Remarks to a 2010 Nursing Recognition Day Ceremony

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by HRSA Administrator Mary K. Wakefield

May 7, 2010
Bethesda, Md.

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Thank you, RADM (Kerry) Nesseler, for your service as Chief Nurse Officer and as head of HRSA's Office of Global Health Affairs. And congratulations to all of the award winners who will be recognized later today.

It's a pleasure to be here. And it's terrific to be surrounded by so many nursing colleagues and to share this special day with you.

Today's theme couldn't be more timely. Nurses today are positioned as never before to play a prominent role in the health policy arena. And especially here in Washington, where the voice of the nursing profession cannot be heard enough, especially in these historic times.

From my perspective, the fact that the President selected a nurse from North Dakota as the administrator of HRSA, a $7.5 billion federal health care agency, underscores his recognition of the role nurses can engage in relative to health policy and reform.

The President's recognition and appreciation of nursing was also made clear last summer when I was privileged to stand with the President, along with several well-known nurse leaders, as he gave remarks in the Rose Garden on health care reform. Let me just quote for you what he had to say about all of you:

“Nurses aren't in health care to get rich,” he said. “Last I checked, they're in it to care for all of us, from the time they bring a new life into this world to the moment they ease the pain of those who pass from it. If it weren't for nurses, many Americans in underserved and rural areas would have no access to health care at all.”

Isn't it great to have friends in high places who appreciate the importance of this profession – from contributors to health care in a practice, public health or clinical environment, to contributors in health policy as exemplified by my appointment.

So how did I become the first nurse to head up HRSA and how did I end up in the Rose Garden with President Obama? Let me tell you my story.

While practice in health care sectors has been traditional for nurses, the profession increasingly fields nurses that recognize the contribution of nursing to leading new directions in health policy. It's a different environment today than it was 23 years ago when my odyssey in policy really took hold. Let me tell you what it was like.

In 1987, I was a 33-year-old tenured associate professor at the College of Nursing at the University of North Dakota. In the spring of that year, without really seeking it, my career in academia took a sharp turn when I was offered a position as a legislative assistant for health and education in the office of a North Dakota senator.

I was torn and wondered what I should do. I didn't know anyone in North Dakota who could give me advice about working on Capitol Hill, so I decided to call some national nursing organizations here in Washington to ask their advice.

I didn't know anybody in those offices, but I thought I needed a perspective from nurses who worked in the policy arena in D.C. After all, tenure at a university is a pretty good thing, and it's hard to leave behind if you're the least bit uncertain.

I called three nursing organizations and left messages. And I got one call back. It was from a woman named Polly Bednash at the American Association of Colleges of Nursing. Polly was the head of government relations then; today she's executive director.

She didn't know me from Eve, but she returned my call. And within a very few minutes of our conversation, Polly had helped me redirect my life and send my career into an entirely new and exciting trajectory.

I don't remember what she said as much as how she said it. It was a strong and unequivocal message: “Of course you should take the job!” As if leaving a tenured position in a familiar environment in the Northern plains to go to an unfamiliar environment in Washington, D.C., and Capitol Hill was absolutely the right thing to do.

The best part of what she said was this: she believed I could and should do it. And if she thought that, then of course I too had to think, “Of course, I can do this.”

That phone call was the first step in a journey that led me to become the first nurse to head a $7.5 billion federal health agency. It was because a new mentor, a person I had yet to meet face-to-face, helped me believe that working on Capitol Hill was an entirely appropriate role for a nurse. And because of her, my career took me to a place hard to imagine from the College of Nursing at the University of North Dakota.

I wanted to share this story with you for two reasons: to emphasize the power of mentoring, and because one thing my career has shown me is that nurse leaders are essential across the spectrum of health care – from academia to public policy.

So, clearly, health care is our work, and health care policy is as well, but it can only be our work when nurse leaders are prepared to take it on. Nursing's expertise is relevant not only when we're behind the scenes, but actually on the scene! Many of us in this room are examples of nurses who are in what would have been viewed back then as non-traditional roles for nursing. More visibility about what we do is really key to serving as role models for other nurses. It's hard to get there, but it's critical that we do, because nurses have a great deal to offer.

Being a nurse certainly enhances and informs my work at HRSA. I don't see issues only from the perspective of a federal official. I also see issues through my experience practicing as a nurse in a variety of clinical environments. I see our health professions training programs not just from here at HRSA but also from having worked as a faculty member in schools of Nursing and Medicine. I think I have a richer understanding of the patient-provider relationship and how they are impacted by decisions around care delivery. And because we've lived in these worlds, we execute our contributions to our work differently. It was the same way on Capitol Hill – I didn't have a political science or law degree, but I had health care expertise.

As HRSA Administrator, I'm committed to developing the next generation of nurse leaders for this country, which is in need of a vibrant nursing workforce. Vibrant in terms of both numbers of nurses and vibrant in terms of their competencies.

I'm certainly not the only nurse serving in a senior position. Today, you will find more nurses in senior executive positions in the federal government than perhaps any other time in recent memory. Most recently, Marilyn Tavenner was named principal deputy administrator of the Centers for Medicaid and Medicare Services.

Since taking over as HRSA Administrator last year, I've been pleased to find nurses in several key leadership positions, and I've appointed some more.

In addition to RADM Nesseler:

• Our $2 billion HIV/AIDS Bureau is run by RADM Deborah Parham Hopson, a nurse
• Dr. Denise Geolot directs our Office of Strategic Priorities, which examines and responds to emerging health issues. Also a nurse.
• Dr. Regan Crump heads our Office of Regional Operations and is a retired Commissioned Corps Nurse Officer.
• Dr. Janet Heinrich, our new Associate Administrator in the Bureau of Health Professions, not only is a nurse, but came to HRSA from the National Institute of Nursing Research.
• And Michele Richardson heads up our Division of Nursing.

These nurse leaders, along with other HRSA leaders, have a significant range of programmatic responsibilities. They include such disparate tasks as prevention, care and treatment of people living with HIV/AIDS; linking oral health and behavioral health with primary care services; leading efforts to educate and train our primary health care workforce, including the nursing profession; and improving health care delivery in rural areas.

They are terrific representatives of what nurses can do to shape national health policy and direct the activities of important federal health agencies.

It's an exciting time for all of us at the agency, both in terms of the people and the programs. The President's American Recovery and Reinvestment Act has set us on a path that is improving health care across the country. Let me bring you up-to-date.

As we all know too well, for many years, health professions took a back seat to other priority programs. That changed in a big way when President Obama launched the Recovery Act early last year. This is what greeted me when I arrived in Washington. Health care reform followed, which I'll talk about in a minute.

Under the Recovery Act, the Administration invested:

• $2 billion to expand, improve and renovate the health center system which, by the way, employs 10,000 nurses;
• $200 million to counter health workforce shortages by expanding training and educational opportunities – reflecting President Obama's commitment to attract and retain more nurses, physicians, and other health care professionals; and
• $300 million to add thousands of new clinicians to the ranks of the National Health Service Corps.

Let me interject here a quick pitch for the NHSC, a great option for nurse practitioners, psychiatric nurse specialists and certified nurse midwives. Of the 4,700 NHSC clinicians currently in the field, 700 are advanced practice nurses, and right now – thanks to the Recovery Act – we have vacancies for 1,700 advanced practice nurses at more than 1,400 sites.

Health care professionals who sign up with the NHSC serve a minimum two-year term in underserved areas. In exchange, they receive up to $50,000 in student loan repayments. Nurses who choose a five-year commitment can get up to $145,000; and we're accepting applications for Recovery Act funds through July 29 of this year -- or until those funds are exhausted.

If you know nurses who might be interested, please tell them about the NHSC and urge them to visit www.hrsa.gov to learn more.

As I've said, President Obama and his administration understand the crucial role of nurses in delivering primary health care, and that's why the Recovery Act invested $42 million in additional nurse training opportunities at HRSA.

The President and Congress then went further in supporting nursing in HRSA's FY 2010 appropriation. Increased funding will support hundreds of additional contracts for nurses in critical-shortage facilities, as well as loan programs.

The President's FY 2011 budget request to Congress supports even more funding; for traineeship and loan programs for nurse anesthetists, for example.

Clearly, President Obama knows how important nurses are to a healthy America – and he understands the urgency of the coming workforce shortages in our profession.

My own professional experience has taught me that engagement in public policy is an important – and frankly a natural – option for a nurse. The evidence that nurses and others bring to bear to inform policymakers can be crucial to achieving good policy decisions. We need to ensure that no opportunities for sharing nursing knowledge are overlooked. Most immediately, while the ink is now dry on the Affordable Care Act, we're just beginning the next phase of this work – policy implementation. And on this front, too, we all benefit from a nurse's voice. When nursing's voice is missing, nursing's expertise is lost and I think the American people lose.

The Act awards competitive grants to nursing schools to strengthen nurse education and training programs and to improve nurse retention programs throughout the country.

It increases the student loan amounts for nursing students and addresses critical nurse faculty shortages by making nursing faculty eligible for loan repayment and scholarship programs.

In many ways, the future of the nursing profession looks brighter than ever.

HRSA's recently released report on the registered nurse population – Initial Findings from the 2008 National Sample Survey of Registered Nurses – found that the number of RNs grew to a new high of 3.1 million between 2004 and 2008, more than a 5 percent increase from the 2006 report. This also reflected growing diversity in the backgrounds of nurses in the U.S., primarily among Asian and African American nurses, less so among Hispanic nurses. You'll want to read this report if you haven't already.

While this is good news, other data show that the average age of a practicing nurse today is higher than it has ever been in the more than 20 years since HRSA first began tracking the profession; and the average age for nursing faculty has risen to 53.5 years old.

In two recent nursing summits co-sponsored by HRSA, we learned that 84 percent of U.S. nursing education programs are now reporting difficulty in recruiting and hiring new faculty – creating a teaching bottleneck that resulted in 99,000 qualified applicants being denied entry into nursing degree programs in just one recent year.

The good news is that we don't lack for applicants, or recognition that we have a challenge.

At the federal level, you need look no further than the Recovery Act funds committed to this cause, and the recent increases in funding allocations to nurse education programs, to know that this President is mindful of the trend, aware of the problem, and committed to doing something about it.

We are all thinking very much about the future, because included in health care reform are such innovations as nurse-managed primary care clinics; bonus plans for NPs who work in shortage areas; and expansion of nursing and other health professions training programs.

Health reform also expands the community health center network that HRSA supports. As I mentioned earlier, more than 10,000 nurses, NPs and nurse mid-wives work in health centers – the largest single professional contingent in the health center system. It is difficult to imagine how we would have risen to the challenges of the recent economic downturn without them.

Between the Recovery Act's impact on health care and health care reform, this is clearly nursing's time in the health policy arena.

With all this happening, nurses have much more to contribute. So I ask all nurses – each of us as individuals and all of us collectively – to recognize more profoundly the absolutely essential need for us to engage in public policy.

But let's be honest, it's not enough to say, “I'm a nurse and I know what we should do.” We need nurses who understand political science and who know economics, informatics and system redesign who know how to generate, interpret, and/or apply evidence. We need nurses who understand the issues involved in building a high quality health care system and who can explain it to the public and to lawmakers.

But nurses must be engaged in the dialogue. The scene may be local, statewide or national – in fact, the arena nurses choose to enter can be almost anywhere, but our individual and collective voice should be heard. As I've said, if I've learned anything in the last 30 years, it's that nurses' engagement in public policy is important.

Health and health care is our work, but health care policy is our work, too.

Thank you and now I'm interested in hearing from you.