New Jersey Health Initiatives is the ‘Face of the Foundation’ in New Jersey
Robert Atkins, PhD, RN, is associate professor of childhood studies and nursing at the Camden campus of Rutgers, the State University of New Jersey, and director of New Jersey Health Initiatives, a statewide grantmaking program of the Robert Wood Johnson Foundation (RWJF). He is an alumnus of the RWJF Nurse Faculty Scholars (NFS) program.
Human Capital Blog: Congratulations on your position as director of New Jersey Health Initiatives (NJHI). What is RWJF’s vision for the program and for the state?
Robert Atkins: Thank you. As the largest philanthropy in the country devoted specifically to health and health care, the vast majority of Foundation resources are, of course, targeted outside of New Jersey. However, New Jersey is the Foundation’s home state. Consequently, the Foundation has a history and connection to New Jersey that is distinctly different from other states and reflected in the kinds of grants made by the Foundation that benefit individuals, communities, and institutions in New Jersey. Although NJHI is only one facet of the Foundation’s philanthropy in the state, as the only national program office of the Foundation that focuses on a state, NJHI is “the face of the Foundation in New Jersey.”
The Foundation’s vision for NJHI and its other New Jersey or “backyard” grants is that they reflect the very best of what the Foundation can do to improve health and health care. I think this tradition of meeting the Foundation’s highest standards of excellence is evident in the legacy of NJHI, and it is a tradition that I feel privileged to sustain and improve upon.
HCB: Do you think it’s significant that RWJF put a nurse in this role?
Atkins: This is a complicated question and one that I have given some thought to over the past several months.
On one hand, the Foundation has a long history of supporting nurses and nursing, and it is minimally significant that they chose a nurse to direct NJHI. I think it is significant that they entrusted me, a nurse who has only a short history with the Foundation, with the proverbial keys to NJHI. As I discussed, NJHI is a program near (literally) and dear to the Foundation and, while I have been a grantee of the Foundation through its Nurse Faculty Scholars program, I come from outside the Foundation. In contrast, my mentor and most recent predecessor at NJHI, Calvin Bland, has been connected to the Foundation for more than 40 years. Understanding the Foundation’s vision and how NJHI could best serve the Foundation’s mission in New Jersey was effortless for him.
Maybe because nurses are consistently rated by Americans as the most trusted profession, the Foundation was willing to make a leap of faith that I would “get it right” and not drive NJHI off the road. However, I like to think that the decision to entrust me with NJHI reflects the work I have done with vulnerable populations as a nurse and researcher and a confidence in the resources that the Foundation invested in me through the Nurse Faculty Scholars program to develop my leadership skills.
HCB: For nearly three decades, NJHI has supported community-based service implementation projects in New Jersey. What are some of its major accomplishments?
Atkins: NJHI has been successful at responding to the specific health and health care needs of our state’s residents. While New Jersey is not a huge state geographically, we have a very diverse population and we are deliberate in funding projects that reach the most vulnerable communities statewide.
Our funding has evolved over the years from addressing the specific needs of individual communities, to targeting funds to specific issues identified as priorities statewide, to bringing other RWJF models that have been proven on a national level to scale in New Jersey. One of our unique characteristics is our flexibility to meet the needs of New Jersey’s communities while strengthening the capacity and network of providers and agencies serving those communities.
HCB: Please tell us about some of the NJHI projects that are currently underway.
Atkins: In November we began funding NJHI: Primary Care Workforce Innovations. The funding supports seven primary care practices to redesign the practice team, in the context of practice transformation, by implementing creative workforce models and using health professionals and other staff in new, more effective ways to improve access to primary care services and improve quality without increasing the costs of health care.
In July of this year we will begin funding NJHI 2014: New Paths to Professional Nursing, which attempts to address the future nursing shortage by supporting development and implementation of programs preparing health care paraprofessionals from underrepresented communities to matriculate into baccalaureate nursing programs in the state of New Jersey by fall 2016.
Programs funded through the NJHI: New Paths to Professional Nursing initiative will provide the financial, academic, and social supports that aspiring nursing students will need to complete the prerequisite natural sciences, social sciences, and humanities coursework required for admission to baccalaureate nursing programs by fall 2016.
The larger project we are working on at NJHI is re-imaging how we do our grantmaking. I am fortunate that my predecessors left me with a talented team of smart and compassionate grantmaking professionals, and we have spent a great deal of time working to make sure that we are even more strategic in our grantmaking. This means that NJHI will play a larger convening role in the state by bringing to the table various constituencies—funders, policy-makers, practitioners, elected and government officials—to start the conversation around how to build healthier communities in New Jersey.
We hope that these ongoing conversations allow us to do a better job of supporting the development and implementation of health innovations that improve the health and well-being of New Jerseyans. By bringing together these constituencies as concepts are being developed, our hope is that the momentum will continue well beyond the limitations of our funding cycles.
HCB: You took the lead on a 2014 NJHI project that aimed to help frontline health care workers become professional nurses. Why did you take on that particular project, and what are the results so far?
Atkins: My interest in this initiative grew out of personal experiences. I had to have blood drawn last year, and the phlebotomist who drew my blood did it skillfully and, equally important, she had great interpersonal skills and she gave great care. Of course, I never pass up the opportunity to try and recruit exceptional individuals into the profession of nursing, and I told her she would be a great nurse.
She was in her late 20s and African-American, and she told me that nursing was a dream of hers that had been placed on hold more than once due to challenges that included affordability, adequate childcare, and her work schedule. This conversation made me think about all of the remarkable health paraprofessionals from culturally diverse backgrounds I had met over the years who aspired to be nurses but for one reason or another did not have a path to the profession.
This is an unfortunate and deplorable situation all around. The aspiring nursing students are denied the opportunity to maximize their potential as health care providers in our society, nursing is denied nurses who have the potential to transform the profession, and probably most important, the patients who would benefit from a nursing workforce that is more culturally diverse have rates of morbidity and mortality that are higher than they need to be.
We are just beginning to review proposals so we have no results yet but we are confident that we will be able to fund a strong cohort of grantees, and we are really looking forward to the statewide conversation that we can catalyze around this initiative.
“My best advice ... ask the right questions; find opportunities to get in over your head and get comfortable with being uncomfortable ...”
HCB: You are an alumnus of the RWJF Nurse Faculty Scholars program. Did that experience help prepare you for this kind of leadership position?
Atkins: Yes it did. The NFS program is, at its core, a leadership development program, and baked into the program from the first day to the last were activities that developed our leadership skills. However, just as important to the experience and my leadership development was spending time in the company of emerging leaders like the scholars in my cohort and renowned leaders who were on the National Advisory Committee such as Courtney Lyder, ND, RN, FAAN, (my mentor), Angela Barron McBride, PhD, RN, FAAN, and Kathy Dracup, RN, FNP, DNSc, FAAN.
HCB: Your RWJF Nurse Faculty Scholar research was about how the health and health-related behaviors of adolescents living in high-poverty, urban neighborhoods are shaped by the demographic, socio-economic, and structural contexts of their lives. What did you learn from that research?
Atkins: My experience living in Camden and working with youth in Camden as a school nurse and co-founder of a youth development program sparked my interest in the influence of high poverty environments on the life chances of youth. What we learned is that poverty matters because poverty affects where children live.
Poverty affects the kind of neighborhood children live in. Impoverished children and adolescents, especially Black and Hispanic children, are more likely to live in vulnerable neighborhoods (where at least 30 percent of residents have incomes below the poverty threshold) than their White and affluent peers. As compared to their affluent counterparts, children living in vulnerable communities have fewer opportunities for youth development, have reduced access to primary care services, are at increased risk for obesity, and have fewer opportunities for play.
Vulnerable communities are more likely to have higher proportions of children than affluent communities, and we are testing hypotheses to better understand how the age structure of vulnerable communities mediates the relationship between poverty and a variety of health outcomes. What we think is happening is that with fewer adults in their households, schools, and communities, many kids in communities like Camden will interact less with adults than do their counterparts in less child-dense neighborhoods. Because youth have fewer resources (e.g., money, transportation, and social networks) and less experience than adults in promoting, maintaining, and restoring health, they are less able than adults to provide support to their peers, and life chances are diminished.
HCB: In college, you majored in political science and American civilization, and had your sites on a legal career. Why did you change course and become a nurse and, ultimately, a nurse scientist and nurse leader? What advice would you give to aspiring nurse leaders?
Atkins: I did have aspirations of a career in law but I switched paths for several reasons.. First, I encountered too many lawyers who said that they enjoyed law school but were not thrilled with the practice of law. And second, after graduating with my first bachelor’s, I had the opportunity to work in behavioral health and I got interested in public health, and everything unfolded from there.
My best advice for aspiring nurse leaders is to focus less on having the right answer and get in the habit of asking the right questions; find opportunities to get in over your head and get comfortable with being uncomfortable; and seek out mentors who have the leadership qualities that you hope to develop.
Learn more about New Jersey Health Initiatives.