Janis P Bellack

Environmental health in medical school curricula : views of academic deans

Academic deans at 126 US medical schools were surveyed in Spring 1994. Comparisons of means and frequencies, multiple regression, and factor analysis were used. Study results showed only low to moderate expectations for graduate competence in seven environmental health competency areas. Over two-thirds of deans (70%) indicated that there was “minimal” emphasis on environmental health at their schools; 61% thought that ideally there should be “moderate” emphasis. An “already crowded curriculum” and “too few qualified faculty” were frequently cited as barriers to greater emphasis on environmental health. Students were identified most commonly as the group expressing the greatest support for environmental health education. Although there was not a clear consensus, occupational medicine departments were most often selected as best suited to offer environmental medicine education.

The RWJ executive nurse fellows program, part 2 Mentoring for leadership success

This article is the second in a 3-part series describing the RWJ Executive Nurse Fellows Program, an advanced leadership program for nurses in senior executive roles who aspire to help lead and shape the US healthcare system of the future. Part 1 (October 2005) described the program, its core leadership competencies, and the primary components. This article discusses the mentor experience that is a cornerstone of the 3-year fellowship program. Fellows are encouraged to have this experience with senior-level executives outside of healthcare in order to broaden their leadership perspectives. Examples of these mentor experiences are described from the viewpoints of both fellows and mentors, including successes, challenges, and lessons learned. Part 3 (February 2006) will explain how fellows are required to create a business plan for their leadership project because it is so important for nurse leaders to offer a strong business case for proceeding with anew initiative, service, or program.

The RWJ Executive Nurse Fellows Program, Part 1: Leading change.

This article is the first of a 3-part series describing the RWJ Executive Nurse Fellows Program, an advanced leadership program for nurses in senior executive roles who aspire to help lead and shape the US healthcare system of the future. This article describes the RWJ Executive Nurse Fellows program, its core leadership competencies, and the primary program components. Part 2 (December 2005) will focus on the nontraditional mentor relationships developed by fellows as part of the fellowship experience and lessons learned regarding best practices. Part 3 (February 2006) will explain how fellows are required to create a business plan for their leadership project because it is so important for nurse leaders to offer a strong business case for proceeding with a new initiative, service, or program.

A PROPOSED FRAMEWORK for Differentiating the 21 Pew Competencies by Level of Nursing Education

Now nearly a decade old, the original Pew Health Professions Commission Competencies have stood up well to the test of time. The competencies were designed to provide all health professionals, from physicians to physical therapists, with a general guide to the values, skills, and knowledge they would need to be successful in the health care system that was beginning to emerge in the late 1980s. They have been used across the range of health professions and in many practice settings to create a framework for curricular change, work redesign, and assessment of professional competence. The interpretation of the competencies offered here should prove to be a useful tool to nurses and health system leaders as they carry on the hard work of adapting the current model of nursing practice to the demands and realties of the contemporary and continually evolving health care environment. This work is important for two reasons. First, many of the skills and attributes of the professional nurse are not adequately used or valued by the health care system because the profession is both fragmented and poorly differentiated and articulated. Without markers that define and promote collaborative practice within nursing, the full potential of nurses at all levels of preparation will continue to be inadequately and inappropriately deployed. This model exacerbates the current nursing shortage because it fails to use nurses in appropriate, well-delineated, and challenging roles. Without this kind of differentiation, one that can be owned and supported by all nurses, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the companion teaching-learning strategies proposed here offer one approach to rationalizing both nursing education and practice, with the potential for improving the quality of care, and reducing fragmentation, cost, and public confusion.

Helping a child cope with the stress of injury.

The nurse who is tuned in to a childs emotional as well as physical needs uses all resources available, including parents, to make an emergency-room visit bearable, perhaps even growth producing.

Characteristics and outcomes of a statewide nurse refresher project.

This article describes a 3-year, federally funded statewide nurse refresher course offered by the South Carolina Area Health Education Consortium (S.C. AHEC) to address the states nursing shortage. A total of 222 inactive RNs enrolled in the 160-hour course during the project period. A follow-up survey of the first 160 graduates of the course revealed that 76% had returned to active nursing practice, the majority in hospital staff nurse positions. Forty percent of respondents returned to work full-time, the remainder part-time. Respondents were employed in 72 health care facilities in 36 different communities in the state. Nearly 25% reported working in rural, underserved areas designated as health professions shortage areas. A survey of employers of course graduates revealed a high degree of satisfaction with their performance. As health care reform takes shape and nursing roles shift, the nurse refresher course will be revised and updated to assure its continued relevance for current and future practice.

Environmental Health Competencies: A Survey of U.S. Nurse Practitioner Programs

Because of widespread public and governmental concern about the health effects of environmental hazards and exposure in recent years, and the increasing incidence of environmentally-induced diseases, it is important that primary care nurse practitioners possess the knowledge and skills to effectively address environmental health as a component of their practice. A mailed questionnaire survey of 187 U.S. nurse practitioner (NP) programs was conducted, with a response rate of 64%, to determine: 1) current and ideal emphasis on environmental health, 2) faculty preparation for teaching environmental health, 3) environmental health competencies expected of graduates, 4) didactic and clinical contact hours devoted to environmental health, and 5) barriers and incentives to greater emphasis on environmental health. Findings reveal that more than two-thirds of NP program directors believe there should be greater emphasis on environmental health in their programs, but expressed concerns about overcrowded curricula and lack of faculty preparation as barriers to change. Competencies with the highest mean ratings included understanding the relationship between environmental hazards and human health, accessing information resources related to environmental hazards and health, and counseling clients about how they can reduce risks associated with environmental hazards. The two factors identified as most likely to increase the emphasis on environmental health in NP programs were having nurse faculty with expertise and being able to access information resources related to environmental health. Currently, insufficient attention is given to environmental health in nurse practitioner education programs.

Differences in curriculum emphasis in US undergraduate and generalist residency education programmes

Little attention has been paid to the differential emphasis undergraduate and graduate medical education programmes place on the broad competencies that will be needed for practice in an increasingly managed health care environment. The purpose of this study was to determine differences in emphasis that undergraduate and primary care graduate medical education programmes are currently placing on 33 broad practice competencies, compared with the emphasis they ideally would like to give them, and the barriers they perceive to curriculum change.

Responses of Baccalaureate and Graduate Programs to the Emergence of Choice in Nursing Accreditation

Specialized accreditation in nursing is a widely recognized and respected hallmark of program quality. The advent of a second specialized accrediting agency for baccalaureate and higher degree programs in nursing prompted a survey of these programs to determine their choice of nursing accreditation agency, factors influencing their choice, their perceptions of the value added by nursing accreditation, and the difficulties encountered with the accreditation process. These study variables and the relationships between choice of accrediting agency and types of degree-granting nursing education programs offered by the institution, agency membership in the National League of Nursing (NLN) or the American Association of Colleges of Nursing (AACN), expected date of next accreditation visit, geographic region, public versus private status, and type of institution (Carnegie classification) were analyzed. Findings revealed that nearly a quarter (24%) of respondents intend to continue with the NLN Accrediting Commission (NLNAC), whereas 30% indicated they have already switched to the Commission on Collegiate Nursing Education (CCNE) or intend to do so prior to their next accreditation cycle. However, nearly a quarter (24%) of respondents said they plan to be accredited by both agencies for the immediate future, and 21% indicated they are still undecided. Study findings suggest an end to single-source accreditation, and the beginning of a new market-oriented approach.

Nurses in the C-suite: leadership beyond chief nurse.

The US health care system is reaching a critical point. Consistent cost increases coupled with a struggling economy has illuminated the burden of more than