The Importance of Diversity in Nursing: Breaking Down Stereotypes and Inclusivity Barriers

The Importance of Diversity in Nursing: Breaking Down Stereotypes and Inclusivity Barriers

Diversity is a worldwide issue that touches nearly every topic. In nursing, it includes all of the following: gender, veteran status, race, disability, age, religion, ethnicity, socioeconomic status, sexual orientation, education, nationality, and physical characteristics. How? Because every day, medical professionals everywhere (especially nurses) encounter people from every race, religion, ethnicity, cultural background, gender, sexual orientation, etc. Every interaction creates diversity and as such the issues that surround the topic are just as vast and as numerous.

The American Nurses Association (ANA) defines diversity awareness as “acknowledgment and appreciation of differences in attitudes, beliefs, thoughts, and priorities in the health-seeking behaviors of different patient populations.” But diversity is more than just a definition. Diversity in nursing means knowing how to respond if a patient becomes violent towards you for your culture, gender, or religion, or what to do next if a medical professional refuses to give you treatment because you identify as LGBTQ. While the ANA urges nurses to grow professionally and personally in their efforts to understanding diversity issues and translating those learnings to quality care for every patient, diversity efforts often involve complex issues that can’t be solved with a simple “yes, we will do better” response. True diversity efforts require action to succeed, so here are some ways to break down diversity barriers like stereotyping and close-mindedness in order to provide better health care for your patients.

Live, Work, and Breathe Diversity in Everything You Do

The number one most important thing you can do to promote diversity and inclusivity in your organization is to communicate everything as clearly as possible. Think about it. Have you ever had a supervisor who did not communicate their expectations clearly to you? Did you ever have a conversation with a patient that was downright awkward or uncomfortable because of the personal or cultural differences between you? Was there a lot of ambiguity in what they asked from you? How well did you work with that supervisor? People get frustrated, scared, flustered, upset, and discouraged. Situations escalate. The key to avoiding miscommunication in the health care space is to incorporate strong diversity efforts. Here’s why:

When diversity and representation is lacking, it’s hard for people to feel welcome. The balance of diversity in the world of medicine starts with culture and beliefs. The best way for health care providers and hospitals to get in on this? By increasing diversity efforts in hiring. Having nurses on staff that can understand the demographics of their patients, communicate, and relate to their individual struggles will improve the lives of patients and the fulfillment of the nurses hired. Why? Because it opens the door to reaching an understanding of your patient’s morals, values, language, religion, and other demographics (i.e., it makes them more comfortable in their environment).

But communication is a two-way street, therefore listening is just as important. When a diverse workforce of nurses exists, they can more effectively listen to what is bothering their diverse population of patients. This is made possible because not one nurse can relate to every cultural background, speak every language, or identify with every gender identity or sexual orientation. Nurses that actually exist in these spaces can make quality suggestions and treat their patient for the best results. In other words, hiring African American, Asian, Muslim, Christian, LGBTQ, transgender, male and female (and many many more backgrounds, religions, identities) nurses are vital to the overall care of every patient.

This communication is not only between health care providers and seekers. It is also along the health care provider plane. Clear and consistent communication among nurses and doctors will help lead to smooth transitions in providing care for a patient. Staffing a diverse workforce will lead to breaking down the barriers of stereotypes and keeping an inclusive and respectful mind when providing healthcare.

Breaking Down Stereotypes

The first major barrier is breaking down stereotypes. Stereotypes are defined as “a widely held but fixed and oversimplified image or idea of a particular type of person.” They have become fatal fallacies in our society, and in the medical profession, they can be a major player in increased discomfort between patients and nurses alike. Categorizing someone into a group or as an image of something they don’t identify with puts a strain on their livelihood and overall health. As a consequence, especially from a nursing standpoint, it can hinder a nurse’s ability to give proper medical treatment and impedes a patient’s ability to recover. No nurse or patient should feel negative pressures from their social environment for their background, especially when receiving medical treatment. Therefore, it is crucial that we attempt to break down stereotypes to help improve the acceptance and abundance of diversity in nursing to advance the openness and inclusivity of treatment and recovery for people of all backgrounds.

Shattering stereotypes is difficult. The Wisconsin Network for Research Support (WINRS) and the Community Advisors on Research Design and Strategies (CARDS) aimed at doing so through the power of “The Personal.” For six plus years, the University of Wisconsin has been funding meetings between these groups. The CARDS were people who were giving advice to researchers who want candid feedback on how they can improve their methods from those who are deemed “hard to reach.” The CARDS were made up of those who come from diverse racial, socioeconomic, and educational backgrounds. At the end of the research, WINRS found two things that can help break down the stereotype barriers:

  1. An open-ended question that has been thoughtfully planned out
  2. Allowing researchers to explain why they personally got into research

The reasoning behind the questions were so they would bring out past experiences in members that provoked positive emotions and reinforced human connection. Establishing an emotional experience makes it easier for people to connect. Justification for the second finding was because CARDS members originally thought they were in it only for the money.

So, what can we learn from this study on stereotypes? The biggest thing we can learn is that disconnect between groups of people is cause for concern. Stereotypes stem from a lack of understanding between groups. At the end of the day, both parties of guest researchers and CARDS members received feedback from those who they didn’t think it was possible. This can be translated into day-to-day care for patients. Finding a common ground between nurse and patient can lead to effective communication and better health care for all. In other words, the key to defeating stereotypes once and for all is with understanding, respect, and compassion.

Establishing Inclusivity

Creating an inclusive culture in health care is incredibly important in today’s world. Duquesne University explains that inclusive nursing practices begin in the classroom. Madeleine Leininger, a nurse anthropologist, developed the idea of “transcultural nursing,” which is nursing based on a patient’s cultural considerations. Teaching transcultural nursing is a stepping stone to inclusion. Interweaving the idea of providing care based on a patient’s cultural beliefs can help establish an inclusive mindset that is respectful to the patient and will translate over to your coworkers.

Developing an inclusive and respectful mindset starts at building strong relationships and understanding, much like breaking down diversity barriers. While efforts have increased to teach transcultural nursing in the classroom, organizations have been created to help support nurses and patients where they can access resources and communities to help them adjust.

The ANA works tirelessly to be a resource for all nurses of every background so they feel welcomed and comfortable. They offer resources from a number of communities, such as the Gay and Lesbian Medical Association and the U.S. Department of Health and Human Services Office of Minority Health. They also offer resources that help you treat patients that are obese, mentally ill, or the elderly. By providing access to all of these communities in one place, the ANA wants to create an industry that is able to treat patients from every walk of life.

Diversity is the key to providing the best health care possible. Understanding how to break down the barriers of stereotyping patients and creating a culture of inclusion within a practice are the two biggest challenges that nurses face today. That is made even more difficult when it comes to being a traveling nurse. Institutes like ANA and WINRS work so hard to educate nurses and medical professionals to knock down the blockades that hinder diversity in nursing.

A Q&A with Vanderbilt School of Nursing’s New Assistant Dean for Diversity and Inclusion

A Q&A with Vanderbilt School of Nursing’s New Assistant Dean for Diversity and Inclusion

Earlier this fall, Vanderbilt University School of Nursing named Dr. Rolanda Johnson, PhD, MSN, RN as the new Assistant Dean for Diversity and Inclusion. Johnson, who is also the assistant dean for academics and associate professor of nursing, has replaced Assistant Professor Jana Lauderdale, who returned to her faculty role. Johnson is continuing to shape and foster VUSN’s environment of inclusivity. We spoke with Dr. Johnson to learn more about her experience and her goals for VUSN.

Dr. Rolanda Johnson

Dr. Rolanda Johnson

What has been your career path so far and how has it led you to your current role as assistant dean of diversity and inclusion?

My desire to work as a health care professional began when I was elementary age. As an 11th grader, I decided to attend nursing school. I completed my Bachelor of Science in Nursing degree at Tuskegee University in 1985. Those were very formative years of training and education when I gained a wide range of clinical experiences with diverse populations. After graduating from Tuskegee University, I worked in a community hospital in Montgomery, AL, at Fairview Medical Center where I was exposed to people who I now know had limited access to health care. At Fairview Medical Center, I witnessed a sense of family among employees who were dedicated to providing the highest level of quality care to all that were in need with genuine caring attitude. I later began employment at Jackson Hospital in Montgomery, AL, working in numerous roles including that of nurse educator and clinical nurse specialist. During this time, I obtained a Master of Science in Nursing from Troy State University located in Troy, AL. Working as a nurse educator, I developed a desire to have a greater impact on African American health. Shortly, thereafter I began doctoral studies at Vanderbilt University and later obtained a Doctorate of Philosophy in Nursing Science degree. I have worked in numerous roles of nursing including clinician, educator, researcher and administrator, which led to my current position.

How has your professional background influenced your passion for diversity and inclusion?

Throughout my education trajectory, I have always been keenly aware of the health disparities and inequities some groups of individuals face. I am employed in Nashville while residing and working with my husband in an extremely underserved rural county in Mississippi. The social determinates of health naturally impact the health status of many. Who you are, where you live and what you have, sadly, monumentally impacts the quality of care one receives and access to health. As an educator, I work with students across the spectrum who are often impacted by these factors either individually or through family and friends. For me, all of these experiences have translated to my desire to make a difference in the lives of those that are often overlooked and to help others see the integration of all facets that impact the lives of our students and their performance.

Where did your passion for diversity and inclusion in the nursing field begin?

My passion for diversity and inclusion began during my studies at Tuskegee University. Those were very formative years of training and education. The wide range of clinical experiences with populations across the socioeconomic spectrum and from rural Tuskegee, AL, to metropolitan Atlanta, GA, opened my eyes to the varying degrees of heath care and access for different groups of people. Naturally, at that time I could only assess health disparities from my early developmental lens but these experiences have proven to be instrumental in guiding my nursing career.

For the past 20 years, I have resided in Macon, MS, a low-income, rural community, and have been employed approximately 300 miles away in metropolitan Nashville, TN. This has afforded me the opportunity to observe health care delivery cycles and the degree of effectiveness across diverse populations including associated gaps and health disparities. This phenomenon has fueled my passion to educate advanced practice nurses who will be equipped to fill these gaps and better meet the health care needs of all populations. The key to have advanced practice nurses who can deliver quality culturally sensitive health care.

How do you define diversity and inclusion at Vanderbilt?

Within VUSN, our core belief is that all students, staff and faculty regardless of our differences should feel included and equitable. This is reflected in the VUSN diversity and inclusivity statement, which states at VUSN “we are intentional about and assume accountability for fostering advancement and respect for equity, diversity and inclusion for all students, faculty and staff.” The full statement can be found on the VUSN website.

What are you most excited about with your new position?

The most important part of my new role is the possibility of enhancing the culture climate within VUSN and creating a path for continued improvement for years to come. I am humbled to be a part of this endless journey. I hope to leave an indelible imprint of creating a difference in this area within VUSN.

What strategies do you feel will have the most positive impact on the Vanderbilt Nursing community?

The umbrella strategy is to transform the level of diversity and inclusion within VUSN by minimizing bias across our core areas of academics, faculty practice, research and informatics among faculty, staff and students. Additional strategies will be to improve the cultural climate of VUSN for all students, faculty and staff and to increase the diversity representation among faculty, staff and students.

What are the biggest challenges that you will face in your new role?

The biggest challenge is to keep the diversity and inclusion momentum moving forward within VUSN. Within any organization, change is often difficult and once that change has occurred, it is so easy to be complacent with past accomplishments. The test is to bask in accomplishments for the moment and then move forward to the next challenge and goal.

What diversity goals do you have for yourself and Vanderbilt’s School of Nursing?

My goal is to pursue a high level of excellence in health care by finding creative ways to deliver this level of care to underserved populations. From a diversity and inclusive view, I desire to minimize bias, improve the cultural climate and increase diversity representation in faculty, staff and students within VUSN.

What is a fun fact about you?

I am a college football fanatic.

Why Prospective Students Should Consider Nursing

Why Prospective Students Should Consider Nursing

As the school year starts up again, we thought we’d share why nurses love what they do to help inspire prospective students to pursue this rewarding career. We asked each nurse why it’s great to be a nurse right now and they gave us many different reasons, but they all agree on one thing: being a nurse rocks!

Here are seven reasons prospective students should consider nursing.

“2018 is a great time to be a nurse. I’m a Clinical Nurse Educator for patients with chronic granulomatous disease, a rare disease that only 20 people in the U.S. are born with each year, and my job takes me around the country to meet with them in person—but we can connect virtually as well. I’m able to build great, personal relationships with my patients—and, having four children myself—being able to be there for patients like that means the world to me. Additionally, the resources available are incredible: connecting my patients and their caregivers with online social communities and others in the rare disease community who understand their experiences is so helpful in ensuring that they feel less alone. Witnessing this positive impact on their outlook on their condition is extremely rewarding.”
—Brian Coyle, BSN, MBA, RN MSCN, Clinical Nurse Educator at Horizon Pharma

 

 “Nursing is future proof. A complex computer algorithm meant to replace nurse anesthetists like me for endoscopy procedures was recently pulled from the market, because robots can’t do this job. The ethical and bureaucratic hurdles have never been more challenging, so nurses feel useful and irreplaceable.”
Nick Angelis, CRNA, MSN

 

“The best part about being a nurse in 2018 is having access to the best education, technology, and resources available, which allows us to pinpoint clients’ needs and help them achieve their daily goals and a better quality of life.”
Eronmwon Balogun, RN, BSN, Skilled Home Care Nurse, BAYADA Home Health Care

 

“I’ve always had an overwhelming sense that I needed to help anyone I felt was in pain either physically or emotionally. I truly believe it’s within my soul—an innate gift. When I was an Army medic, I was in constant awe of my fellow soldiers—whether a medic, nurse, or MD—the camaraderie was powerful. I knew I wanted to pursue nursing as a career.

When I graduated nursing school, I began my journey in Oncology. Twenty-seven years later, I am still fortunate enough to be caring for the Oncology population. To this day, I still have that feeling in my heart and gut—the sense that has allowed me to become part of so many lives, and to help countless patients and families.”
—Kevin Flint, RN, BSN, MBA, OCN, Nurse Director, Vernon Cancer Center, Newton-Wellesley Hospital

 

“Today’s world is fueled by powerful women, and this is very evident in the nursing profession. You are never limited as a nurse because you can work anywhere you want—in a school, hospital, or even home setting. Nursing is an empowering profession that is in demand and can take you nearly anywhere you want to go.”
Pamela Compagnola, RN, Clinical Manager, BAYADA Home Health Care

 

“In our high-tech world, as a nurse I love that I am still able to give a personal human touch to people in need of care. For me, the person-to-person connection is why I went into this field and brings me simple joy every day.”
Lannette Cornell Bloom, BSN, RN, author of Memories in Dragonflies, Simple Lessons for Mindful Dying

 

“Nurses today have endless possibility and opportunity to really make a difference. We need to believe and be empowered that we do make a difference and that we are a big part of the health care system.”
—Rodilyn Glushchenko, RN, MSN, CCRN, CCNS, NE-BC, Nurse Director ICU, Hemodialysis and Cardiovascular Center, Newton-Wellesley Hospital

Rising Demand for Male Nurses

Rising Demand for Male Nurses

There is a growing demand for more nurses in general and that the demand for male nurses is currently on the rise. Male nurses are increasing their presence at the bedside, hospital, clinic, and nursing home. The American Association for Men in Nursing (AAMN) profiles the progress of its campaign for a 20% increase in the number of male nurses in the workforce by 2020. We all know that the nursing profession would benefit from a more diverse representation of gender, age, and cultures within the workforce.

Male nurses are bringing balance to the profession, which benefits patients as a whole. Having male nurses ensures that male patients are well cared and represented. Sometimes patients prefer a nurse of a certain sex, particularly for procedures like inserting a catheter, serving a bedpan, or administering EKG. Male nurses have skills and care-giving strengths that can make nursing an excellent career for them. Importantly, the benefits of being a male nurse are the same benefits of being a nurse.

If you are male and thinking about becoming a nurse, don’t hesitate to explore the career and most importantly look into yourself to ensure that this is the right career for you. Nursing is a challenging job and one that requires hard work, integrity, and dedication. Nurses can treat every patient regardless of gender, but dealing with human sickness and patients who may be crabby and cranky is simply a fact of life for nurses. As nurse, you are able to help patients and give them a level of comfort and put them at ease. The world of nursing holds many possibilities. There are over 100 different nursing specialties available and there are plenty of ways to advance your career if you are willing to work hard. Since not everyone has what it takes to be a nurse, there are a lot of considerations when it comes to nursing and what your personality needs to be like in order to be a good nurse.

Here are four key questions to ask yourself.

1. How well do you cope with stress and emergency situations?

Nursing jobs can be stressful at times. If you are someone who can work well under pressure and copes well with stress, you will do well as a nurse.

2. Are you easily offended?

Nurses sometimes come in contact with patients who are hostile or unfriendly. Being easily offended can make your nursing job difficult and stressful quickly.

3. Do you consider yourself to never stop learning?

The field of health care is continuously changing, whether it is a new disease or recently discovered new treatment, nurses learn something new every day. Therefore, a good nurse is always ready to learn more.

4. Are you a team player?

Teamwork is essential in nursing to getting the job done right and improving the patient’s health. Nurses, who enjoy their job, work well with other team members.

Ambition in the Workplace: Millennial Nurses Drawn Toward Leadership, Higher Degrees, Professional Development

Ambition in the Workplace: Millennial Nurses Drawn Toward Leadership, Higher Degrees, Professional Development

Millennials are rapidly becoming the most predominant generation in the workplace, and in nursing they are driven to seek leadership roles, higher degrees, and professional development more than their generational counterparts.

The AMN Healthcare Survey of Millennial Nurses: A Dynamic Influence on the Profession, compares the views of Millennial nurses (ages 19-36) to those of Generation X (ages 37-53) and Baby Boomer nurses (ages 54-71) regarding their expectations about their work environment and career futures. The results show that Millennial nurses are bringing a dynamic new perspective on such factors as career, leadership, education, and work environment.

Millennial Nurses Survey infographic“Millennial nurses are changing the health care workforce in ways that could further improve patient care and help healthcare organizations,” says Marcia Faller, Chief Clinical Officer at AMN Healthcare. “This survey demonstrates the high ambition of this generation of nurses and provides better understanding about how health care leaders can fully engage these high-achieving health care professionals.”

The report shows Millennial nurses are not only interested in further educational attainment, but are actively pursuing higher degrees and professional certification. Nearly 40% of Millennial RNs said they plan to pursue a master’s degree in the next three years, while another 11% said they would seek a PhD. These responses were significantly higher than those of other generations.

As the health care industry faces an aging patient population needed more complex treatment, this push for increased levels of education will help fulfill the goal of a highly educated nursing workforce.

Since the health care industry is impacted by shortages of leaders as well as practitioners, health care organizations stand to benefit from the increased interest in leadership among Millennial nurses. According to the Millennial Nurse Survey, more than one third—36%—of Millennial nurses said they were significantly interested in leadership roles, compared to one fourth of Gen Xers and 10% of Baby Boomers.

Millennial nurses were also more optimistic toward leadership than their older counterparts.  When responding to positive statements about their leaders, across categories including how much they trust their leaders and whether leaders care about their career development, Millennial nurses more often answered “agree” or “strongly agree” than did Gen Xers and Baby Boomers.

Professional development has proven to be important to recruiting and retaining Millennials in all professions but may be especially important in health care, where workforce demand is high and the need for quality care and team collaboration is significant. In the survey, the majority of Millennial nurses agreed with the statement “the quality of patient care I provide is positively influenced by professional development opportunities.”

The full survey can be downloaded here.

From Public Health Advisor to Congressional Candidate: An Interview with Lauren Underwood

From Public Health Advisor to Congressional Candidate: An Interview with Lauren Underwood

Last issue’s health policy column highlighted nursing’s increased engagement in the public policy arena. To continue this conversation, this column highlights a registered nurse running for Congress to help champion access to affordable health care. Yes, Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois is running for Congress to represent the 14th Congressional District of Illinois.

Her Journey to Pursuing an Elected Position

Underwood is steadfast and fiercely committed to helping shape policies and programs focused on ensuring that everyone has access to affordable health care. She is a registered nurse who received her BSN from the University of Michigan and her MSN/MPH from Johns Hopkins University. Her nursing experiences include service as a health policy advisor, research fellow, senior director, and research nurse at the National Institutes of Health Clinical Center. Her passion for public policy was heightened while serving as a health policy advisor in the Office of the Secretary at the Health and Human Services in Washington, DC initially under the leadership of Secretary Kathleen Sebelius followed by the leadership of Secretary Sylvia Burwell. In this capacity, Underwood worked on private insurance reform, summary of insurance benefits, health care quality in the Medicare program, the Agency for Health care Research and Quality, and preventive services (free screenings, immunizations, and contraceptive coverage) for four and a half years from 2010-2014.

Lauren Underwood

Lauren Underwood, MSN/MPH, RN
Democratic Candidate for Congress, 14th Congressional District of Illinois

Tell us about working for the Obama administration.

Got a call the week that Mr. [Thomas Eric] Duncan was in the hospital in Dallas with ­Ebola asking if I would be willing to join the President’s team to help with disaster response, so I transferred over to ASPR, the Assistant Secretary for Preparedness and Response, at HHS. We worked on emerging infectious diseases (e.g., Ebola, Zika Virus, Middle East Respiratory Syndrome virus, or MERS), we also did national disasters (e.g., wildfires, hurricanes, floods) and then bioterror (small pox, anthrax) and worked with drug companies to develop vaccines, treatments, and diagnostics. I stayed in the administration until the very end, the last day. And so, when the election happened in 2016 we were working on the water crisis in Flint. I was surprised, and I thought that Hillary Clinton’s team was going to win and that we were going to hand off our work on health reform and on Flint to people who cared and wanted to continue the process. And then we got the Trump team who made it very clear they wanted to do away with health care coverage. And that’s not why I went into nursing or why I did this work. So, I knew I could stay in government and help them do that. I wanted to continue the work and so I came back home to Illinois because Illinois is a state that expanded Medicaid. I got a job working for a Medicaid managed care company in Chicago as the Senior Director for Strategy and Regulatory Affairs for a company called Next Level Health.

Are you still there?

I left my job about six weeks ago. The primary campaign was about eight months. I worked full time six and a half months; you know you have to do that. I am a young person, not someone of particular means or whatever, so it was necessary. And then it was like “Lauren, you could really win if you put your time and energy into the campaign.” And so that was an easy choice to transfer to full time.

So, you are now devoting full time to the campaign?

Yes.

This reflects your journey. Describe in a few words what really made you run for an elected position.

I am going to tell you a story. Last spring when I returned home, I went to congressman Randy Hultgren’s one and only public event. It was a moderated event hosted by the League of Women Voters. And during that evening, he made a promise and said that he was only going to support a version of Obamacare repeal that allowed people with preexisting conditions to keep their coverage. That’s important to me as a nurse. I also know how critical it is for people with chronic illness to have access to medications and procedures that they need. Obviously, I worked to implement the Affordable Care Act so I read the law and I know that it works. I know that we can fix what does not work. We do not have to throw the whole thing away. Like so many Americans, I have a preexisting condition myself. I have a heart condition, SVT (supraventricular tachycardia), and it is well controlled. As you know, it is a preexisting condition, so I would not be able to get coverage under these repeal scenarios. And so, when the congressman made that promise I believed him.

And then a week to ten days later he went and voted for the American Health Care Act, which is a version of repeal that did the opposite. It made it cost prohibitive for people like me to get coverage. And so, I was upset not at the vote itself, but because he did not have the integrity to be honest the one time he stood before our community. That’s not what a representative is supposed to do. A representative is supposed to be transparent, accessible, and honest. And we deserve better. I said, “you know what, it’s on! I’m running” and launched my campaign in August and just won the primary on March 20th. I was in a field of seven—the only woman running against six men—and I won 57% of the vote.

Were you the only African American?

Yes.

I know you are concerned about overall access to care and have a deep commitment to utilizing your expertise and experience while working in the Obama administration.

I believe that health care is the number one issue in this election across the country and in our district, and we need a solution to make health care more affordable for American families. It is not enough for families to rake together money for their premiums and have an insurance card in their pockets and cannot afford the coverage.

I believe that a lot of the conversation in the last several years has been political in nature and undoing President Obama’s legacy and not on at all focused on trying to lower costs and make health care accessible for American families. That’s my objective! I want to work on drug prices. I want to work on this opioid drug crisis so that loved ones can get the treatment that they so desperately need. And so, I believe there is a lot of value in having a nurse at the negotiation tables when we are making these decisions and passing policies that will transform our health care system. I am excited about the opportunity to be a leading voice on Capitol Hill on these important issues.

What do you think are the most pressing issues impacting nursing and health care?

Affordability. Any program that is starved of resources will fail. The ACA has been intentionally sabotaged and as a result, we see extraordinary high premiums that are unaffordable for most families. That is not how the program was designed to work and so I think there are technical fixes we can do to make the program more affordable. We can do things like negotiate drug prices, it can be done, we need to take a strong position on this opioid drug addiction crisis. We need to implement reforms like how we pay for rehab and how we award funds to municipalities in order to create a pathway for lasting change. And then there are opportunities to expand coverage so we will have fewer uninsured Americans. What we are seeing now in order to resuscitate it takes 2-3 doses of Narcan because the drugs are so strong. Municipalities who have received Narcan grants are running out of Narcan. A Narcan only solution is not a solution. Law enforcement only solution is not a solution. Addiction is an illness and we need to treat it as such. We need to send people to treatment so they can have a shot at recovery. We could have an evidence-based policy solution. We know treatment can be effective.

What do you think is the most pressing issue affecting nursing today?

I think there are a few things. The high cost of our education. We have not really seen increases in funding. What we have seen are marginal increases or flat funding. I think that this is unacceptable, in particular in the context of what we are seeing in higher education more broadly. And not just at the federal level. In higher education, many states have reduced putting money into public education, shifting the responsibility to families and individuals and with that coupled with flat funding for nursing education we are seeing a generation of nursing students with significant debt. And that is going to be a barrier, I believe, to our profession being able to grow. Right now, we have an economic situation where we are not seeing the shortage that we saw ten years ago. But it’s very easy to get back to that point if the economics of going into nursing shifts when you graduate from a BSN program with $100,000 in debt and are limited in your initial salary. Loan repayment programs are not that plentiful as they used to be. The economics of it makes it tough. Because we are talking about middle class folks who are not able to take on that debt. And when it is becoming increasingly attractive to become an APRN, that is all debt to be able to get the master’s to become a nurse practitioner or a nurse midwife. We are going to need some serious advocacy and a plan to deal with the cost of our education.

What are your thoughts about safe staffing?

It is so interesting. Safe staffing has been a legislative priority for decades. We have not been able to pass these bills. I think the approach needs to be more balanced with safe staffing committees in these hospitals. Moving away from these ratios and having hospitals have safe staffing committees that would take into consideration the circumstances that facilities and the region when staffing levels. On these committees, nurses would serve so a legislative body is not dictating it. I think that this is an appropriate approach coupled with compelling Medicare participating facilities to set staffing levels and monitor outcomes.

When elected, what would you do to go about helping to ensure equitable access to health care?

That’s like the question! For me, equitable access to health care allows everyone to get health care. Health care is a human right. Human rights have been fundamental to my nursing practice. It is written in our Code of Ethics—this idea that everyone should have health care—and I think our policies should reflect that. For me, that includes fixing the Affordable Care Act to ensure affordable coverage; and making sure we have clinics, hospitals, and facilities in communities so that the burden is not on low-income people or people with transportation challenges or resource limitations so that people are able to get the care and services they need. We have so much innovation, technology, and so many improvements now in a way we are able to provide care whether it’s telemedicine or individualized health care. It is a shame if all of that innovation and all of those improvements are seen in resource communities. We need to be focused in these conversations about reform and transforming our system to ensure that it is serving everyone—rural, urban, low income, and elderly.

What advice would you give to aspiring policy advocates who may be considering a run for public office?

Your country needs you! There are too few nurses in policy positions. Seek a County Board position. The County Board supervises the local Department of Health. Run for state legislator, they address scope of practice issues. Run for Congress! There are many opportunities to serve and lead. Step forward!