Category Archives: Human Capital
This is part of the December 2013 issue of Sharing Nursing’s Knowledge.
Americans Favor Increased Access to Nurse Practitioners
A new telephone survey commissioned by the American Association of Nurse Practitioners (AANP) shows strong support for increased access to care provided by nurse practitioners (NPs).
Among the survey's findings:
- A large majority favors removal of requirements that NPs work only under the supervision of physicians. Sixty-two percent of respondents support allowing NPs to prescribe medications and order diagnostic tests without such supervision. Just 17 states and the District of Columbia currently grant NPs full-practice authority, according to AANP.
- An overwhelming majority of Americans back legislation making it easier to choose NPs as their health care providers. Seventy percent of respondents favor legislation to eliminate barriers preventing patients from choosing NPs.
- There is widespread familiarity with NPs. Eighty percent of respondents have either seen an NP or know someone who has. More than half (53 percent) say a family member has seen one.
"These results clearly confirm what we have known anecdotally for years: American health care consumers trust NPs and want greater access to the safe, effective services they provide," AANP Co-President Ken Miller said in a news release.
The telephone survey was conducted by The Mellman Group, a Washington, D.C.-based polling firm. Its margin of error is +/-3.1 percent at the 95-percent level of confidence.
What’s on the minds of this year’s medical school graduates? Among top concerns for the country’s future physicians are uncertainty about health care reform, practice choices, and debt repayment, according to the 2013 Medical School Graduation Questionnaire administered by the Association of American Medical Colleges (AAMC). Overall, most medical students say they are satisfied with their education.
The 2013 graduates in the new survey report an average premedical education debt of $11,849, which is about eleven percent more than students reported in 2012. This ends a four-year trend in which the average premedical debt had been decreasing. In addition, the 2013 graduates report an average medical education debt of $135,084—an increase of two percent from 2012 graduates. Nearly two in five graduates this year (38.1%) say they plan to enter a loan-forgiveness program.
Fewer than 2 percent of 2013 graduates say they plan to go into full-time solo practice. Twenty percent have their sights set on a group practice of three or more. Nine percent expect to pursue hospital work.
This is part of the December 2013 issue of Sharing Nursing's Knowledge.
“Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future. The rise of nonphysician providers will enable more team care. Skilled health aides will monitor patients at home and alert a doctor if certain medical parameters decline. Nurses will provide wound care to diabetic patients, adjust medications like blood thinners and provide the initial management of chemotherapy side effects for cancer patients. ... Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care ... Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.”
-- Scott Gottlieb, MD, American Enterprise Institute, and Ezekiel J. Emanuel, MD, PhD, University of Pennsylvania, No, There Won’t Be a Doctor Shortage, New York Times, December 4, 2013.
“Let me put it this way, we have over 1,200 pre-nursing students. I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
-- Dwight Sweeney, PhD, California State University, San Bernardino, Nursing Students Being Turned Away Amid Faculty Shortage in Cal State System, Los Angeles Daily News, December 1, 2013
Graduates of entry-level baccalaureate and master’s nursing programs are much more likely to have job offers by graduation or soon after, compared with graduates from other fields, according to new data from the American Association of Colleges of Nursing (AACN). A national survey of deans and directors from U.S. nursing schools found that 59 percent of new bachelor of science in nursing (BSN) graduates had job offers at the time of graduation.
That’s substantially higher than the national average across all professions (29.3 percent). At four to six months after graduation, the survey found that 89 percent of new BSN graduates had secured employment in the field.
“Despite concerns about new college graduates finding employment in today’s tight job market, graduates of baccalaureate nursing programs are finding positions at a significantly higher rate than the national average,” said AACN President Jane Kirschling. “As more practice settings move to require higher levels of education for their registered nurses, we expect the demand for BSN-prepared nurses to remain strong as nurse employers seek to raise quality standards and meet consumer expectations for safe patient care.”
Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW). Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*
It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.
Janet Tomiyama, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011), is director of the Dieting, Stress, and Health (DiSH) Lab at the University of California-Los Angeles. She was recently named the 2013 recipient of the Early Career Investigator Award from the Society of Behavioral Medicine.
Human Capital Blog: First, congratulations on receiving the Society of Behavioral Medicine’s 2013 Early Career Investigator Award! What does this award mean for your current research and for your career?
Janet Tomiyama: Thank you! Of course, as I’m fighting my way toward tenure, this kind of recognition is really key to my career. I am trained as a social psychologist, but this award was from the field of behavioral medicine. It shows that my work has interdisciplinary appeal, that people in the medical field find it important. It shows me that I was on the right path in trying to broaden my training through the RWJF Health and Society Scholars program and trying to incorporate aspects of medicine and population health. Getting recognition from a field that’s not my own means a lot to me.
HCB: What specific work did the award recognize?
Tomiyama: I was recognized for a paper about racial disparities in chronic psychological stress and body mass index (BMI) among girls between the ages of 10 and 19. Of all the many, many health disparities out there, the disparity in obesity between Black and White girls in adolescence is one of the biggest. I wanted to tackle a big disparity, and I thought stress had something to do with it. I completed the research during my time as an RWJF Health & Society Scholars fellow.
Guidelines and a toolkit released this week by the Joint Commission highlight the key role nurses play in preventing central line-associated bloodstream infections (CLABSIs). CLABSIs are among the most deadly and costly hospital-associated infections, accounting for 31,000 deaths annually and costing the health system an estimated $9 billion. Studies funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative (INQRI) revealed that nurses can play a key role in preventing these infections.
Patricia Stone, PhD, MPH, RN, FAAN, a principal investigator for an INQRI-funded study on the impact of nurse staffing, skill mix, and experience on quality and costs in long-term care, contributed to the new guidelines. Stone is the Centennial Professor of Health Policy in Nursing at Columbia University School of Nursing.
Human Capital News Roundup: Light-based defibrillators, the primary care workforce, how women change men, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
A strong primary care system is essential to improving health care in the United States, and front-line clinicians, staff, and leaders need to re-examine traditional roles and responsibilities, Maryjoan Ladden, PhD, RN, FAAN, told Medical Home News. Ladden is senior program officer for RWJF’s Human Capital portfolio. To investigate primary care workforce transformation, RWJF funded The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP), Ladden said. Her full interview is available at: http://medicalhomenews.com/ (subscription required.)
Women with post-traumatic stress disorder (PTSD) gain weight more rapidly and are more likely to be overweight or obese than other women, according to a study co-authored by RWJF Health & Society Scholars alumna Magdalena Cerda, DrPH. The study, featured in Health Canal, is the first to look at the relationship between PTSD and obesity over time.
New tools such as the Omnibus Risk Estimator, which the American Heart Association recommends doctors use instead of cholesterol tests to determine whether to prescribe statins, are developed with little regulatory authority over their design and use, Jason Karlawish, MD, writes in a New York Times op-ed. Karlawish, recipient of an RWJF Investigator Award in Health Policy Research, encourages better oversight and regulations to monitor such tools.
Mirroring national trends, the California State University (CSU) system is turning away qualified nursing school applicants due to faculty shortages, reports the Los Angeles Daily News, and CSU officials fear that the situation will worsen the nurse shortage in a state that already has one of the country’s lowest numbers of nurses per capita.
This fall, CSU Long Beach had a nursing program acceptance rate of 18 percent, having received 450 applications for 82 slots. CSU Northridge had a “very highly qualified” pool of 300 applicants but could only accept 60. CSU Chico had to turn down 86 percent of its fully qualified applicants, while CSU San Marcos turned away nearly 89 percent.
“Let me put it this way, we have over 1,200 pre-nursing students,” Dwight Sweeney, interim chairman of nursing at CSU San Bernardino, told the Daily News. “I can only take about 108 a year. In the fall, we had over 600 applicants for 44 positions. Realistically, we are turning away people with 3.6 and 3.7 GPAs. And I think that story is playing out on CSU campuses everywhere.”
Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America”[i] in September, 2012. The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with (1) rapidly expanding diagnostic and treatment options and (2) the increasingly complex and chronic clinical condition of patients. Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how “a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations.”
Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands. The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.