Category Archives: Health policy
Efforts to expand the role of nurse practitioners (NPs) to help address the country’s shortage of primary care providers have been bolstered by legislation in several states. But laws expanding scope of practice may not do all they could to relieve the nation’s primary care crisis, according to a new study by researchers at the Columbia University School of Nursing, which suggests that the culture in health care settings can impede full utilization of NPs.
The study, published in the Journal of Professional Nursing, was conducted in Massachusetts, where state health reform increased demand for primary care and legislation recognized NPs as primary care providers. Researchers found that gains made by government can be neutralized by formal and informal practices at health care organizations. For example, the study cited instances where NPs were not allowed to conduct physical assessments or see new patients.
“Organizational policies can often trump governmental policies, keeping the contribution of the nurse practitioner unrecognized and preventing them from making the fullest contribution possible to effective patient care,” lead researcher Lusine Poghosyan, PhD, RN, an assistant professor of nursing at Columbia and a Robert Wood Johnson Foundation Nurse Faculty Scholar, said in a news release.
Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW). Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*
It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.
Susan B. Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF) and director of the Future of Nursing: Campaign for Action, has been elected to the Institute of Medicine (IOM), the venerable institution announced this morning. It is one of the highest honors in the fields of health and medicine.
Hassmiller shapes and leads RWJF’s strategies to transform the nursing profession to improve health and health care. She joined RWJF in 1997. In 2009, she received the Florence Nightingale Medal, the highest international honor given to a nurse by the International Committee of the Red Cross. Read more about Hassmiller’s election to the IOM.
Among the IOM’s 80 new members are two other nurses: Beverly Louise Malone, PhD, RN, FAAN, CEO, National League for Nursing, New York City; and Bernadette Mazurek Melnyk, PhD, RN, FNAP, FAANP, FAAN, associate vice president for health promotion, College of Nursing, Ohio State University, Columbus.
Established in 1970 by the National Academy of Sciences, the IOM is widely recognized as a national resource for independent, scientifically informed analysis and recommendations on health issues.
Tammy Chang, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.
Over kitchen tables as well as on Capitol Hill, the discussion continues over the Affordable Care Act including who will benefit and what it means for everyday Americans.
To shed light on this debate, my co-author Matthew Davis, MD, MAPP, and I recently published a study that describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act. The study, published in the Annals of Family Medicine, uses a national source of data used by many other researchers who look at national trends—such as high blood pressure and obesity—called the National Health and Nutrition Examination Survey (NHANES).
Alexia Green, RN, PhD, FAAN, professor and dean emeritus, Texas Tech University Health Sciences Center and co-leader of the Texas Action Coalition. She is an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program.
As a nurse, I have long desired to be a full partner with physicians and other health care leaders in improving health care delivery in our country. The truth is many nurses have this desire, but all too often we are not viewed as key players in the larger policy arena. When the Institute of Medicine Future of Nursing report was issued in 2010, I was very excited to see a major emphasis placed on nurses become full partners in redesigning health care in the United States.
I personally became intrigued with impacting health care policy while a graduate student at the University of Texas Health Sciences Center in Houston—where my professor, Dorothy Otto, encouraged me to become engaged, providing me with a vision that policy was something I could shape and develop rather than passively watch. My engagement with the Texas Nurses Association and the Robert Wood Johnson Foundation Executive Nurse Fellows program helped solidify my leadership skills to be well prepared to actively serve on boards where policy decisions are made in hopes of improving health systems to advance patient care.
Susan Reinhard, PhD, RN, FAAN, is senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America, which coordinates the Future of Nursing: Campaign for Action. Here, Reinhard reflects on the impact of the Institute of Medicine’s Future of Nursing report during its third anniversary week.
The Center to Champion Nursing in America was founded six years ago as an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation (RWJF). Ever since, we have devoted considerable energies and resources to transforming the nursing profession to better serve consumers.
Why is AARP so invested in this work? One simple reason: Nurses, the largest segment of the health care workforce, provide critical care to our members, many of whom are aging and managing multiple chronic health conditions. Our work is not as much about improving conditions for nurses as it is about making life better for consumers and their families. A larger, more highly skilled nursing workforce will improve access to higher-quality, more patient-centered, and more affordable care. That is especially important now, with demand for nursing care growing as the population ages and as millions more people enter the health care system under the Affordable Care Act.
That is why we, at AARP, have made it our mission to ensure that all people have access to a highly skilled nurse when and where they need one.
Italo M. Brown, MPH, is a rising third-year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social & behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. Read all the blog posts in this series.
In 1986, Congress took a step in the direction of patient advocacy by passing the Consolidated Omnibus Budget Reconciliation Act (COBRA). One part of this act, the Emergency Medical Treatment and Labor Act (EMTALA), has served as the precedent for federally mandated care and has largely shaped our understanding of urgent care delivery in America. While some have touted EMTALA as a public health victory, many have scrutinized the federal mandate, citing its imperfection and labeling it as a strong contributor to the current ailments of our emergency medical system.
However, 27 years after EMTALA became law, a greater emphasis is placed on preventive measures and comprehensive care, rather than urgent care, as a means to reduce negative health outcomes. Naturally, champions of cost-efficient comprehensive care have suggested that a federal mandate should be explored.
Clyde Evans, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program and president of CE Consulting in Needham, Massachusetts.
In 1995 I was getting “media training” with another colleague, consisting mostly of being interviewed on camera and then critiquing the tape. At one point the consultant stopped the taping of my colleague (a medical school dean) and said “we know you’re smart; we want to know what you’re passionate about.” Though I wasn’t asked at the time, I realized I couldn’t say (or didn’t know) what I was passionate about. I figured I’d better find out.
"It is not important what your particular mission is. It’s only important that you have one."
In pretty short order I came up with this: “I want to help ensure that every man, woman and child in the U.S. has a chance to live a healthy life.” That “personal mission statement” subsequently led me to the RWJF Health Policy Fellows program and guided me as a fellow, becoming a kind of “litmus test” for me: “How does (or could) X help to give people a shot at a healthy life?” If I could see that connection, I could care about whatever X was. While this dynamic was admittedly personal and idiosyncratic, it still helped me navigate several key decisions during my fellowship year.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
The RWJF Health Policy Fellows program will celebrate its 40th anniversary this year. The program supports exceptional midcareer health professionals and behavioral and social scientists to actively participate in health policy processes at the federal level and gain exclusive, hands-on policy experience. Heralded as the “nation’s most prestigious fellowship at the nexus of health science, policy, and politics,” the Health Policy Fellows program provides health professionals the opportunity to work on Capitol Hill and in the Executive Branch, gaining front-line experience in federal health policy-making and an insider’s perspective on our country’s political process.
Founded in 1973, the program is supported by the Robert Wood Johnson Foundation (RWJF) and sponsored by the Institute of Medicine within the National Academies of Science.
Health Policy Fellows have become some of the nation’s most influential leaders in the health care field. As professors, deans, and presidents at major academic institutions, directors of voluntary health organizations and health professional societies, leaders in state and federal government, and experts at think tank and advocacy organizations, the Fellows are transforming the nation’s health care policy and practice.
The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College will graduate six scholars with certificates in health policy during Meharry Medical College’s 138th Commencement Exercise this weekend. Having completed the Center’s health policy education program, the scholars are poised to join the nation's leading health policy experts, researchers, and analysts. They will focus on caring for minority and underserved communities in their careers.
The graduating scholars are:
- Kevin Blythe, MSPH, School of Medicine
- Lamercie Saint Hilaire, School of Medicine
- Ashley Huderson, School of Graduate Studies and Research
- Brandon Morgan, School of Dentistry
- Rebbie S. Timmons, School of Graduate Studies and Research
- Nadia Winston, School of Graduate Studies and Research