1. Remove Scope-of-practice Barriers. - Johns Hopkins School Of Nursing

Hill’sSideThe Impact of the Future of Nursing ReportChris HartloveToday and TomorrowMartha N. Hill, Dean, Johns Hopkins UniversitySchool of NursingIOM Future of Nursing RecommendationsRecommendation 1:Remove scope-of-practice barriers.Recommendation 2:Expand opportunities for nurses to lead anddiffuse collaborative improvement efforts.Recommendation 3: Implement nurseresidency programs.Recommendation 4:Increase the proportion of nurses with abaccalaureate degree to 80 percent by 2020.Recommendation 5:Double the number of nurses with adoctorate by 2020.Recommendation 6:Ensure that nurses engage in lifelong learning.Recommendation 7:Prepare and enable nurses to lead change toadvance health.Recommendation 8:Build an infrastructure for the collectionand analysis of interprofessional healthcareworkforce data.Look for these icons throughout the magazineto see how Johns Hopkins Nursing is addressingthe recommendations.4Johns Hopkins Nursing Since the Robert Wood JohnsonFoundation and Institute of Medicinereleased “The Future of Nursing: LeadingChange, Advancing Health” in February2011, Johns Hopkins Nursing has exploredhow the report’s eight recommendationsare being addressed by nurses and nursefaculty at The Johns Hopkins Hospital,the Johns Hopkins University, andthroughout the nursing community.The Spring 2011 issue featured aroundtable discussion of reactions tothe report by Johns Hopkins healthcareleaders (http://magazine.nursing.jhu.edu/nursingfuture).In our last issue, guest columnist SusanB. Hassmiller, PhD, RN, FAAN, senioradvisor at the Robert Wood JohnsonFoundation, described how the report’srecommendations will help transformnursing education, leadership, and collaboration For this issue, we interviewed JohnsHopkins nursing leaders Dean MarthaHill, PhD, RN, and Karen Haller, PhD,RN, Vice President for Nursing andPatient Care Services at The JohnsHopkins Hospital, about the impact ofthe report’s recommendations on nursingpractice and education today and revealtheir hopes for how it will shape tomorrow’s nursing.Editor: What have you seen as results sincethe release of the report nearly a year and ahalf ago?Haller: To start, it’s received a lot ofmedia attention—in part because manyof the recommended actions seemed controversial and had some initial pushbackfrom physician and hospital groups. Butit’s inevitable that we’ll move forwardwith these recommendations. So manyfactors are driving them: The change in[patient] demographics, a projected physician deficit by the end of the decade, anSummer 2012aging population with chronic diseasesthat are amenable to nursing interventions, and an unsustainable 17 percent ofGNP [gross national product] now spenton healthcare.Hill: A good example of the mediacoverage is the recent article in The NewYork Times (“More Stringent Requirements Send Nurses Back to School,” June23, 2012). New York State is now callingfor 80 percent of their nursing workforceto hold a bachelor’s degree by 2020. Thereporter highlighted evidence showingthe better educated the nurse, the betterthe patient care and outcomes—an argument that’s hard to refute.Haller: We’ve adopted the 80 percentrecommendation here at The JohnsHopkins Hospital and hope to exceed itin the near future. It’s the basic educationwe need today, but we’re also encouraging the workforce to become nursepractitioners and to actively engage incontinuing education.Editor: Were you surprised by any of theeight recommendations?Haller: The scope-of-practice issue is oneof the most out-of-the box discussionsto come out of any report. The rightquestions are raised: Should insurersbe required to cover the services ofadvanced practice nurses? Are undulyrestrictive state regulations governingthe practice of advance practice nursesrestraint of trade? Why is one practicesafe in Pennsylvania, for example, butnot in Maryland?Hill: I didn’t expect to see nurseresidency programs specifically recommended. It’s a strong statement that callsfor resetting expectations for new graduates and for their employers, and it shiftsresponsibility to hospitals to enhanceorientation programs. The notion of a

Haller: It’s very similar to the physicianresidency programs; however there isno funding for it and the report proffered no recommendations for doing so.Ultimately it’s a great recommendation,but it doesn’t go far enough. At Hopkins[Hospital] we are fortunate to have neworientation programs funded through oneof the state grants designed for this purpose. I feel confident now that the grantwill be funded again.Editor: Are the recommendations creatingsignificant change in patient care?Haller: The report added to the momen-tum surrounding scope of practice. Todayin hospital acute-care settings, we’regiving more responsibilities to nursepractitioners. The same needs to happenin primary care, but the reimbursementissues are limiting progress.Hill: And isn’t there a paradigm shift tomore preventive and primary care? Thereport and the research behind it are calling for a system where providers, patients,and their families work together to checkand balance one another, while keepingcontrol of costs. That’s a change that creates motivation for all to work on a team.Haller: In the healthcare communitymany continue to believe that the U.S.public prefers to see a physician. Targetand Wal-Mart are clearly demonstratingotherwise, that what the public wants isto receive care quickly from a competentperson. NPs taking care of commonproblems—such as simple infections—in a variety of settings—give the American public the access they want andless waiting in an emergency room ordoctor’s office.Editor: Do you see challenges to this“blueprint for the future?”Chris Hartloveresidency defines a very clear category oftransition combining new hire orientation and bedside mentoring to create aprofessionally mature staff nurse.Hill: The call for nurses to be ableand committed to lead change facesnumerous challenges. Too often we areout-of-sight, out-of-mind. We have atour fingertips huge databases of aggregatenumbers, numbers that answer thequestion “What does it take to makesystems level changes?” Our DNPprograms are “just-in-time” in preparing nurses as the clinical professionalswho can come to the local and nationaldecision-making tables and write policyand guidelines.Haller: Nurses will have to step upand meet the educational requirementsneeded to be at those tables. It’s a challenge as well as a gift. Today’s nurse hasto prepare to take on these roles, and notexpect that they will just be given.Karen Haller, Vice President for Nursing andPatient Care Services, The Johns Hopkins HospitalEditor: What are the opportunities therecommendations bring to nursing?Haller: Every time I talk with a groupI tell them this is an evidence-basedreport—every recommendation camefrom data. That’s what gives theserecommendations so much power,power that will well position nursingfor the future.Hill: The task now is to ensure there isevidence behind the implementation.We have an opportunity here at Hopkins—with the Hospital and schools ofmedicine, nursing, and public health—toestablish new models for adopting theserecommendations and evaluating theirimpact, all of which will lead to higherquality and more cost-effective care.Haller: Once again, nursing is part ofthe solution.Johns Hopkins Nursing magazine.nursing.jhu.edu5

Nursing AssessmentLetters to the EditorIenjoyed reading your most recent issueof your Magazine focused on IOM.You really do lead on the cutting edge.I scan every one of your magazines andlearn a lot from reading about your workat Johns Hopkins!Nancy F. Langston, PhD, RN, FAANDean and ProfessorVirginia Commonwealth University Schoolof NursingThe enclosed donation to Johns Hopkinsis a “Thank You” for all the informationreceived from your wonderful magazines.Both are read from cover to cover, andthe advertisements about Baltimore areof particular interest.I have lived in Ontario, Canada forthe past 62 years, and benefited from theuniversal health care plan that we have,so it is with great interest that I am following the big health care debate in theUnited States. I hope more informationfrom Hopkins will be coming soon.The three years of Nurses Traininghave been a major blessing in my lifeand the memories of Church Home andHospital and Johns Hopkins are invaluable. Many thanks. I am so proud to sayI am a Johns Hopkins Alumna.Agnes T. Roden, CHH ’49, RNLetters to Johns Hopkins NursingWe welcome all letters regarding themagazine or issues relating to HopkinsNurses. Email 200 words or less toson-editor@jhu.edu or send to:Editor, Johns Hopkins Nursing525 N. Wolfe StreetThe House, Room 107Baltimore, MD 21205Letters will be edited for lengthor clarity.6Johns Hopkins Nursing My wife receives the Johns Hopkins Nursing magazine, having been on the JHHWomen’s board for years. I am a graduateof the School of Medicine (Class of1949) and was a Halsted resident from1950-1958.I am writing because I believe theunidentified resident physician is Dr.Charles Carpenter who was on the Oslerhouse staff at that time.I thought this might be of interest toyour staff.William F. Rienhoff IIII received my Spring 2012 issue of theJohns Hopkins Nursing magazine today. ISummer 2012have only had time to flip through it, butit looks like another outstanding issue.I loved the picture on the inside ofthe back cover. I am happy to supplyyou with the name of the unidentifiedstudent, third from the left in the picture.She is Mary Ann Mentzer Larson, Classof 1959. She was a lovely girl, tall, verypretty, very witty, energetic and a verygood nurse. She is one of the girls fromour class who got married somewherealong the way in nursing school.Mary Susan (Clark) Spahr ’59Editor’s Note: The photo referenced byboth Dr. Rienhoff and Ms. Spahr appearedin “Defining Moments” on the inside backcover of the Spring 2012 issue. Previously,we were only able to identify three of thefive people pictured, but with the help ofDr. Rienhoff and Ms. Spahr, we now knowall five! We forwarded the info to the AlanMason Chesney Medical Archives VisualMaterials Archivist Timothy Wisniewski,MLIS. He reports that, “I can confirmthat the doctor in the photo is definitelyDr. Charles C. J. Carpenter, Jr., who inaddition to being on the house staff at thetime was also a graduate of the School ofMedicine class of 1956.” Thank you,Dr. Rienhoff and Ms. Spahr for your keeneyes and great memories!

On the PulseAP Photo/Alex BrandonJoining Forceswith the First LadyHopkins Nursing SupportsVeterans and FamiliesJohns Hopkins has joined morethan 500 nursing schools com mitted to preparing our nation’s threemillion nurses to meet the unique healthneeds of service members, veterans, andtheir families.“Whether we’re in a hospital, a doctor’s office, or a community health center,nurses are often the first people we seewhen we walk through the door. Becauseof their expertise, they are trusted to bethe front line of America’s health caresystem,” says First Lady Michelle Obama.“That’s why Jill [Biden] and I knew wecould turn to America’s nurses and nursing students to help our veterans andmilitary families get the world-class carethat they’ve earned.”Although healthcare professionalswithin the Veterans Affairs (VA) systemhave received extensive training in issuessuch as Post-Traumatic Stress Disorder(PTSD) and Traumatic Brain Injury(TBI), the majority of veterans seek careoutside of the VA system. Therefore allof America’s nurses must understand theneeds of those who have served.“Veterans who have experiencedcombat bring a new set of challenges tothe table. Our faculty and students areresearching the impact of these postcombat-related issues both on veteransand their families, with the goal ofimproving the overall quality of life.”Led by the American Nurses Association, the American Academy of NursePractitioners, the American Associationof Colleges of Nursing, and the NationalLeague for Nursing, in coordination withthe Departments of Veterans Affairsand Defense, nursing organizations and8Johns Hopkins Nursing First Lady Michelle Obama shakes hands after announcing a major initiative to ensure our nation’snurses are prepared to help meet the unique health needs of service members, veterans, and their families.schools have committed to educatingcurrent and future nurses on how torecognize and care for veterans impactedby PTSD, TBI, depression, and othercombat-related issues, in ways appropriateto each nurse’s practice setting. They willalso work to disseminate effective modelsfor care and to share the most up-to-dateinformation on these conditions acrossacademic and practice settings.“Veterans who have experiencedcombat bring a new set of challenges tothe table,” notes Hopkins Nursing DeanMartha N. Hill, PhD, RN. “Our facultyand students are researching the impactof these post-combat-related issues bothon veterans and their families, withthe goal of improving the overall qualityof life.” nSummer 2012Nurses Reflect,Heal, RenewSharing Stories Reminds Us“Why Nursing?”by Rebecca ProchOne hundred nurses shared a tearfulsilence at the Renewal Luncheon,smiling now and then, a communitydrawn together by the healing power ofstories. Over the loudspeaker, recordingsof several of their own voices describedcherished moments with patients that, foreach of them, defined “why I do this.”“It was really wonderful,” remembersCynda Rushton, PhD, RN, FAAN,professor of nursing and pediatrics in the

News from Around the SchoolIstockphoto.comSchool of Nursing. “It created a real senseof solidarity.”Solidarity, mutual support, connection—these are the hallmarks ofthe annual Spotlight on TransformingPalliative Care, where for the last threeyears approximately 300 bedside nurseshave put aside the rush of daily routinesto spend two days with one another inreflection and professional growth.“The chance to bring nurses togetherlike this is unique,” notes Sharon Krumm,PhD, RN, administrator and director ofnursing, department of Oncology andco-coordinator of the symposium withRushton and Deborah Baker, DNP, MSN,CRNP, director of nursing–surgery. “Itstrengthens our collaborations and allowsus to reexamine the roots of who we areas nurses. There’s learning on many different levels—the intellectual stimulationfrom keynote presentations, the chanceto work through challenging situationsduring clinical and grand rounds, thesense of community from the luncheon.”On grand rounds with keynotespeakers Michael Zenilman, MD, JohnsHopkins Medicine vice chair and regionaldirector of Surgery, and Thomas Smith,MD, Johns Hopkins Medicine director ofPalliative Care and the Harry J. DuffeyFamily Professor of Palliative Care, surgical nurses discussed how to integrate palliation into their work with patients. It’sa topic that Rushton calls “innovative” inthe context of surgery. Smith’s participation in grand and clinical rounds also gavemany nurses a valuable chance to meetand consult with him for the first timesince he joined the staff in October 2011.The day prior to the symposium,another guest joined the program—Buddhist teacher and palliative carepioneer Joan Halifax, author of the bookBeing with Dying and keynote speakerfrom year one. She was invited to consultwith the staff of 11 East (formerly Nelson8) to help them work through the lingering emotional effects of the shootingthat occurred in Nelson 8 in 2010. She,Rushton, and Baker joined them forbreakfast and led them through a longand heartfelt discussion about their fears,their relationships to patients and eachother, and what they love about comingto work in their unit.“It was so therapeutic,” says Baker.She pauses, then adds, “We push everyday. There’s so little time to sit downwith an expert and share and figure outthe next step. The nurses said that Joanwas tremendously helpful. They told usthey now feel ready to move on.” nLearn more about interprofessionaleducation for Hopkins nurses atnursing.jhu.edu/ipe.New Grants forNurse EducatorsState Funding BolstersMaryland Nursesby Jonathan EichbergerIf money is a deciding factor forstudents pursuing a nurse educatorcertificate, the Johns Hopkins UniversitySchool of Nursing has made that decision easier.Through a new State of MarylandGraduate Nursing Faculty Scholarshipand Living Expenses Grant, students mayreceive up to 50,000 over four years.“Increased funding means morestudents can take advantage of our nurseeducator certificate option, and that translates into more nursing faculty to meetthe need of educating the next generationof nurses,” said Pamela R. Jeffries, PhD,RN, associate dean for academic affairs.The Living Expenses Grant, part ofthe Nurse Support Program II (NSP II)administered by the Maryland HigherEducation Commission (MHEC) onbehalf of the Health Services Cost ReviewCommission (HSCRC), is designed tooffset the financial cost of postgraduateprograms to expand the number of qualified bedside nurses in Maryland.As part of the funding agreement,recipients of the Living Expenses Grantmust work as full-time faculty members atJohns Hopkins Nursing magazine.nursing.jhu.edu9

Will Kirk/HomewoodPhoto.jhu.eduOn the PulseNursing student Emeline Mugisha (left) implemented an HIV outreach program for Baltimore’s youth.a Maryland institution: full-time studentsmust work two years for each year ofthe award; part-time students must workone-and-a-half years for each year ofthe award. Scholarship awards are automatically renewed annually if studentsmeet eligibility requirements. Previously,the maximum award amount did notexceed 13,000. nLearn more about the Nurse EducatorCertificate Option at nursing.jhu.edu/nurseeducator.In the StreetsHopkins Nurses Transform Baltimoreby Danielle BurchamReaching out from the confines ofthe East Baltimore campus, JohnsHopkins University School of Nursingstudents and faculty are taking their skillsand knowledge to the streets.Among these everyday heroes arestudent Emeline Mugisha, the Nursing10Johns Hopkins Nursing Student Association, and faculty mentorIbby Tanner, PhD, MS, RN, who werepresented with Community ServiceAwards at the 2011-2012 StudentOutreach Resource Center (SOURCE)Volunteer Appreciation and ServiceAwards luncheon in April.Mugisha helped to implement an HIVoutreach program to empower Baltimore’syoung adults to be leaders in HIV protection. She teaches HIV prevention curriculum to volunteers in hopes they willspread the knowledge even further, andshe played a prominent role in leadingthe first-ever Johns Hopkins UniversitySchool of Public Health World AIDSDay Community Fair in 2012.The Nursing Student Association(NSA) was recognized for continueddedication to the community throughmultiple projects, including offeringfellowship opportunities to families ofchildren receiving treatment at TheJohns Hopkins Hospital, planting treesand assisting in SOURCE food drives,and participating in Maryland legislativeSummer 2012activities. The NSA also partners withlocal groups such as the House of Ruthand Yo! Academy, assembles disaster kitsand provides education in disaster planning, and ships care packages to militarynurses overseas to celebrate NationalNurses Week (May 6–12).Ibby Tanner’s community serviceoutreach was recognized for her role as afaculty advisor for the JHUSON Geriatric Interest Group and Daniels Scholar/Interprofessional Education Program. Sheassists the Baltimore geriatric populationby organizing home visits, health fairs,and social events at assisted living facilities, and she aspires to strengthen boththe Baltimore community and the relationship between the schools of nursingand medicine at Johns Hopkins. nLearn more about these awardeesand view the photo gallery atnursing.jhu.edu/sourceawards2012.Quality Matters inOnline EducationFour online courses offered at theJohns Hopkins University Schoolof Nursing have received a well-recognized mark of excellence: they passedreview by Quality Matters, the preeminent peer review organization providingteam-based evaluation of online courses.The courses Online Teaching andLearning: Development and Instruction;Curriculum Theory and Design; Applications of Research to Practice; and Teaching Strategiesin Nursing nowcarry a QualityMatters seal thatdemonstrates therigorous standardsthese coursesuphold. They willbe listed on the Quality Matters Websitealong with approved courses from othereducational institutions. n

News from Around the SchoolWelcome Nancy GriffinA New Leader for Enrollment and Student Affairsby Pamela McComasAs the new Associate Dean for Enroll ment Management and StudentAffairs, Nancy Davis Griffin is dedicatedto growing and supporting the Schoolof Nursing’s outstanding and diversestudent body.Griffin joined the School in June,bringing 30 years of experience in highereducation to her new role. Her career hascovered the spectrum from enrollmentmanagement to student life and housingand has included more than a decade ofsuccessful senior management in bothstudent affairs and admissions.“Nancy is a seasoned professional whowill bring her own professional style andleadership to all student services,” saysSchool of Nursing Dean Martha Hill,PhD, RN.Griffin notes that she was drawn toHopkins because of the opportunity to“work with talented students from startto finish and beyond.” She adds, “I’ll bejoining a community and an institutionthat knows what it stands for and thatembodies the value of Excellence.”As a first priority, Griffin plans tomeet faculty, students, and staff to “beginto truly understand the culture and talent”

son-editor@jhu.edu 410.955.7552 Send correspondence to: Editor Johns Hopkins University School of Nursing 525 N. Wolfe Street Baltimore, MD 21205 410.955.7552 Fax: 410.502.1043 son-editor@jhu.edu For general inquiries, call: 410.955.4766 Will Kirk has been a photographer at Johns Hopkins since he graduated from its Krieger School of Arts and .