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In Vivo
PUBLIC HEALTH

A recent study led by a team of researchers from the School of Nursing found that in intensive care units at hospitals across the country patients are more likely to acquire potentially deadly infections where there is inadequate nurse staffing. The study showed that an increase in nurses’ overtime hours was linked to higher rates of ventilator pneumonia, catheter infections and skin ulcerations.
   “Nurses are the hospitals’ safety officers, but nursing units that are understaffed and have overworked nurses are shown to have poor patient outcomes,” says Patricia Stone, Ph.D., M.P.H., R.N., assistant professor of nursing and the study’s lead author. “Improvements in nurse working conditions are needed for the safety of our nation’s sickest patients. With the looming nursing shortage, hospitals direly need to address working conditions to help retain current staff and recruit people into nursing.”
   This work by Dr. Stone is one of many patient care and health policy studies that researchers at the school are working on. (See sidebar on p. 8 for a sampling). The school is at the forefront of education advances as well, having just graduated its second class of students with the Doctor of Nursing Practice (DrNP) degree. These 20 clinical experts – all experienced nurse practitioners when they entered the program – now have additional education and skills necessary to care for patients in a variety of settings, from hospital to ambulatory care clinic.
   The DrNP program is the first of its kind in the world. Now, about 200 schools nationwide are setting up clinical doctorate programs, in the wake of an October 2004 position statement from the American Association of Colleges of Nursing that called for moving the current level of preparation required for advanced nursing practice roles from the master’s degree to the doctorate level by the year 2015.
   An urgent need for nurses with such advanced training is necessary in light of looming practitioner shortages. Almost all states will have a shortage of primary care physicians by 2020, according to a 2006 report from the American Academy of Family Physicians.
“Normally, nurse practitioners care for patients in ambulatory care settings,” says Judy Honig, DrNP, EdD, CPNP-PC, who directs the Doctor of Nursing Practice program. “These nurses will be uniquely prepared as primary care providers to see patients across a variety of settings. With more chronic illness and an aging population, there’s a growing need for more primary care, and the DrNP will be qualified to provide that.”
   It’s all part of a sea change for nursing as a profession – a change in which Columbia is playing a critical role. “We have the largest number of applicants to the School of Nursing that we’ve ever had, and they are entering because of the way the profession is evolving,” says Jennifer Smith, DrNP, M.P.H., M.B.A., senior associate dean. “Nurses are changing the face of health care.”
   The stage was set for nurses’ evolving role as primary care providers by programs like Columbia Advanced Practice Nurse Associates (CAPNA), the innovative nurse practitioner-run practice based at East 60th Street.
   While other nurse practitioner-run primary care practices were already in existence when CAPNA opened its doors in 1998, the program differs from most others in that its nurse practitioners are reimbursed at the same rate as doctors. They also have admitting privileges to New York-Presbyterian Hospital. These faculty advanced practice nurses diagnose and treat illness and perform physical exams and tests, making nearly 80 referrals per month to Columbia specialists.
   “We are well regarded by CUMC physicians,” says Dr. Smith. “That we’ve thrived for 10 years is a testament to the kind of care we deliver, as everyone in New York wants to go to the best specialist. But it’s so hard to find primary care now that we fill a niche with our focus on prevention and education. In the long run this not only helps patients live healthier lives, but also saves money. And when patients who have insurance have a choice and choose us, that really says something. They like the kind of health care our nurse practitioners are able to give.”
   Just two decades ago, Columbia’s School of Nursing was struggling with low enrollments and the changing role of women in the workforce – particularly difficult for a profession that is still primarily female. But Mary O’Neil Mundinger, DrPH, RN – appointed dean in 1986 – brought the school roaring back. She required all nurses on the faculty to either have a faculty practice or a program of research. That attracted experienced clinicians and researchers, who stepped into the classroom to teach what they loved, and soon Columbia began accumulating an impressive list of accomplishments:

the first randomized trial comparing nurses and physicians in primary care – and demonstrating that health outcomes were equal

the highest per capita NIH faculty research funding

the first and only nursing school to be designated a World Health Organization collaborating Center for the International Nursing Development of Advanced Practice

the first and only Nurse Principal Investigator in the NIH’s priority funding to establish 21 translational research centers

the first nursing school faculty to gain admitting privileges at a major teaching hospital

   Today, students and faculty at the SON practice at more than 200 sites in New York City, applications to the school are up 30 percent and the program ranks 13th in NIH research funding – up from 27th in 2005.
   “The new nurse is a researcher, a teacher, and a practitioner,” says Dr. Smith. “Nurses are helping to drive changes in health care, with an understanding of the importance of a focus on quality, education and prevention. Columbia is in the forefront of that movement.”

—Gina Shaw

Advances in Nursing Research

School of Nursing faculty are among the nation’s most prominent researchers in the field. They also participate in interdisciplinary teams with faculty from medicine, neurology, ophthalmology, public health and bioinformatics and are the recipients of multiple NIH funded grants.

Suzanne Bakken, DNSc, R.N., Alumni Professor of Nursing and professor of medical informatics, a nationally known expert in bioinfor- matics, has received more than $1 million in federal research grants this year alone. Her study, “Wireless Informatics for Safe and Evidence-based (WISE) APN Care,” is supported by the Health Resources and Services Administration. The National Cancer Institute awarded her a grant to study integration of resources from the Institute’s Cancer Information Service into an existing PDA-based mobile decision-support system.

Elaine Larson, Ph.D., R.N., professor of pharmaceutical and therapeutic research, has received multiple awards from the NIH and the Centers for Disease Control and Prevention. Her expertise in infection control was recently recognized with a $2 million, two-year grant from the CDC for a study of non-pharmaceutical interventions for pandemic influenza.

Joyce Anastasi, Ph.D., DrNP, R.N., FAAN, LAc., Helen F. Pettit Professor of Clinical Nursing, is a renowned expert in HIV/AIDS. Her research focuses on symptom management and the use of alternative therapies to complement traditional interventions for patients with HIV and has been funded by the NIH for more than 10 years.

Mary Woods Byrne, Ph.D., M.P.H., CPNP, professor of nursing and the Stone Foundation and Elise D. Fish Professor of Clinical Health Care for the Underserved, runs a federally funded research program focused on the assessment and early intervention for infants, toddlers and children and their caregivers at risk for sub-optimum development and inadequate parenting. Her current NIH-funded research focuses on parenting and child outcomes in a prison nursery.

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