Blog
Jan 26, 2012
Debra A. Toney, PhD, RN, FAAN, is founder of TLC Health Care Services of Las Vegas, and the immediate past president of the National Black Nurses Association. She is an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. Toney is the keynote speaker at Vanderbilt University Medical Center’s annual Martin Luther King Jr. lecture on Monday.
Today, on this national day of service, people across the country are honoring the legacy of Dr. Martin Luther King, Jr. by making a difference in their communities. They’re picking up trash, making meals at food banks, cleaning up parks and caring for the less fortunate. But this shouldn’t be a once a year occurrence; it is my dream that a sense of caring and greater purpose will someday be ingrained into our everyday lives. As a health care professional, I try to carry this calling with me every day.
Health care is becoming increasingly complex. Our population is aging and becoming more diverse. Patients come to us with multiple chronic diseases and a bag full of medications for refills, often not knowing why they are taking them. The waiting room is packed and everyone wants to be seen now. And the health professional is wondering how to get through the day.
All of this comes with a cost. Not a monetary cost but a human caring cost – the lack of touch, caring and compassion. We call patients by their disease; “the gallbladder in room 232” or “the COPDer in 476.” We order test, tests, and more tests to avoid lawsuits, a form of defensive medicine. Health care costs are out of control and millions of people are without health insurance. Access to quality health care is lacking. Provider salaries are on the decline.
These are the real challenges of health care today. Yet amidst these many challenges, we must not lose sight of patients, who literally put their lives in our hands. Patients look to us to provide them with quality health care. We must continue to provide personalized care and teach the next generation of health professionals how to do so.
My first nursing job was in the ICU. The first thing I did after report was to clean my patients up and make them as comfortable as I could. I would change the wrinkled sheets they laid on all day in a hard bed. I got them up and out of the bed if they were able to do so. I brushed their teeth and combed their hair. I wanted my patients to feel someone cared for them. I made sure their room was clean and then I would let them visit with their family. I know that doesn’t sound like much, but have you been in a hospital as a patient lately? All these little things add up. It makes a big difference if it’s you lying in the hard bed. And if it’s your mother or father, a grandparent or child, it makes all the difference in the world.
Patients don’t live their lives in hospitals. Lives are built in the communities where people live and work – the same place they are today planting trees or serving food at the soup kitchen. And that’s where patients want to return.
More than 15 years ago, I started a home health care agency to care for an underserved minority community. Care in the home is an extension of where you left off in the hospital or clinic. It comes with its own challenges: confronting family dynamics, coordinating with caregivers and educating patients so they feel confident in their care when you leave. But that same sense of caring for each individual carries through no matter what the setting.
Report after report tells us that patients want to be cared for in a humanistic manner. They want to see professionals who look like them, who honor and understand their culture, and speak their language. Members of ethnic and racial groups do not lose their individuality when they come to our health care organizations.
As our nation navigates the uncertain future of health care, one of our greatest needs will be to increase the number of health professionals and to make sure that they can practice to the best of their skills and knowledge – no matter what the setting. Health care is both a science and an art, and providers should be able to deliver both.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Editor's note: National Black Nurses Association is a member of the Champion Nursing Council
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Jan 26, 2012
By Paula Lucey, MSN, RN, Administrator, Milwaukee County Behavioral Health Division, RWJF Executive Nurse Fellows program alumna (1999-2001)
The Robert Wood Johnson Foundation (RWJF) Partners Investing in Nursing program (commonly called PIN) is a wonderful way to address nursing workforce efforts. The Foundation created this program with the concept that nursing workforce efforts needed to become the work of not only nursing but the work of partnership with local foundations and employers.
In Milwaukee, our first PIN grant focused on the impending crisis in public health related to the nursing workforce. We had data that suggested that upwards of 50 percent of the current workforce could retire in the next five years. While not all will do so, this was a wake up call that we needed to begin to work to develop the next generation of public health nurses.
Our program was able to energize some senior nursing students to consider careers in public health. While our numbers were under 20, the students spread the word to their fellow students, and we believe we created a ripple of interest among students at several of the local BSN programs.
As important as the immediate efforts related to these students were, some of the project’s accomplishments will form the foundation for long-term solutions. The most important was increased awareness of the importance of public health and the vital role that nursing plays among our three foundation partners. The lead partner, Scott Gelzer from the Faye McBeath Foundation, was already a nursing funder and supporter. He was able to interest two other foundations in the critical work to invest in public health.
As the nursing leader of the project, I learned a tremendous amount about the work and world of philanthropy. As a nurse leader who has submitted grants before, it was exciting to see how these organizations set priorities, what they need to make funding decisions and how to keep them engaged in the project’s success. As an alumna of the RWJF Executive Nurse Fellows program, I was able to utilize my leadership skills and expand my capacity to lead change by participating in this program.
We are fortunate to be in the latest and last funding cycle as well. This time we will focus on the workforce needs related to mental health nursing. This project comes at an exciting time for Milwaukee. A major effort is underway to redesign the mental health system and the PIN project and leaders are fully engaged in the effort.
The innovative design of the PIN program has been important for the Milwaukee nursing workforce in two critical areas of nursing practice. However, the relationships and partnerships will help nursing to move forward for years to come.
Learn more about theRWJF PIN grant for public health nursing in Milwaukee.
Learn more about public health nursing.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 26, 2012
By Brent MacWilliams, PhD, ANP, Instructor, University of Wisconsin-Oshkosh, ACCEL Leadership Research and Evaluation, and member of the Board of Directors, American Assembly for Men in Nursing
Donna Shalala stated at the IOM Future of Nursing: Leading Change, Advancing Health hearings that accelerated nursing programs could be a strategy to increase the number of men in nursing.
She’s right.
At the University of Wisconsin-Oshkosh, we’ve implemented an accelerated degree nursing program, and it is drawing in male students at a rate that is double the national average.
The program is called the Accelerated Online Bachelors to BSN (ACCEL). It is currently being evaluated as a potential exemplar for nursing education by the Robert Wood Johnson Foundation (RWJF) Evaluating Innovations in Nursing Education (EIN) program. Since 2003, the ACCEL option has offered students a technology-rich, immersive online learning environment coupled with a unique precepted clinical experience.
The ACCEL October 2011 cohort is 20 percent male—a typical percentage for the ACCEL option and for accelerated programs across the country. A 20 percent male student population is double the average number of men typically enrolled in more traditional nursing programs. Men currently comprise 10 percent of the national population of registered nurses, surveys show.
Innovative programs such as accelerated nursing programs are having a positive effect on access to the nursing profession, nursing scholars have found. It’s a pleasant surprise to the nursing community; the link was not anticipated when accelerated nursing programs were originally designed.
Men who are older and who are looking for new and more rewarding careers often gravitate to accelerated nursing programs. In addition, men who have had role models who are nurses and who have already earned academic degrees also gravitate to accelerated degree nursing programs.
That is good news for the profession. Older men appear to be better able to deal with and move past the stigma of being a man in a female-dominated profession. Still, we need more research to better understand why men gravitate to accelerated programs.
Accelerated nursing programs like the Accelerated Online Bachelors to BSN (ACCEL) will help the nursing community reach two important goals. They will help meet the IOM report’s recommendation to increase the proportion of nurses with baccalaureate degrees to 80 percent by 2020. And second, they will help the American Assembly for Men in Nursing (AAMN) reach its goal of increasing the percentage of men in nursing to 20 percent by 2020.
Both of these metrics appear to be attainable if forward thinking organizations like the Robert Wood Johnson Foundation support programs that increase the quality of nursing education and promote diversity.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 11, 2012
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nalo M. Hamilton, PhD, MSN, WHNP/ANP-BC, Assistant Professor at the University of California Los Angeles School of Nursing and an RWJF Nurse Faculty Scholar.
As 2012 approaches, I hope that the United States remains resolute in providing access to equitable health care for all, especially women.
We live in a time where women have made significant contributions in academic, social and political areas but their contributions to women’s health care are eroded with every passing year. Currently, as the working poor, a record number of women are living in poverty and are unable to access affordable health care.
Thus, their diaspora of medical conditions go without primary care management resulting in acute conditions that are stabilized in the emergency department. However, once the condition is stabilized, a woman is sent home without the ability to follow-up with her primary care provider, thus continuing the cycle of acute onset, ER admission and discharge.
In my current practice I primarily manage: hypertension, tobacco dependence, obesity, anxiety, depression, dyslipidemia, breast disorders, diabetes, hypothyroidism, infections, dysfunctional uterine bleeding and family planning. For me this list represents the many organs that exist between a woman’s eyeballs and toes. Additionally, these conditions highlight how critical it is for women to have access to health care, not only for chronic conditions but for preventative screening as well.
The Affordable Care Act is a critical first step but much remains to be done at local and national levels.
A new year brings with it new opportunities and hope, so raise your glass with me in a toast to 2012—the beginning of health care equity.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 11, 2012
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Dennis Sherrod, EdD, RN, RWJF Executive Nurse Fellow, Cohort 2003 and Professor and Director of Graduate Programs, Forsyth Medical Center Endowed Chair of Recruitment & Retention, Winston-Salem State University, Winston-Salem, North Carolina.
Increasing access and quality of health care services and promoting individual health continue to be national priorities. As Affordable Care Act provisions increase access to care and prevention services, demand for primary care providers, registered nurses, and other health professionals are expected to increase. A high priority for health care systems will be to develop innovative health care delivery models that fully utilize health promotion, chronic care management, and health care delivery skills of advanced practice nurses and registered nurses. Health systems will need to collaborate effectively with university systems to measure outcomes of these models and rapidly integrate findings into nursing curricula and educational programs, therefore informing the preparation of future nurse professionals.
The nursing profession will need to attract and retain a diverse nurse workforce educated to focus on health promotion and primary prevention. And health systems will need to encourage advanced practice nurses and registered nurses to practice within the full range of their educational preparation.
My New Year’s resolution for United States health care systems is to establish, activate, and/or reactivate health system and health professions educational program advisory groups to clearly communicate rapidly changing and evolving competencies and skills required to promote health and address evolving health care needs of our citizens. Advisory groups can assist stakeholders from service and education to collaboratively prepare and introduce nurse professionals better equipped and prepared to address health and health care needs in rapidly changing health care systems.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 11, 2012
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing and Co-Director, Center for Health, Media & Policy, Hunter College, City University of New York; Strategic Adviser, Future of Nursing: Campaign for Action; co-editor, “The Nursing Profession: Development, Challenges, Opportunities,” RWJF Health Policy Book Series.
While I was editor-in-chief of the American Journal of Nursing, I and some of the editorial staff noticed that most of the manuscripts we received for our narrative column, Reflections, were about death and dying. We begged people to submit columns on other topics, lest Reflections become As I Lay Dying. But I shouldn’t have been surprised.
As a nurse and daughter of a man who died at 58 from metastatic cancer, I have cared for many dying people and have been privileged to be with some at the moment of their deaths. I’ve had patients who told me that they were going to die that night—and they did. I’ve seen an 85-year-old woman kept alive on a respirator with an open abdominal wound for four weeks before she became septic and died, despite her stated wishes to not have such extraordinary measures. Caring for my father during the last month of his life was the most precious gift I was able to give to him—and to myself. Yet, I had to fight with the health care system to ensure that he was adequately medicated when hospitalized or to be able to remain with him during an emergency room procedure. I fought to take him home so he could die there, as he wished, with love and comfort care.
These experiences imprint themselves indelibly on our memories and our souls. They can be rich and profoundly move us to confronting the realities of our own life and inevitable death. Or they can make us witnesses to torture and inhumane treatment of the dying, and shake our core beliefs about how a rational, caring society behaves.
This is not just a personal matter. It’s also a public one that speaks to the problems of our costly health care system that too often fails to deliver the right care (defined here as what a fully informed patient prefers) at the right time. About 25 percent of Medicare spending is during the last year of a beneficiary’s life and 40 percent of that is in the last 30 days. And yet, some of this spending is for unwanted, futile treatments. The Medicare costs are twice as high for people who die in hospitals compared with home. Some private insurers, such as Aetna, have successfully piloted programs that give fully informed patients more options for advanced illness care. Doing so has improved patients’ and families’ satisfaction with care while reducing costs.
So, the New Year’s resolution that I’d like to see be a priority for our health care system is that we quickly and thoughtfully build upon these efforts and commit to providing more humane options for end-of-life care. Let’s encourage, expect, and pay for ongoing conversations between health care providers and patients and their families about their treatment and care options, ensure that patients are fully informed about these options and can express their preferences, expand hospice at home and in facilities as needed and wanted, and develop quality indicators that will hold health care providers and institutions accountable for focusing on supporting patients and families during this important life transition.
From economic and moral perspectives, expanding people’s choices for advanced illness or end-of-life care is the right thing to do.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 3, 2012
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Susan C. Reinhard, RN, PhD, FAAN, senior vice president and director of the AARP Public Policy Institute. She also serves as chief strategist for the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and RWJF.
Everything we know about the future of health care delivery tells us we need to build – and empower – a health care workforce that meets the real needs of patients and their families. This is absolutely essential if we are going to provide quality care that also is efficient. Doing this requires transforming how nurses are educated so that we can better meet patient needs in a changing delivery system that is expanding its reach beyond hospital settings to the community; and rewarding integrated care systems with a focus on patient-centered and interprofessional care teams.
The Institute of Medicine Committee on the Future of Nursing recognized this changing landscape. They understood that for nurses to deliver safe, quality and patient-centered care across all settings, they must achieve higher levels of education through an improved education system that promotes seamless academic progression. To that end, the committee called for increasing the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree to 80 percent by 2020.
To help implement this recommendation – among the others issued by the Committee – AARP is collaborating with RWJF on the Future of Nursing: Campaign for Action. The Campaign is coordinated through the Center to Champion Nursing in America and includes 36 state Action Coalitions and a wide range of health care providers, consumer advocates, policy-makers, and the business, academic and philanthropic communities.
Just two weeks ago, we convened the first of four regional meetings on nursing education – part of our Learning Collaborative on Advancing Education Transformation. Action Coalitions from the southeast region gathered in Florida to share best practices and collaborate. As I listened to my colleagues, I understood clearly how inextricably linked nursing education is to the other recommendation areas. Education creates pathways to improved practice, nursing leadership and collaboration among the health care professions.
To best serve patients and their families, we must bring down walls, dismantle barriers and work with one another to expand opportunities for learning and advancement.
In the year ahead, we will be focused on further establishing networks for sharing and collaboration through our national network of Action Coalitions, 36 strong as we end 2011, although that number will soon expand. By early spring we hope to have Action Coalitions in nearly every state in the country.
That’s going to mean an exponential increase in momentum – a presence, prominence and power that I know will get us that much closer to our vision: A nation where all Americans have access to high-quality, patient centered care in a health care system where nurses contribute as essential partners in achieving success.
I look forward to the day when we will make that vision a reality and the work of our Action Coalitions is going to help us get there a lot faster – through the partnerships, collaborations and alliances they pursue. This will become a reality through the students who move to higher degrees and more advanced skills, well prepared for the increasingly complex needs of the patients for whom they will care and the health systems that they will help lead.
Transformation is no easy task. But I have faith in the collaboration, sharing and hard work that is being done across the country. And it is my resolution for 2012 to help facilitate this action, on the ground, where change happens.
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
Jan 3, 2012
This blog was reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nancy E. Donaldson, RN, DNSc, FAAN, is a clinical professor and director, University of California San Francisco Center for Evidence-Based Quality Improvement, a JBI Affiliate Centre, and an investigator for RWJF’s Interdisciplinary Nursing Quality Research Initiative.
As health care professionals, nurses are privileged and empowered by a unique proximity to patients and families. We share the first breath of newborns and the last breaths of all those beloved people at the end of life; we see patients and families in clinics, homes, extended care, correctional, community, and acute care settings. In the midst of unprecedented technological innovation, we still honor and practice the fundamentals of care by bringing comfort, cleanliness, safety, nutrition, dignity and caring to persons and families whose values, preferences and health traditions vary widely.
It is difficult and rewarding work, perhaps a calling. As we embark on a new year, more than ever before we are truly called to lead and fully engage in transforming the American health care system. If not now, then when? If not us, then who?
We—you and me, our families and the community of all Americans— deserves the best health care to maximize health and healing and to optimize the lived experience and contributions to benefit society.
We don’t have that level of health care yet, or only a few of us do because we have the funds, mobility and sophistication to seek it out and demand it. We all have stories of friends, loved ones, or strangers whose lives are cut short or changed forever by lack of access to evidence-based, affordable, quality health care.
The most important priority facing us is to achieve the aims of the Institute of Medicine’s Future of Nursing report and to fulfill our destiny as leaders and fully engaged participants in transforming health care. Thousands and thousands of lives depend on us!
What is YOUR personal plan of action? How will YOU step up to the implementation of the Future of Nursing recommendations? How can you use your gifts as a clinician, a leader, an advocate to advance it? If not you, then who?
Imagine what we can accomplish if we all do a little and share the same vision for our profession and for the reformed American health care system!
Dec 28, 2011
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Lynn Mertz, PhD, deputy director, New Jersey Nursing Initiative (NJNI), a project of the RWJF and the New Jersey Chamber of Commerce Foundation.
New Jersey’s Action Coalition has gotten off to a great start, taking on four key recommendations from the Institute of Medicine’s Future of Nursing report. They are to: promote nurse leaders; increase the share of nurses with baccalaureate and advanced degrees and transform nursing education to help accomplish that; collect better data to track the nursing workforce; and free nurses, and advanced practice registered nurses in particular, to practice to the full extent of their education and training.
It is our resolution to continue developing strategies to implement the recommendations for New Jersey. Our ability to make an impact in 2012, coupled with the efforts of the 35 other Action Coalitions around the country, will make a significant contribution toward strengthening the health care workforce, and nursing in particular.
At NJNI in 2012, we will see our second cohort of scholars graduate. It is our resolution—indeed, our mission—that by working with our graduate schools of nursing and our scholars, we will ensure that the state has the highly qualified, diverse nurse faculty that we need to educate the next generation of nurses, so that a nurse is there for you.
Dec 28, 2011
Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Denise Bottcher, Communications Director, AARP Louisiana, which is the non-nurse co-lead for Louisiana’s Action Coalition, a part of Future of Nursing: Campaign for Action.
What is your New Year’s resolution for the United States health care system?
Right now Louisiana–like the rest of the nation—is facing a shortage of primary care physicians. And it’s not projected to get any better any time soon. It just makes sense that we remove the barriers advance practice nurses face so that we can expand access to high-quality care so that we can keep our population healthy.
As the nation grows older, the demands for health care increase. Managing chronic conditions and staying healthy are chief concerns for older adults and the people who care for them. So what’s the excuse for not allowing highly trained educated nurses play a larger role in meeting the needs of patients? It’s time we end the turf war and put people first.
What do you think should be the highest priority for action in the New Year?
Whichever side you’re on, I think Americans are ready for the United States Supreme Court to rule on the Affordable Care Act. Along with the economy, the new health care law continues to be one of the most hotly contested debates among radio talk show hosts, elected officials and voters. It’s not surprising that when you talk about the benefits of the new law–coverage for pre-existing conditions, preventative coverage, and eliminating red tape–everyone supports it. It’s only when you talk about the mandate to purchase insurance that the debate begins. I’m ready for the U.S. Supreme Court to settle the debate once and for all. Let’s get on with it.
