Nurse executives in the United States are often gatekeepers for the advancement of the 3.1 million nurses practicing in the United States. The recent Robert Wood Johnson Foundation (RWJF)/Institute of Medicine (IOM) report, The Future of Nursing,1 defined a path for the profession and set expectations for education, collaboration, and maximization of nurses' roles as healthcare landscape continually evolves. This is the fourth in a series of interviews highlighting executive nurse leaders who influence contemporary education, policy, practice, research, and theory. In this interview, the experiences of the RWJF's senior advisor for nursing and director of the initiative on the Future of Nursing at the IOM, Susan Hassmiller, PhD, RN, FAAN, are highlighted.
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Adams: Dr Hassmiller, most of us by now are familiar with the Future of Nursing report. "How did this report come to be?" and more importantly, how can we be sure this work leads to sustainable action?
Hassmiller: Our board of trustees at RWJF has been very supportive of nursing over the last decade and wanted to do more. Tom Kean, our board chair, former governor of New Jersey and former co-chair of the 911 Commission, encouraged the board to support a national commission on the future of nursing to give themselves a sense of what more they could support and raise the visibility of the profession. Wanting the report to be credible, evidence based, and highly visible, we approached the IOM to be our partner. No one from the outside had ever directed an IOM study, but RWJF President Risa Lavizzo-Mourey, MD, MBA, and the board wanted me to lead the process. Although the process for the Future of Nursing study was rather unconventional for the IOM (including high use of social media), they were tremendous partners in every way. This report has broken IOM records in terms of downloads, sales of the report, and general public interest. The board also supported an implementation campaign to ensure the report's success.
Adams: What do you think is the most easily achievable piece of the RWJF/IOM Future of Nursing report?
Hassmiller: The most easily achievable goals have to do with leadership that depends heavily on nurses. We have to educate ourselves to be leaders and convince others that we indeed have much to contribute. The way to make that happen is to tap into your passion, write and speak about it, become an expert, and take the initiative to be a leader. Nursing leadership is needed at every level, and if there is no paying job in your area of passion, then volunteer to gain the experience you need. There are many small ways to start.
Another achievable aspect is that all nurses must practice to the full scope of their education and training. Although it is difficult to change state laws around adance practice nursing, we should remember that nurses in all areas of practice must be allowed to practice as they were taught. A more difficult goal, however, is ensuring that 80% of all nurses have a baccalaureate degree by 2020.
Adams: I know you have closely studied the life and work of Florence Nightingale. In the context of your current work, how has her work influenced you?
Hassmiller: In a lot of ways, this campaign mirrors Nightingale's vision. Nightingale emphasized evidence and the importance of education for nurses; so, in that way, there is a direct link. Tactically, in getting the recommendations adopted, we are also using her approach as she was a woman facing significant social barriers during her time. Nightingale chose to work though other influential people to get her message out. Her approach was not "woe is me; I am a woman" or "woe is me; I am a nurse," rather she used her existing relationships with influential and powerful people. She worked through respected colleagues in the military, business, and even the monarchy (she was friends with the Queen of England). It was through these relationships that Nightingale advanced her cause for better data, quality care, an improved healthcare system, and the nursing profession. Using her approach of establishing credible sources to make change, we are working with many different sectors, including consumers, the business community, government, providers, and leaders from other disciplines, such as medicine.
While we, of course, are working with many great nurse leaders, we are also working with the chair of the study committee, Dr Donna Shalala, former Secretary of Health and Human Services, and Jack Rowe, MD, the former chief executive officer of Aetna, neither of whom are nurses. Through them and other prominent leaders, we are using their voices and their contacts to speak on the value of nursing in creating a more effective healthcare system. They lend a different credibility. And importantly, we are partnering with the largest consumer organization in the United States, the American Association of Retired Persons, to carry out much of our implementation work. So, like Nightingale, we are using already existing and established multisector networks in our Future of Nursing: Campaign for Action.
Adams: You have been closely involved with the Red Cross throughout your career. Is that something that you would also attribute to following in Nightingale's footsteps?
Hassmiller: Maybe, although it was not a conscious effort. My involvement with the Red Cross started in 1975 when home on spring break from Florida State University. My parents were traveling in Mexico City when I learned there was an earthquake there. Not knowing what to do, I called an operator trying to get through to someone who could help; she connected me to the American Red Cross.
Obviously, 4 decades ago communication was much different, but this person from the Red Cross assured me that there were no deaths as a result of the earthquake. The hotel where my parents were staying did not have electricity or telephone service but was not damaged. I was amazed there was such an organization, and I was so appreciative. Upon my parents return, I immediately drove to the home of the Red Cross in Tallahassee and said, "I'm here to do whatever you need." I felt like I owed them. I have remained involved with the Red Cross serving on the national Board of Governors. I chaired the 911 relief fund where we disbursed $1 billion. Most of the funds were spent on mental health needs. Recently, I went to Alabama for 11 days after the tornado as a volunteer Red Cross nurse. There is nothing like giving back in this way when people are at their greatest need. I did a daily blog that can be found at http://ajnoffthecharts.com/dispatches-from-the-alabama-tornado-zone/.
Adams: You have spoken about your work in policy related to RWJF and the Red Cross, how did you get started in that area? What do you recommend to others?
Hassmiller: I suggest starting small and locally, such as volunteering for committees in your workplace or in your community. Many people are already working on policy issues. If they are on a workforce committee or a facility Magnet Recognition Program(R) committee, then nurses are probably already doing policy work. Professional organizations have policy committees that offer other ways to become involved.
I really started on a larger scope as part of my doctoral studies at George Mason University. With its close proximity to Washington, District of Columbia, doctoral students were required to do a practicum with someone of great influence. I worked with Dr Marla Salmon, new to the Division of Nursing at the US Public Health Service, on the US Public Health Service Primary Care Fellowship program. Although the practicum was 3 months, I stayed for 7 years. It was such a great learning experience. After serving as the evaluator of the fellowship program, I became the director. I was responsible for bringing new primary health leaders to District of Columbia every year and immersing them in the policy-making process. Then RWJF asked me to consider working with them in New Jersey. Although initially reluctant, I did agree to a visit. I liken that visit to "when you go to see the puppies at the pound;" once you are there, you are hooked. So that is how I came to RWJF.
Adams: Inasmuch as you are leading the Future of Nursing initiative, what message would you like to share with current and future nursing leaders?
Hassmiller: A simple message we have talked about is find your passion, speak and write about it, support and inspire the passion of others. And please, get involved with our Future of Nursing: Campaign for Action. There is much work to do!
Specifically chief nurses and other nurse leaders need to support the idea of leaders at every level and develop and foster a culture of leadership. Nurses cannot wait for policy changes or simple patient care improvements to come down from senior level management. Nurses find solutions to complex problems every day; we have to harness and articulate this expertise in a "just in time" way. Our RWJF program, in collaboration with the Institute for Healthcare Improvement, Transforming Care at the Bedside, fosters that empowerment among frontline nurses and this concept needs to continue to expand. Even more specifically, nurse leaders need to take a stand on academic progression; they need to hire more baccalaureate-prepared nurses and support nurses as they continue their education. Also, nurse leaders need to support improved transition experiences from student to practicing nurse. Drawing from personal experience, I was working as a nursing assistant while a student and then I passed the NCLEX and, all of a sudden, I was the "responsible" RN with a license. There is no way I, or anyone for that matter, is ready for that sudden flip of the switch. An important piece of the Future of Nursing report focuses on this transition and residency programs for nurses.
Along those lines, I recently spoke at student nurses convention, with many attendees asking my advice about how to find a job. My response was, initially, you have to do what is necessary to pay the bills, so take any job to get a foothold in the door, but also take the time to volunteer and find your passion. The best way to find your passion is by doing many different things. Nursing should not just be about a job and a paycheck; it is so much more than that. Being without a job is also a good time to continue your education if the financial means are available.
Adams: Given your well-defined career in public health and a community health nursing graduate degree, I was surprised to see some YouTube clips and blogs that suggest the Future of Nursing report is not inclusive of all nurses, in particular, the public and community health. How do you respond to those concerns?
Hassmiller: Thanks for asking that question. The report is about the Future of Nursing, and the future is in the community, much more home care, much more community care and public health. We certainly do need to emphasize education because with more education comes increased autonomy. People who do not think this report applies or addresses public or community health nursing simply have not read it! Nurses are present at every transition point in our lives, from birth to death. It is the nurse's expertise whether in inpatient, outpatient, or home care that increases with education and experience making a difference.
Adams: What is one thing you would like the Journal of Nursing Administration readers to know?
Hassmiller: I would like to pass along a concept that I read in the book, Drive: The Surprising Truth About What Motivates Us.2 The author cited research indicating that achievement and success have more to do with persistence and fortitude than IQ and grade point average. This underscores the need for nurses to be persistent and have fortitude as we implement the recommendations of the Future of Nursing report. It will take everyone reading this to get involved in Future of Nursing's Campaign for Action.3