The $125 million donation by Leonard A. Lauder, Chairman Emeritus of The Estee Lauder Companies, to create this first-of-its-kind, tuition-free Program is the largest gift ever to an American nursing school. Mr. Lauder is a Penn alumnus. The gift comes at a time when the COVID-19 pandemic has magnified the nation’s acute shortage of primary care providers, and persisting inequities in access to quality healthcare.
“This is the most timely and consequential gift not only for our university but for our country. It is unprecedented in its potential to address America’s most critical need of providing primary health care to all who currently lack it by investing in nurses,” said former Penn President Amy Gutmann.
“Growing the number of nurse practitioners who are prepared and committed to working in underserved areas is the most practical and inspiring way to ensuring a healthier country. I am grateful and honored that Leonard would make this gift to Penn Nursing, and thrilled to know that it will have an immediate impact that will last far into the future.”
Nurse practitioners are leaders on the front lines of care, a role never more important as Americans confront a primary healthcare shortage in their communities. With their advanced clinical training and graduate education, nurse practitioners have the knowledge and skill to supervise and manage critical aspects of care in a decision-making capacity, from patient diagnosis, to ordering and interpreting tests, to prescribing medication. Nurse practitioners deliver high-quality primary care to people of all ages, such as treating common illnesses, managing chronic conditions, and providing preventive care that helps patients stay healthy.
Nurse practitioners are also able to take on key leadership roles, from managing and operating walk-in or community clinics to leading interdisciplinary teams within health systems. The new Program will better the lives of patients and communities most in need, while providing a pathway for the many nurses interested in advanced education who may not otherwise have the means to pursue it.
Structure: Leonard A. Lauder Community Care Nurse Practitioner Fellows will enroll full-time in a two-year, rigorous Primary Care Nurse Practitioner Program at Penn Nursing.
Community Practice: Fellows will complete at least 50 percent of their clinical education at community partner sites in the greater Philadelphia area that provide direct patient care, an invaluable experience that will prepare Fellows to meet the complex needs of patients and families throughout their careers. Every Fellow will be expected to commit to practice or service in an underserved community for two years after graduation.
Recruitment: Penn Nursing will select 10 Fellows to begin classes this fall, growing the program enrollment through 2026 when it will reach its annual target enrollment of 40 Fellows, continuing in perpetuity. By 2027, the program will have enrolled 140 excellent nurse practitioner students. Fellows will need to show a demonstrated commitment to working in underserved neighborhoods, where they are needed most, and to promoting health equity.
Tuition: All participants in the program will enter the workforce free of graduate school debt, receiving student aid to cover their tuition and fees and thereby eliminating any potential financial barriers for nurses and others who wish to enroll. Fellows with greater financial need will also receive stipends to help with living expenses.
Program Leadership: Penn Nursing will name the first endowed Leonard A. Lauder Community Care Nurse Practitioner Professor, who will oversee curriculum innovation, support of community sites, and program implementation.
Penn Community Partnership: Penn Nursing will provide support for select community partner sites to support the clinical education of Fellows while providing professional development and networking opportunities and access to School and University resources.
“Penn Nursing has a long history of advancing science, promoting equity, practice excellence, and preparing leaders. That’s why Mr. Lauder’s gift is so meaningful. The synergy between Penn Nursing and the Program will improve the health of underserved patients and families, by uniquely preparing primary care nurse practitioners, who will work with them in their communities. The sustained investment in the education and careers of primary care nurse practitioners and communities is unprecedented. We are excited by the opportunity to lead this important Program and to extend its impact beyond Penn Nursing,” says Penn Nursing Dean Antonia Villarruel. “We are deeply grateful to Mr. Lauder for recognizing and investing in this critical need, and for partnering with us in this ambitious endeavor.”
NPs are “key” to health care in underserved communities
Stephen P. Fera, Executive Vice President of Independence Blue Cross, which is one of the community partners that will be involved in the new initiative, noted that nurse practitioners are key to improving individual and community care. Said Fera: “Bolstering the nurse practitioner workforce is a means to improve access to care and strengthen the health care safety net provided by health centers. This is a key priority of the Independence Blue Cross Foundation and our partnership with Penn Nursing has been synergistic in efforts to prepare nurses to work in community-based settings. The Program will build and strengthen our individual and collective efforts toward improving the health and well-being of communities.”
“Now more than ever, the country needs greater and more equitable access to quality primary care—and highly-skilled nurse practitioners are the key to making that happen,” said Leonard A. Lauder. “The program will ensure that more Americans receive the essential health care services that everyone deserves, and I’m so pleased to be working with Penn Nursing on this initiative. I look forward to welcoming our first class of future nurse practitioners this fall. I know their expertise will be matched only by their commitment to serving our communities.”
The American Association of Nurse Anesthesiology (AANA) is presenting the Pennsylvania Association of Nurse Anesthetists (PANA) with the Excellence in State Government Relations Advocacy Award at its Mid-Year Assembly in Washington, D.C. this week.
The Excellence in State Government Relations Advocacy Award, established in 2016, is presented annually to a state association based on the quality of its efforts in the state legislative or regulatory arena for the nurse anesthesiology profession. The recipient is chosen by the AANA Government Relations Committee.
In 2021, the PANA successfully lobbied for a law that includes formal title recognition for Certified Registered Nurse Anesthetists (CRNAs) in statute for the first time, clarifies the CRNA relationship with physicians and dentists, and allows for CRNAs to work with podiatrists.
“The pandemic raised awareness of the critical roles that CRNAs play in healthcare settings and how some state policies prevented CRNAs from practicing to the fullest extent of their education and training at precisely the time they were most needed,” PANA President Lew Bennett, DNP, CRNA, said. “We are honored to be recognized by the AANA for our achievements.”
To increase the flexibility of healthcare resources, Pennsylvania Governor Tom Wolf waived physician supervision during the pandemic. PANA used this opportunity to build relationships with legislators to support title recognition legislation.
“The relationships PANA developed with the governor and legislators will benefit CRNAs for years to come,” Bennett said. “Thank you to the many Pennsylvania CRNAs who laid the foundation for this effort, and those who will continue to fight to protect CRNA practice in the future.”
In addition, PANA developed relationships with a coalition of nursing, rural health, and other groups, including Americans for Prosperity, the Pennsylvania Farm Bureau, and the National Guard, all of which validated and reinforced PANA’s message to legislators.
As advanced practice nurses, CRNAs are members of one of the most trusted professions according to Gallup. CRNAs provide anesthesia care across all settings and in all patient populations and are the primary anesthesia providers in rural and underserved areas and on the battlefield in forward surgical teams.
During the COVID-19 pandemic, nurse anesthetists across the country have been essential in addressing the deadliest part of the disease in addition to providing top-of-the-line anesthesia care. They have served as experts in airway management, hemodynamic monitoring, management of patients on ventilators, and overall management of critically ill patients.
As 2021 nears its end and we prepare for pinning and graduation ceremonies, our Nurse of the Week is a classic American story about starting from nothing, working hard (and smart), and refusing to give up the pursuit of your dream.
The student marshal who leads her fellow grads in the procession to commencement represents the best of the student body. Selected on the basis of outstanding academic achievement and contributions to student life, the student marshal is often someone who excels even as they overcome obstacles that can bring many to a crashing halt. At Penn State’s Ross and Carol Nese College of Nursing, the fall 2021 graduation ceremony is being led by Aleksandra Williams, who will soon have the letters “BSN” after her name.
Not long ago, the Schuylkill campus student was a near-penniless, non-English-speaking immigrant from Ukraine. Williams came to the United States by herself when she was only 19 years old with one suitcase and $500. She began working as a housekeeper, building her new life, and learning an entirely foreign language. As she progressed through her life in America, Williams knew she wanted to pursue a new and more meaningful career path.
“My mother is a nurse and used to work long shifts at the children’s hospital in Ukraine. She had been raising me by herself and used to take me to work with her because there was nobody to watch after me,” said Williams. “I saw how my mother took care of the children and I thought of her as my hero.”
After meeting her husband in the U.S. and having a healthy baby boy together, Williams and her husband welcomed their second child. Unfortunately, their second child fell ill, and after many visits with nurses and doctors, recently died.
Her dream of becoming a nurse lived on, though, and she simply could not stop excelling. In 2017, Wiliams received the SEDCO Scholarship for Workplace and Adult Education. A year later—as the Schuylkill Campus student with the highest GPA—she earned the 2018 President’s Freshman Award. Apparently, in 2019 the school temporarily ran out of awards. After they replenished their supply, Williams bounced back in 2020 when she won the Lehigh Valley Hospital-Schuylkill Medical Staff Award to the Class of 2020 Valedictorian. Now, Penn has tapped the young mom to be Student Marshal for their 2021 BSN class.
“Aleksandra is such a bright and caring student; she sets high standards for herself and her peers. She has successfully balanced academic, personal, and professional life while completing her BSN and we are so thrilled that she is exploring graduate program options. I sincerely look forward to watching Aleksandra grow as a nurse and her contributions to our profession.” said Marianne Adam, Penn State Ross and Carol Nese College of Nursing program coordinator and professor at the Penn State Schuylkill and academic advisor to Williams.
Williams will accept her diploma on behalf of the college during the University-wide commencement on Dec. 18, in the Bryce Jordan Center. After the daughter of Ukrainian nurse Tatiana Zhukova receives her BSN, she plans to work toward an MSN and DNP at the Penn State Ross and Carol Nese College of Nursing.
Despite the collection of previous awards and honors, Williams has not become jaded. She was surprised and delighted to be chosen as the college’s 2021 marshal: “I could not believe what I was reading,” the future MSN and DNP claimed. “I had to re-read the email several times. For me to be selected as a student marshal is very important and I am beyond honored.” Congratulations, Aleksandra! It takes a massive amount of work, determination, and discipline to become a model of nursing excellence before you even receive your BSN. No pressure :)!
Jennifer Grubb, our Nurse of the Week, is a military veteran who is now deploying her hard-earned experience to help others as a nurse.
The PA native started her career in 2003 at the age of 20, when she served in Afghanistan at the height of the post-9/11 military action. Grubb was a combat lifesaver and worked security details in a place where saving lives was often impossible, and no one could afford to feel secure. She saw comrades die in attacks, witnessed the wretched collateral damage suffered by civilian adults and children, and picked her way through minefields.
Like so many soldiers, she struggled as her psyche attempted to process things that most people are not meant to process. In an interview with her hometown Pennsylvania newspaper, The Daily Local, she recalled, “I saw so many gruesome sights. I just hated where I was and decided my best route was just to feel nothing… I started writing less, I started calling less, I started eating less.” Finally, after Grubb had lost 80 pounds during her quest to seal off the horror of war, the Army medevacked her back to the US with an honorable discharge. Then, again like so many other soldiers, she found that even 7000 miles somehow failed to provide a safe distance from the war. As she describes it, “you don’t fit in in your own life anymore. I was always looking over my shoulder. The slightest thing made me jump.”
The nightmares were so intense that they seemed to taint her waking hours, so she tried her best to avoid sleeping and numbed the trauma with drugs. Eventually, she slid to one of those make-or-break low points: “I was just going to use drugs until it killed me. I had one moment where I had a glimmer of hope, and I prayed to God to save me. Two hours later, I was pulled over and arrested for possession of crack cocaine.”
Things began to arc upward when the court allowed her to enter a drug program, and Grubb’s new therapist diagnosed her with PTSD. “I wasn’t Jenn anymore; I was PTSD, with all of my symptoms, and allowing it to really consume my entire life.” With the help of her therapist, though, and treatment at her local VA medical center, she says, “I started to smile more. And the nightmares became a little less. And not every social situation I was in made me jump out of my skin. And I just tried to stay sober, just one day at a time.”
In 2015, Grubb’s life asserted itself as being on an upward swing when she was invited to a women’s vet breakfast with then-first lady Michelle Obama and Jill Biden. During the gathering, Obama noted, “So much of your rise had to do with that reaching out and realizing that there are so many folks out there that are ready to just take your hand.” Grubb realized she was in an ideal position to help other vets sidestep the pitfalls of the self-reliant military ethos and the notion that “we can do anything by ourselves, and I don’t need your help.” She adds, “And there’s such a stigma attached to reaching out.”
As the urge to serve and help others is part of her nature, the recovering vet soon sought ways to do that. While PTSD is chronic – Grubb will always do her best to avoid crowds and can only tolerate sitting in an auto passenger seat if her trusted husband is driving – the treatment allowed her to acclimate. “PTSD is not hopeless,” she says. “There are ways to make it a part of you rather than have it define you.” Once she felt that her demons were tightly reined in, Grubb became an LPN, then a director of patient services at an SUD treatment facility. When the latter’s lack of resources had her teetering on the edge of burnout, she then found a position at the VA center where she first received help herself, the Coatesville VA Medical Center.
Now, the LPN, Almost-BSN is caring for fellow vets and helping them navigate their own trauma ordeals. The military connection is powerful. “These guys and these gals, they’re my brothers; they’re my sisters. There’s a closeness and a bond even with strangers that I can’t really explain to the rest of the population. There’s a level of trust that comes with it.” Deciding that she had a calling to pursue, Grubb earned a BA in Psychology, then entered Immaculata College’s accelerated BSN program, where she will graduate in 2022.
Becoming a nurse came naturally to Grubb. She was moved by the nurses who cared for her when her daughter was born, and realized, “When I left the service, I missed being in service to people.” Today, she’s finishing her BSN program and working as a communications specialist at the Coatesville VA, where “I’m good at my job because of the personal connection I have to it. With the veteran population, they want other veterans to be their caregivers. They want people who really get it.”
For more details about Jennifer Grubb, see the excellent Daily Local article here.
But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.
We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.
Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.
History of the Opioid Epidemic
Opioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups.
From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.
The state’s stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.
In the following months, the public’s overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people’s use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)
Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.
We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic.
When a Pandemic and an Epidemic Collide
While we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020.
Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.
From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.
People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. “They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can’t like go to meetings, and they can’t make those connections.” (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)
An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, “It’s not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit.”
Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic “just spun everything out of control,” they said. “Overdoses up, everything up, everything.”
One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatmentfor some, it has raised challenges for populations like the rural and elderly. As one provider explained, “it’s really hard for that [rural] population out there” to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.
The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.
In Florida, people under 50 with underlying health conditions can get vaccinated only if they have written permission from their doctor.
In Mississippi, more than 30,000 covid vaccine appointments were open Friday — days after the state became the first in the contiguous United States to make the shots available to all adults.
In California — along with about 30 other states — people are eligible only if they are 65 or older or have certain health conditions or work in high-risk jobs.
How does any of this make sense?
“There is no logical rationale for the system we have,” said Graham Allison, a professor of government at Harvard University. “We have a crazy quilt system.”
Jody Gan, a professional lecturer in the health studies department at American University in Washington, D.C., said the lack of a national eligibility system reflects how each state also makes its own rules on public health. “This hasn’t been a great system for keeping, you know, the virus contained,” she said.
The federal government bought hundreds of millions of doses of covid vaccines from Pfizer, Moderna and Johnson & Johnson — as well as other vaccines still being tested — but it left distribution largely up to the states. Some states let local communities decide when to move to wider phases of eligibility.
When the first vaccines were cleared for emergency use in December, nearly all states followed guidance from the federal government’s Centers for Disease Control and Prevention and restricted use to front-line health workers and nursing home staffs and residents.
But since then states have gone their own way. Some states have prioritized people age 75 and older, while others have also allowed people who held certain jobs that put them at risk of being infected or had health conditions that put them at risk to be included with seniors for eligibility. Even then, categories of jobs and medical conditions have varied across the country.
As the supply of vaccines ramped up over the past month, states expanded eligibility criteria. President Joe Biden promised that by May 1 all adults will be eligible for vaccines and at least a dozen states say they will beat that date or, as in the case of Mississippi and Alaska, already have.
But the different rules among states — and sometimes varying rules even within states — created a mishmash. This has unleashed “vaccine jealousy” as people see friends and family in other states qualify ahead of them even if they are the same age or have the same occupation. And it has raised concerns that decisions on who is eligible are being made based on politics rather than public health.
The hodgepodge mirrors states’ response overall to the pandemic, including wide disparities on mask mandates and restrictions for indoor gatherings.
“It’s caused a lot of confusion, and the last thing we want is confusion,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania.
As a result, some Americans frantically search online every day for an open vaccine appointment, while vaccines in other states go wanting.
The assorted policies have also prompted thousands of people to drive across state lines — sometimes multiple state lines — for an open vaccine appointment. Some states have set up residency requirements, although enforcement has been uneven and those seeking vaccines are often on the honor system.
Todd Jones, an assistant professor of economics at Mississippi State University near Starkville, said the confusion signals a need for a change in how the government handles the vaccine. “The Biden administration should definitely be thinking about how it might want to change state allocations based on demand,” Jones said. “If it does become clear that some states are actually not using lots of their doses, then I think it would make sense to take some appointments from these states to give to other states that have higher demand.”
Jagdish Khubchandani, a professor of public health at New Mexico State University, said no one should be surprised to see 50 different eligibility systems because states opposed a uniform federal eligibility system.
“Many governors don’t want to be seen as someone who listens to the federal government or the CDC for guidance,” he said. Florida Gov. Ron DeSantis, a Republican, has boasted of ignoring the CDC advice when he opted to make anyone 65 and older eligible beginning in December.
“There is a lot of political posturing in deciding eligibility,” Khubchandani said.
To be sure, governors also wanted the flexibility to respond to particular needs in their states, such as rushing vaccines to agricultural workers or those in large food-manufacturing plants.
Jones said the decision to open vaccines to all adults in the state may sound good, but Mississippi has one of the nation’s lowest vaccination rates. Part of that is attributed to hesitancy among some minority communities and conservatives. “It’s good news everybody can get it, but there doesn’t seem to be a whole lot of demand for it.”
Jones, 34, was able to go online for a shot on Tuesday and was vaccinated at a large church a short drive from his home on Thursday morning. “I was very happy,” he said.
Published courtesy ofKHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.