February 9, 2021

Episode 45: What the ANA is doing to combat racism in nursing

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Description

Our second interview in honor of Black History Month is with Dr. Ernest Grant. Dr. Grant made history in January of 2020 when he became the first-ever male president of the American Nurses Association. Across his long and storied career, Dr. Grant has worked tirelessly to advocate for nurses and attract more people to the profession. 

In this conversation, he tells Dr. Nurse Dan about the ANA’s priorities for 2021, including how they are working with the new Biden administration and influencing policy in Washington. He also talks in depth about the role of nurses in the vaccine roll-out, what he’s hearing about nurses’ mental health and what he thinks the long-term impact of COVID-19 will be on the profession. 

Dr. Grant and Dan close out the conversation with details on the ANA’s latest project to combat racism in nursing -- a project Dr. Grant says he hopes will be his legacy within the organization. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Welcome to the show, Dr. Grant.

Ernest:
Thank you for having me, Dan. Delighted to be here.

Dan:
I would love to dig in, as 2021 started a few days ago, what are the priorities for you and the ANA as we enter the new normal, putting 2020 well into the past, hopefully?

Ernest:
I think our number one priority, obviously, is working with the incoming administration to help drive down the COVID crisis, to do our best to get not only members of the healthcare team, but the public vaccinated and educated about the virus and also working with them, which we'll probably talk a little bit more later on. But even with this crisis going on, there's still healthcare issues and agenda that needs to be met and addressed as well. So I'll look for 2021 to be a very, very busy year for us.

Dan:
For the listeners that may not know, how does the ANA interface with the government to drive that policy change?

Ernest:
Well, we do that in a number of ways, actually. Like other associations, we have lobbyists who work on our behalf. By saying our behalf, I mean on behalf of the 4.3 million registered nurses out there, to affect legislation that would make it easier for say, nurse practitioners to be able to practice to the full extent of their education as well as nurses at the bedside as well. Healthcare for the public is one of our big concerns, addressing the social determinants of health and making a true investment in public health. This is just lightly scratching the surface, but and we also offer our expertise to members of Congress and their staff about healthcare related issues as well so that, again, they have a more complete picture. So when they go to discuss or vote on a particular bill or something, they have a pretty good idea of what the domino effect, if you will, of their votes will have to the people that they represent in their home states.

Dan:
I'm always interested in the perception at the government level of nurses and we saw it, initially, with the Biden Transition Team and in other administrations where physicians are always chosen first and obviously they play a great role in medicine and healthcare. Nursing seems to be not always the first choice there. In your experience, what is the understanding of the profession with our legislators?

Ernest:
Our legislators are very respectful of the nursing profession. They understand who nurses are and what we do. I think they need to, perhaps, understand it a little bit more. My agenda is to get nurses more politically involved, asking them at the local and state level to volunteer, to perhaps, serve on maybe as a healthcare expert for someone who's running for office, be that at the state level or at the national level. Again, it takes someone from nursing. If we don't know anything particularly about something that may be health-related, we definitely know somebody who may, so we're very good at networking. That's a great opportunity for nurses to get involved and therefore, obviously, the public respects and knows who we are. So it's a great way to lead down that pathway.

Dan:
18 years running of the most trusted-

Ernest:
19.

Dan:
... profession. Oh, 19. That's right, 19 now. That's a pretty good tenure there. I don't know. No, that's great. I know you've been really involved with the vaccination, even getting the vaccine, one of the first people to get the vaccine when it came out and making it very public. How was that experience for you and what made you kind of put yourself first in line there?

Ernest:
Your statement of putting myself first in line, let me just explain to the audience that I volunteered to serve in the clinical trial for the Moderna vaccine and I did that for two reasons. One, I knew that there was a need for people of color to participate and so I wanted to do that to help with the data and hopefully, get the results of the vaccine out as soon as possible. The other reason I did it was as the leader of the 4.3 million registered nurses in the country, I wanted to have solidarity with those who were on the front lines and let them know that their leader cares and understands what they are going through and even though I am no longer at the bedside, I can identify with what is going on.

Ernest:
So hopefully, once these vaccines were approved, they would not have any hesitancy about taking the vaccines, knowing that their president had participated in the clinical trials. Of course, at that time, not knowing whether I would have gotten the vaccine or the placebo, but as it turns out last Tuesday, my study was unblinded. I already suspected that I had gotten the vaccine, but it was confirmed last Tuesday-

Dan:
The arm pain and a little bit of fatigue or something.

Ernest:
Yeah, yeah. I had the fatigue. I had the chills and everything else and I'm going to continue on in the study. We were given that choice. So I will be followed for the next two years and periodically go to the site and donate blood. Of course, they call me every three weeks or so to ask those same questions and et cetera, so it's really great. I'm enjoying participating in this.

Dan:
Thank you for clarifying. I didn't mean to infer that you jumped in line, that you were intentionally doing this to set the tone and also break down barriers and show safety and lots of other things, so I apologize for that phrasing there. What are you hearing from other nurses? I know the ANA did a study where they looked at nurse's opinion about the vaccine and it kind of was a third is willing to do it, a third was kind of not and then a third was unsure yet. Have you seen that data change or what are you hearing from nurses across the country about getting the vaccine themselves?

Ernest:
Yes. Thank you for citing that study. Again, for your audience, that study was done before we got the results of both the Pfizer and the Moderna vaccine efficacy results. So I am sure that probably, well, I know, we're actually doing another survey. It just completed. We're tallying the total for that, but overall, what I am hearing is that nurses are very excited about the vaccine and have very high confidence. A majority of them I know have already gotten their first dose and eagerly are awaiting their second dose.

Ernest:
So they are embracing the vaccine, especially knowing that those who are working in the COVID units or in the ICUs, to know that you're working with someone who is still shedding the virus, to know now that you have been protected by the vaccines, it reduces your anxiety and worry about possibly taking the virus home to your family members or you, yourself contracting the virus. So they've been very, very open about that. I think for nurses who have a little bit of hesitancy, there could be a number of reasons as to why, perhaps allergies to vaccines or maybe some health condition that they have that does not allow them to take the vaccine or consider taking the vaccine at this time.

Dan:
I've seen on social media, as nurses are getting the vaccine, tears of joy, this relief coming over, excitement, this hope for a path forward. I think with 10 months plus of this pandemic going, it finally gives a ray of hope for a profession that's been really at the front lines and beaten down for a long time. I'm hopeful that this will spark a change and we're coming on the backside of this hopefully soon.

Ernest:
Absolutely. I think, just as we had just mentioned with nurses being chosen as the most trusted profession for the 19th consecutive year, it's crucial that the public sees that nurses are willing to take the vaccine and to answer any questions or concerns that the public may have also. So I know in my role that's one of the things that I have done is to be able to provide my own personal experience with taking the vaccine to those who may be hesitant. But in healthcare or in the general public, and I think once they get their questions answered, their concerns are alleviated. As long as they're getting their information from a trusted source, I think that's what makes a huge difference. Usually those individuals will go on to take the vaccines.

Dan:
I think nursing plays a huge role in that trust. What other role do you think nurses can do to help with the distribution of obviously, besides just jabbing you in the arm? But what other role can they take in helping distribute the vaccine?

Ernest:
Oh, there's a lot that they can do. First of all, they need to be at the decision-making table. When officials are saying, "Well, let's set up a clinic here," or, "A vaccination clinic here or there or whatever," it's that nurse who knows that community. Maybe it's the public health nurse or someone who lives in that community or knows that culture and could say, "Yes, this is a good idea and here's how we should go about doing it," or, "No, that's not a good idea because maybe this part of the community doesn't have this, this or this available, so therefore, we may need to bring in some additional resources."

Ernest:
That's one thing. The other thing is in cases as we're hearing where there's either a shortage of the vaccines or there's a delay in the vaccines, again, nurses can be there to investigate, "Why is this happening? What's going on and what do we need to do to put a system in place to ensure things will go very, very smoothly?" That could also be the supplies and things that are going to be needed. One of the things I'm hearing across the country as I've had talks with the various state nurses association, now that these vaccine clinics or opening up, which I think is a great, great thing, it's a marvelous thing, but now there's becoming a shortage of gloves.

Ernest:
This is on top of the third or fourth wave, if you will, of COVID infection that we're ... in other words, there's competition for supplies between acute care facility and also the supplies that are going to be needed to do the vaccinations such as syringes, alcohol swabs and gloves and et cetera. So again, this is another good reason why nurses need to be at the planning table to ensure that those resources are available and that the distribution chain is fully stocked so that as the need becomes available, there's no interruption.

Dan:
I think that's a great point. Nurses are the center of the healthcare coordination. They know the supply side and the patient side, the system side and so really taking that role and thinking through it to build those distribution networks and plan for it. I've also seen just anecdotally, nurses coming out of retirement, nurses volunteering that may be in academia or other roles outside of a direct patient care coming to saying, "How can I help?" I love that our profession has that comradery and it's just great to see? Have you seen that as well in your travels?

Ernest:
I truly have and again, that's another thing that nurses who are at the planning table can say, "Vaccinate those nurses who've been retired now so that they're willing to do their part, but they need to get vaccinated first." So again, that could free up a nurse that maybe a hospital, perhaps, was going to send to a vaccine camp, now that if you bring a nurse from retirement to fill that position, that nurse could remain in the acute care facility where their skills probably would be much more needed than at the vaccine site. Of course, as we all know, once a nurse, always a nurse. We're always going to answer the call and I have heard of nurses who are coming out of retirement by the droves to help wherever they can.

Dan:
On the other side of that too, the student nurses who are getting accelerated through some of their programs through the pandemic and then, what a great resource to provide shots? It's well within their scope of knowledge and it also, like you said, frees up potentially, more experienced nurses to go do other things where their talents are needed a little bit better too. So I think that it's just that whole system shift, that whole system transformation we need to leverage so that we can make this thing happen.

Ernest:
Yes, absolutely.

Dan:
Our company works in the travel industry and so we see, across the entire country, we see lots of contingent labor and travel nurses all over the place. We're seeing that the vaccine distribution is very much focused facility by facility. So facilities have their own policies. There's been slower roll outs on the state level and then at the government level, it's not as clear, but the facilities definitely have some policies. We haven't seen mandated vaccines for COVID yet, but do you see that as something that health systems will eventually do, similar to the flu where if you decline it, you have to wear a mask for the entire flu season? Do you see something like that happening with the COVID vaccine?

Ernest:
Right now, I really don't. From what I am hearing and seeing across the country, there has been such a high rate of nurses getting vaccinated that I really don't think that health systems are going to need to mandate vaccines for their employees. I think that, perhaps, it may be something that needs to be looked at a little bit later on, but right now, we've been, what, probably about a month, a month-and-a-half since the first injections were given out. Hospitals are very, very happy with the response that their employees, not only nurses, but other members of the healthcare team, even people who may work in patient transportation or housekeeping or dietary or whatever else, they all have a very high rate of employee signing up to get the vaccines. So that speaks very, very highly and also sets of great example for the public as well. I'm not saying that the mandate should be enforced, perhaps look at it a little bit later on, but right now, everything wants to be very, very promising to where we probably would not have to mandate vaccines.

Dan:
That's great insight there. We talked, at the beginning of the show, about your work with the incoming presidential administration. Can you talk a little bit more about how you're directly involved with that and how ANA is working with that team?

Ernest:
Certainly. We have had a few conversations with the Biden Transition Team, particularly those concentrating in the Department of Health and Human Services, sharing our information from the surveys that we have been doing. Every since last March when COVID first came to our shores, we have been doing surveys every other month of nurses who are at the bedside, mainly concentrating on the availability of PPEs, but also other issues as well. Every other month, the surveys always ask about the availability of PPEs, which is still a concern. We are not hearing about it very much, but the distribution chain is still very sluggish to get PPEs out there.

Ernest:
Hospitals are still requiring that nurses wear the N-95s longer than they were intended for. We understand that, but there have not been any significant studies to show the effectiveness of being able to do that. We don't want that to become the new standard now without experiments or research to prove that they still will maintain their effectiveness. It's stuff like that or also encouraging the implementation of the Defense Production Act on a greater scale, so that, again, we can get those necessary PPEs. By that, we're not just talking masks; we're talking gloves, we're talking gowns, we're talking the goggles and things, all the resources that nurses need.

Ernest:
So again, letting the incoming administration know these things are still in dire need. So as a result of that President- elect Biden, one of the first things he's going to do is to implement the Defense Production Act. I'd like to think that part of that decision is based on their conversations with us, looking at our surveys that we have shared with them. Also, another survey addressed the psych mental health fatigue that not only nurses, but just about every member of the healthcare team is experiencing, but definitely nurses, definitely physicians as well, that something needs to be put in place to help address that.

Ernest:
We do have ANA and several of its organizational affiliates have put forth a program on the web called The Well-being Initiative. There needs to be something more on a national level that has the monies behind it to really address the mental health and fatigue of healthcare workers because even though we got the vaccines going, COVID is still going to be with us` for probably another six, nine months or so, or maybe even longer, especially as we're hearing about these mutations and things as well.

Ernest:
So those are some of the things that we're having conversations with them about and of course, educating the public, how to get the public, to take the vaccine as well. If there's hesitancy, the list just goes on and on and we haven't even started talking about healthcare in general. I think your audience get an idea of how we are advocating on behalf of nurses and the health of the public with the administration and we're looking forward to a very long, strong working relationship.

Dan:
That's great and there's a couple points in there that I just want to highlight. One, I love that you're doing the survey. So you're generating the evidence to make evidence-based decisions on which is the core of our profession, but I think is even more important with the new administration as well. Then, I think the mental health aspect is also really important and sometimes overlooked. I've been doing a fair amount of press as well and a lot of it's on the surge of hospitals and the staffing and that kind of stuff. At the end, they ask, "Well, is there anything else you want to add?" I always add, "Our healthcare professionals are not okay right now." I just talked to an ER physician friend yesterday. He said, "I have at least one intubation and one death in my ER every day now it seems to go."

Dan:
The public has to know that's not normal. It's not the glorified Grey's Anatomy, like ER, that that happens every show. That's not normal in a normal ER and in a normal ICU. So I think just bringing more light to that and providing those resources, one thing we did is we partnered with Ohio State and Bern Melnyk related to mental health and some initiatives that we could do in our small cohort of nurses. I think we need to spread that because that's that hidden pandemic, I think. I personally would love your opinion on it. I feel like we're going to lose a big chunk of the profession after this is over, at least in the short term, they need a rest and a break, but maybe even long-term. Do you have a perspective on that?

Ernest:
I do. I speak with about 20 nurses across the country just one-on-one that I just have made friendships with. Either they have sent me an email and just wanting to express their opinions or whatever. I've followed up on that and I said, "Well, do you mind if we talk just on a regular basis, just to get an idea of what's going on in the Western part of the country or the middle of the country?" To have that direct insight really helps me a lot and again, this is something that I can pass on to our leaders that this is what's happening in the Midwest or these are some concerns. What I am seeing is that I think nurses, we do have great resilience and I think that they do need to have something in place that will give them time off, if you will, to reflect or to at least just to come into work and not have the rush, rush of what they have been facing for the last 10 months, 11 months, without the opportunity of a good mental health break.

Ernest:
I don't think that there's going to be a mass exodus. I think they just need to have some means to have just some down time. The good news, what I am hearing from deans and directors of various nursing programs is that their waiting lists have greatly increased by people who are wanting to go into the profession, which I think is fantastic. I think it's somewhat like what happened after 9/11 when there was a rush for a lot of people to join the military service because they recognized the country was in crisis and, "I want to do my part to help."

Ernest:
I think there are a lot of people now who probably maybe were on the fence about maybe going into nursing, but now realizing truly were it not for nurses, we would not have made it through this pandemic as far as we have or as we have. So I think they are wanting to answer that call as well, which is wonderful. The downside is that, obviously, it's going to take anywhere from two to four years or so for that person to complete their studies, pass their boards and become active. But I think the profession, overall, is going to do very well, respond very well to this. It's just a matter of those who are at the bedside right now really needing a mental health break.

Dan:
2020 was the Year of the Nurse and we stepped up for sure.

Ernest:
We're continuing the Year of the Nurse into 2021 as well.

Dan:
Which I love.

Ernest:
Yes, because we didn't get the chance to really celebrate [crosstalk 00:22:48]

Dan:
There is not a whole lot of celebration. There is put our heads down and get back to work.

Ernest:
Yeah.

Dan:
Oh my goodness. That's great. I think there's just so much opportunity and I know there's an excitement around nursing. There's an excitement around healthcare professions in general. I know there is this idea of the Fauci effect for medical school. I'm excited that nursing is seeing the same uptick because the stories about nurses aren't always glorified. It seems like the press kind of highlights the infectious disease side and then shows the mask imprints on nurses. But I think that's still a rallying cry to say, "You can make a real impact in people's lives through this profession." I think that resonates with people and we're seeing it with signups and things. Any other big initiatives that you're looking at for 2021? We got to talk about vaccine, the mental health. Is there another big one? I work closely with Ori, the VP of innovation at ANA. What's kind of your innovation plan?

Ernest:
Ori has some really big plans as far as we do have the NursePitch and things like this, but some of the things I think that people are failing to take a look at is what is some of the good that has come about as a result of this crisis? Innovations has been one of those. So look to see more expansion of tele-health, tele-med, and obviously, the role of the advanced practice nurse concerning that and other unique increase in technology, if you will, that will make nursing that much easier, more effective from that perspective as well. One other thing that I'd like to show that we're addressing, 2020 also was a very staunch year for social justice, if you will, and recognizing the inequities in healthcare.

Ernest:
So actually, just this past Friday, I hosted the first of a series that we're going to have. It's called the Commission to Address Racism in Nursing and I have convened all the minority nursing organizations as well as leaders of major nursing organizations, such as AONL, Association of Colleges of Nursing, The National League of Nursing, et cetera. We are going to put forth a initiative to address the racism that we know occurs in nursing. We're going to do it in the form of a scope and standards of practice, like our documents there.

Ernest:
So it's going to focus on education, on research, practice and leadership or administration so that it can be adopted across the spectrum and hopefully credentialing agencies and et cetera will begin to adopt some of the points that are in there as well as they go about either credentialing organizations or the schools or things of this sort. So we just had our first meeting and it's going to take a while for that document to come out, but I would encourage your audience to please stay tuned and actually help us contribute if they would, because we have a lot of work to do and it's expanding across all cultures. So I'm really excited about this and I think this will be my legacy as president of ANA when I step down in two years.

Dan:
That's so needed. We've done a couple shows with Andrea Dalzell, The Seated Nurse, and a few others as well, talking specifically about racism in healthcare and specifically in their experiences in being accepted into nursing school, their experience through nursing school and then into practice and some of the stories are just heartbreaking. I think it's great to create a system solution through accreditation and scope and standards to address it. I think that's really needed and let us know how we can support that, I think. I trust that we definitely have that as a core of our mission as well. Dr. Grant, thank you so much for being on the show. We'd like to end the show with that one nugget that you want to hand off to our listeners. So what would you like to hand off to The Handoff listeners?

Ernest:
I would think that one nugget is to hang in there. We're seeing the light at the end of the tunnel and we will continue to advocate on behalf of nurses. I could not be more proud to represent this profession at this particular point in time.

Dan:
That's a great way to end it. You can find Dr. Grant on social media, on the ANA website and we'll post all that in our show notes. Dr. Grant, thank you so much for the conversation. If there's anything we can do from the Handoff listeners and from Trusted Health, we are 100% behind the ANA and supporting all the initiatives. We look forward to making 2021 the celebratory Year of the Nurse and pass some of these initiatives so that we can make healthcare better for all. Thank you so much.

Ernest:
Thank you, Dan. Happy to be here.

Dan:
Thank you so much for tuning in to The Handoff. If you liked what you heard today, please consider leaving us a review and subscribing on Apple Podcasts or wherever you listen to podcasts. For more information about Trusted, please visit trustedhealth.com. This is Dr. Nurse Dan. See you next time.

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