1. Adams, Jeffrey M. PhD, RN, NEA-NC, FAAN


This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice policy, research, education, and theory. This interview profiles Joy Deupree, assistant professor, School of Nursing, The University of Alabama at Birmingham.


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Adams: Hello Dr Deupree, can you share a little about yourself, your career, and influence trajectory?

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Deupree: Hi Jeff, it is great to speak with you. I grew up in a politically active family, where both my father and grandfather served in public office, so politics was common conversation at the dinner table. As I entered the work environment as a new nursing graduate, I was shocked and dismayed to find how few nurses had a voice in decisions related to healthcare systems. Even more troubling was how many nurses were afraid to voice their opinion, or worse, did not think their opinion was valuable. A series of events early in my nursing career led me to become politically active as an advocate for policy change leading to improved access and quality of care as well as for the empowerment of nursing as a profession. As such, much of my focus has been in 2 areas: improved patient access to care by removing barriers for advanced practice registered nurses (APRNs) and improved patient outcomes through health literacy initiatives.


Adams: Can you speak a bit more about this policy work and the importance of health literacy?


Deupree: I can say that my participation and leadership surrounding the passage of Alabama statewide legislation granting APRN prescriptive authority of controlled substances is an experience I will remember forever. This legislation, Senate Bill 223 (AL) brought with it significant rule changes and work continues today to further reduce barriers that inhibit APRNs ability to practice to the full extent of their training and education. As president of my state professional organization, the Nurse Practitioner Alliance of Alabama, my role was central in this multiyear effort to effectively influence a positive outcome for patients and the workforce. While legislators want all stakeholders to be in agreement, it has been regularly noted that nursing often has the least amount of influence in the political arena. Thus, we knew we had to be thoughtful, strategic, and purposeful in our efforts. During the 3 years of planning and negotiation, we developed partnerships with those who had historically opposed reducing barriers to practice. I persistently encouraged those stakeholders involved to put the patient at the center of the discussion and consider how many patients in rural areas would have access to care.


That piece of legislation is now 4 years old, and I continue to hear from patients and APRNs that this piece of legislation changed healthcare for Alabama's rural areas. While it is easy to surmise that rural patients and families have greater access to care, for me, the most important lesson is the value of partnerships. I will say that while I am experienced and passionate about advocating for reduction of barriers for APRNs, this particular experience highlighted the importance of developing partnerships with stakeholders and seeking incremental change.


And similarly, my commitment to health literacy focuses on yet another way we can improve care delivery to populations. With more than half of healthcare spending concentrated on less than 5% of the population,1 nursing administrators are seeking new models of care to meet the demands, improve quality and reduce costs. It isn't a coincidence that the same patient populations utilizing the majority of healthcare resources have limited health literacy. Factors impacting health literacy include aging (the largest population segment with health literacy challenges), education, and/or high levels of anxiety due to illnesses and new diagnosis. Further, few healthcare providers, including nurses, realize that nearly 9 out of 10 individuals have difficulty understanding health information.2 While nurses are taught teach back in basic nursing curriculum, this simply isn't enough as care providers are currently not as knowledgeable as they should be about the complexities surrounding patient care for populations at risk for low health literacy.3 This is a huge opportunity for nurse executives to utilize their resources as targeted health literacy initiatives have been shown to reduce hospital admissions/readmissions and improve quality outcomes including a patient-family centered approach to care.


Adams: It is clear how you became involved in policy work. How did you become interested and involved in health literacy?


Deupree: My passion for health literacy also stemmed from a family experience. This time, an activity with my oldest daughter. At 17, she wanted to become a literacy tutor, and because she was underage, she had to have a parent with her to tutor adults. It changed my life. I remember thinking [horizontal ellipsis] now I understand why so many of my patients have bad outcomes and seem to be "noncompliant." The reality was simply; they did not understand what they needed to do to stay well.


I used to routinely make the same mistake many providers do. I assumed my patients understood me when they expressed "no" when asked if they had any questions after I "told" them what to do. After learning and being immersed in this work, I changed my practice to use family- and patient-centered approaches for patient education. The outcomes were impressive. This also led me to enter a doctoral program to better understand the cause of low health literacy.


Adams: What would you say is the most prominent issue for the readers of JONA?


Deupree: We live in a time of great uncertainty, with a newly elected president that has such differing policies than others. We must wait and see how to plan for the future. Depending on who you speak with, this is the best of times or the worst of times, but no one knows for sure. Nursing administrators must be concrete with our messages and articulate the value of nursing in the current care and new care delivery models. I am confident nurses are the fundamental key to better healthcare in America.


Adams: It seems as if you have a unique role and perspective intersecting policy, practice, education, research, theory. Can you share a little about that?


Deupree: When asked about my work at UAB School of Nursing, I often reply that I have the greatest job in the world. I love teaching and research and have dedicated time for both, but my true passion is to be a change agent for improved healthcare, which fits the third of the tripartite mission at UAB service. I have had the privilege of working for 2 outstanding deans [Deans Rachel Booth and Doreen Harper] that saw the value of nursing influence in health policy. My involvement has often garnered me a seat at the table with other influential leaders and provided me with a voice to advocate for change. Developing strong interprofessional relationships with and within nursing has been the cornerstone of my ability to work across professional lines and seek common ground. For any nurses seeking to become more influential, my advice would be to avoid making a case based on how a decision for change will impact nursing. I believe all healthcare providers have a responsibility to be a patient advocate first and foremost. If you can develop a reputation for making decisions based on quality patient outcomes while containing or reducing costs, your opinion will be valued, and others will seek your involvement.


Adams: How best can we prepare the next generation of nurses to lead and advance the profession?


Deupree: In an era where policy leaders and healthcare organizations are seeking improved quality of care and reduction of unnecessary expenditures, nurses have a unique opportunity to showcase their value. Academicians should strengthen policy and leadership curricula at all levels, so that upon graduation students are confident and prepared to make a difference. Nurse administrators at every level must refine their ability to mentor and identify potential talent and emerging leaders to help them find their voice as well as promote opportunities for leadership development. I find that nurses lack the confidence to speak up and are reluctant to seek opportunities to share their knowledge. As a profession, we must prepare healthcare leaders for the future so that they understand the importance of developing targeted messages to impact the bottom line.


Adams: What is one thing you'd like the JONA readers to know?


Deupree: I'd really like to leave everyone with a definition of health literacy so as to leave little question as to what it is. Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is dependent on individual and systemic factors including communication skills of lay persons and professionals.


Adams: Dr Deupree, thank you for speaking with us today.


Deupree: Jeff, thank you and the nurse leader readers of JONA for the opportunity to share.




1. The Henry Kaiser Family Foundation. Health Care Costs: A Primer: How Much Does the U.S. Spend on Health and How Has It Changed? The Henry Kaiser Family Foundation Web site. Accessed January 25, 2017. [Context Link]


2. US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 2010. [Context Link]


3. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. [Context Link]