Posts Tagged ‘Robert Wood Johnson Foundation’

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The Nursing Report That Didn’t Just ‘Sit on a Shelf’

December 18, 2013

Joyce Pulcini is director of the master’s programs and of community and global initiatives at the George Washington University School of Nursing in Washington, DC. She also is the contributing editor for AJN’s Policy and Politics column.

From otisarchives4, via Flickr

From otisarchives4, via Flickr

IOM speakers and panel focus on a major report’s increasingly visible real world effects—while emphasizing diversity and the roles of every type of nurse at every level.

On December 11, I attended the Institute of Medicine (IOM) event celebrating the three-year anniversary of the The Future of Nursing: Leading Change, Advancing Health report, released in 2010. The event at the National Academy of Sciences in Washington, DC, highlighted the impact of the report so far and discussed the continued work of the Future of Nursing: Campaign for Action in terms of priorities for the nursing profession.

Some highlights:

  • Harvey V. Fineberg, president of the IOM and panel moderator, started with the fact that the The Future of Nursing: Leading Change, Advancing Health report had generated more than 1.3 million hits since it was first launched in 2010 and that this was one of the most successful of all of the IOM reports. The goal was that this report not sit on the shelf like many past reports but that it be used to improve the health care system. All speakers agreed that this goal was being realized.
  • Donna Shalala, president of the University of Miami and chair of the IOM Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, said that the response to the report demonstrated that it was “nurses’ time.” She emphasized that all parts of society need to be represented in the health care workforce and that all levels of nursing should play a role in improving the quality of health care. In discussing scope of practice roles for advanced practice nurses, she pointed out that the state of New Hampshire has had full scope of practice for nurses for more than 20 years and that no major safety or quality problems have been reported there.
  • Susan Hassmiller, senior advisor for nursing at the RWJF, discussed the fact that this report was highly rigorous and only used evidence-based studies to validate the findings. She noted that since the report was published, 15 states had introduced new legislation on the scope of practice for nurses. She also said that 51 action coalitions had been activated as a result of the report and that all were working on the so called 80/20 recommendation to increase the proportion of nurses with BSN degree to 80% by 2020. She also emphasized that diversity is the key in this recommendation.
  • Lynda Burnes-Bolton, vice chair of the Committee on the RWJF Initiative on the Future of Nursing and vice president and chief nursing officer at Cedars-Sinai Health System in California, said that lower cost outcomes are the goal and talked about the success of this effort in her home state.
  • Carmen Alvarez, a George Washington University postdoctoral fellow, family nurse practitioner, and certified nurse midwife who practices in Virginia clearly described clearly some of the challenges for APRNs as they try to care for patients. She provided poignant examples of situations in which precious time was lost acquiring physician signatures and the inconvenience to patients that resulted. Read the rest of this entry ?
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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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Transitional Care: How the Affordable Care Act Would Have Helped My Father

July 12, 2012

By Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. This post is also being published at the Robert Wood Johnson Foundation Human Capital blog.

When I heard that the Supreme Court had upheld the Affordable Care Act, I immediately thought of my father. He suffered mightily at the end of his life. Plagued with multiple chronic illnesses, he spent his last year in and out of hospitals. He received good hospital care, but his health deteriorated every time he left the hospital.

He simply couldn’t keep track of a growing list of prescriptions, tests, and doctor visits. He accidentally skipped antibiotics, which led to infections, which landed him back in the hospital. He accidentally skipped blood tests, which landed him back in the hospital. It seemed that every time he came home, he’d land back in the hospital. I lived thousands of miles away and couldn’t be the advocate that he needed.

What he needed was transitional care—he needed a nurse to meet with him during a hospitalization to devise a plan for managing chronic illnesses and then follow him into his home setting. He needed a nurse to identify reasons for his instability, design a care plan that addressed them, and coordinate various care providers and services. He needed a nurse to check up on him at home. Transitional care would have eased his suffering and allowed him a better life.

One of the best parts about the Affordable Care Act is that it will make transitional care possible for more patients. The transitional care program is one of many provisions in the law that will provide an unprecedented opportunity for nurses to take on greater roles as members of health care teams—they’ll be better able to provide preventive health care services, care coordination, and chronic disease management to patients.  

The Affordable Care Act came too late for my father, but I’m grateful that other patients and their families will be able to avoid the costly and heart-wrenching cycle of repeat hospital visits and unnecessary suffering at the end of life. At least that is my hope.

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Year of the Nurse? ‘Don’t Get Mad, Get Elected’

June 15, 2011

By Maureen Shawn Kennedy, AJN editor-in-chief—Comparing the increase of nurses in Congress in the 2010 midterm elections to the near doubling of the number of women in Congress back in 1992, an article in a Robert Wood Johnson Foundation electronic newsletter last week suggested that perhaps 2010 could be called ‘The Year of the Nurse.’ The article noted that there are now seven nurses in the U.S. House of Representatives—four Democrats and three Republicans—up from three in the previous Congress. This is certainly progress, but we’ve yet to gain a nurse in the U.S. Senate.

Nurses see the results of failed social policies every day. We do tremendous work providing restorative care, teaching self-care practices, and promoting behaviors that will maximize health. But how many of us seriously think of engaging in the politics of health care? Instead of promoting health and changing lives on a case-by-case basis, when you hold political office you can affect the health of an entire population. Nursing education provides us with an incredible set of skills: critical thinking, creative problem solving, people skills, time management, the ability to set priorities and to constantly reevaluate their order—to say nothing of multitasking. Read the rest of this entry ?

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Dispatch #3 from the Alabama Tornado Zone: A Tight-Knit Community, the Red Cross ‘CSI’ Unit, Public Health Nursing

May 9, 2011

Panoramic view of Forest Lake Neighborhood in Tuscaloosa, Alabama. Photo credit: Dennis Drenner/American Red Cross.

Sue Hassmiller, the Robert Wood Johnson Foundation Senior Adviser for Nursing, has been blogging from the area in Alabama recently devastated by tornadoes, where she’s volunteering with the Red Cross. This and all previous posts in this series are being collected on a separate page for easy reference.—JM, senior editor/blog editor

Hackleburg Is Gone!
Picture yourself in your present surroundings; take a look around at the buildings, the houses—and now try to picture them completely gone, with you standing right in the middle of it. That is what Hackleburg went through on April 27. Ninety percent of the small town is gone. You can tell that people lived there by the personal items strewn about, but you can hardly tell where the houses once stood. They have all been flattened. This is very different from the aftermath of the flood following Hurricane Katrina, when the flood-soaked houses were pretty much left standing.

Standing there in the middle of the rubble with family members, it’s hard for me to imagine how anyone survived this. But they did . . . at least most of them. This is a close-knit, church-going town, and are all there for one another. Their spirit is unfathomable. Frank (not real name) shows me where his sister was blown to and her medical bag, which he found. She was a paramedic. He shows me where they found the baby, and the fish pond his kids used to play in when they were small, and how he wishes the water and fish were still there. But they’re gone too. He wished he could show me the bathtub that saved his mother, but he can’t find it. He brought me to his “kinfolk” where they were eating their dinner: hot dogs on the grill and cupcakes from Walmart. They were happy to be alive—except for the matriarch, who asked God why He took her daughter and not her. The survivor guilt is unbearable. Frank tells me they will rebuild, love one another even more, and move on. I wonder how they will . . . . Read the rest of this entry ?

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Same Boat, Different Ocean

April 12, 2011

By Shawn Kennedy, AJN editor-in-chief

Since the Robert Wood Johnson Foundation/Institute of Medicine Future of Nursing report was released six months ago, we’ve heard a lot about how nurses need to have more representation on boards of health care institutions and be more active participants in decisions about redesigning health care delivery systems. (See our online resource page for a variety of information about the report.)

To me, it’s a recommendation that’s so intuitive and simple that it’s almost embarrassing—and the need for it only drives home how absurd our health care system can be. It’s mind-boggling to me that organizations feel they can plan effective health care without the input of nurses. Imagine aircraft manufacturers designing a plane without input from the primary group—pilots—who will be responsible for flying it safely.

I suppose many health care entities and boards  feel that they have this input from physicians—but really, in most hospitals physicians aren’t involved in the nitty-gritty operations details that either make or break workflow processes or can impede the delivery of safe, cost-effective care.  How many times have hospitals planned patient care units or purchased equipment without nursing, input only to find that the systems aren’t workable or create more work? Read the rest of this entry ?

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A Nursing Report That Deserves More Than The Usual Shrug

March 14, 2011

By Christine Moffa, MS, RN, AJN clinical editor

The IOM report The Future of Nursing: Leading Change, Advancing Health came out this past October, causing a flurry of excitement among some in the nursing world and groans of “big deal” among others. My immediate instinct was to shrug my shoulders and wonder if yet another report will really make a difference at the bedside.

AJN addressed the report and its implications in our December 2010 and February 2011 issues—so I knew it must be very important. But, for some reason, I had assumed it was going to be a dry, unreadable bore. And I put off reading it until recently, when I needed to use it as a reference. And wow, was I in for a surprise! I especially liked the inclusion of real case studies of nurses from different backgrounds and work experience who are making a difference in health care.

It’s inspirational, and I encourage all nurses out there—and anyone with a stake in health care (that’s pretty much everybody)—to take a look. (Tip: I found downloading the PDF version didn’t take long, and it was much easier to navigate than the HTML version.) If you’d like to hear more on the report and what it means to nurses, sign up for our upcoming Webcast about it. Let us know if you have any questions or comments, and we can try to address them in the discussion. Here’s the official promo info:

LWW Nurse Editors’ Roundtable – The Future of Nursing
Tuesday, March 22, 2011, at 12:00 pm EDT / 9:00 am PDT Read the rest of this entry ?

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