If 2020 was a calamity, 2021 has the makings of a year of hope.

The most visible signs of that hope are the vaccines currently being received by nurses, physicians, and other frontline workers across the country. For our overtaxed care providers, this is a much-needed respite after a year that taxed their bodies and souls.

Yet when you listen to the remarks of health professionals after receiving the vaccine, they don’t talk about themselves. They talk about the people they care for — the ones who have died, the ones they have saved, and the ones who they will be empowered to help in the future. They measure their success in people.

These values should inspire us as much as caregivers’ many hours at the bedside do. The COVID-19 pandemic has challenged the leadership of all our institutions. As we slowly give ourselves permission to imagine a world without social distancing and quarantine, we should also imagine how our institutions can put people first in new ways too.

Over the past few years, I’ve been in search of such models along with my colleagues on Future of Nursing: Campaign for Action’s Population Health in Nursing (PHIN) team. The Campaign is an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.

Of course, the nursing tradition has a long legacy of “putting people first” — the concept of seeing patients as whole persons is one of the foundations of our profession. But this inquiry taught me that there are many models we can learn from outside our profession, outside the health care field, and outside the usual conventions that govern our institutions.

As we look forward to the new year, I thought I’d share a few principles we discovered for “putting people first” in all our institutions. I’ve included some quotes from informants of our work (anonymous due to the research method, which you can learn more about here if you’d like). I offer them in the spirit of new year’s resolutions as we all think about how to rebuild after a terrible year.

Everything starts with a common purpose

Some of the population health projects we observed were the result of community organizing processes. Others were the result of health care system leaders asking how they could provide services more efficiently. But no matter how the project originated, our interviewees described a moment of rallying all of the relevant stakeholders around one big goal or need in the community being served.

“All of the partners need an alignment of goals and objectives, no matter if it’s just two partners or 10 partners,” one of our interviewees told us. “They need to understand each other’s pain points. … We’re going to be asking them to do something different in their community to take advantage of the fact that we’ve got all of these partners here. And that may make their lives a little less efficient in some ways, but we think the lack of efficiency will be more than made up for from better outcomes for kids and adults.”

No one entity should dominate the conversation

People in the health care system are used to making decisions based on the authority of science. And as we nurses know well, clinical instructions need to be followed with extreme precision when a misplaced decimal point can mean the difference between life and death.
As we explored efforts to improve population health, though, many clinicians told us how they needed to open themselves up to other ways of seeing and talking about problems, particularly when addressing problems none of the clinicians have experienced personally.

“We need to understand each other’s vocabulary and language,” one leader we interviewed said. “Doctors often think that public housing works one way, but it may be really important to understand that it does not. There is absolutely no match, for example, between Medicaid income eligibility and housing income eligibility. That leads to silly assumptions like the idea that you can just plop a clinic into a low-income housing site and that’s a marriage made in heaven.”

Trust is essential and needs to be built intentionally

Trusting relationships do not happen automatically just because a health system or university is showing good intentions; they must be deliberately designed. One key ingredient to these trusting relationships is consistency. Our interviewees emphasized that while clinicians may see long-term benefits to a population health project like research and education, the participants also need to see benefits that make sense to them. Leaders of these projects often viewed nurses and community health workers as stewards of relationships in addition to providers of care.

“Trust is not something that can be built right away,” one interviewee argued. “You can’t go into a relationship assuming that the community trusts you because you are wearing a white coat. You should probably think the opposite, that they don’t trust you. You have to realize that you have to build trust until the community feels more confident that you are looking out for their interests and you’re not just there to draw their blood and take from them. You have a commitment to deliver results. Often researchers feel like their work ends when they publish that New England Journal of Medicine paper. You’ve got to bring it back to the community.”

We need to rediscover our people skills

Today’s health professionals are more technically proficient than ever before. But in our conversations with nurse educators as well as population health experts, we learned how important “soft skills” are to discovering and addressing the needs of communities. At the top of the list of skills was teamwork. Nurses are already increasingly comfortable with the idea of working with (and even leading) interdisciplinary teams that might include physicians, pharmacists, dentists, social workers, and community health workers. Educators we interviewed told us that for nurses as well as other professionals, practicing these “soft skills” was a way to reconnect to the core ethical character of their work.

“In our case, bilingual and bicultural clinicians worked better because they had the cultural competency,” one population health authority told us. “Others were willing to get some experience with the population to build that cultural competency. It was people who went in with the attitude that they needed to be flexible. It was flexibility to know that they didn’t already know what would work with this population and they couldn’t just impose their usual way of doing it on this population. They had to go in with the curiosity and the intent to learn from the community what would work with them and adjust their messaging and approach to fit what worked in the community.”

New tools are useless unless they help us better understand people

A major emphasis of our report was the need for new “quantitive reasoning” tools to address population health challenges. At the same time, though, some of our interviewees expressed a somewhat jaded view of technology because of its potential to interfere in human relationships. New technologies were only useful, they argued, if they were utilized in the context of consistent relationship-building described above. Particularly promising were technologies that give nurses and other clinicians insight into health problems at the population level. Applied in the right context, these kinds of tools can help nurses understand how health issues are playing out in the neighborhoods where people live, not just inside their clinical chart.

“There will always be an interpersonal factor in asking about homelessness or child abuse that is not present with biophysical data,” we wrote in our final report. “Since much of this data is collected by nurses, it is our duty to ensure that these assessments are done in ways that are accurate and respectful of patients and communities.”

Putting people first can bring everything together

Over the past few years, we have had the opportunity to visit academic institutions and population health partnerships across America. In all of these institutions, we met people with great ideas and a deep passion for improving human health in all settings, not just in the clinic. These encounters excited us, but also often left us wondering what kinds of institutions would ultimately drive progress in population health. We met experts who envisioned many different candidates as the most important catalysts for change: housing, schools, hospitals, universities, and others.

Yet despite their different institutional backgrounds, all of these experts shared the core values of putting people first. They saw all of the systems they were working in as means to an end of helping people, not as ends in themselves. They were flexible in their thinking about goals, metrics, and sustainability. They saw the need to learn and grow to meet communities’ challenges, rather than forcing communities to follow their rules. Almost all these interviewees described a journey where they came to open their minds about what leadership looks like. Here’s how one veteran of the field reflected on his experience:

“In every case where we have asked, ‘How did this partnership happen?’ It started with somebody who convened people who said, ‘We can do better.’ By the way, there’s absolutely no pattern we’ve been able to discern in who that convener is. It could be a pastor, it could be a health system, it could be a nurse. … It’s somebody who has enough stature in their community that when they call someone and say, ‘Hey, can we talk?’ then that happens.”

No matter what 2021 may bring, here’s hoping that more of us can learn from that example and keep up the conversation about putting people first.

The post How to put people first in the new year appeared first on Campaign for Action.

First, a heartfelt thank you. Thank you for the contributions that we know you have made to your family, your community, the profession, and more, during a year of enormous challenges that include sickness in our ranks, burnout, grief, and worse. The pandemic has tested the world, and nursing as a whole. Even as we help others—as we always do—we also hurt.

Bearing witness to the pain and loss and the frailty of our systems continues to be hard. As the new year brings the hope of widespread availability and use of vaccines, we know that we still need to fight to heal ourselves, our fellow nurses and their families—all who continue to sacrifice.

In these earliest days of 2021, we would like to pause to look back—and forward—at nursing and the role the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation (RWJF), plays in the nation’s well-being.

It was the Year of the Nurse and the Midwife, chosen to honor—200 years after her birth—the founder of modern nursing. But COVID-19 ravaged the world, which means that Florence Nightingale’s name is also now part of another sort of homage: The Nightingale Tribute names the nurses who have given their lives helping others during the worst pandemic in a century.

While the health disaster has highlighted the courage of nurses, it has also highlighted the disparities in health and health care. Then with the killing of George Floyd came a public reckoning of the effects of structural inequities, and the nation’s recognition of the need to right historical wrongs. As we affirmed at the time: Racism and injustice have no place in our country today. Our pathway to equity is to help build better health through nursing.

In ways large and small, we made strides in 2020 to do just that. Progress includes:

Access to Care

States: Through the Center to Champion Nursing in America, the Campaign’s operating arm, also an initiative of AARP Foundation, AARP and RWJF, we hosted monthly sessions to guide others on how to work with state policymakers to lift—at least during the pandemic—legal restrictions on nurses. Participants included Action Coalitions, AARP state offices, and community groups. Successes in Kentucky, Louisiana, Massachusetts, New Jersey, New York, Virginia, and Wisconsin expanded access to care for nearly 59 million people.

Florida, California, and Massachusetts also saw changes in laws that improve consumer’s access to care.

Federal: Nursing organizations including the Campaign, through AARP, helped pass the 2020 Coronavirus Aid, Relief, and Economic Security Act, providing consumers easier access to care at home.

Equity, Diversity, and Inclusion

Among contributions toward building a more diverse nursing workforce, the Campaign’s Equity, Diversity, and Inclusion Steering Committee has created a mentoring program and a health equity toolkit for use by nursing schools. The mentorship program, designed in collaboration with the U.S. Department of Health and Human Services’ Office of Minority Health and historically black colleges and universities, includes mentor-training workshops and a learning collaborative. Postponed last year, but back on track, are similar programs for students at schools that serve largely Hispanic populations, and those that serve American Indians.

Population Health in Nursing

The Campaign, with a grant from RWJF, completed a series of reports exploring promising models of nursing education related to improving population health. The Population Health in Nursing (PHIN) project, found here, also examines how nurses should be prepared for new roles in population health practice.

National Academy of Medicine report

The National Academy of Medicine (NAM) delayed to late spring 2021 its much-anticipated report on the future of nursing 2020-2030, expanded to include nursing’s role in responding to the public health crisis. Many reading this letter have contributed to the committee’s broad outreach and research, including during an August 2020 webinar.

Coming Up: Virtual Gatherings to Plan Action

The focus of each is important, so we’ll list in chronological order brief notes on the meetings we have in store for early 2021.

• On January 12, we held the first of our Health Equity Action Forums, focusing on the value of diversifying the nursing workforce to achieve health equity. It was the first of several such virtual meetings. The second, slated for February 3, will cover the topic of nursing as a career ladder for establishing financial well-being for underrepresented communities.
• February 24, we will honor the work that so many have carried out based on the 2010 Future of Nursing report. We’ll also look ahead to the next NAM report.
• In May, we expect the release of the Future of Nursing 2020-2030 report.
• June 3–4, we’ll gather Action Coalitions and other Campaign members, allies, and stakeholders to plan how to implement the new report recommendations.

Nursing Innovations Fund

Wrapping up our yearly note is a spotlight on an inspiring set of projects past and future: the Nursing Innovations Fund Awards. In October, we announced 10 ambitious projects designed to address health disparities that each earned $25,000 awards. And look for news in May about a similar funding opportunity, for projects that address structural inequities.

Again, we want to thank you for all that you have done. Nursing, long the most trusted profession, has never been more important. You have pushed through and persevered. For all you’ve endured and the grace you have shown, thank you.

Susan B. Hassmiller, PhD, RN, FAAN Senior Adviser for Nursing, Robert Wood Johnson Foundation; Director, Future of Nursing: Campaign for Action

Susan C. Reinhard, PhD, RN, FAAN Senior Vice President and Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America

The post A Heartfelt Thank You appeared first on Campaign for Action.

Roof top view of Cornell University campus

“Is anybody actually in charge here?”

It’s a question far too many of us health care providers have been asking during this pandemic.

It’s not a question we need to ask when we are on the frontlines with our patients. Even though no one had prior expertise in this disease, clinicians across the country have reorganized their operations to respond. Med-surg units became ICUs. Routine checkups became Zoom calls. Elective surgeries disappeared. Nurses held patients’ hands when their families couldn’t. Our usual shifts, our management structures, our institutional priorities — we’ve reconfigured it all to deal with COVID-19.

We’ve got the clinic covered. But we’re wondering who is in charge once we step back into the world outside. Is anyone taking responsibility for testing? For contact tracing? For informing the public? For coordinating with schools and prisons and a dozen other institutions where we also work? When we are away from our usual clinical settings, we often find ourselves throwing up our hands in despair.

The failures that led to this lack of leadership have been well-documented. We’d now like to take a moment to propose a few solutions.

When we released our report Population Health and the Future of Nursing: Conclusions earlier this year, one of our core proposals was a new role for nursing schools in every community.

Specifically, we imagined all nursing schools playing substantial roles in population health partnerships that would involve the majority of their faculty and students. We argued that our schools must ensure all nurses receive practical experience caring for patients wherever they live, work and play; as increasingly this context is recognized to be critical to health and illness.

COVID-19 reached pandemic proportions shortly after we released our report. In the days since, we have often wondered if nursing schools more fully integrated into population health partnerships might have partially compensated for the lack of leadership we now see. Such partnerships could augment the nursing workforce, provide human resources for contact tracing and outreach, and provide assistance with training and evaluation.

All that cannot be done overnight. But we believe one thing all nurses and nursing schools can do in the near term is proactively develop their roles in academic-practice partnerships.

In the absence of federal leadership on COVID-19, universities, academic medical centers, and other higher education institutions have stepped up. All of us now rely on resources like the digital dashboards produced by some of the nation’s leading universities. Universities are also providing guidance to policymakers and the public on the local level. Nursing should be a critical part of that.

Every nursing school, no matter what its size or profile, could meaningfully contribute to such partnerships. In a time where this new disease must be understood in a thousand different local contexts, our diversity is our strength. From the Ivy League to the smallest community college, each of our schools could inform an understanding of how to deal with COVID-19 in its local context.

Over time, these relationships could evolve into more robust academic-practice partnerships that enhance nursing practice and education in a virtuous cycle. Nursing students can be more effectively deployed in caring for those infected and those who need assistance to prevent infection. Nursing faculty could be useful in training staff, supervising students, and assisting with care evaluation and quality improvement initiatives. Nurses in practice can contribute to both groups’ understanding of the evolving clinical context.

The need for this kind of contextualization will be essential if we are to improve our efforts to stop public health threats like COVID-19. The coronavirus respects no boundaries as it invisibly travels between various social and economic contexts. To stop the disease in environments as diverse as congregate housing, prison systems, and elementary schools, we need places where practice, education, and research come together.

Perhaps the most important lesson we learned about such academic-practice partnerships in our research is that their success depends on authentically collaborative relationships with the populations they serve. This is even more essential in the case of COVID-19, since the disease has only inflamed the already painful wounds of racial and economic inequality. It is critical that the perspectives of all populations likely to be affected by academic-practice partnerships are taken into account.

Nurses can provide that all-important bridge between the perspectives of providers and the populations they serve. Our status as the nation’s most trusted profession makes us naturals for the role. However, our professional expertise is just as important. Nurses’ familiarity with control of infectious diseases, clinical care, patients’ diverse needs, and experience addressing them through advocacy and education will also help us fight this pandemic.

Another important asset of the nursing profession is our presence in so many different care settings outside the clinic. At the moment, K-12 schools are “Exhibit A”. Every community in the country is worried about how to handle school this fall. School nurses in every community are qualified to help answer those questions. But they can do it most effectively in the context of partnerships where they can connect with other disciplines and organizations in the community.

Of course, many nurses are probably reading this and thinking, “We don’t have time to organize a whole new structure. We have to act now!” Unfortunately, we agree — many nurses need to act as if the coalitions we wish we could see already exist. At the same time, we would observe that this pandemic is changing everything, including the relationships between care providers and their communities. As new ways of addressing population health are devised out of necessity, nurses should be taking their rightful place at the table.

“Is anybody actually in charge here?” Too often in 2020 the answer has been, “no”. But if nurses take this opportunity to form the right kind of partnerships with the patients and communities we serve, perhaps by the time this pandemic is over we will be able to say, “yes”.

Susan Swider, PhD, APHN-BC, FAAN is a professor in the Department of Community, Systems and Mental Health Nursing at Rush University, Chicago.

The post Nurses Can Help Build New Coalitions to Fight the Pandemic appeared first on Campaign for Action.

During a pandemic, data can make the difference between life and death. The worldwide outbreak of COVID-19 is teaching us this lesson yet again. We need accurate information on where a disease has been, who has it, and how many infected people are dying in order to stop its further spread.

Unfortunately, this pandemic has also revealed serious deficiencies in the public commitment to good data in the United States. For several reasons, the collection of data connected to COVID-19 was inadequate from the start. Early on, the federal government was reluctant to collect or publish data on the unequal impact of COVID-19 by race, which we now know is key to understanding the disease’s toll. Political considerations and a general lack of coordination continue to prevent the collection of adequate data on a national scale. Finally, responding to the data being collected remains difficult because of the lag in testing times; even when a new outbreak has been confirmed, that information often comes too late to do anything about it.

Nurses across the United States are feeling the impact of this problem and are rightly outraged. We can contribute to the solution by advocating for better data practices in our own care settings as well as at the local, state, and federal levels. However, to be effective advocates for better data collection, nurses also need a sufficient understanding of how data contributes to population health.

In our report Population Health and the Future of Nursing: Conclusions published earlier this year, we called for a new era of “quantitative reasoning” in nursing. Starting with the observation that most assessment of social factors in health is done by nurses, we argued that all members of our profession need a basic sense of how the data they collect might be used to develop a picture of health in a population or community.

While we do not believe that all nurses need to be statisticians, all nurses should be able to use the data they collect to advocate for patients on the population level. They should also be able to comprehend the data collected by others and interpret what it means for those individuals in their care.  Since much of this data is married to new technologies, nurses also need to be at the table when those technologies are being designed or improved.

Unfortunately, it is difficult to realize this kind of ambitious agenda while also fighting a pandemic. But based on what we are seeing on the ground and hearing from our colleagues, we see a few points that all nurses should keep in mind as they deal with data during the pandemic. Thank you to informaticist Marisa Wilson DNSc, MHSc, RN, associate professor and chairperson at the University of Alabama, Birmingham, for sharing her thoughts on nursing and data skills, which informed this list.

1. Data has consequences — Many of us are used to focusing on the chart as the beginning and end of patient data. But in the age of electronic medical records, data is being combined and analyzed in many different ways. Accurate data on all patients will be essential for us to better understand how COVID-19 is impacting communities across demographic, geographic, and economic lines. If data is collected in ways that are inconsistent or arbitrary, it is worse than useless. Every nurse should understand that collecting reliable data contributes to the greater good of population health. Education and training must reinforce this.
2. Technology is our friend — Let’s face it, we all hate it when computers get in the way of caring interactions with patients. But these days we are also constantly refreshing multiple tabs in our web browsers to get the latest data on COVID-19. As long as the pandemic is a part of our lives, we will be using technologies to understand it and manage it. New technologies will also emerge in response to this challenge. Nurses should take this opportunity to get comfortable with those technologies and seek opportunities to provide feedback on them whenever possible. Additionally, anyone developing new apps and devices to deal with COVID-19 needs to include nurses as a key user group.
3. We have to reckon with risk — When caring for our patients, we try to eliminate every risk. “Probably” is not a word we like to hear when caring for patients. But when processing the kind of data needed to understand COVID-19, dealing with probability is unavoidable. Patients are asking us for advice about how to live their everyday lives when almost no social activity is completely free from the risk of infection. Nurses who work in schools and other public settings may need to assess risk just to provide basic care. Because of changing regulations as well as inadequate personal protective equipment (PPE), many of us have also been forced to calculate the risk of infection in our own lives. All of this is scary, but we need to approach the situation using the best of our training. That means grounding our opinions in science and working in consultation with colleagues to gather the most valid and reliable information.

We know that during this harrowing time, many nurses are too busy to acquire new skills. Many nurses who are treating COVID-19 patients are lucky to catch a few hours of sleep. But we must also recognize that this pandemic will change the future of nursing in America. Remaining open to opportunities to effectively use data will help us make that future one we want to live in.

Mary Sue Gorski, RN, PhD,  is the director of Advanced Practice, Research and Policy for the Washington State Nursing Care Quality Assurance Commission in Tumwater, Washington and and an advisor to the Campaign for Action.

The post Nurses Can’t Be Good Advocates Without Good Data appeared first on Campaign for Action.

To address population health during the pandemic, we must support and expand nurses’ abilities to assess and address social factors impacting health.

During these trying times, I often think of the faces of my nurse colleagues. Though they wear masks, you can see in the eyes of nurses the impact of experiencing case after case of the same harrowing disease all day, often in longer shifts that they have worked in their entire lives.

In some of those eyes, you can see the impact of losing patients. In others, you can see the fear of how to talk to yet another family over video chat. In all of them, you can see the anxiety over adapting their nursing practice to this new reality. In a real sense, nurses and other healthcare workers are facing this disease on behalf of everyone. What have they seen that no one else sees? What could they look for that no one else can?

In Population Health and the Future of Nursing: Conclusions, published earlier this year, we argued that assessment is the most important area where nurses can immediately address health disparities. We laid out a plan, beginning on page 8 of the report, to help all nurses more effectively address health equity using assessment as a common starting point. While some social needs have changed due to the COVID-19 pandemic, we believe that addressing population health starts with seeing what nurses see.

The pandemic has made assessment even more important as a way for nurses to make sense of their reality. With more than 3 million cases spread over 50 states, all practicing nurses are thinking about what it means for COVID-19 patients to present themselves in their hospitals, clinics, and offices. Many nurses are facing the disease in their homes and communities as they provide advice to neighbors and family about self-isolation or contract tracing. In the months to come, nurses in every setting will gain familiarity with the biological traits of this disease.

But as the emerging data make clear, nurses also need to be aware of the social factors that impact the COVID-19 patient experience and the national response to it. In our research, we learned that many different organizations were already relying on nurses to assess and address the social needs of patients. Therefore, we believe that this is also a natural area where nurses can lead during this crisis.

Many of the social needs assessment practices we observed in our work were preliminary; nurses and others were still working to discover the best way to talk about complicated issues like racism and poverty. As we respond to this pandemic, they will not be able to be so deliberate. Every kind of social issue will be showing up in the bodies of COVID-19 patients who do not have time for testing new approaches.

Nurses will rapidly need to assess how a person’s background, past health issues, and circumstances affect their treatment and recovery. Patients who have lacked access to care over their entire lives may not be prepared to alert clinicians to underlying problems like asthma or diabetes. Many will reject the idea of staying at home if they are a family’s sole provider; others may not be sure they have a home to stay in at all.

As new outbreaks occur, health care providers must understand how to adapt COVID-19 containment and treatment in response to all these issues. We maintain that an adequate response begins with assessment, and assessment will almost always begin with a nurse.

Despite extraordinary circumstances, nurses still desire to perform assessment in a way that reflects our profession’s best traditions and values. These include seeing the patient as a whole person, providing advice to get that specific person adequate care, and performing health education and advocacy appropriate to the situation.

But as a profession, we must also think more critically about how we realize these values in the midst of a pandemic. In our original report, Nursing Education and the Path to Population Health, we laid out a plan, beginning on page 4, for the nursing profession to take responsibility for the assessment of social factors in health care. We believe an updated version of the same plan could be implemented now with a focus on the nurses on the frontlines of this pandemic. Key to the plan is the idea that we must recognize and even expand nurses’ authority to assess and address the social challenges patients face.

Our institutions should immediately do everything they can to support the nurse who is not only diagnosing COVID-19, but also considering how to address a patient’s homelessness or how to adapt stay-at-home protocols for a family where both parents work the night shift.

This support should begin with simply acknowledging the complex situations nurses face. But we hope that over time it can become the basis for the development of best practices, new research into how to best identify and address social factors, and policy advocacy that makes it impossible for decision-makers to deny what nurses are seeing every day.

In the weeks to come, we will explore what the pandemic means for other elements of our plan for population health in nursing, such as the use of data and academic-practice partnerships. But all of our other recommendations depend on centering this assessment experience that is so essential to what it means to be a nurse.

It’s time to acknowledge what nurses see and give them tools to do more to respond.

Patricia A, Polansky, RN, MS, is the director of Program Development and Implementation at the Center to Champion Nursing in America.

The post See What Nurses See appeared first on Campaign for Action.

For the past several years, my colleagues and I have been conducting research in the future of population health in nursing. Much of our research has concerned questions like how nurses can better understand social systems and entrenched inequality. We were especially interested in the role nurses could play in pursuing the famous “Triple Aim” — improving patient experiences and increasing the health of populations while also sustainably reducing costs.

When the COVID-19 crisis first erupted, I think it’s safe to say that we all initially questioned the relevance of our work. This frightening pathogen and the drastic public health measures necessary to fight it seemed so different from the conversations we were having about primary care, chronic conditions, and reducing costs over patients’ lifespans.

However, as the inequalities unleashed by this disease become more and more evident, our views began to change. Now it is clear that population health issues are even more relevant than they were before the pandemic, not less. And we are more determined than ever to enhance nurses’ ability to address them.

In the early days of the pandemic, many of us wondered if it would be a “great equalizer” in our stratified society. But that is only true in the most narrow biological sense (since no one had pre-existing immunity to the disease). Now it is abundantly clear that the same factors that led to differences in life expectancy in the American population before the pandemic are also driving differences in mortality now.

Dozens of these social determinants of health are relevant to the COVID-19 pandemic, from homelessness to immigration status to social isolation. But let’s take a moment to examine one of the most important in detail: structural racism.

Before COVID-19, structural racism was already a driving force behind the most important social determinants of health. African-Americans in particular faced unique health challenges regardless of socioeconomic status.

Traditionally Black neighborhoods often lack the health infrastructure of white neighborhoods. Black mothers and children are more likely to die during childbirth, even when all other explanatory factors are controlled for. The lifelong stressors of racial prejudice have been shown to cause higher blood pressure and other chronic conditions. All of these problems occurred in addition to the poverty and violence that are the legacy of centuries of anti-Black racism in the United States.

In the time of the pandemic, some of the chronic health issues disproportionately faced by African-Americans, like hypertension, diabetes and heart disease, might seem to be less urgent than stopping the spread of the virus. But in fact, the structural inequalities that were already shortening Black lives are also making them more susceptible to COVID-19, worsening the pandemic overall.

Majority Black counties are seeing four times the number of deaths from the disease than other counties. Many of the chronic conditions African-Americans were already experiencing due to structural inequalities are now making them more likely to die when they contract this virus. Inadequate infrastructure in Black neighborhoods also impairs people’s ability to take action in response to the disease. For example, the companies initially chosen by the federal government as partners in drive-thru testing services have few locations in Black neighborhoods. African-Americans are more likely to rely on public transit and to be essential workers, increasing their exposure to the virus in the absence of alternative ways of getting around.

Similar stories could be told about many other groups affected by health inequities, from undocumented immigrants to residents of rural America. Recent weeks have brought attention to the health crisis facing Native Americans; for example, the Navajo Nation is dealing with one of the worst outbreaks in the country with far fewer medical resources than many other regions. In this way, the same population health factors that have been on the minds of nurses these past few years — race, economic inequality, infrastructure, access to care, and more — have appeared in new forms as we deal with the virus. Nurses need an agenda to help them confront these problems as much as they ever did.

In the weeks to come, we will be exploring elements of that agenda, from how we can improve assessment of social needs data to how we can more effectively organize nurses to make a difference. But to wrap up this post, I want to discuss another development we never expected when this work began: the unexpected awakening about anti-Black racism that has occurred in this country over the past weeks.

As professionals who care for the human body, nurses are painfully aware of the words George Floyd said as he died: “I can’t breathe.” Many immediately connected those words to the bodily suffering of patients we have seen in the past as well as to the disproportionate Black death toll from this terrible respiratory virus. The compassion of nurses cries out in response to this pain and injustice.

Despite challenges of personal safety and social distancing, nurses of all backgrounds all over the country have expressed their outrage over Floyd’s death and the systematic racism it represents. Many of us are now also thinking about how to apply a new spirit of anti-racism in our own practice so we can save more lives. While many of us may express it at the bedsides of patients rather than out in the streets, we are also determined to demonstrate that Black Lives Matter. This too is part of the work of population health, and we are grateful we can apply our training.

Patricia A, Polansky, RN, MS, is the director of Program Development and Implementation at the Center to Champion Nursing in America.

The post Population Health Matters More Than Ever Before appeared first on Campaign for Action.

On February 28, 2020, my colleagues and I concluded a major project on the future of population health and nursing (PHIN).

The next day, the first official death from COVID-19 was recorded in the United States.

Now, according to the Centers for Disease Control and Prevention, the virus has killed 132,056 Americans* and many more worldwide. It has drawn attention to many of our nation’s most severe inequalities — the same inequalities many Americans are currently protesting in the streets. We will be reckoning with the consequences of this disease and our society’s response to it for a generation or more.

Like most people, I process this disease in many ways — as a parent, as a citizen, and as a family member and friend to many people whose lives have been impacted by the disease. But primarily I think about it as a nurse.

All nurses feel compassion for the suffering this disease has caused. All of us feel solidarity with our colleagues on the frontlines and the patients they care for. All of us feel a desire to respond to this crisis with the skills of advocacy and education that make our profession unique, as well as new lessons we are learning from scientific analysis and social innovation.

Each week, I discuss these issues with the other members of our Population Health in Nursing team. Even though our formal research project ended earlier this year, we’ve continued to meet so that we might better understand what our findings mean in this new environment.

In the coming weeks, we will be sharing some of those ideas in this space. We plan to offer insights into what COVID-19 and our nation’s awakening awareness of inequality mean to population health and the future of nursing. Specifically, we hope to address topics such as assessing social determinants of health, integrating new technological skills into practice, developing academic-practice partnerships, and strengthening the collective voice of the nursing profession.

But first, I thought our team should introduce ourselves by sharing the stories of how we have made sense of the pandemic as nurses over these past few months. I’ll start with my colleague who first had to deal with the virus and its impact, Mary Sue Gorski, RN, PhD, in Spokane, Washington.

Mary Sue Gorski: The COVID-19 pandemic reminds me about why I first got involved with policy, which was because I felt like I could more effectively improve patient care. Otherwise why are we doing this? That was on my mind when we saw how serious the pandemic was going to be, though even when the lockdown began in March we didn’t see how serious. I work with the Nursing Commission here in Washington State, and due to the need for nurses in the crisis, the governor challenged us to go from two weeks to award a license to 24 hours. The Nursing Commission hired and trained 25 people and within a relatively short amount of time we found out we could do it. But we are still facing many questions about our new reality.

My message to nurses during this time is that we need to seize our power. I believe nurses can be much more influential in health care and we can use that power for positive change. We can be the leaders in so many different areas, from contact tracing to safe re-opening. To do that, we also need a very broad vision of our profession that in of COVID-19 in Chicago.

Susan Swider: I want to think about how we can respond to this crisis in a way that makes every nurse use population health knowledge and skills without necessarily turning everyone into a public health nurse. Adequately addressing the pandemic will require many different moving parts. There will be roles for everyone from students to clinicians to public health nurses to policy advocates. I want to think about how academic-practice partnerships and our nursing organizations can help all nurses find the best role to play.

When I think about the nurses on the frontlines of this pandemic, I reflect on how effectively so many of them are doing exactly what they need to do. Other health professionals come in and out of patients’ rooms, but the nurses are the ones who are there over time with patients during their suffering and pain. That is what makes them such good advocates for patients’ needs. I would like to think about how we can use some of those experiences and stories to create broader change.

As for me, this pandemic makes me remember my early days as an ICU nurse. I remember more than a couple of nights when I had to strip down from my uniform in the dark, not wanting to bring anything into the house that might infect my young children. I also think about the years I spent in New Jersey government helping develop a comprehensive pandemic plan after the H1N1 and SARS outbreaks. It’s surreal to think about it, but the moment we were planning for has finally arrived.

Hearing the stories of nurses in this pandemic reminds me that we truly are the healers of humanity. You see that in the stories of our colleagues on the frontlines who may be the only person who can comfort a dying patient. But you also see it in nurses who are parents, neighbors, PTA members and Instagram influencers, all of them using their roles to help us respond to this moment in a way that is competent and humane.

My hope is that nursing organizations like ours can match the spirit of all of you in the field. We will have more to say on this in the coming weeks, but we would also like to hear your stories. If you would like to tell us your story of responding to COVID-19 or your thoughts on how our profession can respond to this moment of crisis, please comment below.

Patricia A, Polansky, RN, MS, is the director of Program Development and Implementation at the Center to Champion Nursing in America.

*As of July 10, 2020 at 9:02 a.m. ET.

The post Part 2 in A Series on Population Health in Nursing appeared first on Campaign for Action.

Nurses across America are feeling challenged by the events of this year — most especially by the COVID-19 pandemic. But nurses also offer resources and solutions in these crises that no one else can. Working across the spectrum of care, our profession has perspective on the needs of patients, populations, and the system as a whole — a much-needed unifying view in these divisive times.

In the coming weeks, we’ll be using this space to share that perspective as it has been developed by our Population Health in Nursing (PHIN) team. This group’s work is funded by the Robert Wood Johnson Foundation (RWJF) and grew out of previous foundation-sponsored research on the profession’s ability to address unmet social needs. Over the next few weeks, they’ll be sharing insights on population health, nursing, and the response to COVID-19.

The PHIN team’s expertise is based on a two-phase study that began in 2018. The full text of the study’s reports can be found here, but we thought we would provide a brief summary to give context to the upcoming posts.

PHIN Phase 1

In the first stage of the PHIN study, the team explored how population health is taught in nursing schools. The team initially collected data using a 26-question survey answered by an array of nurses and health professionals from many different backgrounds. Additional in-depth interviews were conducted with 26 leaders in nursing and public health. Finally, the team conducted six site visits to nursing schools to learn more about their models for teaching population health. In the resulting report, “Nursing Education and the Path to Population Health Improvement,” the group shared a list of necessary elements to better integrate population health into nursing education. In particular, they emphasized the need for mutually beneficial academic-practice partnerships.

PHIN Phase 2

In the second stage of the PHIN study, the team turned their attention to the many settings where population health is practiced by nurses. Determined to look beyond traditional clinical and public health settings, the team worked with RWJF to assemble a summit of thought leaders in population health and nursing. These leaders encouraged the team to investigate platforms for interdisciplinary collaboration and improved engagement with marginalized communities. The team once again used in-depth interviews and site visits to learn more — not just about what nurses are doing now, but about their potential roles in community settings. In the resulting report, “Population Health Models and the Profession of Nursing,” the team shared several different ways in which these relationships could work. Their conclusions emphasized the need for nurses to understand other social systems and collaborate with professionals who can help them improve health within those systems.

PHIN Conclusions

Finally, after completing the two research phases of the project, the PHIN team released “Population Health and the Future of Nursing Conclusions,” in which they reflected on the meaning of their findings. The team argued that by taking responsibility for the problem of social needs assessment across the care continuum, the profession of nursing can assume a central role in new population health efforts and enhance the well-being of all. The report also made the case for innovation in nursing while acknowledging that nurses have been advancing the field of population health since the days of Florence Nightingale.

The COVID-19 epidemic in the United States began shortly after the PHIN team finished their work. Since then, they have continued to meet and advise the Campaign for Action on what their findings mean for nurses during the pandemic. Those discussions form the basis of the posts they will share here. These short articles will address the role nurses can play in social needs assessment in the pandemic, changing needs for data and technology skills, the need for adaptable academic-practice partnerships, and ongoing challenges for nurse leadership during the crisis. We look forward to the PHIN team’s thoughts and the discussions they will inspire.

Hassmiller  is the senior adviser for nursing at the Robert Wood Johnson Foundation, and the director of the Future of Nursing: Campaign for Action.

Reinhard is senior vice president and director, AARP Public Policy Institute, and chief strategist, Center to Champion Nursing in America, which runs the Campaign.

The post Population Health in Nursing and the Response to COVID-19 appeared first on Campaign for Action.