Front Line Warriors in Pandemic and Care Delivery: Dr. Susan Hassmiller on Impact of Nursing in American Health Care

Dr. Susan Hassmiller

[ M us ic ]

Moderator: Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the hea lthca re
of t he future.

This week, Mark and Margaret speak with Dr. Susan
Hassmiller , Senior Advisor for Nursing at the Robert Wood
Johnson Foundation and Senior Advisor to the President on
Nursing at the National Academy of Medicine. She talks about
the International Year of the Nurse . It's America's largest
health profession , 3.8 million nurses working as the glue for
the health system here, with nurses risking their lives to treat
COVID - 19. Also for work promoting the growt h of the
st
profession to the 21 century.

Lori Robertson also checks in, Managing Editor of
FactCheck.org looks at misstatements spoken about health
policy in the public domain, separating the fa ke from the facts.
We end with a bright idea that's improving health and
wellbeing in everyday lives.

If you have comments, please e - mail us at [email protected]
or find us on Facebook, Twitter, or wherever you listen to
podcast. You can also hear us by asking Alexa to play the
program.

Now stay tuned for our inte rview with Dr. Susan Hassmiller
here on Conversations on Health Care.

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Mark Masselli: We're speaking today with Dr. Susan Hassmiller, Senior
Advisor for Nursing at the Robert Wood Johnson Foundation,
where she also directs the foundation's Future of Nursing
Campaign for Action in Partnership with the AARP. She's
currently Senior Scholar and Residents and Senior Advisor to
the President of Nursing at the National Academy of Medicine ,
is currently working to craft the Future of Nursing 2020 report.

Mar garet Flinter: Dr. Hass miller is a Fellow of the American Academy of Nursing
and served as the Executive Director of the United States
Public Health Service Primary Care Policy Fellowship at HRSA .
She is a recipient of the Florence Nightingale Medal which is
the highest international honor given to a nurse by the
International Committee of the Red Cross. Dr. Hassmiller ,
welcome to Conversations on Health Care .

Dr. Susan Hassmiller

Dr. Susan Hassmiller : Thank you for having me.

Mark Masselli: Yeah, you know, we're celebrating yo ur nurse , and I don't
know how to describe the time that we're in. Certainly with
the backdrop of COVID - 19 pandemic, nurses are clearly on the
front lines of the response, particularly for critical care or
emergency nurse specialists are really everywhere in the
respo nse. But perhaps more shocking is the number of nurses
who are actually dying on the frontlines really being sent into
battle with in adequate protection, such as even some of the
most basic PPE and all this harsh reality has shown a spotlight
o n the profession. I'm wondering if you could just talk about
how the crisis has put a spotlight on nurses , the role that they
play.

Dr. Susan Hassmiller : I think if people didn't know this before, they would know this
now . Nurses have never been more in th e news , and I think
people are seeing that nurses are the glue that is really holding
this altogether . I was struck by a table that I saw in the
economist of the most dangerous possession , and right on the
top right hand corner with the biggest bubble was nursing , and
any nurse and physician really understand that both physicians
and nurses are equally important, but it's real ly the nurse
that's in the room mostly , and you see nurses with their iPads.
This is the most crushing thing that I saw throughout th is
whole pandemic was nurses with their iPads trying to connect
the patient with their family members because the family
members couldn't be there when their loved one was even
dying. We always , you know, with the Future of Nursing
Campaign for Action that I direct, we are always letting nurses
know speak up for your rights, and I think we are seeing nurses
who have found their voice , they really are doing the work
that they feel that they were called to do , and I thi nk they are
getting recognized.

I've be en struck by the number of nurses who are feeling
psychologically battered. I wonder if our profession is going to
be decimated? Or will nurses feel wow , this is what we have
been called to do all this time and people are recognizing this.
I think nurses a re finding their voice. Some nurses have been
fired over their voice, and demanding more PPE , but we're
clearly seeing them as the glue, really expressing a lot of
compassion . Nurses and physicians, all healthcare providers
really go into their profession to connect with people in this
way, but with all of the technology and the rules and the
regulations that nurses have to follow , sometimes they don't
have the time and can't make that connection they want to
make. I think this pandemic, as horrible as it h as been, has

Dr. Susan Hassmiller

allowed nurses to really come forward and show the
compassion and empathy that they've always wanted to in
their career.

Margaret Flinter: Well, Susan, you have such a really large role. You've been
advising the Robert Wood Johnson Foundation and the
National Academy of Medicine on the critical importance of
investing in the continued advancement of the nursing
profession, the largest discipline within healthcare in the U.S.,
3.8 million nurses, to advance training and education for
nurses and then to make sure that they can use that training
and education to practice at the highest level , and we're very
instrumental in drafting the national study that led to the
Institute of Medicine report the Future of Nursing 2020. Can
you highlight some of the goals that we're established then
and share with us , how closest we come to achieving them
and maybe in some cases even exceeded them?

Dr. Susan Hassmiller So the first report was about building capacity. We need more
nursing leaders, we need more nurs es to go on for doctorate
degrees , we need more nursing faculty , we need to diversify
our profession. All nurses here's the big one , right , one of the
big ones all nurses need to practice to the top of their
education and training, and more nurses need to have a
baccalaureate degree. Back when the first report was
published , we had more associate degree nurses in this
country than we had baccalaureate masters and highly
prepared nurses. It matters when it comes to not only the
quality of nursing care . I f yo u have a baccalaureate degree,
you're going to have more information and more clinical
experience around population health. We also knew it was
more important to have a baccalaureate degrees because of
the pipeline . We always have had a s evere nursing facu lty
shortage.

Now, for the first time in the history of forever , we have more
baccalaureate nurses than we do have associate degree
nurses. We haven't reached the goal, the goal was 80% by
2020 , but we have reached a cultural shift in this country
around that particular recommendation because any nurse
now that is in their associate degree program, you ask them to
raise their hand, how many of you will go on for a
baccalaureate degree? They pretty much all do . It is just the
way the culture is now . I will tell you where we do not have a
cultural shift and that is for nurse practitioners to go to school
for all the years that they go to school, and then they come
out and they can't practice what they learned in school. We've
made progress since 10 years ago, we brought along seven

Dr. Susan Hassmiller

more states. But that's not a cultural shift. We only have 22
states in this country where nurses are allowed to pra ctice as I
say what they learn in school. Unfortunately, we've had a
pandemic, but fortunately, seven additional sta tes have
relaxed their regulations so that their nurse practitioners could
easily provide Telehealth and practice without physician
supervision.

We know more nurses are getting onto boards of directors.
We are trying to encourage nurses all over the count ry to have
a voice like we are in this pandemic. You have an important
role to play in health care prevention, population health, and
your voice as one of the biggest and trusted advocates in this
country , need to be on that board. Recommendations ,
diversi ty , we aren't where we should be. But I think we're
making very important strides in diversifying our profession,
more blacks , Hispanics than ever are coming into nursing. The
thing we're not seeing is that the higher the nurses go in their
profession, the least likely they are to be diverse.

Mark Masselli: Well, Dr. Hassmiller , you're now overseeing the development
of the Future of Nursing 2020 report and we know, nursing is
this incredible blend of science and complex technology and
the art of healing int o practice. I think in part because of this
pandemic, the wind has been put in the sa il of technology,
particularly Telehealth , and I'm just wondering how both
technology is guiding your vision here but also just this has
really captured everyone , and I th ink it's globalizing how we
have to think about the future of any one of the professions ,
right? How are we starting to think about the role of nursing as
a particular profession , not only in the issues of technology,
but the globalization of our responses and the role that nurses
will play ?

Dr. Susan Hassmiller : I characterize the first Future of Nursing report as an attempt
to build the capacity of the nursing profession. Now we're
saying, building the capacity of the nursing profession to what
end? What are those things that really matter most in our
country, in the world globally in terms of keeping someone
healthy and well ? It's not always having the best brain
surgeon, the smartest nurse practitioner but really the most
important things that keep our c ountry and really all countries
healthy are social determinants and the inequities and the
disparities that we need to pay more attention to , where
someone lives in a neighborhood they live in , the
transportation system they have , the food supply in their
community and all these issues are so important and they've
been brought to excruciat ing light during this pandemic.

Dr. Susan Hassmiller

So the second report has to do with the nurses ’ role in
addressin g health equity in this country. Technology will be a
part of this report . It has been such an important part of our
healthcare system and even more so in this pandemic. But we
have to make sure that everyone has a fair and just
opportunity to be healthy and well . We want to make sure
that technology is used to justly provide c are. 15% of
everybody in this country do not have broadband access in
their home. So technology is going to make a big difference.
It's already made a big difference. But we can't let it be a
barrier to the compassion , to the empathy that people f eel for
u s.

Four years ago , I lost my husband in a bicycle accident , and he
lived for 10 days in an Intensive Care Unit and I was horrified,
quite frankly, with the level of technology that was used. But it
came at the cost of not providing the empathy and the
sup port that I also felt was critically needed at a time where I
was losing my best friend.

Margaret Flinter: Well, Susan, the Robert Wood Johnson Foundation has as its
mission statement that it's going to promote a culture of
health in this country and the b iggest one that we focus on is
the difference in life expectancy in groups that endure racial
and ethnic disparities. We're in advantageous spot as nurses
to address many of these systemic issues. But we're also
seeing COVID claiming more people of color. What's your
vision of how nurses leverage their role as this largest group of
healthcare professionals to really fundamentally address these
health disparities in the country?

Dr. Susan Hassmiller : I know the audience is fully aware of the Gallup Poll that ’s
taken every year that shows that nurses are the most trusted
profession , and that goes a long way when we are talking
about inequities trying to ensure that everyone has a fair and
just chance at being healthy and well when I'm sitting here in
Minneapol is where the George Floyd incident happened, and
just horrible. So there's so much distrust , but nurses have got
to play a critical and primary role in this relationship building
in this trust. We have found through a survey that nurses do
want to make con nections for people in terms of their food
supplies, and whether they can get into doctors offices, and
they have access to healthcare once they leave a hospital .

But there's not always the mechanisms or the support , the
technological support, or the admi nistrative support , for
nurses to ask those questions and make those connections .
Healthcare systems are bringing in technology so that nurses

Dr. Susan Hassmiller

in their assessments can ask these very important questions of
people and flag some of the inequities that may be occurring
in that person's life. But where the moral distress comes in ,
and this would be moral distress for any profession, that if
nurses ask these questions, if they don't then have a means of
connecting the patients or people to those resources, then
that bec omes a sense of moral distress.

My role with this next report is to remind nurses of the history
that has been so vivid in their own life, Florence Nightingale,
Lillian Wal d . Lillian Wald was the first Public Health Nurse in
New York City, the Hen ry Street Settlement . She paid every bit
of attention to the kids ’ education level, whether they were
going to school . She found that men who lost their jobs, the
children were more at risk for being healthy. She made all of
these connections. Nurses have been doing this. It's part of
their history , and I feel it's my role to remind nurses of this
very important role , trusting role that they have , and to get
back to that, but hospitals and health systems have got to
support nurses in this role that they wan t to play with the
resources that are needed.

Mark Masselli: We're speaking today with Dr. Susan Hassmiller , Senior
Advisor for Nursing at the Robert Wood Johnson Foundation,
where she also directs the foundation's Future of Nursing
Campaign for Action in Partnership with the AARP. She
currently is the Senior Scholar in Residence and Senior
Advisors , the President of Nursing at the National Academy of
Medicine. Dr. Hassmiller , you just mentioned Florence
Nightingale, among the many awards, you've also recei ved the
coveted Florence Nightingale Award from the International
Red Cross. I understand you were inspired earlier in your
career with the work of that organization. I'm wondering if you
could share with our listeners what you learn and what we
might lear n from other countries and how their nursing
professions are able to impact the health systems.

Dr. Susan Hassmiller : I'm so proud to have been a volunteer for the Red Cross since
my college days when the Red Cross helped me find my
parents in an earthquak e in Mexico City. So that's the
connection. You know, the International Red Cross is guided
by humanitarian principles, a man by the name of Henry
Dunant , who stumbled across a war that was going on and
tried to help both sides , and he figured out that the re was no
real organization to provide humanitarian support , relief
healthcare. The International Red Cross is always involved in
refugee health, the border crisis, and in a very neutral stance .
The Red Cross has a particularly very difficult job right now

Dr. Susan Hassmiller

because they are , in our country, they are congressionally
mandated, it's an unfunded mandate , all money to the Red
Cross comes through voluntary contributions, but they are
congressionally mandated to respond to disasters. So how
hard is it now to respon d to any disaster and our hurricane
season is coming up , to respond to people in a humanitarian
compas sionate way, during a pandemic.

They have to protect their volunteers just like you have to
protect your employees. The Red Cross has to protect their
vo lunteers and cannot put them in precarious situations. My
heart goes out to people who are victims of disasters these
days. They'll get what Red Cross can give them at this point ,
but my heart goes out to everyone trying to deal in this
pandemic. And then globally, things are different for those of
us who are fortunate to be in other countries to have been in
other countries, we know that other countries pay much more
attention to population health. There's one graph , a graph of
about I'll say, 20 countries , of what country spend on medical
care. Every other country spends more on social care and the
social needs of their people , and that's where we get into
trouble with our indicators.

Margaret Flinter: If I can, I wonder if I can just go back for a moment to one of
those recommendations in the Future of Nursing 2020 report ,
and tha t was about creating opportunities for postgraduate
training, as nurses have entered advanced practice or change
specialties, we talk a lot about shortages of primary care
provide rs and primary care physicians , the need for primary
care nurse practitioners, but we need advanced practice
nurses everywhere. Certainly the pandemic has laid bare how
acute the need for behavioral health is in psychiatry and
mental health , but we need pe ople in public health , in elder
care facilities, the schools , home , and of course , in policy and
politics. Where do you see education and training evolving
next to support nursing and exerting its full capabilities to
meet the challenges of this global soc iety we live in ?

Dr. Susan Hassmiller : Clearly, we need to do a better job if this pandemic hasn't
shown us now , I don't know what else will the need to retool
our workforce . W e really need to pay much more attention to
public health and population health , getting nurse
practitioners more clinical experience in the communities and
with elderly populations. I saw that actually a lot of
associations were trying to get their nurses into leadership
positions like that, well, why don't we just all work together on
this? So we formed nurses ’ on board ’ s coalition . What we're
trying to do is get more nurses ’ on boards that need a health

Dr. Susan Hassmiller

and an advocacy voice. If we go back to what is keeping people
healthy and well in the first place, you know those social
determina nts, I'm talking about getting nurses ’ on boards of
transportation councils and public health departments and
food banks, maybe neighborhood councils because there's not
generally a health voice on those types of boards or councils. I
think that's a good e xample of trying to bring health into all
kinds of policies t hat we need to think about now.

COVID - 19 has really been a catalyst for change , and some
people we didn't see this coming. But for those people who
are in public health, then said, A , we saw thi s coming , and B,
we've been warning that this is coming. If we had a better
infrastructure , a public health infrastructure, we could have
been in a little better shape than we are now. Public health
nurses are needed more than ever. Nurse practitioners are
needed more than ever , and I'm hoping that we can take the
lessons learned from this pandemic and really grab hold of
those and then bring stakeholders around say, we got to do
better next time because it's coming again.

Mark Masselli: We've bee n speaking today with Dr. Susan Hassmiller , Senior
Advisor for Nursing at the Robert Wood Johnson Foundation,
where she's also directs the foundation's Future of Nursing
Campaign for Action . You can learn more about her important
work by going to www.campaignforaction.org or you can
fo llow her on Twitter at Campaign4Action . Dr. Hassmiller ,
thank you for your tireless dedication to advancing and
elevating the profession of nursing , and for joining us today on
Conversat ions on Health Care .

Dr. Susan Hassmiller : It's has been pleasure.

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Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about healthcare
reform and policy. Lori Robertson is an awar d winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in U.S. Politics. Lori, what
have you got for us this week?

Lori Robertson: At a White House meeting in May with fellow republicans ,
President Donald Trump said without evidence that the
Coronavirus “ is going to go away without a vaccine. ” Experts
say it's unlikely that the virus will simply go away. Marc
Lipsitch , an epidemiologist at the Harvard T.H Cha n School of
Public Health said there was no basis for the statement, calling

Dr. Susan Hassmiller

it “ completely fanciful and not evidence based.” On Fox News
Sunday, Tom Inglesby , Director of the Center for Health
Security at the Johns Hopkins Bloomberg School of Public
Healt h also objected to Trump's claim . “ No , this virus isn't
going to go away ,” he said. Hopefully , over time, we'll learn to
live with it and we'll be able to reduce the risk of transmission,
but it's going to stay as the background problem in the country
and around the world until we have a vaccine.

Anthony Fauci , Director of the National Institute of Allergy and
Infectious Diseases, and a prominent member of the
Coronavirus Task Force has said that it will take a vaccine to
allow society to let up on all of its mitigation efforts.
Researchers at Harvard and the University of Minnesota have
at tempted to model how the virus will spread under different
assumptions to understand what the possibilities might be.
The Harvard team found that repeated wintertime outb reaks
will probably occur and resurgence could occur as late as
2024. That's my fact check for this week. I'm Lori Robertson ,
managing editor of FactCheck .org.

[Music]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's majo r political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, e - mail
us at www.chcradio.com , we'll have FactCheck.org's Lor i
Robertson check it out for you here on Conversations on
Health Care.

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Margaret Flinter: Each week , Conversations highlights a bright idea about how
to make wellness a part of our communities and everyday
lives. It's a known fact that the current g eneration of American
children is more obese than any previous generation , and at
our Washington DC Community Health Center , Unity
Healthcare , a pediatrician was in a quandary over how to
tackle this growing health scourge . He began with a unique
solution targeted to a teen patient whose body mass index or
BMI had already landed her in the obese category. What he
did was write a prescription for getting off the bus one stop
earlier on he r way to school . Dr. Robert Zarr of Unity
Community Health Center under stood that without motivation
to move more kids just might not do it. The patient complied
with the prescription and has moved from the obese down to
the overweight category, certainly an improvement. He then
decided to expand this program by working with the DC Parks

Dr. Susan Hassmiller

Department mapping out all the potential walks and play area
kids have within the city's parks –

Dr. Robert Zarr: -- how to get there? Parking , is parking available if someone's
going to drive bike racks , there's a section on pets , park safety .

Margaret Flinter: Dr. Zarr writes park prescriptions on a special prescription pad
in Engli sh and Spanish with the words Rx for outdoor activity
and a schedule slot the S when and where will you play
outside this week?

Dr. Robert Zarr: I like to listen a nd find out what it is my patients like to do, and
then gauge the parks I prescribed based on their interests ,
based on the things they're willing to do.

Margaret Flinter: He wants to make the prescription for outdoor activity
adaptable for all of his pati ents and adaptable for pediatricians
around the country , Rx for outdoor activity, partnering
clinicians, park administrators, patients and families to move
more yielding fitter healthier young people . Now that's a
bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
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