National Association of Indian Nurses of America Biennial National Conference

From the National Association of Indian Nurses of America’s second biannual national conference, held October 22 and 23, 2010, in Houston Texas. Pictured (from left) are the Executive Advisory Board: Vice President Ann Verghese, Secretary Lydia Albuquerque, Treasurer Ammal Bernnard, Past President and Advisory Board Chair Sara Gabriel, and President Omana Simon. The conference’s theme was “Transforming Health Care through a New Lens: Opportunities and Challenges.” Keynote speaker Jean Watson, Ph.D., R.N., endowed Chair in Caring Science at the University of Colorado, shared her vision of holistic caring in nursing practice.

The NAINA is a professional resource for Indian nurses, established in 2006 to address their unique professional, social, cultural, and political needs. It hopes to serve as the official voice of Indian nurses practicing in America and is currently working to “achieve acceptance and recognition among other associations like American Nurses Association (ANA), National Coalition of Ethnic Minority Nurses Associations (NCEMNA), Trained Nurses Association of India (TNAI), [and] International Council of Nurses (ICN),” says the organization’s mission statement. The NAINA is calling for Indian nurses to unite under the umbrella of the organization, particularly the state-level Indian nurses association found throughout the country, including California, Illinois, Massachusetts, Michigan, Florida, New Jersey, New York, Pennsylvania, and Texas.

The NAINA plans to promote political and professional awareness through its website,, and through newsletters and other publications.

Talking to Korean Parents about the HPV Vaccine

Nurses who care for the children of ethnic minority families often need to assess the parent or guardian’s perceptions of cultural and/or social topics to avoid misunderstandings. It’s an essential part of providing culturally competent care and has become a standard nursing practice. As a public health nurse in Fort Lee, New Jersey, where 20% of the population is Korean, I meet my community’s diverse cultural context daily.

During one of my clinic days, I suggested to a Korean mother, who I’ll call Mrs. K, that her 16-year-old daughter should receive the human papillomavirus (HPV) vaccine. I explained that HPV is responsible for most cervical cancers. Mrs. K wanted to know how the disease was transmitted, and I told her—by sexual contact. Mrs. K quickly responded, “What are you trying to say? My daughter does not have sex,” and I knew by her tone she was upset and offended.

According to the Centers for Disease Control, HPV is the most common sexually transmitted infection (STI) in the United States, with approximately 20 million people currently infected and six million new cases each year.1 As HPV is the cause of almost all cases of cervical cancer, it is considered one of the most preventable cancers in women. Currently two vaccines are in the market to prevent HPV: Gardasil® (Merck & Co., Whitehouse Station, New Jersey) and Cervarix® (GlaxoSmithKline, Brentfold, Middlesex, United Kingdom). These vaccines are licensed to be given to females between the ages of nine and 26 years old. However, to maximize the effectiveness of the HPV vaccines, it is important to vaccinate prior to the first sexual experience.2 

Despite living in a society infused with sexuality, the topic is still considered taboo with my patients, who are predominately Korean. I often encounter Korean parents like Mrs. K who have different perspectives and strong opinions regarding sexuality and communicating with their adolescent children. Korean parents tend to assume full responsibility for their children’s behavior and outcomes, and most are heavily involved in their child’s life, from going through daily routines to deciding on a college to even finding a spouse. Because the parents have that level of influence, it can be devastating to acknowledge that their child would partake in premarital sex.3 The Korean culture follows the ancient Chinese philosophy of Confucianism as well as Christianity, which highly regards family values and sexual innocence until marriage. Additionally, parental and adolescent sexual communication is rarely displayed in Korean families as they discourage premarital sex and it is not an open topic of discussion. Premarital sex among adolescents is stigmatized, unacceptable behavior, according to the cultural norms.4

Having been raised by first-generation Korean parents, I understand these ideas well. My parents still change the television channel when people kiss, and I can sense their discomfort when they see such things.

After speaking with many patients regarding HPV and the vaccine, the parents have expressed concern about the possibility of the vaccine encouraging an increase in risky sexual behaviors. Concerned Women for America (CWFA) says, “Giving the vaccine to young girls before they are sexually active provides them with a false sense of security, possibly leading to risky sexual behavior that would not have occurred had the threat of cervical cancer been present.” 5 When these statements are made to the general public, nurses struggle with the realities of HPV and cervical cancer. Parents will continue to show reluctance in having their elementary- or middle-school-aged daughters vaccinated against STIs. As educators and patient advocates, nurses can emphasize how the HPV vaccines prevent cervical cancer rather than the details of sexual behaviors.

A number of my patients’ parents have expressed an interest in obtaining more information about the HPV vaccination so that they can make informed decisions. The Centers for Disease Control and Prevention (CDC) has information about HPV, cervical cancer, and the vaccines in multiple languages, including Korean. These customized information campaigns target specific ethnic groups to help raise awareness. Providing these printable educational materials from the CDC made it much easier for me to present the necessary information to the parents without offending them. Although I may have offended Mrs. K initially, she returned with her daughter to get the HPV vaccine series after reading the information in Korean. Korean parents may not be entirely confident about talking to their children about sex, but the parents should still be educated about when and how to talk to their children about sexual issues. Sex will become less of a taboo by simply accepting it as a part of life and talking about it openly in a family setting.


  1. Markowitz, L. E. et al, Quadrivalent human papillomavirus vaccine: Recommendations of the advisory committee on immunization practices (ACIP), 2007. MMWR Morbidity and Mortality Weekly Report 56, 1-24.
  2. Saslow, D. et al, “American Cancer Society guidelines for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors,” 2007. CA: A Cancer Journal for Clinicians, 57, 7-28.
  3. McGill, B. (2003, March 14). “Changing attitude toward sex threatens South Korean.” Growing promiscuity, lack of education may lead to increase in AIDS, experts say. The San Francisco Gate. Last modified on March 14, 2003
  4. Cha, E. S., Kim, K. H., & Doswell, W. M. (2007). Influence of the parent-adolescent relationship on condom use among South Korean male college students. Nursing and Health Sciences, 9, 277-283.
  5. Concerned Women for America. (2007). “The truth behind the HPV vaccine: Here’s what you need to know.” Last modified on June 2008
Internship Japanese Style

Internship Japanese Style

It’s not uncommon for college students to participate in an internship-type program prior to graduation. However, it is highly uncommon to experience that internship with one of the leading experts in your field of study. But that’s exactly what happened to Yuko Gilbert, an international student from Tokyo, Japan, during her senior year of nursing studies at Alfred State College in Alfred, N.Y.

Gilbert, who like all other nursing seniors was required to do a pediatric observation sometime during the final semester of the two-year program, decided she would like to lighten her obligations by doing the observation during a holiday break. Other students had done this in the past, says Linda Panter, associate professor of nursing and Gilbert’s lead teacher for her final semester at Alfred State, but the observations are usually done in the United States. Gilbert wanted to do hers at home, in Japan.

Gilbert & KawasakGilbert & Kawasak

Well, why not? Once the school had determined that there really was no reason not to allow an out-of-state observation–or in this case, out-of-country–then it was simply a matter of finding the right place in Japan to do it.

Gilbert, the daughter of a Japanese mother and American father, began by asking her mother, her friends and her mother’s friends if any of them had a personal connection to someone back home who specialized in pediatrics. After a flurry of phone calls and emails, the husband of a friend came forward. He was a full-time translator who had worked with Dr. Tomisaku Kawasaki in the past. Kawasaki, a pediatrician, is world renowned for his 1967 discovery of a childhood disease, known as Kawasaki disease or syndrome. Would Yuko like to do her observation with Dr. Kawasaki?

Following another flurry of letter writing and emails, it was all set. Gilbert had an appointment with the famous doctor, now 78 years old, on December 29, 2003, at the Kawasaki Research Center.

Meeting the Master

As she made her way over to the research center, Gilbert was “a little nervous,” even though the family friend and her husband, the translator, accompanied her. When they arrived, Dr. Kawasaki opened the door himself and they shook hands. They spoke in Japanese, she says, “about everyday things.”

What surprised Gilbert the most was how patient, relaxed and down-to-earth he was. “The interview went very well,” she recalls. “We talked a lot.” The young nursing student had not expected the doctor to be such a humble and modest gentleman. “I was impressed with how he went over case studies and reports,” she says. And if she needed a copy, “he walked over and made the copy himself.”

When it was time to leave, Dr. Kawasaki handed Gilbert a handwritten note. She was scheduled for her observation with him on January 6, 2004. “I was so delighted,” she says.

Gilbert & KawasakiGilbert & Kawasaki

On the scheduled day, she met Dr. Kawasaki at the Ushiku train station. Together they continued on to Tokyo Hospital, where they first stopped at the cafeteria for two cups of coffee; the doctor had sandwiches in a bag. Gilbert offered to pay. Dr. Kawasaki said she could buy him a cup of coffee when he visits New York.

Gilbert remembers that day well. “I knew he was very famous and I guess I was expecting someone arrogant or reserved,” she says. “But he was like a grandfather–gentle, very kind.” He was the same during interactions with his patients, she adds. The only difference was that he wore a white doctor’s coat. He shook each patient’s hand.

She observed how Dr. Kawasaki interacted with a mother and her son. He asked the boy to take a deep breath, then told him what a good job he had done. He calmed the mother, who was anxious.

Gilbert explains that the medical system in Japan is set up so that anyone gets to see a doctor, inexpensively. But that system leads to a lot of “abuse” in that sometimes a doctor’s visit isn’t really necessary. She estimates that Dr. Kawasaki saw 25 to 30 patients from 2-5:30 p.m. and sometimes his caseload reaches 60 patients in a single afternoon.

Dr. Kawasaki’s professional motto, Gilbert learned, is: “Medical Treatment with Warmth and Compassion. Medical Science with Discipline and Strictness.” She interprets this as meaning that the medical field is like a lifelong boot camp where you work very hard training, studying and polishing your skills. Then, when you are ready to implement that knowledge, it should be done with warmth and compassion.

“I asked Dr. Kawasaki what nurses meant to him,” Gilbert adds. “He replied, ‘They are my trusted partners.’”

She then asked what advice he would give to her nursing class. “A little teary-eyed, he replied, ‘Love…and then the medical skills to back this up. Get your hands dirty, don’t just observe but do. Seeing is believing, but doing is what will give you the needed skills and experience.’”

Discovering an Asian Health Disparity

What exactly is this Kawasaki disease that led to the doctor’s fame? Although the illness had probably existed for a long time, it was Dr. Kawasaki who singled it out as a separate entity. It is a children’s disease characterized by fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips and throat. The condition may also affect the linings of blood vessels and the heart muscle, possibly leading to aneurysms and heart attack. Damage to the coronary arteries in childhood may increase the risk of heart attack in adulthood.

The incidence of Kawasaki disease is higher in Japan than in any other country. In the United States, it is more frequent among children of Asian-American background but can occur in any racial or ethnic group. The disease is relatively common, and in the U.S. it is a major cause of heart disease in children. Kawasaki disease almost always affects youngsters; most patients are under five years old, and the average age is about two years. Boys develop the illness almost twice as often as girls.

The cause of Kawasaki disease is unknown. It does not appear to be hereditary or contagious. Because the illness frequently occurs in outbreaks, it is believed that an infectious agent, such as a virus, is the likely cause.

Building Bridges Between East and West

Panter says Gilbert’s unique pediatric clinical observation went very well and resulted in a wealth of information and networking opportunities, which the nursing professor plans on using at Alfred State College in the future. For example, she and Gilbert are investigating the possibility of videoconferencing and long-distance lectures through universities and other institutions in Japan.

“Yuko is going to climb the professional ladder quickly, and without doubt she will be making outstanding contributions to a profession she cares deeply about,” Panter adds.

Gilbert’s precedent-setting internship in Japan has also opened the doors for other international nursing students at the college to do clinical observation assignments in their homelands.

“This [meeting with Dr. Kawasaki] would not have happened if Yuko had not mentioned she wanted to do the assignment over break but did not think it was possible,” says Panter. “It started out as an idea, a wish she thought would never have come true–but it did! Implementing the dream only took encouragement and a nursing student who had the ability and energy to follow through.”

“Never did I think this interview with Dr. Kawasaki would become a reality,” Gilbert agrees. “I thank all the people who were involved in making this wonderful encounter happen.”

What will she remember most about the whole experience? “Dr. Kawasaki is a great doctor with immense knowledge and experience,” she says, “but he is also a person with compassion, warmth, wit, empathy, modesty and love for people–all the things I hope to embody as a nurse.”

The future for Gilbert is bright, combining both the Eastern and Western sides of her cultural heritage. “My father was originally from Hornell, N.Y. [near Alfred], and my favorite aunt and uncle both live near the area. I’ve always loved the United States and I have been blessed with growing up in two very different heritages. [After spending my early years in Japan], I hope to spend the next half of my life in my father’s county, pursuing nursing as my second, lifelong career.” She had previously been working in the computer industry, involved in legal service contract management.

Gilbert graduated from Alfred State College in May 2004 and received the Loretta M. Smith Verbal and Written Scholarship in Nursing at the college’s honors convocation. In early summer, she studied for the NCLEX-RN® exam, which she passed. She then returned to Japan to reapply for a new student visa. The process took months. Gilbert returned to New York State in mid October and has since interviewed for several nursing jobs, ranging from a large facility in Buffalo, N.Y. to a small rural hospital in Pennsylvania.

Several days prior to her return to the U.S., Gilbert visited her “friend,” Dr. Kawasaki, conversing for some two hours. “I thanked him for my past interview/observation and reported about my graduation from the nursing program and passing the boards.”

Both Gilbert and Panter hope to someday welcome Dr. Kawasaki to the Alfred State College campus where he could share his years of wisdom with the medical community and aspiring medical specialists. And Yuko Gilbert would finally get her chance to buy him that cup of coffee.

Internship Japanese Style

Enter the Dragon Boater

For over 30 years, Christine Yee, RN, has worked as a nurse in the neonatal intensive care unit at Kaiser Permanente in Oakland, Calif., and in the pediatric clinic at Kaiser Richmond. In recent years she had witnessed an increase in the number of young patients suffering from chronic conditions such as diabetes and asthma, and she wished there was another way to help improve their health.

She found the solution five years ago, when she offered to teach a group of Bay Area youths, ages 13 to 18, the basics of dragon boating.

Dragon boat racing is an ancient sport that began over 2,300 years ago in China. Generally, each dragon boat team has a crew of 20 paddlers, a steersperson and a drummer, who beats out a rhythm on a large drum to help the paddlers synchronize their strokes. The boat itself is a 45- to 48-foot canoe weighing from 500 to 1,200 pounds and adorned at the bow and stern with a colorful carved dragon head and tail. Today, dragon boating is one of the world’s fastest-growing sports and is practiced in more than 35 countries.

Yee was introduced to dragon boating 10 years ago by a friend and immediately became addicted to it. “I was hooked from the first day,” she says. “It’s a fantastic sport.”

Yee’s team participates in races from March through October of each year. In addition to local competitions, the team travels to Portland, Ore., and Southern California to compete in races there. This year, they’ve added the Hawaiian dragon boat races in Honolulu to their schedule. The team members meet twice a week for regular practices.

“In a race, we always dress our boat with a head and a tail,” Yee says. “Our boat was built in Vancouver and an artist paints each head differently, so we have a unique dragon boat head.”

Although Yee is very athletic and has long enjoyed physical activities like hiking, dancing, scuba diving and backpacking, she admits she wasn’t initially prepared for her first dragon boat race. “It was a grueling experience, because my first dragon boat team was not properly instructed in how to paddle,” she recalls. “After that first race, we began to learn correct paddling techniques.”

For the dedicated dragon boat racer, the commitment to proper paddling technique is always evolving in the search for the perfect stroke. Team members are supportive and camaraderie is quickly formed.

“Being out on the water refreshes the mind after a hard day at work,” Yee adds. “It is a great way to beat stress.”

Teaching Teamwork

Yee soon realized how dragon boating could benefit the health and overall well-being of many of her young patients. Five years ago, she began volunteering to teach local teenagers the fundamentals of dragon boating. Last year, Yee was presented with a Jefferson Award for Public Service for her ongoing work mentoring Bay Area youths.

“The experience of dragon boating has had such a positive impact on my life that I knew it could also be a positive experience for teens,” she says. “For some of these kids, this is their only regular form of exercise.”

To date, Yee has introduced over 100 youths to the sport. Some of them are at-risk kids from disadvantaged backgrounds who learn the importance of hard work, mutual respect, cooperation and pulling together to work as a team. Others come from immigrant families. Yee cites statistics showing that many immigrant youths are fighting chronic health conditions or are at risk for obesity.

“Dragon boating requires upper and lower body strength and can be very challenging as all 20 paddlers attempt to synchronize their strokes and then increase their endurance and power,” she says. “It’s exciting to see the teens develop as a team and form friendships and camaraderie that is so important at this time in their lives.”

Yee’s dragon boating teammates help out by providing the necessary equipment and volunteering their own time to help coach the youths. “The kids are so inspiring,” Yee says. “They come from so many different cultural and socioeconomic backgrounds, and it’s such a great opportunity for them to learn how to communicate with one another and how to work together.”

While she admits to being shy and reserved, Yee feels that dragon boat racing has helped to make her more assertive. Dragon boating, she says, is about more than just what happens on the water. It also stresses teamwork on land.

“We are encouraged to stay in shape by continuing to do aerobic exercise and weight training. Team members are also encouraged to be friendly with competing teams and to show good sportsmanship,” she explains. “I’m used to doing athletic activities by myself, but dragon boating taught me how to be part of a team.”

Christine Yee (standing) steers her teams dragon boat in a race in Long Beach, California Christine Yee (standing) steers her teams dragon boat in a race in Long Beach, California.

Even an injury couldn’t prevent Yee from participating in the sport she loves. Three years ago, she broke her shoulder and may need additional medical procedures. While she has not been able to paddle, she now stands at the back of the narrow boat and steers her teammates to victory.

Her enthusiasm and prowess for the sport recently earned her an invitation to the 2008 Club Crew World Championships in Penang, Malaysia, to compete as part of a women’s master (over 40) dragon boat team.

“I hope to continue dragon boating for years to come,” she says. “It’s inspiring to see people who are well into their 80s continue to enjoy this sport.”

Boomer in Chief

As the youngest and first Asian American president of AARP (formerly the American Association of Retired Persons), Jennie Chin Hansen, RN, MS, FAAN, embodies the changing face of this important advocacy organization and its 40 million members, one-third of whom are baby boomers.

Hansen, who is 59, was elected to her two-year term as AARP’s president in May 2008, bringing with her a wealth of expertise in health care and aging issues. According to her official AARP bio, she teaches nursing at San Francisco State University, holds an appointment as senior fellow at the University of California San Francisco’s Center for the Health Professions and is a past president of the American Society on Aging.

Hansen also spent nearly 25 years as executive director of On Lok, Inc., a not-for-profit family of organizations providing community-based health care and other social services for seniors in culturally diverse California communities. On Lok was the prototype for PACE (Program of All-Inclusive Care for the Elderly), which was signed into federal law in 1997, making this Medicare/Medicaid program available in all 50 states.

“I think I am probably the first nurse in this position [of AARP president] in 25 years,” Hansen says. “It is a tremendous honor and a tremendous responsibility.”

Hansen grew up in Boston, the daughter of parents who were immigrants from China. “Being very bicultural—my first language was Chinese—I bring [to AARP] a mindset that is able to [understand and work well] in a diverse, complex community,” she says. “There are many ways to look at life and living. I think [having a multicultural background] allows you that perspective, because you realize that you are always moving in multiple communities.”

In an extensive interview with Minority Nurse in early March, Hansen discussed several health care-related AARP initiatives and her goals for her presidency. Here are some highlights of that conversation.

Q: During the course of your nursing career, you went from community nursing to rural nursing to being a nurse advocate. How have these roles helped you in your current position at AARP?

I think one of the things you learn [in community nursing] is that when you are [working] outside of an institution, such as a hospital, people look at health and well-being a little differently. I think I am quite grounded in understanding the professional knowledge that we bring but also how people want and use information to maintain their well-being or to address their illness. That approach applies in rural health as well.

Growing up in a Chinatown community, I learned that you need to understand core values and help people view what is important in their lives. When you do that, it really informs how you help do community building or do advocacy. It is not something that is [done] top down. It is really about what matters to people at the living edge, as I call it. So you need to bring [everything] together in ways that make sense from a policy perspective, but it also has to make sense to people whose lives are directly affected by policy.

Q: What led you to AARP and your current position?

When I was president of the American Society on Aging, one of our board members was the [then] director of AARP’s Andrus Foundation, so we were colleagues. He was interested in recruiting members for [the foundation’s] board who would bring a different point of view that would help both the foundation and AARP itself begin to think more broadly.

I was actually brought in as an independent member of the board [in 2000] to add to the mix of what the core board offered. From that, I became part of the AARP affiliated family and was then invited to apply for a position on a larger AARP board.

Q: When you became AARP’s new president last year, you highlighted three core themes: the roles medications play in older people’s health; fall prevention; and encouraging important conversations about such issues as end-of-life preferences. Why those three themes?

It relates back to AARP’s current Divided We Fail joint initiative (, which focuses on bringing the country together [to develop bipartisan solutions] for ensuring affordable, quality health care for all Americans, and also long-term economic security. This [initiative is a partnership between] the business community, the labor community and AARP, along with other independent organizations.

Since I am a nurse, I am focusing a little bit more on the health side, but [my approach also involves] showing how [health care] ties in to economic security, both for individual people and the country. We need to make these issues tangible and not political, bringing it down to specifics that regular people can do something about, regardless of [which political party is in power]. These are three themes that I think people can relate to.

People over 45 years old take, on average, at least four medications apiece. Medications are an important part of our daily lives. When we do not take them correctly, it costs money and it creates [health care] quality problems. The theme of medication is an important one to me. If people go into the hospital and then go home and do not take their medication correctly, they end up back in the hospital.

The second point was about falls. One in three people over the age of 65 will likely fall in a given year. This is the biggest cause of injury for older people. Half of the people [in this age bracket] who break a bone will die within the following year.

Half the falls that happen to older people happen in their own homes. This is an example of how we can use evidence-based practice [to create practical solutions]. The evidence from the Centers for Disease Control and Prevention tells us that there are simple things people can do to prevent falls from happening: make sure there are better light bulbs, that there are not slippery rugs in place, that electric wires are not crossing areas where people walk. They can also learn to do some exercises that strengthen trunk balance and prevent falls.

These are well-known strategies that involve little or no cost. So this is an area where we can use proven research and apply the [data] in our daily lives to enhance the quality and safety of living and save money.

The third theme is about how much money both individuals and the country spend on the last year of life for people. Oftentimes it doesn’t produce the quality or value that people really wanted. We spend more money on health care during the last six months of life than we do in our entire lifetime. Is that really the best use of our precious resources?

We need to focus more on having conversations [with loved ones about end-of-life care planning] because we all know how much angst occurs when a loved one goes into the hospital. Often family members have not had those conversations about the important changes that happen as we age. We need to bring our families together and have some of these conversations at a time that is not an emergency, because only in America do people think death is an option.

Q: How much support has there been for the Divided We Fail platform and how has it manifested itself?

Our core partners include the Business Roundtable, the National Federation of Independent Business and the Service Employees International Union. In addition to the big players, we have more than 100 independent groups that have joined in to pledge their support as well. On the legislative side, nearly 360 members of the last Congress have signed the pledge or written a letter of support on [the initiative’s] behalf.

[This year] we will host more than 50 events in nearly every state to educate the public about the contemporary issues of what is going on in health care reform and economic security. Part of this will be done through the globalization of town hall meetings, especially during this first Congressional recess, so that constituents and their lawmakers can really connect and discuss [these issues] directly. We will collectively present to the lawmakers the 1.6 million pledges that have been signed by people across the country, asking for this above-partisanship focus by our policymakers.

There are three particular policy areas we will focus on:
The first is access to health insurance coverage. We will try to build on the existing employer-based system while also thinking about other ways to provide coverage for people who are currently not insured. We all have a personal responsibility to make sure we have some good choices and participate in coming under the health care umbrella.

Second, we are looking at improving health care affordability, value and outcomes. Part of this includes a focus on preventive care programs, which again emphasizes the personal opportunity and responsibility people have.

Also, we need to address how poorly advanced our health care system is in the area of technology. We are focusing collectively on that to make sure the electronic highway system of communication will be built to help improve the quality of care and decrease health care costs.

We also need to make sure that the system rewards evidence-based care—in other words, not just [doing something] because somebody thinks it’s the best way, but [because it’s based on proven clinical evidence].

We need to make sure that care is coordinated. Older people who have multiple chronic diseases see anywhere from 10 to 14 doctors a year. We want to make sure that more effort is put into place to ensure that one doctor doesn’t inadvertently prescribe something that [will cause a negative interaction] because [they don’t know that] another doctor is treating that person with a different medication. Coordination of care is so important to make sure we are aligned together for good outcomes.

The third area is increasing quality and efficiency and making sure that we think about it from a patient-centered standpoint, so that the patient is not shunted around from place to place and the delivery of care is smoother and well-coordinated on behalf of that individual

[We also need to] compare the effectiveness of different treatments. Sometimes medication may be more effective than surgery. This kind of research really needs to be done and promoted and used. Divided We Fail [calls for] increasing comparative effectiveness in all parts of the health care system and making sure that the public [can access and understand] this information.

We do know there is a lot of money in the health care system—over $700 billion every year, according to the Congressional Budget Office—that is not being used well. Beyond the need for new money, there is money in the system already that can be better used on behalf of coverage and on behalf of quality.

Q: Another joint initiative AARP is involved in, along with the AARP Foundation and the Robert Wood Johnson Foundation, is the Center to Champion Nursing in America (, which is addressing the nursing shortage as well as the shortage of nursing faculty. Last month the Center, in collaboration with the Health Resources and Services Administration (HRSA) Division of Nursing and the Department of Labor (DOL), convened a national Nursing Education Capacity Summit, which brought together teams from nearly all 50 states to discuss solutions to the nursing shortage. What came out of that summit?

What we are doing is aligning all the efforts [across the country, including sharing] of some of the best practices that have been implemented in some of the states. We have states that have signed up to [share information] at the ground level about what some of the best practices are and facilitate the forming of coalitions to bring that about [on a national level].

We are bringing together [representatives from DOL and business], because [they are stakeholders too; we have to] make sure we have a nursing workforce. And we are also bringing in other foundations [that are concerned with aging issues] to try to make sure that not only are we [increasing the number of] nurses in general but also addressing a particular need for nurses to know about [the health care needs of older people] and the complexity of those needs, such as having multiple chronic diseases. This follows on the heels of the [2008] Institute of Medicine report Retooling for an Aging America: Building the Health Care Workforce.

This initiative is also helping to support [health care-related provisions in] the
current economic stimulus bill to make sure that not only is the government
funding nursing education but also education for all [the many] health professionals that are going to be needed for elder care in the future.

So the summit helped bring all of these efforts together to say that this is a national problem and we need advocacy, practice and new ways to think about the care of older people in America.

Q: What are the goals of the Center to Champion Nursing in America?
One of its objectives is to help support the infrastructure for increasing the number of nursing faculty. Without more faculty, thousands of people get turned away [from nursing schools, because there are not enough nursing educators to teach them].

The second goal is the whole aspect of retaining nurses. This especially speaks to people who are middle-aged nurses. Are there ways in which we can help in retention of existing, practicing nurses?

Number three is the ability to advance nurses further into leadership roles, so that they can help represent our profession throughout larger organizations and foundations [that can help shape health policymaking]. We are the largest health care workforce in America. There are nearly 3 million nurses in America right now [compared to] about 750,000 physicians. The contribution and voice [of nurses] to help shape where health care is going to be in the future is an important part of having nurse leaders embedded in the country.

Q: Even though there are 3 million nurses, people of color are very underrepresented in the RN workforce. In your personal opinion as a minority nurse, what can be done to attract more minorities into nursing?

I think having nurses of color as faculty , but there also has to be a focus on providing [more] educational opportunities for [future minority] nurses, such as [bridge programs] that align community college programs with baccalaureate programs. Many students who are immigrants or people of color might find it easier to start with a community-college level of access, so we need to ensure that there is an open pipeline that can lead them to more advanced nursing credentialing, such as bachelor’s and master’s degrees. Some people may find that starting with a BSN program is prohibitive economically. So it may well be that [putting more emphasis on] community colleges as a beginning venue, especially in large urban areas, might be one opportunity to increase the pool of [minority] nurses.

Given [America’s] diversity and the known health care disparities, it is so important to have a workforce that reflects the population.

Q: President Obama’s Health Summit is happening this week. The president is proposing a $634 billion down payment on health care reform. What are your thoughts about what is happening at that summit right now?

One great thing is that all the input and constructive thinking is open and on the table, so we know we agree to these core principles and that there are many ways to approach this. The openness to different ideas that may be delivered is extremely promising. We are recognizing that the need for health care reform is a problem for the whole country, not for one party or another, not for one sector or another. I think if we are able to hold that [inclusive, non-partisan] tone, some give and take will occur. The bottom line is that we have to protect the country’s economic security, and that is so tied to health care security. We have to spend the money, invest in it, but spend it well.

The fact that insurance companies and businesses, as well as advocacy groups [are all coming together and] saying we are committed to change is a very different space to be in than we had back in 1993-94, which was the last attempt at health care reform.

Q: Is there anything else you’d like to add?

This is such an important opportunity for minority nurses and students to become active in thinking not only about the clinical care we give and the research that is in our field, but about the economics, politics and policy issues. It is a time when we need to raise our own bar in understanding both how we fit into the picture and how we can lead the country.