By MATTHEW FAHR
Barber chairs moved like turnstiles as people from all around the area came to the Romeo Lions Field House to show their support for those fighting cancer.
Volunteer event organizer Michael Fiscus said the Romeo event broke its own record, and is currently ranked fifth nationally for funds raised during the St. Baldrick’s Foundation event.
“It was more crowded than it has been since we began in Romeo,” said Fiscus. “We had wall-to-wall people from 1:30 to 4 p.m.”
In a show of support for children who are enduring the struggle of dealing with cancer and its body-ravaging effects, St. Baldrick’s asks people to show their solidarity with those young souls by shaving their heads.
They came out in force to Romeo with the event currently tallying $317,000 raised to date.
Fiscus said he expects that number to rise as people donate after the fact, pledging donations to those who took part in the event.
Last year, the event raised $302,000, with another $30,000 being donated in the days and weeks afterward.
“In the next few weeks we will be collecting cash that was donated and collecting sponsor matching funds, as well as new donations after people see what their friends and family did for St. Baldrick’s,” Fiscus said.
When the event began six years ago, 18 people shaved their heads and Fiscus raised just more than $14,000 to donate to the foundation, which is dedicated to raising money for life-saving childhood cancer research, and it funds more in childhood cancer grants than any organization except for the U.S. government.
Last year, 525 people shaved their heads.
Fiscus said this year more than 500 people sat down in barber chairs to change their image by shaving their heads, but he said donations went up even with the dip in “shavees,” as he calls them.
He said 16 people were also “knighted” for being involved for seven consecutive years.
“The number of folks returning was high this year,” said Fiscus. “The word is out there, and those who started with us and helped bring in others are back themselves for a good cause.”
With 25 barber chairs and an average of 10 minutes per haircut -- which may have felt like a lifetime for some first-timers -- the Lions Field House did steady business through the day and brought people into downtown Romeo at night as haircuts were done upstairs at Younger’s Tavern until well into the night.
“I think by the time I packed up and was heading out of town, it must have been 11:30 p.m.” Fiscus said. “A lot of people had a good time.”
Fiscus took time out of his chaotic day to look around at those making such a sacrifice for a loved one or friend.
“It can be so moving to see someone commit to something like that,” he said. “You can tell who the people are who are doing this for the first time and the look on their face, but afterward they are proud of what they did.”
He said 90 percent of donations this year for the Romeo event were done online, and donations will continue to be taken all year online at www.stbaldricks.org/events/romeo/
Romeo currently ranks fifth nationwide in event donations, a goal Fiscus was aiming for at the start of this year.
“That is the achievement I am most proud of,” he said. “We are still in fifth today and I don’t know how long we will be there, but being there right now is such an honor.”
Historically, both men and women have filled the challenging and rewarding role of a nurse. It wasn’t until the Civil War, when nearly 3 million men filled the ranks of two competing American armed forces, that women began to dominate the field.
Today, over 43 million Americans are aged 65 or older – a number that is expected to double over the next 35 years. A larger elderly population means a greater need for long-term health services, and as a result, the healthcare field is one of the fastest-growing industries.
Why does this matter?
1. The U.S. is already on the verge of a nursing shortage.
The American Association of Colleges of Nursing reports that the U.S. is experiencing a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.
Did you know only 7 percent of nurses are currently men? According to the latest National Sample Survey of Registered Nurses conducted by the Health Resources and Services Administration, the percentage of male nurses has more than doubled in the past three decades, but still lingers at 7% today. This number is expected to triple within the next few decades as the need for both male and female healthcare professionals continues to grow.
2. A diverse population needs a diverse nursing staff.
According to the American Association of Colleges of Nursing (AACN), men are enrolling in nursing programs at a higher rate compared to the past. The IOM report states that there still need to be an emphasis on gender diversification and inclusion in the workforce.
The IOM Report also states that the nursing profession “needs to continue efforts to recruit men; their unique perspectives and skills are important to the profession and will help contribute additional diversity in the workforce.” The increase in men pursuing a nursing career will help create a more diverse healthcare environment.
3. Discrimination issues must be overcome.
The idea that men cannot be nurses will never be eradicated until men take to the profession in greater numbers. While nursing is seen as a nontraditional career for men today, the stereotype must change -- nursing is simply too important of a job, and too attractive of a career.
“There are just far too many benefits that come along with nursing, such as a flexible schedule, a secure position, and high pay,” notes the website NursingWithoutBorders.org, “and so it’s therefore difficult for anyone to refuse to pursue a field that only continues to grow.”
The impact of a mother's smoking can be seen on the face of her unborn baby, new research suggests.
Scientists at Durham and Lancaster Universities in England performed high-definition 4-D ultrasound scans on fetuses between 24 weeks and 36 weeks gestation and spotted distinctive differences in those whose mothers smoked. They say their findings add to the evidence that smoking may harm a developing fetus.
"Technology means we can now see what was previously hidden, revealing how smoking affects the development of the fetus in ways we did not realize," co-author Brian Francis, a professor at Lancaster University, said in a press statement.
The study, published in the journal Acta Paediatrica, involved 20 pregnant women; four were smokers who averaged about 14 cigarettes a day, and 16 were non-smokers. Each woman underwent four ultrasound scans over a three-month period.
The researchers say the fetuses whose mothers smoked showed a much higher rate of mouth movements, suggesting that their central nervous systems, which control such movement, did not develop at the same rate and in the same manner as the fetuses of non-smokers.
"Fetal facial movement patterns differ significantly between fetuses of mothers who smoked compared to those of mothers who didn't smoke," said lead author Dr Nadja Reissland, of Durham University's Department of Psychology.
"Our findings concur with others that stress and depression have a significant impact on fetal movements, and need to be controlled for, but additionally these results point to the fact that nicotine exposure per se has an effect on fetal development over and above the effects of stress and depression."
All of the babies involved in the study were born healthy. The Centers for Disease Control and Prevention warns that smoking during pregnancy increases the risk of preterm delivery and low birthweight, which can lead to a range of health problems.
Previous studies have found that infants exposed to smoking in utero have delayed speech processing abilities, and the researchers say the ultrasound scans may shed light on that aspect of development.
"This is yet further evidence of the negative effects of smoking in pregnancy," Francis said.
The researchers say more studies are needed, including a look at the impact fathers' smoking may have on their unborn children.
© 2015 CBS Interactive Inc. All Rights Reserved.
Written by David McNamee
Male registered nurses are earning more than female registered nurses across settings, specialties and positions, and this pay gap has not narrowed over time, says a new analysis of salary trends published in JAMA.
Although the salary gap between men and women has narrowed in many occupations since the introduction of the Equal Pay Act 50 years ago, say the study authors, pay inequality persists in medicine and nursing.
Previous studies have found that male registered nurses (RNs) have higher salaries than female registered RNs. In their new study, researchers from the University of California, San Francisco, sought to investigate what employment factors could explain these salary differences using recent data.
The researchers analyzed nationally representative data from the last six quadrennial National Sample Survey of Registered Nurses studies (1988-2008; including 87,903 RNs) and data from the American Community Survey (2001-13; including 205,825 RNs). In both studies, the proportion of men in the sample was 7%.
During every year, both of the studies demonstrated that salaries for male RNs were higher than the salaries of female RNs. What is more, the researchers found no significant changes in this pay gap - which averaged as an overall adjusted earnings difference of $5,148 - over the study period.
In ambulatory care the salary gap was $7,678 and in hospital settings it was $3,873. The smallest pay gap was found in chronic care ($3,792) and the largest was in cardiology ($6,034). The only specialty in which no significant pay gap between men and women RNs was detected was orthopedics. The salary difference was also found to extend across the range of positions, including roles such as middle management and nurse anesthetists.
Employers and physicians 'need to examine pay structures'
"The roles of RNs are expanding with implementation of the Affordable Care Act and emphasis on team-based care delivery," the authors write.
"A salary gap by gender is especially important in nursing because this profession is the largest in health care and is predominantly female, affecting approximately 2.5 million women. These results may motivate nurse employers, including physicians, to examine their pay structures and act to eliminate inequities."
The results of a 2010 survey looking at the impact of the economic crisis on nursing salaries published in Nursing Management found that a nurse leader's average salary fell by $4,000 between 2007 and 2010. In the same survey, almost 60% of nurse leaders felt that they were not receiving appropriate compensation for their level of organizational responsibility.
However, that survey found no evidence that workload for nurse leaders had increased. The respondents reported that they were still working the same number of hours per week as they had traditionally and were not responsible for more staff members than before the economic crisis.
"If you thought nursing was immune to the downturn, think again. The poor economy is keeping us working longer than we'd anticipated," said Nursing Management editor-in-chief Richard Hader, "and in addition to wage cuts, organizations are freezing or eliminating retirement benefits, further negatively impacting employee morale."
In a Johns Hopkins Outpatient Center exam room, medical interpreter Julie Barshinger is working with a Spanish patient, a woman in her early 40s with a stocky build and a dark ponytail, who is concerned about complications related to her recent nose surgery.
But first, the woman must complete a medical history form. “¿Qué significa vertigo?” (“What is vertigo?”) she asks, as Barshinger goes through the list of symptoms on the form, verbally interpreting them from English to Spanish. Then later, “No sé qué es un soplo cardiac … ” Barshinger interprets the question — “I don’t know what a heart murmur is” — for the nurse who is preparing a nasal spray for the patient that will allow the doctor to look inside her nose.
“If it doesn’t apply to her, don’t answer it,” the nurse says kindly.
“I just want you to know that I have to interpret everything she says,” explains Barshinger, who is one of 18 full-time interpreters in Johns Hopkins Medicine International’s Language Access Services office. Part of Barshinger’s job is educating providers about her role.
Later, the nurse starts to leave the room to see another patient before the woman has completed her medical history form. “I can’t continue if you’re not in the room with me,” Barshinger says. The patient is consistently giving additional information about her symptoms: She doesn’t see well since her operation; she has some nasal bleeding; she sees the room spinning when she lies down. It’s crucial for Barshinger to communicate these potentially important details to the nurse, who stays in the room, answering questions when needed, until the form is complete.
Throughout the interaction, Barshinger knows little about the full scope of the patient’s health history. But she doesn’t need to know. “I’m not in charge of her care,” she says. “I’m only her voice. I want to make sure her voice is being heard by the right people. I’m also the voice of the provider, so she can communicate the very necessary and important information that she has to the patient.”
While Johns Hopkins, like other hospitals that receive federal funding, has been providing interpretation services for 50 years — since passage of the Civil Rights Act of 1964, which prohibits discrimination based on national origin — requests for interpreters at The Johns Hopkins Hospital have grown dramatically since 2010, jumping from 23,000 to more than 50,000 annually.
This is due in part to the slightly rising limited English proficiency population in Baltimore City, which grew by about 4,000 people between 2000 and 2012, according to the U.S. Census. Today, the hospital also serves more refugees, about 2,500 of whom settled in Baltimore City between 2008 and 2012.
But Susana Velarde, administrator for Language Access Services at Johns Hopkins Medicine International, says the increase in requests is also due to the growing understanding among health care providers that they can do a better job treating their patients with limited English proficiency with the help of interpreters.
Because they prevent communication errors, certified interpreters improve patient safety. A 2012 study in the Journal of General Internal Medicine found that patients with limited English proficiency who did not have access to interpreters during admission and discharge had to stay in the hospital between 0.75 and 1.47 days longer than patients who had an interpreter on both days. Moreover, when the interpreter has 100 hours of medical interpretation training — a qualification that researchers have found is more important than years of experience — they made two-thirds fewer errors than their counterparts with less training, according to a 2012 Annals of Emergency Medicine study.
The Language Access Services office’s full-time interpreters—who speak Spanish, Chinese-Mandarin, Korean, Russian, Arabic and Nepali — participate in an extensive two-year training program, which includes classes, tests and shadowing. Fifty percent of the team is certified; the rest are working toward certification, if available in their language. The office also has 45 medical interpreter floaters, and interpretation services are available 24/7 in person, over the phone or through a video monitor for patients with limited English proficiency who live in the Baltimore area and international residents who come to Johns Hopkins for treatment.
“We are the conduit, but also the clarifier,” says Spanish interpreter Rosa Ryan. “We are not simply repeating words but making sure the message is understood.”
For example, at the end of her visit on the otolaryngology floor, Barshinger walks to the front desk with the ponytailed Spanish woman to help her make a follow-up appointment. With Barshinger interpreting, the woman learns that she must get a Letter of Medical Necessity from her current insurer or change insurance companies before coming back to Johns Hopkins. When the administrator walks away, Barshinger checks in with the woman to make sure she understands the instructions.
“The patient might nod, but the information might not be registering,’” she says. “I try to check for clarification if I sense there is a disconnect.”
Interpreters are also cultural brokers. Yinghong Huang, a Chinese-Mandarin interpreter, remembers when a nurse in labor and delivery tried to give a Chinese patient a cup of ice water. “In China, for a woman who has just delivered a baby, we don’t want her to touch anything cold, let alone ice,” Huang explains. This is one of the many rules that Chinese women abide by for a month to help the body recover from childbirth. With Huang present, providers knew to give the patient hot water with her medicine instead.
Despite the increasing demand for interpreters, their expertise too often goes untapped, says Lisa DeCamp, assistant professor of pediatrics at the school of medicine. She is the lead author of a 2013 Pediatrics study that found that 57 percent of pediatricians who completed national surveys in 2010 still reported using family members as interpreters.
This is a bad practice for many reasons, she says. For one thing, family members often don’t have specialized knowledge of medical terminology. Moreover, both patients and family members may censor information. “If you’re talking about something that is intimate or personal and your son is translating for you, you might not want to disclose something about your sexual activity, your drug use or anything else sensitive that could be contributing to your problem,” says DeCamp, who is also a pediatrician at Johns Hopkins Bayview Medical Center.
Even physicians with basic skills in a particular language should use an interpreter to prevent misunderstandings. “I [know] some high school Spanish, but I’m nowhere near fluent, so I need an interpreter,” says Cynthia Argani, director of labor and delivery at Hopkins Bayview, where about 70 percent of her department’s patient population speaks Spanish. “It’s not fair to the patient not to use one. The message can get skewed.”
DeCamp, who has passed a test certifying her as a bilingual physician, offers a real-life example from the literature that shows how this can happen. A pediatrician with limited Spanish language skills instructed parents to use an antibiotic to treat their child’s ear infection. In Spanish, “if you use the preposition, it really means, ‘put in the ear,’” she says. “So the family was putting the specified amount of amoxicillin that should be taken by mouth in the ear. That child is not going to die from an ear infection, but he’s having pain and a fever, and the family doesn’t have clear instructions on how to provide medication.”
On Barshinger’s rounds, after her otolaryngology visit, she walks at an impressively fast pace to The Charlotte R. Bloomberg Children’s Center, where a mother recognizes her and asks her to be her interpreter. The provider who requested Barshinger’s services is not ready yet, so she has time to help.
A doctor carrying a sheaf of papers joins them in a busy hallway. She points to a long list of care instructions translated into Spanish, then begins to explain them to the mother. Because the doctor is verbally giving the instructions, Barshinger interprets. The mother needs to buy an extra-strength, over-the-counter medication and give her daughter a second medication three times a day, which she will need to “swish and spit,” the doctor says. A third medication will be applied to the daughter’s face two times a day, and a special shampoo is needed to wash her hair. Before an upcoming dentist appointment, she’ll also need to give her daughter three amoxicillin. When the doctor steps away, the mother asks Barshinger a question about her daughter’s dental visit, which Barshinger interprets when the doctor returns.
While interpreting, Barshinger stands to the side of the patient’s mother, allowing the doctor and the mother to face each other and communicate directly with one another. This simple tactic encourages providers to develop a rapport with their patients with limited English proficiency.
The goal? “To make the patient feel like the appointment is with him and not with the interpreter,” says Velarde. “The interpreter is just the voice. We want providers to have a bond with their patients, like they do when everyone is speaking English.”
Tapping the expertise of interpreters doesn’t have to complicate things for physicians, says Lisa DeCamp, a bilingual physician at Johns Hopkins Bayview Medical Center. Her advice for colleagues:
Educate the interpreter about what you’re doing so they’re not going in blind. Say a patient has severe abdominal pain. Providers can quickly explain to the interpreter that the first job is to rule out appendicitis.
Sit across from the patient, with the interpreter standing at the patient’s side, and talk directly to the patient. The goal is for the provider and the patient to feel like they have a relationship with each other despite language barriers. When possible, use short phrases to help the interpreter keep up with the conversation.
Found In Translation
Arabic translator Lina Zibdeh remembers the first time she saw the recommendation in a patient education document that leftover medications should be discarded in used cat litter or coffee grounds.
There isn’t a direct translation for this concept in Arabic, a language that is spoken in different dialects by 22 countries but written in one common form. “It can take hours and extensive research to make sure a concept like this is translated correctly,” says Zibdeh, who translates written materials, such as informed consent forms, welcome packets, care instructions, brochures, video scripts and more. In this case, Zibdeh had to add an additional sentence to explain that medications should be disposed of in this way so they are not enticing to children and pets.
While translation programs like Google Translate are readily available and easy to use, they often produce inaccurate translations, which can confuse patients and lead to poor health outcomes. This is because words in sentences can be organized in different ways from one language to another. Thus, when online programs translate those sentences from, say, English to Chinese, they can change the meaning, says Chinese-Mandarin interpreter and translator Yinghong Huang. Some English words, such as discharge, also have multiple meanings. “It’s very rare for a program to get the right meaning,” Huang says. Even Huang has to use tools, such as her cellphone and an online dictionary, to produce accurate translations.
Along with improving health outcomes, documents that are available in a patient’s own language can make him or her feel more comfortable and secure, says Zibdeh, who organized the American Translators Association’s first webinar for the Arabic Division on Arabic Medical Translation in early 2014. “It helps that patient feel closer to home,” she adds.
A Dutch organization called "Ambulance Wens" (Ambulance Wish) fulfills the last wishes of terminally ill patients free of charge thanks to its 200 medical volunteers.
The company says, "There are still too many patients who die without getting to close everything. One of those reasons is the inability to achieve certain desires because the patient is no longer mobile and other existing facilities are inadequate for this purpose."
Special ambulances and stretchers help transport the patients safely and comfortably. Typical excursions include a visit to the beach, a visit to a neighbor who is also no longer mobile, and various places where the patient has special memories.
This woman's final wish was to visit the Rijksmuseum in Amsterdam.
Another woman enjoys the view from her favorite vacation destination in Tuscany.
This gentleman asked for one last view from the Euromast observation tower.
And this man asked to see the mills in Kinderdijk one last time.
Amsterdam is not the only place doing such wonderful things. A hospice outside Seattle made an old forest ranger's dying wish come true.
"Ed expressed one last hope to the hospice chaplain: He wanted to commune with nature one more time."
As the hospice wrote on its Facebook page, "People sometimes think that working in hospice care is depressing. This story ... demonstrates the depths of the rewards that caring for the dying can bring."
Catharine Paddock PhD
Drug development is a costly and lengthy business, not helped by the fact there is a high failure rate in drug testing due to the reliance on animal models. Animal biology is not an ideal substitute for human biology, but until something better comes along, it is all we have. Now, a new study suggests the organ-on-a-chip method may offer a more ideal model.
Study leader Kevin Healy, a bioengineering professor at the University of California-Berkeley, says:
"It takes about $5 billion on average to develop a drug, and 60% of that figure comes from upfront costs in the research and development phase. Using a well-designed model of a human organ could significantly cut the cost and time of bringing a new drug to market."
As around one third of the candidate drugs that are ditched are those that seem to have a bad effect on the heart, Prof. Healy and colleagues decided to design a model based on the human heart.
They conclude that their work is a major step forward in the development of faster, more accurate ways of testing drug safety. Prof. Healy believes that:
"Ultimately, these chips could replace the use of animals to screen drugs for safety and efficacy."
In their study, they describe how they devised the model and tested it with cardiovascular medications.
'Heart-on-a-chip' contains a network of pulsating cardiac muscle cells
The human heart model that Prof. Healy and colleagues devised is a "heart-on-a-chip" comprising an inch-long silicone device with a thin network of pulsating cardiac muscle cells.
In the journal Scientific Reports, the team says their heart-on-a-chip - which they call a "cardiac microphysiological system (MPS)" - is an ideal tool for testing toxic side effects of new drugs on the human heart because it ticks four important boxes:
- It uses cells that have human genes
- The cells are aligned in a way that reflects the structure of human heart tissue
- It mimics the dynamics of blood flow in heart tissue
- It can be used for biological, electrophysiological and physiological analysis.
The authors note that using animal models to predict human reactions to drugs often fail because of fundamental differences in biology between species. For example, the ion channels that conduct the electrical pulses that heart cells send out can vary in number and type between animals and humans.
"Many cardiovascular drugs target those channels, so these differences often result in inefficient and costly experiments that do not provide accurate answers about the toxicity of a drug in humans," Prof. Healy explains.
Device is populated with heart cells made from human-induced pluripotent stem cells
The heart-on-a-chip is made of heart cells generated from human-induced pluripotent stem cells - the adult stem cells that can be coaxed to differentiate into various types of tissue.
The heart-on-a-chip has a 3D geometry and spacing that is comparable to that of connective tissue fiber in a human heart. The researchers then populated this with layers of differentiated heart cells, which in the confined geometry were forced to align in one direction.
Microfluidic channels on either side of the cell-populated area perform like blood vessels and mimic the same dynamics of nutrients and drugs diffusing from blood vessels into human tissue.
Such a setup could also serve as a model of how the cells get rid of their waste products, note the authors.
Lead author Dr. Anurag Mathur, a postdoctoral scholar in Healy's lab and a fellow of the California Institute for Regenerative Medicine, explains:
"This system is not a simple cell culture where tissue is being bathed in a static bath of liquid. We designed this system so that it is dynamic; it replicates how tissue in our bodies actually gets exposed to nutrients and drugs."
Heart-on-a-chip tested with four drugs and reacted as expected
The authors explain how within 24 hours of populating the device with heart cells, the engineered heart tissue was beating on its own at the normal rate of 55-80 beats per minute.
The team tested four well-known cardiovascular drugs on the device: isoproterenol, E-4031, verapamil and metoprolol. They used changes in the pulse rate of the tissue to measure the response to the drugs.
The changes in pulse rate were as expected for the drugs. For example, after half an hour of being exposed to isoproterenol - a drug used to treat slow heart rate, or bradycardia - the pulse rate of the heart-on-a-chip increased from 55 to 124 beats per minute.
Multi-organ testing devices could have hundreds of microphysiological cell systems
The engineered tissue remained viable and worked for several weeks. Such a timescale is sufficient for testing several different drugs, Prof. Healy says.
He and his colleagues are now investigating whether the method can be used to model multi-organ interactions. Prof. Healy notes:
"Linking heart and liver tissue would allow us to determine whether a drug that initially works fine in the heart might later be metabolized by the liver in a way that would be toxic."
The team anticipates the "widespread adoption" of organ-on-a-chip for drug screening and disease modeling and foresee devices containing hundreds of microphysiological cell systems.
The project is funded through the Tissue Chip for Drug Screening Initiative, which is sponsored by the National Institutes of Health.
In October 2014, Medical News Today learned how the University of Kansas is leading the development of a lab-on-a-chip that promises to detect lung cancer - and possibly other deadly cancers - much earlier. That method, which only uses a small drop of a patient's blood, is also based on microfluid technology. It analyzes the contents of exosomes - tiny bags of molecules that cells release now and again.
By Heather Stringer for Nurse.com
In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” and statistics at halftime offer a glimpse into nursing’s progress so far.
Although the numbers in some areas have altered little in the first few years, infrastructure changes have been set in motion that will lead to more noticeable improvements in the data in the next several years, said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. The RWJF partnered with the IOM to produce the report.
“I am a very impatient person and would like things to move faster, but we have to remember that we are changing social norms with these goals,” Hassmiller said. “We are trying, for example, to convince hospital leaders, nursing students and educational institutions that it is important for nurses to have a baccalaureate degree, and that takes time.”
Hassmiller is referring to Recommendation 4 of the report, which calls academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The most recent data collected from the American Community Survey by the Future of Nursing: Campaign for Action found that the percentage of employed nurses with a bachelor’s degree or higher only climbed 2% between 2010 and 2013. However, Hassmiller suggested the percentage is likely to increase rapidly in coming years because nursing schools have increased capacity to accommodate more students. As a result, the number of nurses enrolled in RN-to-BSN programs skyrocketed between 2010 and 2014, from about 77,000 nurses in 2010 to 130,300 students in 2014, according to the American Association of Colleges of Nursing — a 69% increase.
Campaign for Action leaders also are optimistic about the profession’s ability to approach the 80% goal because nursing schools are beginning to experiment with new models of education, such as bringing BSN programs to community colleges.
Traditionally, students spend at least three years in a community college earning an associate’s degree to become an RN — at least a year for prerequisites and another two to complete the nursing program, Hassmiller said. These RNs may work for a few years before returning to school to earn a BSN — and some may not return at all, said Jenny Landen, MSN, RN, FNP-BC, dean of the School of Health, Math and Sciences at Santa Fe Community College in New Mexico. To avoid losing potential BSN students, leaders from New Mexico’s university and community colleges began meeting to discuss a new paradigm: students who were dually enrolled in a community college and a university BSN program.
The educators started by forming a common statewide baccalaureate curriculum that would be used by all community colleges and universities, Landen said. The educators also discussed how to pool resources, such as offering university courses online at local community colleges. “This opens the opportunity of earning a BSN to people who need to stay in their communities during school,” she said. “They may have family commitments locally, and they can take the baccalaureate degree courses at the community college tuition fee, which is much less expensive.”
Four community colleges in New Mexico have launched dual enrollment programs within the last year. At Santa Fe Community College, there are far more applicants than the program can hold, Landen said. Community colleges and universities in other parts of the country also are working together to create programs in which nursing students can be dually enrolled. In addition to nursing schools buying into the need for more BSN-prepared nurses, there also is evidence that employers are moving toward this new standard as well. According to a study released in February in the Journal of Nursing Administration, the percentage of institutions requiring a BSN when hiring new RNs jumped from 9% to 19% between 2011 and 2013.
So far, the national data related to Recommendation 5 — double the number of nurses with a doctorate by 2020 — suggests there have been minimal changes in the number of employed nurses with a doctorate, yet there has been a significant increase in the number of students pursuing this level of education. According to the JONA article, on average about 3.1% of employed nurses in all institutions had a doctorate in 2011. This rose to 3.6% in 2013. This percentage likely will increase in the coming years because of the proliferation of doctor of nursing practice programs since 2010. These programs are geared for advanced practice RNs who are interested in returning to the clinical setting after earning a doctoral degree. Between 2010 and 2013, the number of students enrolled in DNP programs doubled from just over 7,000 students to more than 14,600. There was a lesser increase in the number of students enrolled in PhD programs, up 12% from 4,600 to 5,100, according to the AACN.
“When the DNP degree became an option, it opened the opportunity of a higher level of education to the working nurse, not the researcher, and that was attractive to many nurses,” said Pat Polansky, MS, RN, director of program development and implementation at the Center to Champion Nursing in America. “Getting a research-based PhD takes longer and not every nurse can do that, so the DNP has become a wonderful option.”
Leaders at the Campaign for Action, however, acknowledge that it is important to find strategies to boost the number of PhD-prepared nurses because the profession needs those nurses in academia and other administrative, research or entrepreneurial roles where they are contributing to the solutions of a transformed healthcare system, Hassmiller said. To encourage more nurses to pursue the path of a PhD, in 2014 the RWJF launched the Future of Nursing Scholars Program, which awards $75,000 per scholar pursuing a PhD. This is matched with $50,000 by the student’s school, and the funds can be used over the course of three years.
In December, the nursing profession will have another opportunity to assess progress on the recommendations when the IOM releases findings from a study that is under way to assess the national impact of the Future of Nursing report. The changes happening in areas such as education are remarkable, Hassmiller said, and she is eagerly anticipating the results from the current IOM study.
“I would never modify the goals because you need something to strive for in order to affect change,” Hassmiller said. “I am extremely encouraged because we have never seen anything like this. For the first time in history, more than half of nurses have a bachelor’s degree, and it is going to keep climbing. The most challenging part has been the number of people that need to be influenced to make the business case as to why it is important, and it is finally happening.”
1) Remove scope-of-practice barriers.
2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
3) Implement nurse residency programs.
4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
5) Double the number of nurses with a doctorate by 2020.
6) Ensure that nurses engage in lifelong learning.
7) Prepare and enable nurses to lead change to advance health.
8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.
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Red toy wagons, used to help caretakers to transport ill children to and from treatments and appointments, are a staple in the hallways of Children's Healthcare of Atlanta. The pediatric patients' IV poles have always had to be pulled awkwardly behind the wagons — until a grandfather and his son decided that needed to change.
Roger Leggett's granddaughter, Felicity, was diagnosed with a brain tumor at the age of 4 in 2011. While visiting the young girl during her treatment at Children's Healthcare of Atlanta (CHOA), Leggett and his son, Chad, saw a mother pulling her child in a wagon, struggling to also drag his IV behind. "Chad looked at me and said: 'There's gotta be a better way to do that,'" Leggett told NBC affiliate WXIA.
Chad tragically died of heat stroke just a few weeks later, but Leggett remembered that moment, which inspired him to create the not-for-profit, Chad's Bracket, which is dedicated to connecting IV poles to patients' red wagons, according to the organization's Facebook page. With help from students at Chattahoochee Technical College, Leggett has affixed IV poles to more than 100 wagons at CHOA, and is hoping to fill requests from hospitals around the country, according to WXIA. His workshop is currently based in the bed of his late son's pickup truck.
Felicity received news recently that she is in remission, and Leggett is humbled by the support his efforts have garnered. "I don't feel I deserve the praise. I'm just trying to make the time a child and parents spend at CHOA easier and safer," Leggett said.