From Nursing to Public Health Policy

    • June 1, 2009

The problem: How can a midcareer health professional interested in national health policy-making get intimate exposure to the process in Washington? Can the political and leadership skills learned there be applied to solving critical issues in nursing? 

Programee background: As a child in Princeton, W.Va., Judith B. Collins played nurse with her dolls, pretending they were her patients. “I came along in the era that if you were a woman in health care, you were going to be a nurse,” Collins recalls. At her parents’ urging, Collins pursued a Bachelor’s Degree in Nursing instead of a hospital-based diploma program, and graduated from the University of North Carolina at Chapel Hill in 1962. She worked for a few years as an Ob/Gyn nurse at the University of Florida Teaching Hospital in Gainesville, but in 1966 was ready to try something new. 

Collins served for a year on the Hospital Ship HOPE in Nicaragua, “an unbelievable experience” that sparked her interest in public health policy. She vividly recalls seeing children in sugar cane fields waving white flags to indicate which fields the crop dusters flying overhead should douse with pesticides. “We would see the children come in ill, but there was no cause-and-effect knowledge or policies,” says Collins. She got a group to clean up a small, but neglected local clinic. “The first delivery I saw there was unbelievable: a woman lying on a metal delivery table, with the doctor smoking a cigarette, and iguanas and snakes crawling everywhere,” Collins recalls. “That experience had an impact on who I was, and the fact that I wanted to be involved in public health policy.” 

Programee Perspective: Back from Nicaragua, Collins worked as the first Caucasian nurse at St. Philip Hospital at the Medical College of Virginia (MCV), a hospital for African-American patients in the still-segregated city of Richmond. “It’s interesting how one life experience gets you ready for the next,” she says. “I was used to working in a different environment.” After getting her Master’s Degree in Maternal-Child Nursing from Boston University in 1968, Collins returned to MCV, by then desegregated and part of Virginia Commonwealth University (VCU). She quickly rose to divisional director of Ob/Gyn Nursing, before leaving when her son was born in 1971. 

In 1975, Collins was drawn back to VCU to establish and co-direct an Ob/Gyn Nurse Practitioners program to help improve prenatal care in Virginia; later her job expanded to include the Family and the Pediatric Nurse Practitioner Programs. While securing a federal grant for the Ob/Gyn program, Collins had an epiphany: “We write this grant, and get the program after [answering various questions] but, I wondered, ‘Who is asking these questions? They are not down here, where the rubber meets the road, so how is policy really made?’” Remembering various nursing association meetings she had attended in Washington, Collins says, “Suddenly, I knew: ‘This is where policy is made!’”

When Collins came across a description for the Robert Wood Johnson Foundation Health Policy Fellows Program, she said, “Let’s try it.” 

Results: As a Health Policy Fellow from 1982 to 1983, Collins worked in the office of Congressman Richard A. Gephardt (D-Mo.), a member of the influential House Ways and Means Committee. There she immersed herself in Medicare reform, working on the creation of the prospective payment system of health care reimbursement that Congress passed in 1983. “It was fabulous,” she says. “I was involved in every bit of it, and I got to see policy and politicking in action.”

She also learned an unexpected lesson. “You have to know why Congress cares about a particular issue,” she explains. “And anytime it comes from personal experience, it’s real.” Because Gephardt’s son had cancer as a little boy, the congressman had a keen interest in health care issues and health policy, and was lobbied by everyone. As the only provider in Gephardt’s office, Collins found her clinical skills unexpectedly useful. “Nurses are educated to be really good negotiators, to advocate for what patients need,” she explains. “So I learned to utilize those skills in a new arena—in policy and politics. Those skills are transferable.”

Collins loved Washington and was tempted to stay after her fellowship, but VCU/MCV officials urged her to return to Richmond.

Impact: Noting that the university was literally across the street from the state capitol, Collins convinced school officials to be “proactive” instead of “reactive” about health policy. She established the VCU/MCV Health Policy Office under the jurisdiction of the vice president for Health Sciences. As director of the office, Collins focused her next 10 years on governmental relations, health policy issues and education, while teaching at the Schools of Nursing and Medicine and caring for patients as a nurse practitioner. “When I started representing the university in the General Assembly,” Collins remembers, “and they were worrying about teen pregnancy, I could say, ‘I took care of a 13-year-old pregnant patient this month and here are the issues.’”

Collins’ long-standing efforts on behalf of nursing reflect her experiences in health policy and her continued association with the Robert Wood Johnson Foundation (RWJF). “The RWJF Health Policy Fellowship launched my career in a whole new direction—it has become the fellowship that keeps on giving,” she says. “The knowledge and skills that I learned—not only in policy-making but in networking and politicking—have continued to have an impact on my leadership ability.” Consider:

  • Collins participated in launching the first annual Nurses Day at the Virginia General Assembly in 1986 to highlight initiatives that impact nursing. 
  • In 1991, she helped organize the first annual Nurses Walk on the Capitol in Richmond, Va., to urge support for prescriptive authority for licensed nurse practitioners in Virginia, which was granted the following year.
  • Collins founded the comprehensive VCU Women’s Health Center at Stony Point in 1993. The center’s services include radiology, internal medicine, Ob/Gyn, surgery, plastic surgery, breast health, psychiatry and a library. “You talk about using political and policy skills—that’s how we pulled that off,” Collins says. “It was the capstone of my clinical career.” 
  • Collins has participated in the Virginia Partnership for Nursing, started 10 years ago under RWJF’s Colleagues in Caring: Regional Collaboratives for Nursing Workforce Development, a national program to strengthen nursing education programs and the nursing workforce. See Program Results for more information on the program.
  • Since retiring in 2000, Collins has served on the board of the Richmond Memorial Health Foundation and is the current chair. In 2007, the foundation was selected by RWJF, in partnership with the Northwest Health Foundation, as a lead agency in the second phase of its Partners Investing in Nursing’s Future (PIN) program, which helps regional philanthropies develop solutions to the nursing shortage. Collins helped develop the PIN project—the Central Virginia Nurse Leadership Institute—a leadership program for midlevel nurse managers. “If you don’t have good leadership skills, you can get burned out pretty quickly,” Collins explains. “This helps with the retention of the nurses.”
  • Collins participated in the RWJF Summit to Build Nursing Education Capacity, co-sponsored by the Center to Champion Nursing in America—an initiative between RWJF, AARP and the AARP Foundation, the U.S. Department of Labor and the Health Resources and Services Administration—to increase the nation’s capacity to educate and retain nurses. Collins lectured on advocacy and messaging, describing how Virginia nurse leaders formed a “Kitchen Cabinet” prior to state elections to educate candidates on nursing and faculty shortages, as a way to illustrate how nurses can impact the political process.
  • Recently Collins and her colleagues in Virginia were selected to participate in RWJF’s Nurse Leaders in the Boardroom project, which seeks to strengthen health care organizations by placing top nurse executives on key boards around the country.

“It is amazing, isn’t it?” says Collins. “Starting with the Health Policy Fellowship, RWJF has been beautifully woven throughout my career. It has been a wonderful ride.”

RWJF perspective: Since 1973, the Robert Wood Johnson Health Policy Fellows Program has given exceptional midcareer health and behavior science professionals an opportunity to better understand health policy at the federal level. After an extensive orientation, fellows seek work placements in government—most choosing a congressional office—where they contribute to research, drafting legislation, briefings and other vital policy-related activities.

“The RWJF Health Policy Fellows Program is a flagship program for the Foundation and one important way we seek to improve the health and health care of all Americans,” says Michael Painter, J.D., M.D., senior program officer and himself a 2003 RWJF Health Policy Fellow. “It is critically important that health care professionals—physicians, nurses, behavioral scientists and others—realize that they can and must play important roles in promoting impactful, positive, informed change. The program provides a great way to help them learn how to do that and to learn firsthand the important relationship between politics and policy. I absolutely could not do what I am today without that experience.”