From the Bedside to the Halls of Congress: Our National Nurses

From the Bedside to the Halls of Congress: Our National Nurses

Outside a dining room in the Longworth House Office Building on Capitol Hill, I asked Congresswoman Karen Bass of California how nursing prepared her for service in Congress. Her response was quick: “Good bedside manner.” But she has had only three terms to hone those skills to propose, advocate, or deliver legislation that impacts the field of her choosing. Not so for Congresswoman Eddie Bernice Johnson of Texas. She is an accomplished nurse, administrator, and legislator covering 23 years in Congress and 60 years as a nurse. I recently visited with them both and gained a fresh perspective on their experiences as nurses in Congress, as well as a candid reflection on the issues currently afflicting our country.

Congresswoman Johnson set her mind on becoming a nurse as a teenager, but in 1952 no nursing program in Texas would accept her, so she applied and was admitted to St. Mary’s College in Notre Dame, Indiana, graduating in 1955. She holds the BS degree in nursing from Texas Christian University, and in 1976, she was awarded the MPA degree from Southern Methodist University. Ten years into her nursing career at Veterans Affairs (VA), she was appointed chief psychiatric nurse at the VA Hospital in Dallas. In 1977, she was appointed regional director of the U.S. Department of Health, Education, and Welfare.

Before her election to Congress, Johnson served as a member of the Texas State House of Representatives from 1972-1977 and a member of the Texas State Senate from 1986-1992. She was elected as a Democrat in 1992 to the 103rd Congress and is in her 12th term representing the 30th Congressional District. In December 2010, she was elected as the first African American and first female ranking member of the House Committee on Science, Space, and Technology, a standing committee of the U.S. House of Representatives. Additionally, she was the first African American female to serve as chairwoman of the Subcommittee on Water Resources and Environment during the 110th and 111th sessions of Congress. Her name is attached to several pieces of legislation. Her office in the Rayburn House Office Building impresses visitors who can clearly see what seniority provides.

The author (left) sharing a copy of Minority Nurse with Congresswoman Eddie Bernice Johnson

James Daniels: Mrs. Johnson, your accomplishments are impressive and even astonishing. Your firsts set you apart as a genuine trailblazer. You are the first woman ever elected to represent Dallas in the U.S. Congress. You are the very first chief psychiatric nurse of Dallas; first African American elected to the Texas House of Representatives from Dallas; first woman in Texas history to lead a major committee of the Texas House of Representatives; first African American appointed regional director of U.S. Department of Health, Education, and Welfare; and the first female African American elected from the Dallas area as a Texas senator since Reconstruction. Your crowning accomplishment, however, is as the first nurse elected to the United States House of Representatives.

Congresswoman Johnson: And I hope I won’t be the last!

Daniels: You are clearly regarded as a pioneer because of all the firsts you have accomplished. What does this mean to you? How do you handle that?

Johnson: I never think about it until someone brings it up. I don’t see it as extraordinary. I see it as opportunities that appeared, and I took advantage of them and was fortunate enough to get elected. It has not been easy because I was the first. As a matter of fact, it has probably been more difficult because of that.

Daniels: What motivated you to enter politics coming from a stellar career in nursing?

Johnson: When I was first approached about running for office, I thought it was a joke. All of the women I spent most of my volunteer time working with were mostly white at that time. The judge that gave Lyndon Johnson the oath of office, Sarah T. Hughes, was the one who pushed it, and along with others, encouraged me. It was the white community that persuaded Stanley Marcus [Chairman of Neiman Marcus] to give me a job because I was working for the government at that time. My African American community had to be brought along because they thought what I was doing was a man’s job.

Daniels: So, you were a pioneer.

Johnson: I guess so! My campaign was run out of my garage and my dining room. Not until I went into a run-off against my opponent did my African American women bring their support. After I won, everyone became my friend.

Daniels: You could not get into any university in Texas to obtain your nursing degree.

Johnson: There was no nursing degree program in Texas [in 1952] with national recognition that I could attend. This was before the University of Texas opened [its doors to black students]. It was before Baylor or Texas Christian opened, so that’s why I went out of state. The colleges [in Texas] were not integrated at that time.

Daniels: Growing up, did your parents influence you to achieve? What role did your parents play?

Johnson: My parents played a very key role, because education was number one for them. They thought it was very important. My grandmother was a teacher and went to Prairie View College. My father finished high school but did not want to go to college. He wanted to be a businessman. I watched them as examples.

Daniels: You’ve been here since 1993. What do you isolate as high points during your tenure?

Johnson: My high point was my first two years. Bill Clinton was president and we [Democrats] had a majority, and I had a chance to work very closely with the president in an environment where we were in the majority and with others who thought just the way we did. It lasted two years. This is my 23rd year and I’ve been in the majority six of those years. What I’ve learned during that time is to keep focused on my work and set the goals of what I was trying to achieve and just keep my attention on that. I have been able to get monies for research, and monies for transportation projects of all kinds. I always saw this as an opportunity to make things better at home. When I look back over my achievements, it feels pretty good.

Daniels: There are six members of the House of Representatives who are nurses. Do you ever find common ground on any legislative issue?

Johnson: Well, some. Four of us are Democrats. Unless I look on the roster, it is hard to tell who are nurses from the Republican side, primarily because they are governed from the top. Many things that we try to do—if they do not get permission to do it they will disappear on you.

Daniels: Some of your nursing background includes time with the VA. What do you think of the state of affairs in the VA?

Johnson: Most of my nursing career was at the VA. It needs great improvement. I didn’t blame the secretary [of VA]. It is that layer of management right under the secretary who has gotten their buddies in these hospitals, and it is fueled by retaliation if anyone complains. Until that is broken we will never get to solve the problems of the VA. People are so afraid if they report something because there is going to be retaliation. It’s a very bad situation.

Daniels: Do you think the president is on top of it?

Johnson: The president is trying. We appropriate enough money for every veteran to get first-class care. Care is not being given to the veterans as this point.

Daniels: Do you think Hillary Clinton is going to be the Democratic Party’s standard bearer?

Johnson: I don’t know, but if Hillary runs I will support her and will give it all I’ve got to see that she becomes president. I’ve known Hillary before she married Bill Clinton, so I know her very well.

Daniels: What’s the whisper regarding who is the likely Republican candidate?

Johnson: I have not seen too many Republican candidates that I liked—and I never thought I’d say this—the one that I liked, compared to the rest of them, was [George W. Bush] I never ever thought I’d say this. He was fun to work with, easy to talk with, he was accessible. He was more accessible than Obama is. Listen, when he called me and told me he would run for governor [of Texas], I said, “You what?” I asked him, “What made you decide to run for office?” He loved to have fun. He loved people. He still loves people. When he was in office he was a people person. I remember I called him to tell him I needed his support on the Water Resources Development bill I sponsored [in 2007]. I told him it’s to make sure there is no flooding of the Trinity River. I said, “Are you going to move back to Dallas when you leave the White House?” He said, “If I can find a house I can afford.” I said, “I just need your address because I want a trench from the Trinity to your front door so you’ll be the first to know when it floods.” But that’s the kind of relationship we had. We have the same relationship now.

About this time in our conversation, Johnson’s director of communications, Yinka Robinson, signaled that Johnson had another engagement. I thanked her for her time and invited her to take some photos with me. As she did, she leaned towards me and said, “I wish I had time to tell you what it was like to be the only black student at St. Mary’s. Perhaps we could do that at some later time.”

Congresswoman Karen Bass grew up with three brothers in the Venice/Fairfax area of Los Angeles and is the only daughter of DeWitt and Wilhelmina Bass. In 1990, she graduated from California State University, Dominguez Hills, with a BS in health sciences and certification as a licensed vocational nurse. She completed the University of Southern California’s Keck School of Medicine Physician Assistant Program, and for nearly a decade, worked as a physician assistant (PA). She also served as a clinical instructor.

Prior to serving in Congress, Bass made history when the California Assembly elected her to be its 67th Speaker, the first African American woman in U.S. history to serve in this powerful state legislative role. Bass serves on the House Committee on Foreign Affairs where she is the ranking member of the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations. As a member of the House Judiciary Committee, she is also working to craft sound criminal justice reforms as well as protect intellectual property right infringements that threaten the economic health of the 37th Congressional District she represents.

Bass’s office is in the Cannon House Office Building, but she is on her way to a luncheon with the Congressional Black Caucus and pauses to chat with me.

The author (left) interviewing Congresswoman Karen Bass

Daniels: You are the first PA ever elected to the Congress, and the first African American and woman elected as Speaker of any legislature in the United States. Does that give you a sense of pioneering?

Congresswoman Bass: No, it gives me a sense of enormous responsibility. I am happy to step up to that responsibility, but it definitely is a big responsibility.

Daniels: You leaped past nursing to obtain credentials as a PA. Why did you do that, and what drew you to the role of the PA?

Bass: When I was a nurse, the pathway to be a nurse practitioner was very, very long. I was a licensed vocational nurse. The pathway to be a PA was much more direct. And in those years I had originally started out to be a PA. But the PA profession was very new, [so] you had to be another profession first.

Daniels: Looking at your nursing and PA careers, how do they inform you to be an effective legislator?

Bass: Well, you know bedside manner can apply in a lot of different places. [Uproarious laughter.] And bedside manner in the political context is called diplomacy. As a PA, I worked in the emergency room, and when I was a nurse, I worked in acute care—both life and death areas—and that type of responsibility and pressure make this pressure seem a lot easier. It gives me a level of calmness in the midst of crisis that other people might not share.

Daniels: Now there are six nurses in Congress. Do you ever collaborate or find common ground with those on the other side of the isle?

Bass: Yes, as a matter of fact, Diane Black [Tennessee Republican Representative] and I are working on child welfare issues. We are both co-chairs of the Child Welfare Caucus. We know each other! It might not be nursing issues per se that we are working on, but it certainly is human service issues.

Daniels: I like what you just said about equipping you with good bedside manner. Does that say you use a lot of touchy, feely ways to persuade support for legislation you are advocating?

Bass: Absolutely.

Daniels: Tell us about your work on behalf of the foster care issue in the country.

Bass: It’s one of those issues that bring Republicans and Democrats together. The basic premise is that for kids who do not have families, who don’t have parents, it becomes the responsibility of government to take care of those kids. And we should take care of those kids as we would take care of our own. Those are the values that underlie the work that I do on child welfare.

Daniels: Do you run up against Republicans who believe this is just another government overreach?

Bass: No, no, I don’t at all. Diane Black is a Republican and she is the co-chair of the committee. This is an area where members of Congress come together because most of the members of Congress are parents. When it comes to juvenile dependency, kids who are without parents, people are a lot more open.

Daniels: About your work on behalf of Africa, do you see a movement towards democracy and the establishment of democratic institutions?

Bass: Absolutely. The big issue in Africa right now from the perspective of minority nurses is the reason why the Ebola crisis happened. The health infrastructure in those particular countries was so weak that it got out of control. In countries like Nigeria, where they had a few cases, they were able to bring it under control. I think one of the biggest issues for the continent of Africa right now is making sure its health infrastructure is strong enough so that when an epidemic happens it is not catastrophic.

Daniels: And your hot button issue that you are pursuing in this Congress?

Bass: My hot button issue regarding Africa is trade. There is a trade agreement that we need to have happen, the African Growth and Opportunity Act. In terms of health care, it is to ensure that our health care reforms stay strong.

Careers in Red, White and Blue

Careers in Red, White and Blue

As a young girl growing up in Oklahoma City, Okla., Yvonne Green, RN, CNM, MSN, dreamed of one day becoming a nurse. Today, she serves as director of women’s health for the Centers for Disease Control and Prevention (CDC) in Atlanta. Her job involves promoting national awareness of a variety of women’s health issues, from breast and cervical cancer early detection to breastfeeding and teen pregnancy. The little girl from Oklahoma has not only achieved her greatest childhood dreams but surpassed them.

Green is one of many minority nurses who have found career satisfaction working for a federal government agency. Utilizing the training and expertise gained from working in traditional clinical, academic or research settings, federal government nurses find their jobs now allow them to impact patient outcomes on a national and even international level.

Green, who has worked in the area of women’s health for most of her career, assumed her current position at the CDC four years ago. In addition to advocating on women’s health issues, she works on education and on monitoring reports and health information for the inclusion of women and minorities. She also establishes working groups to set priorities and goals while working to sensitize researchers to the need for gendered studies.

“There are a lot of challenges and opportunities for minority nurses in the field of women’s health,” says Green, who is African American. “We’ve made great strides over the years, but there is still much work that needs to be done.”

She began her nursing career doing volunteer work at her local hospital while still in high school. After becoming a Certified Nurse-Midwife, Green moved to Atlanta and taught nursing at the university level. Her expertise in the field of women’s health led her to the CDC’s Division of Reproductive Health where she worked for 10 years before accepting her current position.

“At CDC, we strive to recognize trends and to identify issues, such as obesity, that pose a threat to women’s health,” she notes. “Our goal is to help all women lead healthier, safer lives.”

Her office publishes an email newsletter, a print newsletter and a Web site featuring current information on a variety of women’s health topics. The CDC also promotes National Women’s Health Week.

While Green impacts women’s health on a national level, she also remains committed to promoting health education in her own community. “I take our CDC brochures to local health clinics, the library, dry cleaner, flea market, and I mail them to relatives and friends on a regular basis,” she laughs.

Since most federal government projects have long-term outcomes, nurses considering a career with a government agency need to realize they won’t experience the same immediate rewards they see at a patient’s bedside.

“Working in a hospital, you see babies enter the world and help patients regain their health on a daily basis,” Green explains. “In government, the gratification is more long-term and nurses need to set short and long-term markers to gauge their successes.”

Going National

Barbara Aranda-Naranjo, RN, PhD, FAAN, has celebrated several such long-term successes in her work helping patients with HIV/AIDS. As deputy director of the Division of Community Based Programs for HIV/AIDS in the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) in Rockville, Md., Aranda-Naranjo remembers the overwhelming sadness she felt working with HIV-positive pregnant women in South Texas during the early 1990s.

Barbara Aranda-Naranjo, RN, PhD, FAANBarbara Aranda-Naranjo, RN, PhD, FAAN

“Back them, we had no idea how to prevent mothers from transmitting the disease to their newborns,” she recalls. “Today, thanks to anti-retroviral therapy, it’s rare to see babies born with HIV/AIDS.”

Aranda-Naranjo, who is Hispanic, had established an impressive track record working with underserved HIV/AIDS patients in the South Texas area. She was a consultant to a Title IV Pediatric AIDS Demonstration Project and served on a number of advisory boards for AIDS organizations. She was also an associate professor in the College of Nursing at the University of the Incarnate Word in San Antonio. Her achievements caught the attention of HRSA leadership, who invited her to join their ranks.

“Barbara is very modest about her accomplishments,” says Deborah Parham, RN, MSPH, PhD, associate administrator for HIV/AIDS at HRSA. “She transformed HIV/AIDS care in South Texas, and we offered her a job where she could share her expertise with the entire nation.”

Deborah Parham, RN, MSPH,PhDDeborah Parham, RN, MSPH,PhD

Aranda-Naranjo admits she hadn’t been aware of the many career opportunities for nurses within the federal government when she was offered the position at HRSA.
“Working at this level provides nurses with an opportunity to impact patient outcomes on a national scale,” she says. “Nurses bring a holistic approach to patient care and that expertise helps them to successfully guide and monitor [federal health] programs that have been legislated.”

Both Aranda-Naranjo and Parham work on the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act Program, enacted in 1990 to fill gaps in care faced by patients with low incomes and little or no health insurance. Parham is responsible for directing the program, which provides medical care, treatment, referrals and social services to people living with and affected by HIV/AIDS throughout the United States and its territories. Working with a staff of 167, she administers a budget of $2.02 billion that funds services for some 530,000 individuals each year.

Aranda-Naranjo oversees the funding and monitoring of more than 500 Ryan White grant programs serving people with HIV/AIDS. These programs focus on providing primary care and early intervention health services.

“We fund a variety of grants to cities, states and community-based organizations that work with HIV/AIDS patients,” explains Parham. “Each of these entities is assigned to a project officer at HRSA, many of whom are nurses.

“It’s very rewarding,” she adds, “to be in a position where we can award grants to organizations that make such a huge impact on the health of HIV/AIDS patients. We are often the last and only hope many of these poor and vulnerable patients have for treatment and medication.”

Parham is one of many nurses working for the federal government who are officers in the U.S. Public Health Service (USPHS) Commissioned Corps. As one of the seven Uniformed Services of the United States, the Commissioned Corps is a specialized career system designed to attract, develop and retain health professionals who provide care to underserved populations around the world, from American Indian reservations to Third World countries. Nurses who serve in the Corps may be assigned to federal, state or international agencies.

Throughout her career, Parham admits to having many inspiring role models and mentors who encouraged her to reach for the stars–or in this case, the stars and stripes.
She followed their advice and today is one of HRSA’s key staff members. She recently made history by becoming the first African-American nurse to be promoted to the rank of rear admiral.

Parham and Aranda-Naranjo both strive to continue the tradition of mentoring by serving as role models to other nurses of color on their staff. “Minority nurses in any arena face challenges,” Aranda-Naranjo asserts. “If you’re a pioneer in your field and the road ahead isn’t paved, the journey can be even harder.”

Shaping the Minority Health Research Agenda

Janice Phillips, RN, PhD, FAAN, was active in the fight against breast cancer long before she began working for the federal government. Today, her job as program director at the National Institute of Nursing Research (NINR) in Bethesda, Md., one of the National Institutes of Health (NIH), allows her to advocate for breast cancer screening and education in a way that impacts the entire nation.

For Phillips, it was a lifelong passion for research that eventually brought her to a federal career. She wrote her doctoral dissertation on research she had conducted examining breast cancer screening in African-American women of differing employment status. Her interest in research continued long after graduation, leading her to various colleges and universities where she taught nursing courses in community health and oncology nursing. While teaching at the University of Maryland, she became the first African American, as well as one of the youngest individuals ever, to receive the prestigious American Cancer Society Professorship in Oncology Nursing.

In her current position at NINR, Phillips provides technical support and funding to investigators who are submitting applications for research grants on minority health disparities and the special needs of at-risk and underserved populations. For example, she works on grant programs like the NINR Mentored Research Scientist Development Award for Minority Investigators (also known as the Minority K01 grant), which helps support independent research projects by minority nursing faculty.

In this capacity, Phillips is able to utilize her nursing research background to interface with investigators across the country to identify health disparities and implement programs to bridge minority health gaps.

Her work for the federal government has taken her around the world. Phillips recently traveled to South America to conduct breast cancer screening research and to provide education about the risks of undetected breast cancer.

“It’s very rewarding to be able to disseminate valuable screening and education information to underserved patients,” she says. “Without programs such as ours, a large segment of the population would fall through the cracks in the health system.”

Throughout her 27-year career in nursing, Phillips has served as a clinician, researcher, policy regulator, educator and nursing administrator. Her current job utilizes all of her skills.

“Working for the federal government provides nurses with a tremendous opportunity to use cutting-edge research and information to improve the nation’s health,” she emphasizes. “And nurses can help to design behavioral interventions that impact the health of their own communities.”

“An Exciting Change of Pace”

Leslie Wheelock, RN, MSN, began her nursing career caring for patients as a clinical nurse in the Clinical Center Department of Nursing in the Intramural Program of the National Cancer Institute (NCI). Today, she is continuing her efforts to improve patient outcomes, but instead of helping people on a one-on-one basis, she affects the lives of millions.

As associate director for communication at the U.S. Food and Drug Administration’s Division of Surveillance, Research and Communication Support, Office of Drug Safety, Wheelock works as the agency’s co-lead on the Healthy People 2010 campaign, a national health promotion and disease prevention initiative. She also works with MedWatch, the FDA Safety Information and Adverse Event Reporting Program, which focuses on ensuring medication safety.

This issue received national attention in November 1999, when the Institute of Medicine, part of the National Academy of Sciences, reported that medication errors are blamed for some 7,000 deaths annually. “We’re making a national push toward use of computerized medical records,” says Wheelock. “By utilizing information technology, the risk of medication errors will substantially decrease.”

Nurses who have a strong clinical background can take their skills to the next level by working for the federal government, Wheelock believes. “As a bedside nurse, I learned critical skills such as assessing, implementing and evaluating treatments with patients,” she says. “I still use these skills on a daily basis, but I’m applying them to issues such as medical product safety and health promotion.”

Wheelock, who is of Filipino, Portuguese, Japanese and Spanish descent, has worked for the federal government since 1998, and she claims it’s one of the best jobs she’s ever had. “Although I’m not working in direct patient care, I’m still impacting patient health outcomes,” she stresses. “My job offers me the opportunity to leverage my nursing skills in a wonderful environment where I have a lot of autonomy and can work on the cutting edge of health and medication initiatives.”

To work in the federal sector, it’s helpful for nurses to have an advanced degree. Wheelock notes that 80% to 90% of her non-nursing colleagues at the agency have their doctorates. She is currently working to complete her PhD in adult learning at Virginia Tech. Nurses interested in federal careers should also have good decision-making skills and an interest in keeping up to date with the latest health information and trends, she adds.

Perhaps the only downside is working for an entity where politics can change the scope of your job. “When the country moved from a Democratic to a Republican administration, management changed and so did many of our agendas,” Wheelock explains. “To work for the government, you need to be flexible and realize that your work may be impacted by whatever is currently taking place in the nation.”

On the plus side, the federal government offers its employees job security, competitive salaries and excellent benefits. These include the Federal Employees Retirement System (FERS), a three-tiered retirement plan composed of social security, basic benefits and a tax-deferred thrift savings plan.

“I work in a very collegial atmosphere where everyone is on a first-name basis,” says Wheelock. “Working for the government is an exciting change of pace for nurses. It gives them opportunities to expand on their skills while still impacting patient care.”

Some Other Key Federal Agencies that Have Career Opportunities for Nurses

• Agency for Healthcare Research and Quality (AHRQ)
• Agency for Toxic Substances and Disease Registry (ATSDR)
• Bureau of Citizenship and Immigration Services (BCIS–formerly the Immigration and Naturalization Service)
• Centers for Medicare & Medicaid Services (CMS)
• Department of Agriculture (USDA)
• Department of Defense (DoD)
• Department of Veterans Affairs (VA)
• Environmental Protection Agency (EPA)
• Federal Bureau of Prisons (BoP)
• Indian Health Service (IHS)
• Occupational Safety and Health Administration (OSHA)
• Office of Personnel Management (OPM–federal employee health programs)
• Social Security Administration (SSA)
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Finding a Nursing Job with the Federal Government

If you have the desire and qualifications to pursue a career with the federal government, the Internet is an excellent place to begin your information search. Most of the federal agencies mentioned in this article have Web sites that include information about employment opportunities, and many agencies are actively hiring nurses.

In addition, the following sites have comprehensive listings of current federal job openings (along with good general information about working for the government). Many positions are not listed under the heading of “nurse,” so be sure to search under other keywords such as “health,” “clinical,” “diabetes,” “cancer,” “public health,” etc.

U.S. Public Health Service Commissioned Corps




U.S. Office of Personnel Management

Federal Community Grants Program Takes “Steps” to Improve Minority Health

In June 2001, President Bush launched the HealthierUS Initiative to help improve the health and wellness of all Americans by focusing on four key areas: physical activity, preventive screenings, balanced nutrition and healthy lifestyle choices (such as quitting smoking). Since then, the U.S. Department of Health and Human Services (HHS) has implemented a variety of activities to help health care professionals play an important role in achieving the President’s goals, under the banner of the department’s Steps to a HealthierUS program.

One way HHS is helping to bring HealthierUS into underserved minority communities is through its new community grant program. This past September, the agency awarded 12 grants, totaling $13.7 million, to support community health programs targeting African Americans, Hispanics, Native Americans, Asian Americans, U.S./Mexican border populations, immigrants, low-income populations, uninsured or underinsured persons and other vulnerable, high-risk groups. Between them, the grant recipients serve 23 communities, including seven large cities, 15 small cities or rural communities and one tribal consortium.

This first round of grants focused specifically on programs designed to prevent or reduce the burden of diabetes, asthma, overweight and obesity–all of which are serious minority health issues–by addressing three related risk factors: physical inactivity, poor nutrition and tobacco use. The community-based programs that received Steps funding range from walking programs and smoking cessation programs to plans for increasing healthy food choices in schools.

HHS Secretary Tommy G. Thompson describes these Steps-funded programs as “innovative and exciting. From the Michigan tribe increasing its knowledge of traditional foods like fish, berries and wild rice to the expanded walking program in a New York community, each grantee is using creative approaches tailored to achieve success in their individual community.”


Careers in Red, White and Blue

Yes Nurses Can

Eight years ago, shortly after the inauguration of the newly elected 43rd president of the United States, Minority Nurse published an editorial titled “Welcome to Washington, Mr. Bush.” In this open letter to the new president, we urged him to be a unifying force and work across party lines to find real solutions to the urgent problem of racial and ethnic health disparities in America.

Well, we all know how that turned out.

Four years later, MN tried it again. We published another open letter to the newly re-elected President Bush, suggesting that it was time to stop wasting taxpayer dollars on ideology-based programs like sexual abstinence education and start increasing federal funding for proven minority health improvement programs that actually work.

We all know what happened with that, too. Or rather, what didn’t happen.

But now, things are a little different. Our nation has just elected a president who has not only promised to make the elimination of health disparities a top priority but has already put his money where his eloquent mouth is by sponsoring legislation such as the Indian Health Care Improvement Act, the Communities of Color Teen Pregnancy Act and the Minority Health Improvement and Health Disparity Elimination Act during his brief term in the U.S. Senate. So let’s try it one more time:

Dear President Obama:

Welcome to Washington! Here at MN, our ears are still echoing with your much-needed campaign promise to, as you put it, “tackle disparities in health care.” Unfortunately for your ambitious health reform agenda, you are taking the helm at a time when our nation is in the grip of an extremely serious crisis. (Nurses call it “coding.”) The worst economic meltdown since the Great Depression, a staggering budget deficit, two endless wars and other pressing messes the previous administration has left for you to mop up will demand your urgent attention. Federal money and resources for waging war on unequal health outcomes will be painfully tight.

But despite all this, we hope you will somehow find the means to also work on your promises to, among other things, increase funding for the Indian Health Service, implement a national HIV/AIDS strategy, increase the cultural and linguistic competence of the health care workforce and fund proven evidence-based interventions, such as patient navigators, to reduce chronic disease disparities in communities of color. Please don’t let your empowering campaign mantra of “yes we can” become “no we can’t” or “not now” when it comes to minority health.

Editor's NoteEditor’s Notebook

Mr. President, you have publicly stated that nurses will have a place at the table as you craft your health reform plan. We hope this place will be right up at the front of the table, and that nurses of color will be fully represented. We urge you to reach out—not just across political aisles but to vital organizations such as the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), as well as the many individual nurse leaders within those associations—distinguished researchers, clinicians, educators and health policy experts—who have clearly demonstrated that nurses, even more so than the medical profession, are leading the way in developing the practical solutions to health inequities this country desperately needs.Because when it comes to helping you achieve your goal of making equal health care opportunity a reality for all Americans, yes nurses can. Signed, sealed and delivered.

Careers in Red, White and Blue

A Seat at the Table

Most nurses entering the profession probably don’t envision themselves having a seat at the table at health policy meetings with the president and first lady of the United States. Neither did Patricia Montoya, BSN, RN, MPA, whose nursing career led her to being appointed in 1994 by former President Bill Clinton to serve as a regional director for the U.S. Department of Health and Human Services (HHS).

“It was one of the toughest things I’ve ever done in my career,” Montoya recalls. “It was indescribable. Hillary Clinton was someone who always had [health care for] children as a high priority.”

What was it like working with Mrs. Clinton? “She was just like a regular person,” says Montoya, “although I always felt awestruck and sometimes had to pinch myself that [it was really me going to these top-level federal meetings] to talk about issues or discuss any rollouts we were going to be doing on some of the initiatives. I just had the highest level of respect working with the first lady and president. It was an opportunity of a lifetime that I will always value and treasure.”

During her appointment Montoya worked under Donna Shalala, the secretary of Health and Human Services under President Clinton. As a regional director, Montoya oversaw HHS activities in five states: New Mexico, Oklahoma, Louisiana, Texas and Arkansas.

“I helped coordinate activities among federal offices such as the Health Resources and Services Administration, the Administration for Children and Families, the Office of Aging and the Centers for Medicare and Medicaid Services. Essentially, I was Secretary Shalala’s representative [in that region]. I was also a liaison between [HHS] and the business community and elected officials in those states.”

Whether they involve working for a federal agency such as the Centers for Disease Control and Prevention (CDC), a state health department, the legislative affairs department of a health care association or even running for political office, careers in health policy provide nurses of color with a unique opportunity to make a real impact in developing policies and programs that will improve the health of minority and disadvantaged populations.

According to the University of California, San Francisco (UCSF) School of Nursing, which offers graduate degree programs with a focus on health policy, “nurses with policy expertise are employed by health services research firms, hold elected or appointed office, or work in legislative and regulatory offices at the county, state and federal levels. Others work in the legislative or policy offices of HMOs, advocacy organizations or health care provider associations, and in policy and program planning at international government health organizations.”

Minority Nurses Go to Washington

Careers in health policy can take nurses down many different paths—sometimes quite unexpectedly. Montoya, for example, was working as a school nurse in the 1980s when she was bitten by the policy bug.

“I realized that the decisions that were being made by the city council, school board, county commission, state legislature or Congress were directly impacting [health] programs I had developed for my young students and their families,” she says. “I started getting involved, not only through the American Nurses Association (ANA), but also by getting involved in party politics. I worked at the community level with people who were running for office and people who got elected, educating them on health issues.” She also earned a master’s degree in public administration.

Montoya’s combination of local community involvement, MPA degree and health policy work for the ANA earned her the national visibility which led to the opportunity for her appointment with the Clinton administration. Today she serves as the director of government relations and new business for the New Mexico Medical Review Association, a not-for-profit health care quality improvement organization.

Another nurse whose health policy career began at the community level is Lupita Salazar Letscher, BSN, RN, MN. The Oregon nurse says her interest in the field developed out of her experience working to increase access to quality health care for minorities by establishing community health centers.

“Policy began to present itself [as a career option] while I was working in planning and development and learning the process of opening a clinic in urban Portland to increase access to care,” Letscher explains. “I fell in love with that work, and as a nurse I saw the benefit of serving as a patient advocate. I was already an advocate for my patients and their families [earlier in my career, when I was working in an ICU]. So extending that commitment to the wider community was natural.”

In 2007, Letscher was selected to participate in the prestigious Robert Wood Johnson Health Policy Fellowships Program, which gives health care professionals from a variety of disciplines the opportunity to gain first-hand experience in health policy processes at the federal level. Sponsored by the Institute of Medicine, each year the non-partisan program sends a group of Fellows to Washington, D.C. for a one-year working experience in influential Congressional offices on Capitol Hill. Fellows are able to continue their health policy activities for up to two years after their Washington placement period.

“As Fellows, we went through a health policy boot camp [orientation] to become familiar with the ‘health care Olympians’—the experts, think tanks and key organizations,” says Letscher, who is currently working in the office of Sen. John D. Rockefeller (D-W.Va.). “I’m enjoying being in Washington with my eight-year-old daughter. Most people who receive this fellowship are further along in their careers than I am.” She notes that she is one of the youngest Fellows to participate in the program—a major accomplishment in her career.

Health Policy Goes to Nursing School

Lupita SalazarLupita Salazar

Health policy wasn’t a planned career choice for either Montoya or Letscher. But today, a growing number of nursing school graduate programs are recognizing the need to formally prepare nurses to work in the policy arena.

Some programs are specifically targeted to minority nurses, such as the University of New Mexico (UNM) College of Nursing’s PhD Concentration in Health Policy program. Funded by a five-year, $4.8 million grant from the Robert Wood Johnson Foundation (RWJF), this program’s goal is to prepare Hispanic and Native American nurses to become leaders in minority health policy. Post-master’s students selected for the three-year program receive support in the form of tuition, living expenses and resources for computers, books and travel.

The program was launched in late 2007 within UNM’s existing PhD nursing program and complements the mission of the RWJF’s national Center for Health Policy, established at UNM in 2006. This interdisciplinary center has its own leadership and staffing as well as its own physical location on UNM’s main campus in Albuquerque. The PhD in Health Policy curriculum focuses on research, seminars, courses and interdisciplinary collaboration between the Center for Health Policy and the College of Nursing faculty and students.

“Our goal is to increase the number of nurses of color who have the knowledge and expertise to participate in health policy decisions at the state and national level,” says the grant’s principal investigator, Marie Lobo, PhD, RN, FAAN, professor and graduate program director at the College of Nursing. “There is a [great need for more] nurses of color who are involved in health policy. [The purpose of our program] is to educate [minority] nurses who can represent their own communities and speak from their own experiences at the health policy table.”

The UCSF School of Nursing, which serves an ethnically and culturally diverse student population, offers both MSN and PhD degree programs with a specialty in health policy, as well as a master’s entry (MEPN) option for students who have completed a baccalaurete degree in a non-nursing field.

“We really felt that there was a need for more nurses to be in policy positions,” says Ruth Malone, PhD, RN, FAAN, co-director of the nursing school’s health policy graduate program. “Nurses have always been in policy positions, but typically they had to sort of learn by the seat of their pants and didn’t have any sort of formal training to help prepare them for those roles. So we felt that it would be helpful to have a program that really geared nurses toward this kind of role.”

Malone cites an example that illustrates why it’s so important for nurses to be in health policy positions. “Our programs have summer internships that [place students] in a policy setting, such as in Washington, D.C., or Sacramento [California’s state capital]. One student who was interning in a legislative office was working with a legislative aide who was handling a health-related bill. The student was given a draft of the bill and was asked to review it. Our student realized that whoever had drafted this bill didn’t really appreciate the difference between a licensed practical nurse and a nurse practitioner—and obviously that’s a pretty significant difference. We think the kinds of hands-on, street-level experience that nurses with clinical practice experience can bring to a policy setting can make for better policymaking.”

Jennie Solis, RN, MS, is a 2007 graduate of the UCSF School of Nursing’s health policy master’s program. After 10 years working as a bedside nurse, she was looking for new opportunities to further her career.

“I’ve always been interested in processes and looking at problems,” says Solis. “Having worked in various [parts of the country], like New York and Nevada, I noticed that there were different diversity levels and differences in how nurses were treated. I had questions about nurse migration and how [foreign-educated immigrant nurses] adapted into the U.S. work environment. The health policy program fit my needs in terms of answering those questions and identifying problems.”

Solis hopes to work abroad and says that her degree in health policy will help open doors for nonclinical work. “I hope to continue doing policy work having some input into nurse migration issues. But after completing the program, I also became interested in issues relating to quality improvement, such as improving the quality of health care provided to patients and the quality of training for nurses in general and quality work environments. I would prefer to go into the non-profit environment versus [working in a for-profit setting].”

Voice of the People

By pursuing careers in health policy, nurses of color can bring their unique perspectives to critical issues affecting minority populations, such as racial and ethnic health disparities and health care for the uninsured.

“There are very few people of color going to the policymakers and representing positions that will positively impact [minority health outcomes],” says Lobo. “We need to improve people’s health so there are less disparities, and one of the ways that will happen is by changing policies—whether it’s changing the way health insurance is provided for children so that they’re getting preventive care, or changing how we encourage immunizations or how we fund prescription drugs for the elderly. There are a lot of different issues out there that need to be addressed.”

What kind of skills and personal qualities do nurses need in order to be successful in a health policy career? Lobo believes nurses must have a passion to make things better for the communities they serve. “Having a willingness to speak to leaders is important. You must be able to speak to a senator or a secretary of health and be willing to put yourself out there and advocate for your position.”

Minority nurses entering the policy arena can find career opportunities in many different settings, at the community, state, federal or even international level.

“One of our former students went to work for the CDC in Rwanda doing maternal/child HIV-prevention policy,” says Malone. “Two other students were interested in clinical trials policy and technology reimbursement policies; they have both taken jobs with a private company working on those issues. They are involved in lobbying in Washington and Sacramento on technology reimbursement issues. We’ve had other students who have gotten involved in volunteer or part-time positions doing advocacy on issues that they were passionate about. A lot of our [health policy] students have gone on to the PhD program after completing the master’s program, because they get their appetites whetted and would really like to know more about research and develop those skills.”

Minority nurses should also consider running for office. For example, U.S. Congresswoman Eddie Bernice Johnson, RN (D-Texas) began her career as a nurse before deciding to enter politics. She started by getting elected to the Texas state legislature, and she is currently serving her seventh term in the U.S. House of Representatives.

Letscher points out that nursing is one of America’s most trusted professions and that the public perceives nurses as having a great deal of credibility. “I would encourage all nurses to be engaged on a personal level by being an informed voter and getting involved in your local community issues, such as what your children are eating,” she says. “For example, I testified on a nutrition bill here in Oregon to get rid of soda in schools. As nurses of color, we are representatives of a large and growing demographic. It’s very important for nurses to reflect the communities we take care of.”

Malone sees a tremendous need for more minority nurses who can play leadership roles in shaping policy decision-making on health disparities issues, such as tobacco control. “I think we need more minority nurses working on tobacco issues, both in this country and globally,” she asserts. “For example, African Americans have the worst tobacco-related health outcomes of any ethnic group [in this country]. We really need to be focusing on those populations where tobacco use is more concentrated, and that tends to be minority and poorer populations.”

Malone notes that on a global level, tobacco companies are working very hard to get women of color to start smoking, especially in countries where women have not typically used tobacco products. The tobacco industry is bombarding these countries with heavy advertising and marketing that promotes smoking as a cool, Western thing to do.

“Access to care and HIV prevention are other huge [health disparity] issues,” she adds. “There are so many different policy issues that could benefit from having more minority nurses at the table. Health policy is definitely an area where we can be much more powerful as nurses.”