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.

My passion for public health was ignited early on in my career in nursing, serving children and families in St. Louis’ Head Start program. I quickly realized that the health of the individuals for whom I cared depended on a complex mix of factors—including personal choices, the opportunities they had available to them (or not), and the resources within their communities. And my time in St. Louis set me on a career path in nursing that has shown me just how integral a role nurses can play in the health of not just their individual patients, but the broader population.

• View related RWJF analysis and perspectives on Nurses, Nursing and Population Health
  

Nurses have always played a key role in improving our nation’s health and well-being. We see people—not just at different stages of their lives, but also in all of the different places our patients live—using nursing skills and expertise to care for them in many different ways.

As a nurse practitioner at a community health center on Chicago’s West Side, Jewel Scott loved her job, even though helping her patients heal sometimes felt like an uphill battle. Many of her mostly African-American or Latino patients suffered from type 2 diabetes, yet couldn’t afford insulin or struggled to keep appointments due to jobs without flexible schedules. Most had endured difficult childhoods marked by poverty and violence.

One such patient changed the path of Scott’s life. A young woman came in with symptoms of a urinary tract infection. During the visit, Scott discovered that patient had untreated type 2 diabetes—just like her father—and a dangerously high blood sugar level.

Editor’s note: In September 2016, Bob Hassmiller, beloved husband of our own Sue Hassmiller, our senior adviser for nursing, was involved in a bicycle accident that left him critically injured and ultimately took his life. We asked Sue to share her story—and she very graciously agreed—because we believe that a Culture of Health is possible even when people are at their very sickest. She tells us how.

My life is separated into two time periods: Before my husband’s accident—and after.

Bob and I were married for 37 years, and he was, in every aspect, my best friend. While I traveled frequently for work—work I am very passionate about—Bob was the person I came home to, my bedrock, my backstop and my biggest fan. We knew each other as only two married people who have been together for so long can. And we relied on each other for our very different strengths.

I was a visiting nurse early in my career, working outside the bricks and mortar of our health care system to provide care directly in patients’ homes. I saw firsthand the important role that the home and neighborhood environment plays in shaping health. I’m no longer a visiting nurse who sees patients, but I’m still a nurse who is building a Culture of Health—through my work here at the Robert Wood Johnson Foundation and out in the community.  

I recently volunteered with Habitat for Humanity in Trenton, where my colleagues and I helped build affordable homes for people in need of them. The tasks assigned to me didn’t require any nursing-specific skills, but many of the same qualities nurses bring to the job every day—teamwork, empathy, the ability to multi-task, and understanding how the conditions we live in affect our physical and mental well-being—made me feel comfortable (and even somewhat competent) on a construction site

Six years ago, I graduated from nursing school at the age of 40-something—a feat accomplished while working full time, attending class and doing clinical rotations nights and weekends—with no small amount of support from my husband, my teenage children and my almost-3-year-old.

Frankly, when I graduated, I should have given each of them a gift for their support.

Instead, my then 15-year-old daughter gave me a copy of the book Critical Care by Theresa Brown, who, like me, was a second-career nurse. She’d heard her interviewed on National Public Radio and thought I might enjoy it. What I read in that book got me through some very rough overnight shifts when I was working per diem at my first job in long-term care. Her book reminded me that every new nurse is scared, tentative and not quite sure of her or himself. Yet somehow we muddle through, and we do the very best for our patients.

Fast forward to 2013, and I’d come to work at the Robert Wood Johnson Foundation.

Robin Wallin, DNP, RN, first became concerned about the unmet dental needs of children attending the Alexandria City Public Schools in 2000 when one of the school nurses she supervised participated in a multidisciplinary evaluation for a kindergarten boy named José who could not sit still in class.

Upon examining his mouth, the nurse discovered gaping black holes where teeth should have been. She helped find an oral surgeon willing to treat José—who came from a low-income family without health insurance—free of charge. As it turned out, once José’s teeth were treated he no longer struggled with sitting still in class.

This experience led Wallin—who was then the Health Services Coordinator for the Alexandria City Public Schools in Alexandria, Virginia, and now serves as the director of health services at Parkway Schools in the Greater St. Louis area—to wonder if other kids like José struggled with school due to underlying oral health problems.

A nurse leader shares how she overcame significant barriers to pursue a successful career and what we can do to help minorities in nursing succeed.