Nursing on the Front Lines: ANA President Dr. Ernest Grant on Protecting Nation’s 4.3 Million Nurses

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of the future.

This week Mark and Margaret speak with Dr. Ernest Grant, President
of the American Nurses Association, the largest organization
representing the nation's 4 million nurses and the patients they serve.
The ANA has been advocating for a safer work environment for nurses
who borne the brunt of the pandemic across the care delivery system.
ANA has been tracking the impact of the pandemic on nurses ’ physical
and psychological well - being seeking ways to mitigate the harm of
experiencing so much trauma and sufferin g in their work
environment.

Lori Robertson also checks in, the Managing Editor of F act C heck.org
and looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
that's improving heal th and well - being in everyday lives. If you have
comments, e - mail us at [email protected] or find us on Facebook ,
Twitter , or wherever you listen to podcast s . Now, stay tuned for our
interview with Dr. Ernest Grant here on Conversations on Health Care.

Mark Masselli: We're speaking today with Dr. Ernest Grant, President of the
American Nurses Association, the largest organization representing
the nation's 4 million registered nurses and the patients they serve.
He i s a recipient of the Nurse of the Year award under former
President George W. Bush for his efforts treating burn victims after
the World Trade Center disaster.

Margaret Flinter: Dr. Grant is a past chair of the National Fire Protection Association
Board of Directors and in 2002 the American Nurses Association
issued Dr. Grant the H onorary Nursing Practice Award for his
contributions to advancing nursing practice. Dr. Grant, it's a pleasure
to welcome you to Conversations on Health Care today.

Dr. Ernest Gra nt: Thank you for having me. I'm absolutely delighted to be here.

Mark Masselli: You know , Dr. Grant, I think these terrible numbers continue to grow.
2.5 million people have died around the world over 500,000 here in
the United States . T he nation nurses t hey've been really warriors in
this crisis , a nd too many from their ranks have been counted in those
casualties. I wonder if you could just paint a picture for our listeners
to help us truly understand the sacrifices that have been made by the
nursing prof essions as this pandemic continues to roll over this
country.

Dr. Ernest Grant: I would say that it's coming up on a year since COVID has came to our
shores , and d uring that time, a lot has been asked of nurses . F irst of

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all, to go and provide care for pat ients for a disease that we knew
little about so they had to quickly ramp up some education as to how
do I take care of someone who has caught COVID? How do I protect
myself and my family from doing that , and also my colleagues as well ?
W e know that we saw the numbers going up and up and up. While
more and more demands were made of nurses , working overtime
instead of working 12 hour shifts, sometimes they're working 16 and 8
hour shifts, dealing with patients in all sorts of settings in long term
care. O f c ourse, that's taken its toll on the nurses as well both from a
mental perspective as well as physical also. In some cases, they're
only getting perhaps one day a week off. W e know that when you
yourself are not up to par, it's very difficult for you to pro vide optimal
care that patients are going to need as well. T hey're going have to
take care of themselves before they can take care of the patients that
have been involved.

Margaret Flinter: Well, Dr. Grant I know the American Nurses Association is keeping a
very close watch on this, both on the pandemic and the physical and
psychological impact it's having on our country's nurses . You have
survey ed the Pulse on the Nation's Nurses survey and a majority of
nurses ’ survey s are saying exhausted, overwhelmed, d epressed, sad
from their work experience , while of course at the same time we
know that they are also feeling how important their work is. But what
are they revealing about the true impact on the profession from
COVID - 19 and perhaps equally importantly, wh at does this tell us we
need to be preparing for as we go into year two, year three, what is
going to be the impact on our country of this ?

Dr. Ernest Grant: T he American Nurses Association, we do these poll surveys, if you will ,
about every other month , a nd there ’s two central questions that
we're always asking. The first one is around PP Es, and the other one is
about the nurses themselves , h ow are they doing and what is
happening within their lives. As a result of that, yes, it has shown as
this crisis ha s c ontinue d to bore out more and more extreme fatigue,
nurses who are recording that, just essentially signs and symptoms of
post traumatic stress . They can't sleep, they can't eat, and even
though we're making available for them access to receive the
psyc hological or mental health care that they need, nurses are
resilient, but it's difficult, I guess, in a way for them to perhaps either
recognize or to accept tha t they need that mental health.

Other thing s that these surveys are showing as well is that COV ID is
affecting them financially . You may recall that a number of health care
facilities around the country either laid off or furloughed nurses, so
that was a huge impact because you still have to meet the mortgage,
you still have to make the car payment, or the student loan payments
and etc. That's, of course, what the se surveys have shown is that , one,
we were unprepared not only for this pandemic but for the next

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pandemic. I will say that the next pandemic is right around the corner,
given how very clos ely we can do global travel today. Look at the
amount of time it took for COVID to come to our shores and the time
that we learned about it. W e need to not only plan for today, but plan
for tomorrow as well.

It’s g oing to affect how healthcare is practice d . We're seeing now,
how we're using and relying on telehealth and telemedicine . That has
been great for our advanced practice nurses because it allows for
people who still have chronic illnesses to still be seen and have those
illnesses manage d as opposed to sometimes missing those
appointments. I think the role of the advanced practice nurses and
nurse in general is going to be changed. Hopefully , we know that we
have 23 states, where advanced practice nurses already have full
practice authority . We're hop ing that this will shed light on the need
for the other states that do not have that for that to come through
fruition , b ecause we've proven during this emergency that if we can
do this during an emergency we can certainly do it during more when
times retu rn to “ normal ” . But definitely, it is going to change how
healthcare is practice d and also how the role of nursing is also going
to be changing to help meet those needs also .

Mark Masselli: But I think the good news is vaccine is now available, right? W e n ow
have our third that was approved. But there's also quite a bit of
hesitancy in the general public. When you present it to the CDC COVID
vaccine forum and you really reveal that about a third of the nursing
profession has expressed some resistance or hes itancy about the
vaccine. I'm wondering if you could just walk us through that about
the challenges of vaccine hesitancy and what the ANA is seeking to do
about it . Ho w do we really just empower nurses to be really force
multipliers in their own community and be front and center on that
whole process?

Dr. Ernest Grant: Thank you. Well, one of the first things that I think we have to -- I like
to think of them as , perhaps not necessarily being hesitant , but more
or less being slow yessers is the term I want to use, because I find out
that, yes, they recognize that I need to take the vaccine and etc. but
maybe they want to wait and see how their colleagues who have
taken it, how it's going to affect them. Also, when they see that their
colleagues has taken the injection and nothing has happened to them
then that may be the point for them to say, okay my best friend John
took it so I'm going to take it b ecause nothing happened to him.

I also think that what the American Nurses Association in conjunction
with the Ad Council is doing to get their information from a trusted
source, which is extremely important on press from someone like
myself, I participated in the Moderna vaccine trial, so I can from
firsthand tell them about my experience and what it was like for me,

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and that would go a very long way in convincing someone to do that
also. But again, I also have to remember that in some cases there may
be nurses who , because of prior health , they may have had reactions
to vaccines before or that could determine as far as -- or one of the
reasons why they are hesitant or perhaps are not taking the vaccine,
but answering the question that they may have will go a very, very
long way in getting them to move from vaccine hesitancy to vaccine
competency and then subsequen tly on to getting the vaccines.

Margaret Flinter: Well, I like to maybe pull a thread and go back a little bit to those
surveys that we talked about earlier in the experience of nurses and I
think I am talking mostly about acute care, maybe lo ng term care
settings with this. This is the issue of nursing being represented at the
highest levels of decision making and authority in our healthcare
institutions. I see tremendous progress over the years, the advent of
the magnet designations for hospitals and so m any wonderful
colleagues who are now CEOs or in other executive suite positions
within hospitals.

But your surveys, I think, pointed out that there was still a fair degree
of skepticism among nurses about whether leadership, whoever was
sitting in those se ats, had really protected them during the pandemic .
I'd be really interested to hear what is ANA advocating for to continue
to advance as much as you can of prominent role for nursing in the
leadership authority decision making structure within healthcare
institutions . I know that's a focus of the association so tell us a little
bit about that .

Dr. Ernest Grant: Well, y ou're very right about the need for nurses to be at the table
and to be helping with those decisions that are being made. From that
perspect ive, that is some of the things that ANA is advocating, not
only in the healthcare setting but also up at the higher levels, at the
government level, the state level and also the national level having
nurses there because who knows the community who knows people
better than nurses . We're the most trusted profession , have been for
the 19 consecutive year s in a row and chosen that so that's a high
honor to have. It also means that you carry a lot of power. And so by
being at the table, where those decisions a re being made, you can
obviously exert that power .

Now what chief nursing officers can do for the staff nurses or nurses
that may be in long term care or in public health and etc, what we a re
finding, or what I'm hearing from nurses is they want transparen cy .
They understand that there's a lot of decisions that are being made
and , of course , sometimes that's not trickling down to them . I f they
know that, hey, we're trying to get the PP Es that you need but we're
running into a brick wall here or we're trying to get some additional
help but we're running into a brick wall here, you get more of a buy in

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from that nurse who is at the bedside by having like a town hall or
something like that, just to be transparent to let them know, these
are the things we're wor king on , t hese are the roadblocks, if you will,
that we're hitting, and who knows, perhaps they may have an answer
for the chief nursing officers or other people who are in the decision
making arena that perhaps they haven't thought about, because
they're viewing their institution as part of the family . When one part
of the family is hurt or is ailing or whatever, you want everyone to
come to the rescue , a nd that's what I'm hearing from nurses that I
speak with, is that, yes, we understand that our institut ion is meeting
a lot of challenges, what can we do to help them with that, and
maybe share in some ideas that perhaps they haven't thought about .

One hand washes the other, because as long as I know that my chief
nursing officer is advocating for me then I 'm going to do my best to
continue to ensure that the care that I give to the patients that are
entrusted to me, is going to be optimal care as well. W e're in this
together . We have to work together and hopefully they will see that
and begin to move from t hat particular perspective.

Mark Masselli: We're speaking today with Dr. Ernest Grant , President of the
American Nurses Association, the largest organization representing
the interests of the nation's 4 million registered nurses and the
patients they serve . You know, one of your mantras is tha t Healthy
Nurse, Healthy Nation.

You're dedicated to reducing the likelihood of physical harm to
nurses, which they face every day, hard to serve balance that with at
the same time for the last 19 years they've been re cognized as the
most trusted profession . But you have a very important serious
campaign underway #EndNurseAbuse . I'm wondering if you could
give just some examples of what sort of the likelihood of nurses
suffering injury or harm is and where does it rank amongst other
professions and how is the ANA seeking to mitigate these problems
and to protect nurses who were doing such im portant work on the
frontlines.

Dr. Ernest Grant: Well, thank you for mentioning about the Healthy Nurse, Healthy
Nation Campaign . It is definitely one of our h allmark campaigns , and
that we want to -- the whole idea behind that particular campaign is
to improve the health of America by starting with the nation's 4.3
million registered nurses. H ow do you do that? Well, one, you arm
th em with the information and stuff that they need in order to make
their lives a little bit better. One of the campaigns of that, as you
mentioned, is to end nurse abuse . W hat do you do when nurses are,
they may go into a room, they may be assaulted by a pa tient, they
may be assaulted by a colleague, not only another nurse but perhaps
a physician colleague or whatever, that needs to come to an end .

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W ith this campaign what you're doing is we are arming nurses with
the resources that they need in order to brin g about a culture of
change that we're not going to tolerate this anymore and that there's
a system in place to address such issues.

I f it is a patient related nurse abuse environment then that is handled
in one particular way. If it is a fellow healthcare colleague, then that is
handled in a different way as well, because you want just culture, you
also want a zero tolerance policy , s o that means that if someone
violates that policy the institution needs to set that as an example so
that others will see th at this will not be tolerated. Those are some of
the examples of what is listed with that campaign.

But again there are other resources that the nurse can use, either
within the institution or outside of the institution, like some of the
regulatory agencie s and etc . that they may be able to access as well if
they feel that they're not getting the support that they need from
their employer.

Margaret Flinter: Well, that is an incredibly serious concern, and one that we don't care
enough about that , s o thank y ou for addressing that. I'm going to take
us back maybe out of the acute care setting and into the communities
around the United States for a moment, as we think about the now
and we think about the future.

Never in my lifetime have nurses been so called u pon for a single
unifying public health goal, which is to get this vaccine to everybody ,
right, in the country. We are very engaged in that and in our own
state certainly RNs, LPNs, nursing students with their faculty
members, retired nurses, Red Cross n ur ses , nurses of all kinds, and
people are responding to that.

I wonder what you see as you look forward strategically with the
association this moment when we started in March with New Yorkers
banging on their pots and pans to appreciate the work of nurses, to
this moment when nursing across the country along with the other
health professions are responding and stepping up in the cities and in
the country to get vaccines to people. What's the seizing of this
opportunity around support for n ursing at the nati onal level thinking
about our needs in the future which are going to be enormous as
people retire and the population ages . D o you have a grand strategy
you'd like to share with us about what you would like to see all of this
goodwill coalesce into for the very real support that we need for the
nursing profession in the years ahead of us?

Dr. Ernest Grant: Yes, I would -- what I foresee is that , one , that nurses continue to
maintain the public perception as the most trusted profession and
maybe kick it up a notch or two, if you will , b ut also that this puts
nursing in a place where we can be involved more at the table where

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decisions are being made. We're seeing now that sort of a response,
like what we saw after 9 / 11, when there was a rush for people to join
the military, because they wanted to act . W e're now beginning to
hear from the deans and directors of various nursing programs that
their waiting lists are getting longer and longer because people are
seeing what nurses have gone through and they want to be there to
help alleviate when the next pandemic comes around and be a part of
a true and t rusted profession.

I think also, one of the other things that will be most beneficial is that
and hopefully our members of Congress and etc will be able to
appropri ate more fun ds for nursing programs and the other resources
that we need, not only in the healthcare setting but towards nursing
education as well . We only have so many nursing schools, so many
nursing faculties, so many clinical facilities where you can g et that
training. P erhaps maybe look at some alternative sources that will be
able to meet the rising need, because the average age of the nurse at
the bedside right now is it's pretty much close to pushing 60 years of
age. T hat means that we're going to s ee a significant amount of baby
boomers beginning to retire. W e already have a nursing shortage,
we've got to be able to fill not only for the shortage that is existing
now but also as those baby boomers begin to retire fill that shortage
as well.

H opefull y , yeah, I'm really proud of the job that nurses have done. It's
from the perspective of being in this together . We have risen to the
challenge but I'm hoping that those who are wanting to become
nurses will be able to have that opportunity to have the enj oyment of
being a nurse as well.

Mark Masselli: In addition to those workforce challenge, I think we're at this moment
of inflection in whole healthcare system, delivery system itself, how
its organized, technology that we get to use, and frontline nursing
professionals are developing real world solutions to everyday
problems and in care delivery . Of course there's enormous, as I said, a
lot of innovation going on in many areas of the care delivery model.
Obviously, telehealth has grown exponentially during this entire crisis.
Testing is going on. The vaccine development has been just really just
remarkable, right . I mean, who would have thought we would have
truncated a process of developing a vaccine by multiple years.

Again, as you said earlier, when we s tarted off, this has been
happening over a longer period of time, right . This is not new but it is
being applied in a new way. T he ANA has an innovation and
development branch, which is seeking to promote nurse led
innovations across the profession and acr oss the whole health
industry. I'm wondering if you could talk about your efforts that are
underway at the ANA about promoting innovation, and how that will

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enhance not only the nursing environment but patient experience as
well.

Dr. Ernest Grant: Well, nu rses are historically known to be innovators and to develop
these little workarounds, if you will, and problem solvers. So it's only
natural that the Innovations and Technology Division of ANA would
expand upon that. One of the things that it does is it en courages
nurses entrepreneurial ship , if you will. Whenever nurses have ideas,
we actually , at our annual meeting, we have what we call nurse pitch,
which is somewhat like Shark Tank, where we invite people from the
industry as well as nurses who think that they may have an idea that
either they've already fully developed it or it needs to go, perhaps get
a little bit more development . They pitch it towards the members of
the industry, and hopefully, it's a way for them to collaborate , a nd
who knows who may have a product that is coming onto the market
that will not only make nursing easier or make their job a little bit
easier but it also helps to improve the patient care experience as well.
Thus, allowing the nurse to spend more time with the patients inste ad
of perhaps a lot of time punching numbers into a machine or
whatever else. All that can be taken care of. But it does allow for
more one - on - one patient care time.

W e're really excited about the o ffice of innovation and technology
and there ’s been some r eally wonderful and powerful ideas that have
come forth out of that. Again, it just taps into the resources that I
stated earlier of nurses being very innovative and thinking of better
ways to either improve a product or to work around a particular
product if there happens to be a problem that they have
encountered.

Mark Masselli: Are you all weighing in on the Biden stimulus proposal?

Dr. Ernest Grant: Yes, we are, and of course we're working closely with the
administration, particularly as it comes to wit h the COVID Task Force,
making sure that the supply chain is still being maintained . A lso we're
very happy that President Biden implemented the Defense Production
Act so that we can begin to get more and more supplies as opposed to
relying on either, we've seen a number of counterfeit products come
through which is not good obviously. Also, a lot of facilities are tying
up literally millions of dollars for products that they think that they're
purchasing and then it turns out they either do not meet our
sta ndards , s o that's a huge amount of money that is lost as a result of
that as well.

We are continuing to work with the administration, particularly the
COVID Task Force, to ensure that nurses are getting the supplies and
equipment that they need, in order t o do the job that is still even
though we're seeing the numbers come down and etc, there are still
patients that still need to have the care that they need.

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Margaret Flinter: It's a very different world for those still inside the ICU s that are full of
COVI D patients and the rest of us who can celebrate some of this
good news , s o thank you so much for f lagging that.

We've been speaking today with Dr. Ernest Grant , President of the
American Nurses Association, which is the nation's largest
organization repres enting the interest of 4.3 million registered nurses
and the patients they serve. You can learn more about their work by
going to www.nursingworld.org or follow them on Twitter
@ANANursingWorld.

Dr. Grant, we wa nt to thank you for your career long dedication to the
practice of nursing and to the profession of nursing, and for
protecting and advocating for the health and well being and safety of
nurses and the patients and the communities they serve all the time,
but especially during this pandemic. T hank you for joining us today on
Conversations on Health Care .

Dr. Ernest Grant: Thank you very much for having me.

[ Music ]

Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know wh en it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US p olitics. Lori,
what have you got for us this week?

Lori Robertson: We've seen plenty of misinformation about COVID - 19 circulating on
social media. One example, headlines on videos and unreliable
websites have distorted the facts about a recent order by the Centers
for Disease Control and Prevention that mandates face masks be
worn on public transportation. The order doesn't require that
individuals wear two masks as the social media posts claim.

CDC guidance issued with the order does say that cloth masks should
be made of at least two layers as the agency has long recommended.
Some independent experts are now advising that wearing two masks
such as a cloth mask paired with a surgical mask in some situations
could provide greater benefit when it comes to controlling the spread
of the novel Coronavirus. T he CDC has posted the results of a lab
experiment that found a cloth mask worn over a medical procedure
mask can significantly improve the fit and effectiveness of the masks.

The CDC ’s website suggests that form of do uble masking is one
modification for better protection. But the federal agency has not
issued a demand that the public wear two masks as the social media
st
posts claim. The CDC order which went into effect February 1 only
says that those using public trans portation must wear a mask which

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the order defines as “ a material covering the nose and mouth of the
wear er excluding face shields ” . It's worth noting that while the text of
the CDC order says it reserves the right to enforce the order through
criminal pen alties. It said it doesn't intend to rely on such penalties
and instead anticipates voluntary compliance. That's my fact check for
this week. I'm Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accu racy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked e - mail us at www.chcradio.com , we' ll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. While the
world grapples with a global pandemic, public health experts have
been simultaneously battling another ongoing health threat.
Mosquitoes are considered one of the deadliest animals on earth,
leading to hundreds of millions of illnesses and some 2.7 million
deaths per year globally. D iseases such as malaria, dengue fever , and
Zika are on the rise.

Dr. Scott O’Neill: There is one mosquito called Aedes Aegypti that transmits a range of
different viruses to people. They include viruses like yellow fever,
dengue fever, Chikungunya , Zika, and the consequences can be very
dire from a loss of life through to crippling social and economic cost.

Margaret Flinter: Dr. Scott O'Neill is the director of the World Mosquito Program , which
has developed an innovative appr oac h to eradicating the threat.

Dr. Scott O’Neill: I was particularly interested in this bacterium called Wolbachia. This
bacteri um is present in up to 50% of insects naturally, but not this one
mosquito t hat transmits all these viruses. When we put the bacte rium
into the mosquito the viruses couldn't grow any longer in the
mosquito. W e're seeding populations of mosquitoes with our own
mosquitoes that contain Wolbachia . We are able to spread the
mosquitoes across very large areas very quickly. Once the mosquit oes
have it , they're protected from being able to transmit viruses. When
they're protected, th e humans are protected as well.

Margaret Flinter: Dr. O'Neill's team released the genetically modified mosquitoes into a
targeted area and the results showed a dr amati c reduction in human
infections.

Dr. Scott O’Neill: In Northern Australia we deployed the Wolbachia over quite large
areas, entire cities, and we've seen ess entially a complete elimination,
96% reduction in dengue in those cities. We believe if we can scale

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this intervention across entire cities, we can completely prevent the
transmission of diseases like dengue, C hikungunya, and Zika.

Margaret Flinter: The World Mosquito Program is one of the six finalists in the
MacArthur Foundation's 100&Change comp etition, which awards a
$100 million grant to innovative public health intervention s.

Dr. Scott O’Neill: We're hoping that over the next five years, we could bring this
technology to protect 75 to even 100 million people. We would hope
that within 10 years we could bring this intervention to 500 million
people .

Margaret Flinter: The Wo rld Mosquito Program, an effective targeted genetic
engineering approach to eradicating the threat of deadly mosquito
borne pathogens, leading to a dramatic reduction in harm to public
health , now that's a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

[Music]

Female : Conversations on Healt h Care is recorded at WESU at Wesleyan
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