AAN President's Pages
Courage and conviction: The Academy's next 50 yearsCourage is one of the core values of the American Academy of Nursing—and it is as vital and essential in 2023, when we celebrate the Academy's 50th Anniversary, as it was when a group of dedicated nurse leaders visualized and established the organization in 1973 as part of the American Nurses Association (ANA). Courage also fueled the redefinition of our relationship with ANA in 1999, when the Academy secured its own organizational status while staying in partnership with ANA.
A story, serendipity, and the power to actIn my first column for Nursing Outlook as President, I wrote about the power that a story can have on us, both emotionally and intellectually. I chose this topic because reflection is the first theme of the Academy's 50th Anniversary arch. Now, as 2022 comes to a close, I want to share a few reflections from fellows of the American Academy of Nursing who have chosen to honor me with their story.
Can we calm the sea? A reflection on steadying the nursing workforce“The breaking of a wave cannot explain the whole sea.” ― Vladimir Nabokov
If not us, then who? nursing and climate changeNursing has a critical role in addressing the looming public health challenge of climate change and its associated—and inequitable—adverse health consequences. The nursing profession is essential in communicating with patients, families, communities, and societies, as well as legislators and policymakers, to recognize and respond to climate change. The Academy's policy role positions us to take on the important work from the unique perspective of nurses as scientists, educators, caregivers, managers, and leaders as we identify and implement collective solutions.
Bolstering our commitment to equity and anti-oppressionI agree with the Academy's Diversity and Inclusivity (D&I) Committee: equity, diversity, and inclusivity must live not only within our organization and across our Fellowship but also be reflected in our work. Our newly adopted Equity, Diversity, and Inclusivity (EDI) Statement (Academy, 2021), coupled with our strategic plan, will serve as our North Star, advancing our vision of healthy lives for all people. This is hard work, and we must do it: taking an active stance every day to dismantle oppressive and racist practices, wherever they occur in our professional environments, our communities, or globally.
To learn: The power of reflectionReflection can take many forms—writing, journaling, taking a long walk, daydreaming, talking with friends or colleagues—and it can provide us with insights that bring clarity and wisdom. It can spur a new direction or lead to a resolution for change. Reflection can also bring forth a wide range of emotions. Unlike the other kind of reflection— where light, sound, heat, or an image is sent back and not absorbed— our reflections often bring with them strongly felt sentiments. As the American Academy of Nursing (Academy) launches this first year of a three-year, 50th Anniversary commemoration, our theme for 2022 is reflection.
What's in a Story? Looking Back to Move ForwardFor those who do not know me well, know that story telling is a strong part of who I am. From my perspective, stories honor not only a moment in time but also the people involved. Stories help us contextualize and emotionally connect to an experience outside of ourselves. As we go through life, we know that some stories bring us joy, while others caused us pain. It is the experience of this range of emotions, particularly through personal retellings, that is so important to build our character, heal our scars, and create meaningful human connections.
The presidential partnership: leaving a trailThe words change and transition are used frequently to describe a shift in focus or organizational necessity. However, as leaders, we know these words are not synonyms. According to the Center for Creative Leadership (CCL, 2020), “Change is defined as the situations and occurrences that impact organizations and individuals (CCL, 2020).” Change encompasses the adaptation from the previous way of doing things to the new way and should be met with flexibility. “Transition is the internal psychological process of adapting to a new situation, (CCL, 2020).
New Questions, More Questions, The Same Questions: How Covid - 19 is Impacting the ProfessionAlpha, Beta, Delta, and now the Mu variant continue to cloud how we will see past the grip the pandemic has on the public's health, safety, and economic stability. Variants create more questions. And while we are building a tool chest filled with knowledge, each time one variant spreads across a country, the path forward is never immediately clear. What remains certain for the profession— amongst this uncertainty— is that attention must be placed on investing in the nursing workforce. From supporting nurses’ physical, mental, and emotional health to considering education and training in the future, there is a need to refocus and seek more data.
Sustaining Visibility: Environment, Perception, and EquityBeing visible, or the state of being seen by another person, is dependent upon two main factors. The first is the environment through which the object or person is being viewed, and the second is the ability of the viewer to perceive and acknowledge the object or person's presence. When the COVID-19 pandemic began, the visibility of nurses was perhaps never clearer. The media depicted powerful imagery of nurses on the frontlines, reinforcing the impact of the profession. The environment that nurses and other health professionals found themselves in allowed them to step into the forefront of the public eye amid mass anxiety, uncertainty, and frustration.
Beyond Physical Healing: Centering on Mental and Emotional HealthAs the country continues its COVID-19 vaccine rollout efforts, Americans are eagerly and anxiously tracking vaccine availability and vaccination rates in their states. To date, 47% of the total U.S. population has received at least one vaccine dose, and 37% are fully vaccinated (Centers for Disease Control and Prevention, 2021). The exact timeframe when the U.S. is expected to reach herd immunity varies, with some experts cautiously optimistic that we will reach a turning point this summer (Conlen, 2021).
Trust Science and Inspire Hope: Our Duty of CareAt the stroke of midnight on December 31, 2020, we ushered in 2021. While the celebratory nature of the calendar change is nothing new, this year, it seems to offer more hope. As scientists, researchers, and leaders in practice and academia, we know that nothing miraculous happened overnight. Yet, the start of a new year brings an opportunity for a new perspective, a new approach, and a renewed effort.
Aging in America: How COVID-19 Will Change Care, Coverage, and CompassionWhile it is a smaller population that has survived the Great Depression (1929-1939), the Great Recession (2007-2009), and now the devastating financial impact of the coronavirus (COVID-19) pandemic, this group of older Americans has experienced tremendous stress and, at the same time, shown incredible resilience. I reflect on these monumental economic downturns as a concrete social determinant of health—directly impacting access to quality health care. As if the vulnerability for contracting the virus and suffering serious illness associated with SARS-CoV-2 was not enough, older adults are also having to navigate a world of considerable uncertainty in most aspects of life.
Public health nursing: Leading in communities to uphold dignity and further progressPublic health. We have heard this repeated over and over again by politicians, health experts, and media commentators. Over the past few months, the combined negative impact the coronavirus pandemic and systemic racism has had on the public's health has reached a more acute level of global concern. Health inequity has been repeatedly highlighted by researchers and the body of evidence continues to grow. This time it seems different, or at least it must be different. This time, more people are listening, more people want to understand, and the calls for action grow louder by the day.
The Epicenter We Need: ScienceThe global coronavirus (COVID-19) pandemic has continued and will continue to change the course of healthcare, emergency preparedness, and every aspect of how we live and engage in our communities. When the first outbreak occurred in China, Wuhan was considered the epicenter of the virus with the most concentrated number of cases. As COVID-19 spread around the world, Italy became another nation stricken with the contagion's deadly impact and the northern region of Lombardy became its epicenter (Horowitz et al., 2020).
Leadership Evolution: The Academy's Sustained and Growing ContributionLeadership is a fascinating concept. Some will say that you are born with it, while others will say it has to be developed. And there are still others who will say it is both. From my experience, and what the American Academy of Nursing (Academy) believes, all great leaders need development. In preparing for this column, I reflected on the Academy's leadership focus. As I mentioned in my last Nursing Outlook message, it is important that our Academy Fellows and colleagues who read this journal understand our signature initiatives.
Risk and Reward: The Innovation Behind Academy's Edge RunnersFor nearly five decades, the American Academy of Nursing (Academy) has looked to the horizon in our efforts to advance health equity and champion wellness. At its core, the organization has invested in nursing knowledge by inducting thought leaders and change agents as Fellows. Over the years, the organization's vision to be a leading voice for change has been bolstered by the advent of initiatives that elevate the best work within the profession and maximize its public reach. These initiatives have become inseparable from the work of the Academy and serve as critical platforms for dissemination, impact, and influence.
Fluidity: Creating seamless leadership transitionsThere are many ways to describe leadership transitions—passing the baton, handing over the gavel, or a changing of the guard. At the Academy's Transforming Health, Driving Policy conference, our roles shifted from President and President-Elect to President and Immediate Past President. Over the past year, we have worked closely together to prepare for this moment. The Academy has been in what we like to describe as a positive state of flux. Positive from the perspective that we have been able to grow as an organization in our approaches, evaluation methods, and strategies.
Giving voice when barriers are in place: Academy's continued response to the U.S. migrant crisisHeart wrenching. Maddening. Implausible. Any of these words and more can describe the emotions of so many Academy fellows who have written to me and other members of the leadership team expressing their deepest concern with the treatment of migrant individuals at the United States’ southern border. The American Academy of Nursing (Academy), like so many of our partner organizations, is utterly dismayed by the inhuman treatment of children, women, and men who are attempting to enter our country. Health professionals and citizens alike are pained by the recent media reports of children dying in custody, the lack of consistent medical care, and quite simply an unacceptable lack of basic hygiene (Romero et.
President's Message To Mold the Future, Change is EvidentEleanor Roosevelt once stated “The future is literally in our hands to mold as we like. But we cannot wait until tomorrow. Tomorrow is now.” As the profession, stakeholders in health, and partners across industry look to the future of health care, the American Academy of Nursing (Academy) recognizes that the opportunity is now to add its voice for positive change.
President MessageIn March of 2019, the Board of Directors approved the American Academy of Nursing's Policy Priorities for 2019-2020. The process began by seeking insights from the organization's Expert Panels (EPs). With 24 EPs, the organization has a wealth of knowledge that is broadly defined, but also includes specific bodies of research and practice that help inform policy at the institutional, state, and federal levels. Last year, in an attempt to narrow the organization's focus, the Board selected particular policy priorities that were key drivers in only a few select areas.
Moving to Impact: Creating Policy AlignmentWith over 2,700 fellows, the American Academy of Nursing's intellectual capital is vast. Adding the expertise of the honorary fellows yields infinite networks that create a depth and breadth of knowledge which encompasses nearly all healthcare issues and much beyond that scope as well. This is the true strength of the association. At the same time, that broad scope begs the question: can we do it all? This challenge is particularly relevant when it comes to policy matters. The world of policy is saturated with equally expert views that may be consistent, similar, or contrary to that of the Academy.
The opioid crisisThe Academy Board of Directors identified five areas of priority including violence prevention, reproductive rights, opioid addiction, environmental health, toxic stress in children, and violence prevention. This month's message focuses on the Opioid crisis. I am pleased to co-author it with Madeline A. Naegle, PhD, CNS-PMH, BC, FAAN.
Environmental Health: The Future Will Ask, “What Did You Do?”The Academy Board has prioritized five areas for policy consideration and advancement; they include:
Global maternal mortality rate declines—Except in AmericaThe broad topics I will address this issue fall under Reproductive Rights and our value of social justice. The Academy stated mission and vision on policy and advocacy work is based on using the best available scientific evidence. This allows us to lend objectivity to complex, emotionally charged issues, such as maternal morbidity and mortality. It is out of that weighted objectivity that valid recommendations for modifying clinical practice can come. I will cite the negative consequences that occur when the available evidence is not consistently embedded in practice.
A public health crisis: Recommendations to reduce gun violence in AmericaThe Academy Board of Directors has identified five areas of priority including:
Reducing toxic stress experienced by children living in povertyIn my last President's Message I shared the five policy areas set by the Academy Board of Directors. They are:
Mindfulness and the work of the academyMindfulness has become an important concept to help ensure the safety and high reliability of the clinical practice of healthcare professionals. Mindfulness based interventions have been used successfully to decrease stress and burnout in nurses and physicians. The Institute for Healthcare Improvement (IHI) describes mindfulness as assuming an aware, non-judgmental, present state of mind. It is the habit or practice of being in the moment.
May you live in interesting times!At this year's policy conference, as in past years, we highlighted nursing initiatives that are transforming health, leading change, influencing policy, and ultimately improving the health of our nation. It is no accident that the conference focused heavily on social justice given the fact that our nation and the world continue to face ongoing challenges to human rights. Those challenges sadly come in all too familiar expressions—racism, threats to immigrants, limiting women's access to reproductive services, underestimating the impact of climate change on global health, injury, death and psychological impact of gun violence, and many others.
Access to a healthy futureWhat if we decided to weed through the rhetoric and ideology that has dominated the crafting of a health plan and examined the basis for why it is in our country's best interest to assure a pathway for accessing and then gaining high-quality and affordable health care? While we are at it, we might want to examine the equally important premise that how healthy we are is predominantly the result of resilient communities, clean and safe environments, adequate housing, living wage employment, genetics, behavioral choices, and a host of other determinants of health.
Valuing ScienceI just experienced one of my favorite times of the year; the week we graduate our students. I admit that I like a little of the pomp and circumstance that comes from a long tradition within academic environments. I like donning the cap and gown that spent the last 12 months hanging on the back of my office door. I love seeing students transition to colleagues; almost overnight! I admire the commitment of faculty to students and the pride they take in collective success. I am somewhat envious of the opportunities today's education affords our students: mentorship, clinical and research opportunities, rigorous and challenging courses, high expectations of their mentors and peers, opportunities to explore cultures across the globe, preclinical simulation scenarios that reduce the anxiety of their first clinical engagement with an individual; all designed to ignite a love for the practice of nursing.
What nurses are fighting for: The elevator briefingI recently attended a very stimulating 2-day meeting at the Robert Wood Johnson Foundation (RWJF) to engage in a dialogue about the future of nursing's role in population health. RWJF convened the dialogue to explore the opportunities and challenges related to the roles and leaderships in population health and how we, as nurses, can impact the health of populations. The interdisciplinary group of individuals focused on how population health was defined, practiced, taught, studied, and utilized in policy within the nursing profession.
Shaping policy in an antipolicy environmentAs the president of the American Academy of Nursing, I try to limit sharing my personal sentiments about politics and politicians in the pages of Nursing Outlook or Fellows of the American Academy of Nursing Mail. I feel quite comfortable sharing my thoughts on policy, but I do not assume that we all feel the same about our leaders and their style of governing. However, because the academy is primarily a policy focused organization and has integrated the policy process into our mission and vision I feel compelled to share with you that I believe our vision is in peril.
Registered nurses in primary care: A value propositionI feel as if we are finally acting on evidence that has been known for some time; there is significant value to enhancing the contributions of registered nurses practicing in primary care. The outcome of increased efforts to engage RNs in primary care practice could be gains in the health status of patients, reduced dissatisfaction of providers (physicians, nurse practitioners, and physician assistants), and an improved value proposition for primary care. Redesigning primary care through new models that utilize teams of primary care practitioners and high functioning registered nurses could change a dynamic that has plagued primary care for some time.
Culture, practice, science and leadership: Natural partnersThe Academy is committed to the critical role that social determinants of health play in creating healthier people and healthier communities. We positioned the social determinants of health as one of three strategic goals in our 2014 to 2017 strategic plan. The Academy Board is currently engaged in refreshing our strategic plan for 2017 to 2020. A commitment to the health of populations and to health equity is threaded throughout our focus on policy, practice, and leadership and it is evident in the Academy's signature initiatives, policy briefs, position statements, and engagement with partners.
Lost in the shuffleWhat is it like for an individual with complicated health care needs to navigate our modern, technologically sophisticated and highly complex care environments? What is it like for their families when efforts to access information and assistance necessary to manage care at home are lost in the shuffle? Those questions have prompted health systems, governmental agencies, academia, and scholars to investigate the burden and poor health outcomes that patients and families may experience during the transition within and across care environments.
Valuing primary care practiceI become more mindful every day of our educational and practice imperative in nursing to assure that our workforce is robust, well prepared, relevant, and timely. How educators and clinicians translate that to practice is often a complex cooperative approach to seek strategies that align education and practice priorities, assure that faculty and clinicians are current and competent in clinical and research skills, attend to trends in health systems, and engage in health policy. It's a tall order! My enthusiasm for our future in nursing is fueled by my knowledge that our Academy fellows are experts and leaders in these competencies.
Driving change in population healthMy first message as the new President of the American Academy of Nursing continues the conversation Diana Mason began in her July/August President's Message “Building Healthy Communities”. If you attended the policy dialogue on “Leveraging Community Benefit to Reduce the Prevalence of Violence, Poor Nutrition, and Adverse Childhood Events” at the Academy's Policy Conference in October you participated in a discussion about how “Community Benefit” can act as a powerful tool to help engage communities in assessing their collective health.
A mission-driven organizationThis is the last President's Message that I will write for Nursing Outlook, so I want to highlight some evidence of our progress on our strategic plan. Much of what I have to report builds on the work of prior presidents, boards, and staff that laid the foundation for a strong organization and launched some of the initiatives that the current board and staff have moved forward as we focus on our mission of transforming policy and practice through nursing knowledge.
Building healthy communitiesThe Academy's second strategic goal focuses on addressing the broad range of factors that shape the health of individual, families, and communities. I want to share with you three recent developments that align with this goal in the areas of nutrition, violence, and toxic stress in childhood—the three priority areas identified by the board for 2014-2015.
Getting what we pay forOne of my favorite Edge Runner stories was told to me by board member Eileen Sullivan-Marx, PhD, RN, FAAN, now Dean at the College of Nursing at New York University. At the time, she headed the University of Pennsylvania School of Nursing's LIFE program called Living Independently For Elders, a Program for All-Inclusive Care of Elders (PACE; Medicare.gov, n.d.), with capitated payments by Medicare and Medicaid. Designed to keep older adults living independently in their homes rather than in nursing homes, PACE was first developed by Jennie Chinn Hansen, PhD, RN, FAAN, another fellow and Edge Runner who founded On Lok in San Francisco.
Creativity in policyAt the October 2014 annual meeting of the Academy, Stephanie Ferguson went to the microphone and challenged the fellows in attendance to be more visibly involved in some of the most important issues of our day, including the expansion of Medicaid and continuation of the Children's Health Insurance Program (CHIP). Her call is timely, given the continuing need for reforming health care and the changing political landscape.
Wisdom and willIn 2013, the National Research Council confirmed what had become evident to those who conduct comparative analyses of nations' health care systems—the United States ranks poorly on most indicators of health and systems' outcomes but leads other developed nations in health care spending. No wise person would design the health care system we have now. The challenge is whether we have both the wisdom and will to transform our health care system.
Toxic stress in childhood: Why we all should be concernedKaren Cox is the outgoing Secretary and co-lead of an Academy task force on Strategic Goal #2 that addresses the “upstream factors” that affect the health of people. She is an expert in toxic stress in childhood and is leading the Academy's workgroup on this factor. I invited her to coauthor this President's Message with me.
Ask not, what have you done for me lately?I am borrowing from John F. Kennedy's famous line, “Ask not what the Academy can do for you. Ask what you can do for the Academy.” It is a bit of a cliché now but still relevant. The members of the Academy board, committees, and expert panels are contributing their time and talents to advancing the mission of the organization, and most also make annual gifts to the Rheba de Tornyay Fund, recognizing that we are a small but visionary organization that needs more resources than dues provide to move forward on our strategic plan.
Looking upstreamIn the last issue of this journal, I wrote about the imperative for the Academy's second strategic goal—lead efforts, in partnership with others, to address the broad range of factors affecting the health of populations. Although there are data supporting the fact that our nation outperforms other developed nations on health care spending, we trail behind on most leading health indicators (Organisation of Economic Co-operation and Development, 2013). The need to create healthy communities is not new to nursing.
Where and how is health created?Reforming our health care system is necessary but not sufficient for improving the health of the nation.
Diverse voicesThe American Academy of Nursing seeks to be a model organization on diversity and inclusivity. How are we doing? I asked myself that recently when I received feedback from two fellows that gave me pause.
Think globally, act locallyLast year, the board of directors appointed a task force headed by Living Legend Barbara Nichols to examine the Academy's approach to international fellows. Specifically, the board was responding to concerns about how nominations for international fellowship were evaluated, their fellowship fees (which have been at a reduced rate), and membership status that restricted their right to full involvement in the academy (international fellows could not run for office or vote in our elections).
Coming of AgeSince becoming a fellow in the American Academy of Nursing, both it and I have matured. In 1991, Loretta Sweet-Jemmott and I were supposed to be standing quietly in place in a hallway while we awaited our turn to take the stage of the hotel ballroom to be inducted as new fellows. Instead, we were reconnecting (we had worked at the same university for a short time) and laughing hysterically about Loretta's enhanced presentation in a gorgeous dress that hid a “wonder” garment. The then chief executive officer (CEO) Janet Heinrich had to come by and tell us to be quiet.