DiversityNursing Blog

After much anticipation across the nation, President Obama signed the 2013 National Defense Authorization Act (NDAA) into law. In the end, it included 19 amendments to significantly reform Department of Defense sexual assault and sexual harassment policies. This landmark bill has the largest number of sexual violence provisions ever signed into law, and represents the culmination of more than 18 months worth of relentless advocacy work by the Service Women’s Action Network (SWAN). We want to thank the many veterans and service members who shared their voices to demand policy change this year, including Ayana Harrell, Nicole McCoy, Cindy McNally, Ruth Moore, Laura Sellinger and so many others.

The NDAA is an enormous bill that specifies the budget and expenditures of the Department of Defense (DOD). It also contains sections that deal with military issues ranging from the total number of troops to retiree benefits, and everything in between. It is one of the primary vehicles used by Congress to provide oversight and mandate change within the military. Every year, SWAN partners with key members of Congress to provide bipartisan legislative recommendations to both the House and Senate to improve the welfare of service women and women veterans.

This year, SWAN was able to help introduce into the bill a record number of provisions based on our policy agenda, chief among them to improve the way the military handles sexual assault and sexual harassment in the ranks. Other provisions were also included that improve health care for service women and military families. Specifically, the law now provides for:

• Prohibiting the military from recruiting anyone convicted of a sex offense

• Mandatory separation of convicted sex offenders

• Insurance coverage for abortions in cases of rape or incest for service women and military family members

• Retention of restricted report documentation for 50 years if so desired by the victim

• The creation of “Special Victims Units” to improve investigation, prosecution and victim support in connection with child abuse, domestic violence and sexual assault cases

• Allowing victims to return to active duty after separation to help prosecute sex offenders

• The creation of an independent review panel comprised of civilian and military members that will closely examine the way that the DOD investigates, prosecutes, and adjudicates sexual assaults

• Required sexual assault prevention training in pre-command and command courses for officers

• Improved data collection and reporting by the military on sexual assault and sexual harassment cases

• Annual command climate assessment surveys to track individual attitudes toward sexual assault and sexual harassment

• A review of unrestricted sexual assault reports and the nature of any subsequent separations of victims who made those reports

• Notification to service members of the options available for the correction of military records due to any retaliatory personnel action after making a report of sexual assault or sexual harassment

• Requirement for DOD to establish a policy for comprehensive sexual harassment prevention and response

• Language that will allow better oversight and tracking of DOD’s implementation of sexual assault provisions from prior Defense Authorizations in order to ensure they are being enforced properly

Legislating reform of DOD policies can be a difficult, complicated and sometimes painfully slow process, and is only one of several tools SWAN uses to make institutional change happen. Ensuring those policies are properly implemented by the services and fairly practiced in individual units “where the rubber meets the road” is a continuous process for us. Calls from active duty troops and veterans on our Helpline continue to inform and guide our work. We are grateful to be able to provide help to service members and veterans in need. We are also thankful for our incredible coalition of military, veterans and civil rights organizations, the members of Congress who have partnered with us, and each one of you who have supported us this year. In order to eradicate sexual assault and sexual harassment we must continue to work together to transform military culture. The passage of the 2013 NDAA is another critical step in moving the military one step closer to change.

As we move forward with this year’s policy and legislative agenda, and prepare for our second annual Summit on Military Sexual Violence, SWAN will continue to hold our civilian and military leadership accountable for the welfare of our nation’s service members and veterans. We will continue to fight for changes in the execution of military justice for victims of sexual assault, service members’ access to civil courts, and comprehensive reform of VA policy regarding “Military Sexual Trauma” compensation claims. With your support, we look forward to continued success as we begin work on the 2014 NDAA.

* This article is from Service Women’s Action Network

Nurse.com News

The American Association of Colleges of Nursing has released preliminary survey data showing that enrollment in all types of professional nursing programs increased from 2011 to 2012, including a 3.5% increase in entry-level BSN programs. 

The AACN’s annual survey findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs (a 77.6% response rate). In a separate survey, the AACN found a strong hiring preference for new nurses prepared at the baccalaureate level, and a comparatively high job-placement rate for new BSN graduates.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," AACN President Jane Kirschling, RN, PhD, FAAN, said in a news release.

Baccalaureate nursing education

The AACN said its annual survey is the most reliable source for actual — as opposed to projected — data on enrollment and graduations reported by the nation’s baccalaureate- and graduate-degree programs in nursing. This year’s 3.5% enrollment increase for entry-level baccalaureate programs is based on data supplied by the same 539 schools reporting in both 2011 and 2012 (see www.aacn.nche.edu/Media-Relations/EnrollChanges.pdf for year-by-year enrollment changes in baccalaureate nursing education from 1994 to 2012).

Among the most noteworthy findings, the number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012 (471 schools reporting). This year marks the 10th year of enrollment increases in these programs, signaling a growing interest among nurses and employers for baccalaureate-prepared nurses, the AACN noted. 

Stakeholders inside and outside the nursing profession — including the Institute of Medicine, Tri-Council for Nursing, National Advisory Council for Nursing Education and Practice, Carnegie Foundation for the Advancement of Teaching and many others — are calling for higher levels of academic progression in nursing.

Graduate nursing programs

Preliminary data from the AACN’s 2012 survey show that enrollment in master’s and doctoral degree nursing programs increased significantly this year. Nursing schools with master’s programs reported an 8.2% jump in enrollment, with 432 institutions reporting data. In doctoral nursing programs, the greatest growth was seen in DNP programs, where enrollment increased by 19.6% (166 schools reporting) from 2011 to 2012. 

During this same time period, enrollment in research-focused doctoral programs (PhD, DNS) edged up by 1.3% (96 schools reporting), even though 195 qualified applicants were turned away from these programs, based on preliminary findings.

"Momentum is clearly building for advancing nursing education at all levels," Kirschling said. "Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels.

"Further, achieving the Institute of Medicine’s recommendations related to education [calling for 80% of nurses to have BSNs by 2020] will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encouraging and rewarding registered nurses committed to moving ahead with their education."

Turned away

Although interest in nursing careers remains strong, many individuals seeking to enter the profession cannot be accommodated in nursing programs, despite meeting all program entrance requirements. Preliminary AACN data show that 52,212 qualified applications were turned away from 566 entry-level baccalaureate nursing programs in 2012. The AACN expects this number to increase when final data on qualified applications turned away in the fall of 2012 are available next March. 

The primary barriers to accepting all qualified students at nursing colleges and universities continue to be a shortage of clinical placement sites, faculty and funding, according to the AACN (see www.aacn.nche.edu/Media-Relations/TurnedAway.pdf for information about the number of qualified applicants turned away from entry-level baccalaureate nursing programs over the past 10 years).

Hiring preferences

In addition to its annual survey, the AACN has collected data on the employment of new graduates from entry-level baccalaureate and master’s programs to assess how these RNs fare in securing their first jobs in nursing. 

Conducted for the third consecutive year, survey findings show baccalaureate nursing graduates remain more than twice as likely to have jobs at the time of graduation as those entering the workforce in other fields. While the employment rate at graduation increased slightly, from 56% in 2011 to 57% in 2012 for BSN students, the employment rate at four to six months after graduation was identical over the two-year period (88%). By comparison, the National Association of Colleges and Employers conducted a national survey of 50,000 new college graduates across disciplines and found that only 25.5% of new graduates in 2011 had a job offer at the time of graduation.

The AACN also collected data on entry-level MSN programs, which remain a popular pathway into nursing for those transitioning into nursing with degrees in other fields. Graduates from these programs were most likely to have secured jobs at graduation (73% for MSNs vs. 57% for BSNs) and at four to six months after graduation (92% for MSNs vs. 88% for BSNs). These data further illustrate a renewed employer preference for hiring the best educated entry-level nurse possible. 

Once again this year, the AACN queried nursing schools about whether hospitals and other employers express a preference for hiring new nurses with a bachelor’s degree. A significant body of research shows that nurses with baccalaureate level preparation are linked to better patient outcomes, including lower mortality and failure-to-rescue rates, according to the news release. With the Institute of Medicine calling for 80% of the nursing workforce to hold at least a bachelor’s degree by 2020, moving to prepare nurses at this level has become a national priority. 

In terms of this year’s survey, schools of nursing were asked whether employers in their area were requiring or strongly preferring new hires with baccalaureate degrees, with the findings showing that 39.1% of employers require the BSN for new hires while 77.4% strongly prefer BSN-prepared nurses.

Resources

To download the complete research brief on the "Employment of New Nurse Graduates and Employer Preferences for Baccalaureate-Prepared Nurses," visit www.aacn.nche.edu/leading_initiatives_news/news/2012/employment12.

The AACN works on several fronts to enhance the number of baccalaureate-prepared nurses in the workforce, including:

• Working collaboratively with leaders from associate degree programs and the community college arena to encourage academic progression in nursing (see www.aacn.nche.edu/news/articles/2012/academic-progression).

• Partnering with the National Organization for Associate Degree Nurses to disseminate a new brochure titled "Taking the Next Step in Your Nursing Education" (see www.aacn.nche.edu/students/your-nursing-career/Academic-Progression-Brochure.pdf).

• Advancing the Robert Wood Johnson Foundation’s "Academic Progression in Nursing" initiative as part of the Tri-Council for Nursing, which is focused on implementing state and regional strategies to create a more highly educated nursing workforce (see www.aacn.nche.edu/news/articles/2012/rwjf).

• Joining with the Robert Wood Johnson Foundation to enhance diversity in the nursing workforce through the "New Careers in Nursing" program, which provides financial support and guidance to students from under-represented groups enrolled in accelerated nursing programs (http://www.newcareersinnursing.org). 

As seen in The New York Times    

There is already a shortage of doctors in many parts of the United States. The expansion of health care coverage to millions of uninsured Americans under the Affordable Care Act will make that shortage even worse. Expanding medical schools and residency programs could help in the long run.

But a sensible solution to this crisis — particularly to address the short supply of primary care doctors — is to rely much more on nurse practitioners, physician assistants, pharmacists, community members and even the patients themselves to do many of the routine tasks traditionally reserved for doctors.

There is plenty of evidence that well-trained health workers can provide routine service that is every bit as good or even better than what patients would receive from a doctor. And because they are paid less than the doctors, they can save the patient and the health care system money.

Here are some initiatives that use non-doctors to provide medical care, with very promising results:

PHARMACISTS A report by the chief pharmacist of the United States Public Health Service a year ago argued persuasively that pharmacists are “remarkably underutilized” given their education, training and closeness to the community. The chief exceptions are pharmacists who work in federal agencies like the Department of Veterans Affairs, the Department of Defense and the Indian Health Service, where they deliver a lot of health care with minimal supervision. After an initial diagnosis is made by a doctor, federal pharmacists manage the care of patients when medications are the primary treatment, as is very often the case.

They can start, stop or adjust medications, order and interpret laboratory tests, and coordinate follow-up care. But various state and federal laws make it hard for pharmacists in private practice to perform such services without a doctor’s supervision, even though patients often like dealing with a pharmacist, especially for routine matters.

NURSE PRACTITIONERS In 2012, 18 states and the District of Columbia allowed nurse practitioners, who typically have master’s degrees and more advanced training than registered nurses, to diagnose illnesses and treat patients, and to prescribe medications without a doctor’s involvement.

Substantial evidence shows that nurse practitioners are as capable of providing primary care as doctors and are generally more sensitive to what a patient wants and needs.

In a report in October 2010, the Institute of Medicine, a unit of the National Academy of Sciences, called for the removal of legal barriers that hinder nurse practitioners from providing medical care for which they have been trained. It also urged that more nurses be given higher levels of training, and that better data be collected on the number of nurse practitioners and other advance practice nurses in the country and the roles they are performing. Tens of thousands will probably be needed, if not more.

Mary Mundinger, dean emeritus of Columbia University School of Nursing, believes highly trained nurses are actually better at primary care than doctors are, and they have experience working in the community, in nursing homes, patients’ homes and schools, and are better at disease prevention and helping patients follow medical regimens.

RETAIL CLINICS Hundreds of clinics, mostly staffed by nurse practitioners, have been opened in drugstores and big retail stores around the country, putting basic care within easy reach of tens of millions of people. The CVS drugstore chain has opened 640 retail clinics, and Walgreens has more than 350. The clinics treat common conditions like ear infections, administer vaccines and perform simple laboratory tests.

A study by the RAND Corporation of CVS retail clinics in Minnesota found that in many cases they delivered better and much cheaper care than doctor’s offices, urgent care centers and emergency rooms.

TRUSTED COMMUNITY AIDES One novel approach trains local community members who have experience caring for others to deliver routine services for patients at home. Two pediatric Medicaid centers in Houston and Harrisonburg, Va., have tested this concept to see if it can reduce the cost of home care and avoid unnecessary admissions to a clinic or hospital.

The aides are trained to consult with patients over the phone by asking questions devised by experts. A supervising nurse makes the final decisions on the care a patient requires. The community aide may visit the patient, provide care in the home and send photos or videos back to the supervising nurse by cellphone.

The aides are typically paid about $25,000 a year, according to an article in Health Affairs by the pilot study’s leaders. The study concluded that the program would have averted 62 percent of the visits to a Houston clinic and 74 percent of the emergency room visits in Harrisonburg.

The aides cost $17 per call or visit, compared with Medicaid payment rates of $200 for a clinic visit in Houston and $175 for an emergency room in Harrisonburg.

SELF-CARE AT HOME A program run by the Vanderbilt University Medical Center and its affiliates lets patients with hypertension, diabetes and congestive heart failure decide whether they want a care coordinator to visit them at home or prefer to measure their own blood pressure, pulse or glucose levels and enter the results online, where the data can be immediately reviewed by their primary care doctor. The patient could consult by phone or e-mail with a nurse about his insulin dosage, but there would be no need for a costly visit to a doctor.

Taking this idea a step further, a hospital in Sweden, prodded by a kidney dialysis patient who thought he could do his own hemodialysis better than the nursing staff, allowed him to do so and then teach other patients, according to the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Mass. Now most dialysis at that hospital is administered by the patients themselves. Costs have been cut in half, and complications and infections have been greatly reduced.

HEALTH REFORM LAW The Affordable Care Act contains many provisions that should help relieve the shortage of primary care providers, both doctors and other health care professionals.

It provides money to increase the number of medical residents, nurse practitioners and physician assistants trained in primary care, yielding more than 1,700 new primary care providers by 2015. It offers big bonuses for up to five hospitals to train advanced practice nurses and has demonstration projects to promote primary care coordination of complex illnesses, incorporating pharmacists and social workers in some cases. And it offers financial incentives for doctors to practice primary care — like family medicine, internal medicine and pediatrics — as opposed to specialties.

These are all moves in the right direction, but they will need to be followed by even bigger steps and protected from budget cuts in efforts to reduce the deficit.

Not Holuba. She’s different. She’s a nursing student in the pediatric nurse practitioner program at Johns Hopkins University, but she’s also a classically trained soprano whose soaring voice can transport her listeners far beyond the sterile confines of a hospital or clinic.

In between classes and studying, Holuba dons the fanciful gowns of fairytale characters and performs for pediatric patients and their families. Sometimes she gives them a full-on presentation, complete with storytelling and grand gestures and songs. And sometimes, she sits next to a child, holds her hand, and quietly croons her to sleep. She takes her cues from the children.

Either way, she is grateful for the chance to use her gift to help sick children feel better. Even just for the length of a song.

“It’s a great thing to see my dream of fusing my passions--nursing and music--happen,” said Holuba, 23.

As a little girl in New Jersey, Holuba spent many hours visiting a young relative in the hospital, which gave her some natural comfort with the hospital environment. Later, as a teenager, she participated in high school and community theater, honing her performing skills. Remembering her own family’s experience, Holuba called up the local children’s hospital and asked if she could come entertain the children.

She had a calling.

When she was a sophomore in high school, her father was diagnosed with multiple myeloma. Over the years, he received treatment at Memorial Sloan-Kettering Cancer Center in New York, including three different stem cell transplants. As she observed his nurses at work, the idea of a possible career in nursing was first planted.

Holuba eventually went on to major in psychology at Columbia University, graduating in three years. Then she enrolled in the accelerated BSN program at Johns Hopkins. She even recorded a CD of beloved Christmas songs, at her father’s encouraging.

“He really loved it,” Holuba said. “He took full credit for it being his idea…We played it for him that last Christmas, and it was really great to see his smile while it was on.” She was privileged to spend some time with her father before he died in January 2012.

After returning to school, she finished her BSN during the summer and began her current master’s degree program.

In Baltimore, Holuba had discovered Dr. Bob’s Place, a palliative-care home for terminally ill infants and children. Ever since that discovery, she has committed herself to weekly visits. Even when she’s trying to juggle all the demands of her program, she always finds time to visit the children.

“I make the time for this as if it were a job,” she said. “It’s really important to me, and I know how much it means to the families. I’ve been that family member where the hours can’t pass quickly enough.”

She loves seeing the children respond to her costume and to the music. She always takes requests from the young patients. She’s equally enthusiastic about slightly off-key group renditions of “Heads, Shoulders, Knees and Toes” and “Twinkle, Twinkle Little Star” as she is about the big Broadway-style numbers that she performs. And when children ask her to sing songs that she doesn’t know, she just encourages the children to teach them to her.

“It’s always fun to make music with them.”

She sees them as children who love music and singing and dancing, not just “sick kids.” “I think that’s a nice change for them,” she said.

With all of her experience, Holuba believes strongly in the value of good end-of-life care and palliative care. Many people don’t want to talk about death or dying, but she realizes it is part of the life process. She hopes to continue exploring her devotion to helping people at such a vulnerable time in their lives.

Her future will certainly include music, too. This spring, Holuba plans to begin visiting the pediatric patients at Johns Hopkins, in addition to Dr. Bob’s. She’ll also continue her course work, with her dream of becoming a pediatric nurse practitioner still in mind. She’s considering a future working with children with cancer in an outpatient setting.

“It’s really just about sharing the music and sharing the time,” she said.

By AL STRAIN

OWATONNA — A new program is now in place at Owatonna Hospital to help people who have been victims of sexual assault.

The hospital has instituted the Sexual Assault Nurse Examiner program after identifying a need for a sexual assault program to serve Owatonna and surrounding areas.

“There wasn’t a program like this nearby,” said Jody Kaiser, RN, assistant manager for the Emergency Department at Owatonna Hospital, in a news release. “For assault victims, whether physical or emotional, there just wasn’t the option for a trained nurse examiner.”

Four nurses in Owatonna went through a five-day, 40-hour training course through the Sexual Assault Response Service.

“While we don’t see the number of patients the metro area does, it’s important to have a program in place locally,” said Kimberly Glasgow, RN, a trained nurse examiner, in the release. “This program offers patients comfort after a traumatic situation.”

According to Lori Pfeifer, the sexual assault program coordinator for the Crisis Resource Center of Steele County, one in six people will be the victim of a sexual assault at some point.

“That’s Owatonna. That’s Blooming Prairie. That’s everywhere in our vicinity, and that’s men, women, old people, young people and everybody,” Pfeifer said. “(The program) is going to help with gathering evidence for prosecution. It’s going to help with follow-through for victims.”

Pfeifer said the program is very beneficial for the community, and thought it could make a difference for victims to see a medical professional who is trained to handle a sexual assault situation, which may not have always happened in the past.

“Any time someone is in the unfortunate position of being sexually assaulted, they need to be able to go into an ER that’s full of understanding and empathy, and that’s exactly what the nurses are trained to do,” Pfeifer said.

The nurses trained in performing exams with Obstetrics and Gynecology staff and nurse practitioners at Mayo Clinic Health System — Owatonna. The program also received funding from the Owatonna Hospital Auxiliary, which donated $2,500. Thrivent Financial in Owatonna also contributed $500.

The program will receive a digital camera and memory card to document evidence, along with toiletries, underwear, sweat pants and hooded sweatshirts that will be given to victims.

“They don’t have to leave the hospital in a hospital gown,” Pfeifer said. “To be able to give them back something of warmth ... you want to give people their dignity and their privacy back.”

The program is available to anyone over the age of 12. Younger victims are referred to Children’s Hospital and Clinics of Minnesota in St. Paul.

By: Jessica Opoien

School psychologists and nurse assistants in Oshkosh will receive the school district’s first-ever market-driven salary increases.

The school board approved a resolution, which grants three currently-employed school psychologists $20,000 raises each and boosts the hourly pay for nurse assistants by $1.50 or $2.50, depending onexperience, at its Wednesday meeting. The raises for school psychologists range from 37 percent to 43 percent more per employee.

The district has struggled to fill substantial vacancies throughout the last year-and-a-half. Five out of seven psychologists and five out of nine licensed practical nurses have left the district in that time, with three psychologists leaving since August. Postings for LPNs have yielded one applicant per vacancy, and there is virtually no candidate pool for psychologists.

There are 15 districts across Wisconsin with open psychologist positions, according to postings on the Wisconsin Educator Career Access Network. However, districts are in direct competition with medical facilities and private firms that employ psychologists, and no applicants have responded to Oshkosh’s four vacancies for psychologists.

The district is obligated to employ school psychologists for special education assessment and placement, said Superintendent Stan Mack during the meeting.

“As we well know just dealing with the issues in the last week, supporting students in crises demonstrates the need for psychologists well beyond the need of special ed assessment and special ed placement,” Mack said.

Six districts surrounding Oshkosh pay their psychologists an average salary of $67,000, according to a survey conducted by the Oshkosh district. Psychologists in Oshkosh earn an average salary of $47,000.

School nurse assistants face a similar situation. In Oshkosh, they earn between $14.98 and $15.85 per hour, while the regional average pay is between $16.33 and $20.77 per hour, depending on experience.

Mack said responsibilities for school nurses have increased as students’ medical conditions have grown more complex, adding that the current compensation rate is inadequate to recruit and retain LPNs in the district.

The raises follow a series of other compensation-related resolutions aimed at curbing turnover and attracting new employees to Oshkosh schools. The board over the past three years raised salaries for its top administrators 24 percent in direct response to difficulty retaining employees. Last month, the board voted to spend up to $350,000 next school year on raises for teachers who earned graduate credits during pay freezes.

By Karen Cheung-Larivee

A series of simple phone calls from a nurse can reduce readmissions and cut $1,225 in costs per patient, according to a study in this month's Health Affairs.

Researchers from the University of Wisconsin School of Medicine and Public Health looked at more than 600 patients enrolled in the Coordinated Transitional Care (C-TraC), a low-resource Madison (Wis.) VA program that uses registered nurses for quality transitional care, according to the C-TraC website.

Patients discharged from the William S. Middleton Memorial Veterans Hospital and considered high risk received weekly phone calls from a nurse case manager for four weeks or until the patient transitioned to a primary care provider, according to last week's research announcement. High-risk patients had dementia, were over 65 years old and living alone or had a previous hospitalization in the past year.

In an open-ended discussion, the nurse talks about medication adherence--most often the biggest issue--symptoms and other follow-up.

The program has been popular with almost full patient participation, according to lead investigator Amy Kind, assistant professor of medicine (geriatrics) at the UW School of Medicine and Public Health.

"Patients don't mind a phone call," Kind said. "Our role is not to complicate the process but to more seamlessly bridge the patient's journey from the hospital to the home and to primary care," she added.

Such nurse-led contact has saved the hospital nearly three-quarters of a million dollars ($741,125) in healthcare costs over 18 months, according to the program.

Patients in the program had 11 percent fewer 30-day readmissions at 23 percent, compared to 34 percent of the those not enrolled.

Because the nurses don't spend a lot of time traveling, they can therefore reach out to more patients by phone, Kind noted. Most of the patients live in remote areas where a home visit is easily accessible.

"Simple, protocol-driven, telephone-based programs like C-TraC may be able to reach larger patient populations, including patients living a greater distance from hospitals and could be used in a wider variety of care settings than traditional in-home transitional care programs can," study authors wrote.

Researchers said resource-strained hospitals, such as safety nets, that can't afford home visits can implement similar telephone protocols. However, they also recognized that the VA is unique from other hospitals in that the VA has a single electronic health record system, shared among all VA-affiliated inpatient and outpatient providers.

For years, nurse practitioners in Minnesota have been able to see patients only in association with a licensed doctor. But a governor's task force says it's time to let those nurses work independently -- in part, because of a coming shortage of primary care physicians.

The proposal, which has been opposed by physician groups, was endorsed Thursday in the final report of the state Task Force on Health Reform, headed by Human Services Commissioner Lucinda Jesson. The report is expected to set the stage for a debate in the Legislature, which must approve any changes.

The plan would lift restrictions on the state's more than 5,000 "advanced practice nurses," who get extra training to diagnose and treat many routine conditions, from strep throat to chronic illnesses.

Under current law, they must have a working agreement with a physician, although 17 other states have no such restrictions.

"The reality is that we've got a primary care shortage and you can't turn out doctors fast enough," said Dr. Therese Zink, a University of Minnesota physician who served on the task force. "We can't afford to wait. We need creative solutions."

Many advanced practice nurses already operate semi-independently, running clinics in drug stores, schools, rural areas and other locations, under "collaborative agreements" with physicians. The problem, said Zink, is that if the physician retires and no replacement is found, the nurse practitioner would have to close up shop. "It's probably, more than anything, a rural access issue," she said.

But the Minnesota Medical Association (MMA) says the physician oversight is necessary. "This is a patient safety issue," said Dr. Dave Thorson, a St. Paul physician and chairman of the MMA's board of trustees. "I think nurse practitioners ... do a wonderful job. They're a valuable member of the health care team. But they're not the same as a physician, so they shouldn't be given the same scope of practice as a physician."

The American Academy of Family Physicians also objects to the idea. "Substituting nurse practitioners for doctors cannot be the answer," it said in a report in September. It noted that doctors are required to go through twice as many years of training (11 years) as advanced-practice nurses (five to seven years).

But the trend has been spreading. Today, 17 states, including Iowa and North Dakota, permit advanced-practice nurses to diagnose and treat patients, as well as prescribe drugs and devices, without physician supervision, according to the task force.

One of the driving forces is the anticipated physician shortage, as large numbers of doctors retire and aging baby boomers need more care. National experts predict a shortage of 45,000 primary care doctors by 2020.

"We're trying to stay ahead of the curve," Zink said. "We've got to have solutions that are above and beyond and push the envelope."

The task force report, which includes a broad range of recommendations on quality and access to care, will be posted Friday on the Minnesota Health Reform website, mn.gov/health-reform.

DiversityInc CEO Luke Visconti recently interviewed Thomas F. Zenty III, CEO of the Cleveland-based hospital system. (University Hospitals is one of the 2012 DiversityInc Top 5 Hospital Systems.) Zenty discussed the dramatic impact of the Affordable Care Act and how the hospital’s diversity efforts in the workplace and the community are helping it survive.

Zenty spoke on this topic at DiversityInc’s event last month, Diversity-Management Best Practices From the Best of the Best. Click here for video of his talk.

Luke Visconti: What is the intersection of solid diversity-management initiatives and the reduction of healthcare disparities?

Thomas F. Zenty III: Many studies have shown that there is a direct correlation between people of diverse backgrounds being willing to seek care and knowing that people who look like them will actually be providing that care. So the intersection between diversity and disparities is rather significant. We want to make certain that we’re doing everything that we can to make sure that people of color will be able to work in our organization, hold positions of leadership—caregivers, clinicians and support staff—in order to make people of all backgrounds, colors and faiths feel comfortable coming to University Hospitals to receive the world-class care that we provide.

Visconti: How is diversity and inclusion a competitive differentiator for a hospital?

Zenty: There is no better way to gain the pulse of what’s happening in the communities that we serve than by having people who live and work in those communities actively engaged with us at every level. From an employee perspective, it’s critically important that we have people of diverse backgrounds who will bring skills, talents, perspective in order to help us to do a better job as we look to achieve our mission. We think it’s critically important for diversity to be well represented across our entire health system at every level, be it gender, religion, race, color. In fact, we’ve recently reached out to the Amish community because one of our hospitals has a very large Amish population, and we realized that we did not have a member of our board who was of Amish descent. As a result, we added a new Amish board member to our hospital, and he’s brought a lot in terms of a better understanding of the Amish community and the healthcare needs of that community.

The point is we need to look into the community to better understand who are the communities that we serve? Who best represents those individuals within those communities that we serve? And how can we engage them at every level, either as employees, as members of the board, as leadership-council members? And we want to make sure that we’re engaging everyone in the communities that we serve.

Visconti: You’re very personally involved in the community. Why?

Zenty: It’s critically important for an organization of our size in a community of this size, as the second-largest private employer in Northeast Ohio, to make certain that we’re going to be focused on diversity at every level within the communities that we serve. Our organizational values include excellence, diversity, integrity, compassion and teamwork. And diversity is one of the key components of the cornerstones of the work that we do every day in taking care of our patients and meeting our mission. As the leader of this organization, it’s critically important for us to be actively engaged in community activities to make certain that we’re not only aware of what’s happening in the community, but play a leadership role in advocating on behalf of many different agenda items. One of the key ones, though, is in the area of diversity in Northeast Ohio.

Visconti: University Hospitals has a 100 on the Corporate Equality Index, the Human Rights Campaign’s index of equality for LGBT people. Why is that important to you?

Zenty: The LGBT community is very important to us for all the other reasons that I stated in all the other populations that we serve. They’re very much a part of our community. We want to make certain that they’re recognized and represented. They have actually recognized us for our work in this regard, which we’re very pleased about.

Visconti: Your chief diversity officer reports directly to you. You also have hands-on interaction with people who are responsible for delivering results in diversity management. How important are these two things?

Zenty: It’s critically important that the chief diversity officer reports to the chief executive officer. Donnie Perkins is our chief diversity officer and does an excellent job in the role. However, it’s also important to note that we have a very close working relationship with Elliott Kellman, who is our chief human resources officer, because so much of what we do in workforce planning and workforce development is structured around the importance of diversity at every level in our organization.

In our organization, we selected the top 24 people from within our health system to be part of an education-and-training program in conjunction with Case Western Reserve School of Business. We’ve engaged 13 physicians and 11 non-physicians who were at senior levels in our organization who we feel have the potential to grow and develop in the years to come within University Hospitals’ health system. They were selected on the basis of their accomplishment. They were selected on the basis of diversity. They were selected on the basis of their ability to grow and develop within our organization. It’s an 18-month program, but we’ve seen great success thus far. One of those individuals has already been promoted to a new senior position that was recently created in our organization.

But at the other end of the spectrum, we’re also concerned that we don’t have enough people of color in our management ranks. So we put together a mentorship program, which will include people at the senior administrative level who will choose people who have promotional capability within our organization, who will be working with each of us to make sure that they will be given the opportunity to grow and develop within our organization in both non-management as well as in management roles, so that we can encourage more people of color to get actively engaged as supervisors, managers, directors, vice presidents.

Visconti: How are you holding your senior team accountable for diversity-and-inclusion results?

Zenty: Our senior team is very actively engaged with Donnie’s leadership in making certain that we are focused on diversity at every level within our organization, looking at the healthcare needs of the people who we serve, making certain that our employees are given equal opportunity for promotion and growth within our health system, making certain that people who are in middle management have opportunities to grow into senior-management roles, and making certain that we are focused on doing everything that we can to prepare the next generation of leader who will be people of color and of diverse backgrounds. Likewise, it’s important to mention that our board has been focused on diversity over the past many years. And I’m pleased to report that the Council on Economic Inclusion has awarded us for two years in a row recognition for the diversity of our board. If we receive it a third year in a row, we’ll go into the Hall of Fame, and we’re hoping that that will be achieved. This actually starts at the top, beginning with our board, and then filters throughout our entire organization.

Visconti: What do you see as the greatest challenge facing University Hospitals? And how does diversity and inclusion factor into the solution?

Zenty: The greatest challenge will be how to address the changes that we’ll be facing under healthcare reform. One of the key things that we will focus on in the area of diversity is to make certain that the 32 million more Americans who will now have access to healthcare insurance that didn’t have it before, that they will be well represented both within the communities that we serve as well as well represented in the patient populations that we care for. We have a number of very strong specialty clinics that will focus on the needs of specific elements within our population. But we want to make certain that as we see this influx of new patients arriving, we clearly understand what their needs will be—which is more than just episodic acute-care needs, but the continuum of care of services that we’ll be able to provide to them in the years to come.

Visconti: I found University Hospitals’ website to be exemplary in its ability to communicate your mission, your values, how diversity ties into all of this, your corporate citizenship, your engagement with the community. Why is it so important to communicate this?

Zenty: University Hospitals really wants to be a leader in the area of diversity. We’ve been in existence since 1866. We’ve been a very active and vibrant part of this community for that same period of time. And we want to make certain that we’re going to be leaders in the area of diversity—to set the example, to set the tone toward diligently making great things happen in the world of diversity, and to make certain that we’re going to focus not only on the needs of our patients, but also on the needs of those within our organization, to make certain that everyone will be able to realize their fullest potential.