Culture of Health Blog

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.

Anyone who has spent time in a hospital knows that—more often than not—nurses are the professionals who catch the little problems with your care: the uncomfortable IV tube, the bandage that doesn’t quite fit, the pill bottle that’s hard to open.

Nurses are natural problem solvers. They cut down bandages to fit preemies. They fashion a plastic cup around an IV site to stop it from snagging clothes. They roll up two hospital blankets and wrap them in tape to make a “cough pillow”—something to clutch against your stomach to ease the pain of laughing or coughing after abdominal surgery. These DIY medical devices are made by nurses every day in hospitals.

Nurses are uniquely positioned to spot such problems. So, why not encourage nurses to continue devising their own solutions, then give them the tools to create them?

With MakerNurse, that’s exactly what we’re doing.

Imagine your grandmother or someone you love falls and breaks her hip, arriving at the hospital in excruciating pain. She desperately needs pain medication and the nurse or medical resident on duty calls a senior clinician to request it. But the clinician says she’s busy and can’t see your loved one for at least an hour. How would you feel if the nurse or resident passively accepted this response? Alternatively, what if they challenged it?

Nurses and early career doctors regularly encounter thorny scenarios like these. Unfortunately, many hesitate to challenge senior colleagues, even when a fragile patient urgently needs help. Senior clinicians may even berate perceived subordinates for challenging their authority.

At New York University, we are part of a growing movement that aims to change these pernicious patterns. Marc Triola, MD, and I co-led a project to give nursing and medical students the training they need to work better together.