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New Federal Dietary Guidelines Find Support in Medical Community

By Contributor
Healthcare News

‘Eat Real Food’

When U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and U.S. Agriculture Secretary Brooke Rollins released the federal government’s “Dietary Guidelines for Americans, 2025-2030” earlier this year, they hailed the document as the most significant reset of federal nutrition policy in decades, boiling down the report with three words: “eat real food.”

The shift is important, they say, as nearly 90% of healthcare spending goes toward treating chronic disease, much of it linked to diet and lifestyle. More than 70% of American adults are overweight or obese, and nearly one in three adolescents has prediabetes.

“These guidelines return us to the basics,” Kennedy said. “American households must prioritize whole, nutrient-dense foods — protein, dairy, vegetables, fruits, healthy fats, and whole grains — and dramatically reduce highly processed foods.”

Added Rollins, “at long last, we are realigning our food system to support American farmers, ranchers, and companies that grow and produce real food. Farmers and ranchers are at the forefront of the solution, and that means more protein, dairy, vegetables, fruits, healthy fats, and whole grains on American dinner tables.”

Dr. Bobby Mukkamala

Dr. Bobby Mukkamala

“Today, the AMA is making significant commitments to improve clinical competency, deliver educational resources for physicians, and work with Congress to enact meaningful, lasting nutrition change that can improve lives. The AMA is focused on helping physicians translate this science into everyday care and helping patients improve their overall health.”

The new Dietary Guidelines for Americans (DGA), available at realfood.gov, emphasize the following recommendations:

• Prioritize protein at every meal;

• Consume full-fat dairy with no added sugars;

• Eat vegetables and fruits throughout the day, focusing on whole forms;

• Incorporate healthy fats from whole foods such as meats, seafood, eggs, nuts, seeds, olives, and avocados;

• Focus on whole grains, while sharply reducing refined carbohydrates;

• Limit highly processed foods, added sugars, and artificial additives;

• Eat the right amount of food based on age, sex, size, and activity level;

• Choose water and unsweetened beverages to support hydration; and

• Limit alcohol consumption for better overall health.

The guidelines also provide tailored recommendations for infants and children, adolescents, pregnant and lactating women, older adults, individuals with chronic disease, and vegetarians and vegans, ensuring nutritional adequacy across every stage of life.

 

Measured Praise

Major medical groups largely hailed the report, albeit with some pushback on the new protein emphasis.

“The American Medical Assoc. (AMA) applauds the administration’s new dietary guidelines for spotlighting the highly processed foods, sugar-sweetened beverages, and excess sodium that fuel heart disease, diabetes, obesity, and other chronic illnesses. The guidelines affirm that food is medicine and offer clear direction patients and physicians can use to improve health,” said Dr. Bobby Mukkamala, AMA president.

“Today, the AMA is making significant commitments to improve clinical competency, deliver educational resources for physicians, and work with Congress to enact meaningful, lasting nutrition change that can improve lives. The AMA is focused on helping physicians translate this science into everyday care and helping patients improve their overall health.”

The AMA also announced plans to launch a curated collection of nutrition education resources and continuing medical education; convene a series of roundtables with physicians, nutrition experts, and public health leaders to strengthen nutrition education and clinical competency; and work with Congress to incentivize nutrient-dense foods, expand food labeling efforts, define ultra-processed foods, and increase investment in nutrition research.

The American Heart Assoc. (AHA) also welcomed the report, particularly noting the emphasis on increasing intake of vegetables, fruits, and whole grains while limiting consumption of added sugars, refined grains, highly processed foods, saturated fats, and sugary drinks, all of which align closely with its own long-standing dietary guidance.

“In general, protein intake among Americans is adequate. Maybe some older adults have marginal intake, but the tone of the new DGA sounded like we have widespread inadequate protein intake.”

At the same time, “we see an important opportunity to educate consumers about the scientific basis for certain recommendations,” the AHA noted. “For example, we are concerned that recommendations regarding salt seasoning and red meat consumption could inadvertently lead consumers to exceed recommended limits for sodium and saturated fats, which are primary drivers of cardiovascular disease. While the guidelines highlight whole-fat dairy, the Heart Association encourages consumption of low-fat and fat-free dairy products, which can be beneficial to heart health.

“Protein is an essential component of a healthy diet, and we urge more scientific research on both the appropriate amount of protein consumption and the best protein sources for optimal health,” the AHA went on. “Pending that research, we encourage consumers to prioritize plant-based proteins, seafood, and lean meats and to limit high-fat animal products including red meat, butter, lard, and tallow, which are linked to increased cardiovascular risk.”

 

More Protein Concerns

The Harvard T.H. Chan School of Public Health released an interview with three of its faculty members who served on the report’s advisory committee: Teresa Fung, adjunct professor of Nutrition; Edward Giovannucci, professor of Nutrition and Epidemiology; and Deirdre Tobias, assistant professor of Nutrition.

“With some key exceptions, I was appreciative that the quantitative recommendations outlined in the new DGA are actually quite consistent with previous DGAs, carrying forward the recommended servings for the foundational food groups of fruits, vegetables, whole grains, dairy, and oils,” Tobias noted. “Long-standing limits for saturated fat (less than 10% of calories) and sodium were kept the same. The new DGAs also continue to emphasize whole foods.

“However, the biggest deviation from the science is a new prioritization of animal sources within the protein food group, instead of a plant-forward pattern,” she added, echoing the AHA’s concern. “Other critical deviations from science include the recommendation for full-fat dairy. Although vegetable oils were not forbidden, they were notably absent from being listed among healthy oils, despite being primary sources of essential unsaturated fatty acids.”

Fung agreed that the emphasis on animal protein, especially red meats, stood out. “In general, protein intake among Americans is adequate. Maybe some older adults have marginal intake, but the tone of the new DGA sounded like we have widespread inadequate protein intake.”

Still, Giovannucci added, “there are some positive aspects of the guidelines, such as the call to ‘avoid highly processed packaged, prepared, ready-to-eat, or other foods that are salty or sweet’ and avoid sugar-sweetened beverages. The guidelines are hard on added sugar, especially for children. Prioritizing fiber-rich whole grains and reducing refined grains is appropriate. These are good starting points.”

Fung noted that clinicians, nutritionists, and others use the federal guidelines to teach healthy eating, and a a number of federal nutrition programs also follow its standards, including the National School Lunch Program and Women, Infants, and Children. Changes in the new DGA may affect the food and nutrient requirements of these programs.

Nomination Deadline for Healthcare Heroes Extended to July 25

By
Daily News

SPRINGFIELD — In the spring of 2017, BusinessWest and its sister publication, the Healthcare News, created a new recognition program called Healthcare Heroes. It was launched with the theory that there are heroes working across this region’s wide, deep, and all-important healthcare sector, and that there was no shortage of fascinating stories to tell and individuals and groups to honor. That theory has certainly been validated.

But there are hundreds, perhaps thousands of heroes whose stories we still need to tell. And that’s where you come in. The nomination deadline for the class of 2025 has been extended to Friday, July 25, and we encourage you to get involved and help recognize someone you consider to be a hero in the Western Mass. region in one (or more) of these eight categories: Patient/Resident/Client Care Provider; Health/Wellness Administrator; Emerging Leader; Community Health; Health Educator; Innovation in Health/Wellness; Collaboration in Health/Wellness; and Lifetime Achievement.

Nominations can be submitted at businesswest.com/healthcareheroes/nominations.

The Crisis Might Be Over, but Challenges Remain on the Healthcare Workforce Front

By
Healthcare News Special Coverage

Progress Report

Jason Pacheco doesn’t like using that phrase ‘new normal’ any more than anyone else these days.

It’s more than a little tired, and in most settings, it’s been retired.

But when it comes to the workforce issues facing healthcare providers these days, it ultimately works. Four full years after the height of the pandemic and maybe a decade after some not-so-subtle shifts in the workforce landscape, especially the retirement of Baby Boomers, there is what appears to a new normal, and one that will continue for the foreseeable future.

It’s no longer a crisis, in the true sense of that word, although there are certainly many challenges, said Pacheco, director of Workforce Planning, Analytics, and Compensation for Baystate Health.

He noted that Baystate and other providers are no longer using large numbers of very expensive travel nurses, and there is no longer a sense of desperation over if and how vacancies will be filled. But in this new normal, there are still many open positions at any given time — more than before the pendulum started to swing.

“Baystate has implemented several key training programs … for example, we’ll go out and recruit a cohort of medical assistants. Instead of people having to go to school to become a medical assistant, we’ll hire them, and we’ll pay them to train to become a medical assistant.”

There is also a greater need to be competitive with compensation, benefits, and other perks; added emphasis on retention and the many elements of that equation; many more pay-to-train programs, education-assistance efforts, and other inititiatives to get individuals into healthcare and then provide them with the skills to succeed at one job and then advance to others; greater collaboration with area colleges to train existing employees and help them advance; and an ever-growing need to listen to employees and create an environment they want to be part of.

Dr. Robert Roose says a focus on culture has helped to “reset” the workforce crisis.

Dr. Robert Roose says a focus on culture has helped to “reset” the workforce crisis.

“Baystate has implemented several key training programs … for example, we’ll go out and recruit a cohort of medical assistants. Instead of people having to go to school to become a medical assistant, we’ll hire them, and we’ll pay them to train to become a medical assistant,” said Pacheco, adding that the system is partnering with Holyoke Community College to deliver a medical assistant training course, just one of myriad examples of how providers and systems are being proactive, and getting creative, when it comes to recruiting talent and retaining it.

Dr. Robert Roose, chief administrative officer for the Springfield market of Trinity Health Of New England, overseeing Mercy Medical Center, Johnson Memorial Hospital, and the affiliates of both, said both elements of the equation are equally important.

And as he acknowledged that the workforce crisis in healthcare has eased — or “reset,” he said — there are many reasons for this, including, at Mercy and elsewhere, a healthy emphasis on culture.

“Our colleagues have found that culture is what has ultimately compelled people to come to a system and stay within a system and continue to engage in the wellness professions,” he told BusinessWest. “We’re looking at how we better redesign work to attend to the ways that healthcare delivery has changed and will continue to be changing, and looking at ways to reinforce what matters to people to retain them in our hospitals and healthcare systems, while recruiting more individuals.”

Emily Davis, senior director of Human Resources at Cooley Dickinson Hospital, concurred.

“From a retention standpoint, it comes down to … how do we provide an environment where employees feel not only appreciated, but where, in every position, they can understand and feel the impact they’re having on patient care?

Emily Davis says it’s important for employees to feel they are appreciated — and to feel the impact they have on patient care.

Emily Davis says it’s important for employees to feel they are appreciated — and to feel the impact they have on patient care.

“Also, how does the environment they work in every day contribute positively to not just their livelihood, but their lives?” she went on, adding that providers’ ability to answer those questions in a positive fashion will go a long way toward determining their ability to retain the employees they have worked so hard to attract and invested so much in terms of onboarding and continued training and professional development.

For this issue and its forcus on the healthcare workforce, we’ll get back to those questions, how systems and individual providers are answering them, and how they are looking to make additional progress in living with this new normal.

 

Hire Power

As he talked about the workforce issues still confronting healthcare providers — but also about the progress made on some levels — Pacheco used numbers to help get his points across.

He said the system has been averaging 1,600 to 1,650 job vacancies at any given time, a number that is more than double what the system was averaging (maybe 700 to 800 vacancies) before the pandemic, but a significant improvement over the more than 2,000 vacancies at the height of COVID.

Meanwhile, more than 600 individuals are currently in the onboarding process at Baystate, including more than 200 nurses, many of them recent graduates of area colleges, he said, adding that these numbers are one indication of the system’s ability to bring more individuals into postitions, an improvement over a few years ago.

“We’re looking at how we better redesign work to attend to the ways that healthcare delivery has changed and will continue to be changing, and looking at ways to reinforce what matters to people to retain them in our hospitals and healthcare systems, while recruiting more individuals.”

“We are making significant progress in terms of bringing people in,” he said. “For example, we’ve implemented a number of new training programs — we’re training medical assistants, patient care technicians, and our newest one is a sterile process technician; we’re teaching folks how to clean and work with surgical instrumentation. However, all of that requires a significant investment in orienting people.”

Meanwhile, when it comes to retention, while there has been some progress in bringing those vacancy numbers down, “we have not yet returned to a normal place, like what we experiencing pre-pandemic, for turnover levels,” said Pacheco, adding that the system is averaging roughly 19% turnover, with much of it coming in the first year of employment.

Michele Anstett

Michele Anstett says competition for workers in the home-care arena is fierce, and there is little loyalty to employers.

“So, are we making headway in terms of bringing people into healthcare? Absolutely,” he went on. “Do we still have a long way to go? You bet.”

Roose agreed, adding that, at both Mercy and Johnson Memorial, there has been recorded progress in both hiring and retention, with a roughly 40% reduction in turnover the past two years — 50% at Johnson Memorial and 35% at Mercy.

“Reducing those that are leaving the organization to levels that are under 20% has been very stabilizing,” he said. “And while reducing turnover, we’ve also, over the past several months, seen that the number of people coming into Mercy and Johnson Memorial has outpaced the number of those leaving, so the balance has shifted.”

This is true across many professions, especially nursing, where there has been reduced turnover and improved recruitment, he said, adding that other realms, such as transport, food and nutrition, and others, have recorded less progress.

Indeed, while things have stabilized somewhat, building and maintaining a workforce remains quite challenging for most healthcare providers.

Michele Anstett, president of the West Springfield-based home-care provider Visiting Angels, said conditions have improved somewhat since the height of COVID, when people were afraid to enter others’ homes. But competition for workers is intense, and the biggest problem is retention.

Indeed, there is comparatively little loyalty to employers, she said, adding that workers will often chase an additional dollar an hour in wages or some other benefit. She stays ahead of the game, if can be called that, first by “hiring, hiring, hiring,” as she put it, and then taking steps to try to hang on to some of those she brings in.

“People tend to fly more; because of the economy, because of society and everything being on the move, and people being really strapped, they go where they can best provide for their family,” she said. “So I’m going to hire faster than they go; I’m hiring about five a week. How many go a week? Maybe two. That’s how we’re adjusting to this new reality.”

“For a mom in the workforce, the most important thing is her family and making sure she can get them to doctors’ appointments, she can get to school functions, she can make sure that if they’re sick, they’re taken care of without repurcussions from the employer. And those are things that we find are intangible and so important to our workforce, so we do our best to make sure that their family needs are met.”

When it comes to retention, Anstett says she has what she calls a magic formula — a focus on the work-culture factor.

“It’s about how they’re treated, how we respect them, how all those different qualities that they find in an employer make them want to say,” she said, adding that working in such an environment often weighs more heavily with employees than an additional dollar an hour.

“About 95% of our employees are women, and I would say 80% of those women are moms with dependent children,” she went on. “For a mom in the workforce, the most important thing is her family and making sure she can get them to doctors’ appointments, she can get to school functions, she can make sure that if they’re sick, they’re taken care of without repurcussions from the employer. And those are things that we find are intangible and so important to our workforce, so we do our best to make sure that their family needs are met.”

 

Staying Power

Addressing the broad subject of retention, those we spoke with said there is strong need for being creative and showing employees at all levels that they are valued and part of something larger than their own job.

And it all starts with listening, Davis said. “A lot of it is really paying attention to our workforce — what they’re telling us, but also what we’re learning from paying attention to them, not only in their words, but what we see them struggle with and what we see them strive in doing.”

Another key to retention is effective recruitment, she said, attracting people who understand — and value — the environment they’ll be working in and the team they will be joining, and want to be part of all that.

“The key to successful recruiting is agility,” Davis said. “It’s changing our strategies as we see what’s happening outside our walls, what’s happening in our area from the standpoint of where we have people that we can attract, and how we attract them.

“What we’ve been doing recently is getting back into what I call the ‘milk and cookies’ of in-person recruitment,” she went on. “We’ll have a team of talent-acquisition partners, along with leaders, and have a day when people can come in for a given position. They can fill out the application, they can interview with the talent-acquisition partner, interview with the manager, and have a decision about their hiring right on the spot. And then they can meet with the onboarding coordinator. So before they even leave the building, they have an answer, and they’ve started on their journey.”

Elaborating, she said this strategy was recently deployed for the successful hiring of several environmental-services personnel, but it can be used — and has been — for other positions as well, including nurses.

Another key element in the equation is compensation, said all those we spoke with, adding that systems and individual providers must continue making the investments needed to remain competitive — to the extent they can, given the hard reality that reimbursement rates for care provided by those facilities continue to lag far behind the cost of providing that care.

Davis agreed, but said providers who want to retain talent have to go beyond compensation. And this brings her back to that notion of making employees at all levels feel valued.

“Compensation matters,” she said. “But what matters when you get your foot in the door is … how do I feel about the place that I work at? Am I valued? Am I making a difference? Am I treated well? Do I feel like I belong?”

There are many factors that go into how employees will answer those questions, she went on, listing everything from wages and benefits to flexibility in schedules to the willingness of leadership to listen to employees and repond to what they are hearing.

At Cooley Dickinson, there are surveys, said Davis, but the more important strategy is the rounding conducted by members of the leadership team and the visbility of those leaders.

“The staff needs to understand that there is someone there that they can check in with, someone that will get back to me, whether it’s an answer I want or an answer that I wish was different,” she said, adding that rounding, an ever-evolving practice that takes place on many different levels, is key to all-important visbility as well as the listening process.

Roose agreed, noting that Mercy and Johnson Memorial have placed additional emphasis on listening and responding to what is heard through initiatives such as a ‘new-colleague culture experience,’ to start later this month.

“We’ll provide every new colleague that enters our organization with an opportunity to really focus on what about the culture they do identify with and how we can best attend to that during the early period of their orientation and work with us,” he explained. “We find that most people who are going to leave the organization leave within the first year, and a lot of that has to do with expectations around work and whether they’re able to connect with what brought them there.”

 

Bottom Line

But there are other strategies as well, including educational assistance that will help existing employees seize other career opportunities.

At Baystate, the system has essentially doubled the amount allowable per year for tuition assistance, said Pacheco, adding that the new ceilings went into effect in January, and the investment (probably an additional $300,000 to $400,000) is already showing signs of paying off.

“We have people studying to become nurses, we have folks working on various lab occupations … it varies,” he said. “As long as there is a connection to the healthcare system, we’ll support them with educational assistance.”

Returning to the subject of pay-to-train initiatives, Pacheco said that, in addition to the program for medical assistants, there are others for patient-care technicians (another partnership with Holyoke Community College) and other positions, as well as apprenticeship programs, including one that trains individuals to read heart monitors.

All these initiatives are part of a broad response to a new reality — yes, a new normal — one that should prevail, and test healthcare providers across the board, for the foreseeable future.

Bringing More Nurses into the Field — and Keeping Them There — Remains Critical

By
Teresa Kuta Reske
Healthcare News Special Coverage

Easing the Strain

Teresa Kuta Reske

Teresa Kuta Reske, in the nursing simulation lab at Elms College, said many nurses were influenced in their career choice by care they or a loved one received.

Teresa Kuta Reske loves nursing.

She said that on more than one occasion when speaking with BusinessWest recently for this special HCN section celebrating nurses, and especially recent nursing graduates beginning to enter the workforce.

As interim dean of the Elms College School of Nursing and director of the college’s Doctor of Nursing Practice program, she also loves seeing that passion develop in students.

“We prepare nurses with the skills and knowledge it requires to be in the nursing workforce, but when partnered up in the hospital setting, with students having clinical experience and being mentored by these organizations, they’re learning about what nurses contribute to patient care, watching nurses in action, and seeing systems come together,” Reske said, adding that there’s only so much students can learn in a simulation lab; they learn to form their own professional identity when training inside the healthcare system.

She noted that many students gravitate to the profession because of positive experiences with nurses, either for themselves or a loved one. In other cases  they were influenced by a parent’s career in the field. But that passion also quickly gets tempered by the realities of an increasingly challenging job.

“When we build a strong nursing workforce, it begins with education. And educators are tasked with teaching the new demands of the healthcare system,” Reske said, with factors ranging from population-health concerns to a more interdisciplinary focus in patient care. “Learning to become a nurse means understanding the realities of the nursing workforce today.”

Those realities come at a time when staffing shortages have increased stress on nurses. At a time when the annual Gallup Honesty and Ethics poll, released in January, ranks nursing as the most trusted profession for the 21st year in a row, nurses are feeling strain.

In fact, the American Hospital Assoc. (AHA) reports that about 100,000 registered nurses left the workforce during the past two years due to stress, burnout, and retirements, and another 610,388 intend to leave by 2027, according to a recent study by the National Council of State Boards of Nursing (NCSBN).

“The pandemic has stressed nurses to leave the workforce and has expedited an intent to leave in the near future, which will become a greater crisis and threaten patient populations if solutions are not enacted immediately,” said Maryann Alexander, NCSBN’s chief officer of Nursing Regulation. “There is an urgent opportunity today for healthcare systems, policymakers, regulators, and academic leaders to coalesce and enact solutions that will spur positive systemic evolution to address these challenges and maximize patient protection in care into the future.”

Among other recommendations to strengthen the healthcare workforce, AHA has urged federal lawmakers to invest in nursing schools, nurse faculty salaries, and hospital training time; enact federal protections for healthcare workers against violence and intimidation; support apprenticeship programs for nursing assistants; increase funding for the National Health Service Corps and the National Nurse Corps; and support expedition of visas for foreign-trained nurses.

For its part, Baystate Health said the Gallup poll is worth celebrating.

“The honor comes as nurses throughout the country, including here at Baystate Health, continue to deal with the effects of a nationwide nursing shortage and the emotional impact that the COVID pandemic has had on nurses,” said Joanne Miller, chief Nursing executive for Baystate Health and chief Nursing officer at Baystate Medical Center. “I am proud to say that, since the beginning of the pandemic, every nurse at Baystate Health has fulfilled our promise of advancing care and enhancing lives.”

Today’s nearly 4.4 million registered nurses in the U.S. constitute the nation’s largest healthcare profession, and the field offers a wide range of opportunities to those considering a career, including practicing as clinicians, administrators, researchers, educators, and policymakers.

In 2022, Baystate Health welcomed more than 900 nursing students into clinical placements from nursing programs at American International College, Bay Path University, Elms College, Holyoke Community College, Greenfield Community College, Springfield Technical Community College, UMass Amherst, and Westfield State University.

Linda Thompson, left, and Holyoke Community College President Christina Royal

Westfield State University President Linda Thompson, left, and Holyoke Community College President Christina Royal shake hands after signing a dual-enrollment nursing program agreement.

Newly graduated registered nurses (with less than 12 months of clinical nursing experience) can apply to its 10-month paid nurse residency program. During that time, they work directly with a unit preceptor and nurse educator for clinical instruction combined with classroom-style seminars and skills/simulation sessions. The collaborative learning approach is designed to provide the knowledge base and skillset needed to successfully transition into the role of a professional nurse.

Reske said professional experiences like these demonstrate the need for collaborative practice. “They’re not alone but working with other teams, providing patient care where everyone is thinking about how to improve the patient’s health and experience, looking at that patient’s values and experiences.

“We’re preparing students to understand the complex realities of healthcare today,” she went on. “Nurses can really make a unique difference by looking at patients through the nursing lens with a more holistic view.”

 

Satisfaction Suffers

While all this is meaningful work, many nurses feel there’s a long way to go to reach ideal job satisfaction. According to the annual “State of Nursing in Massachusetts” survey conducted by the Massachusetts Nurses Assoc. (MNA), bedside nurses feel undermined in their ability to provide quality care by understaffing and assigning unsafe numbers of patients, which fuels the flight of nurses away from the profession and leads to hospitals relying on expensive travel nurses to fill the void. Among the survey data:

• 85% of nurses say hospital care quality has deteriorated over the past two years;

• 53% say hospitals that rely on travel nurses have worse care;

• 71% of nurses say their biggest obstacle to delivering quality care is understaffing and/or having too many patients at one time; and

• 88% of nurses support legislation limiting the number of patients assigned to a nurse at one time.
That last statistic rises to 98% when only new nurses are surveyed, demonstrating that nurses are entering the field with eyes wide open to to the impact of staffing challenges.

Rather than causing the staffing crisis, said Katie Murphy, a practicing ICU nurse and president of the MNA, “the COVID-19 pandemic has simply laid bare a system already broken by hospital executives. The industry claims it cannot find nurses, but the data shows there are more nurses than ever. There is not a shortage of nurses, but rather a shortage of nurses willing to work in these unsafe conditions.”

“Nurses throughout the country, including here at Baystate Health, continue to deal with the effects of a nationwide nursing shortage and the emotional impact that the COVID pandemic has had on nurses.”

This year’s survey featured an all-time high number of nurses saying hospital care quality has gotten worse over the past two years. The survey has tracked this number since 2014, when it was 38%. In 2023, 85% of nurses saw care quality decline, up two points from last year, 30 points from 2021, and 46 points from 2019. This troubling trend tracks with survey results showing increased numbers of nurses who do not have enough time to give their patients the care and attention they need and who are forced to care for too many patients at one time. In 2023, 72% of nurses saw both of those issues as “major challenges,” up 11 and 13 points from 2021.

Newer nurses are disproportionately feeling the impact. Sixty-three percent of nurses with five or fewer years of experience say understaffing is their biggest obstacle to providing quality care, compared to 56% of all nurses. Of those nurses planning to leave the field within two years, 67% of newer nurses say they will find work outside of healthcare, compared to 31% of all nurses.

Colleges are doing what they can to draw new nurses into the pipeline. For example, Holyoke Community College (HCC) and Westfield State University (WSU) recently announced a new pathway for individuals to earn both an associate degree and bachelor’s degree in nursing simultaneously or in a streamlined manner by combining the curricula of both programs. The concurrent program is the first in the Commonwealth.

“The concurrent ADN-to-BSN pathway is an innovative approach to nursing education,” WSU Executive Director of Nursing Jessica Holden said. “It enables students to earn their ADN while simultaneously completing coursework that counts toward their BSN. This integration of education allows for a more efficient and streamlined approach to nursing education that is advantageous to some students.”

The concurrent nursing program will help address the nursing shortage by increasing the number of students who can get into a bachelor of nursing program and allow them to earn their degree faster.

According to a Massachusetts Health Policy Commission report, “registered-nurse vacancy rates in acute-care hospitals doubled from 6.4% in 2019 to 13.6% in 2022, with especially high vacancy rates in community hospitals. Employment in nursing and residential care facilities has not recovered since 2020 and remained below 2018 levels.”

HCC Director of Nursing Teresa Beaudry explained that “we had to meet with the Massachusetts Board of Registration in Nursing, who had to approve it, and they’re equally as excited as we are to create another pathway for nurses to advance in their education and a different way for those students who might not be able to get into a bachelor’s of nursing program.”

 

A Question of Balance

In fact, moving up in the profession is a significant draw to many aspiring nurses. Most area colleges and universities with nursing programs have master’s and doctoral programs structured in such a way that nurses can work full-time while earning advanced degrees that will open up more doors and set them on track to be nursing managers, educators, administrators, or work in other roles.

“Usually, nurses return for an advanced degree,” Reske said. “They begin to look at, ‘what can I contribute in practice? What attracts me? Is it working in an ambulatory-care setting or rehabilitation, or as a nurse leader or a nurse educator? Maybe I want to be a nurse practitioner.’ The opportunities for nurses are amazing.”

And the education they’re getting — both in the classroom and in the field — must prepare them for the new complexities of medical care today, she added.

“Nurses definitely have to deal with more complex issues — speak the language of finance, speak the language of marketing, speak the language of population health. All those require additional learning beyond the classroom. You’re connecting practice to knowledge and knowledge to practice, and learning how to apply that.”

In short, it’s a challenging time to be a nurse, and also a time of great opportunity. Whether their love of nursing outweighs the stresses is a question for every professional in the field — and those questions are not going away any time soon.

For Those Caring for Those with Dementia, Education, Understanding Are Keys

By
Healthcare News Special Coverage

Living in Their World

Beth Cardillo calls them ‘fiblets.’

These are things that are said to someone with dementia that … well, do not represent the whole truth, or even a portion of it, at least to the person making that statement.

But to that person suffering from Alzheimer’s or one of the many other forms of dementia, it is the truth as they see it in their world. “It’s not a lie,” she said of these fiblets. “It’s an OK thing to tell people with memory issues.”

She offered up an example.

“Let’s say someone’s husband has been dead for 20 years; she might say, ‘I’m not going out shopping, I’m waiting for my husband to get home,’” noted Cardillo. “A fiblet would be … ‘oh, he just called; his tooth is hurting him and he’s going to see a dentist. Why don’t you and I go out for a ride and go to the grocery store?’”

“You’re going to tell someone that their husband died over and over again, every day?” she went on, asking that question rhetorically before answering it poignantly. “I mean, why would I want to do that? It’s cruel.”

Indeed, and fiblets are a good example of how those caring for and simply around individuals with dementia regularly should try to live in their world, rather than constantly try to pull them into the ‘real’ world. It’s also an example of the kind of work that Cardillo has made into a career, or at the least the latter stages of one.

Beth Cardillo

Beth Cardillo

Her latest move comes as a part-time social worker for a unique program called Baystate House Calls. As that name suggests, it’s a program operated by Baystate Health that involves healthcare professionals making house calls to older adults. It includes a physician, nurse practitioner, nurse, social worker, and community health worker, team members who will visit individuals in their home to assess their needs and provide recommendations.

The initiative concentrates on what administrators call the 4Ms — ‘mobility,’ ‘what matters,’ ‘medication,’ and ‘mind.’

It focuses not only on those in need of help and services, but caregivers as well, said Cardillo, adding that her work, and that of her colleagues, takes them to every corner of Springfield. And while she is helping seniors and caregivers with a wide variety of issues from substance abuse to falls to depression, much of her work involves those with memory issues.

And, increasingly, it involves what is known as habilitation therapy (HT), a holistic approach to dementia care that focuses on the abilities that the person still has, rather than what they have lost, and can reduce difficult symptoms.

“It focuses on everything positive — it focuses on people’s strengths, not their weaknesses,” she said of HT, adding that it brings caregivers and patients closer together as they work on daily tasks, makes those suffering from dementia feel respected and valued, reduces stress among caregivers, and creates positive emotional experiences that bring comfort and happiness.

“The reality therapy is for us to learn to live in their reality, not for them to live in our reality of our world. That’s probably the biggest lesson there is.”

Cardillo was recognized by BusinessWest and its sister publication, HCN, with a Healthcare Heroes Award in 2021 in the category of Community Health for her work during her years as executive director at Armbrook Village in Westfield to create ‘dementia-friendly’ communities and help others better understand — and communicate with — those suffering from memory loss.

For this HCN Monthly Feature and its focus on Memory Care, we talked with her at length about the importance of understanding what is reality that for those with dementia — and enabling them to thrive, as much as possible, in that reality.

 

Reality Check

Cardillo told BusinessWest that, years ago, she and others involved with providing memory-care services would offer to those with dementia what was called, by some at least, ‘reality therapy.’

“We would say, ‘no, no, no, you’re wrong — today’s Thursday, or today’s this, and tomorrow is that,’ she said, correcting wrong statements and answers to questions whenever the need arose. “But what we’ve learned is that it doesn’t matter. The reality therapy is for us to learn to live in their reality, not for them to live in our reality of our world. That’s probably the biggest lesson there is.”

Helping others live in the reality of those with dementia is a big part of the work Cardillo has been involved with over the years, especially at Armbrook, but also now as a social worker. She said that to make this leap — and it is a leap for most — it begins with education and an understanding of the disease and how it impacts people.

It robs them of short-term memory and the ability to do certain things — from driving to cooking to reading. But it doesn’t, or shouldn’t, take from them the things that are important to them, and have been important throughout their lives, be it what they did for a living, or travel, music, pets, or a love of the movies.

Cardillo recalled the case of a long-retired college professor who had (and still has) a passion for the New York Times and carries it with her daily.

“Some days, it’s upside-down,” said Cardillo. “But it doesn’t matter; that was her identity. Those are they types of things you don’t want to change; you don’t want to correct people.”

Overall, she said it’s important to treat those with dementia with respect and to not embarrass them with ‘reality’ questions or constant corrections concerning what day it is and what members of the family are no longer alive.

“It doesn’t matter if they say it’s Tuesday and it’s really Sunday. It just doesn’t matter. So, we don’t want to correct people. Does it matter if Mr. Smith thinks it’s a different day? Is that going to change the world? No. If he thinks it’s Christmas tomorrow, that’s OK. Why take that joy away?”

“Just because you have Alzheimer’s doesn’t mean you’re stupid,” she explained. “It doesn’t mean you can’t read people’s emotions. “I know people who will say to family members, ‘what’s my name? What’s my name?’ Why are you saying that to them? It embarrasses them. They know you have a connection. Is it because you think that if they know your name, they’re having a good day and that makes you feel good?

“Because it doesn’t matter if they know your name,” she went on. “It doesn’t matter if they say it’s Tuesday and it’s really Sunday. It just doesn’t matter. So, we don’t want to correct people. Does it matter if Mr. Smith thinks it’s a different day? Is that going to change the world? No. If he thinks it’s Christmas tomorrow, that’s OK. Why take that joy away?”

She recalled the case of a woman who told her that she was pregnant at 66. Instead of correcting her, Cardillo said she simply told her, ‘if that’s true, you’re going to make history.’

“You laugh about it with her, because she tells me these wacky stories,” she went on. “Her parents have been dead, but she’ll say, ‘oh, my mother wants you to come over for dinner.’ “I’ll say, ‘oh, how is your mother? I like your mother; tell her I said hello.’

“Her husband, on the other hand, keeps saying, ‘your mother is dead!’” she continued. “We need to stop that because it doesn’t matter. She doesn’t remember and she doesn’t care, and in in her head, her mother is alive. That’s fine. Who does it hurt?”

Overall, she said it’s important to try to communicate with a positive spin, rather than a negative one.

Indeed, instead of telling someone with dementia that they are not supposed to be going outside, when they suggest that they want to do so, one should instead stay positive and suggest that this person can sit outside when the weather is better.

As she talked about those suffering from dementia and how those caring for them should approach daily conversation and activities, Cardillo said it is important to keep them engaged and to focus “on what they can do, not what they can’t do.”

This brings her back to the concept of habilitation therapy, which, she believes, has benefits, and many of them, for those living with memory loss, their caregivers, family, and friends.

“It’s important to keep people meaningfully busy and not just silly busy,” she told BusinessWest, adding there is a big difference between the two.

Elaborating, she said that television is not a good option.

“We don’t want to put people in front of a TV all day, because it’s … not good,” she said. “It doesn’t make them happy campers. It doesn’t mean that TV is bad, just not as a babysitter all day.”

Instead, such individuals should be involved in activities that speak to who they are, who they were professionally, and what interests them.

“It’s really important to know what people did in their work,” she explained, “because they still retain some of those skills, and it’s still a part of who they are as an identity. For those who were teachers, give them papers to correct; you come up with things that they can do.

“I had someone whose father was a retired electrician,” she went on. “He had a manual of electrical … something; it was bigger than the New York City phonebook. He looked through those pages every day. I don’t know if he knew what was in it — I sure didn’t — but that gave him comfort.”

And some form of comfort is what those caring for people with dementia should be trying to provide each day, she said, adding that this can be done through HT, emphasizing the positive, and, yes, focusing on what those with dementia can do, not what they can’t.

 

 

Bottom Line

Summing up what she tells those caring for people with dementia, Cardillo said it is simply that reality is in the eyes — and mind — of the beholder.

And if we really want to help those with this disease, we have to at least try to live in their world, rather than make them live in ours. It’s not an easy assignment, especially when one is asked the same questions over and over, day after day, but it’s the key to those on both sides of the equation being able to thrive.