Dr. Beverly Malone, CEO of the National League for Nursing

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Mark Masselli : This is Conversation on Health Care . I am Mark Masselli.

Margaret Flinter : And I am Margaret Flinter.

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Mark Masselli : Well, Margret we are celebrating a 50 anniversary this year.

Margaret Flinter : That's right Mark, it has been 50 years since the surgeon general’s
first report on the harm of cigarette smoking and its direct link to lung cancer was
revealed.

Mark Masselli : Well, the surgeon general’s report ed back in 1964 ultimately led to
sharp drop in the number of people smoking. It ’s still the leading cause of
preventable deaths in this country, just under a half of the million people a year die
from the smoking related illnesses.

Margaret Flinter : And it is interesting to know Mark that the numbers have declin ed
more in recent years , thanks to the smoking bans now in place in most public
spaces. You know these public health policies and social marketing impact really
has an impact on the health and well being of a populati on, New York City just
celebrated 10 ye ars of a public smoking ban a nd noted that and estimated 10,000
lives have been saved in that city alone as a result.

Mark Masselli : New York City has certainly been a trail blazer as well as other states
across the country have increased the taxes on cigarettes smoking think that maybe
one of the reasons there's been a dramatic decline in the recent years the number of
young to midd le aged to adults have been diagnosed with one cancer as well as the
bans on smoking. These are certainly preventative interventions that worked.

Margaret Flinter : And we need all the good work we can get b ecause we still have
opposition, hard to believ e but the tobacco industry is still working on it's been
business which is a profit business. A recent study showed that cigarettes been
manufacture today are actually made with more addictive levels of nicotine in them
than in years past. As the Institu te of Medicine, Dr. Harvey Fineberg recently told us
greed is definitely one of the seven deadly sins when it comes to negative impacts
on health.

Mark Masselli : That it is indeed, Margaret. And also we’re commemorating another
anniversary as we do this time in January every year that is the life and work of Dr.
Martin Luther King who once said that of all the forms of inequality, injustice and
health care is the most shocking and inhumane. And those words unfortunately still
ring true today.

Margaret Flinter : And that is something that our guest today is quite expert quite
with, Dr. Beverly Malone is on the Advisory Board of the Office of the Minority Health
at the Department of Health and Human Services. And she will talk about their goal
of ending ethnic and rational health disparities in this country.

Mark Masselli : She is also the CEO with the National League for Nursing. She will
talk about the change in landscape and the nursing profession how educational
adjustments need to be facilitated by enhancing nurse’s education in this country to
meet the growing demands.

Margaret Flinter : Lori Robertson the Managing Editor of FactCheck .org looks into
misstatements spoken about health policy in the public domain.

Mark Masselli : But no matter what t he topic you can hear all or our shows by going
to CHCRadio .com and as always if you have comments please email us at
CHCRadio .com, find us no Facebook or Twitter because we ’d love hearing from you.

Margaret Flinter : And we will get to our interview with Dr. Beverly Malone in just a
moment.

Mark Masselli : But first here's our producer Marianne O’Hare with this week’s
Headline News .

Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines . 2014
and earnings potential hospital groups are cautiously optimistic at the recent JP
Morgan Health Care Conference, representatives from a number of hospital
organizations were looking at continue trends from recent years in - patient volume
down but ou t - patients visits are up. There are signs that the outpatient volume will
continue, ambulatory facility’s growth is in the forecast for many parts of the country
in the coming year and beyond. The trend being is more jobs for physicians and
other practit ioners to fill those spaces. Now, to the Medicaid expansion, well
business is on the insurance exchanges languished in the early days , b usiness has
been b risk in thos e states that expanded Medicaid who are broader sw ath of their
income populations, recent analysis says that the millions of additional Americans
qualifying for medicate expansion had been previously uninsured and often deny
care or avoided care they knew they couldn’t afford where as the bulk of the two
million plus who have signed up for the insurance coverage on the exchanges had
some kind of coverage before signing up on those exchanges. And what about
those cancel led policies that didn't need minimum requirements for the Affordable
Care Act although ( 4:21 Inaudible) corporation study looke d at those folks being
allowed to keep of their substandard plans. And said it won't have a significant
impact on the overall sign up numbers under the Affordable Care Act. Many opted
for more comprehensive exchange plans that offer ed more coverage and a lso attack
subsidy on the backend in many cases. And concussions in kids, study showed
some 56 out of 350 girls in a recent survey had some form of head injury playing
middle school aged soccer. It's an under reported or treated sector of the youth
athle te population. Many of those girls continued to play even after their head injury
and the presence of symptoms of concussions. I’m Marianne O Hare, with this
Health Care headlines

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Mark Masselli: We are speaking with Dr. Beverly Malone, Chief Executive Officer of
the National League for Nursing, a membership organization for nurse faculty and
leaders in nursing education. Dr. Malone was recently appointed to the advisory

committee i n the Office of Minority Health at the Department of Health an d Human
Services which is dedicated to improving the health status of the ethnic minorities
and eliminating health disparities in this country. Dr. Malone also served as Deputy
Assistant Secretary of Health at the Department of Health and Human Services
u nder President Bill Clinton. Dr. Malone has served as President of the American
Nurses Association as well as General Secretary of the Royal College of Nursing in
the United Kingdom and serv e s on the board of Trusties at the Kaiser Family
Foundation, Dr. Malone wel come to Conversations on Health Care .

Dr. Beverly Malone: Thank you so much and happy Martin Luther King Day .

Mark Masselli: Absolutely.

Dr. Beverly Malone: His birthday, yeah.

Mark Masselli: Yeah, thank so much. And Beverly it is that time of year where we
really honour the Legacy of Dr. King whose quest for a (inaudible 6:05) touched on
the need to correct for lack of access to health care for all and you we re r ecently
appointed to the Advisory Board of the Office of Minorit y Health at the (inaudible
6:16) Tell us about the mission and work under way at the office to eradicate racial
health disparities and how are we doing in that fun and how do you see the
Affordable Care Act a s having a n i mpact on the needs of all people?

Dr. Beverly Malone: Well, when we talk ab out diversity and inclusiveness, we
spread it out in terms of not just racial and ethnic diversity but all types of diversity so
that’s the bigger picture but I will focus in on the representation and that we are s till
struggl ing, all the profession s are still struggling but that no one ’s go t it right that the
people who are providing the service look like the people who are recei ving the
service to some degree. For nursing in particular that’s the one that I’ve gi ven the
majority of my time to o and when we are compare d to the other disciplines we look
fairly de cent but, the truth is we are still not there . We still don’t have enough nurses
representing those patient s who are receiving the care 13%, 14 % of the population
who are t he work force is about African American in terms of nursing but that’s still a
big leap in terms of how services are provide d because the burden of illness is
frequently on the underserved and the poor and so that means that th e people who
are most di r e in terms of needs of services, there are people frequently from ethnic
and racial background.

Margaret Flinter: So, Dr. Malone, this is in area that has gotten so much focus and
attention deservedly so within the nursing profes sion both on developing com munity
based health initiatives, maybe you could speak a little bit to some of these
community based health initiatives from your perspective that you think have the
most promise.

Dr. Beverly Malone: I think that my colleague D r. Mary Naylor from the University of
Pennsylvania, is doing a l ot of creative work around that, she will trail blazer in terms
of understanding that the transition is the issue and that transition s into the
community but most people want to be in their ho me, they don’t want to be in health
care facilities, they don’t want to be in hospital, hospital should be just a past, Mary
has been doing a lot of work around that how nurses work effectively to make those

transition and when there is not enough physicia n s out there who are providing
primary car e services that nurses are the re to make sure that the needs of the
patient are met . But we need more advance d practice nurses to do that and so there
is whole piece surround it tied to having enough providers and getting the kind of
funding from congress to make sure that those provider s are prepare, nurses tend to
stay in the community where they have come from. They feel really prepare d
nurses, they will not move away from their environment. I think probably because
we are women to some degree and our families and our roots are the re and so we
tend to stay.

Margaret Flinter: Well let’s dive a little deeper into the framing up of the challenges
that nursing faces in this sort of so many pressure s are being br ought to bear on the
nursing profession so where do you see the biggest challenges lying ahead and
what kinds of new collaborations are being called out for to meet those growing
demands?

Dr. Beverly Malone: You know the nice thing is I'm a baby boomer m yself and so I
know that you are a different breed from the previous generation and that we are
going to be more demanding and expect more. We are going to want to be in our
familiar settings and we are going to be healthier and it's going to take us long er to
get ill so the challenge is the care of the older adult. How are we going to do that,
most providers don’t go into the care of older adult s . So we've got this whole
challenge about how to make sure that nurses and other providers get into taking
ca re of the older adult. Here at the National League for Nursing, we have seven
centre s and one of centres that we have is excellence in the care of older adult and
not one is about how we can help faculty be prepare d to share information with
students get them turn ed on about working with the older adult. So we've got to
indoctrinate the faculty . The other thing is this thing about transitioning from nursing
home into hospital and back to nursing home. It can be one of most dramatic
transition s around so that if we can provide services and bring those services to
whatever facilities they are at including their home that we are already doing so
much more in terms of stabilizing that older adult and making sure that they have a
brighter future and time as possible and as active a time as possible.

Margaret Flinter: We are speaking today with Dr. Beverly Malone, Chief Executive
Officers of the National League for Nursing, a membership organization for nurse
faculty and leaders in nursing education. Dr. Malone is on the Advisory Committee
at the Office of Minority Health in the Department of Health at Human Services which
is dedicated to eliminating the health disparities in this county. So Beverly you
participated in the institute of medicines ground breaking 2010 report on the future of
nursing. I think you have call ed the release of that, tell us why that report is so vital
to the path forward and how you and the NLN are help ing to make sure that the
recommendations contain within that report are being implemented?

Dr. Beverly Malone: Well their all issues that we have been working on for a long
time but we've never have a co ordinate d evidence base d IOM report that says these
are the issues and we've got to do something about them and they are basically like
leadership is a major issue, nurses who have a very interesting perspective about
patients I mean we work with them 24 hours a day and so we know t hem in a very
diffe rent ways tha n other providers. Frequently, while we are listed as people need

to be on board, we re not there. That’s one of the big issues in terms of leadership
that the IOM report talked about. Another one was that we have at least three
different wa ys to become a nurse diploma associate degree and baccalaureate
degree. And it's not a good l adder to get to the baccalaureate degree. And so one
of things that report says very clearly is there has to be that academic progression
and that we have to mak e it as easy and smooth as possible for that nurse wh o
studied out as an associate degree or diploma nurse can move up into the
baccalaureate or to the master’s degree and then the third one had to do with there’s
just not enough data , we don’t know what we need, I think the government appointed
a committee organization to do that work but they never funded it s o we still don’t
have the data . Then every nurse should practice to his or her fully scope that they
have been prepared and t he reports said very clearly that if we are going to need the
Affordable Care Act issues of another 30 new people on the list, we are going to
have had more nurses prepare d at that advance practice level and the thing that’s
different about the report is i t brings all of nursing together and it ve rifies tha t this
was not a nursing derived report. That it was other s, MD IOM, Institute Of Medicine
who said these are the issues, this is what we have to do.

Mark Masselli : Dr. Malone tell us a little bit abou t the National League for Nursing,
which was founded 120 years ago, tell us about the educational directives that you
have going on and how people might be engage with it?

Dr. Beverly Malone: The faculty peace to promote and to build a strong and diverse
nursing work force . The diversity issue is in there that it's not just good enough to
prepare students , it has to be that it advances the help with this nation. So we feel
very connected to what's going on in t erms of the Affordable Care Act, that’s the
oldest nursing organization in the country and it's base d on four core values of caring
integrity, diversity and excellence and the kind of program s that we have are
leadership programs in terms of a leadership centre, a transformation al leadership
centre , w e have a care of the older adult centre, we have a n innovation and
simulation and technology because so much of things changing is going to be
around innovation and simulation. We have a leadership centre for diversity and
global initiative. Then we h ave one for the advancement of the science of nursing
education and that’s the idea that you need evidence based nursing practice. Right
now so much of nursing education and maybe other types of education and sort of
the way we were taught, we teach and w e've got to change that, we've got to move it
to an evidence base system just like the IOM report, was evidence based nursing
education needs to be evidence based. And then there is centre for assessment and
evaluation and the centre for academic and clin ical transitions which was about
academic progressions, about how to move that associate degree or diploma nurse
to his or her baccalaureate or m aster’s degree or how to move them from the
baccalaureate degree to the d octoral degree. All of those are tran sitions and all of
those are academic progressions. So the league i s involved in all types of programs
that revolve around th ose seven centres and we engage with 39 , 000 individual
members about 1200 schools of nursing, all of them are very committed to se eing us
rev up, what we need to do make sure that the programs that are preparing nurses
are one that actually move nurses to advance the nation’s health.

Margaret Flinter: Well Dr. Malone I really appreciates that strong emphasis and call
for both innov ation and evidence based practice certainly t w o drive r s that underlie

our community health centre organisation which in turn is supported by just an
exemplary primary care and advance d practice nursing workforce. We like to look
globally around the world, look at best practices , see what we can learn, not just
what we can teach and I know that you’ve had a very globa l perspective through
serving i n the United Kingdom a s the Executive Director of the Royal College of
Nursing , you’ve have twice been a delegate to the World Health Assembly once
appointed by President Clinton and then again by British Prime Minister Tony Blair
so you have a very global understanding of health care , health care delivery issues
and international nursing issues. May be you could share with us , just a little bit
what did you learn from your work in the UK and these global experiences that you
think is applicable to the work that you are trying to facilitate here in the United
States?

Dr. Beverly Malone: You know that it was so interesting because one of the things
my colleagues in UK would ask me , who is best, I mean who does it best or what’s
the difference between the US and the UK and it really depends on what’s piece you
look at? Amazingly the UK is ahead of us in some of the innovations that they are
doing with nurses. Some nurses are performin g surgery so I was a little awe -
stricken by that. But at the same time there is no one who has a more well
developed educationally promoted workforce than the US. The things we have been
talking about today are the advance practice, those are really striking characteristics
of the US Health Care System. So the kinds of things that I learned that were all
more similar than we are different and I guess that’s not as profound as i t could be
but it’s a truth that I went there thinking oh it’s going to be so incredibly different and
it was different. Language was different. There were other differences but bottom
line , patients are people and provi ders like nurses and physicians, w e provide
services. So I think that’s a pretty big learning thing for providers from the US to
understand that our colleagues whether we are talking about UK or whether we are
talking about ( 18:17 inaudible) here Africa that we are more similar tha n differ ent.
The other thing was that they have a very acute way of testing whether its
medication or whether its technology. There is a whole system of that, that is used
in the UK and that I don’t think we have as clearly here but it just seems that there
syst em is a little bit ahead of us in terms of making sure that whatever the product is
that it has been question ed and that it remains questioned and that everyone knows
there is a big question mark beside of it. The other thing I was definite with is the
educational system is totally different for nurses tha n it is here and that we produce a
generalist who is either at the associate degree of the diploma or the baccalaureate
level. In the UK, they produce a specialist kind of , you know the psychiatrist mental
health nurse, the obstetrical nurse, the paediatric nurse as the first graduation level
so that means they have a slightly like an army of providers who are paediatric
nurses. An army of nurses who are psychiatric mental health nurses and ours are
usually not there until the graduate level. There are pros and cons to that but I'd
have to say that I totally enjoyed working in collaboration with Tony Blair because
one of the big differences was that well Mr. Clinton the president was very attuned to
nursing. His mom was a nurse. I never really sat down for 45 minutes and talk ed
just about nursing with President Clinton b ut twice a year I would sit down with Prime
Minister Blair and to speak with him about where nursing was and what I thought
could be done differently. So, I thought that was a pretty big difference.

Mark Masselli: We have been speaking today with Dr. Beverly Malone , Chief
Executive Officer of the National League for Nursing, a member of the Advisory
Committee at the Office for Min ority Health. You can learn more about her work by
going to www.nln.org . Dr. Malone thank s so much for taking the time, sharing with
us about the great work that you are doing on Conversation on Health Care .
Dr. Beverl y Malone: Delighted.
(Music) Mark Masselli: At conversations on health care we want our audience to be truly in the know when it comes to the facts about health care reform and policy. Lori
Robertson is an award winning journalist and Managing Editor of F act Check.org, a
non partisan, non - profit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori what have you got for us this week?
Lori Robertson: Well, readers have asked us if the Affordable Care Act allows sta tes
to confiscate t he assets of seniors on Medicaid when they die. The answer is no but
a 1993 federal law does require state to reco ver Medicaid cost for long term care
from the estates of deceased Medicaid beneficiaries over the age of 55. The claim s
a bout the ACA have gone viral, one conservative website claim ed that the Obama
administration was quote turning the dead into cash cows but the ACA did nothing to
change existing federal law. What it did do was expand the number of people
eligible for Medi caid, so more could be subject to the old 1993 law. Here's the
background on what's called the Medicaid Estate Recovery Program. Since,
Medicaid began in 1965, all states have been able to recover medicate cost spend on those 65 or older after those reci pient s died. In 1993, congress passed the
budget bill that require d states to recover the cost of long term care such a s nursing
home care for Medicaid recipients 55 and older after they died. In fact, the law gave
states th e option to recover all Medica id expenses for such recipients. If the
deceased recipient has a surviving spouse, minor child or adult disable d c hild, the
state can't recover any cost. There are also exemptions to allow family members to
keep a family farm or h ome under certain circum stances. Because the ACA
expands Medicaid eligibility more people between the ages of 55 and 65 potentially will be subject to the medicate recovery program after they die . And that's my FactCheck for this week. I am Lori Robertson , Managing Editor of F act C heck.org.
Margaret Flinter: FactC heck.org is committed to factual accuracy from the country’s
major political players and is a project of Annenberg Public Policy Centre at the University of Pennsylvania. If you have a fact that you’d like to check e mail us at
CHCRadio . com, w e’ll have F act C heck.org’s Lori Robertso n check it out for you here
on Conversations on Health Care.
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Margaret Flinter: Each week conversations highlights a bright idea about how to make wellness a part of our communitie s and everyday lives. Primary care providers have their work cut out when seeing patients after patients all da y long, in brief basis it can be difficult to cover all of the important basis and often science of drug and alcohol dependents can get overlook ed. And many patients are put off by link the

questionnaires that are aimed at determining whether you have a problem with
drinking or using drugs. Researchers at the Boston University School of Public
Health have determined that asking one simple questi on could actually determine
the level of a patient’s possible drug or alcoh ol dependency. For alcohol use,
participants were asked how many times in the past year they have consumed 5 or
more drinks in a day? For other substance use they were asked how m any times in
the past year have used an illegal drug or used a prescription medication for
non medical re asons? The researchers compare alcohol screening responses with
the alcohol dependant’s reference standards and drug screening questions with drug
depe ndant standards. The single alcohol screening question detected 88% of those
with alcohol dependa nts, the drug question detected 97% of those with drug
dependency. Lead researcher Dr. Richard states says this could provide a valuable
rapid assessment for primary care providers to help patients and get them to the
treatment options they need. A single simple question aimed at revealing drug or
alcohol dependency that could help primary care providers di agnose the problem
more readily, getting patients soo ner to the help they need. Now, that's a bright idea.
This is Conversations on Health Care . I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

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