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DiversityNursing Blog

Share Your Experience for Transitional Care Research (NAHN)

Posted by Erica Bettencourt

Fri, Sep 26, 2014 @ 11:44 AM

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With the generous support of the Robert Wood Johnson Foundation and guided by a national advisory committee, a multidisciplinary team based at the University of Pennsylvania seeks to learn from clinicians or clinical leaders who are primarily responsible for transitional care services in health systems and communities throughout the United States.  Specifically, the team is conducting a research study designed to better understand how transitional care services are being delivered in diverse organizations.  Participation in this research survey is voluntary.

If you are a clinician or clinical leader responsible for transitional care service delivery in your organization, I encourage you to learn more about this study.  To access the survey and more information on the study, please visit:

Transitional Care Survey

NAHN is happy to assist Dr. Mary Naylor and the University of Pennsylvania in this 2 year project.  Dr. Mary Naylor will be providing NAHN with feedback on the survey results. If you know of others who have such responsibility within your association or work environment, please forward this email to them.

Thank you in advance for your consideration of this request.


Topics: work, Robert Wood Johnson Foundation, NAHN, survey, transitional care, hispanic, healthcare, research, nurses, medicine

Commentary: Psychiatric Mental Health Nurse Practitioners Can Help Address Increased Demand for Mental Health Services

Posted by Alycia Sullivan

Mon, May 19, 2014 @ 03:30 PM

By Susan Chapman and Bethany J. Phoenix

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Because the Affordable Care Act requires that individual and small-group plans include coverage for mental health care that is comparable to that for general medical care, many analysts expect the demand for mental health services to dramatically increase over the next few years. In California, finding enough mental health providers to meet the demand will be a challenge, as the federal Health Resources and Services Administration has identified 128 Mental Health Professional Shortage Areas in our state.

After documenting vacancy rates for mental health professionals in county-operated mental health programs and state hospitals, the California Mental Health Planning Council suggested that one way to address this shortage is to increase the recruitment and preparation of psychiatric/mental health nurse practitioners (PMHNPs) as primary mental health providers. Given the direction of health care service delivery in the US, perhaps the most important advantage PMHNPs offer is that they are educated in an integrative practice model that stresses connections between physical and mental health and emphasizes health promotion. This is especially critical in public mental health settings, where many patients struggle to get to any health care appointment, much less multiple appointments with multiple providers.

Using PMHNPs to address shortages and increase access to care in public mental health settings, however, faces a number of challenges. To help understand and address these challenges, we are collaborating with the California Institute for Mental Health (CiMH) to conduct a Robert Wood Johnson Foundation-funded study that will include case studies in five California counties with a history of using PMHNPs. The aim is to document best practices, identify unnecessary restrictions on NP practice and formulate strategies to remove these restrictions. By the conclusion of the study in 2015, we hope to have evidence-based information for key stakeholders – from public mental health care systems to state policymakers – about how PMHNPs can help increase access to mental health services in the state.

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One thing the study will allow us to do is examine in more detail presumed barriers that have emerged both anecdotally and from prior research. To begin with, just as with primary care, there is a need to rapidly fill the pipeline by incentivizing existing and future students to work in public mental health. That’s why beginning in 2009, California’s Mental Health Services Act began funding educational stipends to PMHNP students at three schools of nursing, including UC San Francisco. The stipend requires that students “pay back” their stipend by working in a public mental health setting for the equivalent of a year of service for each year of stipend funding.

That’s a fine start, but many of our colleagues across the state are concerned that scope-of-practice laws and the lack of good practice models for PMHNPs in California appear to undermine the effort to prime the pipeline.

For example, UCSF School of Nursing faculty member Aaron Miller was educated in Oregon and says that the biggest difference between the two states is that, “In Oregon, NPs can practice without a collaborative agreement with a physician…and the scope-of-practice law in Oregon contains an explicit description of the NP’s scope of practice: assessment, diagnosis, creation of plan and treatment.” By contrast, he says, in California NPs must always have a collaborative agreement in place with a supervising physician, and in every setting they have to devise agreed-upon standardized procedures that define what the NP can do – essentially, the scope of practice. Moreover, at present, practice models in the state do not facilitate optimal billing for PMHNP services.

Ebony Anderson, one of our former stipend students, says these limitations have dampened her willingness to strike out into independent practice as a psychiatric mental health nurse practitioner.

Thus, even as many in the state recognize that NPs can provide high-quality care and organizations are starting to utilize NPs’ full scope of practice, a number of factors may be erecting unnecessary obstacles to meeting the mental health needs of many Californians – especially in areas already short on qualified providers. These factors include reimbursement challenges, the effort involved in defining acceptable scope for each setting and finding physicians willing to provide NPs with the mandated level of supervision – and bill for services under their provider numbers, if appropriate.

Our charge, among other things, is to examine how and to what degree these factors affect the state’s ability to meet expected growth in demand for mental health services. Such research is the lifeblood of policy change. Our hope is that the results of our work will enable the state to fully leverage an educational system that is training PMHNPs to deliver outstanding care but, at least at the moment, sending them into a health care system that is not yet taking full advantage of their strengths.

Susan Chapman and Bethany J. Phoenix are leading a study to examine the structural, practice and policy opportunities and barriers that affect psychiatric/mental health nurse practitioners’ ability to most effectively use their skills and expertise in public mental health settings. Chapman directs the Health Policy Nursing specialty in the Department of Social and Behavioral Sciences at UC San Francisco School of Nursing. Phoenix is vice chair of the School’sDepartment of Community Health Systems and coordinates the School’s Psychiatric/Mental Health Nursing specialty. The study is supported by the Robert Wood Johnson Foundation’s Future of Nursing National Research Agenda, which is coordinated by the Interdisciplinary Nursing Quality Research Initiative, a national program of the Robert Wood Johnson Foundation.

Source: Science of Caring

Topics: California, study, ACA, Robert Wood Johnson Foundation, nurse practitioners, CiMH

The quest for 80%

Posted by Alycia Sullivan

Wed, Jul 10, 2013 @ 01:39 PM

Susan Hassmiller, RN

Susan Hassmiller, RNhassmillerAmong the core recommendations in the 2010 report “The Future of Nursing: Leading Change, Advancing Health” (, by the Institute of Medicine ( and the Robert Wood Johnson Foundation (, was for at least 80% of nurses to have BSNs by 2020. 

“A more educated nursing workforce would be better equipped to meet the demands of an evolving healthcare system, and this need could be met by increasing the percentage of nurses with a BSN,” according to a Future of Nursing report brief. Nurses who have BSNs also are more likely to pursue MSNs or doctorates, according to the report, which would help supply much-needed primary care providers, nurse researchers and nurse faculty.

As of 2012, about 50% of nurses held degrees at the baccalaureate level or higher, according to a fact sheet from the American Association of Colleges of Nursing. Efforts to meet the 80% benchmark are ongoing.

The IOM noted a variety of programs and educational models can abet the process, including traditional RN-to-BSN programs, traditional four-year BSN programs at universities and some community colleges, “educational collaboratives that allow for automatic and seamless transitions from an AD to a BSN,” new providers of nursing education such as proprietary or for-profit schools; simulation and distance learning through online courses; and academic-service partnerships.

From 2011 to 2012, nursing schools reported a 3.5% increase in enrollment in baccalaureate programs, according to the AACN. Enrollment in RN-to-BSN programs increased by 22.2%.

The Future of Nursing Campaign for Action (, a national initiative of AARP (, the AARP Foundation and the Robert Wood Johnson Foundation, has strived to mobilize diverse stakeholders in all 50 states and Washington, D.C., to address the nation’s pressing healthcare challenges by using nurses more effectively and preparing nursing for the future.

“As I travel the country, I hear time and again that universities are working with community colleges now more than ever before to make it easier for students to transition to their next degree,” said Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. “The Campaign is providing the infrastructure and mentoring to help states with this work.”
Hassmiller said one of the most important policies in reaching the 80% benchmark is for hospital CNOs to specify that all new ADN hires must get their BSN within five years of their start date. 

The Robert Wood Johnson Foundation’s effort intensified in 2012 with the selection of nine states to receive two-year, $300,000 grants through the Academic Progression in Nursing program. The objective of APIN is to advance state and regional strategies aimed at creating a more highly educated, diverse nursing workforce. 

The program is run by the American Organization of Nurse Executives ( on behalf of the Tri-Council for Nursing, which consists of the American Association of Colleges of Nursing (, the National League for Nursing (, American Nurses Association ( and AONE. The $4.3 million Phase 1 initiative runs through 2014. RWJF will support an additional two years of work at the close of Phase 1 to facilitate continued progress by states that have met or exceeded their benchmarks.

The states chosen for the grants were California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas and Washington. Each works with academic institutions and employers on implementing sophisticated strategies to help nurses get higher degrees. In particular, the states seek to encourage strong partnerships between community colleges and universities to make transitioning to higher degrees easier for nurses.

“The nation needs a well-educated nursing workforce to ensure an adequate supply of public health and primary care providers, improve care for patients living with chronic illness and in other ways meet the needs of our aging and increasingly diverse population,” Pamela Thompson, RN, MS, CENP, FAAN, national programs director for APIN, CEO of AONE and senior vice president of nursing for the American Hospital Association, said in a news release.

Everybody involved in the effort understands the challenges they face. One hindrance to meeting the 80% goal is “the barriers incurred by the students themselves, which include cost and family and life commitments,” Hassmiller said.

For the Robert Wood Johnson Foundation's infographic on RNs' educational pathways, visit:


Topics: higher education, Robert Wood Johnson Foundation, nurse education

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