Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.

On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing. 

What’s the answer to this decades’ old question?  Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.

This is part of the May 2013 issue of Sharing Nursing's Knowledge.

Hospitals that have achieved "Magnet" recognition have lower mortality rates, according to new research led by Matthew D. McHugh, PhD, JD, MPH, RN, of the University of Pennsylvania School of Nursing, with support from the Robert Wood Johnson Foundation (RWJF).

McHugh and colleagues examined patient, nurse, and hospital data for 56 hospitals designated as Magnets by the American Nurses Credentialing Center, along with comparable data from 508 non-Magnet hospitals. They found that "Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification," and that "patients treated in Magnet hospitals had 14 percent lower odds of mortality and 12 percent lower odds of failure-to-rescue." They concluded that "lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes."

About 8 percent of hospitals in the United States have achieved Magnet designation. They are recognized for quality patient care, nursing excellence, and innovations in professional nursing practice.

The study was published in the May issue of Medical Care, a journal of the American Public Health Association. McHugh is an RWJF Nurse Faculty Scholar.

Learn more about the RWJF Nurse Faculty Scholars program.
Read the study.
Read a FierceHealthcare story about the study.

Adejoke Ayoola, PhD, RN, is an assistant professor with the Calvin College Department of Nursing in Grand Rapids, Michigan, and a Robert Wood Johnson Foundation Nurse Faculty Scholar.  This is part of a series of posts looking at diversity in the health care workforce.

Nurses in the United States are caring for a progressively more diverse population. In 2008, ethnic and racial minority groups accounted for about one third of the United States population. According to the United States Census Bureau, people from ethnic and racial minority groups— namely Hispanic, black, Asian, American Indian, Native Hawaiian and Pacific Islander—will together outnumber non-Hispanics over the next four decades. Minorities, now 37 percent of the U.S. population, are projected to comprise 57 percent of the population in 2060. The total minority population would more than double, from 116.2 million to 241.3 million over the period (U.S. Census Bureau, 2012).  So it is essential to have a nursing workforce that will reflect the population of the United States so as to deliver cost-effective, quality care and improve patients’ satisfaction and health outcomes, especially among ethnic and racial minorities.

The importance of promoting diversity in the nursing workforce is acknowledged by various nursing agencies and health organizations, including the American Association of Colleges of Nursing (AACN, 2013).  Diversity in the nursing workforce provides opportunities to deliver quality care which promotes patient satisfaction and emotional well-being. 

When I take my students to the hospital for their clinical rotations in acute care, I often assign those who are Spanish-speakers to Spanish-speaking patients. It has often been a win-win situation for both my students and the patients. Recently we cared for a Hispanic patient who did not speak English and had just given birth to her first baby. Her face lit up when my student spoke to her in Spanish! There was no one else with the woman, so the student’s ability to interact with her in a language she understood made a big difference. We noticed positive progress in the patient’s emotional and physical state as a result of her interaction with the student during the shift.

This blog post offers perspectives from seven Robert Wood Johnson Foundation Nurse Faculty Scholars who attended TEDMED 2013 last week.

Seeing things in new and different ways will advance nursing practice, research, and education.  We need to think of creative strategies to raze perceived boundaries. One way for nurses to enter new frontiers is to engage in interprofessional dialogue with consumers, health care providers, researchers, entrepreneurs, technology experts, designers, and artists. We experienced this interchange at TEDMED 2013—an interprofessional conference for sharing and exploring solutions to health care’s most pressing challenges.

Collaboration is Key
Adejoke Ayoola: The opportunities to explore new advances in technology and interact with innovators remind me of an African Proverb, “If you want to go fast, go alone; if you want to go far, go together.” The outcome is more fulfilling with collaboration. By collaborating with stakeholders (e.g., community residents, community health workers, local agencies), research not only becomes more effective, it becomes more relevant to societal needs. Collaboration with my nursing colleagues promotes scholarly growth and may involve writing manuscripts or conducting smaller studies associated with a bigger study.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

RWJF/U.S. Department of Veterans Affairs Physician Faculty Scholars alumnus Amal Trivedi, MD, MPH, is co-author of a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South. Although the specific reasons for the regional differences are unknown, the researchers hypothesize factors like education, socioeconomic status, and access to quality medical care might be to blame, the New York Times Well Blog reports. NPR and Nurse.com are among the other outlets to report on the findings.

Fierce Healthcare reports on a study led by RWJF/U.S. Department of Veterans Affairs Clinical Scholar Kelly Doran, MD, that finds frequent use of the emergency department at Veterans Health Administration facilities is often due to “severely compromised life circumstances,” rather than poor access to outpatient health care. The study raises questions about the degree to which increasing access to outpatient care, as the Affordable Care Act aims to do, will reduce emergency department use.

Manish K. Sethi, MD, a health policy associate at the RWJF Center for Health Policy at Meharry Medical College, spoke to the Leaf Chronicle about a program he started at Cameron College Prep Middle School in Nashville to teach teens conflict resolution strategies in an effort to reduce violence in the Nashville area. Read a Q&A with Sethi about the program.

The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni.

The Chicago Parenting Program, an innovative program that supports healthy parenting and reduces behavioral problems among children, was recently added to the National Registry of Evidence-Based Programs and Practices, run by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. RWJF Executive Nurse Fellow alumna Deborah Gross, DNSc, RN, FAAN, was a driving force behind the program, which is used by Head Start centers in Chicago and New York City, among others.  RWJF Nurse Faculty Scholar Susan Breitenstein, PhD, RN, PMHCNS-BC, and Executive Nurse Fellow alumna Sharon Tucker, PhD, RN, joined with Gross and others to conduct a study on the program, published in Research in Nursing & Health. It was recently named the journal’s Best Research Article award for 2012.

David Kindig, MD, PhD, RWJF Health & Society Scholars program director at the University of Wisconsin, and Health & Society Scholars program National Advisory Committee (NAC) member George Isham, MD, MS, co-chaired the Institute of Medicine’s Roundtable on Population Health Improvement, which is exploring factors beyond medical care that affect people's health. Among other participants in the Roundtable: RWJF Senior Program Officer Pamela Russo, MD, MPH, and Health & Society Scholars NAC Member James Knickman, PhD.

RWJF Health Policy Fellows alumna Carmen R. Green, MD, was appointed the University of Michigan Health System’s inaugural Associate Vice President and Associate Dean for Health Equity and Inclusion. In the position, Green will find and address inequalities in care, education and research, and promote health care careers to those from groups that are underrepresented in the field.

Sylvia Garcia, JD, a member of the RWJF Community Health Leaders program NAC, was elected to the Texas State Senate (District 6) in a run-off election to fill the seat previously held by the late state Sen. Mario Gallegos.

It’s made of glass, and it glows and changes colors—but it’s not a crystal ball. It’s an “orb” and it’s poised to revolutionize the way providers assess and treat pain in premature infants.

Martin Schiavenato, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, has invented a revolutionary tool to assess pain in premature infants and potentially protect them from its negative developmental effects.

The glass orb translates behavioral and physiological signs of pain in infants—such as body gestures and physiological signals like heart rate metrics—into a “real time” visual display of pain levels. It changes color depending on the subject’s pain levels, giving clinicians readouts on infant pain.

Learn more about how it works.

The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees.

Lindsay Chase-Lansdale, PhD, a member of the RWJF Health & Society Scholars program National Advisory Committee, was elected to the National Academy of Education.

RWJF Clinical Scholars alumnus David J. Shulkin, MD, has been named chair of the board of the New Jersey Council of Teaching Hospitals. Shulkin is president of Morristown Medical Center and vice president of Atlantic Health System.

Flavia Peréa, PhD, an alumna of the RWJF New Connections program, was recognized by Diverse: Issues in Higher Education as a “2013 Emerging Scholar.”

Health & Society Scholars alumna Janxin Leu, PhD, joined HopeLab as Director of Product Innovation, where she will direct the Lab’s “new initiative to promote human resilience and inner values through social-tech innovation.”

The University of North Carolina Board of Governors has approved the UNC School of Nursing’s proposal to add the Doctor of Nursing Practice (DNP) degree to its graduate clinical offerings. Two RWJF Executive Nurse Fellows alumnae were instrumental in ensuring the proposal’s approval: School of Nursing Dean Kristen M. Swanson, PhD, RN, FAAN, and newly-appointed DNP program director Debra J. Barksdale, PhD, RN, CFNP, CANP.

Kevin B. Johnson, MD, MS, the Cornelius Vanderbilt Professor, chair of Biomedical Informatics, and a professor of pediatrics at Vanderbilt University School of Medicine, has joined the RWJF Harold Amos Medical Faculty Development Program National Advisory Committee.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

Health Canal reports on a study led by RWJF Scholars in Health Policy Research alumna Joanna Kempner, PhD, that examines the social stigma surrounding chronic migraine sufferers. “The enduring image of the typical migraine patient is a white, middle-class woman who just isn’t good at handling stress,” Kempner said. “She is seen as neurotic and weak, a stigma that has been hard to change.”

RWJF Nurse Faculty Scholar alumna Ruth Taylor-Piliae, PhD, RN, FAHA, was featured in MyHealthNewsDaily, an online health care news digest, for her study suggesting Tai Chi can reduce the number of falls in adults who have survived a stroke. Taylor-Piliae, an assistant professor at the University of Arizona College of Nursing in Tucson, surveyed 89 stroke survivors and found that practicing Tai Chi helps alleviate balance problems that afflict many survivors. Read more about her work.

Medpage Today reports on research co-authored by William K. Hallman, PhD, director of the Rutgers University Food Policy Institute and recipient of an RWJF Investigator Award in Health Policy Research, about how to motivate consumers to look for and discard recalled food products. Hallman participated in a U.S. Food and Drug Administration advisory committee meeting this week on breaking through food recall “message fatigue” [free subscription].

Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. Yesterday, she blogged about the death of her beloved grandmother, Tootsie, due to complications from medical error that began with an overdose of Synthroid.  This is Part Two of Bellot’s blog post.

In 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) joined resources and released The Future of Nursing: Leading Change, Advancing Health. This landmark report included many recommendations, and a full-scale Campaign for Action is in place that will transform nursing for years to come. Among the many themes advocated in this report is the tenet that nurses should be the very core of reinventing the American health care system. The report encourages the health care system to lean, and lean heavily, upon the skill set and resources of nurses to facilitate access to higher quality care at a lower cost.

At present, we have a health care system that is technology and intervention heavy when we know our population demographics are rapidly changing and technological intervention is not always the right answer. We have a growing need for a system that instead focuses on addressing chronic disease management, prevention and wellness care. Nurses are well positioned to support a system with these foci, managing care of the older adult in the community before inpatient care becomes necessary. Specifically in the outpatient setting, nurse coordinated care that is, by definition, proactive, holistic and comprehensive will help shift the focus of care from acute and episodic to chronic and preventive.