DiversityNursing Blog

Report examines RN work environments

Posted by Erica Bettencourt

Wed, May 28, 2014 @ 02:04 PM

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A new "Charting Nursing's Future" brief from the Robert Wood Johnson Foundation details a series of programs designed by and for nurses that have “spurred the creation of work environments that foster healthcare quality and patient safety” 10 years after a landmark Institute of Medicine report.

The November 2003 IOM report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” concluded that “the typical work environment of nurses is characterized by many serious threats to patient safety.” The IOM offered a series of specific recommendations about how hospitals and other institutions needed to change to reduce the number of healthcare errors. Taken together, the recommendations constituted a fundamental transformation of nurses’ work environments.

The IOM report found that hospitals and other healthcare organizations did a poor job of managing the high-risk nature of the healthcare enterprise. Accidents were too common, and management practices did little to create a culture of safety. 

“We’ve made important gains in the past decade, but we have a lot more work to do,” Maryjoan D. Ladden, RN, PhD, FAAN, senior program officer at RWJF, said in a news release. “Some of the changes needed are systemic and will require collaboration among nurses, doctors, educators, policymakers, patients and others. 

“But nurses also have a critical responsibility to transform their individual workplaces, asserting leadership at the unit level and beyond to help identify and solve problems that affect patient safety.”

Among the initiatives highlighted in the brief, “Ten Years After Keeping Patients Safe: Have Nurses’ Work Environments Been Transformed?”:

• Transforming Care at the Bedside. The RWJF-backed TCAB initiative, developed in collaboration with the Institute for Healthcare Improvement, seeks to empower frontline nurses to address quality and safety issues on their units, in contrast with more common, top-down efforts. Evaluations of the program point to fewer injuries from patient falls, lower readmission rates and net financial gains. 

• Quality and Safety Education for Nurses. Also backed by RWJF, QSEN seeks to improve patient safety by helping prepare thousands of nursing school faculty to integrate quality and safety competencies into nursing school curricula at the undergraduate and graduate levels.

• Nurse-patient policies. In some jurisdictions, policymakers have addressed patient safety through nurse staffing policies, focusing both on nurse-patient ratios and on the composition of the nursing workforce. To date, California is the only state to establish a limit on the number of patients a nurse may be assigned to care for in acute care hospitals. Other jurisdictions have policies intended to encourage lower ratios. Research on the impact of such efforts on patient safety has been mixed to date. 

In addition, the IOM’s 2010 “Future of Nursing: Leading Change, Advancing Health” report gave new impetus to efforts to increase the share of nurses with baccalaureate degrees or higher, and various institutions have begun to address that recommendation through hiring requirements, tuition-reimbursement policies and more.

• Disruptive behavior on the job. Professional discourtesy and other disruptive behavior in the workplace is another barrier to patient safety, particularly given the growing importance of teamwork and collaboration. Noting the consequences of poor behavior can be “monumental when patients’ lives are at stake,” the brief highlights programs at Vanderbilt University Medical Center in Nashville, Tenn., and Johns Hopkins Hospital in Baltimore designed to deter such problems. 

A blueprint for change

The CNF brief goes on to cite a series of initiatives by government agencies, professional associations, the public service sector and credentialing organizations, all designed to advance patient safety and transform nurses’ work environments toward that end. It concludes with an “emerging blueprint for change” that urges providers, policymakers, and educators to follow through on: 

• Monitoring nurse staffing and ensuring that all healthcare settings are adequately staffed with appropriately educated, licensed and certified personnel;

• Creating institutional cultures that foster professionalism and curb disruptions;

• Harnessing nurse leadership at all levels of administration and governance; and

• Educating the current and future workforce to work in teams and communicate better across the health professions.

The brief also provides policymakers, healthcare organizations, educators and consumers with a listing of available tools to help in their efforts. 

This issue of “Charting Nursing’s Future” is a publication of RWJF created in collaboration with the George Washington University School of Nursing in Washington, D.C.

RWJF report: http://bit.ly/1kiMsYX

2003 IOM report: www.iom.edu/Reports/2003/Keeping-Patients-Safe-Transforming-the-Work-Environment-of-Nurses.aspx 
Source: Nurse.com

Topics: workplace, RN, nurse, RWJF

IOM, RWJF leaders assess progress since 'Future of Nursing' report

Posted by Alycia Sullivan

Fri, Oct 25, 2013 @ 11:24 AM

Despite “measurable progress” in the three years since the release of the Institute of Medicine’s landmark report on the future of nursing, more work remains “to fully realize the potential of qualified nurses to improve health and provide care to people who need it.”

That assessment is part of a commentary by Harvey V. Fineberg, MD, PhD, president of the IOM, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, on the aftermath of the report.

“The Future of Nursing: Leading Change, Advancing Health” was released Oct. 5, 2010, by the IOM with the support of RWJF. It provided a blueprint for transforming the nursing profession to “respond effectively to rapidly changing healthcare settings and an evolving healthcare system,” according to a report brief.

The key recommendations: allow nurses to practice to the full scope of their education and training, provide opportunities for nurses to serve as healthcare leaders and increase the proportion of nurses with a BSN to 80% by 2020. Following the report, RWJF and AARP formed the Campaign for Action to implement the report’s recommendations at the state level. 

Regarding scope of practice for advanced practice registered nurses, Fineberg and Lavizzo-Mourey wrote that 43 state action coalitions have prioritized initiatives to remove scope-of-practice regulations that prevent APRNs from delivering care to the full extent of their education and training. Iowa, Kentucky, Maryland , Nevada, North Dakota, Oregon and Rhode Island have removed barriers to APRN practice and care, and 15 states introduced bills this year to remove physician supervision requirements that can hinder APRN care.

Regarding education and training, the proportion of employed nurses with a BSN or higher degree was 49% in 2010 and 50% in 2011. “Progress is likely to accelerate in the years to come,” Fineberg and Lavizzo-Mourey wrote, “because between 2011 and 2012 along there was a 22.2% increase in enrollment in RN-to-BSN programs and a 3.5% increase in enrollment in entry-level BSN programs.” The authors also noted a recent increase in the number of students enrolled in nursing doctorate programs. Of the 51 action coalitions, 48 have worked to enable seamless academic progression in nursing.

The authors noted that the influence of the campaign has paid off with a $200 million Medicare initiative to support the training of APRNs at hospital systems in Arizona, Illinois, North Carolina, Pennsylvania and Texas.

Regarding nurse leadership, Fineberg and Lavizzo-Mourey wrote, the “Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.” 

Full commentary: http://bit.ly/176XyZs

Campaign for Action: http://www.rwjf.org/en/topics/rwjf-topic-areas/nursing/action-coalitions.html

“Future of Nursing” report: www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Graduate Nurse Education Demonstration: http://innovation.cms.gov/initiatives/gne/

Source: Nurse.com

Topics: Institute of Medicine, scope of practice, Robert Wood Johnson, Foundation, education, healthcare, nurses, patients, practice, improve, RWJF, IOM

Developing a New Generation of Nurse Scientists, Educators, and Transformational Leaders Is Aim of Future of Nursing Scholars Program

Posted by Alycia Sullivan

Fri, Jun 07, 2013 @ 02:24 PM

The Robert Wood Johnson Foundation (RWJF) announced Monday that it is investing $20 million in the new Future of Nursing Scholars program to support some of the country’s best and brightest nurses as they pursue their PhDs. In its landmark nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates; doing so will support more nurse leaders, promote nurse-led science and discovery, and put more educators in place to prepare the next generation of nurses. The University of Pennsylvania School of Nursing, which hosted today’s event to launch the new program, will serve as the national program office for the Future of Nursing Scholars program.

“Implementing the Institute of Medicine nursing report is a major priority for RWJF, because we cannot achieve our mission to improve health and health care without a robust, well-educated nursing workforce and many more highly educated nurse leaders,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group. “The PhD-prepared nurses the Future of Nursing Scholars program supports will help identify solutions to the country’s most pressing health problems, and educate thousands of nurses over the course of their careers. They will be positioned to lead change and inspire the next generation of nurses.”

Fewer than 3,000 of the nation’s more than 3 million nurses have doctoral degrees in nursing, and many of them have DNPs, not PhDs, which prepare nurses to conduct research and teach. The average age at which nurses get their PhDs in the U.S. is 46—13 years older than PhD earners in other fields.

In 2014, schools of nursing will apply to join the Future of Nursing Scholars program, which will support up to 100 PhD nursing candidates over its first two years. The first scholars will begin their PhD studies in 2015. They will receive scholarships, stipends, mentoring, leadership development, and dedicated post-doctoral research support. To expand the new program’s reach, RWJF has developed a strategic philanthropic collaborative to engage other donors.

“Having supported nursing in our region for 10 years, we are very proud to be the first foundation to join this new collaborative, which is bringing together diverse funders to support the PhD-prepared nurse leaders the country needs,” said Lorina Marshall-Blake, president of the Independence Blue Cross Foundation. “We expect the nurse scholars this program supports to transform health care through innovation in their communities and nationwide.” Marshall-Blake said the Independence Blue Cross Foundation is committing $450,000 over three years to support nurses in becoming transformational leaders in education, research, and policy.

The co-directors for the Future of Nursing Scholars program are Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing and Julie Fairman, PhD, RN, FAAN, the Nightingale professor of nursing and director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing.
Other speakers at the launch were: Afaf I. Meleis, PhD, DrPS (hon), FAAN, the Margaret Bond Simon Dean of Nursing at the University of Pennsylvania School of Nursing; Elizabeth Galik, PhD, CRNP, an assistant professor at the University of Maryland School of Nursing and an RWJF Nurse Faculty Scholar whose research is helping older adults suffering from dementia; Munira Wells, PhD, RN, an RWJF New Jersey Nursing Scholar whose research focus is New Jersey nurses who were born in India and faced culture shock in the United States; and Maryjoan Ladden, PhD, RN, FAAN, senior program officer at RWJF.
 

About the Robert Wood Johnson Foundation 

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter at www.rwjf.org/twitter or Facebook atwww.rwjf.org/facebook.
 

About the Independence Blue Cross Foundation

In October 2011, the Independence Blue Cross Foundation, an independent licensee of the Blue Cross and Blue Shield Association, launched a charitable, private foundation, whose mission is to transform health care through innovation in the communities it serves. The IBC Foundation and Independence Blue Cross, which is celebrating its 75th anniversary this year, are both committed to improving the health and wellness of the people of southeastern Pennsylvania. The foundation targets the following areas of impact:

• Caring for our most vulnerable: Supporting nonprofit community health center clinics that deliver quality, cost-effective primary, medical, and dental care to uninsured and underinsured people.

• Enhancing health care delivery: Strengthening the nursing workforce through education, career development, and research.

• Building healthy communities: Partnering with community leaders and programs to address community health and wellness needs.

Source: Newswise

Topics: nurse, RWJF, Future of Nursing, nursing scholars, The Robert Wood Johnson Foundation, PhD

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