Nurses Ask: Where is the respect?

Mark Masselli (00:04)
22 years in a row, Americans have rated nurses as the most trusted profession, and there's a need for more of
them. There are projections the nursing field will grow 6% in the next eight years, faster than the average for all
occupations. But nurses face daunting challenges.

Jennifer Mensik Kennedy (00:22)
We keep hearing the word resilient and that we need to make people more resilient. And I don't know, how you
make a nurse who has experienced 17 deaths in seven days, more resilient. But we have to look at the work
environment and how in, you know, nursing is inherently stressful, but when we have more deaths and more bad
outcomes, that does take a mental toll on any human.

Margaret Flinter (00:47)
Our guest today is the president of the American Nurses Association, Jennifer Mensik Kennedy. Dr. Mensik
Kennedy earned her PhD in nursing from the University of Arizona and also holds an MBA in healthcare
administration.

Jennifer (01:01)
We know the likelihood of healthcare workers being exposed to violence is higher than prison guards and police
officers. So with one in four nurses having been assaulted at work. And we know that 29% of nurses in a survey
have said they have faced violence in the last year.

Margaret (01:19)
This is Conversations on Healthcare.

Mark (01:29)
ANA President, Jennifer Mensik Kennedy, welcome to Conversations on Healthcare.

Jennifer (01:35)
Thank you. Thank you for having me.

Mark (01:36)
And congratulations. We read that Modern Healthcare recently recognized she was one of the hundred most,
influential people in healthcare. So our congratulations.

Jennifer (01:48)
Thank you very much. It's a privilege to, to have that.

Mark (01:51)
Yeah. You know, we have lots of issues to ask you about, and we're looking forward to this conversation. Let's
start with workforce. there's a recent survey by the American Nurses Foundation found that 90% of respondents
say that staffing shortages, that their organization is a serious problem. I wonder if you could just share with our
listeners what are the challenges nurses are facing in terms of staffing shortages?

Jennifer (02:15)
Absolutely. You know, this is really important and I, I, I think the, one of the important parts to know is that we
had staffing challenges before COVID, and so these are not new issues. but these issues became so much worse
during COVID when we had some higher turnover, we had nurses going into traveling positions because what
was occurring was nurses were looking for, some work-life balance. They were looking to have, you know, they
needed time for themselves. It was very, very stressful time. And so, while some organizations have recaptured,
some of those nurses that have left, they're still at much higher, from a turnover, turnover perspective than we
saw pre COVID.

Margaret (03:01)
Well, Jennifer, you have some data that I think is, actually maybe well known within nursing, but not so well
known in the public about what happens when there's inadequate staffing, and particularly in the acute care
setting, the ratio of patients to nurses. and I believe that your data shows that, when we exceed what has been
determined to be the ideal ratio based on the complexity of the patient and the setting by even one additional
patient, that the chances of a patient actually dying within 30 days of hospitalization increase by 7%, and that
those odds double if you increase that same ratio by two patients. Yeah. This, it seems, should be at the top of

the headlines on a daily basis, but how do administrators and lawmakers, react when you share these details with
them?

Jennifer (03:52)
Yeah, I, I think people are concerned and really want some to do something about that, because as you noted,
for one addition, for every single additional patient, the likelihood of you dying within 30 days of leaving the
hospital increases by 7%. Of course, if a nurse had three additional patients above that safe level, each patient
within that group has a 21% increased likelihood. So that continues, you know, to escalate. And so there's a lot
of stressors on, you know, from a organizational perspective that says, well, where are we gonna get these
nurses? But how can we, you know, keep nurses if we continue to have short staffing in these organizations? So
we really do need to focus in on items, organizational, the environment of those organizations where nurses,
one, want to stay in those organ in those environments and work in the hospital, and then also be able to provide
the appropriate level of staffing. So we know that organizations can get down below, you know, between a five
and a 10% turnover rate, which is much lower than a 21%, turnover rate. If we focus in on the work
environment, such as, staffing committees, shared governance, listening to nurses' voices are so important. And
then also being able to provide, assistance in other areas. Quite often when we start looking at hospitals and they
start cutting resources that the nurses, the one that ends up providing housekeeping services, some of the dietary
services. And so nurses end up taking on the workload of a lot of other disciplines when we really need the full
approach. So not only do we need more nurses in the hospital providing care, but we also need the team around
them to support the nurses so that nurses can do what nurses do best, and that's provide nursing care and not,
provide, you know, overburden them with a lot of things that it doesn't take a nurse to do. So I think we need to
really focus in on that work environment, being able to make sure there's enough nurses, and then providing that
support, supportive team to help make sure the patient gets their best quality care.

Mark (06:09)
Alright, I'm gonna put my patient hat on and consumer hat on. Scared the heebie-jeebies out of me. Should I be
asking the nurse how many people you're taking care of? How, how would I know if they've got one or two
more? What, what should, how do you empower me in terms of figuring out, is this, you've got three extra
people and I'm, I'm, I'm, I'm getting outta the hospital right away?

Jennifer (06:32)
And you're worried about it? So I think that's, you know, I think patients and family members should be
empowered to ask these questions. And what we've seen, because this has become, you know, we've, we've been
working on this for decades. We haven't really seen big improvement, but what we saw this last year was there
were 19 states that have, you know, started to look at legislation within the state level. And in some states, for
instance, like in Illinois, there's mandatory posting a requirement for each unit. So if you walk into a hospital
unit, it actually tells you the number of RN’s on that unit for that shift. So I think from a consumer perspective
as a patient, it is perfectly fine to ask, you know, how many nurses, how many RN’s are on this unit today, and
even supporting legislation that helps provide that transparency so that, you know, as a patient, the organization,
what's going on. And, and I would continue to, to, you know, if you can, participate or attend hospital and
healthcare board meetings when they have open board meetings, it's really important to provide that feedback on
patient surveys that says, you know, where we really need to work on this. So from a safety perspective, it is
really important for us to also engage the patients and families in this.

Mark (07:51)
Let me just f follow up, with a question around when there's conflict that happens, within the hospital between
administration and nursing. You recently were interviewed by the publication Chief Healthcare Executive, and
you said you see the potential for strikes in the near future. And we noted that last year there was a strike in New
York City that lasted three days. I'm wondering from your vantage point, how effective are strikes and when do
you think, they're the best option?

Jennifer (08:20)
No, I, nurses want to do the best for their patients, and they wanna provide the best patient care. And striking is
usually always the last resort any nurse wants to take. And so this isn't something that they would do from a first
perspective. Often when nurses do, vote to strike, this is something after months of, work and partnership and
being at the table, and things just didn't come to fruition between them and the hospital or the administration. So
nursing strikes are always a last resort, after every other avenue has really maybe deteriorated.

Margaret (08:57)
Well, Jennifer, I think, across our society and in many, professions, disciplines, work groups, resiliency,
wellness, and it's counter yeah, burnout, you know, despair, mental health issues, are everywhere. But I think it's
shocking that the American Nurses Foundation Survey found that 56% of nurses say they're experiencing
burnout. and that's manifested in exhaustion, work frustration at two thirds of those nurses surveyed said they're
not getting any support for their mental health. what more can be done to help on this front, either within the
institutions or within the profession generally? Does the, American Nurses Association have any initiatives
going in this area?

Jennifer (09:41)
Absolutely. This is a great question, and I think this goes hand in hand with the staffing issues. When nurses
don't get those resources, you know, they do, they feel like one of their only options is to maybe take a break
from employment, you know, leave the working, leave actually the nursing workforce, or take a long break. And
we need to look at how we staff and those organizations and, and the attributes in an organization that really
support a nurse's well-being. And so things such as mandatory overtime, we have organizations that basically
say, you know, we are going to make you pick up an extra shift, regardless if, you know, and that's beyond their
40 hours a week. And so what we found is nurses on average work more hours than most Americans, in other
professions, because of this mandatory overtime. So we really need to look at how that, plays out. And then also
the American, so we're, we're looking at, you know, what does that look like from a legislative and a regulatory
perspective? And I would also put out the American Nurses Foundation has a large toolkit of resources, such as
the Well-being Initiative, and the Well-being Initiative is for any nurse, whether you're a member or not, can go
in and take a confidential survey to look at, your well-being. And there's a lot of free resources for nurses to be
able to do on their own time in the privacy of their own home, to be able to help them with their well-being. A
lot of organizations, have maybe have a well-being. program, and I think they need to maybe market it more or
provide it, so that nurses and other healthcare providers, can really access those services. I think one of the
detriments is we keep hearing the word resilient and that we need to make people more resilient. And I don't
know, how you make a nurse who has experienced 17 deaths in seven days more resilient, but we have to look
at the work environment and how, and, you know, nursing is inherently stressful, but when we have more deaths
and more bad outcomes, that does take a mental toll on any human, regardless of how resilient you are. And so
there's a lot more to, you know, resiliency training, because nursing is just a different field. We wanna care for
people and we need to be able to also care for ourselves. And so remember noting to other nurses, and, you
know, the code of ethic, code of ethics for nurses says you need to take care of yourself as well so that you can
take care of others. It's like the safety video on a plane that says, put the oxygen mask on yourself first before
you help others. And we really need to help nurses do that so that they're well for others.

Mark (12:30)
You know, I want to just connect the dots between the regulatory issues and the, and the well-being. issues you
were just talking about. I think most of our listeners know that, licensing for nurses happens at the state level,
and, we've seen that, about half the states have dropped questions about mental health from their licensing
questions for physicians. I'm wondering, do you think they should also drop those questions, on nurse license
applications?

Jennifer (12:58)
Absolutely. What we've seen is we had, I believe one state this year, actually add the question on their, renewal.
I just renewed my license in Oregon, and the same question appeared. And it is a detriment for nurses who
think, what if I do answer yes, what's gonna happen? You know, and, and why do we need to know that
question? And I think about that as that's a barrier. If I needed mental health, services that, you know, my
license is my livelihood. And so we know nurses particularly have a higher rates of suicide. So why are we
creating unnecessary barriers, when we all, when people might fear having their license taken away, that they
don't get the treatment, and then, end up, actually in suicidal because of that. So we really do need to remove all
of those questions from those licensing pieces. And also from a federal level, we need to reauthorize the Dr.
Lorna Breen Act was, it was funded on the last Congress, we need to refund it again. It's going to provide
money and resources for organizations at a national level to be able to address this issue of, provider, and nurse
suicide.

Margaret (14:18)
Well, Jennifer, thank you for, shining a light on, that legislation. That was a very sad story from the, the
COVID, era, which I'm sure many of our listeners are familiar with. But I, I wanna talk about another, very
sobering thing. We're gonna talk about optimistic and positive things sometime before we get through the end of
the show. but in, in all serious, just this, this is a real problem. Two nurses per hour are assaulted in the acute

care setting. And I might add, though, we're gonna focus on the acute care setting right now. This is also a
problem in home care. Long-term care facilities, public health, nurses are often at risk. How is ANA responding
to this? And is this something that needs to be addressed on the federal level by CMS? Or is it really up to the
state legislatures to address it? Share your thoughts on and what's going on on that level.

Jennifer (15:10)
Absolutely. So we know the likelihood of healthcare workers being exposed to violence is higher than prison
guards and police officers. So with one in four nurses having been assaulted at work, and we know that 29% of
nurses in a survey have said they have faced violence in the last year. So I think what we need, and what I've
seen is we have work going on at a state level and a federal level at a federal level. The American Nurses
Association is, has the Workplace Violence Prevention for Healthcare and Social Service Workers Act. And if
this is passed, this legislation would require OSHA, the Occupational Safety and Health Administration to
develop and enforce specific standards for healthcare and social service employers to hold them accountable for
protecting their employees. I've seen some local, state level legislation where increases the fines, makes it a
felony, for instance, to assault a healthcare worker, however. So while those are, good, it doesn't prevent it from
happening. We would rather not see the violence or the assault happen. So how are we really working to prevent
it in a healthcare setting? So that's why we really focus in on prevention in the federal bill. but, you know, we
have states working on it locally to do the same thing, whether it's making it a felony or working on how do we
figure this out from a preventative perspective.

Mark (16:42)
Margaret, I know our good friend, representative, Joe Courtney, has been big on this issue, been a strong
advocate of that. And, we'll certainly keep an eye on this, important piece of legislation. I wanna talk about the
ANA's, readiness and responsiveness. You know, we hear this troubling statistic that 63% of nurses say they
have personally experienced an active racism in the workplace. And I'm wondering if you could share with our
listeners, a and ANA's journey on racial reckoning and its important national commission to address racism in
nursing. how are they making a difference? Tell us more.

Jennifer (17:20)
Absolutely, thank you. So, you know, the American Nurses Association has recognized our own role, and our
past actions that have negatively impacted nurses of color and the perpetuated systemic racism. And so we are
taking meaningful and historic action to begin a journey of racial reckoning. And so what we know is there was
a period of time where the American Nurses Association did not allow, nurses of color to be members. And so
we have a lot of work to do to really, reconcile our own history. We are, as you noted, the, one of the co-leads to
the National Commission to address racism in nursing. And so when we look at this, we, we have seen
individuals say that half of half of our respondents in surveys, said there is a widespread racism and nursing
issue still today. And many respondents, so across the Hispanic, Asian, as well as other communities of color,
have reported personal experiences in the workplace of racism. And what we find is that black nurses are more
likely to personally experience and confront RA acts of racism. And so we are really focusing in on, education
as well as steps to be intentional on being an ally and what ally-ship means in nursing. And additionally, we are,
are coming out with a fourth series, on what we call Project Echo on racism in nursing, which is starting March
6th. And this is an, an eight part interactive series that explores causes of racism, identifies strategies for taking
action towards health equity. But what we're also doing is that we have position statements on DEI and really,
and, and speaking up when we see, our federal government and other, state level organizations pushing back on
implicit bias or DEI activities, we have a position that says, this is really important because we can't be nurses
and take care of people if we don't address racism. Every person deserves the best healthcare, and we also need
nurses that represent, the populations and the communities that they serve. And so another, another way we need
to address this and we're working on it, is, you know, nursing has been traditionally, female and white. And so
increasing more males into the profession, increasing other races into the profession, so that we do reflect a
society at large.

Margaret (20:02)
Well, Jennifer, I know you're, challenged to take, strong positions, and put your voice, out there on behalf of the
profession. And one, that is fairly recent, I think, is that you've, challenged a new American Medical
Association policy amendment recommending that advanced practice registered nurses commonly known as
nurse practitioners, clinical specialists, nurse midwives, be licensed and regulated by both state medical, and
nursing boards. tell us about that. Is that a recent, amendment that would seem like turning the clock back a few
decades?

Jennifer (20:37)
No, absolutely. And definitely this is a more recent, activity for the American Medical Association. However, if
you, from a state perspective, there are still many states that, do not allow full practice authority for APRNs and
those state level, medical associations continue to fight and push back. We, you know, you know, from a
regulatory and licensing perspective, we are not going to license and oversee medical and this, these are
advanced practice registered nurses, in their title. And so they are this our advanced practice of nursing. And so
we need to be able to continue to oversee them from a nursing perspective. Every APRN is a registered nurse,
with their additional education and certification residencies and clinical hours. And so we need to continue to,
oversee them. Now, we know we've had decades of studies that show that APRNs, nurse practitioners
particularly provide the same quality patient outcomes and care as do primary care physicians. Additionally, and
this kind of gets into AI as we see, AI technology in the future, this really, changes the dynamic and provides a
different perspective of care, again, further, you know, reiterating the need for not having additional regulations
and licensing and barriers. We have too many communities who do not have primary care providers and APRNs
are those, individuals. So why would we continue to put additional barriers, for patients getting timely care, in a
time where we just have too many shortages of all providers when we know NPs are safe and can provide
quality care in the communities, particularly rural communities, where, physicians may not be.

Mark (22:33)
You know, over the last decade and a half we've seen, states, legalize, cannabis and marijuana and, you know,
that's been a big sea change. It hasn't happened at the federal level, but it's happening at the state level. And, we
noted with interest that in September, the NA formally recognized cannabis nursing as a nursing specialty. I'm,
I'm wondering, why did you push for this and what benefits does it provide to nurses and patients? And I'd also
maybe pull the thread a little more and say, we're seeing, the intervention by Veterans Affairs on managing with
ketamine, post-traumatic stress disorder. we're seeing a whole new area open up. So tell us about at least the
nursing side and maybe, other broader thoughts that you might have in this area.

Jennifer (23:22)
Absolutely. it was fun to see the res, the, the worldwide response to that, that position statement. I think I got
more traction on that position statement than sometimes anyone else, any other statements. And, it's important
because people are doing this, they are, utilizing, marijuana, whether it's recreational, recreational or for
medicinal uses. And as a nurse, you need to be able to, assess that patient, but also understand how that might,
you know, why they're using it, and then how it also might impact other medical or nursing or healthcare
treatments that patient is getting. So it's part of the patient. And, and when we don't focus in and understand how
that might interplay with other healthcare pieces, we're really ignoring a very vital part of that patient. And that
could actually lead to bad outcomes, if a patient was to go to surgery or to take other medications. So it's really a
part of the patient, and it's important for nurses to be able to understand that. But there's also a specialty piece to
that, especially with the work that the VA is doing. So it's really recognizing that this is a special area of
knowledge that nurses can hold and really hone in on to help people who are maybe looking at it from an, a
medicinal use perspective to really help them get the solutions and the outcomes they're looking for. And so I'm,
I'm glad to see that we're moving that direction. And I think it just a matter of time before we have, federal
change particularly. And, and most importantly is we do need research, and continued research in this area, as,
as it's become legal in different states, we've seen more research. And I think that's just gonna help us
understand, so much about the use and why people are using it and those interactions. So we need to continue.
It's not gonna go away, and I don't think it's served us any, served us well, to have, you know, to have ignored it
for so long in society.

Margaret (25:27)
Well, Jennifer, a a is leading the way through a number of initiatives to bring attention to the role of nurses, in
care coordination. And of course, nurses have always been engaged in care coordination and in all settings. But
in our era of value-based care, and population health, this has taken on a whole new importance. We can do
remote patient monitoring of the patient, in their home, the transitions between hospital and, and home and
community, et cetera. But you're also asking for payment for these essential services as a distinct component of
patient care. And I think payment to nursing for nursing services, this will be a big lift. What are you doing to
overcome the hurdles to this goal? And where is CMS on all of this?

Jennifer (26:11)
Absolutely. This is great questions. and so, we are working this year actually on, on a, a multi-pronged strategy,
one of which is bringing together a group of stakeholders, academics and experts, expert leaders in this area in
April, to really look at the economic model of nursing and to be able then to, to put that out for, for use and
consumption. We've also, from the American Nurses Foundation perspective, we have the Reimagining Nurses

campaign, and we've actually provided multiple millions of dollars to numerous projects that are focused in on
looking at nurse reimbursements, in various settings. And these are items that we believe are scalable that have
the ability to move to other organizations, such as looking at the work of nurses in the community for patients
that, who may be between healthcare settings, be between primary care providers, and really need that
connection, whether it's between after a hospitalization, getting to, getting into the clinics or just, management
of their chronic disease. What happens now is if a nurse does work in a clinic, that their care, you know, we
don't know what nurses do because we don't have, our own NPI number. We can get our NPI number. And
what's one of the things the American Nurses Association is asking every RN and a, every APRN to do is get
your NPI number, national provider identifier, so that when we do something such as care coordination,
education, teaching, management, chronic disease management, we can put that down on the bill so that our
numbers attached to that. So as it is now, typically the physicians will account for it and it'll roll up to them so
that it looks like the physicians are actually doing these activities when it truly is in fact the nurses that are doing
these activities. So one of the pieces is just saying we would just like credit and recognition for all the things we
do. I think a lot of times people, know what nurses do in a sense, but don't realize the extent that which we are,
doing care coordination activities, across the board. And so being able to attach what's in the electronic health
record to what's being billed on our behalf, even though we never see that, I think is really, really important.
And that's the first step, in being able to say, here's the value of that nurse, in the clinic or in the community, or
even in the hospital. for instance, nurses are in the bed charge, in a hospital, it's in the room rate. And so we
have everyone outside the room rate. and so it's really important to be able to say, this is the portion that's
nursing care. And when it's in the bed rate, it's easy for administrators and finance individuals to, you know,
move that money around because you don't really see the impact from a nursing perspective. So that, that's
another component is being able to say, we don't wanna be in the re the, the hospital room rate any longer. We
wanna be pulled out or recognized separate, so that you can see that this is, that what you're being, you know,
this is what nursing time is for you, when you are in the hospitals as opposed to being the bed charge. So, those
are several of those pieces that we're looking at doing and, and focusing in on.

Mark (29:39)
Jennifer, you're ANA president, how did that come about? Tell us a little bit about yourself.

Mark (29:45)
So, thank you. I never would've been a million years thought I would've been ANA president. I did decide I
wanted to be a nurse when I was in high school, and I have been a nurse my entire life. And you know, the great
thing about being a nurse when you get your nursing degree, there are so many possible things that you can do
with being a nurse, and I really do like change and making change happen, and I don't like to complain unless
I'm gonna do something about it. So I think that's what got me involved. I got involved at my local state level
nursing association, and then it kind of just, just evolved from there where then I decided to run and be involved
at a federal level with the American Nurses Association. And here I am today as president.

Margaret (30:29)
Well, we're very glad you are. ANA president, Jennifer Mensik Kennedy, thank you for joining us. And thanks
to our audience for being here. Be sure to subscribe to our videos on YouTube, find us on Facebook and X with
our account name, CHC Radio. As always, you could go online to chcradio.com, sign up for our email updates,
and also please share your thoughts and comments about this program. Dr. Mensik Kennedy, thank you so much
for joining us today on Conversations on Healthcare.

Jennifer (30:59)
Thank you.

Margaret (31:03)
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