Policy – GW Nursing Magazine

November 1, 2021November 10, 2021

Amid Pandemic, Working to Address Health Disparities and Vaccine Hesitancy in Washington, D.C.

For the past few years, GW Nursing Assistant Professor Erin Athey, D.N.P., FNP-BC, RN, FAANP has been working with United Medical Center (UMC) in Washington, D.C., running its mobile clinic program. Before COVID-19 struck, she partnered with the District of Columbia Housing Authority to provide primary and preventative care to people in Wards 7 and 8 public housing. The UMC mobile vans, out of which she operates the clinic, help to address health disparities and improve access to health care for the most underserved populations in D.C. These clinics also provide a unique and vital opportunity for GW Nursing students to get clinical hours and serve these communities.

COVID-19-era work

Once the COVID-19 pandemic hit in early 2020, the mobile clinic program received federal funds through the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support its ongoing work and to equip it for the new challenges posed by COVID-19. By July 2020, the mobile clinic was going into the community two to three days each week. Dr. Athey and her students conducted extensive PCR COVID-19 testing during the summer and fall of 2020 while continuing to provide care such as HIV testing, general health care screenings, and referrals.

Beginning in 2021, once the COVID-19 vaccines received emergency use authorization, Dr. Athey used the vans as vaccination clinics, going to family properties throughout Wards 7 and 8. As was the case throughout much of the country, there was initially a huge demand for the vaccine, but in summer 2021, Dr. Athey and her team began to encounter fewer people willing to take the jab and more resistance to vaccination. This phenomenon is known as vaccine hesitancy.

According to Dr. Athey, the two main issues now leading to vaccine hesitancy and low vaccine uptake are access and trust. She said that even the complicated issue of misinformation can be broken down into having access to the facts and trusting the source enough to believe them. Overall, access issues can be greatly mitigated with the mobile clinic, which takes the shot directly to the people who might not have the time or means to get to the pharmacy. Trust, however, takes time to build. The strategy of the clinicians and students running the mobile van: Make connections, bring the facts, keep showing up. Dr. Athey said, “I do feel like it matters to go out, to show up… It’s not overnight that it’ll get fixed, but being there continuously over time makes a difference.”

Wards 7 and 8 have the lowest vaccine uptake of all of D.C., and given that these are primarily Black communities, this is a matter of health and racial equity. In D.C., Black people make up 56 percent of COVID-19 cases, 71 percent of deaths, and 46 percent of the total population, but they have received only 43 percent of vaccinations.ⁱ Continued vaccination efforts like those of the mobile clinic are crucial.

One unique way that Dr. Athey and her team have sought to reach new populations with the COVID-19 vaccine in recent months was the Beat the Streets program, a community outreach event in which they partnered with the Metropolitan Police Department. Outreach events like this allow Dr. Athey, the students, and other clinicians to talk to people in their own communities and help inspire confidence in vaccine safety, an approach that has been most successful with people who are still on the fence about the vaccine. With those who are firmly opposed to the vaccine, talking about its merits often has limitations. However, as vaccine mandates become more and more common among various employers—including the D.C. police, health care institutions, federal government, and many private businesses—there has been an influx of vaccine acceptance. Tapping into this, Dr. Athey and the mobile clinic team recently held a clinic downtown for restaurant employees as new mandates went into effect for their places of work.

The future of the clinic

The mobile clinic will continue to operate throughout the pandemic, providing testing and vaccinations, and building trust with the community. Dr. Athey hopes that the program will continue to grow. She is looking for grants, donors, and foundations to help fund the clinic’s care of the underserved communities in D.C. Furthermore, although UMC has not previously seen children, Dr. Athey is hopeful that the clinic can soon expand its services to include wellness exams, prevention, and vaccinations for kids. She also would like to expand the partnership with the D.C. Housing Authority and begin creating place-based clinics at some of the public housing properties. This would follow the cost-saving “minute clinic” model, utilizing nurse practitioners, nursing students, and resident navigators to continue to build trust and provide access to care.

GW Nursing is proud to be in partnership with Dr. Athey, UMC, the D.C. Housing Authority, and so many others who are working to advance health equity in our community. It is important for nurses and our GW Nursing community to be innovative and committed to equity, continuing to create new models of health care that build trust and increase engagement with disenfranchised communities. The mobile clinic is just one such model. As the most trusted health care professionals, nurses are in a unique position to lead this movement. Dream big and take action!

i. Nambi Ndugga, Latoya Hill, and Samantha Artiga. Latest Data on COVID-19 Vaccinations by Race/Ethnicity. September 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

AUTHOR Meredith Lidard Kleeman

June 7, 2021June 9, 2021

Media Summit 2020

camera in foreground, woman in background

In December of 2020, the GW School of Nursing’s Center for Health Policy and Media Engagement co-hosted¹ a follow up to last year’s inaugural Media Summit for Nursing Organizations. The goal of the Media Summit is to improve the representation of nurses in the media.

This work took on greater urgency over the past year, during which time the COVID-19 pandemic has dominated healthcare and the media. Nurses may have been featured in the media more than in years past, but often they were portrayed as heroes, angels, victims, or strictly bedside caregivers. Despite the fact that nurses are also thought leaders, scholars, innovators, policy influencers, and the backbone of healthcare systems, nurses and nursing organizations are still rarely the go-to for the science and evidence. Nurses have valuable knowledge, unique perspectives, and stories that deserve to be told and represented in the media.

The 2020 Media Summit convened leaders from 20 nursing organizations seeking to improve the representation of nurses in the media and enhance their media engagement skills. The participants discussed challenges and successes they have had implementing lessons from last year’s Summit. Some nursing organization representatives said they have noticed a trend of media requests seeking to portray nurses in a stereotypical manner. Others, who had success building relationships with journalists since the previous Summit, suggested that once your organization has a connection with journalists, you can begin to redirect their questions, pivoting away from discussing only bedside care to discussing the ways in which nurses are well-rounded leaders, in healthcare and policy.

At the 2020 Media Summit, we also hosted two journalists: Sheree Crute, director of communications at the National Institute for Health Care Management Foundation, and Courtney Stewart, vice president of strategic communications at Missouri Foundation for Health. These esteemed panelists advised our nursing leaders on many media topics, including how to navigate the current polarized media environment.

Sheree Crute told attendees that “sitting comfortably in the center is almost not possible,” so to consider, what are you willing to say and what you are willing to be known for. As she stated, “nurses have important stories. Finding people who can tell them factually, effectually, and efficiently is the challenge.”

To have the greatest impact, Ms. Stewart advised the diverse group to hone in on their organization’s specific audiences based on their niche or comparative advantage. Responding to the many participants who expressed wanting to see the underrepresentation of nurses and the media’s narrative around nurses change, she said that journalists do have a responsibility in this, including educating themselves on better understanding the complex roles of nurses. However, it is also partially up to nurses and nursing organizations to make themselves known, pivot the narrative, share unlikely stories, and come up with creative ways to enter conversations. She told our attendees to build relationships with journalists now, even in small ways, and that those relationships are what will, down the road, make the more in-depth healthcare and health policy conversations that nurses want to have possible.

1. The Center for Health Policy and Media Engagement looks forward to continuing these conversations and partnerships in 2021.

AUTHOR HALEY STEPP

June 5, 2021November 5, 2021

Innovation in Policy Teaching

The Innovation

While the COVID-19 pandemic has devastated the world in many ways, it has also fueled innovation and inspired resilience among many sectors of society. One of the many ways our GW Nursing community has been adaptive is through enhanced teaching methods, a prime example being the policy course, NURS 6205 – Health Policy, Quality, and Political Process. This course is designed to orient both master’s and undergraduate students to the policy environment, connect the dots between policy and health care quality, introduce the political process, and encourage students to be advocates.

In years past, one of the major assignments was for each student to contact their federal or state representative and dialogue with them about a specific policy issue. However, in the summer of 2020, COVID-19 had thrown Capitol Hill into chaos and the demands of legislating at that time were all consuming for members of Congress and Hill staff. Realizing this, one of the course professors, Ellen Kurtzman, created an alternative way to enhance students’ education while not inundating Hill staff with calls. Students were given options to either proceed with having a dialogue with a representative, join a virtual lobby day, or engage with a Hill staffer in a virtual Q&A session.

Q&A with a Hill Staffer

Dr. Ellen Kurtzman, Ph.D., MPH, RN, FAAN, a former Robert Wood Johnson Foundation (RWJF) Fellow, used her contacts to recruit guest lecturers from Congressional offices. This provided students with the opportunity to interact with someone working on Capitol Hill while being sensitive to the dramatic political climate. Dr. Kurtzman said that the experience was both useful and inspiring because each staffer who chose to give these lectures and talk to students, did so out of a passion for inspiring nurses to be engaged in policy.

This option, which many students chose, provided an opportunity to learn why each staffer picked this career and what, in their backgrounds and experience, led them to Capitol Hill. They were able to dialogue with students about the most pressing issues in Congress (the 116th), how to be an effective advocate, and how to best interact with a lawmaker.

When asked about the decision to host these Q&A sessions, and what that experience was like, Dr. Kurtzman explained that the staffers who spoke were policy generalists and their job depends on constituents coming to tell them what is important to their stakeholder group or using their expertise to help them interpret a bill. Dr. Kurtzman summed up the message to students as “we can’t do our job without you, so coming to visit shouldn’t be intimidating.”

With regard to the interview sessions, Dr. Joyce Pulcini, Ph.D., RN, PNP-BC, FAAN – the course coordinator – stated that the helpfulness lies in getting instructions and encouragement directly from staffers; helping students to “break the fear” of talking to legislators. She said that based on student feedback, this assignment gave them a sense of what advocacy is – that the term finally began to “become real and come alive for them.” Dr. Kurtzman agreed by saying that these extra training sessions are an important piece of the training puzzle if we are to expect students to advocate or approach their representatives on their own.

In the spring 2021 semester, Dr. Melissa Batchelor, Ph.D., RN-BC, FNP-BC, FGSA, FAAN, a former Health and Aging Policy Fellow, set up the interview session with Hill staffers. Dr. Pulcini noted how unique and extremely helpful it is to have multiple faculty members “who have worked on the Hill and know the players.”

Lobby Day

The lobby days, the other option provided, were also very successful with the students. Virginia hosted a virtual lobby day this semester, free and specific to students, that they were encouraged to attend. Maryland hosted a similar virtual lobby day option, too. Dr. Pulcini noted that these virtual sessions are another COVID-19 related innovation – stemming from necessity – but have allowed for much higher participation rates, including among our students, who might not have otherwise traveled to the state capitals to participate.

This past year has been a crucial and dynamic time for nursing legislation, particularly at the state levels. For one, scope of practice laws are finally changing in many states like Virginia because of COVID-19. Between this and the fact that most nurses will end up conducting state level (rather than federal) political advocacy, these opportunities for students to get state lobbying experience has been invaluable.

Dr. Pulcini said that these virtual options will become a regular part of the course because they provide expanded opportunities and meaningful interaction for our students.

Why this is unique and innovative

GW Nursing is uniquely situated with the right environment, context, and connections to allow for this type of innovative educational experience to exist. This “Only at GW” opportunity enables students to learn from Hill staffers and begin to immerse themselves in the legislative process.

Dr. Kurtzman credits her time as a Robert Wood Johnson Fellow with her ability to bring this opportunity to students. Her goal during her fellowship was to absorb as much as she could and translate and disseminate the lessons learned into her classroom teaching. She is proud to have been able to enhance the experience of her students and leverage her year on the Hill to inform her teaching.

Gregg Margolis, Director of the RWJF Health Policy Fellows Program, said that this innovation is a great example of how he hopes and expects alumni, like Dr. Kurtzman, to share their experience once they return to their teaching positions. He said that because many policy makers “lack the perspective of frontline providers,” it is “important for students and clinical workers to engage with them.” He added that it is equally important that they learn how to do it effectively, though.

The student perspective

One of our former nursing students, Mehdi Rahmati, now a cardiac nurse at GW Hospital, took this course with Dr. Kurtzman in the summer semester and attended the Q&A session with legislative correspondent, Shivani Pampati. About this experience, Mehdi said:

“It allowed us to learn and know how legislatures would like to connect with healthcare workers and what avenues are more effective. The interaction [of hearing from and speaking with the Hill staffer] also helped break down the walls of pessimism and hesitation that some of us had in contacting a senator. Knowing that not only can our voice be heard, but that we, as healthcare providers, can serve as a resource to the legislatures was eye opening.”

When asked how his time at GW Nursing as a whole influenced his understanding of policy, he said that he now has an appreciation for how policy is woven into everything and how important it is to nursing…

“… especially during the current pandemic. In this course, we were discussing policies every class, but I appreciated the discourse with other professors and the administration about the importance of healthcare policies and their impact on nursing. How, for instance, the government drafted policies to fight the pandemic that directly impacted nurses and healthcare workers. We learned that now, more than ever, we as nurses should take great interest in policy work, otherwise policies will be drafted without our input, and those policies will directly change our day-to-day work at the hospitals, nursing homes, clinics, and elsewhere. “

**A special thank you to NURS 6205’s guest speakers from the Hill: Shivani Pampati (legislative correspondent), McKenzie Fields (legislative aide), Alexander Urry (policy advisor), and Samantha Koehler (policy aide).

AUTHOR Haley Stepp

October 7, 2020June 9, 2021

Knowledge Sharing in the Age of COVID-19

Just as the emergence of COVID-19 affected many aspects of GW Nursing’s operations, the Center for Health Policy and Media Engagement saw interruptions of our typical lecture series. Knowledge sharing is one of the pillars of the Center for Health Policy and Media Engagement, and we were determined not to let the inability to host in-person events hinder our ability to further that goal. By utilizing technological innovation and the impressive expertise of our faculty, we found our solution.

In April, amid the height of the shortage of personal protective equipment that was plaguing the U.S. health care system, center Executive Director Y. Tony Yang moderated a webinar titled Masks and PPE: COVID-19 and the Next Pandemic. Utilizing the expertise of Senior Service Professor Diana Mason and a colleague at University of Michigan, Christopher Friese, the center had the opportunity to educate a large and diverse virtual audience on the current state of the coronavirus and personal protective equipment (PPE) shortages. The webinar covered routes of transmission of COVID-19, PPE needed to reduce transmission for both health care workers and the public, reasons for shortages of PPE for health care workers, short-term options for addressing the shortage, and finally, long-term options for preparing for the next pandemic. This partnership of nurse experts was reflected further in the Journal of the American Medical Association (JAMA) forum piece on “Protecting Health Care Workers Against COVID-19—and Being Prepared for Future Pandemics.”

In May, the center had the opportunity to utilize the expertise of two GW Nursing professors, Joyce Pulcini and Joyce Knestrick. In conjunction with Susan Hassmiller of the Robert Wood Johnson Foundation, Silvia Cassiani with the Pan American Health Organization, and David Stewart of the International Council of Nurses, we brought together this team of global nursing expertise and put on a webinar titled Global Advanced Practice Nursing Leadership in the Era of COVID-19. They spoke on the role of advance practice nurses in the health workforce in the U.S., in different regions across the globe, the role of nursing during COVID-19, and how the pandemic will influence the future of nursing. The speakers of this center-sponsored virtual event are also the authors and editors of the book Advanced Practice Nursing Leadership: A Global Perspective.

Many of the center’s members are also utilizing their expertise to conduct COVID-19 related research, win grants, and publish think pieces on health during the pandemic. Dr. Yang, for example, has written multiple pieces examining the legality of vaccine mandates and travel restrictions during the pandemic. Ashley Darcy-Mahoney wrote an op-ed weighing the dangers and importance of getting children back to school. Diana Mason has written on the challenges of care and lessons learned.

It is an understatement to say that the COVID-19 pandemic has presented a lot of hurdles to the way work gets done — including at GW, the center, for nurses and the medical community at large. However, there has been great resilience and incredible adaptation. The Center for Health Policy and Media Engagement was proud to engage our community in new ways during this time, to continue to share timely and critical information, and for the opportunity to showcase the great work and expertise of our quality faculty.

by HALEY STEPP

May 11, 2019October 12, 2020

Why Should You Join a Professional Organization and Get Involved?

AUTHOR Richard Ricciardi

Participation in professional organizations has substantially shaped my career and has provided me with opportunities to not only become a more productive, informed and engaged nurse, but also a more thoughtful and globally connected individual. I encourage everyone, both those who are new to the profession and those who are already established, to engage deeply in the transformative and healing power of our nursing profession through membership in a professional organization.

Active membership brings with it the joy and privilege of helping others beyond those in your immediate workplace and provides access to limitless possibilities for professional achievement and fulfillment, both locally and globally. The nursing profession offers a number of valuable organizations you might consider joining. Some are nursing focused, whereas others are interprofessional or specialty focused.

Regardless of your professional experience or career phase, being an active member in one or more professional organizations has tangible benefits. Obvious benefits include access to local, regional and national conferences, journals and other resources to ensure continuous learning and support licensure or specialty certification. Participation in conferences and other programming, whether in person or virtually, provides the added benefit of an opportunity to interact with scientists and subject-matter experts to share ideas about how to implement new evidence to improve practice and care delivery. Some professional organizations also partner to offer reduced fees for malpractice insurance and continuing education credits.

Exposure to fresh ideas and innovations in care delivery stimulates our creativity and provides an opportunity to tackle complex issues in practice, education, research and policy. Professional organizations offer a rich and unparalleled venue to engage with and learn from talented and successful leaders. The opportunity to network with a diverse group of colleagues, to strengthen your leadership, writing and public speaking skills, and to develop a broader understanding of organizational systems are key benefits. Participating in organizational initiatives such as guideline development, conference planning or policy statement preparation, or serving on a journal editorial board stretches your skills, confidence and scholarship.

In my own career, the opportunity to work alongside a diverse group of colleagues on committees or work groups has nudged me to take on new roles and progressively greater responsibility while also providing mentorship and support. Taking on active roles in professional organizations has also allowed me to give back to the profession that has given much to me. We all stand on the shoulders of the giants that have come before us, and professional organizations provide a venue for us to pay that legacy forward, both individually and collectively. These organizations play a critical role in capacity building, career development and succession planning for the profession through scholarships, academic awards, leadership development workshops, formal mentoring programs and research funding.

Contemporary health care is demanding, fast-paced, complex and dynamic. Day-to-day stressors can lead to a loss of purpose and joy in our work. Professional organizations provide programming and networking opportunities that allow us to share our joys and challenges and evolve our careers through meaningful opportunities.

Nurses represent the largest segment of the health care workforce. As such, nursing organizations play an important role in representing and strengthening the capabilities and value that nurses bring to improving health for individuals, families and communities. Ensure your unique voice is included through active participation as we move our profession forward.

May 11, 2019October 12, 2020

Helping Caregivers Give Care

Melissa Batchelor on steps of Capitol building

AUTHOR MELISSA BATCHELOR

On Dec. 31, 2018, the president signed into law Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act, bringing much needed attention to the needs of over 5.7 million Americans living with Alzheimer’s disease and related dementias.

I served on the Senate’s Special Committee for Aging in the office of the chair, Sen. Susan Collins (R-Maine), during my Health and Aging Policy Fellowship in 2018. A large part of the work I did for the senator and Aging Committee focused on Alzheimer’s disease and working to get the BOLD Infrastructure for Alzheimer’s legislation passed in the 115th Congress.

More than 5 million Americans over the age of 65 are living with Alzheimer’s and that number is expected to triple by 2050. Of the top 10 leading causes of death for older adults, Alzheimer’s is the only one that cannot be prevented, slowed down or treated.

The number of deaths from Alzheimer’s increased 145 percent between 2000 and 2019, while deaths from other diseases, such as heart disease and cancer, decreased in that time frame. The cost of unpaid family caregiving is estimated at over $232 billion and more than 18 billion hours.

While we wait for a cure, those with the disease will need care. All types of dementia are essentially “brain failure,” and providing care requires a unique set of skills. Our communities and families do not have these skills in today’s society, and the BOLD Infrastructure for Alzheimer’s Act seeks to address this.

Headed by the Centers for Disease Control and Prevention (CDC), the BOLD Infrastructure for Alzheimer’s Act will establish Centers of Excellence to implement the CDC’s Healthy Brain Initiative through state and national partnerships.

Most caregivers are friends and family members, and their lives are negatively impacted by the financial, emotional and physical cost of caring for someone with dementia. The Centers of Excellence will promote public education on early detection and diagnosis. By supporting early detection, the BOLD Infrastructure for Alzheimer’s Act allows persons living with the disease and their caregivers more time to plan and prepare their health care and end-of-life strategies.

As the BOLD Infrastructure for Alzheimer’s Act moves into the implementation phase, the work will be accomplished through cooperative agreements among public, private and nonprofit organizations. The CDC’s proposed action plan has one goal to monitor prevalence rates across the country. Data grants will improve the analysis of data collected on Alzheimer’s caregivers, and will illuminate health disparities at the state and national levels.

We know that Alzheimer’s disease is on track to be the costliest condition in our nation’s history and is the most under-recognized threat to public health in modern times. The BOLD Act is among the first to draw attention to the enormous burden this disease brings. There are things we know to do that help, and we need to get that information out to the public to minimize the impact Alzheimer’s has on our families, communities and the nation.

May 11, 2019October 12, 2020

Lecture Series Brings Health Care Leaders to Campus

U.S. Surgeon General Vice Admiral Jerome M. Adams speaks at GW's Foggy Bottom campus at the launch of the Health Policy Leadership Lecture Series.

AUTHOR GW NURSING

The Center for Health Policy and Media Engagement last fall launched the Health Policy Leadership Lecture Series, which brings to campus notable leaders in the health care field.

U.S. Surgeon General Vice Admiral Jerome M. Adams visited GW’s Foggy Bottom campus in October as the series’ first speaker. Dr. Adams discussed the nation’s opioid epidemic and identified stigma as the number 1 killer.

“As members of the most trusted profession, nurses can help alleviate that stigma and encourage patients to seek recovery,” Dr. Adams said. “There is nothing more powerful than a nurse armed with the correct information.”

Mental health, opioid abuse and obesity are just a few of the stigmatized health issues. The stigma keeps people in the shadows and prevents them from getting help, Dr. Adams said.

Victor Dzau, president of the National Academy of Medicine, also spoke this past winter as part of the series.

Currently, health and health care are the most prolific areas for technological advancement, Dr. Dzau said during a wide-ranging discussion on the burgeoning innovation in health care. Despite a political climate in which research budgets have been cut, health care is relatively safe because it is so clearly critical, he said.

This spring, Terry Fulmer, president of and chief strategist for the John A. Hartford Foundation, visited the campus as part of the series to discuss age-friendly health systems.