AAN News & Opinion
At-Risk populations and public health emergency preparedness in the United States: Nursing leadership in communitiesPublic health emergency preparedness is defined as: …the capability of the public health and health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action (Nelson et al, 2007, p.
Opioid Crisis through the Lens of Social JusticeThe United States opioid crisis brings into sharp focus the health inequities for persons dependent on opioids due to long-term use for chronic pain and persons with opioid use disorder (OUD). Disparate access to health-care services, however, is widespread for vulnerable populations like frail older adults, children, incarcerated individuals, and members of racial, ethnic and sexual minorities, groups for whom opioid use exacts a heavy burden. Stigma combined with few prevention services and limited access to healthcare for life-saving treatment are costly for the society and its citizens.
The crucial role of all current and future nurses in addressing the continuum of substance useThe American Academy of Nursing believes necessary measures must be taken to address the negative consequences of substance use on the health, economy, productivity, and social aspects of individuals and communities. The burden of disease attributable to alcohol and drug use varies substantially across geographic locations, yet much of the burden is due to the effects of substance use on other health outcomes. Despite the existence of evidence-based strategies, including screening, brief intervention, and referral to treatment (SBIRT), and knowledge of the impact of substances on the brain and body systems, further education is needed to identify persons who are at risk because of substance use and provide interventions to prevent and reduce substance use disease burden.
Policy brief on climate change and mental health/well-beingClimate change has a significant global impact on individuals’ mental health and well-being. However, global health systems are inadequately prepared to address this issue. Studies indicate that climate events such as floods, droughts, tornados, earthquakes, and fires not only exacerbate chronic mental illness, but also impact well-being causing anxiety, stress, and in the worst case, suicide. The World Health Organization estimates that 12.6 million preventable deaths per year can be attributed to environmental factors, all of which are exacerbated by climate change, and an additional 250,000 deaths per year are projected between 2030 and 2050.
Improving the care and health of populations through optimal use of clinical nurse specialistsPatients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CNSs) are uniquely qualified to care for patients with complex illnesses as well as having the skills to optimize care for entire populations with complex needs.
Improve nurses’ well-being and joy in work: Implement true interprofessional teams and address electronic health record usability issuesThe three components of the Triple Aim – enhancing the patient experience, improving population health, and reducing costs – have become the guide for optimizing healthcare system performance in the U.S. (Berwick, Nolan, & Whittington, 2008; Sikka, Morath, & Leape, 2015). The three aims are intrinsically intertwined and therefore need to be addressed simultaneously. However, constant efforts to maintain a harmonious balance of the Triple Aim is a challenge and often causes unintended consequences especially as it relates to a consistent change in clinician work processes, decreased joy in work, and burnout (Dyrbye et al., 2017; Shanafelt et al., 2016).
Policy brief: Nurse fatigue, sleep, and health, and ensuring patient and public safetySociety needs critical nursing services around the clock and, as a result, nurses often work shift work and long work hours (SWLWH). These hours can prevent nurses from getting the seven or more hours of quality sleep each day that experts recommend (Watson, et al., 2015). Nurses on SWLWH are at risk for cardiovascular disease, gastrointestinal and psychological disorders, cancer, type 2 diabetes, injuries, musculoskeletal disorders, all-cause mortality, adverse reproductive outcomes, and difficulty managing chronic diseases (Caruso, et al., 2017; Caruso & Waters, 2008; Gan, et al.
Preventing adverse health outcomes among children and adolescents by addressing screen media practices concomitant to sleep disturbanceIn today's digital age, screen media use is prevalent in the daily life and functioning of children and adolescents. Sleep disturbance and adverse health outcomes related to screen media practices are on the rise affecting physical, cognitive, and behavioral health outcomes. Mounting evidence from studies worldwide support the following recommendations addressing practice, research, and policy: (a) All practitioners are encouraged to assess youth and their families at each health encounter for screen media practices, sleep disruption and daytime sleepiness, and be able to refer to specialists or be trained on interventions to address problems; (b) Children and families are encouraged to seek information about and take responsibility for screen media use practices, effective sleep habits, and signs and symptoms of adverse health outcomes; (c) Policy makers are encouraged to promote public awareness and provide funding for further research into screen media practices, sleep disturbance, and adverse health outcomes.
Comparing residential long-term care regulations between nursing homes and assisted living facilitiesThe long-term care (LTC) sector is a major component of the U.S. health care system that continues to grow (Bureau of Labor Statistics, 2014; Congressional Budget Office, 2013). Most of this increase is due to growth in the population of oldest adults (85+), a group with limited capacity for self-care due to health conditions (Congressional Budget Office, 2013; NIA, 2015). In 2014, there were over 46 million Americans 65+ years, and 6.2 million 85+ years old (Federal Interagency Forum on Aging-Related Statistics, 2016).
Pregnant and Parenting Women with a Substance Use Disorder: Actions and Policy for Enduring Therapeutic PracticeThe American Academy of Nursing (Academy) calls for an end to criminal prosecution and punitive civil actions against pregnant and parenting women based solely on their substance use or substance use disorder (SUD). The Academy supports a public health response to the needs of women and their children and families affected by SUDs that incorporates multi-disciplinary culturally- and trauma-responsive models of health care, child welfare, treatment and recovery supports and clinician practices that are in line with the accumulated scientific evidence.
Nursing innovation: The joint effects of championship behaviors, project types, and initiation levelsHealth care organizations worldwide strive to deliver safe, high-quality, patient-centered care while fostering a proficient nursing staff and maintaining fiscal accountability. To achieve these aims, these organizations promote innovation at various organizational levels and in various domains (Drach-Zahavy, Somech, Granot, & Spitzer, 2004; Kaya, Turan, & Aydın, 2015; Länsisalmi, Kivimäki, Aalto, & Ruoranen, 2006; Weng, Huang, Chen, & Chang, 2015). It is increasingly recognized that nurse champions, namely excellent front-line practitioners, come from within the organization and are passionate about improving quality of care, and serving as key agents in implementing innovation via self-developed or management-developed projects (Byers, 2017; McSherry & Douglas, 2011; White, 2011).
American Academy of Nursing on Policy position statement: Disaster preparedness for older adultsThe American Academy of Nursing recognizes the significant impact of natural disasters on older adults. Unfortunately, despite decades of planning, deficiencies continue to exist in disaster preparedness for this population. While recent federal and state legislative efforts have attempted to address some of these issues, gaps in allowing for a consistent level of preparedness and disaster response across the U.S. continue to be exposed. This position statement outlines practical policy and organizational recommendations to enhance the ability of frontline providers, health care organizations and emergency planners in responding to disasters on the behalf of older Americans, the most rapidly growing sector of the United States (U.S.) population.
Position statement: The American Academy of Nursing opposes prevention and limitation of transgender individuals from serving in the United States militaryThere are an estimated 1,320 to 6,630 transgender active duty service members in the U.S. military (Schaefer et al., 2016). Notably, their ability to serve has been unaffected by changes in policy on lesbian, gay, and bisexual service members.
Policy brief: Protecting vulnerable LGBTQ youth and advocating for ethical health careLesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) youth are at heightened risk for bullying, victimization, homelessness, and being subjected to harmful therapies and associated physical and mental health issues. Health disparities in these populations are strongly associated with increased vulnerability based on stigma and discrimination due to their sexual orientation, gender identity, and gender expression (United Nations, 2017). Additional threats to the health of LGBTQ youth include: expanded religious freedom exemptions of providers, permitting legal refusal to provide health care or other services to this population; a halt to Title IX enforcement for transgender persons by the Department of Education; and regular threats to repeal Section 1557 of the Affordable Care Act (ACA), thereby excluding coverage for transgender-related care and eliminating coverage for pre-existing conditions (U.S.
American Academy of Nursing on policy: Reducing preterm births in the United States: Maternal infant health, child, adolescent and family, and women's health expert panelsThe rising rates of preterm birth (PTB) (less than 37 completed weeks gestation) in the United States is an urgent population/public health issue. Education of the healthcare workforce, policy makers and the public on risk factors for prematurity, and identification of strategies to counter the rising rate of PTB is critical. This policy brief illustrates the problem and sets forth policy recommendations to reduce prematurity rates.
The American Academy of Nursing on policy: Emerging role of baccalaureate registered nurses in primary care (August 20, 2018)Increased access to health insurance and health care, increased complexity of patients in our aging society, and challenges in primary care team staffing are among many current challenges to providing high quality, effective, and satisfying care to all patients. At the same time, the team is expected to attend to the equally important need for prevention, health promotion, and care coordination and management of the population at large. The demand to manage multiple, comorbid complex chronic illnesses are overwhelming the primary care system and causing waits, delays, and a shifts toward receiving primary care in inappropriate settings such as the emergency room (ER).
Supporting breastfeeding for infants born to opioid dependent mothers June 18, 2018Infants exposed to opioids during gestation demonstrate signs of withdrawal within 3 to 5 days of birth. Maternal opioid dependency may be the result of prescribed, illicit or nonmedical drug use. Breastfeeding reduces the severity of withdrawal and the need for pharmacological management (Abdel-Latif et al., 2006; Dryden, Young, Hepburn, & Mactier, 2009; Hodgson & Abrahams, 2012; Isemann, Meinzen-Derr, & Akinbi, 2011; McQueen, Murphy-Oikonen, Gerlach, & Montelpare, 2011; O'Connor, Collett, Alto, & O'Brien, 2013; Welle-Strand, Skurtveir, & Jones, 2012).
Policy brief on the nursing response to human traffickingHuman trafficking is a public health emergency affecting an estimated 12 to 30 million people globally. Given that 85% of trafficked victims have contact with health care providers in any year, nurses are critical to: the identification of trafficked persons; effective promotion of their physical, mental, and cognitive health; development and implementation of practice guidelines; implementation of research to inform bestpractices globally; and championing public policy initiatives at local, state, and national levels.
Sexual and Reproductive Health Rights, Access & Justice: Where Nursing StandsAlthough the American Academy of Nursing (Academy) has for decades played a major role in advocating to protect the sexual and reproductive health (SRH) of all women and men regardless of race, color, sexual orientation, or social economic status, many government officials are aggressively pursuing ways to create barriers to evidence-based SRH care access. The Academy continues to “resist and respond” to these tactics, in the form of statements, policy briefs, amicus briefs and coalition letters—raising the voice of Nursing against the dismantling of the Affordable Care Act (ACA) and longstanding national health goals, programs, and essential services.
Expanding nursing's role in responding to global pandemics 5/14/2018We know by now that the world will see another pandemic in the not-too-distant future; that random mutations occur often enough in microbes that help them survive and adapt; that new pathogens will inevitably find a way to break through our defenses; and that there is the increased potential for intentional or accidental release of a synthesized agent. Every expert commentary and every analysis in recent years tells us that the costs of inaction are immense. And yet, as the havoc caused by the last outbreak turns into a fading memory, we become complacent and relegate the case for investing in preparedness on a back burner, only to bring it to the forefront when the next outbreak occurs.
Strengthen federal and local policies to advance precision health implementation and nurses’ impact on healthcare quality and safetyThe American Academy of Nursing (The Academy) supports sustaining and building on institutional and regulatory policies to ensure that adequate infrastructure and workforce is in place for precision health implementation by nurses and other healthcare team members. In order to realize anticipated improvements in healthcare quality and safety, the Academy will continue to provide opportunities in the area of precision health policy development to Academy Fellows and nurses across the nation. In 2016, H.R.
Position statement: Policies to support family caregiversIn 2013, an estimated 40 million family caregivers provided an average of 18 hours of care per week, reflecting approximately $470 billion in unpaid caregiving contributions (Reinhard, Feinberg, Choula, & Houser, 2015). Projected demographic shifts in the U.S., including the rapidly aging population (World Health Organization, 2015) and increase of individuals living with chronic conditions across the lifespan (American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, 2011; Houtrow, Larson, Olson, Newacheck, & Halfon, 2014), will increase the demand for family caregivers.
Requiring a nurse residency for newly licensed registered nursesWe recommend that a nurse residency for newly licensed registered nurses (RNs) be required for all new graduate RNs as a component of their employment. Requirement through mandate or incentives at federal or state levels would enable that 100% of all newly licensed RNs complete an accredited new graduate nurse residency program (NRP). Evidence demonstrates the benefit and need for all newly licensed RNs hired into acute care hospitals to complete a clinical NRP (Benner, Sutphen, Leonard, & Day, 2010).
American Academy of Nursing on policy: Recommendations in response to mass shootingsWhen Americans gather in public places, schools, work, places of worship, and at home, they should feel safe and not afraid. The recent massacre at Marjory Stoneman Douglas High School in Parkland, Florida, where 17 individuals were murdered, has led to a public outcry for action by policymakers to address mass shootings. This call to action is similar to those made in response to the mass shootings in Columbine, Sandy Hook, Orlando, and Las Vegas, making a case for a lack of progress and apathy in addressing mass shootings.
Assessing and addressing cardiovascular risk in young womenOver the past 2 decades there has been an increase in cardiovascular disease (CVD) mortality for young women aged 35 to 54 years that corresponds with an increase in CVD risk factors. Yet, both young women and their providers underestimate CVD risk. Expert recommendations to provide patient education on CVD prevention and consider CVD risk factors in women have failed to detail the unique considerations in young women. The American Academy of Nursing (Academy) supports (a) increasing National Institutes of Health (NIH) funding for both basic research and clinical trials that focus on CVD risk in young women; (b) amplifying health-care system quality improvement initiatives to increase clinicians' rates of practice consistent with clinical guidelines for CVD risk; (c) partnering among primary care providers and specialists in women's health and cardiovascular health to assess and manage women's CVD risk; and (d) collaborating with public health and community organizations to lead initiatives for CVD risk reduction in young women.
Achieving advance care planning in diverse, underserved populationsThere remains a gap in meeting the palliative and end-of-life (EOL) care needs, including advance care planning (ACP) needs of ethnic minority, under-resourced, veterans, and lesbian, gay, bisexual, transgender, and queer (LGBTQ) Americans, as well as persons with disabilities and residing in geographically isolated regions. Intersecting socially constructed characteristics influence the lived experience of marginalized communities, including their health-care experiences. These persistent gaps pose a serious barrier to achieving high-quality care, including palliative and EOL care, across the life span of members of these growing populations.
African-American mothers' persistent excessive maternal death rates“Maternal health has significantly improved in the 21st century, but too many women continue to die or suffer severe pregnancy complications every year” (Centers for Disease Control and Prevention, 2016). African-American mothers in the United States die more often than their counterparts during childbirth and delivery. Research findings highlight disparity among African-American mothers as it relates to childbearing (Research overview of maternal mortality and morbidity in the United States). A focus on disparities during childbearing has been a national priority with federal support programs directed toward improving the health disparities of Maternal and Infant Health (MIH) among disadvantaged populations ( https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm ).
An effective human papillomavirus vaccination policy will reduce infection- and malignancy-related morbidity and mortalityTwelve human papillomaviruses (HPVs) are classified as strong human carcinogens, commonly referred to as high-risk HPVs (hrHPVs), and are responsible for nearly all cervical malignancies and 40% to 50% of all vaginal and vulvar cancers in women (Bouvard et al., 2009; International Agency for Research on Cancer, 2006; International Agency for Research on Cancer (IARC) Working Group on Evaluation of Carcinogenic Risks to Humans, 2007). Together these hrHPVs are the cause of ≥75% of anal and perianal cancers in male and female adults (Bosch & de Sanjose, 2003; Clifford, Smith, Plummer, Munoz, & Franceschi, 2003; Munoz, 2000; Walboomers et al., 1999).
Nurses play essential roles in reducing health problems due to climate changeClimate change is endangering the stability of the planet's ecological systems and poses untoward risks to the continued survival of humans (Kurth, 2017; Landrigan et al., 2017; Melillo, Richmond, & Yohe, 2014; Watts et al., 2017). In our communities, climate change is experienced as increased frequency and intensity of wildfires, heat waves, winter storms, hurricanes, and floods, as well as changes in vector distribution. Climate- and weather-related conditions affect health conditions as diverse as asthma, sudden cardiac death, premature birth, gastrointestinal illness, depression, malnutrition, and vector-borne illness (Schifino, Lallo, De Sario, Davoli, & Michelozzi, 2013; Sheffield & Landrigan, 2011).
Critical conversation: Toxic stress in children living in povertyOn October 27, 2017, the American Academy of Nursing President and Executive Vice President/Chief Operating Officer Children's Mercy Kansas City Karen Cox, PhD, RN, FAAN, convened a critical conversation on Toxic Stress in Children Living in Poverty. An invitation-only event, the critical conversation was launched in response to the Robert Wood Johnson Foundation's Culture of Health working group that met in 2016 on eliminating childhood poverty. Among the approximately 100 participants who assembled at the National Press Club, Washington, DC, were representatives of 33 organizations and 15 universities including First Focus, the Child Welfare League of America, Zero to Three, the Association for the Education of Young Children, the Campaign for Grade-Level Reading, National Association of Social Workers, and the Coalition to Stop Gun Violence.