“She poured her heart into helping patients and keeping her fellow nurses safe.”
—President Joseph Biden, as he draped a Presidential Medal of Freedom around the neck of Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC.
“Thank you for inspiring us.”
The impact her example had on vaccine-hesitant Americans can’t be measured, but Sandra Lindsay herself has heard directly from people who say that watching the Jamaican-born nurse persuaded them to get their shots. Last year, while on a visit to the Jamaican Embassy, a woman recognized her and thanked her profusely. She and her family had not intended to be vaccinated—until they saw Lindsay getting that first jab on TV. After seeing the nurse’s confident mien, she said, “We all went and made an appointment. So I want to thank you so much for inspiring us.”
That sort of recognition can be a force for good, and Lindsay is surely one of the best-known living nurses in the United States (and in Jamaica, of course!). It’s become a milestone in the history of the pandemic and a powerful symbol of what it means to be a nurse: the image of her serene face wrapped in a pale blue surgical mask, her expressive brown eyes gazing into the distance as she extends her arm to receive the first Covid-19 jab in the US.
Like most people who become symbols, she is not unique. The profession is filled with nurses like Lindsay—nurses who lost family to the pandemic and had no time to grieve; who continued pursuing their education through all of the upheavals; who coped with almost unbearable stress, and scrambled for data when the mRNA vaccines really did emerge at “warp speed” and forced us to rethink everything we thought we knew about vaccine development. But Lindsay’s exceptional poise and sense of responsibility during her frank “I trust the science” spotlight moment have made her representative of the skills, empathy, common sense, and honesty we associate with nursing.
A quiet icon of nurse leadership
While everyone yearned for certainty, Dr. Lindsay never claimed that science is a source of 100% correct, oracular knowledge; she merely said that this is the way that science works—and in effect acted as America’s test pilot for the vaccine.
As she sat down to receive her jab on December 14, 2020, what Lindsay displayed was a nurse’s dedication to evidence-based practice. When she backed this up by not collapsing on the spot or exploding in the weeks following her vaccination, she faded from national headlines and proceeded with her duties at Long Island Jewish Medical Center and worked toward yet another degree. But Lindsay’s persistent lack of rare side effects, her utter failure to cash in on her time in the spotlight, and apparent inability to catch even a mild case of breakthrough Covid made her a quiet icon of nurse leadership during the pandemic.
Millions of mistrustful, frightened people at all levels of society heard her speak with the sane, confident, honest voice of a nurse who has no agenda other than a desire to see her patients well and healthy. Amid rumor-driven panics, false claims based on specious data, and adult mobs throwing tantrums that would be the envy of any 3-year-old, Lindsay’s voice – imbued with a science-based assurance similar to Dr. Fauci’s but without any confrontational edge – resonated. Meanwhile, she has navigated her unasked-for celebrity and public honors with a cool-headed grace and continues to keep her head above water in an era when staffing shortages and burnout are the norm, women’s health care decisions are predicated not on science but on a peculiar blend of metaphysics and politics, and public health officials are driven from office… for doing their jobs.
How about featuring American Nurses on some postage stamps?
Today, after a year and a half of combining full-time work with study, waving from cars during ticker-tape parades, holding a little girl’s hand for her Covid jab, and adding tchotchkes to her diploma and awards wall, Dr. Lindsay is making space for the Presidential Medal of Freedom she received today from President Biden. (He obviously likes standing next to her and handing her things. This is their second rendezvous). As the White House defines the honor, the medal is bestowed on people who have made exemplary contributions to the prosperity, values, or security of the United States.
Lindsay has been a very atypical American celebrity, and there has not been a peep about reality TV deals, an as-told-to book, or even a barrage of media appearances. However, this writer still thinks she belongs on a stamp. While we still have a postal service, we deserve a “nurse” postage stamp of a more recent vintage than 1961—and in fact, it would not be amiss to issue a full series of stamps honoring American Nurses and Nursing.
When New York Gov. Kathy Hochul signed the state budget into law, it secured improved health care access for residents in the state. New York joins 24 other states, the District of Columbia and two U.S. territories in adopting Full Practice Authority (FPA) legislation. The legislative action enables nurse practitioners (NPs) to provide the full scope of services they are educated and clinically trained to provide. The American Association of Nurse Practitioners® (AANP) commends Gov. Hochul and the New York Legislature for modernizing nursing licensure law and positioning New York for a healthier future.
“New York has taken a critical step forward in our country, increasing access to vital health care services. New Yorkers will now have full and direct access to the comprehensive care NPs provide,” said April N. Kapu, DNP, APRN, ACNP- BC, FAANP, FCCM, FAAN, president of AANP. “Over the past two years, New York has waived unnecessary and outdated laws limiting access to health care. AANP applauds the state legislature and Gov. Hochul for recognizing that these provisions need to continue. These changes will help New York attract and retain nurse practitioners and provide New Yorkers better access to quality care,” said Kapu.
FPA is the authorization of NPs to evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications, all under the exclusive licensure authority of the state board of nursing. This framework eliminates unnecessary, outdated regulatory barriers that prevent patients from accessing these vital care services directly from NPs. Leading health policy experts like the National Academy of Medicine have long recommended that states adopt such legislation to improve health care access and outcomes.
“As the 25th state with Full Practice Authority, New York joins an expanding list of states acting to retire outdated laws that have needlessly constrained their health care workforce and limited patient access to care,” said Jon Fanning, MS, CAE, CNED, chief executive officer of AANP. “This is a no-cost, no-delay solution to strengthening health care for the nation. Decades of research show that states with Full Practice Authority are better positioned to improve access to care, grow their workforce and address health care disparities, while delivering quality health outcomes for patients. We look forward to more states following suit.”
NPs deliver high-quality health care in more than 1 billion patient visits each year. As of April 2022, there are more than 355,000 licensed NPs in the U.S. providing care in communities of all sizes across the nation. Recently, U.S. News and World Report ranked the NP role first on its 2022 Best Health Care Jobs list.
Nurses care for patients with asthma exacerbated by poor air quality and heat exhaustion during heat waves. They respond during natural disasters like hurricanes and flooding. Now, a growing number of nursing schools are incorporating an underlying driver of these health issues into their courses: climate change and the environment. Their goal is to prepare nurses to better care for patients and communities in a world with a changing climate.
At NYU Rory Meyers College of Nursing, faculty have developed content focused on climate change and the environment for several courses. In 2020, the college added a module on the clinical relevance of climate change in health care decision-making to the applied epidemiology course for Doctor of Nursing Practice (DNP) students, and the following year added modules on the environment for the health policy-focused course for PhD and DNP students.
Beginning this fall (2022), NYU Meyers will devote a brand-new course to climate and environmental health: The Environment and Health of Populations. The course is designed for graduate nursing students, but undergraduate students can enroll with permission from professors.
Historically, nurses may have learned about air quality and its effects on respiratory health, but haven’t necessarily been taught to care about dirt and water sources, which can become contaminated or carry pathogens, putting communities at risk. New coursework focused on climate might cover issues such as disaster preparedness, severe weather and health (for instance, protecting older adults during storm-related flooding or rising temperatures and infectious diseases) and sustainability in healthcare.
Robin Klar, DNSc, RN, a clinical associate professor at NYU Meyers who focuses on the environmental context for nurses in the U.S. and around the world, said that this growing interest in climate change demonstrates nursing education’s eye on the future—as healthcare evolves, so does how we train nurses. “Nursing is not static; it’s a dynamic profession,” said Klar.
NYU Meyers is one of 53 schools currently taking part in the Nurses Climate Challenge, a national campaign to mobilize nurses to educate 50,000 health professionals on the impacts of climate change on human health. Thus far, the movement has reached nearly 36,000 health professionals, including more than 15,000 nursing students.
Managing any nursing team carries its challenges, and the pandemic has added even more complexity to that formidable task. With such a daunting landscape, how do nurse leaders enable a nursing organization to perform at a high level, and what steps are needed to get there?
In developing a high-performing nursing culture, nurse leaders need to focus on two things, notes Courtney Vose, DNP, MBA, RN, APRN, NEA-BC, FAAN, senior vice president and chief nursing officer at Robert Wood Johnson University Hospital. The first is “truly driving employee engagement.” The second is to “really drive for RN satisfaction.”
Vose started her role in late January. Previously, Vose served as vice president and chief nursing officer in the New York-Presbyterian Hospital system.
Courtney Vose, senior VP and chief nursing officer.
“From a nursing leadership perspective,” says Vose, “I feel that if we take better care of our staff, they can take better care of patients and their families. The benefit of creating an engaged culture is that outcomes should improve in every domain, from quality to satisfaction to flow to affordability. When you have a high-performing team, they want to perform well in all domains.”
When it comes to employee engagement, “it’s really helping to create a shared vision and developing the strategy with the voice of the team from all levels and disciplines so that there’s a shared sense of purpose and direction on where we want to go,” says Vose
At New York-Presbyterian/Columbia University Irving Medical Center, employee engagement scores rose so quickly that Gallup, who measured these scores, wanted to know what they were doing. “At the end of the day, it was really very simple,” Vose says. “We listened to the collective voice of all team members. We created a shared vision that everyone got aligned to, and then we developed our strategy and then tactics on how we were going to get there.”
“If I were to boil it down, I would say create a shared vision that gives people a sense of purpose. And then really dig into that to figure out how you’re going to get there and then take action to make it happen.”
RN satisfaction, notes Vose, is tied to employee engagement since it is a key component of engagement. Satisfaction measures how much employees enjoy their work. Components of this for nurses include autonomy in their practice and access to professional development opportunities.
Vose notes that the American Nurses Credentialing Center (ANCC) Magnet Recognition Program is related to high-performing nursing organizations. “Magnet organizations invest more in nursing. The evidence strongly suggests Magnet organizations have higher engagement and RN satisfaction, which leads to better results for patients and families.”
Learning from the pandemic
The pandemic holds lessons for creating a high-performing nursing organization, notes Vose. One involves resilience. “How we provide respite and keep a workforce resilient is an incredibly important learning,” she notes.
A second lesson involves creating new models of care that allow nursing to become more “elastic,” says Vose. “That’s my word for how can we expand our workforce quickly when we have an event that requires more resources.”
At Robert Wood Johnson University Hospital, nursing students from Rutgers University School of Nursing assisted staff nurses during the Omicron wave. This allowed RNs to delegate to the nursing students and take better care of patients and families.
“So how could we utilize students all the time?” asks Vose. “Why do we have to wait for a pandemic to do that? How could we utilize licensed practical nurses who could be delegated to and allow us to take care of more patients, especially when the time comes when we really need additional resources? Those are the things that the nursing community at large is really engaged in trying to figure out.”
No need to “complexify”
In developing a high-performing nursing organization, nurse leaders should avoid the tendency to “complexify” leadership, says Vose. “I think leadership is actually fairly easy, but the work is hard with long hours,” she says.
Many nurse leaders, says Vose, make the mistake of wanting to jump into higher-functioning activities before they’ve established trust with their team. “Establishing trust with your workforce is probably the most important thing that you can do as a leadership team,” says Vose. “Until you have that, it’s hard to get to the next levels where you would engage and empower them to really take ownership of their practice and make decisions about their practice environment.” If it takes a year to develop that trust “then take the year to do that because it will be a year well spent.”
Leadership, Vose notes, will set standards. “But for me, it’s always trust and respect first, however long that takes to establish, moving quickly into engaging and empowering leaders and staff. Once you have those two solid foundations in place, you can achieve anything that you want to.”
The Act was named in memory of Dr. Lorna Breen, a Virginia physician who worked on the front lines of the pandemic in New York and died by suicide in the Spring of 2020. Breen’s tragedy—which took place when New York CIty’s Covid death toll was at its height—drove concerns about clinician mental health into the spotlight and raised public awareness about the mental and emotional struggles of health practitioners.
Once signed by President Biden, the Breen Act will lay the groundwork to provide resources to help destigmatize and provide better access to mental and behavioral wellness support for nurses, physicians, and other health care workers. The bill’s provisions include, among other things: establishing grants for training health care professionals on ways to reduce and prevent suicide, burnout, substance abuse, and other mental health conditions; grant funding for employee education, peer support programming, and behavioral health treatment; and creation of a national education and awareness campaign focused on encouraging health care workers to seek support and treatment.
“When you see statistics indicating nurses die by suicide at a considerably higher rate than non-nurses, you quickly realize the critical importance and timing of this legislation.”
“When you see statistics indicating nurses die by suicide at a considerably higher rate than non-nurses, you quickly realize the critical importance and timing of this legislation,” said ENA President Jennifer Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC. “Our country’s mental health crisis has only worsened during the pandemic, and emergency nurses can certainly attest to the stress, fatigue, and burnout they’ve experienced.
Schmitz added that passage of the Breen Act “will deliver help to health care workers, ultimately saving lives and preserving their ability to provide the best care possible to patients.”
In a February 18 statement, April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of AANP, remarked: “This historic pandemic has taken a heavy emotional toll on nurse practitioners [NPs] and other health care workers across our nation. The importance of passing this bill can’t be overstated. By providing much-needed mental health services and support to NPs, registered nurses, physicians, and other health care providers, we are offering a lifeline to those who often put their patients before themselves. Taking care of health care providers’ mental health positively impacts their ability to serve others and will help prevent suicide among so many who are feeling extreme burnout.”
Breen’s surviving siblings also applauded the Senate passage of the act. In a video, Jennifer Breen Feist and Corey Feist, co-founders of the Dr. Lorna Breen Heroes’ Foundation, cheered the bill as it completed passage through Congress: “We want to take a moment with you to pause and let all those health care professionals know that we heard you and we have been working diligently to support you. We owe each of you our deepest gratitude for all you’ve done for us and for this country.”
Twelve med students and twelve BSN students from NYU Rory Meyers College of Nursing are learning how to work together in a groundbreaking interprofessional collaboration program.
The future nurses and physicians are doing their clinical rotations in tandem based on a new collaborative model for nursing education, with an emphasis on considering the environmental factors that influence a patient’s health.
“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools.”
The program, which takes place at NYU Langone Hospital—Long Island, aims to develop effective working relationships between different types of healthcare students and practitioners to support health outcomes. Research shows that interprofessional healthcare has many benefits, not only improving patient care, but collaboration can lead to fewer preventable errors, reduced healthcare costs, and improved working relationships.
“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools. Some schools do one-off interprofessional simulations or experiences, but our program at NYU Langone Hospital—Long Island is unique,” said Selena Gilles, associate dean of the undergraduate BS nursing program at NYU Meyers and a Long Island resident.
“The essence of what healthcare should be in the 21st century.”
Twelve nursing students were selected to participate in the program’s first cohort, which began in the fall of 2021. On their clinical days at NYU Langone Hospital—Long Island, each nursing student is paired with a medical student. The dyads are assigned to care for the same patients and work together to assess them, develop care plans, and attend rounds and “huddles” of interdisciplinary healthcare teams where their assessments and care plans are discussed.
“This program speaks to the importance of collaborative practice,” said Vincenza Coughlin, the director of professional nursing practice and education at NYU Langone Hospital—Long Island. “We each bring our unique and complementary knowledge and skills when working together in patient care.”
Notably, the students assess patients’ social determinants of health—the environmental conditions such as housing, education level, income, and access to healthy foods that can influence one’s health. This holistic view of people encourages students to think beyond a diagnosis, including how patients end up in the hospital, what hospital services could benefit them, and how to improve health after discharge, beyond the hospital setting.
“Nursing and medical students forming one team, and working toward the same goal of moving patients toward wellness, is really the essence of what healthcare should be in the 21st century,” said Alice Nash, system senior director of nursing professional development & clinical outcomes at NYU Langone Health.
The interprofessional education program, which will run for five years, is funded by a $7 million gift from Howard Meyers and his late wife Rory. The funds provide full-tuition scholarships plus room and board for the school year for the nursing students selected.
“Throughout the COVID-19 pandemic, healthcare professionals have pivoted to work in new ways as interdisciplinary teams, with nurses working closely alongside doctors, respiratory therapists, physical therapists, and others,” said Eileen Sullivan-Marx, dean of NYU Rory Meyers College of Nursing. “While interprofessional education has long been an interest of ours at NYU, teamwork has never been more important and we are thrilled that this interprofessional program is now underway preparing a new generation of nurses and physicians.”
Historically, nurses may have learned about air quality and its effects on respiratory health, but haven’t necessarily been taught to care about dirt and water sources, which can become contaminated or carry pathogens, putting communities at risk. New coursework focused on climate might cover issues such as disaster preparedness, severe weather and health (for instance, protecting older adults during storm-related flooding or rising temperatures and infectious diseases) and sustainability in healthcare.
