Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

How do nurse faculty members spend their time?  How do they assess key aspects of their work-life?
 
In 2010 the Robert Wood Johnson Foundation’s Evaluating Innovations in Nursing Education program (EIN) conducted a nationwide survey of full-time nurse faculty focusing on their employment characteristics, workloads and attitudes toward work-life. More than 3,000 respondents completed the survey, answering questions about more than 60 characteristics of work-life.
 
Now, using an online tool—the Nurse Faculty Query (NuFAQs)—you can search the survey results. The interactive tool allows you to customize the findings to suit your interests in faculty with particular backgrounds or rank, in specific settings or circumstances.
 
To see a brief demonstration and begin using this resource, click here.
Read more about NuFAQs in the latest issue of Sharing Nursing’s Knowledge.

By Jeannie P. Cimiotti, DNSc, RN, Executive Director, New Jersey Collaborating Center for Nursing, Associate Professor, Rutgers University College of Nursing

For decades, the Health Resources and Services Administration (HRSA) has employed experts in sampling and statistical analyses in its attempt to monitor the registered nurse workforce through the National Sample Survey of Registered Nurses (NSSRN). Though the NSSRN has been used widely to estimate the supply and demand of registered nurses nationwide, it is often criticized in that states appear to be underrepresented. 

In New Jersey for example, it was reported that less than 1 percent of our registered nurses participated in the 2008 NSSRN.  To address New Jersey’s issue of monitoring the nurse workforce, the New Jersey Collaborating Center for Nursing (NJCCN) has instituted a number of initiatives, including three surveys developed by the Forum of State Nursing Workforce Centers.  These surveys assess New Jersey’s supply and demand of nurses, and the educational capacity of our nursing programs.

Even before the release of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, which recommends an infrastructure for collection and analysis of workforce data, NJCCN was collecting data on the educational capacity (registered nurse and licensed practical nurse) of all nursing programs statewide.

By Patricia Moulton, PhD, executive director, North Dakota Center for Nursing and  co-lead, North Dakota Action Coalition

In 2010, the Institute of Medicine (IOM) issued a groundbreaking report on the future of nursing that identifies as one of its key messages the need for improved data collection and an enhanced information infrastructure as requirements for effective workforce planning and policy-making.

The report, called The Future of Nursing: Leading Change, Advancing Health, recognizes that data “on the numbers and types of health professionals currently employed, where they are employed and in what roles” is imperative to the establishment of accurate workforce projection models. Such models are necessary to inform policy-makers in their aim to ensure effective workforce planning as well as to make needed changes in nursing practice and education to meet population needs.

Nurse leaders and researchers are working toward that goal.

In 2008, before the IOM released its report on the future of nursing, the Forum of State Nursing Workforce Centers embarked on a multi-year process to develop minimum data sets for the collection of nursing education, supply and demand data across the 34 nursing workforce centers. The minimum data sets were finalized in 2009 and are available at the forum’s website. 

For the project, the forum’s research committee recently surveyed the 34 current nursing workforce centers to determine how many have implemented the minimum data sets.

Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) grantee Susan Letvak, PhD, RN, recently spoke to the New York Times about her research on nurses with musculoskeletal pain and depression.

The study results were published in the February issue of the American Journal of Nursing.  Letvak and her team found that nurses experience depressive symptoms at a rate twice as high—18 percent—as the general public. The researchers specifically addressed depression in nurses and focused on treatment options in, “Depression in Hospital-Employed Nurses,” published in the May/June issue of the journal Clinical Nurse Specialist.

“The only way to ensure the best quality for our patients is to have an expert staff of qualified nurses who are healthy enough to offer that kind of care,” Letvak told the New York Times. “We can’t ignore nurses’ health anymore.”

To learn more about INQRI, visit www.inqri.org or follow @INQRIProgram on Twitter.

In a month when national employment data were largely unchanged, the U.S. Bureau of Labor Statistics reports that the health care industry added nearly 33,000 jobs in May, continuing as a strong and growing field. Over the year, health care employment has risen by 340,000 jobs.

Employment in ambulatory care services accounted for the majority of the new jobs in the industry (23,000). That growth was seen mostly in physicians’ offices (9,900), home care services (6,900) and outpatient care centers (4,600).

Demand for health care employees remains strong. Nurse.com reports that data from Wanted Analytics finds that employers posted more than 620,000 online job ads for health care careers in May, an increase of 5 percent from a year prior.

Read more about the Bureau of Labor Statistics May Employment Situation Summary.

Read the Nurse.com article.

The Robert Wood Johnson Foundation (RWJF), NPR and the Harvard School of Public Health commissioned a poll to better understand Americans’ experiences and attitudes related to the cost and quality of their medical care. Released on May 21st, Sick in America found that many Americans who experienced a serious illness or injury in the past 12 months are concerned about the financial costs of medical care, and struggle to ensure that their care is appropriate. Nearly nine in ten respondents (87 percent) think the cost of care is a serious problem for the country.

In addition to surveying the public, the poll examined sick Americans’ experiences and perceptions. “Sick Americans” (27 percent of adults surveyed) were defined as those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or who had been hospitalized overnight in the past 12 months. A quarter of sick Americans said a doctor, nurse, or other health professional did not provide all the needed information about their treatment or prescriptions – or they had to see multiple medical professionals, and no single doctor understood or kept track of all the different aspects of their medical issues and treatments (23 percent). Three in 10 hospitalized Americans said there was poor communication among the doctors, nurses, and other health care professionals involved in their care.

In addition, 34 percent of patients who were hospitalized for at least one night in the past year said “nurses weren’t available when needed or didn't respond quickly to requests for help.”

To learn more, NPR published a call-out to nurses on its Facebook page. It was a non-scientific way to gather information, NPR notes, but the response from nurses was significant. “We received hundreds of responses and read them all: piles of stories about nurses feeling overworked, getting no breaks, no lunches and barely enough time to go to the bathroom. Even worse, many nurses say breaks and lunchtimes are figured into their salaries and deducted, whether they take them or not,” NPR reported on Morning Edition.

The poll also found that consumers see a shortage of nurses and physicians as one of the problems with the quality of health care in the country today. Of the one-third of total respondents who were asked about major reasons for quality problem, 35 percent identified “not enough doctors or nurses in hospitals or medical offices” as a major problem.

Learn more about the Sick in America poll.

Listen to the story on NPR.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the latest nursing news, research and trends. Here are descriptions of some of the stories in the March issue:

Afghan Refugee Takes Long, Arduous Path to the Nursing Career She Loves

New Careers in Nursing scholar Waheeda Siddiqui, who will graduate this fall from an accelerated degree nursing program, has overcome enormous odds to follow in her mother’s footsteps as a nurse. Born in Afghanistan, her family escaped the oppressive clutch of the Taliban and Siddiqui survived a trying childhood in a refugee camp in Pakistan before her family fled to the United States. She achieved academic success at her U.S. high school and a major university before a New Careers in Nursing scholarship allowed her to enroll in nursing school.

New and Expanded RWJF Initiatives Aim to Strengthen Nursing

Read about RWJF’s new initiatives to promote and strengthen nursing, as part of the Foundation’s ongoing commitment to ensuring that nurses can contribute as full partners in a reformed health care system. The recently launched initiatives focus on public health nursing, academic progression, primary care and implementing recommendations from the Institute of Medicine’s Future of Nursing report.

Nursing Profession is Rife with Occupational Hazards

Recent research shows that nurses are at risk for injuries, illnesses and violence on the job. There have been improvements in workplace conditions—like greater access to patient lifting and transfer devices, more use of safe needle devices, and better reporting of workplace violence—but experts say more education and awareness is needed.

Georgia Action Coalition Sows Nursing Campaign Seeds in Rocky Terrain

In a less than hospitable climate for nurse-led changes to health and health care, leaders of the Georgia Action Coalition—now officially known as the Georgia Nursing Leadership Coalition—have made quick and measurable progress in advancing the recommendations of the Future of Nursing report.

Vote for Your Favorite Fictional Nurse

The newsletter’s “In the Media” column, reprinted on this blog, looks at depictions of fictional nurses in movies, books and television. Take a look, leave a comment, and tell us who your favorite fictional nurse is!

See the entire March issue here. Sign up to receive Sharing Nursing’s Knowledge here.

By David Krol, MD, MPH, FAAP, Robert Wood Johnson Foundation Human Capital Portfolio Team Director and Senior Program Officer

For many Americans, a visit to the dentist is a rarity—not by choice, but because their health plans don’t cover dental care, they can’t afford it, or because there is no dentist anywhere near where they live or work. If you’re on Medicare, you know that dental isn’t covered. If you’re part of the VA system, you know that dental benefits are treated differently. If you’re an adult on Medicaid or serve adult patients who are on Medicaid, you know the chances are slim that there’s great coverage for dental care, unless you are lucky to be in a state that still covers it. Why does this happen and what can result?

A study recently released by the Pew Center on the States offers startling data on the scope of the problem and its consequences. In 2009, some 830,000 Americans visited an emergency department for a preventable dental condition. It should be obvious that the emergency department isn’t the best place to seek dental care. The same year, 56 percent of Medicaid-enrolled children got no dental care whatsoever, not even a routine exam. That’s no care even with insurance for it!

Those numbers are alarming for many reasons, but mostly because they reveal a significant public health challenge confronting the nation: Many Americans simply aren’t getting the oral care they need, at any age, including the basic preventive services and education that can detect oral disease in early stages. They are putting their health at risk, and increasing the strain on an already-overwhelmed health care system.

By Nancy Fishman, BSN, MPH and Maryjoan Ladden, PhD, RN, FAAN. Fishman and Ladden are senior program offers at the Robert Wood Johnson Foundation

Spring is blooming all around us here in central New Jersey and that means nice weather, flowers and a constant search for allergy solutions! For those of us on the Robert Wood Johnson Foundation (RWJF) Human Capital team, this brings up several questions about how to use the primary care workforce more creatively. In this scenario, who in the primary care office could help us with our common allergy symptoms? How would we feel if we went in for a visit and didn’t see a health professional but were instead counseled about common over-the-counter treatments by the medical assistant according to standard protocol?

These are questions that seem practical and every day, but tie back to some basic questions about the primary care workforce and how we could be more creative in using all members of that workforce to improve patient access to care and the value of that care.

At the Robert Wood Johnson Foundation, we are all aware of the shortage of primary care providers – but short of producing a large number of physicians, nurse practitioners and physician assistants this instant – we need to get creative with what we have.

To that end, we are thrilled to be launching a new program to identify those practices that are already creatively using their whole office teams in new ways. This program “The Primary Care Team: Learning from Effective Ambulatory Practices” (LEAP) will first identify and then study sites that have succeeded in providing high quality health care and involving all staff in new and creative ways.

We believe that studying these sites will provide us with insights that we can share with other practices that would like to make changes.