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

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Mark Masselli : This is a conversation on H ealth C are I'm Mark Masselli.

Margaret Flinter : And I'm Margaret Flinter.

Mark Masselli : Well Margaret w e're just coming off an important week National
Nurses Week .

Margaret Flinter : That’s right an d that’s the time when we honor the incredible
work that's done by the vital player on our healthcare team the nurse. To cross
multi disciplines nurses provide so many levels of essential care in the health
care system and that role is growing.

Mark Mass elli : Y ou know it’s a significant sector of the health care work force
Margaret as of 2012 there were over 3 million RNs and LPNs working in the field
and according to the Bureau of Labor Statistics this current trend of growth in
nursing employment is ex pected to continue at a really brisk pace.

Margaret Flinter : Well a couple of forces are driving that growth Mark and as
health care gets even more team based and patient centered, nurses play a
more pivotal role in care delivery in managing patient care and the population’s
ageing growth t rend towards more folks choosing to age and place so requires
more coordinated care certainly between primary care and the home.

Mark Masselli : We will be seeing more people coming into health care system.
We will se e more nurse practitioners leading primary care practices and
community health centers to meet that growing demand.

Margaret Flinter : And according to the Bureau of Labor statistics employment
projections, registered nursing RN is listed among the top oc cupations in terms of
job growth through 2022 an increase of 19 percent. Sure Mark it’s not going to
be in the same settings. It’s not going to be in hospital so we s ee that growth.
It's really going to be in the community in primary care in ambulatory care and
that is a very exciting development.

Mark Masselli : You are absolutely right and if we pull the thread a little more all
the way out to 2030, there is another significant nursing shortage projected.
Currently the number of organizations are wor king to address th e shortfall to
make more slots available at nursing schools, nursing organizations across the
country to help facilitate trained nurses to the highest practice level they can
achieve. It’s a health care workforce issue that’s going to re quire a concerted
effect to meet the growing demands.

Margaret Flinter : It’s not just RNs and nurse practitioners but clinical specialists,
nurse mid wives anesthetist a nd a host of researchers and educators as well .

A nd that’s something that our guest t oday knows quite a bit about. Dr. Beverly
Malone is the CEO of the National League for nursing an organization that’s
dedicated to improving the education for nurses and to meet the growing
demands in health care. She has some terrific insights. She has worked as a
top administrator in leadership capacities both in the US and in England. So
really looking forward to hearing her perspective as we come off of National
Nurses week.

Mark Masselli : And we are going to also be hearing from L ori Robertson wh o
checks in from F actcheck.org. She is always on the hunt for mistruth spoken
about the health policy in the public domain.

Margaret Flinter : And no matter what the topic, you can hear all of our shows by
going to chcradio.com.

Mark Masselli : And as a lways if you have comments please email us at
chcradio.com or find us on Facebook or Twitter we 'd love hearing from you.

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

Mark Masselli : But first here’s our pr oducer Mar ianne O'Hare with this week's
headline news.

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Mar ianne O'Hare : I am Mar ianne O'Hare with these healthcare headlines. The
nation’s uninsured rate is the lowest it's been since g allop began tracking such
rd
numbers back in 2008. The rate p eaked in a bout 80 % uninsured in the 3
quarter of 2013 before the start of open enrolment last October. The national
uninsured rate is now down to 13.4 % . Analysts credit the last minute surge
towards the end of open enrolment for the significant decreas e certain states
though like Texas and the Louisiana still have significantly higher rates of
uninsured residents. Still there are hiccups and headaches across the country
when it comes to the functionality of the state run insurance mark et places.
Orego n has scrapped its troubled sight entirely defaulting instead to the Federal
Exchange. Now Massachusetts is considering the same option as a way past
their trouble plagued system which they have deemed too costly to fix .

A nd speaking of Massachusetts, re cent statistics out of that state show that i n a
4 years since Massachusetts passed a requirement for mandatory coverage.
The death rate began to drop about 3 % a modest number but statistically
significant to warrant a connection. A direct correlation wa s drawn between
coverage, access to primary care and improved outcomes overtime. The study
builds on prior research showing health coverages reducing income and racial
disparities in Massachusetts.

And while millions of Americans are newly insured t here are still millions who
aren’t. Study showed just how much it would cost to care for that population.
Health care providers faced 75 billion to 85 billion in care cost for the uninsured
according to new estimates in the journal health affairs. The urban institute
researchers calculated hospitals provided about 45 billion of the uncompensated
care publicly supported community providers delivered about 20 billion and office
based physicians and other 11 billion. And we know this generation of American
yout h are heavier than any of the preceding generations and a significant up tick
in diabetes to go along with the mix both type - 1 and type - 2 diabetes . An d a
significant study charting millions of children up to age 19 from 2000 t o 2009 the
rise was significan t. The prevalence of type - 1 diabetes increased to 21 % . The
prevalence of type - 2 diabetes among those ages ros e 30 % d uring that period.
The study's author s peculated the up tick in type - 2 diabetes may result from
minority population growth obesity, ex posu re to diabetes and uterine and
perhaps endocrine disrupting chemicals . I ncrease will have public health
consequences according to research. I am Mar ianne O'Hare w ith these health
care headlines.

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Mark Masselli : We are speaking today with Dr. Be verly Malone Chief Executive
Officer of the National League for N ursing a membership organization for nurse
faculty and leaders in nursing education. Dr. Malone was recently appointed to
the advisory committee and the office of Minority Health at the Depa rtment Of
Health And 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
A nd Human Services under 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 serves on the board of
trustees at the Kaiser Fami ly Foundation. Dr. Malone welcome to our
conversation on health care.

Dr. Beverly Malone: Thank you so much.

Mark Masselli : You are recently appointed to the advisory board at the Office of
Minority Health at the DHHS . And tell us about the mission a nd the work
underway at the office to eradicate racial health disparities and how are we doing
on that front and how do you see the Affordable Care Act is having a impact on
the needs of old people?

Dr. Beverly Malone : Well, we are still struggling. All the professionals are still
struggling with that for nursing in particular that’s the one that I have given the
majority of my time to and when we are compared to the other disciplines, we
look fairly decent. But the truth is we are still not there. We still don’t have

enough nurses representing those patients who are receiving the care. 13 %,
14 % of the population who are the work force is about African - American in terms
of nursing. The burden of the illness is frequently on the underserved and the
poo r and so that means that the people who are most d ire in terms of needs of
services they are people frequently from ethnic and racial background.

Margaret Flinter : So Dr. Malone this is an area that has gotten so much focus
and attention. Maybe you coul d 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 Dr. Mary Naylor from the
University of Pennsylvania is doing a lot of creat ive work around that
understanding that the transition is the issue and that transitions into the
community but most people want to be in their homes. They don’t want to be in
health care facilities. They don’t want to be in hospitals. Mary has been doi ng a
lot of work around that how nurses work effectively to make those transitions and
when there is not enough physicians out there who are providing primary care
services , that nurses are there to make sure that the needs of the patients are
met. But we need more advanced practice nurses to do that and so there is a
whole piece around that 's tie to having enough providers and getting the kind of
funding from c ongress to make sure that those providers are prepared. Nurses
tend to stay in the communities where they come from. If you really prepare
nurses, they will not move away from their environments. I think probably
because we're women to some degree and our families and our roots are there
and so we tend to stay.

Mark Masselli : Well let's delve a little deeper into the framing up of the
challenges that nursing faces in this service. So many pressures are being
brought to bear in 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 this growing demands?

Dr. Beverly Malone : Well, you know, t he nice thing is I am a baby boomer myself
and so I know that we are a different breed from the previous generation . And
that we're going to be more demanding and e xpect more. We 're going to want to
be in our familiar settings and we are going to be healthier and it is going to take
us longer to get ill. So the challenge is is the care of the older adult. How are we
going to do that? Most providers don’t go into the care of older adults. So we ’ve
got this whole challenge about how to make sure that nurses and other providers
get into taking care of the older adult. Here at the National League f or Nursing,
we have seven centers and one of our centers that we have is excellen ce in the
care of older adults . And that one is about how we can help faculty be prepared
to share information with students, get them turned on about working with the
older adult. The other thing is this thing about transitioning from nursin g home
into hospital and back to nursing home. It can be one of the most dramatic

transitions around so that if we can provide services and bring those services to
whatever facility they are at, we are already doing so much more in terms of
stabilizing th at older adult and making sure that they have a brighter future and
time as possible and as active for time as possible.

Margaret Flinter : We are speaking today with Dr. Dr. Beverly Malone , Chief
Executive Officer of the National League for Nursing , a me mbership 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 And
Human Services which is dedicated to eliminating health disparities in this
country. So Beverly you participated in the Institute of Medicines Ground
Breaking 2010 report on the future of nursing. Tell us why that report is so vital
to the path forward and how you and the (inaudible 11:08 ) helping to make sure
that the recommend ations contained within that report are being implemented.

Dr. Beverly Malone : Well we’ve never had a coordinated evidence based IOM
report that says these are the issues and we got to do something about them and
leadership is the major issue. Nurses wh o have a very interesting perspective
about patients and frequently now we en listed as people who need to be on
boards , we're not there . Another one was that we have at least 3 different ways
to become a nurse. Diploma Associate Degree and Baccalaureate Degree and
there's not a good ladder to get to the Baccalaureate Degree. There has to be
that academic progression and that we have to make it as easy and smooth as
possible for that nurse who started out as an associate degree or diploma nurse
to move up into the Baccalaureate or to the Masters Degree . And then the third
one had to do with there is 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. So we still don’t have the data and the report said very
clearly that if we're going to meet the Affordable Care Act issues of another 30
million new people we 're going to have to have more nurses prepared at that
advanced practice level and the thing that’s dif ferent about the report it verifies
that this was not a nursing derived report. That it was others and the IOM the
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 about th e National League for
Nursing , which was founded 120 years ago. Tell us about the educational
direct ives that you have going on and how people might be engaged with it.

Dr. Beverly Malone : It’s not just good enough to prepare students. It has to be
tha t it advances the health of this nation. That’s the oldest nursing organization
in the country and it’s bas ed on 4 core values of caring, integrity, diversity and
excellence and the kind of programs that we have are leadership programs in
terms of a leade rship centre, a transformational leadership centre. We have a
care of the older adult centre. We have a innovation and stimulation and
technology because so much things chang ing is going to be around innovations

and simulation s . Then we have one for the advancement of the science of
nursing education.

Right now so much of nursing education and maybe other types of education and
so the way we were taught we teach . And we 've got to change that. W e got to
m ove it to an evidence based system just like the IOM report was evidence
based nursing education needs to be evidence based. And then there is this
centre for assessment evaluation and a centre for academic and clinical
transitions which is about academic progressions about how to move that
associate d egree or diploma nurse to his or her Baccalaureate or Masters
Degree . All of those are transitions and all of those are academic progressions
and we engage with 39,000 individual members, about 1200 schools of nursing.
All of them are very committed to s eeing us rave up what we need to do to make
sure that the programs that are preparing nurses are ones that actually move
nurses to advance the nation’s health.

Margaret Flinter : Well , Dr. Malone I really appreciate that strong emphasis and
call for both innovation and evidence based practice certainly two drivers that
underlie our community health centre organization. We like to look globally
around the world, look at best practices, see what we can learn, not just what we
can teach . A nd I know that you have had a very global perspective t hrough
serving in the United Kingdom as the Executive Director of the Royal College of
Nursing. You 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. 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 the UK would ask me , who’s best ? I mean who does it
best or what’s the difference betwee n the US and the UK and it really depends
on what piece you look at. Amazingly the UK is ahead of us and some of the
innovations that they are doing with nurses -- some nurses are performing
surgery. So I was a little odd 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’ve been talking about today with the advanced practice.
Those are really striking characteristics of the US healthcare system that we ' re all
more similar than we are different. I guess that’s not as profound as it could be
but it’s the truth. I went there thinking o h it’s going to be so incredibly different
and it was different. Language was different but bottom line patients are people
and providers like nurses and physicians we 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 the UK or whether we are talking about
Sub - Saharan Africa that we are more similar. The other thing was that they have
a very acute way of testing whether it’s medication or whether it’s technology.

There is a whole system of that -- that is used in the UK and that I don’t think we
have a s clearly here. I know we have our FDA and other but it just seems that
their system is a little bit ahead of us in terms of making sure that whatever the
product is that it has been questioned and that it remains questioned and that
everyone knows that there is a big question besi de of it.

The other thing I was fascinate with is the educational system is totally different
for nurses than it is here and that we produce a general list who is either at the
Associate Degree, the Diploma or the Baccalaureate level. In the UK, they
pro duce specialists kind of -- you know the psychiatric mental health nurse, the
obstetrical nurse, the pediatric nurse as the first graduation level. So that means
they have a slightly like an army of providers who are pediatric nurses, an army
of nurses wh o are psychiatric mental health nurses . A nd ours are usually not
there until the graduate level. So there are pros and cons to that. But I do have
to say that I totally enjoyed working in collaboration with Tony Blair because one
of the big differences was while Mr. Clinton the President was very attuned to
nursing. His mom was a nurse. I never really sat down for 45 minutes and
talked just about nursing with President Clinton but twice a year, I would sit down
with Prime Minister Blair and speak with him about wh ere n ursing 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 and a member of the
Advisory Committee at the Office for Minority Health . You could learn more
about her work by going to www.nln.org . Dr. Malone thank you so much for
taking the time and sharing with us about the great work that you are doing on
conversations and health care.
Dr. Beverly Malone : Delighted.
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Mark Masselli : At C onversations on H ealth C are we want our audience to be
truly in the know when it comes to the facts about health car e reforming policy.
Lo ri Robertson i s an award - win ning journalist and managing editor of
Fac tcheck .org a non partisan nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. L ori what have you got for us this
week? L ori Robertson : Wel l the Affordable Care Act increase in come tax brackets
capital gains and the state taxes in 2014 . That’s what a viral email says but it’s
not true. The anonymous message claims that several taxes went up on January 1

st
2014 because of the Affordable Care Act but none of the taxes listed had
anything to do with the health care law. Most were part of the fiscal cliff package
st
that c ongress passed on January 1 2013. For instance the top income tax rate
did go back up to 39.6 % for singles making more than 400,000 dollars a year and

couples earning more than 450,000 dollars. That increase was part of the fiscal
cliff deal in 2013.

Capital gains and dividend tax rates also went up under that deal and not as
much as the viral message claims. The top capital gains rate and dividend rates
are both now 20 % for those earning more than 400,000 or 450,000 a year. The
email wrongly says that the e state tax went from 0 % to 55 % . The tax is still 0 %
for anyone who dies this year and has an estate worth less than 5.3 million
dollars. The top rate is thanks to the fiscal cliff deal 40 % . This message goes on
to claim that the tax increases -- it list “passed with only d emocratic votes” not
true at all. The fiscal cliff deal passed by a vote of 89 to 8 in the senate w as 40
r epublicans in favor. In the House 85 r epublicans voted in favor. The ACA does
include some tax increases such as a 3.8 % tax on net investment income and an
additional M edicare tax a 0.9 % for those earning more than 200,000 dollars a
year or 250,00 0 dollars for couples. But that increase is no where to be found in
this bogus viral message and that’s my fact check for this week. I am L ori
Robertson Managing Editor of F actcheck.org.

Margaret Flinter : Factcheck.org is committed to factual accuracy from the
country’s major political players and is a project under the Ann enberg P ublic
Policy Centre at the University of Pennsylvania. If you have a fact that you would
like to be checked, email us at chcradio.com. W e ' ll have Factcheck.Org's Laurie
Robe rtson 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 communities and everyday lives. According to
Michigan Organic Farmer Mi chell e Lutz, H ealth C are spends too much time and
money trying to fix the problems that are caused by a poor diet. that the powers
would be at the Henry Ford West Bloomfield Hospital agree with her. For a year
she had offered organic food growing and coo king demonstrations at the health
care facility just outside of Detroit. But when officials drew up plans to renovate
the hospital 3 years ago, they decided to take it to the next level and thanks to an
anonymous donor a million dollars certified organic hydroponics green house and
garden were built and L utz was hired away from her farm to run the operation.

Michelle Lutz : We really wanted to change the way that food culture w as done in
a health care setting. When you have the opportunity to heal someon e, it’s very
important that what they are eating becomes part of that plan, that cliché thing
are what we eat is absolutely true.

Margaret Flinter : The facility now provides most of the nutritional organic greens,
vegetables, fruits and herbs used in the food that is prepared there . N ot just for
patients who have come there to heal but for their families and hospital staff as
well.

M ichelle Lutz : The layout was very important so that we could have a very
complex diverse variety of herbs and produce for the kitchen to use. It’s rather
seasonal. In the winter time and in the fall, we change to more of a co ld tolerant
crop and then in the summer time like this time we are now transitioning to the
point where we are picking cherry tomatoes and we have swe et peppers and
things like that that we will be supplying for the kitchen.

Margaret Flinter : Predicated on the idea that modern health care has to be more
ab out well care than sick care, Lutz says there is an educational component to
the program that’s o ngoing and multi generational.

M ichelle Lutz : Right now we are averaging 3000 students per academic school
year that go through our healthy habit program and so, we are lucky enough to
have kind of a dual combination here as offerings. We have a demonst ration
kitchen inside of our hospital and then we have the greenhouse right behind the
hospital to make sure that we are pressed upon especially our youth i n our
community what does it take to you know have the foundation of healthy habits.
We know that o ur health care employees are sometimes the least. Their priority
is to take care of themselves because they are so used to taking care of others.
So it is not uncommon for a nice day for us to have a nice dream of doctors and
nurses out there and just to be in a beautiful setting and how therapeutic that can
be . B ut to also you know have them ask questions about what it is that we are
growing and how is that being used.

Margaret Flinter : The nation’s first hospital based year around certified organic
h ydroponics green h ouse one that provides fresh fruits and vegetables to patients
who are healing and the clinicians working to heal them, improving health and
well being for the system community wide and teaching the next generation
about the benefits of or ganic produce for a healthier diet.

M ichelle Lutz : The idea of being just a hospital doesn’t work anymore. You have
to be a community centre for wellness.

Margaret Flinter : Now that’s a bright idea.

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Margaret Flinter : This is C onversations o n H ealth C are , I'm Margaret Flintier .

Mark Masselli: And I'm Mark Masselli. P eace and H ealth.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University. Streaming live at www.wesufm.org and brought to you by
the Community Health Centre.