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Policy

Jim Stubenrauch is a CHMP senior fellow. Follow him on Twitter: @jimstuben.

It was nine o’clock on Sunday morning, October 14, and an audience of young cancer survivors, their parents and siblings, and physicians, social workers, and other clinicians were gathered in the spacious third-floor library of the New York Academy of Medicine, listening to a keynote address by reality television star Kathy Wakile.

CHMP senior fellow Joy Jacobson and I were there, too—and no, we hadn’t accidentally wandered into an episode of The Real Housewives of New Jersey.

The occasion was the first-ever “Campference”—part camp, part conference—of the Children’s Brain Tumor Foundation (CBTF), an organization dedicated to improving “the treatment, quality of life, and the long-term outlook for children with brain and spinal cord tumors.” The CBTF, which marks its 25th anniversary this year, supports research, education, and advocacy to help both survivors and their families.

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Jim Stubenrauch is a CHMP senior fellow. Follow him on Twitter: @jimstuben.

It was nine o’clock on Sunday morning, October 14, and an audience of young cancer survivors, their parents and siblings, and physicians, social workers, and other clinicians were gathered in the spacious third-floor library of the New York Academy of Medicine, listening to a keynote address by reality television star Kathy Wakile.

CHMP senior fellow Joy Jacobson and I were there, too—and no, we hadn’t accidentally wandered into an episode of The Real Housewives of New Jersey.

The occasion was the first-ever “Campference”—part camp, part conference—of the Children’s Brain Tumor Foundation (CBTF), an organization dedicated to improving “the treatment, quality of life, and the long-term outlook for children with brain and spinal cord tumors.” The CBTF, which marks its 25th anniversary this year, supports research, education, and advocacy to help both survivors and their families.

Health, Policy

Ann Campbell, RN-BC, MPH is a hospice nurse at an inpatient palliative and hospice care program in New York, and is currently an NP student at Hunter Bellevue School of Nursing. She is a research associate for the CHMP.

In nursing, we often joke about needing a feeding tube or urinary catheter ourselves. In the 14-hour workday we are often so focused on patient needs that sometimes it’s a luxury to take a break for food or even use the bathroom.

Every nurse I know wants to help people; patients and their loved ones know this from firsthand experience. However, nurses function within the confines of a system driven by economic, political, and legal forces. The challenge to turn caring into policy can seem insurmountable.

As a public health policy masters student at Columbia University, the topic of nurses in leadership positions triggered a memorable discussion. One classmate, when asked if she thought a nurse could become a CEO of a hospital or other health care organization, responded with a resounding “no.”  Nurses lack the necessary clinical and leadership training, she argued. My classmate raised a provocative question; are nurses prepared to become leaders in the redesign of healthcare?

I believe that nurses are uniquely equipped to lead. In fact, a nurse now leads the Center for Medicare and Medicaid Services (CMS).  And many others are CEOs of health care organizations.

Nurses must have the necessary tools and knowledge to influence this complex system. Obviously, the nursing role has evolved dramatically since the days of Florence Nightingale. Modern nursing education deeply involves sciences, and benefits from accomplished theorists and instructors. There are several masters’ level degrees that prepare nurses for clinical, administrative, and educational leadership. Moreover, two doctoral level advanced degrees are available: the research-focused PhD and the clinical leadership DNP.

The clinical leadership Doctor of Nursing Practice (DNP) coursework has been refined by evidence from the Institute of Medicine (IOM) reports: To Err is Human: Building a Safer Health System (1999), Crossing the Quality Chasm (2001), and Health Professions Education: A Bridge to Quality (2003). DNP clinicians are trained in health policy, scientific underpinnings of practice, organizational/systemic leadership, analytics, health information technology, and interdisciplinary collaboration. These tools can be utilized to produce quality healthcare delivery models.

Development of the DNP curriculum has been so effective that the American Association of Colleges of Nursing (AACN) took a position in 2004 recommending that all APNs be doctorally-prepared. While this is what AACN wanted, the plan will not go into effect by 2015.

Despite this progress, nurses must prepare for the challenges ahead. This includes caring for the 32 million newly insured patients with implementation of the Affordable Care Act over the next 10 years as well as a rapidly aging population. An estimated 1.2 million new nurses are needed by 2020. It also includes developing a strategy for changing the mindset of those who do not understand the leadership capacity of nurses.

The IOM report on the Future of Nursing sets forth clear goals for nurses to lead in this dynamic environment:

  1. Practice to the fullest extent of the scope of their education and training
  2. Achieve higher levels of education and training through an improved education system that provides seamless progression
  3. Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts
  4. Improve data collection for more effective workforce planning, information infrastructure, and policymaking

The implications for practice, research, and advocacy are extensive.  With the right education, nurses will lead innovative transformations in healthcare into the future.

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Ann Campbell, RN-BC, MPH is a hospice

Health, Policy

Dean Dorrie Fontaine, PhD, RN, FAAN

The University of Virginia recently hosted a conversation with the Dalai Lama (who recently received an honorary doctorate from our own Hunter College) and representatives of the UVA health professions leadership, including Dean of the School of Nursing Dorrie Fontaine, PhD, FAAN. Dean Fontaine spoke about an initiative on compassion and mindfulness that the school has created that includes reflective practice.

It’s so encouraging to see the possibilities of creating a health care system that embraces mindfulness. But, as one panelist pointed out, the system’s focus on through-put and volume doesn’t always lend itself to contemplation and pauses. Under the leadership of Senior Fellows Joy Jacobson and Jim Stubenrauch, the Center for Health, Media & Policy at Hunter College is engaged inworking with nurses, other health professionals, patients and families on reflective narratives to promote understanding of oneself and others, promote healing, and reconnecting with the passion that drew us into health care.

I was also encouraged last week when talking with the American Academy of Nursing‘s “Edge Runners”–nurses who have developed innovative models of care for which there are excellent clinical and financial outcome data. These innovators spoke about key elements of their models of care and central to each were the ideas of listening (to individuals, families and communities) and building relationships.

The challenge we face is how to develop public and private policies that support these key elements. It’s not through the 7-minute visit or “drive-through deliveries”. We need all of our best thinkers who understand the importance of mindfulness, listening and relationships to explore how our policies can support these key ingredients to better care and better health in an affordable way. The Edge Runner models provide evidence that these key elements can reduce or contain health care costs.

Click here to watch the entire video or cue it up to 33 minutes to hear Dr. Fontaine describe this initiative.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

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[caption id="attachment_5164" align="alignleft" width="112"] Dean Dorrie Fontaine,

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