Stretching: A Key Component of Physical Fitness

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on stretching.

Regular stretching is an important part of physical fitness yet it is often omitted during workouts. Stretching is imperative to maintain flexibility (the range of motion one has in their joints) and is an essential component of all physical activities.

One’s flexibility is influenced by factors such as:

  • Age- The joints and surrounding connective tissues become more rigid and lose much of their elasticity as we age. This results in greater stiffness and decreased range of motion.
  • Gender- Women tend to have more flexibility than men most likely due to structural, anatomical and hormonal differences.
  • Activity level- Physical activity that stresses the joints with greater ranges of motion help maintain flexibility thus active individuals have greater flexibility than less active individuals.
  • Joint and tissue structure- there are inherent joint and tissue structure differences (joint capsules, tendons, ligaments and skin) between individuals that result in varying levels of flexibility. Certain individuals are endowed with higher elasticity and plasticity components to their connective tissue, making them inherently more flexible.

To improve flexibility, two stretching techniques are recommended: active stretching and passive stretching. An active stretch occurs when an individual applies the force for the stretch. For example, during the seated hamstring and lower back stretch, the individual would lean his or her upper torso down toward the lower torso, and upon meeting significant resistance would hold the stretch for a few seconds and then relax. On the other hand, the passive stretch requires the assistance of a person or device to apply the force for the stretch.   Using the same example of the seated hamstring stretch, a person would apply pressure on the back of the individual to help push the upper torso down.

Stretching can be further subdivided into static, dynamic and ballistic stretching.

  1. Static stretching is often referred to as the stretch-hold technique. The individual begins a stretch by moving the joint and muscle through the range of motion until the stretch sensation is felt in the belly of the muscle. The stretch is then held for 20 to 30 seconds followed by a relaxation period for a few seconds. The stretch is then repeated for an additional two repetitions with the goal of increasing the range of motion each time. The individual should always try to avoid stretching the muscle too intensely, as this could lead to injury. Static stretching is a very effective method for increasing flexibility, easy to learn and is generally considered to be safe.
  1. Dynamic stretching is a method of stretching using activity-specific movements to increase flexibility. This type of stretching helps prepare individuals for the movement patterns of their activity by stretching the involved muscles, tendons and joints. For example, a baseball pitcher could use stretch bands to simulate their throwing technique while increasing the intensity and range of motion during each successive throw. This stretching technique has an added advantage of developing both flexibility and strength concurrently.
  1. Ballistic stretching is often referred to as the bounce technique. The stretching movement is generally done rapidly without a hold (bouncing) at the end of each successive stretch. The muscle is stretched quickly and returned to its original position rapidly, and then stretched again. Ballistic stretching has the potential to cause harm and should be avoided. During ballistic stretching, the muscle is never allowed to relax causing a stretch reflex in the muscle (shortening), which leads to a tightening. An example of a typical ballistic stretch is the standing toe touch. During this technique, the individual stands with the legs slightly apart and tries to touch the toes by continuously bouncing up and down in rapid succession.

Flexibility is most effectively attained during the warm-up and cool-down periods of exercise. Prior to exercise, it is recommended that a general dynamic warm-up that involves the entire body (such as jumping jacks, fast walking with arm swings, light cycling) be completed for a few minutes to warm the muscles. When the muscles are warm, five to ten minutes of stretching can help reduce injury, increase joint range of motion and increase performance through increased elasticity of muscles and tendons. Post-exercise (cool-down), stretching the warm muscles allows the elastic components within the muscles and tendons to be more easily stretched. Warm muscles are able to stretch to greater lengths than cold muscles. To improve this capacity, stretching should be done when the muscles and tendons are warm and most receptive to being stretched.

Stretching is a simple way to maintain flexibility, increase physical fitness, reduce injuries and improve performance. Flexibility can be acquired quickly and can be maintained with incorporating just three stretching sessions per week. Persons of all ages and athletic abilities can improve their health by increasing their flexibility with stretching. information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to . Questions will be answered on a monthly basis.

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Support National Public Health Week!

Happy National Public Health Week!

Support National Health Week of their goal to make the U.S the Healthiest Nation in One Generation by 2030.

Please join us in celebrating National Public Health Week (NPHW) now through April 12th. NPHW has raised awareness of the role public health plays in our communities.

Get involved with the Daily Themes:

To learn more about public health, checkout Jones & Bartlett’s Public Health textbooks:

Want to learn more about National Public Health Week? Visit:

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Big Brother Is Watching

2014 Headshot_Short HairLast month, I talked about job searches from the other side of the desk, that of the candidate and how to help students avoid going into a house of horrors. In this post, I will be talking about something we don’t read a lot about in healthcare settings, but I anticipate we will be hearing more, that is employer surveillance and monitoring of employees.

Electronic Performance Monitoring and Control Systems (EMPCS)
We’ve all heard the announcement when we’ve called customer service lines: “This call may be monitored for quality and training purposes.” I suspect another purpose of the statement at the start of the call is to signal the customer to speak nicely to the agent. After all, isn’t the customer being monitored, too?

Increasingly, employers are going well beyond this type of surveillance. While on the employer’s clock, workers check and respond to personal emails, update their status in social media websites, participate in personal virtual messages and chats, check sports scores, and go shopping, to name but a few of the abuses that contribute to decreased worker productivity (Ciocchetti, 2011; Sanders, Ross, & Pattison, 2013). Ciocchetti’s 2011 review of employer electronic performance monitoring and control systems (EMPCS) included the following:

• Access panels;
• Attendance and time monitoring;
• Automatic screen warnings;
• Desktop monitoring programs;
• E-mail monitoring;
• Filters and firewalls restricting Internet access;
• Global Positioning Systems (GPS) and Radio Frequency Identification Devices (RFID);
• Internet use audits;
• Keystroke logging;
• Physical searches;
• Social-network and search engine monitoring;
• Telephone, text messages, and voicemail monitoring; and,
• Video surveillance. (Ciocchetti, 2011, pp. 302-321).

As faculty, I’m sure we’ve all given the same lecture to our students about not posting “bad” information about personal activities or over sharing on social networking sites. However, with newer technology in play, we need to be aware of what employers can do and provide advice about EMPCS to our students.

As we have warned our students time and again, employers often conduct Internet searches and examine social networking sites for inappropriate behaviors when considering a candidate for employment. In addition, depending on the level of the job and the security clearance required, they may also hire investigators to conduct extensive background checks. In my part of the country, many of the government agencies will send former or current FBI or ATF agents out to have face to face interviews with references. When I asked one such investigator why it couldn’t be conducted over the phone, he replied, “I need to see you and watch your body language.” Apparently the student and I passed his tests because the agency hired her.

EMPCS in Healthcare Settings
Once the candidate is employed in a healthcare organization, there is usually a lengthy orientation that includes a plethora of training modules for HIPAA and blood-borne illnesses, to name but a few. There is also a policy manual, either physical or electronic, that should specify any policies and procedures for employee surveillance. Even if the EMPCS are not specified, there are a number of laws that give the employer the right to use them. This doesn’t mean the employees like them or feel the use of certain invasive ones (physical search, for example) are justified.

Here are some examples of how EMPCS are being used and can be used in healthcare settings.

Access panels: Electronic pads or keypads allow employees with the correct code to access restricted areas, either by entering a code or by swiping with their employer identification badge (see also RFID). Ciocchetti (2011) writes that some extreme cases include access panels to rest rooms where the employee is allowed only a specific number of bathroom breaks per day.

Attendance and time monitoring: Most healthcare organizations have done away with the physical time clock where employees lined up to punch in. Replicon, one of many technology firms specializing in time tracking, offers various approaches to attendance monitoring, from waving a badge or swiping in at an access panel, to online computer clocking in, and now mobile device clocking in to a cloud for those employees who work away from home base.

Automatic screen warnings: These pop-ups act as warnings to the employee that their electronic journeys will be monitored. In some instances, it will appear on the screen if the employee spends too much time on the computer away from job related tasks. If the employee is supposed to be working on a financial spreadsheet and decides to go shopping online, the warning screen alerts the employee that this is not a good use of her time.

Desktop monitoring programs: Call it spyware, if you will, this is another way an employer can assess employee productivity. If the employee likes to play solitaire, this will track time spent on the card game and report it to the supervisor. These monitoring programs can also be inserted into emails and other “private” correspondence.

E-mail monitoring: Many companies already monitor emails for key words that can indicate a potential for violence, or other inappropriate behaviors, such as stalking or harassment. Others may be more interested in if you are sharing company secrets. In healthcare, we care most about patient privacy and securing medical information.

Filters and firewalls restricting Internet access: I know a few physicians who despise this feature on their hospital computer systems. Shopping websites have been barred from many, as well as websites that include the word “sex.” While it is likely the intention was to prevent employees from spending time on pornographic websites, the unintended consequence has been to deter physicians from providing information to patients who may have sexual issues.

Global Positioning Systems (GPS) and Radio Frequency Identification Devices (RFID): In response to loss and theft of durable medical equipment, some hospitals have implemented the use of GPS technology to reduce the loss of these assets. The days of wheel chairs rolling out the door without return may be over. In some instances, employees’ physical movements can be monitored, as well, to ensure they are where they are supposed to be.

Internet use audits: If a job does not require an employee to use the Internet, employees should not be surprised to find their access to the Internet is denied or restricted. Healthcare is no different from any other industry with respect to productivity expectations.

Keystroke logging: If your graduates work for an employer that expects them to be on the computer eight hours a day, their keystrokes may be monitored and converted to readable records of what was typed. According to Ciocchetti (2011, p. 315) “keystroke logging is generally done in secret to obtain more accurate results.” In a healthcare setting, I could imagine this being used as an investigative tool if someone is suspected of committing fraud or other illegal activities.

Physical searches: As noted before, the least justified in employee perception, as well in some courts of law, is the physical search. Employers have the right to search offices, files, lockers in some circumstances, such as suspicion of illegal activities. On two occasions, I witnessed pat downs of employees in a hospital by security personnel. Why? Because one was stealing drugs and needles and selling them on the street and the other was stealing drugs and using them.

Social-network and search engine monitoring: Once employed, our graduates should bear in mind the same warnings we gave them before graduation. Employees should never post inappropriate information on social networks or blogs. Nor should they complain about their employer or post potentially identifying information about patients. All of these can be considered grounds for termination.

Telephone, text messages, and voicemail monitoring: Much like email monitoring, some companies already monitor telephone, text, and voicemails for key words that can indicate a potential for violence, or other inappropriate behaviors, such as stalking or harassment. Others may be more interested in if you are sharing company secrets. As noted above, in healthcare, we care most about patient privacy and securing medical information.

Video surveillance: So called “granny cams” in long-term healthcare settings and other settings with vulnerable populations are no longer a possibility, but a reality. Cisco’s white paper on video surveillance in hospital settings provides ten compelling reasons for using their product.

1. Centralize patient observation;
2. Remotely monitor the emergency department;
3. Monitor for drug diversion;
4. Help prevent infant abduction;
5. Monitor patients with diminished faculties;
6. Help prevent theft;
7. Comply with operating room procedures;
8. Support triage in disaster scenarios;
9. Defend against false accidents claims; and
10. Increase safety in public areas. (Cisco, n.d., pp. 1-5)

With that list, why would anyone argue against video surveillance? Perhaps those who worry the video surveillance will extend to locker, changing, and rest rooms!

As healthcare management faculty, it is important for us to stay abreast of current employer expectations and inform and advise our students about these techniques. Employers are paying employees to work, not participate in leisure activities on company time. In a fluid and dynamic industry that is determined to control costs, increase quality, and increase access, we should expect to see increased use of employer electronic performance monitoring and control systems to decrease employee abuses and increase employee productivity.

Sharon B. Buchbinder, RN, PhD

Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

Here are some references if you are interested in this topic:
Ciocchetti, C. A. (2011). The eavesdropping employer: A twenty-first century framework for employee monitoring. American Business Law Journal, 48(2), 285-369.

Cisco. (n.d.) Cisco video surveillance in hospitals: Ten ways to save money and improve the patient experience: White paper. Retrieved from

McNall, L. A., & Roch, S. G. (2007). Effects of electronic monitoring types on perceptions of procedural justice, interpersonal justice, and privacy. Journal of Applied Social Psychology, 37(3), 658-682.

Sanders, D. E., Ross, J. K., & Pattison, P. (2013). Electronic snoops, spies, and supervisory surveillance in the workplaces. Southern Law Journal, 23(1), 1-27.

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King v. Burwell: A Policy Expert’s View, Part 1

This is the first installment of a 2-part commentary by Jones & Bartlett Learning author and health policy expert, Joel Teitelbaum, on the most recent challenge to the Affordable Care Act (ACA), now a case before the U.S. Supreme Court. The second installment will discuss the Supreme Court’s decision in the case (expected by the end of June, when the Court concludes its current term).

On March 4th, 2015, the United States Supreme Court held oral arguments in yet another case – the third since 2012 – concerning the legality, meaning, and/or operation of the Affordable Care Act (ACA). In King v. Burwell, the court is considering whether “the Internal Revenue Service [IRS] may permissibly promulgate regulations to extend tax-credit subsidies to coverage purchased through exchanges established by the federal government under Section 1321 of the Patient Protection and Affordable Care Act.” While seemingly dry and technical on its face, in fact the answer to this question will determine whether millions of low- and moderate-income Americans will continue to have access to affordable health insurance coverage. In this blog post, I describe the issue at the heart of King v. Burwell; in a later blog post, I will discuss the Supreme Court’s decision in the case (expected by the end of June, when the Court concludes its current term).

The background:  The ACA directs states to create an insurance exchange – effectively, an online marketplace where individuals can compare and shop for health insurance policies for themselves and their families. Should a state decide not to set up its own exchange – and a whopping 34 states ultimately took that path – the ACA indicated that the federal government would fill the void by creating a “federally facilitated marketplace,” or FFM, in the state, thus allowing residents of a “non-exchange state” the opportunity to purchase affordable health insurance. Furthermore, the ACA offers federal tax credits (i.e., a subsidy) to individuals who need financial assistance in order to purchase products through an exchange. In establishing the formula used to determine the awarding of the tax credits, Congress wrote in the ACA that the credits apply to insurance purchased through an exchange “established by the State.”  Put another way, the ACA’s language about the flow of tax credits to those who purchase insurance through an exchange does not specifically mention marketplaces that were established by the federal government to assist those individuals in “non-exchange states.”

After the ACA was passed and federal agencies began the task of passing thousands of rules implementing the law, the IRS issued a regulation indicating that tax credits were available for purchases under both state-formed and federally-facilitated exchanges. Subsequently, about 90 percent of the approximately five million people who purchased insurance through a federally-facilitated exchange received the ACA’s tax subsidy.

The plaintiffs who initiated King v. Burwell contend that the IRS regulation is unlawful. They argue that the statutory language “established by the State” means that ACA tax credits are allowed only in the event that the purchase of insurance occurred through an exchange established by a state. In contrast, those legislators who wrote the statute, and other supporters of the ACA, contend that when read as a whole, the ACA makes it clear that both state- and federally-run exchanges are subject to the law’s subsidy language.

Taken most simply – and least politically – King v. Burwell presents a straightforward question of statutory interpretation: How should the four words at issue be reconciled with the rest of the statute? This is hardly a novel question of law, as courts are routinely asked to interpret statutory ambiguities; and under existing Supreme Court precedent, courts are required to uphold regulations that reasonably resolve those ambiguities.

Two federal appellate courts – those courts that reside just below the U.S. Supreme Court – have already ruled on just what the ACA’s tax credit language means. As part of the King v. Burwell litigation, the Fourth Circuit Court of Appeals ruled, unanimously, that the subsidy language applies to state-based and federally-facilitated exchanges alike. In contrast, the D.C. Circuit Court of Appeals determined, in a 2-1 split decision, that ACA tax credits are limited to purchases made through federally-facilitated exchanges.

The stakes in King v. Burwell are incredibly high: If the Supreme Court sides with those challenging the IRS regulation and Congress does not subsequently amend the ACA to make clear that the subsidies apply to all exchanges (which is likely, given Republican disapproval of the ACA and the political logjam that exemplifies Congress), estimates put the number of adults and children who would become uninsured as a result at between 8 million and 10 million. Furthermore, insurance markets across the country would be likely to falter badly as a result of the destabilization that would occur from removing these millions of low-income but relatively healthy individuals from insurance pools.

Reading the tea leaves after Supreme Court oral arguments is risky, a fact about which we need look no further than the Court’s first ACA decision (in NFIB v. Sebelius), which defied nearly all expectations. That said, those hoping that a majority of the Court will employ a common sense, contextual reading of the ACA’s subsidy language – as opposed to one that is literal and purely textual – came away from the arguments with reason to hope. Of particular import, Justice Anthony Kennedy – oftentimes a key swing vote in the Court’s social policy jurisprudence – seemed concerned that by following the logic of the challengers, the ACA would be read to either coerce states into creating an Exchange or accept the fact that in not setting up an Exchange, they would face near-certain destruction of their insurance markets.

TetelbaumJoel Teitelbaum, JD, LLM is an Associate Professor and the Vice Chair of Academic Affairs in the Department of Health Policy at the George Washington University School of Public Health and Health Services. He also serves as Managing Director of the School’s Hirsh Health Law and Policy Program. Along with co-author Sara Wilensky, Professor Teitelbaum is the author of Essentials of Health Policy and Law, Second Edition from Jones & Bartlett Learning. (Qualified instructors are invited to request review copies here.)


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Jones & Bartlett Learning Author Elected President of SHAPE America

Jacalyn Lund

We’re so proud to share that Jacalyn Lund, author of Standards-Based Physical Education Curriculum Development, Third Edition, has just been elected President of Society of Health and Physical Educators (SHAPE) America.

When asked about her leadership qualities and motivations for seeking the presidency, Lund said that:

“For the past 5 years I have had the privilege of serving as the Department Chair of Kinesiology and Health at Georgia State University. In my role as chair, I have managed a budget, evaluated personnel, honed my communication skills, and sought ways to promote our department across the college and university and with the community surrounding Georgia State.

In my outreach endeavors, I have found that the physical education profession has much to offer, but until others understand what we are about, they often miss the potential connections. My continual advocacy for the department has led us to some interesting partnerships.

I have learned that there are often multiple ways to address a problem and that by involving the thoughts of others, there is increased buy in and willingness to compromise. My years on the NASPE Board were an immense help in preparing me for my current role of department chair as we worked as a team to solve problems and brainstorm new ideas to help build and brand the association.”

Read the full press release.

Standards-Based Physical Education Curriculum Development, Third EditionCreated around the 2014 National Standards for Physical Education for K-12 education, Standards-Based Physical Education Curriculum Development, Third Edition is written by experts with a wealth of experience designing and implementing thematic curriculum. This innovative resource guides readers through the process of writing dynamic curriculum in physical education.

The text begins by looking at the new national standards and then analyzes physical education from a conceptual standpoint. From there, it goes on to examine the development of performance-based assessments designed to measure the extent of student learning and explores the various curricular models common to physical education. The Third Edition also delves into sport education, adventure education, outdoor education, traditional/multi-activity, fitness, and movement education, describing each model and how it links with physical education standards.

Would you like to learn more? Preview a sample chapter now or visit our website.

Please join us in congratulating Jacalyn Lund on this impressive achievement!

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Health Navigators: Characteristics Through Internships


In 2015, Kay Perrin, PhD, MPH, joined us as a guest blogger for a series of five blog posts on the topic of the exciting new career field of the Health Navigator. This is the second of five.

In the first blog, I introduced the concept of the role of Health Navigators. In this second blog, I expand this conversation to include some valuable characteristics of Health Navigators as well as the need for internships within their training. Before jumping into required internships, let’s step back and explore some personality traits desired in Health Navigators. When seeking a fulfilling career as a Health Navigator professional, students may assess if they have a desire to serve as a patient advocate, if they have an aptitude for attention to detail, and if their life experience allowed for the development of empathy.

First, whether they are called community health workers, patient navigators, health insurance navigators, or a growing number of other job titles, Health Navigators, serve as a liaison between patients, caregivers, and their health care providers. It is essential that they work as advocates within the complex health care system to improve patient care. Health Navigators are one additional piece of the health care puzzle that attempts to catch patients’ problems prior to falling through the cracks. Therefore, whenever a member of the health care team identifies an issue, every team member needs to listen so the details are not ignored. Although there will be an educational level gap between physicians, nurses, social workers, dieticians, health navigators, and other members of the health care team, the Health Navigators work to investigate problematic situations to find plausible solutions.

Health Navigators serve as effective and persuasive advocates for patients and their caregivers. For example, a Health Navigator works with the discharge physician, nurse, and social worker by conducting a home visit prior to discharge to evaluate wheelchair accessibility, height of bed, and bathing options. This evaluation is not a home health assessment (e.g., wound care or administration of intravenous medications), but rather a holistic approach for the patient and the caregiver with emphasis on a safe recovery at home with the tools and support needed or incurring a readmission due to lack of knowledge and support or an unintentional injury.

Second, Health Navigators do not merely follow written medical orders or prescriptions, but rather they approach each situation with a holistic approach. For instance, if a patient’s follow-up medical visit is scheduled for three days after discharge, the Health Navigator needs to ask the patient and caregiver a few questions to ensure that keeping the appointment is possible rather than merely assuming that the patient will arrive on the given date and time.

  1. Who will be driving you to the follow-up appointment?
  2. Will your driver be able to lift and fit your wheelchair into the car?
  3. Is your driver available when your appointment is scheduled?
  4. …and many more similar questions.

If the Health Navigator asks these or other appropriate questions, there is a higher probability of appointment compliance. On the other hand, without a Health Navigator, the time and date of the appointment is given to the patient during discharge with the expectation of agreement. However, without asking specific questions, the unresolved issues prevent compliance with a follow-up appointment. These types of simple questions ensure that the patients and caregivers have complete understanding of appointments, medications, wound care, treatment plans, etc. for utmost compliance through reduction of barriers and lack of understanding.

Third, Health Navigators need the quality of empathy rather than sympathy. A sympathetic Health Navigator shares the feeling of the person suffering from the bad news or sad feelings. An empathic Health Navigator focuses on trying to understand or vicariously experience the sad feelings from a past personal event rather than feeling sorry for the person. For example, the Health Navigator might remember the sad feeling when his or her grandparent died, but would not attempt to share in the experience. The attribute of empathy is acquired through personal experience across the lifespan. An empathic Health Navigator knows to ask simple questions to move the conversation forward towards purposeful action or resolution.

With these qualities in mind, let’s explore the proposed curriculum and training described in the Community Colleges and Public Health Report. With expert input and years of discussion, this report recommends that all health navigators as well other public health students at the associate degree level complete the following courses:

  • Population and Personal Health
  • Overview of Public Health
  • Health Communications

In addition, Health Navigator students should complete the following courses:

  • Prevention and Community Health
  • Healthcare Delivery
  • Health Insurance
  • Health Information

Along with the course requirements, there are nine semester hours of electives.

In this blog, I would like to put forth the notion of incorporating a required paid internship into the nine hours of electives. After years of working with undergraduate students, I have observed that most students fall into one of two categories. Either they are locked into a career path and have limited interest in exploring other options or they are seeking a diploma with limited exploration of career choices. Neither of these common scenarios works for the evolving field of Health Navigators. First, since the concept of Health Navigators is unfamiliar, students are not likely to know what the career entails. Second, if students do not have personal or employment experience with health care providers, patients, and caregivers, they are less likely to visualize a holistic approach of care. For these and many more reasons, it is essential that future Health Navigators obtain internship experience during their degree program; otherwise, it is improbable that they will obtain employment upon graduation. In addition, these internships must offer a modest stipend for several reasons.

For the students, the internship stipend focuses the responsibility on being a future health care team member rather than being a hospital volunteer. This mindset encourages professional workforce development skills, e.g. appropriate attire, time management, and communication skills. On the hospital side, the financial commitment of paid internships introduces the concept of Health Navigators into the hospital workforce; forms strong links between community college and local hospitals; and allows hospitals to make a financial commitment to the development and employment of Health Navigators as a way to reduce ACA penalties associated with Medicare readmission rates. Lastly, for the community colleges, the paid internships provide positive recruitment strategies into the new Health Navigator degree; allows faculty to network with hospitals through the development of responsibilities of the student interns; and connects the classroom with the internship experience.

Ideally, the internship would not be a culminating experience during the last semester, but rather one 8-hour shift per week in the hospital for two semesters. Therefore, as the students gain knowledge and understanding in the classroom, they would experience higher levels of critical thinking in their hospital internship. Yes, of course, this paid internship concept is expensive and time-intensive for hospitals, community colleges and students. However, without a serious commitment at all levels, Health Navigators will gain academic knowledge and receive diplomas, but may not secure employment. Their employment is based on creating and demonstrating the need for Health Navigators to become a profession, a valuable, cost-saving member of the health care team.

 —Kay Perrin

KayPerrinKay Perrin, PhD, MPH, is an Associate Professor and Assistant Dean for the Office of Undergraduate Studies at the University of South Florida, College of Public Health. Dr. Perrin’s research focuses on adolescent health with a special interest in teen pregnancy. Dr. Perrin also serves on several community boards in the Tampa Bay Area. Dr. Perrin is the author of three titles from Jones & Bartlett Learning: Principles of Evaluation and Research for Health Care Programs, Essentials of Planning and Evaluation for Public Health (both published in 2014), as well as a forthcoming introductory Health Navigator textbook, available in late 2016. Follow Kay Perrin on Twitter @KayPerrinPhD or watch a webcast of Dr. Perrin’s October 2014 Webinar on Teaching Health Research, Program Planning, and Evaluation.

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5-Star Review For Mastering Leadership: A Vital Resource for Health Care Organizations

Mastering LeadershipExcellent news to share– Mastering Leadership: A Vital Resource for Health Care Organizations by Alan T. Belasen, Barry Eisenberg, and John W. Huppertz recently received a perfect score of 100 and 5 stars from Doody’s Review Service. According to reviewer, Cynthia Lee Cummings, RN, MSN, EdD, from the University of North Florida Brooks College of Health, it “provides valuable information to those interested in healthcare leadership and management.”

Read more excerpts from the review:

“The book deals with becoming an effective master leader. The authors incorporate the CVF and four main domains — communication and collaboration, competition and commitment, coordination and compliance, and community and credibility. They discuss the important topics of performance management, patient satisfaction, and strategic planning. The case studies and the review questions that are incorporated throughout are the best features.

I enjoyed this book. The authors provide a new concept with CVF, and the realistic and timely case studies provide an opportunity for important questioning and student interaction. The Affordable Care Act, marketing strategies, and technology are just some of the topics the book covers. It is well done and resourceful.”

Would you like to learn more? Preview a sample chapter now or visit our website.

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Juice: Can It Really Make You Faster?

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on juice drinks.

Juice products promising health, fitness, and longevity in a bottle are a dime a dozen these days. Marketers are luring athletes into purchasing costly juice drinks by promising performance gains. Are they true? Can a glass of juice really improve athletic performance? We have reviewed the research of three of the most popular juices in the athletic world—beetroot, tart cherry and pomegranate. The science has shown several promising results including reduced blood pressure, improved sleep, and decreased recovery time, but don’t guzzle these beverages just yet.

The main findings include:



  • High in inorganic nitrate which converts to nitric oxide
  • Nitric oxide relaxes and dilates blood vessels
  • Decreases the amount of oxygen required for exercise thus less energy used
  • Performance improvement greater for anaerobic activities
  • Improves blood flow
  • Reduces blood pressure

Current recommendations and cautions:

  • Consume ½ liter of juice or a one shot of concentrated juice 1-12 hours prior to exercise.
  • Beetroot is not very palatable and many report it tastes like “sweet dirt.”
  • Consuming high levels of beetroot juice may turn urine and stools reddish.

Tart Cherry


  • High in antioxidants – anthocyanins
  • Highest anti-inflammatory compound of any food (found in the peel)
  • Decreases DOMS- Delayed Onset Muscle Soreness
  • Faster muscle strength recovery
  • Packed with natural sleep aids (melatonin)
  • Reduces chronic inflammation – joint pain and arthritis
  • May be safer to consume tart cherries than over-the-counter pain relievers

Current recommendations:

  • 8 to 10.5oz 1-2x/day
  • Montmorency tart cherries (sweet cherries do not provide the same benefit)
  • Add dried and frozen tart cherries to recipes



  • High in antioxidants – polyphenols
  • Decrease DOMS- Delayed Onset Muscle Soreness
  • Increases blood flow
  • Lowers cholesterol- specifically LDL or “bad” cholesterol
  • May block or slow build-up of cholesterol in the arteries
  • May slow prostate cancer growth

Current recommendations:

  • 8oz/day
  • Consume fresh pomegranate seeds alone or add to recipes

 Although we have included the current dosing recommendations, research is ongoing and most likely dosing instructions will change as the scientific research becomes stronger. If you do decide to add one or more of these juices to your nutrition plan, select juices that are 100% juice rather than a mix or cocktail that has added sugars. You can’t go wrong by adding more of these nutrient-rich foods to your diet, but as with all foods do not over do it. There can be too much of a good thing.

*Note: There are several supplements on the market that claim to provide the benefits of these juices in a concentrated pill form. We do not recommend consuming supplements that have not been tested for safety and efficacy. information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to . Questions will be answered on a monthly basis.

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Don’t Go Into That House! Helping Students to Avoid Horrific Jobs

2014 Headshot_Short HairAs spring and graduation approach, the focus for many of us in academia is on helping students to prepare for their careers and finding a new job. Two years ago, I blogged about employability. In that post, I took the perspective of the needs of the employer and what they are looking for in candidates. In this post, I will be talking about job searches from the other side of the desk, that of the candidate and how to help your students avoid going into a house of horrors.

Pre-Gaming the Interview
Faculty members insist on students doing their homework. In a job search, the rule still applies. Here are some areas where students can find public information in newspapers, online articles, and state and local government websites on indicators of dysfunction in healthcare organizations.

High leadership turnover, i.e., frequent Changes in Chief Executive Officers (CEOs), Chief Operating Officers (COOs), or Chief Financial Operators (CFOs) can indicate turbulence within an organization. Some changes in leadership can be positive. However, when an organization changes leadership at the top every year or two, there’s a problem. Politics and financial issues are often at the root of this turmoil. Tumultuous leadership means chaos and erratic organizational direction.

Fraud and abuse scandals, never a good thing, are particularly toxic in healthcare. It is a betrayal of the public trust at a deep level. Those who are fired may not always be the guilty parties. They can be scapegoats for the actual wrong-doers. Going into an organization with this kind of history can be a major risk. Who will be the next victim?

High staff turnover is reflected in the frequency of job postings and the vacancy rate. If a department is supposed to employ eight people, yet there are only four, there is a problem. Pressure cooker environments, the “Queen Bee Syndrome”, and bullying in the workplace lead to “churning”, i.e., rapid employee turnover. If the same position is posted repeatedly, it may not reflect growth; it may reflect a dearth of good managers.

High healthcare provider turnover, especially in managed care organizations, is a major indicator of discontent. Physicians, nurse practitioners, nurses, and other healthcare providers are in demand. With a recurrent nursing shortage and a looming physician drought, these expensive employees can be selective. Good healthcare providers need not stay with bad organizations. Follow the leaders to find good places to work. Tell your students to ask healthcare providers about an organization’s reputation before applying.

High client/patient/enrollee turnover is also an indicator of a poorly managed organization. Fragmented systems that treat patients like numbers will not keep them for long. Patients, like healthcare providers, can choose, and as you will see in the next bullet, lots of information is available at their fingertips.

Low patient satisfaction scores are frequently associated with low employee and provider satisfaction and a poor response to patient issues and concerns. These scores are a reflection of the organization’s culture. already provides a searchable website for consumers to compare hospitals. Similar websites exist in Centers for Medicare and Medicaid Services (CMS): Nursing Home Compare and Physician Compare. In April, 2015 the Centers for Medicare and Medicaid Services will be launching a five-star rating system in its Compare websites. Using these websites can provide valuable clues on where to apply and where not to apply for a job.

During the Interview
If your students do their homework and find all indicators are positive, some trapdoors may still be ahead of them. Tell them to be on the lookout for the following clues.

Vague responses to questions about previous employees in the position are an indicator of a hasty or discordant departure. Employees who were promoted or left for better positions are usually spoken of in positive terms. If no indications are provided about why someone left the job, the student should proceed with caution.

Lack of contact with prospective co-workers is unusual in this era of team-driven programs and projects. Most employers utilize group interviews where a candidate meets other team members over lunch or in a conference room setting. A culture of teamwork insists on assessing the goodness of fit of a new team member. If that option is not provided, the applicant should ask for it and observe the interviewer’s response.

Multiple reporting relationships are common in matrix organizations. However, even in the early 1900’s Taylor spoke against this, calling for a delineation of authority. Clear reporting relationships are critical. While an employee may be “on loan” for a team or task force to another manager, the employee needs to have someone to go to in times of conflict or concern. An employee is not likely to please multiple bosses all of the time.

Disrespectful interviewers are the exception, rather than the rule—one hopes. However, in my four decades of job interviews, I recall the worst, not the best ones. In the 1980’s, I interviewed at a medical school for a research assistant position. I had a Master’s degree and I was a Registered Nurse. The interviewer glanced at my resume, mulled aloud that he had no idea why I was called in for the interview, told me point blank he “wouldn’t know what to do” with me, smirked and said, “Can you type?” I stared at him and said, “No.” A few months later, I walked back into that same medical school with my team from a major medical publisher to meet with his boss, a physician. The look of dismay on the interviewer’s face was priceless.

After the Interview
As professionals, we know what should be done after a job interview, but our students don’t always have that knowledge embedded in their coursework. Be sure to advise them to:

Write a thank you note, and, if withdrawing their application, provide a polite reason. Say the commute is too far, the job is not a good fit, or a better opportunity came along.

Do not burn bridges. Healthcare is a large business, but it is a local one. Healthcare managers will see the same people they met on their job searches when they go to association meetings or conferences.

Desperation, anger, bitterness, and vindictiveness are not attractive qualities in any job candidate. No matter how badly the interview went, or how disrespectful the interviewer was, the student/graduate must rise above the occasion.

Remember, we were all there once. Support your students and graduates in their job search and remind them they are not required to accept the first job they find. If we have done our jobs, they will be competent, confident, reflective practitioners who will make meaningful contributions to healthy organizations.

Sharon B. Buchbinder, RN, PhD

Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

Here are some references if you are interested in this topic:

Balik B., Conway J., Zipperer L., & Watson J. (2011). Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Available on

Bernabeo, E. & Holmboe, E.S. (2013, February). Analysis & commentary: Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Aff 32(2):2250-258; doi: 10.1377/hlthaff.2012.1120

Buchbinder, S.B. (2013, May 6). Employability: If you don’t A.S.K, you don’t G.E.T.

Drexler, P. (2013, March 6). The tyranny of the Queen Bee Syndrome

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Kusy, M. & Holloway, E. (2009). Toxic workplace! Managing toxic personalities and their systems of power. San Franciso, CA: Jossey-Bass.

Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: US Department of Health and Human Services.

Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2011). Crucial conversations: Tools for talking when stakes are high. New York, NY: McGraw-Hill.

Stevens Institute of Technology. (2015). Samuel C. Williams Library. Frederick Winslow Taylor Collection.


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JBL Author Patti Rose Will Be a Keynote Speaker at Annual Health Disparities Conference

patti rose 1Dr. Patti Rose, author of Cultural Competency for Health Administration and Public Health and Cultural Competency for Health Professionals, will be a keynote speaker at the Annual Health Disparities Conference at Teachers College, Columbia University—The Health Equity and Social Justice Conference.

Join Dr. Patti Rose in the Cowin Center Auditorium, Saturday March 7th at 10:00 AM.

In Dr. Rose’s Keynote, She will be speaking on  An Exploration of the Convergence of Unjust Factors—Health Inequities, Mass Incarceration, Prison for Profit Healthcare, the School to prison Pipe-line and Beyond—and Culturally Competent Multidisciplinary and Community Based Approaches Towards Solutions

For more information about the event, visit:

About Dr. Rose’s titles on cultural competency:

Cultural Competency for Health Professionals reviews the importance of the implementation of cultural competency by allied health professionals, and the process of assessment, training and evaluation. Providing a concise overview of the necessary tools to apply cultural competency processes, it also offers insight into how to apply this knowledge in day-today work clinical work environments.

For more information, visit our website.

Cultural Competency for Health Administration and Public Health  is a concise introduction to the tools necessary for the application of cultural competency processes in various healthcare settings. Each chapter offers an overview of demographic changes in the United States, as well as accreditation requirements, cultural competency, and cultural nuances of specific groups. Attention is also given to the associate costs, time, and skill sets associated with the process of moving a health care organization toward cultural competency.

For more information, visit our website.


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