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Congressional Report: Congress Has Some Unfinished Business as New Term Begins AAMC Efforts Help Roll Back CMS Paperwork Requirements Innovations in Medical Education: Doctors-in-Training Learn How to Tell Stories Healing Deep Wounds: Program at Bellevue / NYU Provides Care for Torture Survivors Nursing Shortage Prompts Creative Solutions Author Q&A: 'Sometimes Wrong, Never in Doubt' 'Flagging' Debate Continues; Data Show Score Fluctuations A Word from the President "A Day in the Life of a Medical Student"
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Nursing Shortage Prompts Creative SolutionsThe latest U.S. Department of Health and Human Services (HHS) report analyzing the nursing shortage issued a stark warning: If the current workforce crisis is not addressed and if trends continue, the shortage is projected to grow by 29 percent by 2020. Fortunately, nursing schools and academic medical centers (AMCs) have been responding to the crisis in proactive and creative ways. Many academic institutions have boosted student recruitment efforts and expanded the academic options available for individuals interested in nursing careers through initiatives such as second-degree bachelor's programs, long-distance education options, and the infusion of information-technology classes into their curricula.
Emory University's Nell Hodgson School of Nursing last fall launched a specialized program for individuals who have earned bachelor's degrees in fields other than nursing. After three years of study, graduates of the Emory Nursing Segue Program earn both a bachelor's (B.S.N.) and a master's of science (M.S.N.) degree in nursing. "Declining enrollments in nursing schools, drastic changes in the financing and organization of healthcare systems, and rapid technological advances in all aspects of health care contributed to the current nursing shortage," says Marla Salmon, R.N., Sc.D, FAAN, dean of Hodgson. "The Segue Program will produce more nurses and a leadership corps with a broad background to find innovative solutions to our healthcare challenges." The Duke University School of Nursing, in partnership with Duke University Health System, has also developed a second-degree B.S.N. program for students who have a bachelor's in fields other than nursing. The program is accelerated and clinically intensive, requiring its students to perform 1,000 clinical hours, which is twice the requirement of many regular BSN programs. Fifteen of the program's required 58 credits can be applied toward a master's degree. "We have a strong relationship with our academic medical center," explains Mary T. Champagne, Ph.D., M.S.N., B.S.N., Duke University School of Nursing dean. "This makes this degree program quite advantageous. Students can participate in a loan forgiveness program that allows them to work in one of our AMC's hospitals after graduation and, for every year that they work, have a third of their loan paid off by our health system." After the third year of working in Duke's AMC, up to $30,000 in loans can be paid off, says Dr. Champagne. It's a win-win situation for participating students, Dr. Champagne adds. "Out of our program's current 40 students, 35 have signed for the loan- forgiveness program, and they are guaranteed a job in a world-class aca-demic medical center after graduation," she boasts. Another program designed to increase the number of B.S.N.-edu- cated nurses is being implemented in Cedars-Sinai Medical Center, in Los Angeles. The state of California is dealing with a severe nursing shortage, and ranks 49th nationally in the number of registered nurses per capita. The statewide nursing vacancy rate averages between 15 and 20 percent. "The state of California, more so than any other state, has a limited capacity to produce baccalaureate-degree nurses," explains Cedars-Sinai's chief nursing executive and vice-president Linda Burnes Bolton, Dr.P.H., R.N. This is in large part due to a decision by the University of California system to adopt a policy to gradually slash B.S.N. programs for nurses, she explains. New institute createdReacting to the policy, Cedars-Sinai Medical Center created last year the Institute for Professional Nursing Development. In order to assure the availability of a qualified nursing force, the medical center will attempt to increase the number of graduates with BSN degrees through a partnership with California State University, Los Angeles (CSULA). Cedars-Sinai will support the expansion of CSULA's Nursing Program by funding 20 additional students throughout the students' three-year educational program. In addition, clinical rotations of nursing students will be completed at the medical center. "With the creation of a world-class nursing institute, we are working to increase the pool of qualified nurses," says Thomas Priselac, president and CEO of Cedars-Sinai. "Our partnership with CSULA is one example of how we are working to better meet the health needs of our communities," he says. Another way that Cedars-Sinai has attempted to tackle the nursing crisis has been by seeking to expand diversity in nursing programs. The center's Youth Health Academy supports individuals from disadvantaged backgrounds who would otherwise not be able to pursue a nursing education. Students participating in the program start working at Cedars-Sinai while juniors in high school, and, later, the medical center pays their nursing school tuition. There are currently 20 students enrolled in the program, according to Dr. Bolton. Nursing schools and academic health centers have also tried to tackle the shortage by offering working nurses the opportunity to receive bachelor's and master's degrees without leaving the workforce or their communities. "The University of Kansas has received national recognition for its online [nursing] program," explains Karen Miller, Ph.D., R.N., FAAN, dean and professor of the University of Kansas School of Nursing and dean of the University of Kansas School of Allied Health. The university offers several degrees online, ranging from B.S.N. to M.S.N. degrees, Dr. Miller says. "We are the only academic medical center in the state, and we feel that we have an obligation to reach out and partner up with other baccalaureate regions' institutions and schools of nursing to provide good distance education options," she says. "We offer educational options for people who are working and whose communities can't afford to have them leave to go to school." "Our most successful program has been the family nurse-practitioner program," continues Dr. Miller. "It has been a successful distance-education program for a long time, and it is now Web-based. People can take courses from wherever they are, and get hooked up with experts in their communities for their clinical practices." In thinking about proactive ways to address the shortage, nursing schools and academic medical centers have also implemented information technology programs into their curricula. The University of Kansas School of Nursing and Cerner Corporation, a supplier of clinical and management information and knowledge systems, have created a program to educate nursing students using clinical information systems. University of Kansas nursing students can track patient information trends electronically in a state-of-the-art laboratory through a simulated electronic medical record powered by Cerner Millennium IT solutions. "We now have the tools needed to teach our students how to use electronic patient-record systems that assist health professionals to make decisions about care or services rendered," says Dr. Miller.
"For our graduating healthcare students to function completely in this electronic information age, our educational approaches must address the new skill sets and languages needed to change the way data is structured, recorded, and communicated," she says. "The KU School of Nursing is providing its students and graduates a competitive advantage in the marketplace and a comprehensive under- standing of how information tech- nology is playing a vital role in the improvement of nursing care." The program addresses the nursing shortage in a very fundamental way, says Dr. Miller. "One reason why nurses are going out of the field is the lack of good integration of technologies that results in loads of paperwork," she explains. "Documentation has quadrupled in the last decade due to various federal and state healthcare regulations, and people are just bogged down with papers." This situation has translated into nurses having to spend far too much time dealing with documents and less time with patients, Dr. Miller continues. "Nurses don't go into health care to be with paper," she says. "They are far less satisfied with a day filled with demands for keeping records than they are with interacting with patients and actually doing good nursing care." Shortage felt in dwindling facultyBeyond the shortage in hospitals and clinics, the nursing shortage can also be felt in declining student applications and in a nursing faculty shortage. Duke is tackling this problem through a program done in partnership with the Southern Region Area Health Education Center. "In North Carolina, we have a large number of associate-degree programs for nurses, many of them in rural counties, but a lot of these programs don't count with enough faculty," says Dr. Champagne. According to state law, professors need at least a master's degree in order to teach in a community college nursing program, she continues. "So we are now doing an online master's degree program in nursing education. We have 32 students enrolled and about two-thirds plan to become community college teachers, while the other third wants to work as educators in rural shortage areas." Besides programs at the institutional level, the states and the federal government have approved a number of programs and legislation designed to address the workforce and the faculty nursing shortage. The Nurse Reinvestment Act, which was recently signed into law, authorizes a number of programs that attempt to increase the number of nurse faculty and the overall number of working nurses. Although a legislative success, it has not yet been funded. "It's going to be very important for the U.S. Congress to put some funding behind the Nursing Reinvestment Act," says Cedars-Sinai's Dr. Bolton. "Passing it is great, but we need real money to be able to implement all the proposed programs." AHCs can helpA report by the Nursing Shortage Advisory Committee of the Association of Academic Health Centers states that AHCs can play crucial roles in helping to reverse the nursing shortage. Among the suggestions cited are things such as strengthening nursing education programs by training nurses at the graduate level to prepare students to fill the needs for advance-practice nurses. Another suggestion is to form cooperative networks for nursing education and research, such as networks with non-university-based nursing education programs in their region, much like what the University of Kentucky's School of Nursing is doing. Dr. Bolton says that solving this complex public health crisis will call for a multifaceted approach. "To address the shortage you need to work with aca-demic institutions to build programs that enhance the ability of the existing workforce to be as productive and knowledgeable as it possibly can, as well as attract new individuals into the workforce to have a pipeline of new entrants into the profession," says Dr. Bolton. "You also have to collaborate and develop new models of care, and technology can assist in that effort." Dr. Champagne agrees that technology plays a crucial role in addressing the shortage. "AHCs should try to work out systems in which nurses spend less time nursing the system and more time nursing the patients," she says. Collaboration and respect among the health professions could go a long way in improving the work environment for nurses and their job satisfaction, according to Dr. Miller. "AHCs have the capacity to be labs for helping students from across the various disciplines to learn together," she says. "Our AHC has multiple kinds of schools of health professions, and it is possible for us to help students learn how to be educated together so that they can function as a team later, for the public good. That's been one of our problems as health educators: historically we've done too much 'silo education,'" she says. - Suria Santana, ssantana@aamc.org |
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