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Sunday, February 28, 2016

Improving the Healthcare System Is an Endurance Race: Are you Part of the Team?

As the Democrat and Republican Presidential primaries heat up, the topic of healthcare is front and center…and for good reason. The United States health care system is the most expensive system in the world but consistently under performs about other countries on most dimensions of performance. With the US economy in turmoil, all the candidates agree on one fact; allowing trillions of dollars to continue to be spent on a system that provides a poor return on its investment does not make sense. Where they all differ is how to fix the system.   

It is not a surprise that our political leaders don't agree. Heath care is personal and is individual to each person. That is why the only way to improve the healthcare system so that it provides safe, quality, equitable care for every citizen of the US is for each of us to do our part. 

I put together this post to share where our healthcare system is today and the important work that is ahead of us. Take time to read this post and share your thoughts and comments. I am not asking for political comments, but common sense thoughts you have regarding how you are doing your part in improving our healthcare system, so it works for each of us when we need it. 

A Starting Point

As we all know, President Obama and the US Congress were able to pass the Affordable Care Act in 2010.  The law is not perfect and can use tweaks in many areas, but it was a starting point to address some of the gaping holes in our health care system that were driving up costs year after year.

The law focused on three critical elements that are fundamental to ensure a sustainable healthcare system that can meet the needs of its citizens. The fundamentals are cost, quality, and access. The architects of the ACA have put into place strategies that mandate that every citizen is to have health insurance. Having healthcare insurance allows consumers to receive preventative care to detect problems early and receive treatment when an issue is found. Also, having adequate coverage is needed if an unexpected injury or illness occurs. As I learned last year when I was diagnosed with a brain tumor having health insurance through my employer allowed me to have access to an expert treatment team that diagnosed and treated me.  If I did not have health insurance, I would be experiencing enormous debt due to astronomical medical bills and loss of income due to my inability to work. In addition, I probably would not have seen the excellent team of doctors who saved my life.  Everyone in the US should have access to affordable healthcare insurance as a citizen of this country. The ACA gave those who do not have access to health insurance through their employer a way to purchase it.

Other strategies that are being put in place are focused on how to change how healthcare is paid for as a way to control escalating costs. Traditionally, healthcare has been paid for by insurance companies based on what a physician ordered. No questions were asked as to the need, benefit, evidence and expected outcomes of tests and or procedures. A doctor simply wrote an order; the test was done and a bill was generated.  That is how the system was set up to work. Today, payers require a reason before a test or procedure is done. They need evidence to support the order. Today there are scientific guidelines that are used to guide treatment. Using evidence to support decisions has helped to eliminate many of the tests and procedures that were done simply because they were available.  Yes, this process has put an additional burden on the physicians to explain their rationale for their decisions.  Most doctors have adapted to this process and supply the information needed, gain approval and move forward. Studies also show that as a result of these rules, over-utilization is down which has had a dramatic impact on overall healthcare spending.

Another strategy that is being put into place is that physicians and other providers are being held accountable for their outcomes. The strategy is set up to pay providers who achieve positive results extra dollars over the fixed payments that are part of their contracts with payers. This concept has resonated with many physicians who have always gone the extra mile for their patients but were not paid any more than those who did not go that extra mile. Doctors love competition, so this strategy is allowing physicians and other providers to vie for extra payments for taking the time to educate a patient to improve their health, for overseeing care coordination and for working with the family to decide on a course of care for an elderly patient.  

The theory behind each of these strategies is that if the care provided is evidenced based, safe and specific for the patient, costs will be lower, and the patient experience will be improved.  Statistics show that despite the negative rhetoric about the Affordable Care Act, the strategies are working. Again, it is not perfect, but it is a start.

Changing the American healthcare system is a massive endeavor and will take time as the infrastructure of the system has to be retooled. As a result of the ACA, changes to the healthcare infrastructure is being put into place. Such things as health information technology are becoming more widespread and helping physicians, hospitals and other organizations to collect data that provides the information they need to know how they are doing from an operational, quality and financial standpoint. Before the law, the system had no way to measure data. Today, executives have the information they can use to make informed decisions on the workings of their organizations and the outcomes produced. They can see information on quality issues and where they are doing well or where they need to improve.

In addition to data, technology is allowing information to be shared among providers and organizations. Sharing of information about patients who transition through the system has reduced errors and duplication. As a result, hundreds of thousands of dollars has been saved, care has improved for patients as the providers have the information they need in real time when they are part of a connected healthcare system. There is still work to do so that the entire healthcare system is interoperable, and all systems can talk to each other in a secure environment. Until this occurs, we will still have gaps, but it is a start.

Another strategy taking place is for physicians, nurses, pharmacists and other members of the healthcare team work together as a team. The average person reading this post may be surprised to learn that most physicians and other members of the healthcare team do NOT work collaboratively. But it is true.  Until the ACA became law, each healthcare provider (Physicians, nurses, pharmacists, social workers, physical, occupational and other therapists) worked independently of each other and in a silo.  As a result, there was fragmentation vs. collaboration among integral members of the treatment team and payers. Patients were discharged without proper discharge planning, so readmission's to the hospital were common. People were not adherent to the plan of care because they were not part of the design. Each of these system challenges caused costs to rise and patient and providers to be dissatisfied with the system as a whole as it was not working.

To change this, the ACA introduced incentives and disincentives mechanisms into the payment system that allows physicians and other members of the team to develop innovative ways to improve care coordination, transitions of care and effective discharge planning processes. Because of these strategies, we have began to see better outcomes in areas such as reduction in unnecessary re-admissions, the closing of gaps and barriers in care and more attention to the patient and their family, so they had a better understanding of the discharge plan and access to the resources they needed to be successful.

Today, we see doctors, nurses, therapists and others professionals making rounds together and taking the time to learn the value each member brings to the team. We see payers working collaboratively with providers to help complex patient transition across the healthcare system with help.  As a result, gaps which often led to costly medical setbacks are being closed.  Understanding these challenges and encouraging more collaboration allows each member of the team to work up to their full potential to address the needs of the patient.

Another change is that today, the patient and their family are included more and more as active members of the healthcare team. It has been recognized that none of the changes can work if the patient is not a central member of the healthcare team. This concept may seem logical that the patient is the primary person as they are the reason and the sole purpose for the healthcare system, but it is a relatively new concept, but one that is taking hold and being noticed by everyone. 

A tremendous amount of work is going into implementing systems to improve communications so that the patient has access to his/her medical records and can have a way to seamlessly communicate with the team when needed. Patients are being included in decisions about their care, and the team is listening to them. As a result, there is more buy-in from the patient which results in an increase in adherence to the plan of care, so outcomes are better.

The word about these changes is reaching the average consumer who is recognizing the important role they have to play. They also know they have more to pay as a result of rising insurance premiums, deductibles and other costs associated with their benefits so they understand that being a more savvy consumer is to their benefit. 

They are also realizing how difficult this challenge is, and how much they don’t know. They realize that the healthcare system is like no other entity consumers utilize in their daily lives.  Getting information on the cost of care, resources, and other services are not readily accessible to consumers or their providers. Today that is changing as insurance companies and provider’s set up patient portals that provide information that consumers can use to learn who is in their insurance network, how much they will need to pay based on their policy for a visit, procedure or a test and how they are doing with regard to their health and healthcare. Consumers now have access to many of the lab results or other diagnostic tests they have received. Having access to this information allows them to be more in charge and informed as to their health and healthcare and to share the information with providers they may see for various healthcare issues. As a result duplicate testing is down which has been a driver of healthcare costs. 

Through my experience as a patient with a serious medical condition, I learned that I was the only constant member of my healthcare team. It was I who was responsible for providing my history to each member of the team as they came in and out of my life to care for me. When I could not provide the information due to my condition, it fell to my husband.  We realized early on that we had to advocate for ourselves and try to figure out the system every step of the way. 

It was my responsibility to know all of my current and past medications, the dosages and why I was taking them. Many times, a doctor tried to put me on something that I had already been on, or that was not indicated on the protocol I was following as part of my treatment. It fell to us many times to tell the doctor that the medication or therapy he was considering had been tried or would not work with my treatment plan. Many would acknowledge this, but some would not be happy. Those who were not happy were referred to my Hematologist so they could have a discussion peer to peer. But I had to be the first line of defense. 

What I realized early on was that it was my role to recognize problems and to raise the red flag to cause everyone to STOP. It was my role to ask questions if my husband or I did not understand something. It was our role to tell a nurse, the aid, medical student, intern or resident to call the attending as we are NOT doing something that did not feel right. Many times I felt intimidated but overall I knew that if my husband or I did not say something, problems would occur.

As an experienced nurse, this was a challenge for me. I could not image how the average person who was sick functioned in the same situation. That is why I feel so strongly about writing this Blog, Nurse Advocate so I could educate and empower others to advocate for themselves.

But this is not enough. Every physician, nurse, pharmacists and another member of the healthcare team has to remember that WE all have an obligation to assist each patient as they navigate through the healthcare system. The average consumer does not have the education that members of the healthcare team has to advocate for themselves. They need help to do this, and it is up to the professionals in the system to do our best to educate and empower each consumer and their family. 

Today there are professionals who can work with a patient and their family when a healthcare crisis arises. Patient Advocates are in place to assure the person has a voice in their care. They are an objective professional who works exclusively for the patient and and or the family. They are paid for privately, so they do not have an obligation to the payer or the providers providing service. 

Advocates do not provide direct care, but instead inform, educate and provide the person with information so they can make informed choices. The advocate works with the patient and the healthcare team to ensure thee individual patient receives the care and the resources to meet their goals.

Yes, health care is changing and will continue to be in a disruptive state for a long time because changing the system is a monumental task. The most important thing we can all do is to pace ourselves, learn about the changes, stay involved and remain level headed throughout these disruptive times. 

We all know that change is never easy, but today with the internet, there is a wealth of information that can help consumers and members of the healthcare team better understand the new roles all are being asked to play.  I have provided some resources to help you and your family understand some of the strategies being put in to help transform practice so that healthcare is safe, effective, equitable and meets the needs of the individual consumer. Take time to read through these resources so that you are ready for the marathon. 

The Triple Aim: The Triple Aim was developed by the Institute for Healthcare Improvement to describe an approach to optimizing health systems performance.

The Affordable Care Act is working:  Here are some statistics on strategies from the ACA and how they are improving access to health insurance, allowing improvements in quality and slowing healthcare costs. Take a minute to read. Hospital Compare is a site that is helping providers to be more transparent as to what they do and how they do it. Hospital Compare shares insights into how new payment models are changing how healthcare is delivered to hospitals.   To view other compare sites for physicians, home care, nursing homes and other settings, go to These sites allow consumers can see how organizations they might choose compare.  Reviewing the information enables the user to make more informed choices.

Patient Survey’s: Just like other providers, healthcare providers want to know how they are doing and how they meant your expectations. Whenever you visit a doctor, a hospital or another service provider, you will probably get a survey soon after to complete.  It is important to take the time to fill out these and give your honest opinion as the information is recorded for quality improvement training. Also, providers are being paid for how well they do. Here is a link to learn more.

Patient and Family Hospital Advisory Boards: today many hospitals and organizations are developing patient and family advisory boards to better understand their patient’s needs. These boards are listened to and have helped organizations to improve the care they provide through honest and frank input. If you do a google search, you will find examples of hospitals who have these boards in place and the important work they are doing. Here is a case from Vanderbilt University. 

Shared Decision Making: Today there are many ways to treat medical or mental health decisions. Knowing the pros, cons and cost of these decisions is important as today, you as the consumer will have to pay for more and more of the care. What if you do nothing? Will it change the outcome? Understanding the diagnosis and the care that can be provided is important. Today consumers are sharing in the decision-making process. Shared Decision Making is a relatively new concept that is being employed by many physicians to provide patients and their caregivers with various choices to help them understand the choices and how the choices may impact their goals. To learn more visit this site,  Dartmouth-Hitchcock is one of the leaders in shared decision making.

Patient Advocate: When I was first diagnosed with the brain tumor, I was not thinking clearly and asked two colleagues for help. Both became my advocates and assisted my husband and myself in understanding what was happening, why it was happening and what were some alternatives. They did not replace the medical team but were there for my husband and me. They communicated with the team, so they understood the plan of care and helped my husband, and I get to the best place for my care. I honestly believe if it were not for these two professionals and my husband, I would not be here today. There is no doubt in my mind that everyone needs to have a patient advocate.  Many people say you would not go into a court of law without an attorney, so why would you enter the complex world of healthcare without a patient advocate. Here is an article I wrote for Nurse Together that explains an independent patient advocate Not every person needs an advocate to address a healthcare problem. But when a need arises that is a challenge for your or a family member to handle, it 's nice to know one is available.

I hope this information is helpful and provides you with some useful information. If you have questions, please feel to email me and we can set up a time to discuss your questions or concerns. I might not have all the answers, but I can connect you with the people who do! 

Have a good week! 

Sunday, February 14, 2016

A Positive Patient Experience

As consumers, we all have a responsibility to take care of ourselves and manage our health in a proactive manner. Today, the concept of ‘managing our own health’ or ‘staying healthy’ often translates to eating healthy and regular exercise, while going to the doctor is associated with being sick. In fact, visiting the doctor regularly for preventive care is an important part of staying healthy.

I feel like I have been proactive in taking care of myself by getting regular checkups and having most of the preventative screening test - except for one…my colonoscopy. I am embarrassed to say that I have procrastinated for 11 years in having a colonoscopy despite it being recommended by several doctors during annual examinations.

I can hear the collective groan from all of you reading this. You probably think I am going to answer the million-dollar question of WHY have I put this test off for so long with a thoughtful answer?  I honestly can say that I have no good reason to justify my procrastination- except that I was afraid to have a colonoscopy so I put it off year after year.

So what changed my mind and prompted me to get a colonoscopy after an 11 year delay? What changed my mind was a blunt doctor who drove the point home to me like no other doctor ever has.

Here is what happened.

As you know, I was diagnosed with a central nervous system brain tumor in late November 2014. During chemotherapy that successfully eradicated the tumor, it was found that I had elevated liver enzymes. To evaluate this, my oncologist recommended I see a Hepatologist. During the assessment, the doctor asked me “when my last colonoscopy was. I replied, “well I have not had my first one yet.” He looked directly at me and said; “so let me get this straight - you are going to beat brain cancer but die from colon cancer.”  Those words stuck with me over the next few months, and I promised myself, that when I got stronger, I would have my colonoscopy.  I am proud to say that I had my first colonoscopy on February 10, 2016!

I would like to share my story as it demonstrates the system does work and provides a good example of how one facility scored high in satisfying this patient. So here it goes.

At the beginning of January, I had gotten the name of a GI specialist from a friend and called to make an appointment. I visited him for a preliminary examination to schedule the colonoscopy. The office staff was very pleasant and efficient. The tech who brought me in took my vital signs and weight was kind and caring. As we talked, she shared that she was a breast cancer survivor. She was a young woman and shared how the experience has impacted her. I was impressed when she shared that she was able to work during her treatments. She said she was tired and at times it was hard for her to come in every day, but she was working through the process.  Next, I saw the doctor for my interview.  He came into the room, said hello without making eye contact with me and got right to work. He reviewed my chart and asked me some questions again without actually looking at me. His demeanor let me know that he did not have time for small talk, so I answered his questions so not to delay him. He then examined me and once done, said he was glad to meet me and that he would see me when I had my procedure. Next I went to the scheduler so we could set the date for my colonoscopy. The scheduler gave me a few dates that were open, and we picked February 10th at 7 am. She went through the process and what I would take as a prep. She explained everything very clearly, and I felt good and ready to move forward.

I am sure most of you reading this post will agree with me that the next step in the process is the worst part of the entire event: The PREP. I won’t go into detail except to say that I hope by the time I have to have my next colonoscopy there will be a better way.

On the scheduled day, February 10th, I arrived at the surgical center at the appointed time. The receptionist was bright and friendly (even at 6:30 am.)  She reviewed and completed all the paperwork and then let the nurse know I was ready. I was taken back to the pre-op room where I was prepared for the procedure. Everyone was pleasant, friendly and efficient. The nurse even gave me heated blankets, made sure my belongings were stored and was able to insert the IV on the first try! I was feeling safe, comfortable and prepared. As I waited to be taken to the procedure room, I observed the action going on around me. It brought back memories of working in the emergency department with everyone moving around doing needed activities while talking about what they were going to for the weekend. What stood out to me the most as I waited, was that at every step, each person introduced themselves to me (and the other patients in the pre-op room), asked our names, our date of birth and why we were there. These questions were reassuring to me that the staff was taking precautions to make sure their patients were safe.

Around 7:30 a.m., a nurse came over to me and said she was going to be my nurse for the procedure and was I ready. I said yes and off we went. In the procedure room, I looked around and noted where the O2 was, where the suction machine was, and where the emergency cart was. As a nurse, I was a little nervous having the procedure in a surgical center and not the hospital, but everything seemed to be in order. I told myself everything was going to be ok and said a little prayer for insurance.  To take my mind off of things, I talked to the GI tech and the nurse as they got things ready. Next the anesthesiologists came in and said hello to me. He asked me a few questions that indicated he had read my chart and was familiar with my history. This gave me confidence that I was in good hands. He got the meds ready while the nurse positioned me for the procedure. Both asked me if I was comfortable and said to relax while we waited for the doctor.

My doctor came in, said hello to the team and then came over to me and asked me how I was doing and if I was ready. I told him, yes, and he said ok, let’s get started. The next thing I remember was hearing people talking and someone calling my name and telling me to wake up. I was in the recovery room, and the procedure was over. As I woke up, the nurse gave me some juice, removed my IV and gave me my clothes so I could get dressed. The doctor came over and asked me how I was. He said everything went well. He said I had a small polyp which he said was benign, but they would test it, and he would let me know the results as soon as they were back.

The nurse brought my husband in, gave us the instructions and walked us to the car. Later in the day, the doctor called to see how I was doing. I told him I was fine and thanked him for the call. He said to call him if I had any trouble; as he would be there for me. I smiled after we talked and I thought he was a nice person, and I was glad he was my doctor.

The next day around 8 am, I got a call from the Surgical Center to see how I was doing. I told them I was fine and asked the person calling to thank everyone who cared for me. I said, “you have a great team, and I was grateful for their care." Later in the day, I got another call from the doctor who wanted to let me know that the polyp he found was negative, and he would see me in 3 years.

I wanted to share this story, as it is an example of how the system can and does work in providing safe, effective care. I had an excellent experience from everyone who cared for me and as a result, I will not be afraid to have my next colonoscopy in 3 years as recommended by my doctor.

I urge anyone who has been putting off getting their colonoscopy or any other preventative test to take a deep breath and make the appointment. Don’t be afraid and you will feel relieved when it is over.

Hope you have a good week!

Saturday, February 6, 2016

The Impact of Nursing in Transforming Healthcare

A few weeks ago, I had the opportunity to attend a conference entitled Building Health Policy Competencies in Graduate Nursing Programs. The program was presented by the Nursing and Health Policy Collaborative at the University of New Mexico with the Robert Wood Johnson Foundation. I  was attracted to this conference as I believe nurses play a vital role in transforming the healthcare system in the United States and I wanted to see what educators were doing to ensure the profession was prepared. 

Why do I think nurses are vital to transforming healthcare? There are several reasons, here are a few. Nurses as a professional number over three million people. As a result of the sheer numbers, nurses have a strong voice and a common goal that the profession is based. As a result when nurses come together, they have a strong voice and can make an enormous impact.  Nursing as a profession is diverse in practice and as a result, nurses have an impact on each patients they meet at every point along the healthcare continuum.

Today, nurses provide care throughout the healthcare system 24/7. As a result, they are closest to the patient at the most vulnerable times throughout their lifespan. Their role allows them to see the miracles of our healthcare system as well as the challenges people have in managing their health and healthcare. They see first-hand how social determinants and public policy impacts their patients ability to manage their care as well the nurses ability to do their work in a safe and efficient manner.   

Once a person completes a nursing program and gains a license to practice nursing, they choose the setting where they want to work and utilize their expertise. It might be on a medical-surgical floor,  in a community health clinic or another entry level setting that allows them to put their nursing training into practice. After a few years, they may choose to stay at the bedside to mentor new staff, decide to specialize in an area such as the neonatal intensive care unit or one of the many adult care specialties or move up the ladder of management.  These choices are possible due to their broad educational background as well as from the creativity and innovate spirit each nurse brings to the profession.

Regardless of their choices, nurses get to see the broad landscape of the healthcare industry up close and personal. They gain a unique understanding of how the system works (or doesn’t) and how each person faces their health and healthcare responsibility.

Today, with health care in a disruptive state, nurses are becoming frustrated with the system and the challenges that disruption brings. They are seeing that the chaos is impacting how care is delivered. Many are using their expertise and their voices as integral members of the team to help their organizations and communities to improve.

To be truly effective, nurses need to use their collective voices in areas of education, public policy and other venues that influence change. Nurses are finding seats at the table by serving on corporate boards, by being active in their community via their City Council, by working with employers and legislature representatives on the local, state and federal levels to help enact health care policy that serves the community.

Nurses are instrumental in helping policy makers, employers and consumers understand the complex health care system and are assisting them in making informed decisions regarding their health and healthcare.

To do this effectively, nurses need education on how to be effective leaders and how they can influence heath policy. As a result, Nurse Educators at the baccalaureate, masters, and doctorate levels are working to develop programs that incorporate advocacy and health policy education into their curriculum.

To spearhead the effort, the Robert Wood Johnson Foundation in collaboration with the University of New Mexico have developed a collaborative to educate educators and other nurse leaders on the importance of building health policy competency in nursing education.

The conference Building Health Policy Competency in Graduate Nursing Education was one of the attempts to meet this need. The meeting was held on January 23-24th in Naples FL. The gathering followed the American College of Nursing annual Doctoral Education Conference and brought together educators from across the country. The goal of this conference was to increase the quality, rigor and uniformity of health policy education by bringing together inter-professional experts in the instruction of health policy content. 

The conference  planning committee brought together an expert faculty and produced a  range of pedagogical material and approaches to enhance health policy education in nursing programs at all levels as well as introduce a  national repository of health policy education resources.

The interactive conference provided a venue for all in attendance to share best practices, academic teaching styles and learning activities via lectures, round table discussions,  poster presentations and other networking opportunities.

Post-conference educators and other nurse leaders are encouraged to visit and add to the repository that has been set up by the University of New Mexico. The repository is meant to be used by faculty teaching health policy. Materials submitted are peer reviewed and once approved added to the portal. They are available for use at no cost.

The conference was an important step in building a community of colleagues committed to bringing health policy acumen to faculty and students.  The overarching goal to provide nurse leaders with the skills needed to influence the policy making process at all levels, to engage in rigorous health policy research and analysis, and to promote improvements in population health and healthcare.

The faculty was impressive as they are the current leaders who are making an impact internationally, nationally, regionally and locally in the area of health policy and health education.

Among them was Susan Hassmiller, Ph.D., RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing and Director, Future of Nursing Campaign for Action. Joining her was Eileen O'Grady, Ph.D., NP, RN, Nurse Practitioner and Wellness Coach and Nancy Short, DrPH, MBA, RN, Associate Clinical Professor at Duke University

All of the speakers provided insights into the important role of nursing as an essential member of the healthcare team and why it was critical for nurses to use their voice in advocating for patients and the health care team as we move through the complex process of transforming the healthcare system. All of the speakers shared the importance of building health policy competency in graduate nursing programs as a critical tool for the profession as well as our country.

The Keynote speaker, was Judith Shamian, Ph.D., RN, FAA, President of the International Council of Nurses.

In her keynote speaker, Dr. Shamian shared her impressions of the role nurses can play in addressing challenges in healthcare nationally and internationally. As President of the International Council of Nurses, she shared how other countries look to the United States as a leader in the area of public policy, healthcare, and nursing. 

She implored nurses to use the power they have to make an impact by stepping up to the challenge and being part of the transformation of healthcare not only in the US but around the world.

I was grateful to attend this meeting and provide insights in this post of Nurse Advocate so that you can be encouraged to make your impact in transforming healthcare. 

Please take the time to review the resources noted below and share with your colleagues.

I look forward to your comments and how you are making an impact in your community.

It is truly and exciting time to be a nurse!

Nurses: The Vital Role of Nurses in Transforming Healthcare. A thirty-minute video produced by Johnson and Johnson that explores the impact nurses have on our country's healthcare system, our communities and families. Take time to watch this and share with your colleagues. 

Nursing and Health Policy Repository: The Nursing and Health Policy Repository is a web-based library that provides resources on a variety of topics relating to health policy in general and the intersection of nursing and health policy in particular. Resources have been submitted by many of the nation's top experts and health policy professionals and are meant to be used for educational purposes to facilitate the continued knowledge-building of future nursing and health policy experts, particularly at the doctoral level. If you have resources that you would like to have added to this repository, please send them to  All resources are screened and verified before being uploaded. The RWJF Nursing and Health Policy Collaborative at the University of New Mexico does not endorse any policy or candidates that may be promoted by a resource provided here.

International Council of Nurses: The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations (NNAs), representing the more than 16 million nurses worldwide.  Founded in 1899, ICN is the world’s first and widest reaching international organization for health professionals.  Operated by nurses and leading nurses internationally, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce.

Robert Wood Johnson Foundation:  The Robert Wood Johnson Foundation is the nation’s largest philanthropy dedicated solely to health. Since 1972, the Foundation has worked to identify the most pressing health issues facing America. The Foundation believe that good health and health care are essential to the well-being and stability of our society and the vitality of our families and communities. The Foundations work is guided by the fundamental premise: We are stewards of private funds that must be used in the public's interest. Together with grantees and collaborators, they strive to bring about meaningful, lasting change—with the goal of building a Culture of Health that enables all in our diverse society to lead healthier lives, now and for generations to come. RWJ and the Institute of Medicine collaborated to write the Future of Nursing Report and are committed to seeing the recommendations from the report come to fruition. 

Future of Nursing Report: In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. –

National Nurse Act of 2015: This is an example of a grassroots public policy project that I have been involved for over five years. The National Nurse Act amends the Public Health Service Act to require the Department of Health and Human Services (HHS) to designate the Chief Nurse Officer of the Public Health Service as the National Nurse for Public Health within the Office of the Surgeon General. The Act includes among the duties of this position that include: providing leadership and coordination of Public Health Service nursing professional affairs for the Office of the Surgeon General and other agencies of the Public Health Service, conducting outreach and education, providing guidance and leadership for activities that will increase public safety and emergency preparedness. The Act requires the National Nurse for Public Health to participate in the identification of national health priorities, (2) encourage volunteerism of nurses and strengthen the relationship between government agencies and health-related national organizations, and (3) promote the dissemination of evidence-based practice in educating the public on health promotion and disease prevention activities. To learn more and support this legislation, please visit the website

If you have questions, please email me at Have a good week!