Posts Tagged ‘IOM’


Angelina, Florence, End-of-Life Care, Nursing History, Postpartum Depression: A Web Roundup

May 14, 2013

By Jacob Molyneux, AJN senior editor/blog editor

In the news today we have an op-ed piece in the New York Times by Angelina Jolie about her rationale for getting a double mastectomy. There are sure to be many reactions to this disclosure, with many offering praise for her frankness about her decision. There may also be some who disagree with her decision to take this preventive step because she has the BRCA1 gene, which sharply increases her risk of getting breast cancer. Jolie’s perspective seems to be one of empowerment for women rather than a sense of helplessness or sorrow. Though Jolie’s circumstances are hardly universal in terms of the cushion provided by her great wealth, it’s hard not to admire the strength it takes to see things in such a positive light: “Life comes with many challenges,” she writes. “The ones that should not scare us are the ones we can take on and take control of.”

MarchCoverIt’s come to our attention that, in honor of Nurses Week, the American Antiquarian Society blog,, put together an interesting collection of items related to nursing from its mid-19th century archives, leading their post with a mention of AJN‘s March cover, which featured a vintage illustration, “A Map of the Open Country of  Woman’s Heart.”

A recent post we ran about the fading away of certain nursing blogs gets a mention from PixelRN, who has written a post called “Why I Stopped Blogging.” Short answer, for her: she stopped working in nursing, and “life got difficult.” Understood. As always, we hope new voices will pick up where the early nurse blogging pioneers have left off.

At the INQRI blog, there’s a post about recent nurse-related research, including the finding that nurse home visits decrease postpartum depression. Yes, in a way this is obvious, in that we are well aware that a little attention from nurses could, in many instances, go a long way toward preventing more serious problems down the line. But it’s good to let it be known far and wide in this age of sequestration cuts and lean staffing.

And in the May issue of AJN, Joy Jacobson gives an in-depth look at the important and timely subject of end-of-life care, paying special attention to recent research, whether or not we are improving the quality of the dying experience or still focusing too much on aggressive treatment, and the important role played by nurses at this crucial time when families and patients need a truly understanding presence at the bedside: “Palliative and End-of-Life Care: Where Are We Now?”

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Best Care at Lower Cost: New IOM Report Spotlights Crucial Role of Nurses

September 6, 2012

By Mary D. Naylor, PhD, FAAN, RN. Dr. Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She is also the National Program Director for the Robert Wood Johnson Foundation program, Interdisciplinary Nursing Quality Research Initiative, aimed at generating, disseminating, and translating research to understand how nurses contribute to quality patient care. She was appointed to the Medicare Payment Advisory Commission in 2010. 

Building on the Future of Nursing report’s call for nurses to fully engage with fellow health care professionals, a new report from the Institute of Medicine, Best Care at Lower Cost, calls on nurses and others in the health care system to apply emerging tools, technologies, and approaches to yield lower costs and better health outcomes. I had the great fortune to serve as a member of the study committee.

The complexity problem. The report couldn’t be more timely or relevant, particularly for nurses and the patients they serve, given the complexity of the current health care system. Administrative and workflow inefficiencies limit hospital nurses from spending more than about 30% of their time on direct patient care. With increasing specialization, modern medicine now includes nurses in more than 50 specialties. To successfully coordinate a patient’s care, nurses need to communicate and collaborate with patients, family caregivers, physicians, pharmacists, social workers, and many other team members.

The complexity of patient care can blur accountability. Among hospital patients, 75% are unable to identify the clinician in charge of their care. Breakdowns in communication also can contribute to poorly coordinated care. As a result, almost one-fifth of Medicare patients are rehospitalized within 30 days, at a cost to Medicare of $15 billion in 2005 alone.

The ‘care team’ model. The report envisions a health care system with organizational cultures and incentives that prioritize leadership, team care, transparency, safety, and continuous improvement. And at the core of a continuously learning system is the care team, centered on the patient and comprised of family caregivers, clinicians and others involved in the patient’s care, within and between critical transitions in care settings.

What would a continuously learning health system mean for nurses? At every stage of patient care, nurses remain focused on the patient’s goals. They help ease the complexity, stress, and confusion of the health care system. When forming a care plan, they’re connectors who can help bridge clinical knowledge with a patient’s care needs. During a course of care, they’re explainers who can help patients understand and implement their care plan. And during care transitions, they’re facilitators, connecting the hospital, community, home, and other providers and services involved in the patient’s care.

Nurses are the common thread linking all components of a patient’s care, and are therefore also the key to advancing a less complex, less costly health care system. Continuously learning health care cannot wait.

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Vampire Nurses, PhDs, Your Best Moment as a Nurse: Today’s Notes from the Nursosphere

March 30, 2011

Here are some recent posts of interest we noticed on the nursing blogs. Many of these blogs can actually be found on our blogroll, so we hope you’re exploring what’s there from time to time, even if we know the list isn’t exhaustive and is probably missing some other excellent (and at least somewhat frequently updated) blogs.

It’s good to know that Will, the nurse/comic artist who shares his drawings at Drawing on Experience, has started posting again more regularly. One of his most recent efforts depicts a night shift nurse as a kind of vampire. It’s funny and, in a way, insightful. We give just a thumbnail version of it below on the right, in the interests of preserving the artist’s copyright; to see it enlarged, click the image and visit the version posted on his site, where you can also find a bunch more drawings, many about his life as a relatively new nurse. 

The INQRI Blog (that INQRI stands for Interdisciplinary Nursing Quality Research Initiative, a real mouthful) has a new post about an increase in enrollment in nursing doctorate programs. Here’s an excerpt:

According to new data released recently by the American Association of Colleges of Nursing (AACN), enrollment in doctoral nursing programs increased significantly in 2010. The AACN believes that this shows a strong interest in both research-focused and practice-focused doctorates.

The post also connects this enrollment trend with some recommendations from the IOM Future of Nursing Report, which we’ve written about more than once on this blog in recent months. But no more policy today! Whatever your degree, if you’re a nurse, you probably wonder from time to time why you do such a challenging job. An evocative post at Those Emergency Blues recounts an after-dinner conversation between two friends about just this. One of them asks the other, “What’s your best moment in nursing?” The author struggles to find an answer. Here’s part of what she says:

I stopped and thought. I could see my reflection in the dining room mirror, dimly, and even I could see bone-tired in my face. But I thought about codes and trauma. I thought about why I was once made Employee of the Month. I thought of smaller moments of giving care— warm blankets, a back rub, a cup of ice chips, repositioning. I thought about missed findings. I thought about the time a patient an ambulance gurney went VSA while I was triaging her, and walked out of hospital ten days later. I thought about innumerable STEMIs caught and thrombolysed (and later sent for rescue cathetherization) within minutes of arrival. I thought about the times when I pushed for some extra intervention which made a real difference in the patient’s life.

It’s engaging, but it’s probably not the most important part of her answer, which you’ll have to read the entire post to learn. Anyway, maybe we’ll steal the question and ask it here, since we’d really like to know what our readers think (as the chill air hangs on at the end of March and energy levels waver). So what’s your best moment as a nurse?—JM, senior editor/blog editor

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True Believers at the 2011 Clinical Nurse Leader Summit

January 26, 2011

By Maureen ‘Shawn’ Kennedy, AJN’s editor-in-chief, who is in Florida this week attending meetings and visiting local schools

It’s January and I’m in Miami (I know, I know). I just finished attending the CNL 2011 Summit (CNL = clinical nurse leader). It was a relatively small meeting, as nursing meetings go, with about 350 attendees who were CNLs, faculty or students in CNL programs, or chief nursing officers from clinical facilities employing CNLs. They were all believers in the value the role brings to clinical practice. There was an energy, an atmosphere of being in on a new and growing phenomenon.

Some background: the CNL is a relatively new role in nursing, first formally proposed by the American Association of Colleges of Nursing in 2003 after several meetings with other nursing groups concerned with nurses’ “education for practice” (see the white paper on the development of the role). CNLs function at the unit level, coordinating care, working with staff, focusing on improving outcomes.

Described as “master’s-prepared advanced generalists,” CNLs now number about 1,300, according to Mary Stachowiak (see photo), president of the Clinical Nurse Leader Association (CNLA). There are currently about 100 institutions with master’s programs preparing CNLs and about 1,800 CNLs in programs.

AJN carried a short news article back in October 2004 noting the creation of the new role, and in December 2005 we reported on the controversy surrounding the role,  much of it coming from the National Association of Clinical Nurse Specialists (NACNS), who saw the role as duplicating some aspects of the CNS role in a way that might “disenfranchise” those who already had that credential.

More recently, our update in January 2010 showed that, while there still were some reservations about the role, broader support was emerging. Read the rest of this entry ?


Revamping CE

February 22, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

I finally got to the bottom of my inbox. There I found a transcript of a Webcast I had listened to back in December. I had forgotten about it and am amazed that there wasn’t more buzz around it because there’s a call for a drastic overhaul of continuing education for health professionals.


On December 4, the Institute of Medicine released a report, Redesigning CE in the Health Professions, which is the result of consensus recommendations by (what else?) a group of experts.

The experts were harsh in their criticisms, claiming that there are “major flaws in the way CE is conducted, financed, regulated and evaluated.” They also noted conflicts of interest and varying regulations from state to state, and pointed out that the scientific basis of CE is underdeveloped and lacks an interdisciplinary format.

You can read the full report online—but briefly, it calls for a federal “blue ribbon panel” to develop an interprofessional, independent Continuing Professional Development Institute to provide oversight to ensure reforms, new processes and accountability. 

Changes are coming . . . and it’s about time.

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National Forum to Focus on Role of Nursing in Community, Public Health, Primary Care, and Long-Term Care Settings

December 2, 2009

Below is a press release we received for an important and timely December 3rd event on the future of nursing, including links to attend the forum by live Webcast or to follow it on Twitter.

Initiative Exploring the Future of Nursing Convenes National Forum in Philadelphia

The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine ( will hold the second of three national forums on December 3 in Philadelphia. Participants including committee chair Donna Shalala discuss how to improve the delivery of medical treatment for Americans in Community Health, Public Health, Primary Care, and Long-Term Care settings across the country. This forum will look at 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.

**A live webcast of the meeting will be available via**

**Follow the forum live on Twitter at**

Read the rest of this entry ?


Why Doesn’t the U.S. Have an Office of the National Nurse?

September 21, 2009

By Diana Mason, editor-in-chief emeritus

Ann Keen

Ann Keen

First, the necessary throat-clearing about who and where: I recently attended a public session held by the Institute of Medicine Initiative on the Future of Nursing. Chaired by University of Miami president and former secretary of Health and Human Services Donna Shalala and chief nurse for Cedar Sinai Medical Center Linda Burnes Bolton, the session began with presentations by two nurses involved in the Prime Minister’s Commission on the Future of Nursing and Midwifery in England: Ann Keen, Member of Parliament and Parliamentary Undersecretary for Health Services, who chairs the British commission; and Jane Salvage, the lead secretariat for the commission and a former contributing editor for AJN.

Now the point: During the formal session, Keen noted that various countries in the UK each have a chief nurse officer (CNO) who is responsible for developing a national nursing strategy. Afterwards, I interviewed Keen and Salvage, who both said they didn’t understand why American nurses were not supporting the call for a CNO for the United States, one who would be charged with developing and overseeing a national nursing strategy for this nation. In their eyes, a CNO who is on par with the surgeon general could help the nation to develop approaches to ensure an adequate nursing workforce, identify barriers to their full utilization, identify new models of care to better promote the health of the public, and develop strategies for removing the barriers that impede forward movement.

Opposition from nursing groups. In the U.S., organized nursing has largely opposed the efforts of a group of grassroots nurses who are calling for the establishment of an Office of the National Nurse. Read the rest of this entry ?


Medical Research–You Get What You Pay For

September 15, 2009

By Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief

Mike Licht/, via Flickr

Mike Licht/, via Flickr

Last week I attended the Sixth International Congress on Peer Review and Biomedical Publication in Vancouver. Hosted by JAMA and the British Medical Journal, the Congress brought together 415 editors from 34 countries. The presentations focused on research about peer-review quality, publication bias, conflicts of interest, and the quality of reporting research. (I know, I know: some of you would rather have a root canal than hear about this stuff.) What I came away with was a new skepticism and a bit of dread.

A study in JAMA got a big splash in the New York Times last Friday. The editors reported findings from their evaluation of the presence of honorary authorship and ghostwriting in six of the major medical journals, including JAMA. They found that overall, 8% of articles had ghost authors. Among research articles, 12% had ghost authors. These are fairly close to findings from a survey done in 1996, showing that little has changed.

Another presentation by Canadian researchers examining investigators’ experiences with conflicts of interest reported that in industry-related clinical trials, only 44% of the investigators had access to all the data (as opposed to 72% in non–industry related trials).

So, despite the best efforts by many journals to ensure accuracy and transparency in reporting research, it may be impossible to do so unless authors and investigators adhere to the same standards. AJN requires authors to disclose ties, financial and otherwise, to companies with products mentioned in their papers. This is not to imply any guilt, but to inform the reader of the ties and to acknowledge that there may be some potential bias.

Decisions about health care treatment are based on research. If research results are based on incomplete data or written by someone paid (often by pharmaceutical companies) to present results in a favorable light (and the two studies reported above indicate that this happens far too often), how can we trust in the results? How can we confidently base our practice on evidence if we can’t trust the evidence?

Medical editing: a ‘public good.’ My feeling of dread comes from the presentation by Harold Sox, former editor of Annals of Internal Medicine and chair of the Institute of Medicine’s Committee on Comparative Effectiveness Research. In discussing the importance of publishing the results of research, Sox said, “The public relies on journals to evaluate research. Good medical editing is a public good, but it’s expensive.” He’s right. Maintaining a high-quality editorial office to do the fact-checking (we check every reference to ensure it’s cited accurately); do our own search of the literature (to ensure seminal and new studies weren’t overlooked); and then do the careful editing that presents the content in a clear, accurate, concise, and interesting way is not cheap. But you get what you pay for.

He also asked, “If journal income declines, what happens to good medical editing?” Hence my feeling of dread—many nurses and other health care professionals feel that they can get information free on the Internet and so don’t see a need to subscribe to a professional journal. With less income, journal publishers feel the need to scale back staff and resources.

But someone is paying for the production of the content on the Internet—if it’s not a reputable organization or journal, who is it? Is it unbiased? Is it evidence-based, and who vetted the evidence and the authors? Let the readers—and their patients—be wary of what they read online and ask themselves just who paid for it, and why.


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