Wednesday, November 14, 2007

The Power of the Individual

Our Deans’ lecture series, co-sponsored by my colleague Arthur Rubenstein at the School of Medicine, were created to inform and encourage a thoughtful discourse on the issues that challenge and inspire the nursing and medial community. After listening to Dr. William Foege’s speech on November 13th on the power of individuals, I hope those who could not attend can still read about him and his accomplishments to learn how he practiced what he talks about: the power of the individual in making the world a better place.

From citing the works of Maurice Hillman – the microbiologist Foege referred to as “the Louis Pasteur of our time” – to discussing Molly Melching – the founder and executive director of Tostan, an organization designed to empower African women, Dr. Foege highlighted the many ways in which “individuals make coalitions work.”

Hillman, for example, developed eight out of the 14 vaccinations routinely given to children across the globe, such as vaccines for mumps, measles, chickenpox, pneumonia and meningitis. Hillman, who died in Philadelphia in 2005, “left a legacy pf social DNA,” Foege said. “The product of his mind has gone into millions of people’s bodies and changed them forever.”

That, he said, is the essence of global health: “A million steps in a chain where everything goes right so that everyone at the end benefits.”

I have had the pleasure of serving on the Global Health Council with Dr. Foege for more than four years, and I learn something new and inspiring every time I see him. Beyond his own work – from spearheading the eradication of smallpox to creating a model for improving the rate of immunizations in developing countries – Dr. Foege offers a plan of action to all of us, but most especially to the future generation of health care providers.

The challenges to global health, he explains, are clear: poverty, illiteracy, unemployment, gender bias. But, he maintains, this is the golden age of global health because the tools, the resources and the communication methods utilized are all better. But perhaps most importantly, he added, individuals are making coalitions work.

As I think about the School of Nursing, I see that Dr. Foege’s challenge to the leaders of tomorrow – to think and act both locally and globally – are evidenced in all that we do. Look, for example, at the United Community Clinics, housed in the basement of the First African Presbyterian Church in West Philadelphia, where nursing students experience the challenges of running a free clinic – recruiting volunteers, collaborating with different disciplines, securing funding, addressing community needs. Then note Dr. Loretta Sweet Jemmott, an eminent researcher who has revised her safe-sex curriculum to meet the cultural and community needs of people throughout Africa, where she works on both the governmental level and in the field to help stop the spread of HIV that threatens the continent.

The challenges are many, but we at the School of Nursing are prepared for the task. And perhaps the reason we are so prepared is because we realize that our work –as nurse scientists, clinicians, and members of the global community – is work that makes a difference in the lives of all people. We also focus on vulnerable and underserved populations, and we have answers that could make health care available for all.

I am so grateful to have had Dr. Foege address the Schools of Nursing and Medicine, and I would like to end this blog with some of his own wisdom: As we embark upon the challenges of the future, we must remember who are bosses are – and remember that they are not the ones who sign our paycheck. Our boss is every person who will be born in the future because we are preparing the world in which they will live.

Friday, August 3, 2007

A Solution to the Healthcare Provider Shortage or a New Problem?

Across the globe, the significant shortage in the number of healthcare providers has prompted thought leaders in healthcare to develop numerous plans of action to meet the needs of the sick. The article “Non-physician clinicians in 47 sub-Saharan African countries,” published online by Lancet on June 14, 2007, discussed how 25 sub-Saharan African nations classified by the World Health Organization as having a critical health worker shortage are enlisting the services of non-physician clinicians (NPCs) to fill the void created by a lack of physicians and nurses.
NPCs, while not trained as doctors, can perform many of the same diagnostic and clinical tasks as physicians. In some African countries, NPCs have received advanced training so that they can carry out more specialized tasks, such as administering anesthesia and performing caesarean sections. NPCs are experienced nurses who receive an additional year of education and a six-month internship or non-nurse secondary school graduates who have three additional years of training and a yearlong internship. The NPC system allows nations to provide their citizens, especially those in extremely rural and poor areas, with much-needed healthcare workers who are trained at a fraction of the cost and in less time than it takes to educate and train physicians.
Are NPCs the answer to the worldwide nursing and physician shortage? According to the Lancet article, the sub-Saharan African countries that have employed the use of NPCs are planning to increase their training programs. They have found that NPCs from rural and poorer areas that returned to practice in those same regions were less likely to leave, as has been the case with physicians and nurses.
Since developing nations have struggled to recruit and maintain a sufficient number of nurses and physicians, there are many who say NPCs are a viable, cost effective solution. However, in America and other developed nations, our certified nurse practitioners, midwives, clinical nurse specialists, and nurse anesthetists are trained and qualified to provide quality care and more enhanced access to healthcare. Leaders, elected officials, and/or healthcare ministers from different countries need to recognize the important roles these nurse specialists play in healthcare, provide them with healthy work environments, compensate them well, and amend laws and regulations that will allow them to function up to their education and experience capacities. Providing more funding for educational programs will also attract more potential nurses to the field and keep them practicing.
The nursing shortage is at a critical stage around the world and it will only become worse as the population ages. It is time to make a commitment to finding qualified healthcare providers and offering creative solutions that do not include developing new categories of workers. NPCs confuse the public, and may decrease women’s and men’s interest in nursing education. Could this accelerate the nursing shortage? What are your thoughts?

Tuesday, July 31, 2007

A Historic Day for Pennsylvania at Penn Nursing



July was a historic time for the nursing profession and healthcare in Pennsylvania. Our state legislature approved several of the first bills that are a part of Governor Ed Rendell’s Prescription for Pennsylvania healthcare reform plan, including those that expand the scope of practice for nurses, nurse practitioners, clinical nurse specialists, midwives, dental hygienists, physician assistants.

To celebrate this milestone, on July 20 Governor Rendell once again came to our School, where he signed the bills into law. In January, we were excited to host the governor, honored guests, and a standing room-only crowd when Rx for Pennsylvania was unveiled at our School. It is wonderful to see that, with the passage of some of the plan’s components, Prescription for Pennsylvania is coming to fruition.

The governor’s plan is important, not only because it will increase access to affordable medical coverage for uninsured Pennsylvanians and allow all healthcare workers to play an expanded role delivering healthcare services, but also because it places Pennsylvania at the forefront of the nation’s healthcare reform initiatives.
Across the country, elected officials are debating similar legislation. We applaud Governor Rendell for being a visionary and making the hot topic of healthcare one of his administration’s top priorities. We thank him and our state representatives for understanding the capabilities of nurses, nurse practitioners, clinical nurse specialists, and midwives by providing measures in the laws that allow these licensed professionals to use their education in providing evidence-based practice that is not limited because of outdated regulations.

This is just the beginning of healthcare reform in Pennsylvania. For complete adoption, the plan will require the passage of almost 50 bills and the creation of numerous new rules and regulations. At the School of Nursing, we have been actively involved in working for the plan’s approval as it relates to nursing, nurses, and midwives. We established two taskforces that have closely followed the legislative process, contacted elected representatives from across the Commonwealth to encourage their support of the bills, and informed students, faculty, staff, alumni, and the public about the importance of this historic plan and the significance of having their voices heard by their representatives.

We will continue to follow with great interest the progress of the additional components of the Prescription for Pennsylvania plan. For updates, I encourage you to visit http://www.rxforpa.com/.

Thursday, May 24, 2007

Perspectives on the Challenges in Global Health

Alumni Weekend is a wonderful time to catch up with old friends and celebrate our University and our School. Alumni Weekend also presents the opportunity to become engaged with Penn graduates from across the University through a variety of discussions and activities.

I recently had the opportunity to participate in a discussion on “Health in the Developing World: Meeting the Challenges,” hosted by the Leonard Davis Institute of Health Economics (LDI) and held at The Wharton School. LDI is a cooperative venture of the Schools of Nursing, Medicine, and Dental Medicine, Wharton, the Annenberg School of Communication, and Children’s Hospital of Philadelphia. Along with Dr. Richard Cooper from the School of Medicine and Dr. Mark Pauly from the Wharton School, we discussed three of the many pressing healthcare issues facing citizens around the world — the safety and health of women, worldwide physician and nursing shortages, and healthcare financing systems.

While it is true that around the world, the average life expectancy is higher for women than for men, the quality of life for women is much worse. Women are physically abused, maimed, killed for the actions of their families members, for what others perceive as inappropriate behavior, or simply for being female. Women are trafficked not only by “business associates,” but also by members of their families, and forced into teenage marriages. The many rules and traditions in the developing countries ignore the health, safety, and well-being of women. Achieving global health is not possible without empowering, educating, and financing women’s initiatives.

Global health is profoundly influenced by shortages of healthcare professionals. These shortages have prompted shifting of human resources from the developing to the developed world. Our discussion revealed that the developed world takes doctors and nurses away from countries that desperately need healthcare providers. AIDS, malaria, and other diseases are decimating the populations in Botswana, Sierra Leone and sub-Saharan African nations because there are not enough caregivers to provide care to those who need it most. The developed world has a moral obligation to address the shortage issue first in their countries as well as collaborating with international organizations in providing equitable solutions that are global.

Achieving better health is also not possible without reliable insurance systems available to all citizens. Many countries have universal healthcare, but out of pocket costs are too expensive for many residents, so costly that some families need to choose between paying for everyday necessities or paying for medical services. Solutions to this situation could include creating insurance systems that provide real support and creating community insurance programs in which members of villages pool their money in a common pot controlled by the community and used by the community in case of emergency.

For many of the discussion’s participants, this was the first time they had to opportunity to hear about world health issues directly from those who have been immersed in it for many years. It is an insightful learning experience for all to discuss health-related issues from different fields and perspectives, including engineering, law, and business. We brought to the discussion different angles on the global health problems and provided very different solutions. The different perspectives provided promoted conversations that are necessary to inspire action and evoke change. While it is easy to define the major problems, it is far more complex to outline action plans and even more complex to implement change. Thought leadership, partnership between different disciplines, and intersectional collaborations are “must have” ingredients for solving global health problems.

Tuesday, May 22, 2007

The Importance of Advanced Nursing Degrees

This month we celebrated the commencement of the 323 members of our Class of 2007. As we continue to fight the growing nursing shortage, each Penn Nursing graduation is a significant milestone — it means that we have prepared another outstanding cohort of exceptionally educated professionals who are ready to meet our nation’s healthcare needs.

In its April 15, 2007 issue, Parade magazine featured the article “The Hottest Jobs (No College Degree Required)” and included registered nurses in that category. After receiving numerous responses from the nursing community, including the president of the American Association of Colleges of Nurses (AACN), Parade issued the following apology:

“We [also] regret any misunderstanding that may have been caused by the
inclusion of registered nurses…. While non-college diploma and certificate
programs do exist for th[ese] occupation[s], the majority of RNs…have college
degrees and additional levels of training.”

While I am pleased that Parade acknowledged its error and issued a retraction, I am reminded again that many journalists still do not differentiate between different educational levels nor understand the value and importance of BSN, MSN, and PhD degrees in the field of nursing and how these degrees relate to the quality of care delivered.

The American Nurses Association, American Organization of Nurse Executives (AONE), and AACN have declared that all practicing nurses should have at least a BSN. The AONE declared the BSN as the degree of choice for practicing nurses. Why?

At the University of Pennsylvania School of Nursing, our undergraduates are taught not only the fundamentals required for practice, but also the importance of incorporating nursing research, ethics, history, and humanities into their work. Over the course of their four years as baccalaureates, our students are encouraged to participate in faculty research projects in our research centers of excellence. Our students have the opportunity to advance their knowledge base and to develop the evidence for best practice models. They are given the opportunities to study abroad and to enroll in a joint degree program in health care management with Penn’s Wharton School. Clearly, when Penn Nursing students graduate, they are ready to hold responsible positions in all healthcare settings and are on track to become expert clinicians, managers, care coordinators, and faculty members who will teach the next generation of nurses.

During four years of study, BSN students experience complex clinical judgment and experiment with critical thinking through on-site clinical rotations in a variety critical care, home health, public health, and community settings. They have learned not only how to care for patients across the healthcare continuum and coordinate care plans with other providers, they have also acquired the skills necessary to make quick, clinical judgments and life saving decisions.
This is why nurses with BSNs and higher degrees are in demand. Dr. Linda Aiken, Penn Nursing’s own Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research, and her research team reported in the Journal of the American Medical Association in 2003 that hospitals with a higher proportion of nurses with bachelor’s degrees have a lower mortality rate. In fact, each 10 percent increase in proportion of staff nurses with BSNs is associated with a five percent decline in mortality and a five percent decline in failure to rescue patients experiencing a complication.

Hospitals and healthcare institutions cannot afford the consequences of undereducated nurses. The universal requirement of a minimum of a bachelor’s degree should be adopted to make some of the “hottest jobs” in America safer for everyone. We are proud of our graduates for what they achieved and for what they will accomplish.

Wednesday, April 25, 2007

Proposed Federal Budget Could Impact Nursing Shortage

This is a critical time for nursing. Our ongoing efforts to alleviate the shortage of nurses at the bench, bedside, and in the classroom are facing a setback if President George W. Bush’s proposed fiscal year 2008 budget is approved without modification.

While we appreciate the President’s support now and historically for nursing, this year’s budget presents nursing schools with a $44 million decrease in funding for Nursing Workforce Development Programs and provides no funds for the Advanced Education Nursing program. The American Association of Colleges of Nursing (AACN) indicates this lack of funding for the Advanced Education Nursing program could eliminate the grants and traineeships that provide vital financial support for graduate nursing students and future nurse faculty. The AACN reported in 2006 that almost 42,600 qualified applicants were turned away from baccalaureate degree programs primarily because of a faculty shortage. And we know that with projected retirements for current nursing faculty members that we need to renew the pipeline today for tomorrow’s teachers.

In 2004, the Associated Press reported that the average age of a nursing faculty member as 51.5 and the average retirement age as 62. At this rate, we will lose hundreds of nurse educators each year for the next 15 years. Unfortunately, without federal support of our academic assistance programs, there will continue to be a limited number of doctorally-prepared faculty and an overall lack of qualified teaching applicants. Without funding, institutions will not be able to offer competitive salaries to potential professors interested in teaching clinical courses and conducting research.

As the U.S. population ages, we need not only to be concerned with attracting and preparing more caregivers to the nursing profession, we also need to work toward educating the researchers who will make a difference in advancing healthy aging outcomes, as well as training the future faculty members who will replace our retiring workforce.

President Bush has recognized the importance of the impending nurse shortage by offering increased support for the National Institute of Nursing Research and the Nurse Loan Repayment and Scholarship Programs which will help incoming students. However, the potential cuts in funding for graduate nursing education programs could impact the ability of schools of nursing to produce sufficient numbers of educators to teach the 800,000 nurses our country will need by 2010.

Working together, we can show our president and elected officials the importance continued funding of all nursing programs and initiatives. For more information on the proposed FY 2008 federal budget and its impact on nursing and healthcare, visit www.aacn.nche.edu.