Dr. Anthony Pho: An LGBTQ Health Advocate

Dr. Anthony Pho: An LGBTQ Health Advocate

Nurses could have never predicted the upheaval and disruption that COVID brought to everything they considered normal in their work and personal lives. But for Anthony Pho, PhD, MPH, ANP-C, a Propel postdoctoral scholar for The PRIDE Study at the Stanford University School of Medicine, the pandemic’s chaos brought a real silver lining.

Pho, who worked in New York City in the beginning of the pandemic, says the nursing community and his nursing work gave him a purpose through a distinctly challenging time. “You choose a place and you choose an environment to create the most potential for relationships,” he says. “The people and nurses I met are so phenomenal.” And while the pandemic did bring a fear of an unknown threat, Pho says nurses just did their jobs. “When you sign up for nursing, this is what you sign up for,” he says.

Nursing is Pho’s second career; he was in the software industry for more than a decade. “I didn’t want to do that anymore,” he says. “It was the same plot line and a different cast of characters.” Pho was accepted into the Johns Hopkins School of Nursing accelerated BSN program with the intention of returning to the Bay Area and working as a nurse. “But I met my tribe at Hopkins,” he says, and ended up staying to complete an MSN and an MPH there as well, working as an ED nurse and even working with an emergency medical residency program in Tanzania.

After Hopkins, Pho moved to New York City and became an NP at Weill Cornell Medical while also holding a teaching role. A lifelong advocate for LGBTQ health issues, Pho had a casual conversation with a physician who needed someone to develop the LGBTQ section of a curriculum on vulnerable populations and asked if he was interested. That led to a five-year teaching role at Weill Cornell Medical where he taught the first-ever LGBTQ health curriculum for the internal medicine residency program. In 2017, he left the role to pursue his PhD studies at Columbia University which he completed in 2020.

The spring of 2020 was a pivotal time for any nursing student, but for one in New York City, it was working in chaos. But for Pho, it totally cemented his dedication to his profession. Pho worked at Callen-Lorde Community Health in New York City, one of the largest providers of LGBTQ health care in that city.

“We staffed one of the convalescent hotels in Queens, and 50 percent of the patients were COVID positive from the shelter system and the remainder symptomatic,.” he says. “During that time I lived in a third-floor walkup in New York City, and I worked from 8 pm to 8 am while working on my dissertation,” recalls Pho, who also serves as a board member for GLMA: Health Professionals Advancing LGBTQ Equality. “Nursing saved me. It was a horrible time, but my queer nurses–we were together all the time. I think about my nurses, my role, my identity, and how it all gave me a purpose. I know it saved me. We were helping save people who society didn’t want to help.”

Through it all–the uncertainty, the lack of solid information, the severe illness of patients–Pho said a guiding principle made all the difference. “I think about being a nurse,” he says, “and a sense of purpose. I knew this is what I was meant to do. It got me up every day.”

Pho says his career has been paved by taking chances and finding opportunity when he could, and making opportunities when he couldn’t. And each task he completed or each chance he took led him to be in the right place at the right time–and with the right skills–to be able to offer the help that was so needed. “You make your own luck,” he says, a lot of which he says is based on the grind of doing the hard work day in and day out. “It’s important that you show up, not because you think it’s good for your career, but because you are truly passionate about it. The rest will follow. You do it because you want to make the queer universe a better place.”

He remains enthusiastic about nursing and the students who aspire to roles like his. “New grad nurses are so inspiring to me,” he says. One new nurse was having a hard day, Pho says, and he could tell she needed the pep talk he offered. “She said to me, ‘I needed to hear that validation.'” The moment struck a chord for Pho. “I told her, “Don’t think for a minute that I don’t have those days.'” Despite his experience and education, Pho says nurses still sometimes need someone to let you know, yes, you are a nurse and look at all you are doing.

“I started to see my role a little differently,” Pho says. “Sometimes it seems like all the dots seem to connect perfectly, but I’ll tell you it doesn’t feel that way when you’re doing it.” In fact, the way a nursing career progresses is sometimes based on opportunity but, more frequently, it’s something else. “I don’t think it’s predestined,” he says. “You make choices–not right choices and not wrong choices. There’s grace in the work.”

Q&A with Nursing Now’s Barbara Stilwell

Q&A with Nursing Now’s Barbara Stilwell

Barbara Stilwell, PhD, RN, FRCN, is the Executive Director of Nursing Now, a three-year global campaign seeking to raise the profile of nurses.

Dr. Stilwell recently talked with Minority Nurse about what she hopes Nursing Now will accomplish before the campaign ends next year.

What follows is an edited version of our interview.

Nursing Now's Barbara Stilwell

What do you hope to accomplish?

The campaign ends in 2020 and by then we aim to achieve the following:

1. On investment: There is greater investment in the nursing workforce—in education and professional development, standards and regulation, and employment conditions as well as in numbers in training and employment.

Measurement: that there are increases globally in investment in nursing and in the numbers of nurses in training and employment, and that a trajectory has been established and progress is being made towards eliminating the shortfall of nine million nurses and midwives by 2030, tracked through the State of the World’s Nursing report.

2. On policy: The health workforce generally—and nursing and midwifery specifically—are more central to global and national health policies.

Measurement: that all global and national policies on health and health care acknowledge the role of nursing in achieving their goals and include plans for the development of nursing. That national plans for delivering UHC make specific proposals for enhancing and developing the role of nurses as the health professionals most able to deliver patient centred UHC to individuals, families, and communities.

3. On leadership and influence: There are more nurses in leadership positions where they are able to influence policy and decision making and more opportunities for leadership and development for nurses at all levels.

Measurement: at least 75% of countries have a CNO or Chief Government Nurse as part of their most senior management team with the longer term aim of all countries having such posts; there is an increase in the availability of senior leadership programs for nurses; and a global nursing leadership network is established. More young nurses have access to leadership development programs.

4. On evidence: There is more evidence available to policy and decision makers in forms that are understandable about: i) the impact of nursing and where it can have most effect, ii) the barriers that currently prevent nurses from practicing to their full potential, iii) practical methods for addressing these barriers, iv) and that there is more research underway.

Measurement: There are increasing numbers of articles on aspects of nursing in peer reviewed journals that reach an audience broader than nurses; there is a coordinated global network on research on nursing; and there are innovative methods tested of bridging the evidence to policy gap in nursing.

5. On effective practice: There is more dissemination and sharing of effective and innovative practice in nursing and improved methods for doing so.

Measurement: that there is a coordinated global portal allowing access to examples of effective practice and innovation that is supported by nursing organizations and available to nurses and policy makers globally.

What has the campaign accomplished so far?

We now have 170 Nursing Now groups in 77 countries and growth continues. We are a social movement that works through its groups and networks to change the culture of nursing, and feedback so far suggests that the campaign has come at a moment when nurses are ready for change.

What do you hope to have happen in the next year?

WHO has declared 2020 will be the Year of the Nurse and Midwife and is preparing a State of the World’s Nursing Report—the first one ever. While there is support at WHO for nursing and midwifery, the presence of a global campaign has highlighted the significant issues in nursing development if Universal Health Coverage is to be achieved.

Our Nursing Now groups are spearheading initiatives to tackle today’s health issues—for example, how to achieve universal health coverage, the health of homeless people, gender-based violence, men in nursing, the image of nursing and midwifery, and many more.

How can nurses and/or health care providers become involved in it?

We have a great web site which invites comments and case studies. Please explore it and contact us if you have ideas. This is a movement that belongs to all nurses.

To learn more about Dr. Stilwell and the global campaign, visit www.nursingnow.org or check out the radical advocacy special issue of Creative Nursing.
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Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing

Pursuing a Career in Public Policy: No Longer the Road Less Traveled in Nursing

A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.

In addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health ­policy consultants or health care ­lobbyists. Regardless of role or setting, nurses working in the policy arena are ­required to

use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that are of benefit to consumers, patients, and the profession.

Nurses serving as elected/­appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in influencing the public ­policy ­agenda. Both opportunities ­require a comprehensive knowledge of the complexities associated with ­lawmaking and a willingness to listen and ­assess varying perspectives. The ability to communicate well and build partnerships while working with diverse ­stakeholders cannot be overemphasized.

Noteworthy, three nurses are serving as elected officials during the 115th Congress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. ­Congresswoman Bass serves as a ranking member of the Subcommittee on ­Africa, Global Health, Global ­Human Rights, and International ­Organizations.

Representative Diane Black, BSN, has represented ­Tennessee’s sixth congressional ­district since 2010. She serves on the House Ways and Means Committee.

Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House ­Transportation and Infrastructure ­Committee; the Aviation Subcommittee; the Highways and Transit ­Subcommittee; and Water ­Resources and Environment Subcommittee.

Many nurses are familiar with former representative, Lois Capps. Capps represented ­California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the ­Congressional Nursing Caucus.

No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring ­access to high-quality health care for all.

Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communication skills, research/analytical skills, detail orientation, knowledge of political, legislative, and ­regulatory processes, and the ability to create and deliver messages to a wide array of diverse stakeholders including legislative officials. Health lobbyists are ­responsible for ­conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/­specialty nursing or non-­nursing ­organization, health care facility, insurance company, or ­pharmaceutical company, to name a few.

The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to ­become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To ­illustrate, I ­acquired some of my health policy skills while serving as the Chair of ­Public Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to ­shape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead spokesperson providing testimony before my state legislature ­regarding the “­Reducing Breast Cancer ­Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among underserved and underinsured women across the entire state.

In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system:

  • Dean/Associate Dean of a School or College of Nursing
  • Director of Government and/or Regulatory Affairs
  • Office of Government Relations
  • Director/CEO of a Government Agency
  • CEO or Executive Director of a Nonprofit Health Care Organization
  • CEO of a Professional Nursing Organization
  • Chief Nursing Officer
  • Surgeon General/Assistant Surgeon General
  • Chair of Health Policy ­Committee for a Professional or Specialty Organization
  • Health Commissioner
  • Board Member for a Health Department, Hospital, or Community-Based Health Care Organization
  • Chair of a Health Policy Committee for a Voluntary Organization
  • Nurse Attorney
  • Hospital Administrator
  • Executive Director of a State Board of Nursing
  • Health Policy Analyst
  • Nurse Regulator

Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. ­Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying.

Getting involved with the advocacy/legislative arm of one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative ­office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy.

Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected ­officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing ­meeting is ­another excellent way to become ­acquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy and political activism in the health policy arena.

Policy Engagement: A Call for All Nurses

Policy Engagement: A Call for All Nurses

The need for nurses to become familiar with and engaged in the policy-making process has never been greater. While nurse leaders throughout time have emphasized the need for nurses to become more involved in advocating for patients and the profession, the passage of the Affordable Care Act (ACA) and the release of the Institute of Medicine’s The Future of Nursing report both call for the transformation of health care delivery and underscore opportunities for policy engagement.

The renewed interest in policy engagement for nurses is further evidenced by the proliferation of health policy books and resources for the nursing profession and the increased emphasis on including health policy content in nursing education programs. In fact, the American Association of Colleges of Nursing developed a set of core competencies for integration into nursing education programs, all of which emphasize the need for nurses to develop competencies in this area.

Practice, Research, Policy: Connecting the Dots

I recall the aha moment when I realized the importance of identifying the policy implications of my practice and research. While I had worked in underserved communities for many years, it was not until I started conducting breast cancer disparities research with underserved women that it occurred to me that someone (e.g., survivors or cancer organizations) was advocating for legislation to improve access to cancer screening services. Concurrently, the Breast and Cervical Cancer Mortality Prevention Act of 1990 directed the Centers for Disease Control and Prevention to establish the National Breast and Cervical Cancer Early Detection Program to assist low-income and uninsured women in gaining access to breast and cervical cancer screening and diagnostic services. Expanding on the need for follow-up care, the Breast and Cervical Cancer Prevention and Treatment Act was signed into law in 2000, helping to ensure access to breast cancer treatment services for low-income and uninsured women diagnosed with breast cancer.

As a volunteer for the American Cancer Society and the chair of public policy for the Chicagoland Affiliate of Susan G. Komen for the Cure, I started participating in lobby days advocating for more affordable and accessible cancer prevention and treatment services.

Building on my desire for more engagement, I began lobbying with my professional nursing organizations to advocate for funding to support nursing education and research. Thankfully, I realized the strong connection between practice, research, and policy—and now encourage nurses to do the same.

To Get You Started, Suggested Activities Include the Following:

• Complete a health policy course during your nursing education and your nursing career.

• Become more involved through your professional and specialty organizations.

• Attend state lobby days sponsored by your nursing organizations or home institutions.

• Participate in virtual lobby days.

• Invite congressional leaders to tour your nursing program, professional meetings, or community activities.

• Look for policy implications in presentations, publications, and textbooks.

• Seize the opportunity to identify public policy implications in your everyday practice.

• Incorporate a policy component into your clinical experience (e.g., student interviews with state lawmakers and city council members, and student attendance at public hearings).

• Tap into your institution’s Office of Government Relations.

• Read policy-related journals (e.g., Nursing Outlook or Policy, Politics, and Nursing Practice).

• Become familiar with websites that offer health policy resources (e.g., National League for Nursing, American Nurses Association, and the American Public Health Association).

• Tap into your professional organization’s resources for policy development.

• Share your personal experiences in the policy arena.

Regardless of practice setting, there are public policies and legislative initiatives that influence the scope of nursing practice or the amount of available resources to provide patient care or support nursing education. For example, the recent push toward full scope of nursing practice has already influenced the way advanced practice nurses practice in each state. Members of the nursing community, along with a number of stakeholders, are working with state and federal legislative officials to see what legislative and regulatory actions are needed to ensure that nurses are practicing to the full extent of their preparation. The outcomes of these efforts will have huge implications for the nursing profession and the patients we serve. Akin to this are the provisions outlined in the ACA, many of which have direct implications for nurses. Key provisions focused on primary workforce, patient-centered care, nurse-managed health centers, school-based clinics, quality improvement, and patient safety, to name a few. These provisions present opportunities for nurses to pursue leadership roles that will enable them to help implement aspects of the ACA legislation.

What a great time for nurses to contribute to the policy discourse that is taking place on the local, state, and federal level. From the new grad to the more seasoned professional, nurses are encouraged to become familiar with the policy-making process and identify ways in which they can make a meaningful contribution to improving the quality of patient care and advancing the profession through advocacy and political activism.


Health Policy Resources

American Association of Colleges of Nursing Government Affairs
www.aacn.nche.edu/government-affairs

American Nurses Association Policy & Advocacy
www.nursingworld.org/MainMenuCategories/Policy-Advocacy

Center on Budget and Policy Priorities
www.cbpp.org

GovTrack (site for tracking legislative bills)
www.govtrack.us

Kaiser Family Foundation
http://kff.org

National Conference of State Legislatures
www.ncsl.org

National League for Nursing Advocacy & Public Policy
www.nln.org/advocacy-public-policy

Office of Legislative Policy and Analysis
https://olpa.od.nih.gov

Office of Minority Health
www.minorityhealth.hhs.gov

Careers Stemming from an Education in Health Care Policy

Careers Stemming from an Education in Health Care Policy

In 1996, two game-changing pieces of health care legislation had the attention of the industry. The Health Insurance Portability and Accountability Act (HIPAA) was being enacted, and the Balanced Budget Act (BBA) was being debated. Nurse leaders crowded into public hearing rooms to try to understand the potential ramifications of HIPAA and to protest the challenges they foresaw if the BBA’s provisions were enacted. Many nurses watched in dismay, feeling like victims of federal policy-making engines. Some tried to learn more about political action in an effort to save their businesses and help their patients. Out of that experience, and others that followed, political activism started growing among nurses. Nurse professionals learned that if they weren’t more involved in influencing health care policy decisions, then they would have to live with the results.
We are in the midst of another dramatic upheaval in health care regulation, with most of the provisions required by the Affordable Care Act going into effect between now and 2014. Instead of being victims of the process, nurses are at the table more than ever before, and our involvement is making a difference. By fighting in the political arena for safe, high-quality health care, we give our patients a voice and function as true patient advocates at and beyond the bedside.
In addition, a growing number of nurses are finding that involvement in health care policy leads to new and exciting careers that didn’t seem possible just a few years ago. A new nursing specialty in health care policy is evolving and expanding. If the thought of making a real difference in the world gets your heart racing, healthcare policy nursing might be the career path for you.
 
What Does It Take to be a Successful Health Care Policy Nurse?
The most important trait of a nurse in the health care policy arena is a desire to make a real difference. If you believe that health care around the world can be improved, and you want to help make that happen, then you can learn the rest of what you need to know. Other favorable characteristics include:
  1. Willingness to engage in negotiation and the give-and-take of debate
  2. Persistence in researching the facts of a situation and maintaining a long-term commitment to policy developments
  3. Listening skills to help you understand the agendas of various stakeholders
  4. Communication ability to help you educate others on the issues
  5. Organizational skills to help you stay on top of multiple initiatives
What Paths Can I Take to Become a Health Care Policy Nurse?
Very few nurses start their careers with an in-depth understanding of how health care policy work is done. Some graduate nursing schools have recognized this need and offer educational programs in this growing specialty to registered nurses who have a Bachelor of Science in Nursing (BSN) degree. Chamberlain College of Nursing, for example, offers a health care policy specialty track in its Master of Science in Nursing (MSN) degree program. Students in this track complete a core of six MSN courses in theory, informatics, leadership, research, advanced nursing roles, and health care policy before progressing to six specialty classes. The specialty courses address health care systems, economics, global health, and leadership, all from a politics and policy perspective. A 100-hour practicum under the mentorship of experienced health care policy nurses leads to a capstone project that puts concepts into practice and gives students valuable experience in the work of this specialty.
After completing an educational program in health care policy, a nurse can be well-equipped and well-connected to launch this exciting career. It is possible to embark on a health care policy nursing career without an advanced degree, but many employers prefer it. Prior experience is often preferred; however, nurses who have completed a graduate program with a strong practicum have often gained significant experience in the field through rigorous academic work. Practicum projects such as researching a health care policy initiative and writing a summary for a political officeholder, or working with a community organization to secure political support for a new program, provide the experiential base employers seek.
Where Do Health Care Policy Nurses Work?
Health care policy nurses are sought after to evaluate the impact of health care policy changes, to advocate for patients and organizations as educators, writers, speakers, or researchers, and to help nurses mobilize around political action. These specialty nurses can work with lobbyists, politicians, consulting firms, health departments, education foundations, nonprofit groups, and government organizations in a wide range of roles. Some health care policy nurses enter academics, while others become community leaders or political officeholders themselves.
The range of tasks they perform can include analyzing health care policies, laws, and regulations, advising policymakers, leaders, and the public, administering grants, researching public health care issues, or planning and proposing new health care policies. Health care and education systems hire healthcare policy nurses as spokespeople, analysts, and regulatory officials. Wherever health care policy and health care organizations intersect is a place where these specialized nurses may be needed.
Why Should Nurses Enter the Policy Arena?
Health care policy nurses are the experts, the people that others turn to for advice on how governments should structure their health care systems to best meet the needs of their populations. Nurses who care about making a difference, who are passionate about health care issues, and who are willing to persevere through the challenges and triumphs of change can fashion a career that can have a broad impact on the world. There are currently seven nurses in the U.S. Congress, and their presence at the federal table means that our profession is being heard. Nurses know patients better than anyone, and it is our job to protect the safety, quality, and efficacy of global health care in every way we can.

 

 

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