TAG: "Nursing"

First class of UC Davis doctoral nurses graduates


Betty Irene Moore School of Nursing celebrates 62 graduates.

The Class of 2014 Doctor of Philosophy Class shows their appreciation for the school's namesake, Betty Irene Moore.

For the first time, eight Doctor of Philosophy students collected degrees through the Betty Irene Moore School of Nursing at UC Davis this graduation season, along with 24 Master of Science students and six nurse practitioner and 24 physician assistant certificate graduates.

“In a month, or year, or perhaps in a decade, the facts that you learned will have changed. Many will be, frankly, wrong. But your ability to approach questions systematically, to thoughtfully define your objectives, to gather accurate information, to work with colleagues, to apply what you know, will remain with you forever,” said Jill Joseph, associate dean for research who provided the keynote speech at the school’s annul graduation celebration on June 12. “And already, those of us who have walked with you during your time here can see the impact.”

Following the School of Nursing event, the graduates received their degrees at the formal Office of Graduate Studies commencement later that day, which included presentation of more than 1,100 graduate degrees.

According to both Joseph and Dean Heather M. Young, the continued growth and impact of the 5-year-old Betty Irene Moore School of Nursing can be measured by the accomplishments of its students and graduates.

“There are many measures of what we are accomplishing and certainly we should each take great pride in the students who graduate today,” Joseph said. “Equally remarkable, we are also forging, however imperfectly, a culture characterized by respect and collaboration and mutual support, as well as a lot of very hard work.”

Young emphasized this impact is the direct result of the vision of the school’s namesake, Betty Irene Moore.

“Together, we will make certain the next generation of nurses, physician assistants and other health-care professionals are equipped to make a difference in ways that are important to the individuals, families, and communities we serve,” Young said.  “As you will see today, our students are assuring Mrs. Moore’s dream takes shape in very important ways.”

Five students were recognized by nursing faculty with awards of excellence highlighting the school’s five core attributes:

  • Excellence in Leadership Development: Lauren Burke
  • Excellence in Interprofessional Education: Robin MacPherson-Dias
  • Excellence in Transformative Research: Katherine Kim
  • Excellence in Cultural Inclusiveness: Bertha Odhiambo
  • Excellence in Innovative Technology: Deborah Greenwood

The graduation marks the school’s third graduation since the Betty Irene Moore School of Nursing was established in 2009 and opened its doors in 2010. The school now boasts 48 alumni.

The Nursing Science and Health-Care Leadership Graduate Degree Programs, which includes master’s degrees in leadership, nurse practitioner and physician assistant studies as well as a doctoral program, are led by an interprofessional team of faculty from across UC Davis. Learn more at http://nursing.ucdavis.edu.

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Telehealth improves forensic exams for sexual abuse


‘With this technology, we can help children who might otherwise not receive this level of care.’

Sheridan Miyamoto, UC Davis

Researchers at UC Davis and other facilities have shown that telehealth consultations for clinicians at rural hospitals improve their ability to provide forensic examinations for sexual abuse. Published in the journal Child Abuse & Neglect, the study showed that clinicians with access to expert UC Davis nurses provided more thorough and nuanced exams, improving their ability to gather evidence and to make an accurate diagnosis.

“Providing telehealth support really improves the quality of these forensic exams,” said first author Sheridan Miyamoto, a forensic nurse practitioner and research nurse at the Betty Irene Moore School of Nursing at UC Davis. Miyamoto is also a 2014 doctoral graduate of the Betty Irene Moore School of Nursing. “With this technology, we can help children who might otherwise not receive this level of care.”

Provided by advanced practice nurse practitioners and sexual assault nurse examiners with more than 10 years of experience evaluating abuse, telehealth consults offer tremendous benefits for rural communities. In addition to improving quality, they ease the burden on families, who no longer need to travel many hours for expert care, and clinicians, who have access to trained mentors when conducting these delicate exams. As a result, these consults provide a safety net for clinicians, patients and parents, ensuring these procedures are both thorough and accurate.

“It’s important that we get this right,” said Miyamoto. “Due to a lack of experience and regular exposure, many examiners are prone to assess normal variations as injuries from trauma. On the other hand, we also want to protect the child. Strong evidence may result in a plea bargain, eliminating the added stress for children of having to testify in court. Telehealth offers support and built-in peer review for nurses, physicians and other clinicians practicing in relative isolation.”

The telehealth network uses secure teleconferencing equipment to link UC Davis nurses with rural clinicians. The systems provide video and audio, as well as images from colposcopes (magnifying devices used to examine genitalia) and other equipment. This advanced technology essentially puts expert nurses in the room with examining clinicians.

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UCLA nursing school names acting dean


Linda Sarna will serve one-year term.

Linda Sarna, UCLA

Professor Linda Sarna, who holds the Lulu Wolf Hassenplug Chair in the UCLA School of Nursing, has been appointed acting dean of the School of Nursing as of July 1, 2014. She will serve a one-year term while Dean Courtney Lyder is on leave.

Sarna served as chair of the UCLA Academic Senate during the 2012–13 academic year, and she chairs the committee that implemented UCLA’s tobacco-free policy.

At UCLA and beyond, Sarna is recognized for her scholarship promoting the role of nursing in tobacco control and for her research on the symptoms and quality of life of people with lung cancer. As the principal investigator for the Tobacco Free Nurses Initiative and through her active involvement in tobacco-control policy efforts nationally and internationally, she has emphasized the need to change expectations for nursing education and clinical practice.

Sarna is the author of more than 200 peer-reviewed articles, books, chapters and other publications. Her numerous honors and awards include election as a fellow to the American Academy of Nursing and recognition as a distinguished research professor by the Oncology Nursing Society.  She has served on commissions and task forces for the National Cancer Institute, the American Society of Clinical Oncology, the Institute of Medicine and the University of California, among others. Sarna received her bachelor’s and master’s degrees in nursing from UCLA, and her doctorate from UC San Francisco.

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UC Davis nursing leader tapped for White House advisory group


Heather Young is only nurse leader on Systems Engineering for Healthcare Working Group.

Heather Young, UC Davis

Betty Irene Moore School of Nursing at UC Davis founding Dean Heather M. Young serves as the only nurse leader on the 14-member Systems Engineering for Healthcare Working Group of the President’s Council of Advisors on Science and Technology (PCAST). The group, which includes hospital CEOs, health care leaders, physicians and other experts, is developing a report for President Obama that focuses on how to improve quality and lower costs of health care from the management and design perspectives.

“Because interprofessional collaboration is essential to improving health systems,” Young said, “I was honored to be a part of this group and add a nursing leadership perspective. We know that it takes input from all members of the health care team to effect change. To me, this opportunity to participate in a national work group affirmed that our UC Davis programs and research are on the cutting edge of this important area of system improvement.”

PCAST is an advisory group of the nation’s leading scientists and engineers who directly advise the president and the Executive Office of the President. The council convenes a number of work groups to study various issues and report back to the president.

The Systems Engineering for Healthcare project builds on the council’s previous assessment of information technology for health care. The council sought recommendations for improving health care that utilizes systems engineering. The group recently presented its recommendations which include:

  • Accelerating alignment of payment systems with desired outcome
  • Increasing access to relevant health data and analytics
  • Providing technical assistance in systems engineering approaches
  • Involving communities in improving health care delivery
  • Sharing lessons learned from successful improvement efforts
  • Training health professionals in new skills and approaches

The council will use the work group’s study to develop a final report to the president.

You can view a webcast of the group’s report here.

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Cancer care specialist named oncology nurse of year


UC Irvine’s Deborah Boyle is honored.

UC Irvine Health nurse Deborah Boyle, R.N., has received the 2014 Advanced Oncology Certified Nurse of the Year award for her work with cancer patients and commitment to advancing oncology nursing.

The award is bestowed by the Oncology Nursing Certification Corp., a subsidiary of the Oncology Nursing Society, and recognizes nurses who are leaders in patient care, education and research into best nursing practices.

An oncology clinical nurse specialist and palliative care nurse lead in the Chao Family Comprehensive Cancer Center, Boyle’s responsibilities include ensuring adherence to national quality of cancer care standards, leading the nursing component of UC Irvine Medical Center’s palliative care team, patient education and acting as a liaison between inpatient and outpatient cancer care.

“Being recognized by one’s peers is the highest of all accolades,” said Boyle. “I am humbled to receive this honor and do so in acknowledgment of the tremendous contributions made within cancer care by all oncology advanced practice nurses.”

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Sen. Boxer praises UC efforts to prevent medical errors


She tours UCLA, notes its safety measures.

Sen. Barbara Boxer observes two nurses demonstrating a bar code scanning safety procedure at Ronald Reagan UCLA Medical Center.

Every year, 325,000 patients die in the United States due to medical errors, a number that would fill the Rose Bowl nearly four times, according to a special report released today (April 25) at a UCLA news conference by U.S. Sen. Barbara Boxer (D-Calif.).

Boxer presented the findings of her report at Ronald Reagan UCLA Medical Center and noted steps UCLA already takes to prevent medical errors and that could serve as models for other hospitals around the country. Boxer’s report also highlighted efforts by UC Davis to reduce ventilator-associated pneumonia and by UC San Diego to reduce blood clots and central line bloodstream infections.

“These deaths are all the more heartbreaking because they’re preventable,” Boxer said after she toured the medical center with Dr. David Feinberg, president and chief executive officer of the UCLA Health System, so she could see for herself two systems being used to prevent medical errors. “This is not the time to sit back and do nothing. I will not turn away from this challenge when I have the opportunity to pull back 325,000 people from disaster every year simply by preventing medical errors.”

The third leading cause of death in the country, medical errors can be avoided by something as simple as washing your hands. These errors commonly result in hospital-acquired infections, bedsores, patient falls, adverse drug reactions, sepsis, blood clots, catheter-related urinary tract infections, ventilator-related pneumonias and surgical site infections. In addition to saving lives, preventing medical errors could save up to $19.5 billion annually, Boxer said.

While touring the seventh floor, Boxer was first was shown the bar code technology and electronic medical records system used at UCLA to ensure patients receive the right medications in the right doses at the correct times. The process begins with a medication dispenser that operates much like a vending machine, providing one dose of drug at a time. A nurse logs in to the patient’s medical record to determine what medications are due and accesses them from the dispenser.

Once in the patient’s room, a nurse logs into a bedside computer and scans a bar code on the patient’s armband that automatically opens up his or her electronic medical record. The nurse then scans the medication, which is individually wrapped and bar-coded for that specific patient. If the medication’s bar code isn’t recognized as belonging to the patient’s medication profile, a warning will flash on the computer screen. After giving the patient the medication, the nurse selects the “administer” button, which instantly updates the medical record that the medication has been administered.

UCLA nurses were heavily involved the development of the bar code system, said Renee Appleby, director for the seven west cardiothoracic telemetry unit. The nurses first studied the errors to determine what was going wrong, and then participated in the creation of a safer system.

Boxer called the bar code and electronic medical record system “exciting, an enormous change for the better,” and said it must give the UCLA medical team more peace of mind.

“As a nurse, it makes me feel safe,” nurse Megan Kelly told Boxer.

Prior to the installation of the bar code system, the medical center was making two to four medication errors a month. Since the new system has been in place, no medical errors have been made, Appleby said.

That’s an impressive accomplishment, since the medical center dispenses five million doses of medication a year, said Cathy Ward, UCLA’s chief nursing officer.

“You’re really doing everything you can to save lives,” Boxer said. “Congratulations.”

Boxer then went to the seventh floor ICU to see the medical center’s ultraviolet disinfection system in action. The medical center has two Xenex machines, which can disinfect a hospital room in five minutes. The Star Wars-like robots use a Xenon bulb, a powerful form of UV light, combined with technology that generates high intensity pulses of light that are effective against 22 pathogens, including MRSA.

“The light kills micro-organisms by breaking down the cell walls of bacteria and fungus,” said Dr. Daniel Uslan, assistant clinical professor of medicine in the division of infectious disease.

“This is amazing technology that will help save lives,” Boxer said.

Feinberg said he is proud of UCLA’s commitment to patient safety and he looks forward to partnering with Boxer to find new and effective ways to ensure patients remain safe.

The report was compiled after Boxer wrote to 283 California acute care hospitals asking them to respond with the actions they are taking to reduce medical errors. Of those, 149 hospitals responded.

All of hospitals that responded reported taking at least some steps to address the most common medical errors, Boxer said. The report includes some common approaches to combating medical errors, such as using bar code technology and electronic health records to ensure patients receive proper medications to avoid adverse drug events. This technology is currently in use at Ronald Reagan UCLA Medical Center.

Other common approaches to preventing medical errors in the report included maintaining hand hygiene, using central line anti-microbial port covers, assessing all patients for bedsores prior to and upon admission, assessing patients for blood clot risks preoperatively and elevating the heads of patients on ventilators from 30 to 45 degrees.

Boxer’s report, which will be sent to the 283 hospitals initially queried, made six recommendations to improve patient safety, including:

  • Requiring all federal programs designed to reduce medical errors to work off a single list where appropriate, specifically the Partnership for Prevention’s list of the nine most common medical errors.
  • Having the Department of Health and Human Services report to Congress the time it takes for quality measures to be developed, endorsed and implemented in programs related to medical error reduction.
  • Creating a standard way of reporting medical errors, allowing hospitals and researchers to better collect data on errors, their frequency and where they are occurring.
  • Evaluation of information collected by hospitals when assessing whether medical centers are meeting the requirement to track and report adverse events as a condition of participation in Medicare.
  • Have Congress review the adequacy of whistleblower protections to ensure health care providers are able to report errors.
  • Have the Office of the Inspector General examine the Hospital Patient Safety Initiative’s new surveyor tools and analyze their impact on increasing staff reporting of medical errors.

“If we work together, we can prevent these needless tragedies,” the report states. “If we ensure that doctors, nurses, hospital administrators, medical technology leaders, federal officials and patient advocates are all focused on this common goal, we can make great progress in preventing avoidable deaths and ending the epidemic of medical errors in this country.”

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UC Davis welcomes students to clinical training


Nursing school hosts White Coat Ceremony for physician assistant, nurse practitioner students.

Nurse practitioner and physician assistant faculty Shelly Henderson (left) and Debra Bakerjian (right) help physician assistant student Elizabeth Bradbury (middle) put on her new coat as part of the White Coat Ceremony at UC Davis nursing school.

The Betty Irene Moore School of Nursing at UC Davis conducted a White Coat Ceremony on Monday to celebrate the formal transition from classroom education to clinical preparation for physician assistant and nurse practitioner Class of 2015 students.

More than 100 family and friends filled the Robert T. Matsui Lecture Hall at UC Davis Health System’s Education Building to cheer on the six nurse practitioner and 21 physician assistant students as they were presented their first white coats.

Similar to the white coat tradition at many medical programs, the ceremony signifies the completion of the academic year of study and the move to clinical education, where students complete rotations in primary care, inpatient medicine, rural medicine, pediatrics, surgery and other areas. During this time, students experience their first patient interactions.

“In keeping with the concept that medicine, and health care in general, are team sports, this tradition has expanded to a variety of other health professions such as pharmacy, optometry, therapy, veterinary, physician assistant and advanced practice nursing, and is now celebrated internationally,” said Debra Bakerjian, senior director for the nurse practitioner and physician assistant programs.

The event included comments and advice from two program alumni — Karimeh Borghei, a 2006 nurse practitioner graduate and Jeremy Weis, a 2012 graduate of the physician assistant program — as well as a current physician assistant student, Kim Ward, and other faculty.

The UC Davis physician assistant and nurse practitioner programs are the only ones in the nation where the two professions learn together in the classroom. Additionally, the UC Davis programs focus on developing providers to deliver care in areas where it’s needed most, thus expanding access for a growing population. The UC Davis School of Medicine’s Department of Community and Family Medicine first offered a nurse practitioner graduate certificate program in 1970. The physician assistant program was added in 1982.

In 2013, the program was reconfigured into master’s degree programs at the UC Davis nursing school. Over the past 40 years, UC Davis has graduated more than 1,800 nurse practitioners and physician assistants, with 67 percent of graduates working in underserved areas. Additionally, nearly 70 percent of graduates work in primary care, compared to significantly lower national averages of between 30 and 40 percent.

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Nursing school hopes to improve care for cancer patients with social network


Participating patients will use a tablet device as part of UC Davis project.

Several chemotherapy patients at the UC Davis Comprehensive Cancer Center will be invited to use tablets with a unique social networking tool as part of their treatment plan. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost.

The project is part of a two-year, $199,854 grant from the McKesson Foundation and its national Mobilizing for Health Initiative. Research on mobile health technology in cancer care is new, said Jill Joseph, the associate dean for research at the nursing school. Other cancer-related mobile applications are available, but are limited to education and awareness and don’t provide disease management tools or real-time communication.

“We have ample evidence that cancer patients often receive fragmented care, experience significant distress, and may needlessly require care in emergency departments or inpatient settings, particularly during chemotherapy,” Joseph said. “Little research and development has focused on providing novel technologies to support cancer care coordination.”

Participating patients will use a tablet device, such as a Google Nexus or iPad, to connect to their unique and private Personal Health Network that includes a nurse coordinator — who manages the their care — along with family, caregivers, clinicians and other desired partners. These people can connect with one another through real-time messaging, video and audio components as well as schedule appointments, assign tasks, store and track information and more.

A nurse coordinator is assigned to support each chemotherapy patient who uses the mobile application. This coordinator monitors the patient’s care plan, triages issues and communicates with caregivers. Unlike electronic health records and other information systems common in hospitals, the social networking platform allows patients, their families and caregivers to not only access information but communicate with another and make decisions about care and health management.

“This is a new tool designed with the patient and family at the center of care,” said Katherine Kim, a recent doctoral graduate of the UC Davis nursing school who is now a visiting faculty member and project director.

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State grants to improve primary care to underserved populations


UC Davis nursing school awarded grants to expand clinical rotations, classroom training.

The California Office of Statewide Health Planning and Development awarded $265,000 to the Betty Irene Moore School of Nursing at UC Davis for the nurse practitioner and physician assistant programs to improve primary care to underserved populations through expanded clinical rotations and simulated learning based on real-life situations.

As part of the Song-Brown Health Care Workforce Training Act Nurse Practitioner and Physician Assistant Training Program, the School of Nursing received $115,000 to create patient case simulations and $150,000 to provide housing and travel funds for students doing clinical training in underserved areas of central and Northern California.

“Primary care providers need to leverage the social, economic and physical conditions that shape health and then better work together as a team,” said Virginia Hass, director for the nurse practitioner program. “The Song-Brown grant enables the preparation of health care professionals to understand the impact of the environment on health outcomes and to deliver care within an interprofessional team.”

As part of the $115,000 one-year grant, the Betty Irene Moore School of Nursing will partner with the UC Davis Center for Virtual Care to develop simulated case scenarios for use throughout the two-year clinical curriculum. Plans call for specific simulations that address culturally relevant care to communities that experience difficulties accessing health care.

The second grant assists students with the costs of travel and housing during clinical rotations in underserved and rural areas. Rotation sites within the California Endowment’s Building Healthy Communities have priority. These 14 geographically diverse communities — ranging from Riverside to Del Norte Counties — are generally low income and rural with a significant proportion of uninsured residents.

“A primary objective of the Betty Irene Moore School of Nursing nurse practitioner and physician assistant programs is to provide student rotations that improve availability of care,” said Mark Christiansen, director for the physician assistant program. “Because many of the designated communities and counties are within the school’s service and recruitment area, the program is a natural extension of current activities.”

Over the past 40 years, UC Davis graduated 1,800 nurse practitioners and physician assistants, with 67 percent of graduates working in underserved areas. Additionally, nearly 70 percent of graduates work in primary care, compared to significantly lower national averages of between 30 and 40 percent.

The Song-Brown Program partnered with the California Endowment to provide both grants. The California Endowment’s 10-year initiative for Building Healthy Communities invests billions in community-based strategies to prevent chronic illnesses, including obesity prevention, nutrition access and tobacco cessation programs. More information is available at www.calendow.org.

The Song-Brown Program was established in 1973 by the state legislature to assure access to primary-care services for Californians. UC Davis has been one of the largest recipients of the funding, with a total amount exceeding $5 million. More information about the program is available at www.oshpd.ca.gov/HWDD/Song_Brown_Prog.html.

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UC Davis nursing earns Magnet designation


All five UC medical centers now have Magnet recognition.

UC Davis Medical Center joins the ranks of elite clinical-care institutions in the nation with its new Magnet Recognition Program status, which was granted this week by the American Nurses Credentialing Center (ANCC). The designation is the nation’s highest form of recognition for nursing excellence and a benchmark for the quality of care patients receive.

All five UC medical centers now have been designated as Magnet hospitals.

“UC Davis has a long history of demonstrated nursing excellence, and the Magnet recognition is a testament to the dedication and hard work of our nurses and their care-team colleagues,” said Carol Robinson, chief patient care services officer and director of nursing at UC Davis Medical Center.

The Magnet Recognition Program was developed by the ANCC to recognize health care organizations for quality patient care, nursing excellence and innovations in professional nursing practices. To achieve designation, the medical center provided written documentation demonstrating qualitative and quantitative evidence about patient care and outcomes as part of a rigorous certification process that also included a multi-day, on-site visit by ANCC representatives.

Only about 7 percent of U.S. hospitals carry Magnet designation. UC Davis is the 25th organization in California, and the only one in Sacramento, to earn the highly regarded recognition. Studies indicate that Magnet Recognition Program hospitals typically have lower mortality and infection rates, as well as higher patient satisfaction and better work environments for nurses.

“I am proud of our entire team of health-care professionals,” said Ann Madden Rice, chief executive officer of UC Davis Medical Center. “Led by our nurses, this truly was a collaborative effort with our physicians and others in an organization that has always been committed to the highest standards of patient-centered care. Achieving this elite status demonstrates UC Davis’ dedication to continuously improving the health of our patients, our community and our region.”

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Smoking rates drop dramatically among nurses


Significant decline in smoking among RNs found from 2007 to 2011.

Linda Sarna, UCLA

Linda Sarna, UCLA

On the eve of the 50th anniversary of the U.S. surgeon general’s first report alerting the nation to the negative health consequences of lighting up, there is good news about registered nurses who smoke: There are a lot less of them.

A new UCLA study tracking changes in smoking prevalence among nurses and other health care professionals between 2003 and 2011 found that the proportion of registered nurses who smoke dropped by more than a third during that period.

The findings appear in the January issue of JAMA: The Journal of the American Medical Association, which commemorates the surgeon general’s landmark 1964 Report on Smoking and Health.

The study’s principal investigator, Linda Sarna, a professor at the UCLA School of Nursing and oncology nurse who has been committed to tobacco cessation for the past two decades, said she was energized by the results.

“This decline is so important, not just for the health status of nurses but because studies continue to show that smoking by health care professionals sends a mixed message to patients,” she said.

The study used data on health care professionals from the Tobacco Use Supplement for 2003, 2006–07 and 2010–11; the supplement is administered as part of the U.S. Census Bureau’s Current Population Survey.

While the researchers found no significant decline in smoking among registered nurses between 2003 and 2007, the years from 2007 to 2011 witnessed a big drop. The data show that the proportion of registered nurses who smoke dropped from 11 percent to 7 percent — an overall decrease of 36 percent and more than two times the 13 percent decline among the general U.S. population during the same time period.

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UCSF nurse-midwives collaborate with doctors for high-quality maternity care


Changing the culture of childbirth.

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center. (Photo by Elisabeth Fall)

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center.

In the early 1970s, a group of obstetricians at San Francisco General Hospital began discussions with certified nurse-midwives in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UC San Francisco School of Medicine, who also chairs the leadership council of the nurse-midwives of SFGH.

It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.

The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.

The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.

“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.

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