This week, the DailyNurse Nurse of the Week is one of the heroes of The Rebel Nurse Handbook (a 2020 AJN Book of the Year, awarded third place in Professional Issues). Nurse of the Week Richard Moore (PhD, MBA, BSc, RN, RNT, DMS, for entire panoply see his astonishing LinkedIn) is one of the passionately committed “rebel” nurses in the book whose journey shows that your nursing career can be just as unique, adventurous, and varied as you want it to be.
Setbacks such as ulcerative colitis, ADHD, and autism spectrum disorder failed to impede the nursing education or career of Richard Moore. The globe-trekking RN and MBA has treated everyone from cardiac patients in Leeds to a beloved dog in a desert village. A dedicated nurse, educator, and entrepreneur, Moore seems to be at home anywhere in the world, whether he is resolving toilet emergencies in the Australian Outback or teaching nursing students in England, North Korea, and New Zealand.
Starting at the age of seven, Richard Moore accompanied his mother on her nursing house calls in Ghana. She brought him along on visits both to the “very poor and the very rich,” and the boy’s keen eyes did not miss the Dickensian health disparities between the one and the other. His mother and sister were both nurses, and after they moved to the UK, 16-year-old Richard decided to follow in their path. He had struggled throughout high school: “my grades were so poor, I became the only student to finish in last place every year that I attended,” and was plagued by uncertainty as to whether nursing was the career for him, but it was all he knew.
Richard just managed to gain acceptance at the renowned St James University Hospital in Leeds, England. Before long, his uncertainty about nursing vanished, and he became passionate about working as a nurse. Even as he was stricken with ulcerative colitis from the start of his second year in school and underwent treatment, the erstwhile poor student threw himself into his work, and excelled.
After graduating, Richard became a Cardiac Care Unit nurse—which he loved—but also felt driven to further pursue his education and career. Richard went on to attain an MBA and before long, he started to pursue his “other passion” and became a nurse educator.
After teaching in major nursing schools in England, his felt a calling to move on. Richard ventured far from home and emigrated to New Zealand, where at first he directed nursing degree and post-graduate programs. Before long, though, Richard relocated to the Tanami Desert in Australia. There, he embarked on another dramatic life change as an Indigenous Learning Nurse Administrator. Working as a remote area nurse among the Warlpiri people, he provided “every conceivable healthcare from acute trauma to primary health for children to adults,” and when necessary, treated sick dogs as well, as the area had no veterinary care. Before long he was asked to direct outback hospitals. In love with the land, the desert, and the people, he happily accepted.
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Eventually departing from the desert, Richard’s life changed again. His six-year-old son was diagnosed with Asperger’s Syndrome, and not long afterward, so was Richard himself. In addition to Asperger’s, Richard was also found to be suffering from ADHD and sensory processing disorder and endured two years of clinical depression. With treatment, he started to recover and continued his global travels. His latest stop has been a North Korean university, where he has been simultaneously been teaching students at both the school of medicine and the school of international finance and management.
Reflecting on his varied and adventurous path, Richard says, “Nursing is a brilliant role. We make a difference for many people, often those who we don’t know. If I—with my ulcerative colitis, autistic spectrum disorder, ADHD, sensory processing disorder, depression, coming last in high school, living in several countries, deserts, and rainforests—can nurse well, so can you. You can make a difference to patients, families, and staff. Every person is unique and has their own story. Find it and walk with them.”
Nursing programs have had to innovate to meet the challenges posed by the pandemic. Restrictions imposed by shutdown orders, social distancing, limited in-person meetings, changes to course delivery and clinical placement requirements, and integrating technology into the classroom like never before are just a few of the ways that Covid-19 has impacted nursing education.
Ground-based nursing colleges and universities quickly created hybrid and online versions of their courses and materials and replaced live clinical assignments with scheduled simulation class events, web-enhanced synchronous meetings, and digital clinical experiences. Programs that were fully online already helped to provide support to those who had never taught in the online environment.
In both the nursing clinical and academic settings, a pervasive shortage exists. During the pandemic, many nursing faculty members were called back to the bedside to aid in addressing the demand for care. For faculty who were working in academia and the clinical setting, the pull and strain associated with competing priorities were evident. The stress and tension felt by faculty befell the students as well.
Nursing students already work to balance competing priorities. During the pandemic, they were having to work extra shifts, be placed on mandatory stay orders, travel far from home to agency assignments, and keep their families safe. Concern for their own safety and efforts to minimize exposure were often waylaid by the desire to serve and improve patient outcomes. Needless to say, the pressure to perform in a challenging crisis was intense and the tension palpable.
Nursing faculty members and administration found themselves in uncharted territory. How do we help students persist in their academic journey during a time of unprecedented emergency? We rose to the occasion by doing what we do best, supporting our students. We became confidants in practice. Assignment deadlines were extended where feasible, student support mechanisms were erected, and leveraging technology to facilitate learning became the norm.
Over time, and all during a pandemic that does not seem to be finding its end as yet, nursing faculty have found ways to bridge gaps that exist when a product that was designed for face-to-face delivery has to be moved to a virtual setting. Technology, like the applications Zoom, Webex, Microsoft Teams, and GoToMeeting, was used to help students feel connected. Learning management systems (LMS) like Desire to Learn (D2L), Canvas, Moodle, Blackboard, and many others were used to deliver content, keep students on track, and offer a way to persist without missing a beat.
Together, nurses do what they do best, see through the problem, not to the problem. We are innovative critical thinkers who also support one another and the profession. These times have proven challenging and often arduous, but the power of nursing presses on. We collectively advocate for each other and our patients. During times of crisis and ease, we progress, inspire, encourage, support, and work with compassion and diligence to serve our communities and our profession.
Now that diversity and inclusion programs can sigh with relief that they are not “unAmerican” after all, we can proceed to celebrate their vital role in encouraging non-Whites to enter the nursing workforce. One of the nursing school champions in this area is Frontier Nursing University, and this year, Dr. Geraldine Young, DNP, APRN, FNP-BC, CDCES, FAANP, FNU’s Chief Diversity and Inclusion Officer, is being recognized as one of the Outstanding Women in Higher Education by Diverse: Issues in Higher Education magazine. This is the 10th consecutive year that Diverse has named 25 women “who have made a difference in the academy by tackling some of higher education’s toughest challenges, exhibiting extraordinary leadership skills, and making a positive difference in their respective communities.” The issue will be published on March 4, 2021, in honor of Women’s History Month.
“I am incredibly honored and humbled to be recognized on this special list of women,” Dr. Young said. “I am thankful to have led the diversity, equity, and inclusion initiatives at FNU over the past year. As we strengthen our own environment, we have the opportunity to set an example and standard for other institutions to follow. I thank Diverse magazine for this honor and for giving us this platform to inspire others.”
As a member of the Essentials Task Force and NONPF Board of Directors, Dr. Young is ensuring cultural diversity and inclusion are at the forefront of nursing education to address the health disparities and inequalities that exist in our nation. She has effectively delivered models of clinical practice to improve the outcomes of underserved and minority populations with diabetes in conjunction with the Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid (CMS).
FNU President Dr. Susan Stone, CNM, DNSc, FAAN, FACNM cheered Dr. Young’s “experience and expertise as an advocate for diversity, equity, and inclusion,” and added, “With the guidance of Dr. Young… we will continue to make diversity, equity, and inclusion a top priority at all levels of the university.”
In each of the past three years, FNU has also received the prestigious Health Professions Higher Education Excellence in Diversity (HEED) Award from INSIGHT Into Diversity magazine. The Health Professions HEED Award is the only national honor recognizing U.S. medical, dental, pharmacy, osteopathic, nursing, veterinary, allied health, and other health schools and centers that demonstrate an outstanding commitment to diversity and inclusion across their campuses.
FNU’s commitment to emphasizing and valuing diversity and inclusion was formally instituted in 2006 when the university began intense efforts to recruit minority students in an effort to diversify the advanced practice nursing and midwifery workforce. FNU’s initial efforts were funded through the support of an Advanced Nurse Education grant from the Health Resources and Service Administration (HRSA). In 2010, FNU held its first annual Diversity Impact Conference. Held each summer since then, the Diversity Impact Conference opens the door for nurse practitioner and nurse-midwifery students plus faculty and staff to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups. Today, the goal of a diverse health care workforce continues with efforts to recruit and educate faculty, staff, students, and preceptors and integrate diversity, equity, and inclusion efforts throughout all of FNU operations with a goal that it should be fully integrated into the university’s culture. FNU’s diversity, equity, and inclusion efforts are currently funded with a Nursing Workforce Diversity Grant from the HRSA.
These diversity initiatives span all facets of the university, but one of the most telling and important data points is the percentage of students of color enrolled at FNU. In 2009, that number was 9 percent. Starting in 2010 with the HRSA funding, FNU’s diversity, equity, and inclusion initiatives have resulted in the percentage of students of color enrolled growing to 25 percent today.
The events of 2020 highlighted the inequities in health and the injustices faced by Black and Indigenous People of Color (BIPOC) in Minnesota. Many across the state have been awakened to the realities of racism and injustice. On a national level, we witnessed the devastation of COVID-19 and its disproportionate effects on Black and African-American communities.
On a local level, we witnessed the public murder of George Floyd in our city of Minneapolis. At the University of Minnesota School of Nursing, our faculty, students, and staff engaged and reflected with open eyes, ears and hearts the subsequent call to action. There is an unjust dual system that has been carefully woven into the very fabric of our society, including academia and yes, nursing. We acknowledge that white privilege and white supremacy has been institutionalized in academic settings. White supremacy is an insidious, toxic, and expansive system that must be renounced, including within our own schools of nursing.
Many schools of nursing in the United States have renewed their commitment to the courageous work of dismantling systemic racism in their schools and curriculum. The University of Minnesota School of Nursing is, likewise on a courageous transformational journey toward becoming more inclusive, equitable and diverse. As a place dedicated to educating nurses and transforming the healthcare system, our school has committed to unapologetic and unequivocal advocacy to address injustice and create sustainable change.
We, as the School’s Inclusivity, Diversity and Equity Director and Co-Director, recognized that leading a school toward anti-racism requires a combination of reflection, commitment and action. Paulo Frieree, Brazilian educator and philosopher, best known for his text Pedagogy of the Oppressed, said “Reflection and action must never be undertaken independently”. Reactive changes rarely provide the depth of understanding necessary to deal with deep issues of racism in healthcare, nor are they sustainable. We started by analyzing our school’s policies for student recruitment and admission,our systems of faculty hiring and promotion, and our fundraising and communication strategies.
In our experience, faculty needed time to reflect, learn about historical and systematic inequities, and the space to unpack the complex baggage of white supremacy and privilege that persists in our nation. As a school community, we created opportunities for safe and honest sharing and learning through listening sessions and discussion groups. Faculty were provided with resources to unlearn unconscious bias and deepen understanding about institutional racism in healthcare. Similar opportunities were offered to students across programs, from classroom learning, deep day activities, to monthly affinity group forums. Reflection is necessary, yet reflection without action is essentially the same as inaction. Without action, reflection can become a passive, self-absorbed pastime and is not helpful in creating substantial and sustained systemic change. Reflective and intentional planning, coupled with committed action is needed to bring about the changes in nursing education and dismantle places in our school where inequities persist. We are empowering faculty to recognize and interrupt microaggressions in the classroom. We are providing them with resources to make curriculum changes so social justice and antiracism content can be purposefully woven throughout nursing education.
The courageous and transformational journey is not a sprint, rather it’s a marathon that requires long-term commitment. At the center of this change is community because the commitment is ours to share. There is room for each person in the school community to work for equity and inclusion – from book clubs to policy writing; from recruitment and support of students to search, selection, and faculty development; from teaching antiracism curriculum to highlighting antiracism research. Reflection, coupled with commitment and action will lead to transformational change in nursing education and healthcare systems.
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DN: The judge commented that “What I loved about this book is that the authors made complex leadership and business topics accessible and interesting by sharing leaders’ personal stories… Provides actionable and practical strategies students can use to further their own development… Readable and clear, it is sure to be a favorite among students.”
TR: “I love hearing that, by the way. I’m so grateful for the comment about the book. Because you know, when I went into academia, I committed to never writing a book, because I don’t learn particularly well through reading books. It’s just how my brain is wired.
And two, I’ve never, I have never heard anyone say ‘I love a textbook’ before. One thing that I think is missing from all academia is storytelling. So we said, if we’re going to write this book, we’re going to lean heavily on not just our stories, but the stories of people who’ve succeeded and failed at putting these evidence-based innovation leadership and entrepreneurship tactics in the place. And so it’s great to hear that shine through from the reviewer because that’s exactly what we were trying to do: create a type of textbook that students would enjoy, and they can actually be engaging with the content and be able to put that into practice.”
DN: How does the Innovation Studio connect with your book’s study of nursing leadership, innovation, and entrepreneurship?
TR: “I actually teach in our masters of healthcare innovation program and is fully founded on innovation leadership, which adopts what we like to refer to as the entrepreneurial mindset. So if you are in charge of leading people, and that may be in a small capacity to large capacity formally or informally, but you’re always doing a few things.
One new favorite term that I have is building a culture of ambition. And I mean ambition in a way that you’re striving for excellence. So what we teach our team—and what’s in the book—is teaching people to find out what stories resonate most effectively with their co-workers and teammates in the population they engage in, and have that be the driving force that your team unifies around to make significant and substantial change. So by building this culture of ambition, you’re taking on ownership for your actions, you’re taking on ownership for the things that surround you, and the system that you work in.
And that doesn’t mean that you are saying that your system is perfect. But it’s saying that we are in the system, and we’re going to do the best that we can with it. That’s what we’re trying to get people to recognize. And when you come into that with an entrepreneurial mindset, you think about what resources are available to you, what are your key performance indicators, and how you can maximize those, and you let the things that are noise filter out.
So you focus on what’s important, you develop a ‘yes, and’ culture, you empower people to bring their ideas forward, incentivize them, provide them the permission to be innovative, and validate them when they engage in those behaviors. And you build a structure of innovation that lasts beyond your tenure within the organization.
Those are all things that are built into the textbook. And those are all things that we try to get the people engaged in the innovation studio to buy into because we know that if that happens, eventually we’ll find the success that we’re looking for.”
DN: 2020 was a big year for nurse leaders. They’ve been finding innovative ways to cope with shortages, fight burnout, and manage other pain points, and have made a huge impact.
TR: “And you know what, I’m very hopeful. I’m not one of those leaders right now, but I am very hopeful that through the exercises that you just mentioned, people are taking notes and debriefing and finding out what works well.
Because I do think that the exceptional leadership that’s occurring throughout health systems now needs to be the norm. Those things about celebrating our wins, focusing on what’s important today. ‘What’s important now’ — you know, that’s an acronym for ‘win’. How do we win today? What are we going to focus on?
A big component of leadership is making sure that your team is all aligned on the same goals. And, you know, creating the value that you commit to create so that that’s where innovation and leadership all come together.”
Founded in 2017, The Ohio State University Innovation Studio is run by the OSU College of Nursing and Center for Healthcare Innovation and Wellness. In normal times, the Innovation Studio travels the country, encouraging students to create healthcare solutions, and helping them to use technology to develop their ideas into marketable new products.
How has the pandemic affected the innovation program? DailyNurse spoke to Tim Raderstorf, MSN, RN, the co-founder of the Innovation Studio and Chief Innovation Officer (as well as Clinical Instructor of Practice) at the OSU School of Nursing. Dr. Raderstorf has conducted neurosurgical research on Tethered Spinal Cord Syndrome, but his passion is healthcare innovation.
Before the pandemic, when he wasn’t teaching, Raderstorf traveled the country with OSU’s mobile Innovation Studio. He is also an expert on the role of innovation in nurse leadership and is now an award-winning textbook author. Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare, the textbook Raderstorf co-wrote with OSU School of Nursing Dean Bernadette Melnyk was an American Journal of Nursing (AJN) Book of the Year, winning first place honors in its category. (In Part Two, he discusses the book and explains why he found the judge’s comments particularly gratifying).
DailyNurse: How have things changed for the Studio during the pandemic?
Tim Raderstorf: “We used to do to makerspaces that would travel. And, you know, it acted as this hub of interaction and engagement and excitement. But when COVID hit, people didn’t want those things [the makerspaces] in their lobbies… and we didn’t want 15 people hanging out in the same location. So, we shut down the traveling innovation studio, which was our original one, and [now we] just run our permanent location, which is right in central campus.”
DN: What did you do when the pandemic hit?
TR: “For the first six months of COVID, because we didn’t open our doors until the students came on campus in September, we ran a virtual makerspace. So Josh Wooten, our shop manager, particularly at the beginning, used our laser cutter and CNC router to make PPE, with our College of Engineering and a variety of public-private partnerships, to get our clinicians the safety equipment they needed to be able to save our communities. We wanted to keep Josh as safe as we possibly could, so we set up a makerspace in his house. He had five 3D printers in his home, and he was printing PPE around the clock with mostly faceshield frames, so that we could hook transparencies or plastic to them. It’d be running day and night, doing work for us while we slept.”
DN: Were the students able to participate at all last year?
TR: “Well, in May , we launched a COVID [Campus Safety] challenge, encouraging everyone to submit their ideas to us virtually. And when students came back to campus, we ran a second virtual challenge asking for ideas that would impact their safety on campus. Things like how to improve mask adherence, social distancing, and the mental health of our student population. We also had pitch days in October and December.
In fact, at that December pitch day, one of the nurses on the unit [came by on her] 15-minute break to pitch her idea to us. And she was wearing PPE, and—unknown to her—it was PPE that we had printed for her.”
DN: Has the pandemic been inspiring nurses to innovate?
TR: “I feel that during the pandemic, some of the acclaim and attention and interest has prompted more nurses to raise their voices in terms of public health and policy, but also to innovate and come up with solutions for the various pain points that you’ve encountered during the pandemic. And I think that’s going to build. I’m very bullish on that. I’m big on systems of innovation and building a structure of innovation, to have a proper culture of innovation that thrives.
Dr. Tim Raderstorf demonstrates an innovation exercise at the Academy of Nurse Leaders.
I’d argue there probably still isn’t much structure for nurses, physicians, pharmacists, whoever is at the frontlines to bring their ideas for [innovations] to most organizations. I do think clinicians have never been more willing and engaged in changing the system. The question is, can systems become engaged and willing and set their clinicians up for success so that they can appropriately drive the changes that need to occur? Particularly as we become cash strapped and healthcare is going through a massive transformation.
I think it there’s going to be a very challenging component to the future of healthcare once the pandemic is over. We have to decide what we refuse to go back to and what we will continue to make changes on.”
DN: Who comes to the pitch days? Students? Faculty?
TR: “We’ve had over 1000 people pitch to us over the last three years. It’s about 55 to 60% students and about 40 to 45% faculty and staff, which is a nice healthy mix, and it’s trending much more towards the students. We are seeing an increase in faculty and staff, but the students are increasing at a much faster rate.”
DN: Are nurses pitching ideas?
TR: “You know, one of my least favorite terms is ‘nursing innovation’. Because there’s no such thing as physician innovation, there’s no such thing as dentist innovation, there’s no such thing as pharmacist innovation. So why do we label ourselves other than just being innovators and really showcasing that we are indeed equals with our peers?
We knew that in order to raise the awareness of the amazing things that nurses do, and create and innovate and invent, that we need to do this alongside our peers, and, you know, almost be humble bragging, as we go along, and said, ‘hey, look, what we’ve created, why don’t you come over here and create something great with us too’.”
DN: When you describe the Studio as “interprofessional,” can you elaborate a bit?
TR: “We encourage people to engage with other individuals who have different backgrounds and professional expertise; [in fact] we require it. If you don’t have an interprofessional team, that is one of the things that disqualify you from being eligible for funding. So if two physicians come up with a great idea, we say, ‘awesome, who are you going to use this on’? And they usually say, ‘well, it’d be an operating room or height’. ‘So who preps your trays? Well, that person needs to be on your team, or you need to be getting insights from the people who are going to be interacting with this tool as well.’”
DN: Are the people who pitch to you mainly aspiring entrepreneurs looking to develop a product that they can sell?
TR: “It’s probably about half and half. A lot of people are interested in developing a new business, a new tool, something along those lines. But [we] also see a lot of people interested in policy change and awareness campaigns. Our most successful commercial effort was a method for preventing addicts from injecting drugs into their system through their IVs at the hospital. We really want to be able to help these people while they’re under our care and give them the resources they need to continue to be successful. So this nurse in the team wanted to find a way to stop people from being able to access the lines without us knowing about it and created a tape that would go over IV ports.
And, you know, it’s now on the market. Her idea has gone from something she drew on a napkin to a tool that is now being used worldwide to help patients.
[The entrepreneurial aspect helps spur change because] there’s nothing that’s free in our health system. That makes it really challenging to scale your ideas without going the commercialization route. If you can’t sell it, it’s really hard to have that mass impact. But really, the key goal of innovation studio is to build a culture of innovation at Ohio State. We really believe that the true impact is in getting our students, faculty, and staff together and creating an atmosphere where great things can happen.
That’s a long game, you have to you have to be patient, and you have to be willing to continue to water the seeds until they’re able to until they’re able to sprout.”