Marilyn Oermann to Receive Award for Excellence in Nursing Education

Duke University School of Nursing Scholar Dr. Marilyn Oermann to be Honored with

the Elizabeth Russell Belford Award for Excellence in Education

from Sigma Theta Tau International

Durham, NC…Dr. Marilyn Oermann, director of evaluation and education research at Duke University School of Nursing is the recipient of the Elizabeth Russell Belford Award for Excellence in Education by the Sigma Theta Tau International (STTI), the honor society of nursing. The award, named in honor of one of the five founding members of STTI, is awarded every two years and pays tribute to excellence in teaching, significant contributions toward advancing the science of nursing and influencing the professional practice and public image of nursing.

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Interesting Podcast with Jeffrey Beall

Thanks to Tom Long, who brought this podcast to my attention via the INANE listserv. Stewart Wills of the Scholarly Kitchen interviews Jeffrey Beall, librarian the the University of Colorado, Denver who maintains the blog, Scholarly Open Access. Jeffrey is also going to be speaking at INANE 2014 in Portland, ME next summer.  From the website:

In this episode, we talk with librarian Jeffrey Beall of the University of Colorado, Denver — who maintains a celebrated scholarly publishing “hall of shame,” the list of predatory open access publishers and journals and blogs regularly at — about the inherent vulnerability of gold open access to scams and fraud, the potential pitfalls of article-level metrics, and where his research on the scholarly publishing environment is headed.

Note that near the end of the podcast, Jeffrey mentions doing research on predatory journals in nursing–that is specifically for INANE. He is going to be on sabbatical at the beginning of 2014, doing research on predatory publishers and journals. He will be presenting his findings (among other things) at the conference.

New Editor for International Nursing Review

Geneva, Switzerland 17 May 2013 – Sue Turale has been announced as the new editor of the International Nursing Review, replacing Jane Robinson who has edited the INR, the official journal of the International Council of Nurses, for the past 11 years.

Dr Turale, previously Editor-in-Chief and Editor of the journal Nursing & Health Sciences, said, “I am delighted to be appointed to work with the International Council of Nurses and the INR Editorial Board, reviewers and authors around the world.  This is a prestigious and historic journal. I have observed it to play an important global role in the dissemination of knowledge to improve nursing and midwifery practices, health, health care and health policy. Since I love working across cultures and countries, sharing ideas, learning from others and developing scholarship, I value this opportunity to build on the significant work of Dr Robinson and others to grow INR as an even more vital resource for the future”.

Dr Sue Turale

Dr Turale trained as a psychiatric nurse, general nurse and midwife, and holds nurse registration in Australia.  She received a Diploma of Applied Science (Advanced Psychiatric Nursing) and a Bachelor of Applied Science (Advanced Nursing) from Phillip Institute of Technology, Melbourne (now RMIT) and a Master of Nursing Studies from La Trobe University, Melbourne.  In 1999 she obtained a Doctor of Education from the University of Melbourne, and is a Fellow of both the Australian College of Nursing and the Australian College of Mental Health Nurses.

After many years working in clinical, management and education roles in psychiatric nursing, Dr Turale became a lecturer at the University of Ballarat, Australia where she later worked as Deputy Head and Director of International Programs, and Associate Professor and Head of the School of Nursing. From 2001-2003 she was the Inaugural General Manager of the Helen Macpherson Smith Institute of Community Health, part of the Royal District Nursing Service in Melbourne.  She then became Director of Nursing and Strategic Planning Consultant at Medea Park Residential Care in St Helens, Tasmania. In 2005, Dr Turale managed the National Indigenous Nursing and Midwifery Education Project at CATSIN, and then became Professor of International Nursing at the Faculty of Health Sciences, Graduate School of Medicine, Yamaguchi University, Ube, Japan – a position she held for seven years. In 2006, she also took on the job of Editor-in-Chief, Nursing & Health Sciences. Currently she works as visiting professor in a number of countries in the Asia-Pacific region assisting in capacity building of the profession and health care systems through education, research, and developing scholarship.

Jane Robinson, who has been editor of the INR since 2003, said: ” I have loved editing INR and working with authors in helping to disseminate so much valuable scholarship across the globe.  It is time to move on, and I am delighted to hand over to the capable hands of Dr Sue Turale.  I know that we share the same values in encouraging nurses to publish from around the world, and the future is bright for INR.  I also thank ICN for this wonderful opportunity to work internationally, and to be a small part of ICN’s incredibly important global mission.”

Notes to editors:

About International Nursing Review

The International Nursing Review (INR) is the official journal of the International Council of Nurses (ICN). It is a quarterly, peer-reviewed journal that focuses predominantly on nursing and health policy issues of relevance to nurses and has an increasing impact factor. INR welcomes original articles that help to forward ICN’s global mission by representing nursing, advancing the profession and shaping health policy. INR also contributes to the ongoing development of nursing internationally with its regular section on International Perspectives. The diverse international readership of INR is located in more than 130 countries. Published both in hard copy and on-line, INR is a key resource for nurses worldwide.

INR encourages unsolicited original manuscripts where nurses describe the policy relevance of their work and document their experience and research. Authors are encouraged to develop a ‘global intelligence’ on nursing and to address INR’s diverse audience by exploring beyond local or national interests to the more general, global application of the principles underlying their work. Background information on the local arrangements for nursing and health care in a country also provides useful context for this global readership. Policy concerns of this journal include: regulation of the profession, workplace issues, innovations in practice, patient safety, quality improvement education, ethics, nurses’ and midwives’ work-life experiences, and the impact of globalization and technology on nursing and health and social policy.

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.

Why Nurses Need More Authority

An interesting op-ed piece from The Atlantic. My thanks to Thomas Long, PhD, Associate Professor in Residence at the University of Connecticut for bringing it to my attention.


Allowing nurses to act as primary-care providers will increase coverage and lower health-care costs. So why is there so much opposition from physicians?  

Think it takes a long time to get an appointment with a primary care provider now? Brace yourself: it will likely only get worse. We’re facing a severe shortage of primary care physicians in the nation. The Association of American Medical Colleges predicts a shortfall of 29,800 primary care physicians by 2015, and 65,800 by 2025, mainly because of the anticipated increase in demand for services from the Affordable Care Act (ACA), deterrents to entering the field, such as relatively lower incomes, and growth in the general population and specifically growth in the elderly population. Should the ACA pass muster with the Supreme Court next month, an additional 30 to 33 million previously uninsured Americans will be covered — and even if ACA is not implemented in full, and in the end merely expands Medicaid, it will add 17 million to the insured ranks by 2020.

One of the best ways to alleviate this shortage is to expand the scope of practice for advanced practice registered nurses (APRNs), well-trained registered nurses with specialized qualifications who can make diagnoses, order tests and referrals, and write prescriptions. APRNs could provide a variety of services that primary care physicians now provide.

The definitive word on medical practice in America — the highly respected and impartial Institute of Medicine (IOM) of the National Academy of Sciences — has weighed in on this idea of allowing APRNs to do more, in a landmark 2010 report “The Future of Nursing.” The IOM conducted an exhaustive review of all the available studies of the efficacy and safety of care provided by APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians. They can provide wellness and preventive care services, diagnose and manage common, uncomplicated acute illnesses, and help patients manage chronic diseases such as diabetes. In its report, the National Academy of Sciences recommended that “[a]dvanced practice registered nurses should be able to practice to the full extent of their education and training.”

But despite an urgent need and clear evidence that APRNs can complement and extend primary care providers’ roles — without sacrificing quality of care — nurses are only permitted to practice independently to the full extent of their training and competence in 16 states and the District of Columbia. The remaining states impose regulatory barriers that limit their scope of practice. These barriers should and can be removed.

But the turf wars of organized medicine are preventing progress. The American Medical Association, the American Osteopathic Association, the American Academy of Pediatrics, and the American Academy of Family Physicians all oppose expanding the scope of nurse-practitioner responsibilities, despite the IOM report and recent research demonstrating that an expanded scope of practice for APRNs has no impact on primary care physician income.

In Colorado, where there are far too few anesthesiologists available for rural and critical access hospitals, the state’s medical and anesthesiologists societies sued to overturn former Governor Bill Ritter’s 2010 decision to allow Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia and pain management care in these hospitals. Instead, they prefer to make people travel hundreds of miles out of their communities to have a procedure that a CRNA is licensed and trained to carry out. They are also apparently fine with hospitals being forced to close as a result of a lack of anesthesiologists. This is a classic example of doctor-centric care trumping patient-centric care.

Apparently the physician organizations are threatened by some mix of concerns about lost income and their traditional position as “captain of the ship.” Those opposed to expanding the scope of nurses’ practice also argue that physicians with more years of training under their belts must necessarily know more than an APRN ever could. Of course they know more, but it is well established that they do not know more about providing the core elements of basic primary care.

And why primary care physicians — already overburdened and overworked — wouldn’t want some support with routine care and services is puzzling. Allowing well-trained APRNs to handle routine care frees up physicians focus on diagnostic dilemmas and more complex management issues while dramatically reducing waiting times for care.

Expanding nursing scope of practice not only can help fill the gap in primary care providers, but it can save money as well. RAND estimates that in Massachusetts, using nurse practitioners to their full capacity could save the state between $4.2 and $8.4 billion over ten years. Other studies find sizable savings from care provided by nurses in clinics in retail pharmacies. In these cases, APRNs have the authority to diagnose, treat, and prescribe medications, among other services. Also, tapping nursing’s potential is the fastest and least expensive way to meet growing demand for primary care. Nurses can be trained faster and for a lot less than medical school costs. Between three and 12 nurses can be educated for the price of one doctor.

There is hope. Employers and patients are beginning to clamor for progress in this area and the turf wars may lose steam as we move away from fee-for-service and toward accountable care organizations, in which a team of providers takes responsibility for the well-being of a population in return for global rather than provider-specific payments. The Federal Trade Commission may provide a further nudge. It has weighed in on a handful of states’ efforts to restrict nursing’s scope, finding cause for anti-competitive practices and, in some cases, evidence that the restrictive laws protect professional interests rather than consumers.

The remaining 34 states that restrict APRN’s scope of practice will eventually have to come to terms with a growing shortage of physicians and increasing demands to save money and restructure how we receive and pay for health care. The inconsistent, often punitive, and highly politicized regulatory environment surrounding APRNs must recognize the new horizons in medical care in the United States.

About the Author:   John Rowe is a physician and professor in the department of health policy and management at the Columbia University Mailman School of Public Health.

This article available online at

New Editor for Nurse Author & Editor

Marilyn H. Oermann, PhD, RN, FAAN, ANEF has been appointed Editor of Nurse Author & Editor, a quarterly online newsletter published by Wiley-Blackwell. Nurse Author & Editor was founded  by Suzanne Hall Johnson, MN, RN,C, CNS in 1991. Charon A. Pierson, PhD, GNP-BC, FAANP has served as Editor since 2008.

Dr. Marilyn Oermann is a Professor and Division Chair in the School of Nursing at the University of North Carolina at Chapel Hill. She is author/co-author of 10 nursing education books and more than 150 articles in nursing and healthcare journals. She has edited 6 volumes of the Annual Review of Nursing Education. Her current books are Evaluation and Testing in Nursing Education (2nd ed.), Clinical Teaching Strategies in Nursing Education (2nd ed.), and Writing for Publication in Nursing. Dr. Oermann has written extensively on educational outcomes, teaching and evaluation in nursing education, and writing for publication as a nurse educator. She is the Editor of the Journal of Nursing Care Quality and past editor of the Annual Review of Nursing Education. Dr. Oermann has a Certification in Writing/Editing from the American Medical Writers Association. She lectures widely on nursing education topics and is a facilitator of the NLN Writing Retreat, sponsored by the NLN Foundation and Pocket Nurse. She is a member of the American Academy of Nursing and NLN Academy of Nursing Education.

Each issue of Nurse Author & Editor consists of articles offering advice on writing quality manuscripts, avoiding rejection, finding publishing opportunities, editing and reviewing.  Each issue also has a section containing short articles to update readers on new developments in nursing journals and journal publishing. You can access the publication here. You must register to access the current issue and archives (going back to 2006) but there is no charge.

If you would like to contribute an article to Nurse Author & Editor, contact Marilyn at

The Power of Nursing

An incredible article from the New York Times–it was buried in the blogs and I suspect a lot of people didn’t see it. The bolding (for emphasis) is mine. LHN

May 16, 2012, 7:00 AM

The Power of Nursing


In 2010, 5.9 million children were reported as abused or neglected in the United States. If you were a policy maker and you knew of a program that could cut this figure in half, what would you do? What if you could reduce the number of babies or toddlers hospitalized for accidents or poisonings by more than half? Or provide a 5 to 7 point I.Q. boost to children born to the most vulnerable mothers?

Well, there is a way. These and other striking results have been documented in studies of a program called the Nurse-Family Partnership, or NFP, which arranges for registered nurses to make regular home visits to first-time low-income or vulnerable mothers, starting early in their pregnancies and continuing until their child is 2.

We tend to think of social change as more of an art than a science. “What’s unique about Nurse-Family Partnership is that the program was studied in what’s considered the strongest study design, and it showed sizable, sustained effects on important life outcomes which were replicated across different populations,” explained Jon Baron, president of the Coalition for Evidence-Based Policy, a nonpartisan group. “This is very unusual. There are probably only about ten programs across all areas of social policy that currently meet that standard.”

What that means, notes Baron, is that if policy makers replicate the program faithfully they can be confident that it will change people’s lives in meaningful ways — improving child and maternal health, promoting positive parenting, children’s school readiness and families’ economic self-sufficiency, and reducing juvenile delinquency and crime.

NFP is not a new idea — it’s almost 40 years old — but after decades of study the program, which has assisted 151,000 families, has the potential for broader impact, thanks to the Affordable Care Act’s Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion for states to expand such programs.

Done well, it could be among the best money the government spends. Investments in early childhood development produce big payoffs for society. (A 2005 RAND study estimated that NFP provided $5.70 in benefits to society for every dollar spent.) But there’s an important concern: home visiting programs are not all effective. When carefully studied, only a few have been shown to reduce the physical abuse and neglect of children. Among the programs that meet the government’s standard for funding, there are large variations in evidence of impact (pdf). Policy makers and proponents of home visiting would do well to pay attention to the specific elements in the Nurse-Family Partnership’s model that account for its success.

NFP was founded by David Olds, who directs the Prevention Research Center for Family and Child Health at the University of Colorado Health Sciences Center. Early in his career, Olds worked in a day care center in Baltimore because he believed that quality preschool attention would help disadvantaged children succeed in life. What he began to see was that, for some kids, it was already too late to make big gains. If children had been abused or neglected or exposed to domestic violence, or if their mothers had abused drugs, alcohol or tobacco while pregnant, their brains could have been damaged in ways that limited the children’s abilities to control impulses, sustain attention or develop language.

Olds developed NFP in the early 1970s. He conducted his first large study in 1977, in Elmira, N.Y., a semi-rural, mostly white, community with one of the highest poverty rates in the state. The program produced strong results. Follow-up studies would reveal that, by age 19, the youths whose mothers received visits from nurses two decades earlier, were 58 percent less likely to have been convicted of a crime. In the 1980s and 1990s, Olds spread the work to Memphis and Denver and subjected the program to more randomized study with populations of urban blacks and Hispanics. The results continued to be impressive. In 1996, NFP began wider replication; the model is now being implemented by health and social service providers in 40 states.

As Olds published his results, the idea gained momentum, but the imitations did not remain faithful to NFP’s approach. “People adopted all kinds of home visiting models and used our evidence to make claims,” he recalled. In the early 1990s, for example, the federal government, inspired in part by NFP, began a $240 million program to train paraprofessionals, rather than nurses, to make home visits to low-income families with young children. NFP also experimented in Denver, using paraprofessionals (trained from the communities they served) in place of nurses for a subset of families.

In both cases, paraprofessionals didn’t get the same results. When it came to improving children’s health and development, maternal health, and mothers’ life success, the nurses were far more effective. In the federal program, paraprofessionals produced no effects on children’s health or development or their parents’ economic self-sufficiency.

What’s special about nurses? For one thing, trust. In public opinion polls, nurses are consistently rated as the most honest and ethical professionals by a large margin. But there were other reasons nurses were effective. Pregnant women are concerned about their bodies and their babies. Is the baby developing well? What can I do for my back pain? What should I be eating? What birthing options are available? Those are questions mothers wanted to ask nurses, which was why they were motivated to keep up the visits, especially mothers who were pregnant for the first time.

Nurses had more influence encouraging mothers to delay subsequent pregnancies, Olds explained. They could identify emerging complications more promptly, and they were more successful at getting mothers to stop or reduce smoking, drug or alcohol use. This is vital. Prenatal exposure to neurotoxicants is associated with intellectual and emotional deficits. It can also make babies more irritable, which increases risks of abuse. (A mother who was abused herself is more likely to misinterpret an inconsolable baby’s crying as “bad behavior.”)

“A lot of the young mothers have had some pretty terrible early life experiences,” says Olds. “It’s not uncommon for them to have been abused by partners or never have had support and care from a mother. Their lives haven’t been filled with much success and hope. If you ask them what they want for themselves, it’s not uncommon for them to say, ‘What do you mean?’”

A big part of NFP’s work is helping them answer this question.

Consider the relationship between Rita Erickson and Valerie Carberry. Rita had had a methadone addiction for 12 years and was living from place to place in Lakewood, Colo. She found out she was pregnant; a parole officer told her about NFP. “I’d burned bridges with my family,” Rita told me. “I was running around with the wrong people. I didn’t have anyone I could ask about being pregnant.” In the early months, Valerie had to chase her around town, Rita recalled. “I was worried she might say, ‘This is too much hassle. Come back when you have your act together.’ But she stuck with me.”

Over the next two years, they embarked on a journey together. “I had a zillion questions,” Rita recalled. “I was really nervous at first. I had lived most of my adult life as a drug addict. I didn’t know how to take care of myself.” On visits, they discussed everything: prenatal care, nutrition, exercise, delivery options. After Rita’s daughter, Danika, was born, they focused on things like how to recognize feeding and disengagement cues, remembering to sleep when the baby sleeps, how to manage child care so Rita could go back to school. For Rita, what made the biggest impression was hearing about how a baby’s brain develops — how vital it was to talk and read a lot to Danika, and to use “love and logic” so she develops empathy. Once Valerie explained that when babies are touching their hands, they’re discovering that they have two. “To me that was really amazing,” Rita said.

This month, Rita is graduating from Red Rocks Community College with an associate degree in business administration. She’s going to transfer to Regis University to do a bachelors degree. Her faculty selected her as outstanding graduate based on leadership and academic achievement — and she was asked to lead the graduation procession and give one of the commencement speeches. Danika is thriving, Rita said. Recently, she came home from preschool and announced:  “Mommy, I didn’t have a good day at school today because I made some bad decisions and you wouldn’t be proud of me.” (She had pushed another child on the playground.) As for the NFP, Rita says that it helped her recover from her own bad decisions. When Valerie came along, she needed help badly. “I didn’t care about my life. I didn’t care about anything. I never ever thought I would have ended up where I am today.”

“When a woman becomes pregnant whether she’s 14 or 40, there’s this window of opportunity,” explained Valerie, who has been a nurse for 28 years and has worked with more than 150 mothers in NFP over the past seven. “They want to do what’s right. They want to change bad behaviors, tobacco, alcohol, using a seat belt, anything. As nurses, we’re able to come in and become part of their lives at that point in time. It’s a golden moment. But you have to be persistent. And you have to be open and nonjudgmental.”

Beyond the match between nurses and first-time moms, there are multiple factors that make NFP work. (NFP has identified 18 key elements for faithful replication.) The dosage has to be right: Nurses may make 50 or 60 visits over two and a half years. The culture is vital: It must be non-judgmental and respectful, focusing on helping mothers define their own goals and take steps towards them. The curriculum should be rigorous, covering dozens of topics — from prenatal care to home safety to emotional preparation to parenting to the mother’s continuing education. Nurses need good training, close supervision and support, and opportunities to reflect with others about difficult cases. And, above all, data tracking makes it possible to understand on a timely basis when things are working and when they are not.

With the government making such a large investment in home visiting, it’s crucial for programs to get the details right. Otherwise, society will end up with a mixed bag of results, and advocates will have a hard time making the case for continued support. That would be a terrible loss. “When a baby realizes that its needs will be responded to and it can positively influence its own world,” says Olds, “that creates on the baby’s part a sense of efficacy — a sense that I matter.” It’s hard to imagine higher stakes.

Source: The New York Times

More Men Trading Overalls for Nursing Scrubs

More Men Trading Overalls for Nursing Scrubs



IN 2007, Kurt Edwards figured he would be stacking and racking 80-pound boxes of dog food and celery in the back of a grocery store for the rest of his working life. And he was fine with that.

But that June, after nine years on the job, layoff notices arrived on the warehouse floor at the Farmer Jack store in Detroit where he worked. His employer, Great Atlantic and Pacific Tea Company, closed the Farmer Jack chain. Today he still does a lot of lifting, but of people, not boxes. Mr. Edwards joined the ranks of former warehouse, factory and autoworkers trading in their coveralls and job uncertainty for nurses’ scrubs.

At 49, divorced with no children, he now tends to patients on the graveyard shift at Sheffield Manor Nursing and Rehab Center, a two-story, gray brick building in a ramshackle neighborhood on Detroit’s west side. Interviewed last month, he says he is making about $70,000 annually, $20,000 more than he did at the warehouse.

The story of how he made the transition is one that men like him appear to be telling with increasing frequency, and the demand for their services is what is setting so many of them on similar paths.

Hard figures are elusive, but the Michigan Department of Energy, Labor and Economic Growth estimates a shortage of 18,000 nurses in the state by 2015 — and the labor force is adapting.

Oakland University in nearby Rochester, Mich., has established a program specifically to retrain autoworkers in nursing — about 50 a year since 2009. And the College of Nursing at Wayne State University in Detroit is enrolling a wide range of people switching to health careers, including former manufacturing workers, said Barbara Redman, its dean. “They bring age, experience and discipline,” she said.

David Pomerville brings a few more years than Mr. Edwards. A 57-year-old nursing student, he spent most of his career as an automotive vibration engineer, including almost 10 years at General Motors. His pink slip arrived in April 2009.

At the time, Mr. Pomerville was earning almost $110,000 a year at the General Motors Milford Proving Ground in Milford Township, Mich.

But having watched another round of bloodletting at G.M. three years earlier, he had already decided on nursing as his Plan B. “I thought, ‘Well, I worked on cars for this long, now I’m going to work on people for a while,’ ” he said.

A married father of two and grandfather of two, Mr. Pomerville had almost no money saved when he was laid off. But the federal Trade Readjustment Act, which aids workers who lose their jobs as a result of foreign competition, paid for nursing school tuition. His wife is a teacher, and he receives unemployment benefits. He hopes to graduate at the end of this year, and he expects his salary will be about half what he used to make.

Timothy Henk ultimately decided not to try to stick it out as long as Mr. Pomerville did. Mr. Henk, 32, worked for eight years at the Ford Sterling Axle Plant in Sterling Heights, Mich., installing drive shafts in the F-150 truck, and was making about $25 an hour by 2007. With overtime, he earned $70,000 a year.

But as he and his wife contemplated having children, he worried that income would not last. So in 2007, he took a buyout, which included $15,000 a year for four years to put toward education. Two friends in nursing — both women — had suggested he look into joining their profession. He researched the demand for nurses in Michigan and used the buyout money to pay his tuition at Wayne State.

The amount of schooling required to be a nurse depends on the level of nursing a student chooses to pursue. Mr. Henk went through Wayne State’s four-year program to obtain a bachelor of science in nursing and then took a licensing exam to become a registered nurse, or R.N. Other levels of nursing include the C.N.A., or certified nurse’s aide, which can require as little as eight weeks of training plus a certification exam, and L.P.N., or licensed practical nurse, which requires one or two years of schooling and a licensing exam.

All of that assumes acceptance in a nursing program. The American Association of Colleges of Nursing said more than 67,000 applicants were turned away in 2010 for lack of faculty or classroom space — not a good sign with a national nursing shortage projected to be as high as 500,000 by 2025.

Mr. Henk now works in the critical care unit at Beaumont Hospital in Royal Oak, Mich. He makes about $50,000 annually for a 36-hour workweek, though Ford’s health insurance was better.

The choice to make this switch was probably least likely for Mr. Edwards, the former grocery worker. He dropped out of college and spent four years in the Army as a paratrooper with the 82nd Airborne Division. He found his unionized warehouse job after a stint working for his father, an accountant.

“You have this plan, this goal,” he said. “I was going to be at this warehouse; all the guys were retiring with great benefits. I was part of the middle class, and I was going to make it.”

When it became clear that he would not make it to retirement there, someone he was dating suggested nursing.

Though he wrote it off as woman’s work at first, he realized he was getting a bit old for manual labor. So he returned to school, living on unemployment checks and occasional groceries from by his mother. He spent the last four months of his L.P.N. training with no electricity because he could not afford to pay any bills except rent.

Once he finished, the Sheffield Manor administrator, LaKeshia Bell, pretty much hired him on the spot. “They are like a hot commodity,” she said. “A male presence actually helps us in the facility.” At 5 feet 9 inches tall and 220 pounds, Mr. Edwards lifts patients as easily as he stacked boxes.

But he still appears to be a rarity. Just 7 percent of employed registered nurses are men, according to a 2008 Department of Health and Human Services survey. It did not count licensed practical nurses. Still, the percentage of people certified in nursing in some way who are men has risen to 9.6 percent since 2000 from 6.2 percent before, according to the department.

Ms. Bell noted that new nurses coming from manufacturing had unusual adjustments to make. When dealing with parts on the factory floor, she said, repetition is a major part of the job. “These are not parts. They’re people, so you can’t just have a set regimen like in a plant setting,” she said.

That cultural shift goes both ways. Mr. Edwards’s supervisor, Yvonne Gipson, provided an example. “I mean Kurt is not an ugly man, O.K.?” she said. “You got all these female workers, and they’re all looking at him like, ‘Oh! Potential husband!’ So, yes, it does change.” Her voice trailed off, erupting into peals of laughter as Mr. Edwards slipped a $20 bill into her pocket.

While these success stories point to opportunity, Michigan’s unemployment rate is still 9 percent. And Nelson Lichtenstein, director of the Center for the Study of Work, Labor and Democracy at the University of California, Santa Barbara, says history is a cruel taskmaster when it comes to struggling industries.

“When one industry goes in decline and another comes to the fore, you don’t have a one-to-one employment replacement at all,” he said. “It takes a decade, two decades. In the meantime, some people find their careers are ended, ruined, and they never get them back.”

For these new nurses, the advantage is the demand in Michigan. Mr. Edwards knows he is lucky. “You know I wake up every day and I’m very proud,” he said. “I’m looking in the mirror. I’m happy. I’m proud. I’m saying, you know, this turned out great. The lights are on!”

Devin Maverick Robins contributed reporting.

Source: New York Times

An Interesting Study from the University of Pennsylvania

I love when nurses do interesting and creative research and to me, this study fits that description to a “T.” This was a press release I received from Penn entitled “Science in Action.”

Food Stamps and Farmers’ Markets

Current food stamp programs at urban farmers’ markets attempting to bring fresh produce to economically stressed city dwellers are so complicated for the shopper and expensive for the farmer that fewer people are taking advantage of the federal program designed to help them, according to research at the University of Pennsylvania School of Nursing.

Record numbers of Americans are receiving Supplemental Nutrition Assistance Program (SNAP) benefits, as food stamps are now known, and many SNAP participants live in neighborhoods with little or no access to healthy food. A study conducted at the Clark Park Farmers’ Market in Philadelphia, Pa., found that making it easier for vendors to collect SNAP payments with electronic point-of-sale systems increased fresh produce sales to SNAP recipients by 38 percent.

However, the costs associated with such systems may put them out of reach for farmers. The study, by Penn Nursing professor Alison M. Buttenheim, PhD, MBA, and colleagues, appears in the Journal of the Academy of Nutrition and Dietetics.

“Our study highlights the need for an equitable approach to subsidizing Electronic Benefits Transfer (EBT) fees at farmers’ markets,” Dr. Buttenheim reported. “Vendors told us, and we confirmed with a cost-benefit analysis, that they would not be able to break even on sales after paying the associated costs.”

SNAP participants access their benefits through EBT cards. To accept the cards at farmers’ markets, vendors must rent wireless POS terminals, pay for wireless service, and cover transaction fees. Because of the associated costs, many market managers operate a single wireless POS terminal for the entire market. SNAP beneficiaries may buy a token that they can exchange for produce, but they can’t receive change. Alternatively, customers can make their selections with a vendor, get a paper receipt for the total amount of the purchase, and present the receipt to the central terminal, where the customer’s EBT card is swiped for the exact amount of purchase. This must be repeated for each vendor the customer wants to visit.

Dr. Alison M. Buttenheim

Instead, Dr. Buttenheim and colleagues provided each vendor at the Clark Park Farmers’ Market with a wireless POS terminal for EBT and credit/debit card transactions. A grant covered all associated wireless charges, transaction fees, and processing fees during a pilot program which ran from June 2008 through February 2009. After the pilot period, the market returned to a single market-operated terminal and receipt system.

Researchers analyzed sales data at the market for four years, beginning 17 months before the pilot project and ending 22 months afterward. There was a 38 percent increase in SNAP/EBT sales during the months with multiple vendor-operated terminals. However, after the pilot project ended, sales to SNAP participants returned to pre-pilot levels, controlling for increases in SNAP participation in Philadelphia.

“Many stakeholders want to increase SNAP redemptions at farmers’ markets,” said Dr. Buttenheim. “We hope this study can inform policymakers about the specific mechanisms driving SNAP redemptions and about the need for subsidies for wireless POS technology at farmers’ markets.”

In an accompanying podcast, Dr. Buttenheim and co-author Allison Karpyn of The Food Trust, a Philadelphia nonprofit working with communities on lasting and stable sources of affordable food, discuss the impact of wireless POS terminals at farmers’ markets on sales to SNAP beneficiaries, and the policy implications of their research. The podcast is available at


Buttenheim AM, Havassy J, Fang M, Glyn J, Karpyn AE. Increasing Supplemental Nutrition Assistance Program/Electronic Benefits Transfer Sales at Farmers’Markets with Vendor-Operated Wireless Point-of-Sale Terminals. J Acad Nutr Diet. 2012 Mar 15. [Epub ahead of print] PubMed PMID: 22425028.

AAN and IOM Partnership

American Academy of Nursing Joins the IOM Global Forum on Innovation in Health Professional Education as Founding Member-Sponsor

IOM collaborative to incubate and evaluate new solutions to today’s health professional education challenges.

WASHINGTON, Feb. 23, 2012 /PRNewswire-USNewswire/ — The American Academy of Nursing reaffirms its commitment to the future of health care and the dissemination of innovative nursing knowledge by joining the Institute of Medicine’s Global Forum that brings together interdisciplinary leaders to address challenges in health professional education and support the incubation and evaluation of new solutions.

Set to launch in March 2012, the Institute of Medicine’s Global Forum on Innovation in Health Professional Education will further investigate the Lancet Commission’s Report Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World as well as the Institute of Medicine’s and Robert Wood Johnson Foundation’s 2010 report The Future of Nursing: Leading Change, Advancing Health.

Academy Fellow Afaf Meleis, PhD, and Jordan Bohen, MD, two Lancet report Commissioners, will serve as co-chairs for the new forum — a forum whose visible work will manifest through several workshops held yearly in addition to video-conferencing with international partners.

“The Academy is honored to join this Global Forum,” said Joanne Disch, PhD, RN, FAAN, President of the Academy. “We look forward to collaborating with esteemed education and health care organizations and ensuring that nurse innovations are on the table as part of the solutions to our professional health education needs.”

Academy Fellow Madeline Schmitt, PhD, RN, FAAN, Professor Emeritus, University of Rochester School of Nursing, who encompasses both a vast experience with health professional education and keen sense of innovation, will represent the Academy. Dr. Schmitt is a nurse-sociologist who has conducted extensive research on interprofessional collaborative practices. In addition to her research and teaching agenda, Dr. Schmitt serves as a national and international consultant and chairs the Expert Panel commissioned by the AACN, AACOM, AACP, ADEA, AAMC, ASPH to develop core competencies for interprofessional collaborative practices.

The American Academy of Nursing anticipates and tracks national and international trends in health care, while addressing resulting issues of health care knowledge and policy. The Academy’s mission is to serve the public and nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge.

In Memory of Joyce C. Clifford, 1935-2011

I didn’t realize that Joyce Clifford died in October. When I was a student, we practiced primary nursing while the actual staff nurses were all still doing team nursing. It was a tumultuous time. Joyce was truly a visionary and deserves the honor of being a nursing legend.

The following obituary is from The New York Times.


Joyce C. Clifford, a nurse who advocated a partnership of equals between doctors and nurses in the treatment of patients, and whose ideas were adopted in some of the nation’s best hospitals because they reduced medical errors and improved survival rates, died on Oct. 21 in Boston. She was 76.

The cause was heart disease and kidney failure, said her husband, Lawrence.

Dr. Clifford, who received a Ph.D. in health planning from Brandeis University, was part of the first generation of registered nurses who sought to make bachelor’s degrees a minimum requirement in a field where most held associate degrees. It was a requirement she set for all the nurses she hired at Beth Israel Hospital in Boston, a Harvard teaching hospital, where she worked from 1974 until 1999 as the nursing administrator and later vice president.

Under the “primary nursing” model she introduced in 1975 at Beth Israel, nurses were assigned primary responsibility for four or five patients — caring for each while on duty, being on call when off duty, and acting as an advocate and intermediary with each patient’s doctors.

The idea was to restore the continuity and accountability that were considered casualties of the nursing system then widely in use, known as team nursing. In the team system each nurse had a specialized task, like dressing wounds or managing medication, but no single nurse had a glimpse of the big picture.

“Doctors see a patient for a couple of minutes a day, but nurses are there 24/7,” Margaret Grey, dean of the Yale School of Nursing, said in an interview after Dr. Clifford’s death. “Joyce Clifford put together a system that gave the primary nurse the benefit” of that accumulated round-the-clock nursing information, she said.

Dr. Clifford was not the creator of the primary nursing model, but she was probably the first to put it into practice in a large teaching hospital, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, who published research about the work of Dr. Clifford.

Studies showed that the system was good for patients and for hospitals, Professor Aiken added. The increased accountability and higher level of education it demanded were linked to a decline in patient mortality and a lower turnover of nurse staff.

“Beth Israel had a waiting list of applicants,” Professor Aiken said, “even when there were nurse shortages everywhere else.”

Primary nursing has never become the norm. Only about 10 percent of the nation’s hospitals use it in one form or other. In the face of corporate mergers and cost-cutting, some hospitals where it was once in practice — including Beth Israel, now known as theBeth Israel Deaconess Medical Center — have since modified or eliminated it in favor of more decentralized systems.

Dr. Clifford’s achievement was in showing how primary nursing could work, said Dana Beth Weinberg, an assistant sociology professor at Queens College. Professor Weinberg’s Harvard dissertation, published in 2003 as the book “Code Green: Money-Driven Hospitals and the Dismantling of Nursing,” chronicled the dismantling of primary nursing at Beth Israel after its merger with Deaconess Medical Center in 1999 and Dr. Clifford’s departure.

Dr. Clifford went on to found and lead the Institute for Nursing Healthcare Leadership, which promotes research and advanced education in nursing and the primary nurse system.

She was born Joyce Catherine Hoyt in New Haven on Sept. 12, 1935, one of four daughters of Raymond Hoyt, an ironworker, and his wife, Helen. She received a nursing diploma from St. Raphael Hospital in New Haven and a bachelor of science degree in 1959 from St. Anselm College in New Hampshire.

She joined the Air Force in the early 1960s and received a master’s degree in nursing administration in 1968 from the University of Alabama in Birmingham, where she was stationed.

She and her husband met at the university. Besides Mr. Clifford, she is survived by a sister, Rita Brown, of West Haven, Conn.

Dr. Clifford was hired as Beth Israel’s chief nurse by its president and chief executive, Dr. Mitchell T. Rabkin, a member of the Harvard Medical School faculty.

Dr. Rabkin said Monday in an interview that he had had an insight when he was a young intern. “On my very first day of internship,” he said, “I realized that nurses knew a hell of a lot more than I did.”

Dr. Rabkin gave Dr. Clifford carte blanche to put together a nursing staff that would work collaboratively with doctors. There was some resistance at first. Medical doctors complained that instead of talking to one nurse about the patients in a section of a ward, say, they had to contact each patient’s primary nurse, which meant making a number of separate contacts.

“The resistance did not last long,” Dr. Rabkin said. “Because the doctors soon realized that they were getting far better information, and the patients were getting better care.”