Blog

Patricia Deyo, BSN, BA, RN

On TV, hospital heroes are usually physicians, rushing to a patient’s bedside whenever an alarm goes off. But in real life, nurses are the first responders to patient emergencies. When it’s you or a loved one in that hospital bed, you hope that your nurse is 100% focused.  

Burnout is a fact of life in nursing today, so healthcare organizations are looking for innovative ways to create work environments where nurses feel engaged and inspired. Research shows that these healthy work environments improve not only nurse satisfaction, but also patient safety, patient satisfaction, and quality of care.

So why isn’t everybody doing it? It may seem simple, but creating a positive work environment is challenging, especially in today’s complex healthcare climate. While many hospitals and healthcare organizations successfully implement some aspects, they fall short on others.

With this in mind, the American Nurses Credentialing Center (ANCC) established the Pathway to Excellence® Program to recognize healthcare facilities that create healthy work environments where nurses can flourish. To earn this mark of excellence, a hospital must show that it has incorporated specific standards into its day-to-day operations, including:

• A patient-centric, safe, and healthy work environment
• Abundant opportunities for nurses to expand and improve their skills
• A focus on collaboration, quality, and evidence-based practice 

This is good news for nurses, but it’s even better news for patients. High nurse satisfaction and retention directly impact quality of care. The Pathway credential tells consumers that a hospital’s quality and safety outcomes are second to none. It provides them with the ultimate benchmark when choosing a healthcare facility.

There are now 57 Pathway to Excellence designated hospitals in the United States, and the number continues to grow. Success in the acute care environment has spawned the Pathway to Excellence in Long Term Care™ Program, which recognizes the essential elements of an optimal work environment in skilled nursing facilities, nursing homes, and assisted living centers.

It’s the first program of its kind in the country and comes at a crucial time. As our population continues to age, quality long-term care is increasingly important to all of us. The Pathway designation reassures families that their loved ones will receive safe, high quality care in an environment of excellence from nurses [with long-term care expertise] who are focused, motivated, and fulfilled.

By M. Christina R. Esperat, RN, PhD, FAAN
Professor and Associate Dean for Clinical Services and Community Engagement
The School of Nursing, Texas Tech University Health Sciences Center
Lubbock, Texas

One of the drivers of the current health care reform movement is the lack of access to primary health care, particularly for vulnerable populations within American society. This is an opportune moment for nurse-managed health centers, a largely unheralded group of primary health care providers, to accept responsibility for shaping the health care reform movement, thereby improving health care for their consumers. A model for the nurse-managed health center is a full service primary health care clinic administered by nurses and whose services are essentially provided by advanced practice nurses. In Texas, the Larry Combest Community Health and Wellness Center (LCCHWC) is one such clinic located in a medically underserved area in East Lubbock, providing what are primarily health promotion and disease prevention activities within the city of Lubbock’s most economically deprived area. Clinic patients come from diverse backgrounds, but predominantly, the typical profile is that of a low-income, working family with members who do not have health insurance coverage. Majority belong to minority ethnic groups, predominately Hispanic, with a significant population of African-Americans.  Administered by the School of Nursing at Texas Tech University Health Sciences Center, the academic nursing center essentially has three operations: 1) the primary care clinic; 2) the American Diabetes Association-certified Diabetes Education Center; and 3) the Senior House Calls Program, a primary care service for home-bound elders. 
 
In March of 2009, the LCCHWC achieved status as a federally qualified health center (FQHC). It has thus joined the ranks of a very few of the nation’s nurse-managed health centers which are recognized FQHCs. It achieved FQHC status as a public entity model, and this further sets it apart from the vast majority of the traditional private, non-profit FQHCs. The Center is managed and care is provided by Advance Practice Nurses.   The Executive Director is a doctorally-prepared nurse administrator, and the clinical providers are Family Nurse Practitioners as well as one Women’s Health Nurse Practitioner. The LCCHWC further improves access to quality health care services for residents of its catchment areas by providing home visitation services through the Nurse-Family Partnership Program and the Patient Navigator Program for chronic disease self management. As one of Lubbock’s best-kept secrets, the LCCHWC is truly a “light under a bushel”!

Editor's Note: The National Nursing Centers Consortium has organized the first-ever "National Nurse-Managed Health Clinic Week" this year from October 3-9. This blog was submitted as part of this week-long celebration.

By Tina Johnson, CNM, MS
Director, Professional Practice & Health Policy
American College of Nurse-Midwives

The Patient Protection and Affordable Care Act will bring millions of newly insured citizens into the health care system.  In order to meet the country’s needs, leaders are calling for high value, evidence-based solutions.  Let’s start with the health condition that affects 100% of all Americans...childbirth!  How can we provide high quality, high value maternity care for all women and families?  The answers are in the evidence:  midwifery care improves maternal and newborn outcomes and patient satisfaction, reduces health disparities, and saves money and resources.

The U.S. grossly outspends every other nation per capita on health care, yet our maternal and newborn outcomes lag far behind those of other developed nations.  Childbirth is the number one reason for hospitalization, and its related hospital charges surpass those of any other health condition.  Resource-intensive interventions like labor induction, epidural analgesia and cesarean section are overused, often without indication or consideration of alternatives, resulting in increased risk of maternal and newborn harm.

Cesarean section is the single most common operating room procedure in the U.S., and the rate is steadily climbing.  Incredibly, in 2007, nearly one-third of American women delivered their babies by cesarean section.  Maternal mortality has risen dramatically, and glaring racial disparities in maternal and neonatal outcomes persist.

How can we reverse these disturbing trends?  Ensure that all women have access to maternity care providers and practices that support the normal processes of birth. Labor support, freedom of movement, intermittent monitoring, alternative birth settings, vaginal birth after cesarean...all have been identified as evidence-based practices that are underused.

Midwives truly are the experts in supporting healthy vaginal birth in all settings.  Midwives caring for low-risk women improve infant mortality rates in both hospitals and birth centers when compared with physicians caring for equally low-risk women.  Midwife-led models of group prenatal care reduce preterm and low birthweight rates and improve patient satisfaction. Birth centers provide improved outcomes for even the most at-risk women, reducing preterm birth, low birthweight and cesarean section rates, and reducing costs to our health care system.  Skilled midwifery care is the gold standard among nations with the best maternal and neonatal outcomes, and has been identified as essential to reducing maternal mortality worldwide. 

It’s time to bring that message back home.  The time is now to promote and support midwifery in America--and to follow the evidence.

Visit the American College of Nurse- Midwives to learn more about their activities and join the conversation at Midwife Connection.

By Andrea Brassard, DNSc, MPH, FNP, Strategic Policy Advisor, Center to Champion Nursing in America at AARP

In my role as Strategic Policy Advisor for the Center to Champion Nursing in America, I think daily about the need to expand consumer access to advanced practice registered nurses (APRNs). But it is when I put on my clinician hat (or rather white coat) that I see the critical link that must be made between ensuring APRNs can provide the services for which they are trained and experienced and ensuring that Americans have access to health care coverage. This was never clearer than last week when I volunteered at the DC Cares Free Clinic, sponsored by the National Association of Free Clinics. More than 1,000 people came to this one-day free health clinic to get the basic health services they can't afford or are otherwise denied because they have no insurance. The District of Columbia has 57,200 residents without insurance—and there are millions of uninsured in nearby Maryland and Virginia.

As a nurse practitioner, I was there as a clinician to provide primary care assessment, diagnosis and to work with patients on developing treatment plans. At the DC Cares Free Clinic, nurse practitioners and physician assistants worked side by side with physicians, each clinician providing primary care to the more than 1,200 patients we saw that day. In the District, APRNs can practice independently; that is, we can diagnose, prescribe and otherwise treat patients without physician oversight.

As I began to see patients, the experience underscored what I’ve long known—what patients without access to health care will do to get by and the health risks these actions pose.

The question—"what meds are you taking?" became "what meds were you taking before you ran out?"  One man borrowed diabetic medications from his brother and friends. One woman who I’ll call Louise (not her real name) ran out of her thyroid medication just that morning. Louise told me that she has seen a veterinarian (for her cats) more often than a physician since she lost her job. I was able to write $4 and $10 generic prescriptions for Louise. Louise was 54 and had not had a mammogram in 3 years.  She put off her last mammogram and then lost her full time job two years ago. I was able to refer Louise for a free mammogram (and a Pap smear) at Howard University Cancer Center. The other screening test that Louise needed is a colonoscopy, which is likely out of reach for her until she can obtain private health insurance, or until her “Welcome to Medicare” exam. 

At the end of my shift I introduced myself to Nicole Lamoureux, Executive Director of the National Association of Free Clinics. Nicole and I recently were appointed to a Department of Health and Human Services Committee to review and update the criteria used to define medically underserved areas and health professional shortage areas. The committee was formed as part of the implementation of the Patient Protection and Affordable Care Act.

You would not think that the District of Columbia was a medically underserved area. Yet, according to the DC Department of Health, approximately 45% of the population of the District resides in a medically underserved area.

APRNs, such as nurse practitioners, should be an important point of access for our underserved communities. In fact, DC has the largest percentage of nurse practitioners per population in the nation. Karen Scipio-Skinner, the Executive Director of the DC Board of Nursing thinks that the large number of NPs per population is due to the District’s APRN rules and regulations. APRNs can practice in the District without the barriers found in other jurisdictions. They can practice independently without physician supervision or collaboration agreements and prescribe medications without protocol requirements.

This is good news for consumers of health care. The District, like a number of states across the country who also allow independent practice for nurse practitioners, is well-positioned to take advantage of more funding for primary care and community-based health centers found in the recently passed Patient Protection and Affordable Care Act.