Culture of Health Blog

I confess I have felt ambivalent about Nurses Week since 2011, my first year as a second-career registered nurse. Back then, in addition to a full-time communications job, I was working weekends in a long-term care facility. Despite having no experience other than clinical rotations just nine months before, I had been given a short orientation that I essentially had to structure myself; I was then thrown onto a skilled nursing floor with 15 residents during the day and 32 residents at night—most of them unable to walk on their own, some with dementia, and all with at least one chronic condition. I was hanging tube feeds, flushing central lines, and dressing stage IV pressure ulcers, all while trying to keep everyone safe and happy.

My colleagues and I received many tributes during Nurses Week—a message from the administrator, posters and food in the break room, giveaways. Don’t get me wrong; the gestures and the sentiment were lovely. But what I wanted more than encouraging emails and pizza was help. What I wanted was permission to say “I’m scared and could use some more support,” but nursing culture there—and in many places, still—was “sink or swim.” Not long after, I decided to “swim” out of long-term care, rather than make an error that would cost me my license or, worse yet, a resident his or her life.

I’m not telling you this so you’ll feel sorry for me; I’m telling you this because I have come to realize that I wasn’t alone in feeling frightened and overwhelmed on the job. Almost anyone who takes their nursing responsibilities as seriously as they should has felt that way at one point or another. And now, this Nurses Week, with two years of this awful pandemic under our belts, nurses—particularly those on the front lines—are feeling more stressed and burned out than ever; many are leaving the profession.

In Manhattan’s financial district, the average resident can expect to live until the age of 85. In East Harlem, life expectancy is only 76 years. Ten stops on the subway and a nine-year drop. That’s what Jasmine Travers, a nurse and New York University assistant professor, told me when we talked about the importance of digging out the root causes of health disparities.

As Black women in the nursing profession, both of us understand the need to “get real” about structural racism because we’ve seen how it plays out at the patient’s bedside and in our own professional lives. In fact, Jasmine left hands-on nursing to pursue research into the policies, practices, and structures that impede good outcomes. Talking about the realities of racism isn’t easy, but being uncomfortable isn’t an excuse to avoid tough conversations. The goal is not to accuse or shame anyone, but rather to shine light on enduring inequities, the forces that perpetuate them, and the ways we can heal the damage they do.

As an example, Jasmine described differences in how hospital staff sometimes approach pain control. The immediate response to a White patient’s complaint tends to be “let’s see how we can ease the pain.” But patients of color face more scrutiny. Too often, the first question a healthcare provider asks is, “what’s really going on here?”—the assumption being that pill-seeking behavior needs to be ruled out before considering the use of pain meds.

Maria Gomez has had her finger on the pulse of our healthcare system and the people it serves throughout her storied, 30+ year career running a community health center that serves a low-income, immigrant community in greater Washington, D.C. Maria entered the United States at age 13, started Mary’s Center after becoming a nurse, and helped grow it into a powerhouse serving 60,000 people each year. Mary’s Center helped pioneer an integrated model of healthcare, education and social services to put people on a path to good health, stability and economic independence. In 2012, President Obama presented Maria with the Presidential Citizens Medal. She retired in late 2021. Here, in the second part of a two-part interview, she reflects on the challenges facing our healthcare system, how nurses can continue leading efforts to meet them, and what we can learn from the pandemic.

What are the greatest challenges facing our healthcare system?

Today, it’s all about the numbers—the number of patients you see and the number of minutes it takes. Because that’s how you get paid. To transform lives, we need to change how we address patient needs. Providers can’t do it all in 15 minutes. Some are so overwhelmed by the numerous demands on them that they’ve grown numb to what their patients are feeling. Too many smart, incredibly passionate people who devote themselves to healthcare have become disheartened, burned out, and are even leaving the workforce. This is the most discouraged I’ve seen providers in my career.

To this day, I still choke up when I remember the moment, two decades ago, that changed my life. As part of the Martin Luther King Day of Service, I had volunteered to help feed some folks who were homeless. At the end of the afternoon, I turned to one of the women who ran the sponsoring program, and said, “That was great, I look forward to doing this again next year.”

She paused, looked directly at me, and said quietly, “We do this every week.”

In those words, I suddenly heard a calling. My Dad was a church pastor and I had always expected to follow his path. But now I wondered, “Am I going to preach about this, or am I going to actually do it?” And so I signed up to work among people who were living mostly on the streets. Some struggled with mental illness or substance use, others had been forced from family homes because of their sexual identities. All were poor and most were Black or Brown. I learned to listen, not judge, and to think more broadly about how poverty and race intersect.

For children and families, last year’s expansion of the Child Tax Credit provided crucial support, helping them afford basic needs like food, clothing, and housing. Yet this historic policy achievement that almost immediately reduced child poverty was fleeting. Just six months after the first payment went out, the opportunity to help children thrive abruptly ended. The expanded policy was never extended, and these families are now right back where they started.

Research shows that long term, sustained cash assistance has the greatest impact, confirming that this policy should be permanent. As we mark Tax Day here are four reasons why the expanded Child Tax Credit should be permanent:

1.  Reduces the number of children living in poverty. (That should be reason enough).

Even in a nation as wealthy as the United States, 10 million children experience poverty. The damaging effects of the conditions of poverty are relentless: hunger, homelessness, substandard schooling, and a lack of access to healthcare and child care. The populations hit hardest by the pandemic are the same ones experiencing the highest poverty rates: Black, Hispanic, and Indigenous children and their families.

On a host of issues ranging from commercial tobacco regulation to public health authority, paid sick time to advancing the health of children and families, a policy tool known as preemption can impede local decision-making. Preemption is when a higher level of government, such as a state legislature, restricts the authority of a lower level of government, such as a city council. Depending on how it is used, preemption can either support or undermine efforts to advance health equity.

In one example of the latter, we know that health and economic well-being are intertwined, which is why raising the minimum wage has been used across the United States to advance health equity for workers in low-wage industries. In 2016, the majority-Black city council of Birmingham, Ala., passed an ordinance raising the minimum wage from $7.25 to $10.10 per hour. But the new minimum wage never took effect because the majority-White state legislature responded with a law preventing municipalities from setting their own minimum wages. It effectively nullified Birmingham’s ordinance.

Eight years later, Alabama still follows the federal minimum wage of $7.25 an hour. At that wage, someone working 40 hours a week, 52 weeks a year, earns about $15,080. Birmingham decision-makers recognized in 2016 that $7.25 an hour is not a living wage. Yet to this day the state still prevents the local government from acting.

Families around the country, mine included, are feeling fortunate to have our kids back in school after a turbulent, unpredictable couple of years. Students, teachers and school officials were forced to navigate unexpected changes.  For most, the ongoing shifts from virtual to in-person learning were stressful and added to many other pandemic-induced hardships. Through it all, school districts quickly spearheaded innovative approaches to ensure they could continue to serve much-relied-upon school meals to students. They implemented “Grab and Go” models allowing parents to pick up meals in school parking lots or other community hubs; loading up school buses with meals and dropping them off at stops along neighborhood routes; and delivering meals directly to students’ homes.

Schools were able to offer this continuity and flexibility because when the Covid-19 pandemic forced nationwide school closures—and hunger and food insecurity spiked—Congress passed the Families First Coronavirus Response Act and CARES Act in 2020. 

Provisions in these laws provided the U.S. Department of Agriculture (USDA) with authority and funding to implement waivers that permit schools nationwide to serve meals to all students free of charge (also known as universal school meals). The measures also allowed schools flexibility to help ensure that meals are provided safely during a public health emergency. That includes distributing meals to families outside of the school setting and  temporarily serving meals that meet the less stringent nutrition standards of the Summer Food Service Program, which require fewer fruits and vegetables than USDA’s current nutrition standards for school lunch.

Thirty-five local non-profits will be awarded up to $40K to work with local data to dismantle structural racism via a new funding opportunity.

Editor's note: This funding opportunity is now closed. 

Life is harder than it has to be for families where grandparents or other relatives step up to care for children when their parents can't. Our family-supportive policies and systems were designed to serve “traditional families,” with services aimed at “parents” and foster families, not relatives who step up. These families face unnecessary barriers to getting the support children need to thrive. This is especially true among Black and American Indian families, who make up a disproportionate share of the 2.6 million families in the United States where children are growing up without parents in the home. The pandemic has made things worse. COVID-19 has robbed thousands of children of their parents and sent them into the care of relatives.

What happened to the Brown family of Baton Rouge, La., helps to tell the story of grandfamilies, also known as kinship families, which form when children are separated from parents through life events like death, illness, incarceration, or deportation. After a horrific onslaught of gun violence killed four members of their family, Robert and Claudia Brown took custody of three grandsons. They fought for 12 years to adopt the boys.

The Browns struggled through trauma, grief, and loss. They scrambled to pay lawyers while supporting three growing boys. They blew through retirement savings. They didn’t know about services or support that could have bolstered their mental health and financial security.

Maria Gomez was 13 years old when she immigrated to the United States with her widowed mother to escape violent political turmoil in Colombia. They landed in Virginia on a snowy day with no boots, no coat, and not speaking a word of English. Together, they faced many challenges while navigating their new life. In spite of them, Maria’s gratitude and drive to give back led her to a nursing career. She ultimately joined a group of advocates in launching Mary’s Center to address gaps in access to healthcare and structural barriers that many immigrants face.

Today, Mary’s Center uses an integrated model of healthcare, education, and social services to serve patients at five clinics and two senior wellness centers in Washington, D.C. and Maryland. In 2012, President Obama presented Maria with the Presidential Citizens Medal, the second highest civilian honor in the United States.

After an illustrious career, Maria retired in December of 2021. She shared reflections on how she has led efforts to serve a diverse population and insights into the challenges our healthcare system and nation face. In this interview, Maria discusses how she shaped a system of care that aims to build trust with patients and provide integrated care that addresses more than medical needs.