A New Age for Nursing

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UM nurses and health care experts are at the heart of a national debate about how to help improve health care in this country.

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Nurse practitioner Maria Elena Torres, B.S.N. ’84, M.S.N. ’89, brings affordable care to Miami clinic patients.

U.S. Army Major Hope Williamson, D.N.P. ’09, is taking her University of Miami training to the battlefield. Armed with a doctorate in nursing practice, the acute care nurse is helping to save wounded troops in Iraq—and teaching doctors, medics, and other nurses her techniques.

She even developed a phone app intended to give emergency personnel the latest medical information while treating casualties in a war zone.

“The Army is field testing it now,” says JoAnn Trybulski, associate dean at UM’s School of Nursing and Health Studies. “We are so proud of her.”

Last October, a national committee tasked with assessing the future of nursing concluded that the U.S. health care system will require an injection of such highly trained nurses to address rising health care needs and costs.

“And, in fact, they can do 70 percent of what primary care physicians can do,” says President Donna E. Shalala, who was selected to chair the 18-member committee of health professionals and policy experts.

Williamson’s degree is one of several popular programs the School of Nursing and Health Studies has launched with an eye toward training nurses for an advancing profession and increasingly complex global health issues. In two years, enrollment in the D.N.P. program has more than doubled to 43 students whose advanced training prepares them to create innovation in nursing practice and health care.

Ph.D. candidate Shakira Henderson, B.S. ’03, implements a lactation program in the NICU.

Other strategic additions have included the certified nurse anesthesiologist program, nurse practitioner master’s program with an emphasis on acute and adult care, minor in public health, and online and accelerated programs for working nurses and career changers. Last year 95 new students enrolled in the school’s accelerated B.S.N. degree, which enables individuals who hold degrees in disciplines other than nursing to obtain a bachelor’s in nursing in just 12 months. The new Certificate in Nursing Education program, offered online and at a reduced tuition, aims to infuse hospitals and nursing programs across the U.S. with 100 new nurse educators by 2013.

“We have been quite busy,” says Dean Nilda “Nena” Peragallo, whose school ranks 20th in the U.S. and first in Florida for National Institutes of Health funding received. “It’s been exciting.”

That excitement and input extended into the national sphere when Shalala and assistant professor of nursing Rosa M. Gonzalez-Guarda, Ph.D. ’08, were both tapped for the Future of Nursing Committee. Their contributions have helped “create a game-changing vision for the future of nursing,” says Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation (RWJF), which co-sponsored the two-year, evidence-based study with the Institute of Medicine (IOM).

Facing a grave shortage of providers to treat the additional 32 million insured Americans expected to enter the system under the new federal health care reforms, the committee advises creating a seamless academic pipeline for nurses. It concludes that the profession needs to grow the proportion of nurses with bachelor’s degrees to 80 percent by 2020, with another 10 percent going on to master’s or doctoral programs within five years. It also recommends doubling the number of nurses pursuing doctorates by 2020, offering residency programs, and encouraging more lifelong learning opportunities.

In addition, “The Future of Nursing: Leading Change, Advancing Health” states that nurses must become full partners in health care with physicians and other health care professionals.

“Health care is a team sport,” explains Shalala.

Future of Nursing Committee recommendations include engaging more nurses as industry leaders prepared to advance health care, removing scope of practice barriers for nurse practitioners, and increasing the number of nurses who proceed along the educational pipeline to earn advanced degrees.

Future of Nursing Committee recommendations include engaging more nurses as industry leaders prepared to advance health care, removing scope of practice barriers for nurse practitioners, and increasing the number of nurses who proceed along the educational pipeline to earn advanced degrees.

Perhaps the most ambitious and debated recommendation of the 562-page report is for a uniform policy that will allow nurse practitioners (nurses with at least a master’s degree) to practice to the full extent of their license—including monitoring, evaluating, and prescribing treatments for patients—in Florida and about 35 other states that restrict the duties they can perform (known as scope of practice).

Gonzalez-Guarda, whose interdepartmental Ph.D. combined nursing, epidemiology, and psychology, says the industry needs to take advantage of nurses’ skills and unlock their potential, a point she made on National Public Radio’s Talk of the Nation last year, noting “overwhelming evidence” for “great outcomes with the type of care that nurse practitioners provide.”

In April the Florida Legislature discussed the state’s scope of practice rules, rejecting a bill that could have led to an expansion of the roles of advanced practice nurses.

That decision doesn’t make sense to Harvey V. Fineberg, president of the Washington, D.C.-based IOM, who notes that the nation’s 3 million nurses make up the largest group of professional health care providers in the United States. “We need to use them to their fullest capacity,” he says.

A December 2010 report by the nonprofit, nonpartisan group Florida TaxWatch notes that BlueCross BlueShield of Florida has projected the state could save up to $6 million annually if nurse practitioners and physician assistants were allowed to practice to the full extent of their license and training without a physician’s supervision as Florida law currently requires. “The savings for private employers and self-paid residents would likely be even greater,” the report states.

Vero Beach midwife Angela Love, M.S.N. ’04, agrees. “Any good health care reform should involve nurses and nurse practitioners because we are cost effective,” she says, adding that Florida law currently makes health care more expensive in ways legislators never envisioned. If one of her patients develops kidney stones during pregnancy, for example, Love can’t dispense medication. While state law allows licensed nurse practitioners to treat patients, order diagnostic exams, and prescribe many medicines under the supervision of doctors, it does not allow them to prescribe a controlled substance (a narcotic or other potentially addictive drug). Instead, a doctor has to be called in.

“That means the patient has to spend extra money,” Love says. “That is not cost effective. I have been trained to handle it, but I can’t.”

Laura Dominguez, B.S.N. ’86, M.B.A. ’89, vice president for business development at Mercy Hospital in Coconut Grove, says her work as an intensive care nurse taught her to prioritize and make quick decisions—and informed her career as a hospital administrator. “Nurses,” she says, “are stars.”

As efforts to implement the Future of Nursing Committee’s findings proceed on a local and national level, nurses like Maria Elena Torres, B.S.N. ’84, M.S.N. ’89, continue making a difference on the ground. During a shift at the St. John Bosco Clinic in Miami, the family practitioner prescribes diabetes medicine for 62-year-old Ana Marina Robles. When Torres also gives her a pair of shoes designed for diabetics, courtesy of her podiatrist husband, the Salvadoran immigrant’s face lights up. “They fit!” she exclaims. Torres then shows Robles a food chart. “See my hand?” she asks. “You can eat that much of vegetables.” Meats, however, should be limited to the size of her palm. Torres hopes to help Robles lose weight and control her disease. “I am so proud of her,” she says. “She’s already lost four pounds.”

Whether on the battlefield, in the boardroom, or at the research bench, nurses are increasingly on the front lines of improving and expanding access to health care.

“Nurses are still at the bedside,” Williamson explains in an email between shifts at the Combat Support Hospital in Iraq, where she’s a head nurse serving her third tour of duty. “But moreover, they are creating health policy and technology for use at the bedside…and seizing opportunities that were not available to nurses of the past.”

Opportunities at the School of Nursing and Health Studies include centers of excellence in health disparities research as well as patient safety and nursing human resource development, plus top-notch research and clinical experiences throughout Miami, Latin America, and the Caribbean.

“The school enjoys a wonderful national reputation for programs and does cutting-edge research that involves multicultural perspectives,” says Future of Nursing Committee member Michael Bleich, a dean, professor of nursing, and vice provost at Oregon Health & Science University. “This contribution to the science is recognized nationally.”

Award-winning students like Shakira Henderson, B.S. ’03, reflect the vitality and relevance of the school’s approach. A Ph.D. candidate at UM and a staff nurse at South Miami Hospital, Henderson won the 2010 Leadership Award from the National Association of Neonatal Nurses for developing a lactation program for preemies. In her nominator’s words, she has had an “overwhelming impact on her patients and staff, and on her unit’s reputation.”

Thanks to Henderson, nurse-counselors in the hospital’s neonatal intensive care unit help train moms on pumping milk to feed their tiny premature infants who are confined to incubators.

“It’s really hard, and it can be scary for the moms,” she says. But the breast milk is crucial. “It’s brain food, especially for preemies.”

Henderson, who gave up biochemical research for a career in nursing, says working with patients has transformed her. “I am excited that I became a nurse—there are so many opportunities.”

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