educators.

During the Houston forum on February 22, the Future of Nursing committee members will hear testimony about other opportunities and challenges in nursing education, but in the mean time, we will hear from nurse bloggers about their views on everything from nursing education to their favorite movies.

We are really excited by the diversity in submissions this week. We hope you’ll enjoy reading them as much as we have. Happy reading!


Posts on Nursing Education

In Closing the Nursing Shortage Demands Creativity, Collaboration, the Center to Champion Nursing in America blog discusses their approach to redesigning nursing education.

Jerry at Death Club for Cuties posted Someone's story - The man on the bench by the sea. In it he talks about his decision to practice in Palliative Care and shares a poignant story that helps reflect, as he puts it, “the role narrative plays in end of life care.” Warning: grab some tissues before you click to read.

At Experiences of an ICU Nurse, Lisa talks about a different kind of Road Trip. Throughout the post she demonstrates that travelling with a critically ill patient through the hospital is the best kind of on-the-job training for nurses. What are some lessons you’ve learned from a road trip?

The Initiative on the Future of Nursing blog posted a guest spot by Marla Salmon, Dean of the University of Washington’s Nursing School. The post, What Should We Teach the Nurse of the Future details key elements for the future of nursing education including pre-clinical training, lifelong learning curriculum and technology. She says, “What nurses do today is not what they will need to do tomorrow.” What do you think they’ll need tomorrow?

Lynda at the Muse, RN explains her “Nurse Squat” theory on Nurses that Squat. Luckily she has the solution – Step Up & Move Your Butt! This is a must-read for new and experienced nurses alike. Are you a Squatter or a Mover?

In 101 Blog Posts Every New Nurse Should Read, posted at Nurse Practitioner School, posts touch on advice, personal stories and exams. Skim the list for well-rounded nursing perspectives.

Laney at Nursing Student Chronicles shared one way her nursing school clinicals have shaped her in I’ve Gotta Fever. Did anyone else have babies on the brain during the mother and baby semester?

In the post, Experience, new nurse blogger Janine Anderson at Shades of Grey talks about working with new nurses. She thinks that new nurses who already have the basics down are able to really learn from the new experiences they encounter during their shifts.

May, at the Uncreative Writer, has lost her nursing spark. In the Age of Reason, May describes the over-the-top enthusiasm of a young nurse. This encounter makes her reflect on her own nursing career and how she went from having that same enthusiasm and excitement for nursing to a cynical and routine outlook. Read and relate.

Victoria Powell at VP-Medical News shares her daughter’s decision to enter the nursing field, while confronting the impending nursing shortage, in So You Want To Be a Nurse.


“Best-Of” Posts

At Master of Health Administration medical student Diana Diego posted her list of The 20 Best Hospitals in America– and What Makes them the Best. Find out who made her list.

John Q. Stakes at Nurse Assistant passed along the Top 50 Nursing Assistant Blogs. He says, “When you are a nursing assistant, it can help to have the perspective of a number of different people…Nursing can be rewarding, but also quite difficult.” Check out his list for new insight.

Looking for a good movie to rent this weekend, but still want to stay in the medical (er, sort of) mindset? Emily, at Nurse Practitioner Schools, has 10 recommendations that are sure to please. Check out her list at Top 10 Medical Movies of all Time.

Katie, at Radiologic Technologist Schools, touts 7 Twitter Users Every Healthcare Professional Should Follow to help stay on top of developments in the field.

Mary Jones presents 25 TED Talks Every Medical Professional Should Watch posted at Ultrasounds Tech Schools.


Additional Posts

Pediatric Nurse Practitioner Degrees provides advice for parents in How to: Take Care of a Sick Child Like a Nurse Does. These recommendations might be common sense to all the nurses out there but offer a good crash course for dealing with a sick kid.

Be sure to pass around Healthy Living Gal’s 10 Tips to Help You Stay Healthy During a Hospital Trip post on X-Ray Technologist Schools to any patients you know. The list has some key pointers to complement treatment.

Dean at The Millionaire Nurse compares illnesses we’ve all heard of to financial woes that have parallel affects in Diseases and Your Money.

That’s it for this edition of Change of Shift. Thanks for stopping by!

Also, stay tuned at 9 p.m. ET on Thursday, February 18 for #RNChat on Twitter, where the conversation about nursing education continues. Follow the Initiative on the Future of Nursing Twitter feed @FutureofNursing for our comments during the chat.

The next CoS will be over at MamaTrauma. Submit your blog article to the next edition of Change of Shift to clynewarnr@earthlink.net or by using the carnival submission form. Past and future hosts can be found on the blog carnival index page.

Future of Nursing Report in the News

The recent National Summit on Advancing Health Through Nursing has gained much attention in the media.  Check out the following stories:

"The Future of Nursing/The Future of the IOM Report"
The Harford Foundation blog: Rachael Watman
 "On November 30 and December 1 about 500 nurses and health care leaders convened in Washington, DC, to launch the Robert Wood Johnson (RWJ)-funded Institute of Medicine (IOM) “Future of Nursing: Leading Change, Advancing Health” report."

"UAH symposium focuses on growing role of nurses as national health care changes"
The Huntsville Times: Paul Gattis
"Nurses should be at the forefront of health care reform, according to a recent national report."

"‘Problems Worthy of Attack’: Takeaways from IOM Summit on Nursing’s Future"
AJN: Off the Charts: Shawn Kennedy
"Last week, I spent two days at the summit convened by the Robert Wood Johnson Foundation to launch the Campaign for Action—the strategic plan to implement the recommendations of the Institute of Medicine’s (IOM) report on the future of nursing."

"An 'Action-Oriented Blueprint' for the Future of Nursing"
American Journal of Nursing: Susan B. Hassmiller
"On October 5, the Institute of Medicine (IOM) released a new report, The Future of Nursing: Leading Change, Advancing Health, an unequivocal call to action for all who care about improving health care in this country."

"The Future of Nursing, A New Initiative"
About.com: Michael Bihari Health Insurance
"Given the serious shortage of primary care physicians in the U.S. (which most likely will get worse as the Accountable Care Act is fully implemented), I read with great interest the executive summary of The Future of Nursing: Leading Change, Advancing Health, an examination of the nursing workforce."

A Look Ahead at the Future of Nursing - Catch the Webcast Today at 5pm Eastern

This year marks the third anniversary of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health.  A live webcast this afternoon as part of the IOM's 2013 Richard and Hinda Rosenthal Lecture series, will discuss the impact of the report, progress in implementing the report's recommendations at the national and local levels, and what's on the horizon.

The discussion will be moderated by Harvey Fineberg, president of the IOM and Donna Shalala, president of the University of Miami and chair of the Committee on the RWJF Initiative on the Future of Nursing will deliver the keynote address.

Panelists will be:  

Carmen Alvarez, Julio Bellber Postdoctoral Fellow, Department of Health Policy, The George Washington University

Linda Burnes Bolton, vice president and chief nursing officer, Cedars-Sinai Medical Center; vice-chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing

Susan Hassmiller, senior adviser for nursing, Robert Wood Johnson Foundation; study director, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing

Darrell Kirch, president and chief executive officer, Association of American Medical Colleges

David Vlahov, dean and endowed professor of nursing education, School of Nursing, University of California, San Francisco


Watch the webcast at 5pm EST today.

Health Wonk Review Wishes You a Happy Veteran's Day

Happy Veteran's Day! On this day, we commemorate and thank those who have served our country, making incredible sacrifices to preserve those things we hold dear. We reflect upon their struggle, their dedication and their commitment to a greater purpose.

The bloggers who submitted posts for this week's Health Wonk Review have that same dedication and commitment to our nation, but in the health care arena. They reflected on the numerous changes and issues that we must address if we are to improve the health and health care of our nation. Most submissions focus on Initiative on the Future of Nursing report, the mid-term elections' effect on health reform and an old favorite - health care costs. Enjoy!

Future of Nursing Report

We will exercise our prerogative as the hosts of this week's edition, and suggest that you first check out the posts on INQRI's site! They begin with a blog carnival we hosted yesterday which features a selection of blog posts written by students with their reactions to the Future of Nursing report. I think you'll find their thoughts provocative, insightful and interesting.

Terri Schmitt at NurseStory was inspired by the IFN report to consider the "original purpose of nurses advancing their practice and how that purpose is just as relevant today as it was 40 years ago."

At the Disease Management Care Blog, Jaan Sidorov suggests that "dog whistle" politics (the use of rhetoric to signal deeper meaning to an attuned constituency) is behind the phrase "practice at the top of license" for non-physicians... A doctor who has decided (at least for the moment) to keep his thoughts about independently practicing nurses to himself, Sidorov encourages advocates for broadening scope of practice to be as clear as possible about what they mean.

Although she doesn't mention the Future of Nursing report in her post on the Nursing Staff Development blog, Teresa Heithaus does discuss in length one of its key points: the importance of lifelong learning and development for nurses. Her post details the challenges associated with research and publication from behind the "hospital firewall."

Mid-Term Elections and the Affordable Care Act (ACA)

Last week's mid-term elections have have spurred great debate among health wonks everywhere, including on the web, where many pondered the future of the Affordable Care Act...

In advance of the overwhelming GOP victory last Tuesday, Joe Paduda at Managed Care Matters wrote about his anticipations for big Republican wins.

HealthInsurance.org/blog editor Steve Anderson discussed possible changes to the funding for health reform. At the same site, Chuck Smith-Dewey pondered then-candidate and now-Senator Rand Paul's idea of requiring that seniors pick up of the first $2,000 of medical expenses that are currently paid for by Medicare.

Over at The Lucidicus Project, Jared Rhoads provides all the reasons that the Republican party has gained themselves a new voter.

Over at the Health Business Blog, David E. Williams (cofounder of MedPharma Partners and blog author) provides the transcript of his conversation with Dan Mendelson (President and CEO of Avalere Health, a health care business and policy advisory firm) one day after the mid-term elections about the impact on health reform.

Over at Insureblog, Henry Stern shares a recent conversation with a physician regarding his profession's view on accountable care organizations.

David Harlow at HealthBlawg, discusses the Office of Inspector General's new Roadmap for New Physicians, while explaining that it will probably need to be revised once provisions for accountable care organizations change under the ACA.

On the Health Affairs blog, Linda Berthgold questions what an "essential benefit" looks like under the ACA.

Health Care Costs

One of the Incidental Economists, Austin Frakt, discusses the range of ideas on controlling health care costs.

NCPA President John Goodman says the real problem in health care is not now, and never has been, prices. It is the suppression of real markets.

And in other news...

At her blog, On Your Meds: Straight Talk about Medication Safety, Barbara Olson discusses a new study in the New England Journal of Medicine and provides tips regarding the "hunt for safe prescribing practices." (FYI: this blog is on Medscape which requires that you create a free account to log in.)

Verna Dutton at @nursingpins Amplified, writes an open letter to the Nevada State Board of Nursing regarding the case of two nurses accused of intentionally harming patients.

The Healthcare Economist, Jason Shafrin, explains that although pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform, there is a lack of uniformity in the development and implementation of P4P.

On the HealthNewsReview Blog, Gary Schwitzer assesses eight mainstream news media outlets' stories on the National Lung Screening Trial and finds that most of them... excepting NPR... were lacking in their coverage.

At Healthcare Technology News, Rich Elmore wonders what will happen to quality of care and patient outcomes if electronic health records are unequally deployed.

Over at his Healthcare IT Blog, Neil Versel suggests that patients be empowered to enter their own medical information, putting quality controls in the hands of the consumer.

One patient who is indeed empowered is Jonathan Morgan, who chronicles his own healthcare journey at his Spondylosis Treatment blog. Check out his tips for strengthening exercises.

Initiative on the Future of Nursing - Editorial

This month's American Journal of Nursing features an editorial about RJWF's Initiative on the Future of Nursing at the IOM. Initiative chairperson Donna Shalala and vice chairperson Linda Burnes Bolton have co-authored the piece which outlines the ways that nursing care is transforming American health care. The authors explain concerns about the effect of the nurse shortage on health care reform.

Click here to read the editorial.

***

Donna E. Shalala is the former secretary of the U.S. Department of Health and Human Services and the president of the University of Miami and chairperson of the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing at the Institute of Medicine. Linda Burnes Bolton is the chief nursing officer at Cedars-Sinai Medical Center, Los Angeles, and the vice chairperson of the RWJF Initiative on the Future of Nursing. The authors acknowledge the contribution of Gina Ivey, communications director at the RWJF Initiative on the Future of Nursing, in the writing of this article.

Forum on the Future of Nursing: Acute Care

Registration has opened for the Forum on the Future of Nursing: Acute Care. This meeting, the first of the three nationwide forums convened by the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, will be held in Los Angeles, CA at the Cedars-Sinai Medical Center on October 19, 2009.

The topic of discussion at this forum will be nursing across acute care settings. Please view the agenda for more information.

Webcast
If you are unable to attend the meeting in person, you are welcome to take part in the meeting via a live webcast. On the day of the meeting, a link to it will be posted on the project webpage. After the meeting takes place, the webcast will be archived for viewing. Please note that there is no need to register to view the webcast.

Invitation to Submit Testimony
To inform the discussion at the forum and the committee's deliberations, the committee is inviting individuals and organizations to submit written testimony--which might include innovations/models and barriers/opportunities--in the following three areas: quality/safety, technology, and interdisciplinary collaboration. You may submit testimony in any or all of these areas. All testimony received prior to Monday, October 5 will be considered in the development of the forum discussion. Please note that you are welcome to submit testimony whether you plan to attend the meeting or not.

Future Forums
Subsequent forums will cover the topics of community health, public health and primary care in Philadelphia on December 3 and nursing education in Houston on February 22. We hope that you will be able to attend and ask that you save these dates below. These forums will also be webcast.

• Forum on the Future of Nursing: Primary Care, Community Health, and Public Health - December 3, 2009 - Philadelphia, PA
• Forum on the Future of Nursing: Education - February 22, 2010 - Houston, TX

More Information
For more information on the Initiative and members of the committee, please visit www.iom.edu/nursing or www.thefutureofnursing.org. You may also wish to sign up for updates on the Initiative via email. If you have questions, please contact us at nursing@nas.edu.

Research Grants Awarded to Study Nurse Residency Programs, Scope of Practice, Primary Care Workforce

The Robert Wood Johnson Foundation and INQRI today announced the recipients of four new grants from the Future of Nursing National Research Agenda. The grants will support research into key issues being addressed by the Future of Nursing: Campaign for Action: nursing education and scope of practice regulations.

A fifth study funded last year, to determine the how emerging models of primary care will affect future primary care workforce needs, is nearing completion.That study was co-funded by the Donaghue Foundation. It's being conducted by David Auerbach of the RAND Corporation.

The other four studies are:

• A team from the University of Pennsylvania will examine the impact of the provision of the Prescription for Pennsylvania law that removed practice barriers for APRNs. The research team will evaluate the development and architecture of the bill, and the success of the provision in expanding access to health care, particularly in medically underserved communities.
  

National Research Agenda Funds Two Studies on Nurses' Scope of Practice

The Robert Wood Johnson Foundation (RWJF) today announced the recipients of two new grant awards totaling nearly $500,000 from its Future of Nursing National Research Agenda.The two newly-funded studies will examine the regulations, policies, and practices that affect nurses’ ability to practice to the full extent of their education and training.

RWJF created the Future of Nursing National Research Agenda in 2011 to support research that would inform implementation of the recommendations in the Institute of Medicine’s (IOM) groundbreaking report The Future of Nursing: Leading Change, Advancing Health. The project is coordinated by RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI) and these new grants bring the total number of projects funded through this initiative to seven.

The newly funded studies are being conducted by researchers at the University of Florida and the University of California.

A research team at the University of Florida will examine the impact of state regulations and other barriers on advanced practice registered nurses’ (APRNs) practice, particularly in rural and other underserved areas.

The University of California, San Francisco research team will examine the structural, practice, and policy opportunities and barriers that affect psychiatric/mental health nurse practitioners’ ability to most effectively use their skills and expertise in public mental health settings.

“The studies being funded through the National Research Agenda are addressing some of the key contemporary issues in nursing,” said Mary Naylor, PhD, FAAN, RN, Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing and co-director of the INQRI program. “The findings will help us build a base of evidence to support policies and practices that will not only advance nursing but also improve the quality of health care and increase access to health care.”

The other five studies, funded earlier through the initiative, address:

• the impact of emerging models of primary care for future primary care workforce needs; 
• the impact of the provision of the Prescription for Pennsylvania law that removed practice barriers for APRNs; 
• the effect of state regulations on APRN and physician teamwork, collaboration, and patient outcomes; 
• the impact of loosening state restrictions on scope of practice for nurse practitioners on cost, quality, access to care, and the size of the nurse practitioner workforce; and 
• the return on investment for nurse residency programs, and the entities to which returns accrue.

September Meeting of RWJF's Initiative on the Future of Nursing, at IOM

We are pleased to announce that registration has opened for the September 14, 2009 meeting of the Robert Wood Johnson Foundation's Initiative on the Future of Nursing, at the Institute of Medicine. The meeting will be held at the Kaiser Family Foundation in Washington, DC. The agenda for the open session is now posted on the Initiative website. If you would like to attend, please register online by September 9, 2009 as space is limited.

Webcast

If you are unable to attend the meeting in person, you are welcome to join via webcast. The webcast will be provided by Kaisernetwork.org, and a link to it will be posted on the project website, www.iom.edu/nursing the day of the meeting.

Future Public Forums

The committee has set the dates, locations, and themes for three public forums. More information on the forums, including options for public involvement, both in person and via webcast, will be sent to the listserv in the coming weeks. We hope that you will be able to attend and ask that you save the dates below.

• Future of Nursing Forum: Acute CareOctober 19, 2009 - Los Angeles, CA
• Future of Nursing Forum: Primary Care, Community Health, and Public Health December 3, 2009 - Philadelphia, PA
• Future of Nursing Forum: EducationFebruary 22, 2010 - Houston, TX

More Information

For more information on the Initiative and members of the committee, or to sign up for updates on the Initiative via email, visit www.iom.edu/nursing. If you have questions, please contact us at nursing@nas.edu.

Future of Nursing on WIHI

WIHI will host a web-based program on the Future of Nursing on October 22 from 2p – 3p, featuring Donna Shalala, Sue Hassmiller, and Pat Rutherford. Please follow the link below to learn more about this program. (Note that registration is required for this event).

http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/WIHI.htm

The Future of Nursing
Thursday, October 22, 2009 2:00 PM – 3:00 PM Eastern Time

Donna Shalala, PhD

Former US Secretary of Health and Human Services, President, University of Miami

Sue Hassmiller, PhD, RN, FAAN

Director of the RWJF Initiative on the Future of Nursing, Institute of Medicine

Pat Rutherford, RN, MS

Vice President, IHI

Learn more about the speakers

There may be a shortage of nurses in many parts of the US, but there’s no shortage of rethinking and redesign underway to strengthen the profession and to help nurses be more effective providers of quality patient care. Health care reform, along with a greater emphasis on primary care and prevention, are just some of the forces that point to a more prominent, satisfying, and critical role for nurses in the near future.

A new IOM committee on the future of nursing is criss-crossing the country, harnessing the best ideas to ensure that nurses, nursing educators, and the health care system are prepared. Donna Shalala and the RWJF’s Susan Hassmiller are leading this effort. On the next WIHI, they’ll be on hand to describe what they’re learning that will eventually result in a major blueprint for action. IHI’s Pat Rutherford joins this exciting lineup to share the latest on improvement innovations that can enable nurses to work to their full professional capacity. WIHI host, Madge Kaplan, invites you to come learn from people at the sharp end of a changing profession and to contribute to the discussion with your comments and questions.

There is no fee for participating in a WIHI program, but enrollment is required.

Employing Substantial Numbers of Foreign Educated Nurses in U.S. Hospitals Raises Risks of Poor Patient Outcomes

New Study Shows More Deaths in U.S. Hospitals That Have Higher Percentages of Nurses Educated Abroad

For over 60 years, U.S. hospitals have employed non-US-educated nurses during nurse shortages to supplement their workforce.  Although recruitment of nurses from abroad is cyclical, many foreign-educated nurses that come to the U.S. in times of shortages end up staying.  Thus their presence in the U.S. nurse workforce is long-lasting.

Little is known about the impact of foreign educated nurses on quality of hospital care in the U.S.  The majority of foreign-educated nurses in the U.S. are from countries with transitional economies, such as the Philippines, where the health care system is substantially different from that of the U.S. Unlike requirements for foreign trained physicians who practice in the U.S., nurses are not required to complete any educational program in the U.S. if they pass the licensure exam, English speaking and comprehension exams, and provide evidence that their education is “equivalent” to that required of U.S. nurses.  However, nurses from countries with transitional economies have RN licensure exam pass rates significantly lower than that of US nursing school graduates and often take the exam multiple times.

While the demand for foreign educated nurses is low at this time, improvements in the national economy and increased demand for nurses resulting from expanded health insurance coverage from the Affordable Care Act may trigger a new cycle of hospital nurse recruitment from abroad.  Thus knowing more about the potential implications of importing foreign educated nurses now is important in nursing workforce planning for the future.

Researchers from the University of Pennsylvania’s (Penn’s) Center for Health Outcomes and Policy Research in the School of Nursing in collaboration with the University of Florida’s College of Nursing in Gainesville undertook a study to determine whether U.S. hospital employment of non-US-educated nurses is associated with higher mortality after common surgical procedures, and if so, under what circumstances. They found that in hospitals in which patient-to-nurse ratios were average (five patients per nurse) or worse, mortality and failure to rescue patients with complications is significantly higher when 25 percent or more nurses were educated outside the U.S.

The study, “Utilization of non-US educated nurses in US hospitals: implications for hospital mortality,” was published in June 2013 in the International Journal for Quality in Health Care. The study was funded by the National Institute of Nursing and RWJF.

This study of 665 hospitals directed by Penn’s Center for Health Outcomes and Policy Research is one of the largest ever undertaken of the potential quality of care impact of utilization of non-US educated nurses in US hospitals.  The senior author of the paper is University of Pennsylvania professor and director of the School of Nursing’s Center for Health Outcomes and Policy Research and Leonard Davis Institute of Health Economics senior fellow, Linda H Aiken, RN, PhD, FAAN.  Co-authors include Donna Neff, RN, PhD, Associate Professor, University of Florida College of Nursing, Jeannie Cimiotti, RN, PhD, FAAN, formerly from Penn and now Associate Professor at Rutgers University College of Nursing and Director of the New Jersey Collaborating Center for Nursing, and Douglas M. Sloane, PhD, Adjunct Professor of Nursing at Penn.

The study concludes that employing substantial numbers of non-US-educated nurses in U.S. hospitals is associated with significantly higher risk-adjusted 30 day from admission mortality and failure to rescue patients who experience complications after common general, orthopedic, and vascular surgery. Only when nurse staffing in hospitals is better than average, as when nurses care for four or fewer patients each, do we find no effect of foreign educated nurses on mortality. Only 37 percent of hospitals in the study had staffing ratios of four patients per nurse or less.  The effect of having more than 25 percent non-US-educated nurses becomes increasingly deleterious as patient-to-nurse ratios increased beyond 5:1. Thus, in practical terms, high proportions of non-US-educated nurses are a potential risk factor for excess mortality.

Recruiting nurses from countries with greater burdens of illness and fewer nurses than the U.S. has been criticized in terms of its potential adverse effect on global health.  This study suggests that it is not in the public’s interest in the U.S. to rely extensively on foreign educated nurses.

The findings suggest that the US should be largely reliant on its own domestic supply of nurses to prevent future nursing shortages which would require better national nurse workforce planning and policy intervention to balance domestic nurse supply and likely future demands for nurses.         

Initiative on the Future of Nursing Releases Workshop Summary

Yesterday, the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine released a summary document encapsulating the presentations and discussions from the Forum on the Future of Nursing: Community Health, Public Health, Long-term Care and Primary Care held in December 2009.

The Initiative on the Future of Nursing seeks to transform nursing as part of larger efforts to reform the health care system. As part of this Initiative, three forums were held to explore challenges and opportunities in nursing. The second forum, on December 3, 2009, was held in Philadelphia, Pa. More than 600 health care leaders attended this forum in person and via webcast. Speakers, including Pennsylvania Gov. Ed Rendell, discussed opportunities in which nurses—who are key front-line providers of care—can play a role in ensuring patients in all settings receive the best possible care.

The IOM will use the perspectives and ideas summarized in this document to inform a final report on the future of nursing, expected to be released in October 2010.

To download a copy of the summary, please visit www.iom.edu/nursing.

Announcement of Final Grantee Team for Future of Nursing National Research Agenda Marks End of INQRI Funding

Dear Colleagues:

Since its inception in 2005, the Robert Wood Johnson Foundation’s (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) has funded 48 research studies.  Forty were conducted by interdisciplinary teams of scholars from nursing and other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality.  The remaining eight funded studies, answered the call of the Future of Nursing National Research Agenda launched in 2011 to support research that would inform implementation of the recommendations in the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health.

A part of our journey is now complete.  The recent announcement of the final grantee team funded through the Future of Nursing National Research Agenda marks the closure of the INQRI program.  RWJF will not be issuing any further calls for proposals or directly funding any additional INQRI proposals.  There remains the possibility that other funding partners could support proposals “on the board” in further development of these ideas.  RWJF will continue to support the site and facilitate conversations that may help to advance the science through December 31, 2014.

We are grateful to INQRI’s grantee teams and to each of you for your efforts to advance the science linking nursing to quality of health care in the U.S.

Sincerely,

Mary Naylor, PhD, FAAN, RN, Co-Director, INQRI

Mark Pauly, PhD, Co-Director, INQRI

Lori Melichar, PhD, MA, Senior Program Officer, Robert Wood Johnson Foundation

The Future of Nursing Report: Education

In the IOM report, The Future of Nursing: Leading Change, Advancing Health, the committee made several recommendations related to education, including an increase in the proportion of nurses with baccalaureate and doctoral degrees, an engagement in lifelong learning and more. 
  
Click here to download a report brief on the Future of Nursing: Focus on Education.
 
Last week, we learned that there are some new standards at play for master's prepared nurses and that the current educational capacity has room for improvement...

Advance for Nurses has reported "a bold move to transform nursing education at the graduate level."  Nursing schools affiliated with the American Association of Colleges of Nursing recently voted to endorse The Essentials of Master's Education in Nursing, a set of national standards for preparing nurses to have a high impact in the healthcare environment.

 

Click here for more information.

 

Last week, the National League for Nursing released its annual survey of schools of nursing for 2009-2010.  Their data shows some progress toward meeting the goals outlined in the IOM report related to increasing workforce diversity and higher levels of education and training... but also show areas for improvement.  For example, hispanics are still underrepresented among basic RN students and demand for nursing education continues to exceed the current capacity due to faculty shortages and lack of clinical placements.

 

Click here for more information.

Three Years After Release of 'The Future of Nursing' Report - What Progress Have We Made?

On December 11, the Institute of Medicine's (IOM) 2013 Richard & Hinda Rosenthal Lecture focused on progress made advancing the recommendations of the IOM report, The Future of Nursing: Leading Change, Advancing Health, released three years ago.

Donna Shalala, president of the University of Miami in Florida, former head of the U.S. Department of Health and Human Services, and chair of the Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, gave the keynote address, urging nurses and their allies to take this opportunity to transform nursing.

Among the victories cited by Shalala, RWJF President and CEO Risa Lavizzo-Mourey, and other speakers  were: the launch of the Future of Nursing: Campaign for Action; the removal of barriers to expanded scope of practice for advanced practice registered nurses in seven states; an increase in the number of streamlined nursing education programs that enable nurses to advance their education; and an increase in the appointment of nurses to decision-making boards.

Watch the webcast here.

Nurses Lead Innovations in Geriatrics and Gerontology

This story originally appeared in the July 2014 issue of Sharing Nursing's Knowledge, a monthly email newsletter from the Robert Wood Johnson Foundation.

Nurse-led initiatives are intended to help the nation’s health care system prepare for a crush of elderly people with multiple chronic conditions.

Nurses have been leading health care innovations since the dawn of the profession. They have ushered in broad-scale changes in areas ranging from better hygiene practices for wounded soldiers to public health visits to overcrowded urban homes to reproductive health services for women.

In more recent decades, nurses have begun developing innovations in geriatric care to help meet the massive health care needs of an aging population. They are finding new ways to improve the quality of care for older adults and ensure that it takes family and community considerations into account; improve access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more.

Their work answers the call from a groundbreaking report on the future of nursing that was released in 2010 by the Institute of Medicine (IOM). It urges nurses to continue their long legacy of innovation “as the health care needs of the population change from acute and infectious disease to that of an aging population with chronic disease.”

The country is, indeed, undergoing dramatic demographic changes. As Baby Boomers age and immigration patterns change, America is becoming older and more diverse. By 2050, the number of Americans age 65 and older will hit 40 million, about 20 percent of the population, according to the U.S. Census Bureau. These changes will strain the health care system and the nursing profession, the largest segment of the health care workforce.

Experts say the nursing workforce is not adequately prepared for a crush of elderly patients who are living longer, and sicker, with more chronic and complex health conditions. To meet these growing health care demands and bridge gaps in services for older Americans, the IOM said nurses “must continue to develop innovative care models based on current successes” in rural aging and other areas.

Fortunately, many nurses are already leading efforts to meet current and future health care needs. “Nurses are beginning to home in on the chronicity and the larger number of older people coming down the pike,” said Jennie Chin Hansen, RN, MS, FAAN, CEO of the American Geriatrics Society and a member of the study committee supported by the Robert Wood Johnson Foundation (RWJF) that drafted the IOM’s nursing report.

She pointed to the Transitional Care Model, developed by Mary Naylor, RN, PhD, FAAN, national program director for RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The model utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged from the hospital. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.

The Program for All-Inclusive Care for the Elderly (PACE) is an example of a nurse-driven innovation in geriatric care. A replication of a program spearheaded many years ago by Chin Hansen, PACE is a now a federally legislated program in which interdisciplinary teams of providers give frail elders coordinated health, medical, and social services support by a one-stop system, a process that enables many to live in their own homes for longer periods of time.

Another nurse-led innovation, Nurses Improving Care for Healthsystem Elders (NICHE), was developed to better meet the needs of older adults in a health care system that, in general, lacked access to gerontology-trained providers and to care coordination services. The NICHE program is helping hospitals and, increasingly, community health systems, provide older Americans with “sensitive and exemplary care.” Under the program, “nurses are empowered by knowledge to provide high-quality care for older adults and, in doing so, teach others about the uniqueness of caring for older adults,” said Tara Cortes, PhD, RN, FAAN, executive director of the Hartford Institute for Geriatric Nursing in New York and an alumna of the RWJF Executive Nurse Fellows program (1999-2002).

And that’s just the beginning:

Promoting cancer screening among older African American women

Nurses all over the country are studying ways to improve care for older Americans. In North Carolina, for example, Dee Baldwin, PhD, RN, FAAN, a nurse educator at the University of North Carolina-Charlotte and an RWJF Executive Nurse Fellows program alumna (2000-2003), has spent decades exploring ways to prevent cancer in older African American women, who are more likely to die from the disease than other groups.

In 1992, Baldwin launched Project Breast Health, a culturally sensitive educational program to encourage more African American women to take advantage of cancer screening services. She also led an effort to hire lay navigators to raise awareness about breast and cervical cancer among older women in African American communities and developed electronic computer messaging to target the population. “We tried to look at different ways to reach people.”

Improving the quality of care in assisted-living facilities

Anna Beeber, PhD, RN, an RWJF Nurse Faculty Scholar (2011-2014) also from North Carolina, is exploring ways to improve the quality of care in assisted-living facilities. She is conducting research that examines staffing, service delivery, and resident outcomes in order to help assisted-living communities better match services with resident needs. “We really don’t know in assisted-living communities what, if any, influence nurses have on quality of care,” she says. And that is a critical piece of information that has the potential to improve care for the roughly 1 million Americans who currently live in the country’s 22,000 assisted-living facilities.

Increasing the number of geriatrics-trained nurses

In North Dakota, Jane Strommen, PhD, project coordinator of the North Dakota Gerontology Consortium, an initiative supported by Partners Investing in Nursing’s Future (PIN), is working to ensure that older people have more access to geriatrics-trained nurses. She and her team are promoting gerontology nursing via marketing materials, nursing conferences, nursing-themed summer camps, and stipends for nurses and nurse educators who study gerontology and geriatric nursing. “We have a growing population of older adults in our state, and we know the need for nurses who have the skills and training to care for them is just going to increase,” she says.

Creating safer homes

And in Maryland, Sarah Szanton, PhD, ANP, an RWJF Nurse Faculty Scholar (2011-2014) and associate professor of nursing at Johns Hopkins University, has come up with an innovative program to use “handymen” to turn older people’s homes into safe environments. Her goal is to enable elderly people to continue living in their homes as long as they are willing and able—and to stay out of nursing homes, which create considerable taxpayer expense. Read more about Szanton’s work here.

These projects are among the many nurse-led efforts under way across the nation to improve care for older Americans—a natural outgrowth, Chin Hansen says, of nurses’ skills, abilities, and population focus. “One of the things that nurses have always done is advocate for the patient and the family,” she says. They will continue to do that as their patients get older, and they will likely have a greater ability to transform health care as more earn master’s and doctoral degrees and assume positions of leadership in health care and society. Says Chin Hansen: “More nurses are being sought out for their leadership and their ability to change the current culture of medical care towards health and health care in an aging America.”

Guest Blogger: INQRI Grantee Robin Newhouse

I commend the Initiative on the Future of Nursing committee on their tremendously important and timely report. I was especially pleased to read their second recommendation: “Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.” The committee suggests that funders collaborate to advance research on care models that will enable nurses to contribute to the improved quality of health care by offering nurses the chance to lead collaborative efforts with clinicians from other disciplines.

In my own research, I have seen the importance of nurse-led interventions to make positive change. In 2007, my colleagues and I were awarded a grant from RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI) program to conduct our project, “Rural Hospital Quality Collaborative on Evidence-Based Nursing.”

Recent estimates indicate that people with chronic conditions receive 55% of the recommended care with only 68% of patients with heart disease receiving the appropriate treatment. Our interdisciplinary research team evaluated the effects of a rural hospital collaborative established to facilitate translation of evidence on heart failure (HF) patient care. Specifically, we examined nursing characteristics that are associated with improvements in HF patient care. Results indicate that the collaborative enhanced networking, increased evidence-based tool use, and fostered multidisciplinary teams. Nurses in better practice environments use more evidence based interventions. A quality collaborative is an effective mechanism to enable rural hospital nurses to fully engage in improving quality of heart failure care.

As a researcher, I know that it is important to have a wide distribution of successfully proven interventions in order to affect greater change. I was honored to be selected as a member of INQRI’s latest cohort of grantees, all of whom will focus on translation of programs of proven effectiveness to more settings and more general applications. This November, my team and I will launch our project, “Nurse-Led Intervention to Improve Screening and Treatment for Substance Abuse: An RCT of Hospitals.” An alarming one in four hospital admissions are related to substance abuse. Because of the prevalence, health risks to society and strong evidence of effectiveness and efficacy, this study will test implementation of a nursing intervention using substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) in an acute hospital setting. SBIRT is a comprehensive, integrated, approach to the delivery of early intervention and treatment services for persons at risk or with substance use disorders. Results of the study will move us toward learning how to implement sustainable evidence-based behavioral practices that have significant effects on quality of care outcomes.

By contributing to the evidence-base with proven nurse-led interventions, my team and I hope to provide the type of support that the Future of Nursing committee needs to illustrate the vital role that nurses can play as leaders on health care teams.

The committee notes that “nurses must see policy as something they can shape.” I am happy to report that I am one nurse that sees policy in just that way.


Robin Newhouse, PhD, RN, NEA, BC, CNOR is the Assistant Dean for the Doctor of Nursing Practice Program at the University of Maryland School of Nursing.

Nursing Students on the Future of Nursing Report

The INQRI program is pleased to host an impromptu "blogging carnival" featuring the thoughts of several nursing students regarding the Initiative on the Future of Nursing report.  Educator Terri Schmitt of Nurse Story, a blog that is full of thoughts on nursing, nurse practitioners, service to others and life in general, requires all of the students in her nursing informatics class to create and maintain blogs. We are so thrilled that so many of her students chose to write about this important report.  The committee would be pleased to know that most of these students will be contributing to their recommended increase in the proportion of nurses with BSN degree to 80% by 2020, as almost all of these bloggers are in an RN to BSN program.

• In fact, in her post, Meaghan Boland provides support to that very recommendation, explaining that her own BSN classes have allowed her to prepare to serve a more diverse group of patients.
• Todd MacDonald refutes the AMA's response to the report with some figures of his own.
• Marcia Howard ponders the committee's recommendation about nurses practicing to the full extent of their education, sharing a story about a recent interaction she shared with a neurologist.
• Tina Fulbright gives an "older new nurse's" perspective on the recommendations.
• Cassidy White discusses the importance of nationwide standards for scope of practice and the continuing education of nurses. 
• Amy Hopkins considers what her own role might entail in the future of nursing.
• Lori Vanderpool writes about the responsibility that nurses have to become involved at all levels of decision-making.
• ASN student Julia Cruzan provides her support to the committee's report.

Terri Schmitt is a nurse practitioner who is currently finishing up her PhD at the University of Missouri-Kansas City (UMKC).