Category Archives: Interdisciplinary Nursing Quality Research Initiative
Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.
Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity. It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery. It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.
A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior? A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals. Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives.
A Brighter Future
What can be done to make these hospitals better? A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research and trends relating to academic progression, leadership and other essential nursing issues. Following are some of the stories in the October issue.
Campaign Helps Advance Institute of Medicine's Call for More Nurse Leaders
On the fourth anniversary of the release of the Institute of Medicine’s (IOM) landmark report on the future of the nursing profession, more nurse leaders are stepping into positions of power and influence—and efforts to prepare even more nurses for leadership are gaining ground. Today, the Future of Nursing: Campaign for Action is putting new emphasis on the report’s leadership recommendation, and nurses and their employers in government and other sectors are responding. The Campaign is a joint initiative of RWJF and AARP.
Nursing Improvements Could Boost Outcomes for 7 Out of 10 Critically Ill Black Babies
A new study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research provides insight into the issue of very low birth weight (VLBW) infants, who are disproportionately black. Researchers found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for VLBW infants born in those facilities.
California has “Well-Educated” Nurse Force, Study Finds
While California has a “well-educated” nurse force, a survey published by the state’s Board of Registered Nursing shows that there is a long way to go toward meeting the goal set forth by the Institute of Medicine’s landmark report on the future of nursing that 80 percent of nurses hold bachelor’s degrees or higher by 2020. About 60 percent of the state’s registered nurses have earned a bachelor’s or graduate degree in nursing or another field, the survey found. Nearly 40 percent of respondents—and nearly 80 percent of those under 35—said they are considering or seriously considering additional education.
Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation (RWJF), was honored by the American Academy of Nursing (AAN) yesterday, receiving the President’s Award from the venerable institution.
The presentation was made by AAN President Diana Mason, PhD, RN, FAAN, at its conference, Transforming Health, Driving Policy Conference. Lavizzo-Mourey, MD, MBA, spoke to the assembled conference participants via video. “At the Robert Wood Johnson Foundation, we like to say that nursing is in our DNA. That’s because we believe to our core that nurses are the glue that holds together our health care system across the entire continuum of an individual’s lifespan ... We envision a future where all Americans realize a new and robust Culture of Health ... We cannot and we will not ever achieve a Culture of Health without the support, help and the leadership of nurses.”
“I am grateful to be honored with this award,” Lavizzo-Mourey continued. “And know that you are all committed to transforming health, leading change, influencing policy, and ultimately improving the nation’s health ... And I am humbled to be in the company of this year’s FAAN inductees and the Living Legend honorees who will be recognized tonight. Congratulations to everyone – and a shout-out to those who are RWJF scholars, fellows and alumni.”
Some 170 people will be inducted as fellows of AAN (FAANs) tomorrow. They include four RWJF Executive Nurse Fellows, eight RWJF Nurse Faculty Scholars, two RWJF Interdisciplinary Nursing Quality Research Initiative investigators, and Mary Dickow, MPA, the statewide director of the California Action Coalition of the Future of Nursing: Campaign for Action.
RWJF Scholars in the News: Autism and birth order, nurse staffing and underweight infants, long-term care insurance, 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:
There is an increased risk of Autism Spectrum Disorders (ASD) among children born less than one year or more than five years after the birth of their next oldest sibling, Forbes reports. The study, led by RWJF Health & Society Scholars program alumna Keely Cheslack-Postava, PhD, MSPH, analyzed the records of 7,371 children born between 1987 and 2005, using data from the Finnish Prenatal Study of Autism. About a third of the children had been diagnosed with ASD by 2007. Researchers found that the risk of ASD for children born less than 12 months after their prior sibling was 50 percent higher than it was for children born two to five years after their prior sibling. “The theory is that the timing between pregnancies changes the prenatal environment for the developing fetus,” Cheslack-Postava said.
The health outcomes and quality of care for underweight black infants could greatly improve with more nurses on staff at hospitals with higher concentrations of black patients, according to a study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The study, led by Eileen Lake, PhD, RN, FAAN, found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for very low birthweight babies born in those facilities, reports Health Canal. More information is available on the INQRI Blog. The study was covered by Advance Healthcare Network for Nurses, among other outlets.
Because of a “medical-industrial complex” that provides financial incentives to overuse and fragment health care, patients nearing the end of their lives need an advocate to fight for their interests, Joan Teno, MD, MS, writes in an opinion piece for the New York Times. Teno encourages readers to “find a family member or friend who can advocate for the health care that you want and need. Find someone to ask the hard questions: What is your prognosis? What are the benefits and risks of treatments? Find someone not afraid of white coats.” Teno is an RWJF Investigator Award in Health Policy Research recipient.
Physicians who have both doctor of medicine (MD) and master of business administration (MBA) degrees reported that their dual training had a positive professional impact, according to a study published online by Academic Medicine. The study, one of the first to assess MD/MBA graduates’ perceptions of how their training has affected their careers, focused on physician graduates from the MBA program in health care management at the University of Pennsylvania.
The MD was more often cited as conveying professional credibility, while 40 to 50 percent of respondents said the MBA conveyed leadership, management, and business skills. Respondents also cited multidisciplinary experience and improved communication between the medical and business worlds as benefits of the two degrees.
“Our findings may have significant implications for current and future physician-managers as the landscape of health care continues to change,” lead author Mitesh S. Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, said in a news release. “A study published in 2009 found that among 6,500 hospitals in the United States, only 235 were run by physicians. Moving forward, changing dynamics triggered by national health care reform will likely require leaders to have a better balance between clinical care and business savvy. Graduates with MD and MBA training could potentially fill this growing need within the sector.”
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends related to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the June 2014 issue.
Campaign for Action Is Chalking Up Successes that Will Improve Patient Care
Three years after it launched, the Future of Nursing: Campaign for Action is making steady progress on nurse education, practice, interprofessional collaboration, data collection, and diversity, according to a series of indicators released last month. Led by RWJF and AARP, the Campaign has created Action Coalitions in all 50 states and the District of Columbia that are working to implement recommendations from the Institute of Medicine. “Because of the Campaign, there’s more awareness about the importance of preparing the nursing workforce to address our nation’s most pressing health care challenges: access, quality, and cost,” says RWJF Senior Program Officer Nancy Fishman, MPH.
Pioneering Nurse Scientist Addresses Asthma-Related Disparities
Kamal Eldeirawi, PhD, RN, a pioneering scientist with expertise in immigrant health, was born in the Gaza Strip in Palestine, where he saw the profound impact of poverty and disadvantage on health in his own community. A career in nursing, the RWJF Nurse Faculty Scholar believed, would allow him to make a difference at both the individual and population-wide levels. Today, Eldeirawi, is researching risk factors that contribute to asthma in Mexican American children living in the United States, and the effects of immigration and acculturation on children’s health.
The largest study to examine the relationship between nurse staffing and patient care reveals that patients get the best care when they are treated in hospital units staffed by teams of nurses who have extensive experience in their current jobs. The study, conducted by an interdisciplinary team including Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at the Columbia University School of Nursing and Ciaran Phibbs, PhD, research economist at the Health Economics Resource Center at the Palo Alto Veterans Administration Health Care System, was funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI).
The research team reviewed more than 900,000 patient admissions over four years (from 2003 through 2006) at hospitals in the Veterans Administration Health Care System. They analyzed nurses’ payroll records and patients’ medical records to see how nurse staffing affected patients’ length of stay. Longer hospital stays tend to be associated with delays and errors in care delivery, so shorter stays indicate better care. Shorter stays also reduce the cost of care.
Researchers found that a one-year increase in the average tenure of registered nurses (RNs) on a hospital unit was associated with a 1.3 percent decrease in the average length of stay.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the April issue.
Consumers Benefit from Expanded APRN Practice, FTC Says
In March, the Federal Trade Commission (FTC)—the government agency that works to protect consumers and prevent anti-competitive business practices—released Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses. It warns that barriers to advanced practice registered nurse (APRN) practice could reduce the kind of free-market competition in the health care industry that benefits consumers. The report also says APRNs play a “critical role” in alleviating shortages of primary care providers.
Building a Community of Nurse Scientists
Ann Cashion, PhD, RN, FAAN, has been hooked on the promise and potential of genetics and genomics in nursing since the first survey of the human genome was completed in 2000. She participated in the inaugural cohort of the Summer Genetics Institute at the National Institute of Nursing Research (NINR), and it changed the trajectory of her career. Now, 14 years later, Cashion is NINR’s newly appointed scientific director. She is also an alumna of the RWJF Executive Nurse Fellows program.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
Comparing Nurse and Physician Performance on Colonoscopies
A new study finds that colonoscopies performed by nurse and physician endoscopy trainees are comparable in terms of quality and safety.
Researchers in The Netherlands studied 15 endoscopy trainees—seven nurses and eight physicians—at two medical centers over the course of three-and-a-half years. At the beginning of the study, none had experience in endoscopy. All were trained according to the applicable regulations of the Dutch Society of Gastroenterology, performing a minimum of 100 colonoscopies. After completing their training, each performed 135 consecutive colonoscopies under the supervision of a gastroenterologist, with their work evaluated for safety and quality.
The nurse group and the physician group had comparable results on both measures, with the nurse group producing marginally better scores in some areas. Each group detected the same percentage of adenomas (benign polyps), and had the same low rate of complications. The nurses had slightly higher rates of cecal intubation (successfully passing the colonoscope to a key part of the colon), and slightly higher rates of completing the procedure without assistance.
RWJF Scholars in the News: Nurse staffing and patient mortality, communicating about vaccines, specialized HIV training for NPs, 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 study led by Linda H. Aiken, PhD, FAAN, FRCN, RN, and covered by CNN.com, finds that hospital nurse-patient ratios and the share of nurses with bachelor’s degrees both have an important impact on patient mortality. Aiken, a research manager supporting the Future of Nursing: Campaign for Action and a member of the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) National Advisory Committee, found that increasing a hospital nurse’s workload by one patient increased by 7 percent the likelihood of an inpatient death within 30 days of admission. The same research revealed that a 10-percent increase in the number of nurses with bachelor’s degrees at a given hospital reduces the likelihood of a patient death by 7 percent. Aiken’s study has also been covered by the Guardian, Philly.com, and FierceHealthcare, among other outlets.
Public health messages aimed at boosting childhood vaccination rates may be backfiring, according to a new study led by RWJF Scholars in Health Policy Research alumnus Brendan Nyhan, PhD. Campaigns that use studies, facts, and images of ill children increased fears about vaccine side-effects among some parents, NBC News reports. In fact, messaging that debunked myths about links between vaccines and autism actually made parents less inclined to have their children inoculated. Time magazine online also covered the study.
The Johns Hopkins University School of Nursing has developed a new curriculum that provides specialized HIV training to nurse practitioners, with funding from the Health Resources and Services Administration, Medical Xpress reports. “The design of our program starts with the recognition that HIV care cannot be provided in a silo, that it needs to be integrated holistically into primary care," RWJF Nurse Faculty Scholar Jason Farley, PhD, MPH, said in a statement. Farley is the developer of the curriculum.