Scholarship - Reflections on Serving as Chair of the National League for Nursing

In this episode of the Nursing EDge Unscripted podcast, Dr. Steven Palazzo hosts Dr. Kathleen Poindexter, Interim Associate Dean at Michigan State University, as she reflects on her service as NLN Chair. Dr. Poindexter highlights the impact of the COVID-19 pandemic on the nursing shortage and the increasing reliance on temporary staff, emphasizing the need for long-term, sustainable solutions. She stresses the importance of stronger academic-healthcare partnerships and the need for more funding, resources, and a unified voice within the nursing profession to address these issues. The conversation also touches on the critical role of diversity, equity, and inclusion in shaping the future of nursing.

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Transcript

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[Music] Welcome to this episode of the NLN podcast Nursing EDge Unscripted the Scholarship track. I am  your host, Dr. Steven Palazzo, a member of the editorial board for  Nursing Education Perspectives. Nursing EDge Unscripted in our track entitled scholarship  celebrates the published work of select nursed educators from the NLN's official journal,  Nursing Education Perspectives and the NLN Nursing EDge blog. The conversations embrace  the author's unique perspectives on teaching and learning innovations and the implications  for nursing program development and enhancement. Today we have a really special guest with us, Dr.  Kathleen Poindexter. As you all know, our past chair of the NLN and she's also the Interim  Associate Dean for Academic Affairs and the Assistant Dean for Undergraduate Programs and  Faculty Development at Michigan State University in Lansing, Michigan. Dr. Poindexter, welcome, so  glad to have you. Thank you and I appreciate the opportunity to speak with you. This is great. So one of the conversations briefly Dr. Poindexter and I had was about the shortage of nursing. We've been talking about that for quite a while. It really was enhanced during  the Covid pandemic and we're coming out of it but we're still seeing a lot of turnover in the  nursing workforce, especially with our new nurses and when I've been talking to physician colleagues  and nursing colleagues, some of the chatter I've been hearing is about new and innovative  and entrepreneurship type of endeavors and the lack of nursing or qualified nursing to help  lead and to help progress those endeavors. I've had physician colleagues say to  me, if nursing's not going to be there we don't we don't have them because they're not in the in the  pipeline. We'll create positions, we'll create education for the needs that we have.  So Dr. Poindexter, what I really like for you to talk about is kind of in your last couple  years as Chair, what has been your experience in nursing recruitment, workforce retention, where  you see the biggest gaps and what can we do about this? What do you think are the solutions? That's a big question! It is. It is. But you don't have to have the solution today. But those are the challenges that we're facing. They were there pre-pandemic and then during the pandemic they've expanded so  I think it's important to recognize that this is a deeper issue that we really need to look  at in our profession and come up with some sustainable, longstanding, supportive solutions to  rethink and kind of reimagine how we prepare the workforce for the future. And you're right, what  I'm seeing too, not just hearing, but seeing is that because of the shortage of nurses and the  tremendous expense it's been for so many health care organizations to bring in travel nurses and  as you know there's a there's a tremendous influx in and a rapidly growing increase in the number  of foreign nurses that are coming in to take the places, which is which is good. Everything has its  own consequences as a result of it but I think the most important piece here is that you're  right. We're seeing that other health care specialties, disciplines are replacing the workload  and the ability of nurses to hold positions and we're seeing it in many areas whether it's  paramedics that are now taking place or EMTs working on on floors and they're just staying there but that's our profession and it's not that they didn't  do a phenomenal job in an emergency situation, so I commend the ability of our health care systems  and organizations to work together. However, they don't have the background, skill set that nurses  that nurses have and the ability to provide that holistic type care that's necessary to really  promote quality, evidence-based care holistic care that our patients deserve and what they've come to expect. And that is what we stand for. We have to go back and look at,  I think the beginning roots. There's one,  a supply chain that's an issue and  what are we doing in education to help prepare the workforce. But there's also a big issue with  what happens within the workforce so that we can continue to retain those nurses. We do have the  ability to have those senior level nurses, those expert nurses, those that are willing to go on  and move on to grad school that become the faculty that become the leaders of our profession because  there a big ripple effect for all of it and you can't have...one significantly  impacts the other. I envision...I think the long-term production method that we've  had throughout all my years of nursing education is, it's almost an industrial approach to producing nurses. Yes, I agree. And I hesitate to say that term but I'm speaking honestly and transparently. Is that we just keep rolling them off the assembly line. And we've got plenty of applicants,  but as we look at the rates of retention we're still seeing according to the most recent  data I've read that we're still close to 50% that not only leave their positions but they leave our  profession after the second year. Yes. We're also hearing loud and clear that our students  are not coming out prepared with the competencies that they need to be competent and confident  nurses so that it's taking the strain on an already strained health care system to have  to prepare and educate our novice nurses that are coming in. Residency programs are good, however,  what I am hearing in all of our meetings with our health care partners is that there's much  greater demands on preparing nurses as they come into the workforce now than they've had  historically and they are not coming in with the competencies, skills that they really require in  order to transition into practice. Everything I heard from a national meeting or committee  that I'm involved with is we had health care leaders that are saying they have to teach them  even skills as making beds and yet we're trying to focus on higher level, complex care, clinical  decision making prioritization and I think we really need to come together closer with that  partnership in that academic environment. So one, the partnerships are crucial right now. We lack the  clinical sites in order to prepare our nurses at both undergrad and grad so I'm not confining this  to just new novice nurses. We lack sites and preceptors in order to prepare the future  workforce. Without the sites, without the preceptors, without the ability to work together, we're limited  on the number of nurses that can transition into the workforce and it's a perpetuating cycle. The  more we create innovative, collaborative models and really move forward to say academics and  health care are in this together. We both have the ultimate goal in mind is to prepare  a workforce with the competencies, the confidence, the skill sets to be able to provide the level of  high quality care in our health care environments to be able to partner with them and to leverage  resources together, to be able to collaborate and partner with some of the nurses that they have  on the units to allow our students to really experience a full role of the nurse to be able  to work with them to partner with them from the beginning of their their educational process has  really a strong potential to better prepare the students for the future needs. Our current models  nationally are generally that one or eight students or 10 students to one clinical  faculty and we know that that acuity really minimizes the amount of work any one clinical  faculty can work with their students. So it's preventing them from becoming fully  prepared to enter into the workforce. They're limited with medications. They're limited with  patients. They're limited with skills. They're limited...we are their barrier so educators are  their facilitators and their barriers because we're limited. I think strong academic health care partnerships are just a must. They're absolutely essential. We both have shared  resources. We can help each other. We can come up with a sustainable, more long-term solution so  that we re-envision and rethink how we prepare nurses for the workforce and make it, like I  said, that's sustainable change. It's not a temporary Band-Aid, right, not a temporary change.  It's really putting those think tanks together to say let's permanently address this concern  and prepare what we need. The big issue is that nursing has to come together and really  speak with this single voice from practice, regulation, academics and I think we've been all too siloed. Well, that's been a that's been a theme since I've been a nurse. I've been   a nurse over 20 years and nothing's changed in that area too much. And it limits our practice and we're seeing some measures moving forward. The pandemic has opened up the  use of much more technology so from an academic perspective we've become much more open to the use  of virtual simulation and simulated environments where we can provide that controlled, safe  environment for our students to learn to practice before they go into the environment and actually  provide that type of care on on a real patient. That's a huge movement forward and it has  been costly, there's no doubt about it. That's one of the challenges is the resource availability,  but we are able to move that forward. We're able to use more telehealth. It helps with education  as well because we can now use telehealth to collaborate with some of the advanced practice  nurses where we can't always access the types of environment that we need to place our  patients or our students in, especially those remote hard-to-access areas and we all  know that part of the problem is how best do we prepare our future workforce to meet the needs  of not only the patients that are convenient but those that are rurally located, those  that have problems with access, those that don't have the resources. We're really looking  at preparing nurses to be able to reach and expand out in the communities where health care has really been a challenge. So, what role does the federal government potentially have in incentivizing our clinical partners and our universities? Well, as I started to say, resource allocation is a major problem. It's funding. This is expensive. The more that we can prepare students. We  need more resources. We need more sites. We need more faculty for those nurses that have left  the workforce. Many of them really didn't want to leave the workforce, but perhaps we can collaborate  and find ways where we can use their expertise. They've got tremendous ability to  not only prepare future nurses but help with education and perhaps help in patient care in  different ways that address some of the concerns they had during the pandemic, but we need funding.  We need the federal government to be able to provide funding for nurses for scholarships  we need funding for faculty development and for faculty salaries. We know one issue   at least limiting the number of students that can come into the academic environment is a  limit on the number of faculty that we have. Many faculty find it very difficult to transition from  because of the pay differential. And then you've got - who are the faculty, they're the ones with  the advanced degrees. They're the ones with the potentially school loans on their own. This  is something that the federal government could certainly step in and provide the funding  to support faculty development and loan repayment and scholarships not only for the students but the  faculty themselves to offer more funding that's available in the form of grants. So what are some  innovative and creative ways that we can develop partnership models that are truly research-based  and that we can test and validate that this is a sustainable model? Again, that costs money  and we know that grant money is becoming more and more competitive and education is not always  number one or high on the level of research grants and the funding that's available. That's right, that's right. Many of the areas that I really learned that were so essential during my time as chair at the National League for Nursing and I think we all cognitively know it. I smile  I could get it right on the test, but to really live the experience of the absolute essential  importance of nurses and multidisciplinary teams communicating together to identify that shared  voice and the shared priority and speak with one voice to move forward, that's what can be  used to advance policy initiatives to advocate for funding to move initiatives forward. It  doesn't happen without that and I think that's a challenge that nursing needs to work more on  because we aren't very unified in our voices and our requests. That was that was a huge component  is the power of networking, power of having a seat at the table and a voice where you're heard,  where you're respected and collaborative with others so that we can move forward. That was  that was absolutely imperative. The other component piece that I really learned is that really,  again, I think we all hear about it. We hear so much about diversity, equity, inclusion, anti-racism and  we know that we want to be able, we must be able to increase the diversity of our future workforces  so it's not a matter of just getting nurses or students in here to like I said to to move them  forward in the workforce. We need to look at the diversity because we know and again, Covid made  this huge chasm visible to all of us that we could no longer ignore it. It's always been there but we  were able to look the other way and we can't do that anymore. We know that the populations  that suffered the most were those that were the most vulnerable, those that were marginalize, those  that didn't have access, those that had poverty concerns. We're seeing more and more problems  with planetary health issues, climate change and again, where's the impact on health? It's the same  populations. We don't have the ability to the diverse workforce, the diverse nursing workforce  to best reach out to various populations that are most impacted and most affected by some of  the major changes that we are seeing today in our communities, in our health care environment.  It is so important to really focus on not only diversity in true inclusion and understanding and appreciating what equity means in our nurses, in our students, but we also have to  be able to reach out to the workforce because our students go in the workforce and and it they get  mixed messages sometimes because I'm not sure that we're all on that same level. And what can  they do about it? How can we help promote leaders that are diverse so that there's more role models  for our students to be able to look up to and emulate? Absolutely important and I hear it  over and over even from our students. No one here looks like me. There's no one I feel comfortable to  go to or we have a challenge maintaining leaders within the academic organization or within the  health care organizations so it's important to know that not only can we bring greater diversity  into the workforce that's necessary to promote the health and advance health equity across all  populations as the diversity of our nation grows . That's our responsibility. That's what nurses do  and I think we've got to look at it again from not only the educational perspective but from  the health care perspective and again, a lot can be helping with our federal government funding,  supporting scholarships, incentives, continued education, continued programs, workforce  development programs, grants for equitable workforce development programs so that they do  have the ability to do seamless transition, reduce the barriers to advancing in their  education, meeting students where they're at, and helping them to move forward. So I think that  was a major I think those are some of the major initiatives that I've really learned and there's a  lot going on. Tri-Council is an organization where we have those leaders  from practice, academics and regulation and the lead top leading five nursing organizations come  together to really collaborate and discuss and identified shared agendas and how do we prioritize  where our efforts are going to be because we could go on for a long time and talk about challenges  and we can't use a shotgun approach. We've got to be able to be strategic, establish those action  plans, and know where we're moving forward and moving forward as a group nurses on the front  line can be a part of that and they can start it and they need to follow that same process. We  as educators need to need to provide that type of background for our students. Well, thank you so much for sharing your experiences and what you learned in your two years as chair. This is a topic obviously that deserves a lot more time than we able to give it in these podcasts, but my hope  is that those who are listening, who are I'm sure many of them are well aware already of  these concerns and issues, but will spark something that they can take back to their individual  facilities, their places of education and think about how to strategize in a way that  brings industry, our clinical partners and the universities and colleges together to  address some of these workforce issues. So leave us with one of the one of your highlights  of your tenure, the uplifting thing that you saw in the two years that just really inspired you when you left office. I think the most inspiring message and the most inspiring  thing I took away is that nurses are phenomenal leaders and we have the skill set that includes  the leadership, the communication, the personal, the human touch, the creativity, the resilience, the  innovation. We have a lot of skills in our profession that I think we take for granted and  the ability for one person to come back and to include others to move this forward. It doesn't  take a national...it doesn't take NLN or AACN or any of the other  organizations. It's something that every one of us can do is we come back to our own organization and  use those same leadership principles, the advocacy principles, the diversity principles and to reach  out to our health care partners and to create that shared vision to move forward to how we are going  to together address the issues and the concerns of our health care environment and our health care  workforce. So there's nothing that's going to stop any one person or any individual that  steps up, solicit, network, recruit, drive motivation, excitement, enthusiasm, remind all of  us of what we're here for and to really look at those topics. What are the priorities in the  wide ranges of what was necessary in health care? But I think that's the biggest message is that I  always say, any one of us are just one person and anybody can do the same  thing that we've all accomplished and don't don't feel restricted. Don't feel that you  can't do it. And I'm going to quote Bev Malone. It's a message that's resonated with  me forever and I think comment is that she said, "I never thought I would, but I never thought  I couldn't." And if that is one message that every single nurse can take with them is that you can.  You just need the motivation and the enthusiasm and the focus and and try be  a part of the solution. Nurses should be part of the solution, not contribute to the problem and  we have the ability to do that. Dr. Poindexter, what a honor to have you on. I really appreciate it. Thank you for your words of wisdom. Thank you for your service to the profession, to the  NLN. Again this will be a nice treat for our viewers. Thank you as always it's been an honor and a privilege and I greatly appreciate all you do as well and all the NLN does in the podcast.[Music]