Leadership Interviews – “3 Questions” – Afaf Meleis on Gender Inequity and Nursing

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

After a near century following the classic reports of Flexner (1910), Rose-Welch (1915) and Goldmark (1923) that laid the foundations for higher education in health, we find ourselves today challenged to keep pace with the revolution in health professional education and desperately seeking reform to meet the demands of educating future physicians, nurses and public health professionals in a global world. In 2010, the independent Commission on Education of Health Professionals for the 21st Century was launched with the aim of focusing globally on the field, identifying gaps and opportunities, and offering recommendations for reform published in Lancet. The Institute of Medicine (IOM) Global Forum on Innovation in Health Professional Education has launched activities that are inspired by the Lancet report and the Future of Nursing report to explore promising, scientifically based innovation in health professional education and to cultivate new ideas through multi-disciplinary collaboratives that are undertaking the recommendations.

Does gender matter in these issues? Dr. Afaf I. Meleis takes a hard look at gender inequity as a global phenomenon that manifests itself in different forms (see Meleis & Glickman, Nursing Outlook, 2012, v. 60, issue 5 supplement: “Empowering expatriate nurses: Challenges and opportunities – A commentary”, p. S24 – S26). She speaks passionately about linking some of the issues in nursing with global issues that affect women in general, including health professional inequalities in the workplace and educational change needed.

Afaf I. Meleis, Dean and Professor at the University of Pennsylvania School of Nursing, speaks to the issues of gender inequity and nursing.

Click here for the Lancet report.

“Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World.”

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Afaf I. MeleisAfaf I. Meleis, PhD, DrPS (hon), FAAN

Margaret Bond Simon Dean of Nursing

Professor of Nursing and Sociology

University of Pennsylvania School of Nursing



Question 1. Are there opportunities and forces that promote or hinder the changes in the occupational structure that dominate healthcare systems?

There are. The pyramid view of the health care system reclines at the base and physicians at the apex. It’s being challenged, but it still continues to be the norm in our country and actually globally, and that’s definitely a hindrance. There are lots of indicators though that this is being challenged and challenged well. One is the Lancet report – the title is “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World.” It’s a global report challenging the current way by which we are educating nurses, physicians and public health folks. The recommendations of that report speak to the urgent need for a new era in education which transcends the silos. It breaks barriers between the professions – those three important professions – and calls for creating curricula that are more integrated, that could lead to more teams functioning after they graduate. Instead of waiting for them to form teams after they graduate, they teach them ahead of time in teams so that they can graduate and continue to do what they learned in school.

And so, as a follow-up to this Lancet report, IOM (Institute of Medicine) took that really seriously and developed a three year commitment to a global forum for innovative education programs lead by inter-professional principles. Some of these things are going to break not only the silos, but that pyramid view. So that is the first challenge.

The second challenge is to this hierarchical approach – created by the advanced preparation of nurses, allowing them to take on more responsibilities. So that pyramid is being challenged by the Lancet report, but it is also challenged by preparing nurses – graduating nurses – who are well prepared with knowledge, evidence and research, that allows them to have a wider scope of practice and to have the evidence behind it. I believe that nurses are better educated in science and systems. And it gives them the tools and the power to become partners and challenge that pyramid approach.

The third challenge to the status quo is the more informed consumer. Consumers are far more informed now. They expect to be part of the decision-making and they will not want that somebody makes the decision for them nor will they accept that pyramid approach.

So, I think these things provide the framework that promotes a more egalitarian relationship and as such, we know that the egalitarian relationship actually affects the kind of care that’s provided and the outcomes for patients.


Question 2. In the past, nurses distanced themselves from gender inequity and feminism.  Could you speak to why you connect gender inequity with inequities that nurses face?

Excellent question! I think it has been disconnected in the past and I think we really are not going to make a difference and move forward unless we connect some of the issues. Since the nursing workforce is still made up of 90 percent women (and we are trying to change that situation, definitely, by recruiting more men in nursing), but since it is 90 percent women, has been in the past, we should not and cannot separate the situation of women in the world from that of nurses. Putting nurses’ issues within the context of inequalities due to gender provides us with a platform to understand, to explain, to interpret how nurses’ options and how the opportunities manifest themselves – and how the obstacles, why they have obstacles in front of them.

Women, I think we know, have been treated as objects, as helpers, as caregivers, and as such they are expected to be altruistic, they are expected to be giving, they are expected to be sacrificing without expecting compensation. That’s really our history. Many women are sacrificing wives, sacrificing mothers in the world, and what they do – my research when I studied women in different parts of the world – they expect to be rewarded in their old age by their children. That is their reward. So they sacrifice all their lives but they know it’s going to happen later on – that they are going to be rewarded. They expect this delayed reward by family when they become the respected matriarch, whom others then sacrifice for.

The analogy between women and nurses’ situation is partially similar. Nursing grew from a sacrificing war model as well as a church model: nurses as caregivers in wars and as nuns were expected to be compassionate caregivers. They are altruistic and they expect no immediate reward other than the reward of just really caring for others, and that should bring that intrinsic wonderful feeling. Compensation in monetary terms was not the main consideration – they were taught not to really expect immediate rewards and compensation, financially, as an immediate reward. So nursing and mothering as a calling, not as careers really required little compensation other than the intrinsic reward from the act of giving to others. So here are some of the similarities that prevented nurses from being compensated appropriately.

Now, while women as mothers may get their rewards later on in life and nuns after they go to heaven, they expect to get those rewards, nurses may end their lives with little reserved savings to support them – and with actually the lack of valuation because of the little compensation they are given, because, I think societies tend to value people who are well compensated. As we carry the analogy further, we can understand why nurses’ work is valued – just as mothers’ work is very much valued. I think caring all over the world is very valued – there is intrinsic value in it – but the value does not translate into more regulated hours, to more respect, to better compensation equal to the effort – and to more power and to more autonomy. So it doesn’t translate to these things – it just translates to “yes, we love caring people and we value caring.”

Now, give nurses, as we give women more power, give them better compensation, give them more autonomy, and some of that translates to their ability to do even better work in supporting the patients and in making a difference in society, making a difference in the health care system. It gives them the potential of having a voice, and it gives them the potential with that power to be able to effect the changes that they believe should happen in the health care system and society.

I really think very strongly that gender inequity in work or life has the same properties and the same consequences, whether it is for women or for nurses. So why not use the example of nursing to change gender inequity? And why not use gender inequity in general as a platform for inequities that nurses experience? I think by linking them we have more voice and we are empowering a larger group of people. And we’re going to make a difference in policies and make a difference in patient care.

Question 3. How would you characterize the current situation in nursing?

We need to change the metaphors that describe nursing and differentiate nursing from medicine. The metaphor is that nursing is soft, compassionate, caring, historical, and “touchy”; and the metaphor for medicine is hard evidence of science. I do like the nursing metaphor. It should continue to be compassionate caring and giving, but it should also be attached to the metaphor that it is hard evidence, scientific, and it is a career. And I think that sums up where nursing is now. There is such an amazing momentum now that nurses must take advantage of with health care reform and with all the reports that are coming out. It’s the best time for nursing and we have to take advantage of that time to move forward.

By empowering nurses and by allowing their voices to come forth on the policy table – we  are a very large body of people and we are very large in the world – we really could become such an amazing force in improving the quality of care in the world and increasing access to health care. At the same time we use that power to empower women, and if you empower women then you empower families, you empower communities, and you empower society. Maybe that will bring us some peace in the world.


Leadership Interviews – “3 Questions” – Geropsychiatric Nursing

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

Last year, NURSING OUTLOOK featured a special issue on Gerontological Nursing: Development of the Science, Education and Practice. Early this year, Nursing Outlook published: “Carpe diem: Nursing making inroads to improve mental health for elders” (Evans, Beck & Buckwalter), a summary of the accomplishments of the Academy’s Geropsychiatric Nursing Collaborative (GPNC), a Hartford-funded project. Here, all three authors expand on their points of view and the lessons learned from the project and the evolving specialty of geropsychiatric nursing.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Evans, L., Beck, C. & Buckwalter, K. (2012). Carpe diem: Nursing making inroads to improve mental health for elders. NURSING OUTLOOK, 60, 2, 107-108. 

Cornelia Beck, PhD, RN,FAAN

Louise Hearne Chair in Dementia & Long-Term Care

University of Arkansas for Medical Sciences

Question 1.  “Why is it important that geropsychiatric nursing (GPN) be integrated into other specialty programs?”


I think it’s very important because we find that people often don’t just have a mental illness. They often have that along with another chronic illness. For example depression and diabetes commonly co-occur. The cost of caring for diabetic with depression is much higher than the cost of caring for an older adult with diabetes without depression. So, even people who don’t consider themselves mental health psychiatric nurses have a need to understand the relationship between the mental health illnesses like depression and anxiety and other chronic conditions.

Now, I think the same is also true if we look at Alzheimer’s disease. For example, people who have Alzheimer’s disease are often cared for by people from other specialties – even let’s say, a women’s health nurse practitioner might be caring for an older woman who has Alzheimer’s disease and some other chronic condition. We know from all lot of work that the cost of caring for someone with Alzheimer’s disease, if we just look at Medicare claims alone, is about three times as high as people with other diseases. I think it’s not because they’re sicker but it’s because often practitioners who are caring for them don’t take into consideration all of the issues that are going on with the other chronic diseases and the co-occurring mental illness. So, the person doesn’t get the kind of treatment and care that’s needed. It’s also probably also true for family nurse practitioners who may be caring for even children and their grandparents and knowing about the mental health issues of the older adult who might be a grandparent and how that plays with the rest of the family care.

I think that one of the reasons it’s a particularly important for all nurses to have some knowledge about geropsychiatric nursing – about mental illness in older adults – is because in each of their practices they are going to be caring for people who not only have physical illness but also have some kind of psychiatric illness or mental health issues. With the baby boom generation coming up, they are seen to be higher risk for depression and anxiety disorders and substance abuse disorders – more so than people who were born before World War II. So as we see the baby boomers coming more into health care, all nurses and nurse practitioners need to have the knowledge to address those mental health care needs of that population.

Lois K. Evans, PhD, RN, FAAN

van Ameringen Professor in Nursing Excellence, Emerita

University of Pennsylvania School of Nursing

Question 2. “What have you learned from this project about the importance of networking and collaboration?”


Well I think that in the middle of the project and certainly in retrospect, we recognized that we would never have been able to accomplish even a miniscule amount of the goals that we did accomplish without using our contacts, our professional networks and taking advantage of opportunities as they arose during the course of this particular project. We had started out with a very ambitious goal to improve the mental health of older Americans by preparing nurses at all levels to provide some geriatric mental health. It was fortuitous that we set the goal that broadly. We set two particular strategies: one was to develop some competencies in geriatric mental health for nurses, and then to develop or make available curriculum materials that faculty could use to actually help nurses learn how to provide mental health services for older people. But by having the goals so broad – improve the mental health of older Americans by nurses, we actually could take advantage of all sorts of opportunities that occurred over the project. So maybe I’ll just share a few that come to mind, because I think there are lessons to be learned in it.

Once we recognized that we couldn’t do it all – we are three: Cornelia Beck, Kitty Buckwalter and myself – who had planned this project with the John A. Hartford Foundation and housed it at the American Academy of Nursing because we wanted it to be seen as a national nursing project, not something that was closely aligned with one school or one particular setting but one that could be more national in scope, similar to how the Hartford Building Academic Geriatric Nursing Capacity (BAGNC) project has been running at the Academy until recently.

We housed it there and we had collaboration of certainly the three of us, and we came from three different schools representing three of the Hartford Geriatric Centers of Excellence in the country. (There are now nine of them that Hartford supports). We came from Arkansas, Iowa and the University of Pennsylvania. Each of us had some expertise with a history of expertise in research and teaching with some practice in geriatric mental health. But we knew that we couldn’t just among ourselves to do everything – so we really reached out early on by developing a national task force that was pulled together to help develop the competency statements for this project. Now, we couldn’t even do that by ourselves. One of the things we did early on was to review the status of competencies and program competencies for nurses in all the different fields that actually work with older adults. We were overwhelmed by how many there are, who writes them, the fact that none of them are sequentially done in the same timeframe – some got done in 92 and some and 96 and 02 and some in 08.  There was no clarity about when they would be revised or what the schedule was for that sort of thing. We also recognized that it was not timely to think about preparing competencies for a whole new field – geropsychiatric nursing – and I’ll spend a minute just saying about that.  The problem is that it is an area of practice that probably has two strikes against it at least. One of them is that it’s focused on mental health which still has a lot of stigma in our country in the general population, but also certainly among nurses. The second area of stigma is that it’s about old people. So put both of those together and it’s been very difficult to recruit nurses to train in that area to practice in that area etc.

We realized that the timing was short to be able to prepare the cadre of health providers in all the mental health fields that are going to be needed to care for the rapidly increasing elderly population where the estimate is that about one in 5, 20% of people in late life do have mental disorders or mental health problems that require service. At the moment we are woefully under-prepared in terms of just the sheer numbers of providers who have any training in geriatric mental health. Nursing is probably the lowest group for that because we have never had a specialty area proclaimed – there’s no certification exam for it etc. So we said that the best thing to do is to really figure out how to infuse this knowledge and skill set into the preparation of all nurses who are ever going to touch older people. That model was one that had been used by the Hartford Institute of Geriatric Nursing, housed at NYU, in trying to really make geriatrics be a more prominent component of undergraduate and graduate education. They recognized that probably 80% of hospital patients are over the age of 65, and most homecare patients and in many other settings are in fact elderly, but hardly any nursing schools had geriatric course. There were few geriatric nurse practitioner or geriatric CNS programs in the country. The notion was: we really need to get that kind of content and skill set in the hands of all nurses not just a handful. So we use that same kind of model and said let’s see if we can write competency enhancements for all of the programs that prepare graduates to work with adults, therefore with older adults. In our case we chose entry-level including associate degree and baccalaureate level graduates.  And then we looked, at the time there was still an adult health program (this was in 08), adult health, geriatrics, psych mental health, family health, women’s health and acute care were the areas that we targeted because they all care for older adults.

We pulled together a selective group through our networking – who did we know, who had practice expertise, educational expertise from across the country. We represented all the regions of the country, we represented diversity in terms of practice backgrounds, people who were essentially educators, undergraduate and graduate levels. We made sure we had gender diversity and ethnic racial diversity on the team. We tried to cover all of our bases, but again, putting together that committee or task force together, we reached out to our network to identify who were key people. That group worked diligently over a two-day period with materials we had already pulled together for them, to lay out what the essence of these competencies would be.

Again we had reached out of the process to someone who from the AACN, Joan Stanley, who had lead the process of competency development for a lot of the graduate programs when they were looking at how to infuse geriatrics into those graduate program competencies. She had a well-developed process that had been funded by HRSA. We consulted with her about how to go about doing this in a way that would be consistent and would therefore have credibility in what we were doing. She agreed to serve with the director of AACN on our national advisory panel. Beyond that, we used our national advisory panel which was also was a group of people deliberately representing credentialing, education, accreditation and practice, and other kinds of arenas where a lot of work is going to develop geriatrics in the country. That group has really served us very well to identify opportunities, trends and things that were happening before we knew it that might be ways that we could collaborate to further our cause in this project without having to reinvent wheels. I think that was another goal that we had – that we really didn’t have the resources (the time, the money, the personnel) to be able to reinvent wheels. It was too costly to do. We really needed to take advantage of opportunities as they came along and to piggyback onto projects that were already being developed and implemented that related to geriatrics infusion, helping people to recognize that infusion of geropsych was a part of infusion of geriatrics.

People just hadn’t thought about it, but when we brought it up to them they were very willing to have us work side-by-side to add value to the products that they were already producing. A couple of examples of those are: the Hartford Institute of Geriatric Nursing together with the American Association of Colleges of Nursing were preparing a series of geriatric cases – case studies that could be used for teaching core competencies around good geriatric care. It had not occurred to them to have any that related to mental health. But when we talk with the leaders of that project, they saw right away the value doing that and were very willing to add two new cases that related to geriatric mental health.

With our network, mostly capitalizing on people we knew including some alums from the Building Academic Geriatric Nursing Capacity (BAGNC) program, the pre- or post- doctoral training program that Hartford had supported over the years, we were able to help some people produced to wonderful case studies. One of them relates to mental health function in primary care, primarily for nurse practitioners, and the second one was geared toward the clinical nurse specialist and it had to do with confusion in the acute care setting. Those were really well done. They are posted on the NYU web site and I believe you can get to them from AACN, and you can also get to them from our postings on POGOe, which is Portal of Geriatric Online Education. That’s an example of collaboration. The timing was right, we learned that they were into this project. We said – “what about a having a couple of mental health ones?…great!…can you get them done in this time frame?…” and now they’re out there for people to use.

Our second one was one of our representatives on the advisory panel was a leader in the National League for Nursing at New York, and she had been a leader in establishing a new program called ACES [Advancing Care Excellence for Seniors] that had to do with teaching geriatric nursing to their generic students at any level – associate degree, bachelor’s degree. And when we learned about that project, the leader said “is there any way that you can review what we’re doing and make sure that we have all the key concepts from the geropsych project embedded in this project?” So we were able to facilitate that being done. So those cases are enriched with geropsych as a result – again timing, connections and helping build awareness for these opportunities to enrich what was already being produced.

And a third one is all the work that was being done by AACN and the Hartford Institute to help prepare faculty for integrating geriatrics into their education program included a set of webinars on examples of how to go about reviewing one’s curriculum, selecting material, how to find material etc. We proposed to them “what about one on geropsych?” – we were trying to get the word out (we had notified the deans of all the schools, making a lot of presentations, we published articles, we were trying to make as many people aware of this as possible, but it takes a long time for the word to get out for people to use it). They were very happy to use it in their final webinar that was focused on infusing geropsych into the curriculum as a the component of geriatric care. That got done this past fall and is available. A lot of people participated in it while it was live but the recording is available on line for people to access as well. It’s a really important way of getting the word out.  Again, timing, collaboration and networking as a way to get those things to happen.

We have collaborated in addition with the nine Hartford Centers. We engaged them in thinking about how to help their own faculties infuse geriatric mental health into their curricula and we involved the alumni from the pre-doc and post-doc programs. There are quite a large number of them now who do have an interest and background mental health. That group has been very eager to participate is now beginning to assuming some leadership nationally for promulgating the information, doing some of the talks at national meetings, helping keep/update materials that are already posted on the website etc. So were really happy about that.

One other that I can think of – we were planning to produce a video that would highlight the work and thinking of some of the national leaders in geropsychiatric nursing. We really did not have enough resources within this particular project grant to be able to do a videography of some sort. But then we learned about one of our colleagues from Penn State who had actually produced a number of videos, short video clips that were being used to try and interest young nurses in the field of geriatrics. In the process of making the videos, they had a lot of clips that just went onto the cutting floor – and so we said “do you have any pieces from those video clips that might be mended together in a way to make a coherent story about geropsych?”  because all four of the persons that we wanted to showcase on the film had been interviewed for those videos. So we worked with the professional staff at Penn State and they were able to do it. We wove the story – now we have this video for a very modest amount of money and the videotape has been circulated broadly and free online for use. Another example of how as we knew people and things that were happening, and people would tell us “did you know about this or that”? We had filters on our glasses and [filtered] anything about mental health and aging for this project, this opportunity, these new things that were happening.

I guess the last thing I would really want to mention is the opportunity that really showed itself in the publishing of the Consensus Model document, which did happen in late 2008 when we were already finishing up the first year of the project. That Consensus Model – by making the decision that nursing at the graduate level would focus on six populations, four of which dealing are adults and therefore would include older adults that the gero and adult health populations would be merged into one group. But that every of the other four groups (women’s health, psych mental health, family health nursing) all because they were dealing with older adults in their adult population, they all had to have some geriatrics both didactic and clinical learning experiences in their curriculum. Now that requirement was brand new. Many of these programs may have a lecture or two on something related to older people. But to acknowledge that they are actually the major provider of geriatric care, because we don’t have that many geriatric specialists in the country, it now means that they are recognized and are scrambling try this get more content and clinical opportunities for their students. One of the things that consensus document did was to open up the pressure at the credentialing level and accreditation level to say “Now that you have to have geriatrics, geropsych is part of that. Let’s see how we can help you with meeting these new requirements.”

So that is how we’ve sold this stuff. We also sold it by saying “it really is infusing; it really is enhancing what you’re doing; it’s not completely changing what you’re doing but helping you have a broader lens to know some of the specialist information about geriatric care that is so important.” As we’ve worked with a range of people, we’ve been able to have either members of our secondary team or those that we know who are experts, appointed to the competency revision groups or panels that have been put together early on by AACN when they were developing what the adult gero – the new fused program – would look like. We were able to have a geropsych person on both the NP panel and the CNS panel and the same for the gero-adult acute care groups. So the first one was focused on primary care and the second set was focused on acute care. So the views of our geropsych people were infused into those two documents. We were also able to have that level of participation in the revision of the baccalaureate competencies as well. Then when NONPF (National Organization of Nurse Practitioner Faculties) was working on how to make the last three (the women’s health, psych mental health and family nurse practitioner) competencies fit with the new Consensus Model, we were able to have input into those as well.

We’re hoping that the whole area of mental health, as the Affordable Care Act – however it comes forward – everyone is talking about the need for more integrated care. Certainly, mental health needs to be integrated into primary care, community care, acute care etc. and geriatrics needs to be integrated into all of those areas as well.  I think our timing is right for having something available and building awareness of the country both in nursing and outside of nursing about the importance of this field and we obviously could not have done all of that in a short four-year period with just the three of us. The networking, the collaboration and the timing, I think, gave us opportunity to take advantage of all that came forward to move towards our goal of helping to improve the mental health of older Americans – [and]it has been a fabulous, fabulous road to be on for these four years.


Kathleen “Kitty” Buckwalter, RN, PhD, FAAN

Professor Emerita, University of Iowa College of Nursing

Question 3.“What do you think the future holds for geropsychiatric nursing GPN?”


Well I’m very optimistic about the future of geropsychiatric nursing. I think there are a lot of indicators over the last few years and good promise for continued growth and enhancement of geropsychiatric nursing in the future. Some of those indicators include the number and quality of Building Academic Geriatric Nursing Capacity (BAGNC) alumni, whom I believe are the largest subgroup of the alumni organization and who are actively engaged in the preparation and presentation of papers in the area of geropsychiatric nursing. [They] have been helping us to develop case studies, for example, that we can post on the Portal of Geriatric Online Education – or POGOe – for use by others as they infuse geropsychiatric content into all levels of nursing education. We also see with support from the Hartford Foundation the continued growth in the number of pre-and postdoctoral students and fellows who are prepared to do research in the area of geropsychiatric nursing and who will become faculty to teach others about the needed content.

There is also growing national attention to the issue of mental health and substance abuse in older adults. In particular, there will be an Institute of Medicine (IOM) report forthcoming  [Released:July 10, 2012] – the official title is the Committee on Mental Health Workforce for Geriatric Population. This report is really an outgrowth of the 2008 Retooling for an Aging America report that highlighted the need for more and better trained practitioners. In this case, the report focuses on workforce issues for the mental health and substance abuse needs of older adults. So that will be exciting and the Institute of Medicine reports generally have high impact and garner the attention of funders and Congress. So we are looking forward very much to that report.

Our geropsychiatric nursing collaborative (GPNC) and, as you know, with the support from the University of Arkansas, the University of Pennsylvania (in particular Cornelia Beck and Lois Evans from those institutions) and myself here at the University of Iowa, have really accomplished a lot in the past four years [in terms] of increasing visibility of the field of geropsychiatric nursing. We’ve developed and revised brochures that can be used on the “Hill.” We’ve published a number of articles about geropsychiatric nursing in both the periodic peer-reviewed literature and book chapters. We’ve made presentations around the country – most recently at nursing educator conferences, and with the NLN – but also at interdisciplinary meetings such as the Gerontology Society of America. We have convened a joint mental health and aging workgroup at the American Academy of Nursing. While not officially one of the interest groups of the Academy, it is comprised of members from both the mental health and aging special interest groups. They have been active and will continue to outlive the GPNC work.

We also have provided technical assistance to schools of nursing that were interested in infusing geropsychiatric nursing content into their curriculum. And other indicators to me include – I was the editor of the Journal of Gerontological Nursing up until January 2012 for 13 years – and over that 13 year period, I noted a marked increase in both the number and quality of submissions and publications relevant to geropsychiatric nursing. The same thing could be said for the other journal, Research in Gerontological Nursing, that I established four years ago [that] is primarily a research journal whereas JGN is primarily clinical in orientation. But, the high number and extraordinary quality of research articles with geropsychiatric nursing focus has also been very heartening.

Finally, there are two other areas – the growth of evidence-based practice protocols – those coming out of the Hartford Institute of Geriatric Nursing at NYU, and from our Hartford Center of Geriatric Nursing Excellence at the University of Iowa. This will really help to translate the evidence base in geropsychiatric nursing into a usable palatable form for use by clinicians in a variety of acute care, long-term care and community-based settings. (Not that all of the evidence-based protocols produced by the Hartford Institute or the Iowa Hartford Center are geropsych focused, but a high percentage of them are very relevant to geropsychiatric nursing).

The final note I would like to make is that – coming back [just] yesterday from the Midwest Nursing Research Society (MNRS) – I was so impressed again with the quality and quantity of symposia and papers and student posters with geropsychiatric nursing themes. All of these indicators suggest to me that we’re in good shape in terms of the future of the field. But of course, we still face a number of challenges for the future. The challenges include [that] we’re still dealing with a very fragmented and uncoordinated system, especially for older adults with chronic illnesses, mental health and substance use problems.  We’ve got to adapt our acute-care models of care delivery and change them to a more chronic care model. And, despite the recent advances, there are still an insufficient number of nursing faculty with adequate geriatric mental health preparation – and we still need more geriatric mental health content in curricula at the undergraduate and graduate levels.

It still remains a challenge in terms of adequate leadership in the field of geriatric nursing in general but geropsychiatric nursing particular. There are advances in this realm as well. For example, the Geriatric Nursing Leadership Academy sponsored by Sigma Theta Tau and a number of the recipients/participants in that Academy have been interested in geropsychiatric nursing. So, whether they’re from nursing home or acute-care roles, their leadership will serve us all well.

We know a number of other things that happened outside of the work of the collaborative that will foster our work and continues to do so in the near future. One of those is with the advent of the minimum data set 3.0, which came on the scene in October of 2011, there really is marked improvement in the areas of cognitive assessment, mood, routines and activities that are mandated for nursing homes, where many persons with cognitive, functional, and mental health impairments reside. Also we are excited about the proposed APRN regulatory model, the Consensus Model for APRN regulation, licensure, accreditation, certification, and education, because we see with the advent of this Consensus Model, the specialty of geropsychiatric nursing certification is now a possibility. Although full implementation of the proposed model nationally isn’t expected until 2015, work can begin on specialty certification in the field.

Finally a number of the strategic plans of NIH institutes, including NINR, NIMH, and NIA, are very friendly with regard to geropsychiatric nursing. So we are hopeful that as we prepare more better- qualified researchers especially at the postdoctoral level and beyond, they will be able to take advantage of funding opportunities from foundations as well as NIH institutes. We continue to face (a) challenges in the area of tackling mental health disparities in the older adult; (b) the need to systematically demonstrate a cost benefit of mental health nursing services for this population; (c) and to adapt an evidence-base for applications in new settings of care such as prisons and homeless shelters where many older adults with mental health and substance use issues reside.

It’s exciting to think about new service delivery models and setting of care, the research that people with training and interest in geropsychiatric nursing will be able to conduct, and the future emphasis on translation of that research into practice. Still, we need to prepare more nurses with geropsychiatric expertise and who focus, not just on those people who have impairments already, but on health promotion and disease prevention. We still need to develop that critical mass of nurses with the knowledge and skill to provide mental health care to older adults and potentially certifying them in the field.


Leadership Interviews – “3 Questions” – Risa Lavizzo-Mourey

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

The Robert Wood Johnson Foundation and Institute of Medicine report, The Future of Nursing, offered bold recommendations for change in the current health system to meet the growing need in health care delivery.

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation speaks out in NURSING OUTLOOK on the commitment to strengthen America’s nursing workforce.. 

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Risa Lavizzo-Mourey, MD, MBA, President and CEO
Robert Wood Johnson Foundation
Co-Sponsor, The Future of Nursing Report

Question 1. Why has nurse education become such a high priority for the Robert Wood Johnson Foundation?

(Prepared Commentary) The Robert Wood Johnson Foundation has a long-standing commitment to strengthening the health care workforce and to nursing in particular. For many reasons, nurses are essential to our efforts to improve health and health care, especially as the delivery of care continues to increase in complexity and moves from hospitals to community-based and primary care settings. And at the same time, the roles of the insured will increase by tens of millions of people.

In The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) asserted that in order for nurses to maintain their effectiveness in providing patients with high-quality care, they will need advanced competencies in care management, working as part of interdisciplinary teams and problem solving. These are skills that nursing students attain as they pursue the Bachelor of Science degree; as a physician I have seen firsthand the tremendous impact of these capabilities. We also need more nurses to obtain advanced degrees in order to address shortfalls in both nurse faculty and primary care.

Thus RWJF supports the IOM recommendation to increase the percentage of nurses with BSN and higher degrees to 80 percent by 2020 and is helping to facilitate its implementation through the Future of Nursing: Campaign for Action. Through the campaign, we are engaging a wide range of groups at the national and state levels to make this concept a reality.

Question 2. What can health care organizations do to encourage nurses to advance their education?

(Prepared Commentary) There are a number of things that hospitals and other organizations that employ nurses can do to facilitate education progression. Employers can adopt policies that favor the hiring of BSN nurses or that require nurses to obtain a BSN or higher to advance beyond a certain level (these are called career-ladder programs). One of the nation’s leading hospitals, Johns Hopkins in Baltimore, does these things. So do the Veteran’s Health Administration and Tenet Health Care.

Certainly paying BSN nurses at a higher rate is a tremendous incentive, as is offering tuition benefits. And having some scheduling flexibility also supports nurses in continuing their education.

Question 3. How are educational institutions approaching the issue?

(Prepared Commentary) There’s no one-size-fits-all answer, but there are some very promising approaches being implemented across the country. For example, the Oregon Consortium for Nursing Education has created a shared curriculum across community colleges and the Oregon Health & Science University School of Nursing. This addresses one of the barriers to obtaining a BSN by making it possible for students to get the degree right in their own communities through a community college. In New Mexico, too, nurse education institutions are adopting a uniform curriculum and also will share faculty.

Florida and Colorado are working on models to facilitate the transition to BSN either via community college-to-four-year-institution partnerships. And states including Georgia, Illinois and Ohio are offering online doctoral programs for nurses.

These types of innovative solutions, combined with action by employers, businesses and others, are exactly what we need—diverse sectors coming together to transform the nursing profession, which in turn will help to ensure access to high-quality, patient-centered care for all. What we need is for many people and organizations to get involved with Campaign for Action and their state Action Coalitions.


Leadership Interviews – “3 Questions” – Debra Barksdale on PCORI

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

Are we getting better patient outcomes today in our healthcare systems? Does our research get implemented where it’s most needed – at the bedside and in patient care?

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Debra Barksdale, Board Member of the Patient Centered Outcomes Research Institute (PCORI), spoke at the Council for the Advancement of Nursing Science (CANS) Conference, October 2011. Debra_Barksdale_CANS_presentation_10-12-11(1)


Debra J. Barksdale, PhD, FNP-BC, ANP-BC, CNE, FAANP
Associate Professor, University of North Carolina-Chapel Hill
Board of Governors, PCORI  (Patient Centered Outcomes Research Institute)

Question 1. What is PCORI and how has it evolved to date?

PCORI was established by Congress through the 2010 Patient Protection and Affordable Care Act (PPACA). So, by law it is an independent, non-profit organization.  The Patient-Centered Outcomes Research Institute (PCORI) was created to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed health decisions.

PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports options. The law clearly outlines five core duties or responsibilities of PCORI. These are:

  1. To establish national research priorities ;
  2. To establish and carry out a research project agenda;
  3. To develop and update methodological standards – the scientific standards for patient centered outcomes research (PCOR) and comparative effectiveness research (CER);
  4. To provide a peer-review process for primary research; and last but not least
  5. To disseminate research findings.

The evolution of PCORI is very interesting because in one year, PCORI has created a national research institute basically out of nothing except very dedicated people and some money. The Board was established bylaws and the board has created standing committees. Right now we have four standing committees. By the date of our anniversary, which was September 23, PCORI held six public Board meetings in five different cities. This demonstrates our intention to reach out to communities nationally. We have held patient or stakeholder events in conjunction with every Board meeting since March.

We have provided two opportunities for public input – on the working definition of PCOR (Patient Centered Outcomes Research) and the initial topics for our pilot projects – which go beyond our statutory requirements and show that we are committed to conducting our work in an open and transparent manner that ensures credibility, and access. We have issued three RFPs (Requests for Proposals) and our first funding application is for the PCORI Pilot Projects. Those grants will be due on December 1st.

The Pilot Projects will assist PCORI with ongoing development and enhancement of our national research priorities for patient-centered outcomes research. They will also support the collection of preliminary data that can be used to advance the field of patient-centered outcomes research (PCOR). These Pilot Projects will also support the identification of methodologies that can be used to advance patient-centered outcomes research as well as identify gaps where methodological research needs further development.

The Methodology Committee, which was also created as part of PCORI, was instituted in January 2011. And they have made great progress in the just seven months they have existed. They inform the Board regarding the methodology and methodological standards. They have outlined a clear process for developing our first Methodology Report by May 2012.

Question 2. What is your role and how do you see that connection with opportunities for nurse researchers, educators, administrators and clinicians in health care?

The statutes were very clear about the composition of the Board of Governors. Those statutes mandated that there had to be at least one [nurse] member of the PCORI Board of Governors. I feel very fortunate and honored to be that nurse selected to serve on PCORI. I was endorsed by over 30 nursing organizations as well as my university, and my local, national and state representatives.

As the only nurse on the PCORI Board of Governors, I think I bring a unique perspective in addressing the needs regarding health and health care in our country. I draw from my knowledge as a researcher, as a primary care nurse practitioner (I’m a family nurse practitioner), and as an educator, so I draw from that knowledge in representing our nurses and our patients on the PCORI institute. I also consider myself an advocate for the disadvantaged, for the underserved and for the underrepresented regarding issues of health and also research.

As the most frequent point of care, because there are so many of us in the country, nurses will be able to use PCORI’s research which will allow clinicians to deliver the best quality care tailored to individual needs. As a result PCORI’s research will affect how we teach nursing, how we deliver patient care at the bedside and elsewhere, and also how we are able to function and continue to function or more effectively function in our role as advocates for our patients and also for our profession.

There’s a tremendous amount of opportunities for nurses to be involved in the work of PCORI. One of the first opportunities is in terms of giving input. PCORI does host public meetings as we move around the country. I am really honored when I see nurses in the audience – nurses who are brave enough to get up to the podium and to address nursing issues with the Board of Governors.

There are also opportunities for nurses to participate through our webinars. All of our public meetings are broadcast via webinars. Also there are opportunities for people to dial in. Our agendas are posted well in advance usually with the PowerPoint slides. So, issues that are really important to nursing will be posted ahead of time and you could dial in or call in when you wanted to listen to that discussion.

Also, in terms of input, we have and will continue to seek input on the decisions that we make. There will be an opportunity very soon for nurses to provide input on the national priorities that we will be setting, and they can do that through our website –  writing in, or, any mechanism just to make sure that voice of nursing is heard.

Another opportunity for nurses is employment. PCORI plans to have a staff of about 40 people which does include some scientists and other types of representatives. So, I would encourage people to check out the website – to look at those employment opportunities.

There is also opportunity for nurses to apply for PCORI funding and PCORI grants. I mentioned earlier about the pilot projects, but there will be other funding opportunities. And nurses are in prime positions to apply for these grants because “patient centeredness” is what we are all about. And when I say “patient” I mean it in the broader sense of people – people and their health needs.

Another opportunity for nurses is to participate as reviewers of those grants. PCORI is not just seeking the same traditional types of reviewers  – all academic researchers. PCORI is extending its research reviewers so that people who are not [traditional] reviewers – in fact community people, [even] patients can apply to be reviewers for PCORI grants.

So, those are just some of the potential opportunities for nurses to be involved with PCORI. Let me know, let me hear what your needs and concerns are and I will try my best to make sure that those needs are heard by the PCORI Board and are represented in the work that we do.

Question 3. What should nurses know about the plans and potential outcomes for the future PCORI resources?

What nurses should know about the plans and potential outcomes for the future PCORI resources is that PCORI is committed to patient and stakeholder engagement throughout our work and has provided several channels to receive input and will continue to provide those channels. One of my roles on the Board is to serve on the Communication, Outreach and Engagement Committee. So a lot of our work is around: How do we engage our patients? How do we engage our stakeholders, be they nurses or other types of clinicians or policy makers? So we’ll continue to provide those opportunities.

I hope that the nursing community continues to take the opportunity to provide PCORI with feedback on its work to date and to provide constructive input on PCORI’s national research priorities and research agenda. Individuals and organizations can provide input at PCORI Board meetings, or online, or you could write letters, to

So I think the major point I would like to make here is that nurses should expect that the work of PCORI will impact their work at whatever position or level that they are. And because of this I am hoping that nurses will be more involved in the development of those resources in providing input and commentary   on those resources so that it’s not  all about some other discipline setting the  standards that nursing will have to apply in its research, in how we teach or what we teach, or how we function as practitioners in this health care arena.

Leadership Interviews – “3 Questions” – Mary Woolley at the 2011 FNINR Nightingala

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

Budget cuts, federal budget negotiations, and funding for health research and related programs………..

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

Mary Woolley, President and CEO of Research!America gave the keynote address at the 2011 FNINR “NightinGala” on October 14th in Washington DC. Click here for the transcript. 

“Building Support for Nursing Research in Challenging Economic Times”

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Mary Woolley, President and CEO of Research!America

Question 1. Funding for health research is at risk as Congress grapples with a federal deficit and weakened economy.  How will funding cuts for research and prevention impact our nation’s health and global competitiveness?

The first thing to say is that cutting medical and health research is not a deficit reduction strategy. The American public very strongly supports medical research and also supports prevention as goals we must achieve sooner rather than later.  We know from a recent poll commissioned by Research!America that in fact 94 percent of Americans believe accelerating, not reducing, our investment in research to improve health should be a national priority.


There is so much is at stake right now.  The handwriting could go up on the wall in permanent ink in the next weeks and months regarding funding cuts that could impede scientific discovery and evidence-based health care delivery for a generation or more — impeding innovative work by younger researchers in particular – and young researchers who are already making alternative career choices at that, or even decamping to more science-friendly nations. Cuts could slow rather than stimulate job growth and weaken our global competitiveness.  I mentioned other nations – several have made great strides in innovation and in evidence-based health care dealing with a model that we developed here in the U.S. And right now, they are committing to a higher investment in research with the U.S. falling behind relative to our gross domestic product or GDP.  The total public and private spending on research and development (R&D) is currently about 2.6 percent of GDP in the U.S. and higher in a number of other countries as a percentage. The federal government’s investment in this country for health R&D still totals a significant amount of money – approximately $135 billion. But that is less than 1 percent of GDP.

Question 2. Describe some of the ways research supports economic growth?

 Economists have long recognized the importance of investment in research and development as a driver of technological development and U.S. economic growth.  In fact, R&D accounts for approximately 50 percent of our economic growth over the past several decades.  A recent report from United for Medical Research (UMR) notes that last year alone, NIH research funding led to the creation of almost 500,000 jobs. Fifteen states experienced job growth of 10,000 or more due to this support. 


Research conducted at universities and other institutions across the country impacts local communities and local businesses through the purchase of equipment and materials and the employment of so many people, not only those actually conducting research, but those who support the research enterprise. That UMR report estimates that NIH research funding, in total, produced $69.19 billion in new economic activity — $58 billion from the annual FY2010 budget and $11 billion from ARRA or so called stimulus funds.


There is another way that research supports economic growth. By helping achieve better health, research helps drive economic growth and prosperity by increasing productivity via a healthier work force, and by reducing health care costs as more care becomes evidence-based and prevention of disease and disability becomes both more prevalent and more effective. There’s really nothing better than research to stimulate economic growth.

Question 3. What role can the nursing community play in sustaining funding for research and building a case for a stronger investment in research and innovation?

There’s so much that the nursing community can do. Nurses have a storied history of impacting policy through the conduct of research and the application of evidence – and also impacting it by advocacy! Since this is a time of heightened challenge and threat, advocacy really can’t wait.  It’s critical to assert greater influence in the public policy and decision-making process as we are besieged with challenges to science and even logic that could undermine advances in health and health care delivery.  Nurses can help set the record straight by educating the public and policymakers about the benefits of research.  Your involvement is a must here.  The country needs more nurses as advocates for policy change. 


There are three specific things I recommend that nurses can do now to effect change:


1.         Request facetoface meetings with your congressional delegates and/or those who are running for election against them in the 2012 election. We’re already in the midst of the election season. If you can’t talk to a member of Congress or someone running against them, then talking to one of their top aides is just as effective. Tell them why research and nursing research in particular should be a central part of their agenda – should be featured on their website – should be part of all their speeches. Tell them it’s central to you and central to our nation’s future.


2.         Visit our website, (, which is a voter education initiative. It will be up and active in the new year. It should be one of your New Year’s resolutions to find out where your candidates and other elected officials stand on research-related issues. You can visit the site often and urge everybody you know to do the same thing.


3.         Throughout 2012, the year ahead, it should be a priority to attend rallies and town hall meetings in your community to tell the candidates and other elected officials that investing in research helps Americans live healthier lives, grows our economy and strengthens our global competitiveness. Please tell them to make research for health and wellness a priority.


I really think that with the combined impact of large numbers of the nursing community taking up the advocacy challenge, with the added power of many more who you could recruit to the cause, we can navigate today’s uncharted political currents by advocacy. That’s advocacy with credibility, assurance and impact – things that distinguish the nursing community. We can work together and create a positive course forward for our nation.

Leadership Interviews – “3 Questions” – Diana Mason on Nurses and the Media

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing

Health reform, quality and safety, medical liability, information technology, nursing education redesign………..

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN

Nurses’ Visibility in Health Policy – Speak Up!

Diana Mason – Past Editor of the American Journal of Nursing, Rudin Professor at Hunter College Bellevue School of Nursing, and Director of the Center for Health Media and Health

Question 1: In the late 1990s, Sigma Theta Tau did a study of nurses’ representation in health stories by major print newspapers, weekly news magazines, and health care publications. Their results were disturbing. Nurses were represented less than 4% of the time, even though they would have been germane to the story. Are we doing any better today and does it matter?

Diana Mason: The Woodhull study that was published by Sigma Theta Tau in the late 1990s did find that nurses were underrepresented not only in public media but in our own media such as Modern Healthcare. I think we were represented in Modern Healthcare health stories less than 1% of the time even though we could have contributed significantly to the storyline. What was brilliant about Sigma Theta Tau’s follow-up was that they held regional meetings in which they had panels of nurses and journalists to comment on the story. So it raised visibility on this issue among journalists, particularly women journalists, since we’re predominantly still a female profession. Women journalists understand gender issues that prevail in many professions, and I think for some of them they realized they were doing a disservice to the healthcare field by not including nurses in their stories. At the panel that I was on in the Northeast region, a journalist who was there was a television journalist who brought the cameras into that meeting and actually did reporting there from that meeting.

And so Sigma not only held these regional meetings to raise the awareness of the issues among journalists and among nurses, but they also developed media expert lists of nurses on various topics and they did media outreach. And I think that really did have an impact on the extent to which nurses have become more visible in media.

I have to share with you that about three weeks ago I was reading a story in the New York Times. I pay attention to the issues that are being represented in public media on health and whether they are referring just to physicians or nurses or other health care providers – not just nurses, but social workers nutritionists etc. Increasingly, the language is physicians and nurses; and in this story, the language was nurses, physicians and other health care providers. And I thought, “Gee, haven’t we come a long way when nurses are positioned first in the sentence even before physicians.”

So I think we are more visible in the media. I think also a factor is that there are more nurses who are going into journalism. I’m a member of the Association for Healthcare Journalism and there is a listserv where journalists post questions and ask for help on stories etc. Increasingly there are nurses who are participating in that conversation. So I try to make it a point that if I know a nurse or another healthcare provider or a good physician to make sure that I’m offering those folks up as a source. And I think all of this makes a difference, including the visibility of nurses as experts in healthcare that have come to the attention through the Institute of Medicine’s report on the Future of Nursing. I think journalists are realizing, increasingly, that nurses have a different perspective on health and healthcare, but we’re still not where we need to be.

2. Why are nurses still not at the top of journalists’ lists for interviews about health stories?

Diana Mason: Nurses are still not up at the top of the list for a couple of reasons. We need to do better media outreach. I would question how many people who are listening to this interview would be able to say that their institution regularly promotes their work and their expertise to public media even in within their region. We often don’t think to work with our PR people around promoting the work that we are doing.

Second, is because we’re scared of the media. [For example], Irene Wielawski is a journalist who actually sits on the board of the Association for Healthcare Journalists and has written for the New York Times, Health Affairs, etc. She was on the planning committee for a conference the Association for Healthcare Journalists was holding in Miami on older adult health issues. She chaired a panel on workforce issues and asked me for names of nurses because she understands that it’s important to get nurses’ views on these issues. I gave her the names of several leading experts in the field. She got back to me later and told me that she was unable to get any of them to be on the panel. One had her assistant say she was away and would get back to her in two weeks. Another said she had meetings that day and wouldn’t be able to do it. Irene said to me: ”when I called physicians, the physicians had other meetings but understood the power and the opportunity of being in front of healthcare journalists on a panel. One immediately said, ‘I’d be happy to do this and I will rearrange my schedule to do so.’”

So why aren’t nurses grabbing these opportunities? I think it’s because we’re afraid. We’re afraid that we might say something wrong. We might misstep with the media and might embarrass ourselves.  So I think we have to be a little bit more risk-taking. We have to be willing to be more responsive to journalists – if a journalist is on deadline, that journalist is not going to wait a week for you to respond!

3. What should we be doing to increase nurses’ visibility as leaders in health care and health policy?

Diana Mason: We have to be more media savvy, and to be more media savvy, I think we need media training. Media training prepares people to deal with tough questions; prepares people to keep the focus on the issues that you want to talk about rather than where the journalist wants to take it; and to give you a bit more of a comfort zone in dealing with media. So I think one strategy for dealing with this is media training. I think we also need to examine if we say we are world leaders what does that mean? Part of leadership is being spokespeople around the important issues of our day. Media is very influential in shaping those issues and deciding which issues get on the agenda.

So I would challenge all of us who see ourselves as leaders, to think about how are we doing with the media? What do we need to do to develop our skill set to be more effective in interfacing with the media? And to take advantage of some of the media opportunities that exist – not to wait for them but to go after those media opportunities. I think it’s really important that we keep putting our perspective out there defining what is important to us.

The Woodhull Study on Nursing and the Media (1998). Sigma Theta Tau International. Available at:

AAN Leadership Interviews – “3 Questions” – Kathy Dracup on the DNP

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing

Doctorate in Nursing Practice – DNP – Impact on education, practice, and the profession…

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN



Kathy Dracup

Kathy Dracup – Past Editor, Heart & Lung and the Journal of Critical Care,  member of the American Academy of Nursing and Institute of Medicine

On the Doctorate in Nursing Practice

Question 1: The “Future of Nursing” IOM Report has made a variety of bold recommendations including the need to increase dramatically our doctorally-prepared nursing workforce by 2020. How do you see nursing education leaders responding to this need?

Many nursing education leaders have urged the adoption of a professional doctorate (DNP) and the proliferation of these programs suggest that these same leaders believe that the DNP is both good for the profession and good for their individual schools. There are some of us who have to questioned the wisdom of creating a professional doctoral tract in our profession. In the short term, it will certainly increase the number of nurses with a professional doctoral degree. Many nurses working as advanced practice nurses (ANPs) or as educators on nursing faculties have returned to school to obtain a DNP and the ever-increasing number of DNP programs across the country — 153 to date with another 106 in the planning stages — insure that the programs will be available for nurses interested in obtaining a professional doctorate. Moreover, for nurses who already have a MS degree, the DNP only requires an additional one to two years to complete compared to the average three to four years for a PhD.

Question 2: As one of our distinguished thought leaders, you have voiced some concern about the rapid proliferation of DNP programs and challenges to the current masters-level preparation of advance practice nurses. Can you talk briefly about these areas of concern?

What could possibly be wrong about nursing programs offering another tract to obtaining a doctorate? As a nurse educator, I find myself a bit amazed to be in the position of questioning whether nurses should continue their education. But I am concerned that the DNP may have unintended negative consequences for our profession. First, we have argued convincingly for several decades that ANPs provide health care that is safe, high quality, and cost-effective, as well as enhancing access for patients. If we were correct in our assertions, how can we now say that ANPs require additional education to attain these same outcomes? Second, it appears that employers will not preferentially hire or pay for the DNP over the MS degree, a reality that is often not made clear to applicants of these programs. Third, research-intensive universities are unlikely to award tenure to DNP graduates because they are not prepared to conduct the research expected at these institutions, but again this is often not made clear to applicants who are planning on joining a nursing faculty. Fourth, applicants to PhD programs in nursing have remained flat over the past decade, despite a major economic recession that has caused increases in almost all other disciplines’ doctoral graduates. I am concerned that DNP programs will “siphon off” potential applicants to PhD programs at a time when the need for a PhD-prepared nursing work force has never been greater to generate the science needed to support our clinical practice. Finally, requiring a longer educational trajectory for APNs at a time in our country’s history when millions of new patients will be seeking care because of changes in health care reform seems unwise.

I look at the history of other professions to see how they have dealt with this same issue and think that we can learn from their experiences. For example, engineering views itself as an applied science and some schools began offering a professional doctorate rather than a PhD degree in past years. However, when Schools of Engineering looked at disciplines that adopted a professional doctorate early in their development (e.g., education with the EdD and public health with the DrPH) the engineering profession decided that a professional doctorate was confusing to the public and resulted in second-tier programs. Therefore, all engineering doctoral programs in the United States now award the PhD. I wonder if we might come to the same conclusion a few years from now.

Question 3. What suggestions would you give to academic program leaders to plan for impending changes while meeting current needs of preparing nurses in advanced practice for the health reform-related new patients on the horizon?
I do think that three concepts are key to an era of health reform and must be embraced by both nursing and medicine:  population health, disease management and the health care team. All three of these are relatively new concepts for some members of the health care team. We have focused on individual patients in our educational systems and have not emphasized disease management or team dynamics and communication. All that must change.

Related to the DNP, one of the favorite phrases of DNP advocates is “the train has left the station.” I do understand that many School s of Nursing have embraced the concept of this degree and have been eager to create programs to attract a new market of students. Given that reality and our profession’s important commitment to the MS degree for advanced practice, I hope that academic program leaders will continue to offer the DNP as a post-Masters degree. Currently no state Board of Registered Nursing has made the DNP mandatory for advanced practice and that CCNE has continued to accredit MS programs for advanced nursing practice. So this is the time to gather the data essential to the argument. Proponents of the DNP insist that these programs will not threaten enrollments in PhD programs and are necessary to meet the challenges of health care today. Let academic program leaders gather the data  essential to the argument.

Call for Commentary:

A recent 2011 issue of Nursing Outlook published a variety of points of view on the topic of the DNP. Now it is the time for the dialogue to expand. Give voice to your thoughts on the issue here – but be sure to include your name and institution with your response! Please consider the following 3 questions to post your opinions:

1. What do you think the DNP offers the profession beyond what the existing masters preparation provides for advanced practice nurses? Marketability? Quality of service? Nursing faculty supply? Research expertise?

2. How do you think the DNP and PhD prepared nurse will be identified in the market place? How do they relate to each other? How will they interact in the same job arenas?

3. What impact will the DNP education track have on the university’s bottom line? Impact on resources? Impact on student supply in the future?

Expert Panel Action Blog – Emerging and Infectious Diseases

Welcome to the Expert Panel Action Blog – Commentary and Information Posted by the American Academy of Nursing Expert Panels

Genetics, Violence, Informatics, Children Adolescents and Families, End of Life ………..

These are but a few of the Expert Panels of the American Academy of Nursing. The issues they follow and the activities they lead are important to the entire nursing community and warrant rapid dialogue among informed readers. Timely dissemination and responses are critical as traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment for Expert Panel dissemination! Topics should engage nurses in discussions around focused topics that are important for the profession. “Op-Ed” pieces and other reports are posted for readers to learn from the distinguished leaders on the Expert Panels of the American Academy of Nursing who monitor and engage in health policy and practice today.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN
Editor/Moderator (Contact

In Observance of National Women and Girls HIV/AIDS Awareness Day (March 10).

Believe it or not, there is an incontrovertible public health concern that needs addressed: the incidence of HIV/AIDS infections among girls and women. According to the Centers for Disease Control and Prevention, approximately 280,000 women are infected with HIV and face treatment hurdles that men do not with disproportionate distribution among African American and Latina women.  In observance of National Women and Girls HIV/AIDS Awareness Day, it’s an issue worth finding a constructive solution and silencing futile back-and-forth debate. To decrease the risk of HIV infection, establishing a system of routine testing in health settings is a good place to start. 

While there is an onus on individuals to utilize prevention methods, there’s a responsibility on health providers to make the testing process as seamless as possible. As a nation, we are falling well short of meeting acceptable standards of routine testing because of implementation and knowledge gaps. Without widespread testing, the disease burden at the individual, family, and community level of care will continue to increase. Consequently, rising rates of infection will reduce the known positive effects of prevention efforts. This is not an acceptable trend.

Statistics indicate nearly a quarter of infected individuals do not know their HIV/AIDS status, while more than half of new HIV/AIDS infections are passed on by unwitting individuals. For states and newly elected officials attempting to espouse a commonly held public health solution, implementing five-year old recommendations for routine HIV/AIDS testing can achieve widespread benefits. These recommendations were originated by the Centers for Disease Control and Prevention (CDC) in 2006, calling for routine HIV testing among people between ages 13-64 and eliminating unnecessary administrative barriers to receiving testing. Despite their societal promise, the recommendations have not been adopted across health care settings universally.

In December, an Expert Panel on Emerging and Infectious Diseases, endorsed by the American Academy of Nursing, drafted suggestions designed to see the manifestation of routine HIV testing and improve prevention initiatives leading to decreased transmission of HIV.  The expert panel calls for nurses to assume a greater leadership role in implementing the 2006 CDC recommendations.  The recommendations come in the wake of the Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health, which identifies nurses as a catalyst for ensuring a high-quality, patient-centered health care system.

Among a host of suggestions delineated by the expert panel, nurses are key clinicians who can identify knowledge deficits among health care providers regarding the CDC recommendations, developing educational programs to address deficits among health care providers, and generating data to assess routine testing programs.

In addition the expert panel calls for the creation of interdisciplinary teams to develop specific implementation and evaluation plans to operationalize the CDC recommendations in hospitals and clinics.

Routine testing will save money and reduce rates of transmission. For clinicians, it’s imperative that they are equipped with the right information and resources. And for the sake of expanding a patient-centered health care arena, it’s a solution deserving of support, not discourse.

Corresponding Authors:

Rosanna F. DeMarco, PhD, PHCNS-BC, ACRN, FAAN
Co-Chair, American Academy of Nursing Expert Panel on Emerging and Infectious Diseases
Associate Professor, Public/Community Health, Connell School of Nursing
Affiliate Faculty of Dept. of African & African Diaspora Studies, College of Arts and Sciences
Boston College

Joe Burrage Jr., PhD, RN, FAAN
Associate Professor
Indiana University School of Nursing

AAN Leadership Interviews – “3 Questions” – Margaret McClure on Fellow Selection

Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing

Health reform, quality and safety, medical liability, information technology, nursing education redesign………..

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN



Margaret McClure – Past President of the American Academy of Nursing and “Living Legend”

On Leadership, Change and Fellow Selection in the Academy

Question 1:As one of our most esteemed thought leaders in nursing and change agents in health care, can you describe how you see the horizon of health reform and its concomitant need for leadership?

To listen, click here.

Margaret McClure: I think for nursing, probably, this is probably a golden opportunity, and one that I hope we don’t miss. We’re about to cover 32 million new lives with our health care reform act. I have great faith that it will, in fact, be implemented much the way that we have it written. I realize that there are large numbers of people who are trying hard to prevent this from happening; however, I’m very much a proponent of the changes in health care that this portends. The problem, as I see it, is that we need nurses who are prepared to step up to the plate and assist in very important ways with the changes we are about to make. One of the things helping nursing to come to the forefront is the fact that it’s pretty clear, even to people who have never paid much attention to nurses that it can’t be done without nursing. That gives us a whole different grounding in the formation of public policy and how it’s carried out. Unfortunately, it had to come to a manpower issue, but we ARE at a manpower issue. We simply will not have enough primary health care providers in any of the more powerful roles that we’ve had all along. We don’t have enough of those folks and we’re going to have to have more and more nurses who are prepared to step forward. And to be honest with you, nurses know a great deal more than they have shared with others. The potential of nursing has never been tapped. This is an opportunity for us to participate in ways that we haven’t been able to in the past.

As we go forward, we have this golden opportunity if we play our cards right. What I’m most concerned about is that we’re rational about how we do the implementation of health care reform so that it does the best for the greatest number of people across the country.

Question 2: As the current co-chairperson of the Fellow Selection Committee, Past President of the American Academy of Nursing, and a “Living Legend,” as we prepare to solicit nominations of new Fellows, what do you see as the ingredients of leadership that when added to the mixtures of position and opportunity result in the records of achievement?
To listen, click here.

Margaret McClure: The thing that has troubled me a little bit in the past few years is the fact that I believe there are more able, wonderful candidates for admission into the Academy than we’re actually seeing join. While I recognize that we have very strong criteria for applying to the Academy on the one hand, and therefore not everyone can apply, it seems to me that at the moment the fellowship in the Academy is not representative enough of the fine leadership that exists across the country. Some of this is related to the fact that there are a lot of myths about what you have to do to be in the Academy. For example, some say “You can’t possibly get into the Academy without a PhD.” Well, obviously that’s not the case. If you look at our membership, in fact, we have a large numbers of Academy Fellows – great achievers – who do not have the PhD, EdD or DNSc and are making fabulous contributions and continue to make them. We need these people for leadership in health care reform. And we need them to be in the Academy to help us to influence policy in the most important ways we possibly can!

I am anxious to see greater diversity among the people who are Academy Fellows – and I’m talking about diversity in every possible way. Our field is so diverse. We have large numbers of people doing very important work that many don’t even know about.  We want to be sure that we capture those folks and they become a part of our Fellowship so that we can tap into them and involve them. My interest in this is very serious and it is the reason that I ran for the office of the Fellow Selection Committee.

One of the most interesting issues that we stumbled on recently that I want to make very explicit to members of the Academy is the fact that the bylaws were changed some time ago, changing the criteria for admission. We discovered that many Academy members are unaware of this. In the past, the bylaws said that one criterion for being admitted was that your important leadership contributions be above and beyond your employed position – in other words, beyond your job. We changed that several years ago because there were people who were making fabulous contributions – and every one of them, you could point to and say “Yes, but that was part of his or her job.” As an example, people who have very important positions in the military, such as the Chief of the Army Nurse Corps, have done incredible work which has had very important national impact both within and outside the military. But, if you sat on the Fellow Selection Committee and looked at the old criteria, you would say that all of their work was part of the job.

The truth of the matter is, we’re looking for people who are making a national impact, not people who are doing work above and beyond their jobs. And so, it became a stumbling block to admit some of our brightest and best. The consequence of our discovering this was a change in the bylaws – but obviously many of our fellows do not know about it and they are sponsoring people to the Academy saying to them “Be sure that you say in your application that what you’re doing is above and beyond your job.” And that’s not true at all. It is absolutely not necessary any longer. The most important thing for people to demonstrate is that they are making important leadership contributions to the profession in whatever area they work in – whether it’s in academia or elsewhere. We have people in practice, we have people in information technology, we have people in the insurance part of the world, we have people in policy, we have people in state government – many are doing wonderful work – and the “above and beyond” criteria would not fit! We don’t need it to fit.

What I really would like everyone in the Academy to understand is that the old definition is gone. Now we are looking for people who are leaders in their fields who are making important contributions with a national impact. Having said that, we are looking for people from all our diverse specialties, and more and more, we are beginning to see those folks applying to the Academy, although they often think they’re not eligible.

I think one of the things we haven’t done is to have Academy Fellows see themselves as recruiters – to go up to people they recognize as real leaders and say “Are you a Fellow of the Academy? If not, we have to do something to get you into the Academy.” We need to begin to bring these folks into the fold. They may say “I don’t think I’m eligible…” when in fact you know inside your heart that they are. This is the kind of thing we can help our own Fellows understand in terms of their own responsibilities. The Academy is going to have an important role to play in health care reform and we want to realize that in big ways.

Question 3:Can you discuss the leadership role of the Academy in preparing for this freight train of health policy change through its nomination and selection of Fellows who will drive it into the near and distant future?
To listen, click here.

Margaret McClure: The Academy has over the years increasingly positioned itself, thank goodness, to serve the people of the United States in policy reform and in helping to make health care better and better. I am encouraged about our own involvement in what has gone on to date – and I’m also encouraged at our potential to be tapped as one of the leadership organizations to turn to in health care as we begin these reform processes. A good example: President Catherine Gilliss is doing a terrific job and was recently interviewed by the New York Times. This is an acknowledgement that there is an Academy and that the Academy has something to offer. We have had fine leadership from our Executive Directors: Pat Ford Roegner did a great job to set us up in Washington and get us going. It’s the reason we need to be in Washington. Our new Executive Director, Cheryl Sullivan, has wonderful ties in the Washington area and will be in a position to help the Academy find opportunities to participate to move some of this. One of the most important things you do in an organization such as the Academy is to position yourself in such a way that when people are forming new commissions, new committees, new task forces at the federal level, they call the Academy and say “Do you have someone from nursing who can serve on this commission/committee/task force so that we’ll have that voice.” That they call the Academy – and that they know about the Academy! One of the problems we had being in Wisconsin, as fine as the folks were there, it did not place us where we needed to be in terms of health care policy. The move back to Washington was overdue, badly needed, and I’m so pleased we’re there with the kind of leadership we have at this moment.

The Academy represents our brightest and best in nursing. The Academy should be where we turn. We should work hand-in-glove with the ANA because often the ANA is the group that is called. With the great relationship we have with them, we can help them to place people as well. I remember when we were putting together Quality Commissions and nominating people to serve, we worked very closely with ANA so that we were speaking with one voice and we were putting forward the same people. It’s terribly important that we speak with one voice and that we do what we need to do.

I think the Academy is in a very strong position right now and I think we need to make sure that the officers of the Academy have a way to identify the right people for the right jobs. And then, of course, we have to have members who are willing to step up to the plate and say “Yes – I will sit on that commission – Yes – I will be a part of this work.” What I know of the Fellows of the Academy, it will not be hard work. We do not have difficulty convincing them to be heavily involved. We have a very important and bright future in helping to shape what will go on in health care reform in this country.

The Future of Nursing: Leading Change, Advancing Health (IOM/RWJ) Questions

On October 5, 2010 a landmark report on “The Future of Nursing“ was published by the Institute of Medicine, sponsored by the Robert Wood Johnson Foundation. This report is the most comprehensive and data based analysis of the various issues facing the profession and the discipline, written by a committee of experts from within and outside of nursing.

All nurses in leadership positions should read the 600 page report you can access via the web link provided here. The report provides a framework for the work to be done by all of us to maximize the contributions of the nursing profession to improving the health and well-being of citizens in this country and so many others.

I have asked several members of the IOM committee to share their thoughts about questions I posed. I highly recommend to you their valuable answers and insights —and WELCOME your thoughts in response!! Please do sign on and tell us what you are thinking…..
Marion E Broome, editor, Nursing Outlook: The Official Journal of The American Academy of Nursing

Question: What do you think is the single most important issue that nursing must address in the next 2 years?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Nurses and nursing organizations must assume professional and leadership responsibility to adopt the committee’s recommendations on improving the professional nurses’ capacity to participate in the transformation of our health care system. As stated in the committee’s report we need nurses across all settings to be better educated and to work within and outside of their organizations for safer, patient centered, equitable, effective and efficient health care for the American public.

Question: Based on the work of the committee what advice would you give nurses newly entering the field who want to maximize their contributions to the field over the course of their career?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

New nurses entering the field should seek opportunities to participate in transitional programs that will facilitate their adoption of evidenced based, effective health care. Nurses must adopt a commitment to life-long learning that includes working with consumers, physicians and other health professionals as full partners in the promotion of health , prevention of adverse events and the fostering of health system renovation across the continuum of care. The greatest demand for nursing care remains outside of acute care settings. Individuals entering the field should seek to acquire knowledge, skills and experience to provide care across the life span and settings.

Response from: Liana Orsolini-Hain, PhD, RN
Nursing Instructor, City College of San Francisco, CA

Stay in school. I am hearing from chief nursing officers that they will become further financially strapped due to healthcare reform and probably won’t have the financial resources to train new graduates. They are being selective and are hiring BSN prepared nurses over AD prepared nurses in many parts of the country. Some hospitals in California are advertising that they prefer new graduates to have a master’s degree in nursing to make up for their lack of experience. Healthcare Reform will provide many new opportunities for nurses who get their NP and can practice primary care, especially collaboratively within medical homes and other chronic care management entities. A certification in geriatrics will go a long way as 78 million baby boomers continue to age. Also, consider a trajectory that will enable you to become a nursing educator. We have a serious nursing faculty shortage that will worsen as older faculty retire. We desperately need more doctorally prepared nurses to teach in universities and in community colleges offering the BSN degree. Lastly, join a few nursing, political, and leadership professional organizations. All of us should be active members of our specialty organization to help us stay up to date in our practice. We need more nurses to lead the implementation of health care reform, and we need to learn to lead at the national level.

Question: What strategies should leaders in nurse education employ most effectively to lead their faculty to respond to the mandates in the IOM report on the Future of Nursing?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Presidents of universities and colleges must work with deans of nursing and other health professional schools to promote interdisciplinary education at the undergraduate and graduate level. It is essential that faculty actively lead efforts to prepare nurses to work within complex systems, engage consumers and patients at the community and point of care level, to identify opportunities to work environments so that they are beneficial to patients and less burdensome to health professionals through the use of technology and the creation of innovative systems of care.

Response from: Liana Orsolini-Hain, PhD, RN
Nursing Instructor, City College of San Francisco, CA

Every university that offers a BSN or higher degree in nursing should reach out to community college nursing programs and employers of RNs to form education consortiums which provide seamless co-enrollment of Associate Degree (AD) students, the automatic transfer of financial aid, joint-teaching appointments, shared staff RN clinical faculty in dedicated education units, elimination of curriculum redundancy and a streamlined process of earning a BSN degree in no more than 3 semesters. Universities should also streamline AD and diploma to MSN education for working RNs who wish to make a contribution to nursing that requires a minimum of a master’s in nursing degree. Community colleges that wish to offer the BSN degree should incentivize their faculty to return to school for a doctoral level degree and obtain and those colleges should maintain CCNE or NLNAC accreditation. We should also tap into our LVNs and incentivize them to return to school for higher degrees. Our LVN population has a level of diversity that is more reflective of the population of the US so recruiting them to return to school will probably increase the diversity of RNs.

Question: How do we best prepare and mentor dynamic leaders for the future of health care practice?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Leaders of the future should be prepared by today’s leaders through the deployment of mentors from across health care settings and the implementation of programs where individuals have the opportunity to lead projects in diverse environs. Leadership is a practiced art and to create the leaders of the future we must provide individuals with the education and willingness to lead with opportunities to do so.

Response from: Michael R. Bleich, PhD, RN, FAAN
Dean and Dr. Carol A. Lindeman Distinguished Professor
Oregon Health & Science University School of Nursing

First, we need to embed clarity around the idea that every nurse is a leader, manager, and follower and improve conceptual clarity that leading requires innovation and risk, managing is both a set of personal attributes and an ability to persist in goal achievement, and that following is not a “less than” function, but is an act of acquiescence and energy given willingly to the “team.” If we can embrace a non-hierarchical perspective on this, then we look for traits in those entering the profession who are risk-takers, who believe that they can influence and engage with a range of stakeholders in the health system (beyond the expectation of roles with patients/families/communities), and who will bring forward their best game to work to outcomes. In basic nursing education, all students are given feedback on leadership skills in every course, strengthening the sense of self purpose and awareness in context with others.

Next, we need to create environments for leaders to flourish. This includes creating informational and transformational knowledge experiences of organizations, systems and work design, quality improvement, complexity science approaches to change to complement programmatic approaches to change management and the use of conflict engagement strategies.

Role models and mentoring should become part of a career and life experience, with individual and organizational strategies to “match” individuals both from within and outside of nursing and health care circles. Having a career plan that is developed for short and long term development is an imperative and employing and regulating/certifying organizations should encourage an articulation of this development plan.

Senior level nurses and stakeholders close to nursing must create opportunities and formal programs for leadership development, preferably staged to align with critical times in a professional trajectory. For example, the Veterans Administration as a system is a model for promoting continuous growth and aligning programs at sensitive times over the course of a career, engendering loyalty and an infusion of perspective to advance the health needs of veterans. Other programs that are examples of leadership development include programs sponsored by the Robert Wood Johnson Foundation, the Wharton School of Business at the University of Pennsylvania, Sigma Theta Tau, the American Organization of Nurse Executives, and the Cockcroft Fellows program at the University of South Carolina, and the University of California Center for the Health Professions. All of these programs – and others – have a history of producing effective leaders and can serve as a basis for expanded opportunities.

Question: What role should nurse scientists play in helping shape the future of nursing and how do they expand their capacity to do so? 

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Nurse scientists have made significant contributions to health care delivery, health policy and the design of effective programs that have facilitated the provision of safe, effective, efficient, equitable, patient centered care across the continuum of services. However, as stated in the report there are insufficient numbers of nurse scientists and nurses with earned doctorates to fulfill the needs for nursing faculty, nurse researchers, nurse executives and public health leaders. The committee’s recommendation on the increase in the number of nurses with BSNs from 50% to 80% of the workforce by 2020 is foundational to increasing the pool of applicants that will enter graduate and doctoral education. Our recommendation on the doubling of nurses with earned doctorates to teach nurses, to expand the number of nurse scientists actively engaged in comparative effectiveness research, translational research, health services research, community participatory research as well as basic and clinical research. The report also identifies the need for more data and nurse researchers are best positioned to lead and disseminated studies that will provide the profession with the requisite evidence to move forward in so many areas.

Response from: Michael R. Bleich, PhD, RN, FAAN
Dean and Dr. Carol A. Lindeman Distinguished Professor
Oregon Health & Science University, School of Nursing

First, nurse scientists must continue to play the critical role they already play in generating clinical knowledge through a nursing lens. From my vantage point, knowledge generation around symptom management, health promotion and maintenance, and discovery to expand knowledge around disease and disability can only strengthen our contributions to the public, inter-professional team performance, and our own discipline. The report reframes the importance of bending the cost curve of health care expenditures by placing added relevance to those areas which are within nursing’s purview of promotion and disease management and curtailment. We must prevail in these areas.

Second, it is my sense that this report challenges nurse scientists to expand our presence at other “systems” tables. As new models of care develop, the efficacy, efficiency, and scalability of these models will require nurses to gain and incorporate comparative effectiveness skills to test and advance new approaches to care. As the public grapples with the acceptance of nursing roles in expanded capacities, we will need nursing science to test and monitor how the nurses who contribute to care can assure safe and effective outcomes in contrast to or when combined with other disciplines, including physicians. The need for additional knowledge generation around nursing and inter-professional education is yet another critical area that nurse educators lament as lacking (and for which there is limited funding) and this report shines a light on the paucity of research to advance teaching, learning, and competency attainment. Finally, as a discipline, we cannot discount that nurse scientists will play expanded roles on inter-professional teams which may include research that is conducted outside of traditional academic settings.

Putting these needs together and in context, expanding our capacity to produce and engage scientists in research is no small task. The first fundamental question is “How do we enlist those nurses with current doctoral research preparation who have never substantively used their education for the purpose of research?” Are there non-research intensive environments where we could enlist these individuals in areas of workforce, educational, or organizational research that does not require an academic health science center setting, but may require linking them with each other and alternate settings, such as workforce centers? The second question is, “How do we enliven the experience of obtaining a research degree, such that it is more appealing and achievable than current perceptions?” Although ideal, not every nurse wants or even needs the same level of preparation for a purist science-based role. Are we able to address variability in learning styles and career trajectories within our doctoral education programs to address those who might want a blended role(s)? If so, how can we market the delivery of those programs and ensure that there is a research “return on investment” in all who graduate. Third, “How do we engage doctoral research educators – within and outside nursing – to augment our perspectives on research careers and expanded content consciousness?” Is there room in nursing education for organizational, econometric, environmental, and other scientists to expand our capacity similar to what was done in the pre-nursing PhD years?

If we can address these issues, then funding options for career development could expand beyond traditional federal funding. Organizations, including accountable care organizations, hospitals and health systems, professional societies, and philanthropy can step forward to play an added role in support.