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COVER STORYPromoting partnerships to improve public health
by James E. Mattson On Aug. 29, 2005, Hurricane Katrina invaded the Gulf Coast of the United States at the delta of the Mississippi River. Churning onto land with sustained 127-mph winds, the cyclone was accompanied by a massive 21-foot-high storm surge that breeched levees intended to separate the waters of lakes Borgne and Pontchartrain, the Mississippi River and the Gulf of Mexico from vulnerable, below-sea-level New Orleans neighborhoods (Swenson, n.d.). After wreaking death, destruction and devastation in southeastern Louisiana, the storm proceeded northward, recklessly spending what remained of its Category 3 energy on the cities and casinos of coastal Mississippi. The costliest hurricane in history, Katrina was the third deadliest to strike the United States in more than a century (Knabb, Rhome, & Brown, 2005). In the finger pointing that followed Katrina, many criticized the “too-little-too-late” responses of local, state and federal governments. One success story that attracted relatively little notice, however, was a Web site and hotline, set up at the order of the U.S. surgeon general, to facilitate recruitment and deployment of health care workers to areas ravaged by the hurricane. U.S. Surgeon General Richard Carmona assigned the order to get the Web site up and running in two days to then-Capt. Carol A. Romano, RN, PhD, BC, CNAA, FAAN. On Aug. 31, 2005—just two days after Katrina made landfall—the
new Web site began accepting applications from health care workers
wanting to aid in the relief effort. In the next three weeks,
the site attracted 260,000 visitors, 34,000 of which completed
an online application to volunteer their services as uncompensated
temporary federal employees. To complement the Web site and to
triage questions, a “24/7” toll-free hotline was set
up with response centers in the District of Columbia, Maryland
and Kansas. By the time recruitment was completed, the hotline
had handled approximately 21,000 phone calls that came in from
all 50 states and 15 foreign countries. More than 1,300 credential-verified
volunteers were deployed through the program. Interestingly, it was a USPHS chief nurse officer who first inspired Romano to become an officer in the USPHS. After receiving a nursing diploma in 1971 from Geisinger Medical Center in Danville, Pa., Romano began her nursing career as a civil-service clinical research nurse at the National Institutes of Health (NIH) Clinical Center. After earning a BSN in 1977 and an MS degree in 1985, she had an opportunity to speak with Chief Nurse Officer Faye Abdellah, RN, EdD, LLD, ScD, FAAN, who encouraged her to consider opportunities available in the Commissioned Corps of the U.S. Public Health Service. In 1986, Romano was appointed to the Corps and, in 1993, assimilated as a Regular Corps officer, the same year she received a PhD from the University of Maryland. A pioneer in the field of nursing informatics, Romano was involved in 1976 in designing and implementing one of the first computerized medical information systems. Co-architect at the University of Maryland of the world’s first graduate curriculum in nursing informatics, she has authored more than 50 published papers, edited two books, served on three editorial boards and given numerous presentations on the subject. In addition to her roles as chief nurse and assistant surgeon general, Rear Admiral Romano is currently assigned as the deputy chief information officer at the NIH Clinical Center in Bethesda, Md., where she directs clinical operations for development, implementation and evaluation of the NIH Clinical Research Information Systems. She and her husband, Anthony, have two children and two grandchildren. Recently, I interviewed Rear Admiral Romano and asked about her first nine months as chief nurse officer of the U.S. Public Health Service. Q: You were instrumental in creating the Federal Volunteer Line and Web site within the first couple of days after Katrina landed, which were very successful in recruiting and deploying health care volunteers. With the benefit of hindsight, are there things you would do differently next time? Better coordination with state and local recruiting initiatives will be critical in future disasters, to prevent confusion and duplication of efforts. While the volunteer effort provided a useful resource, it underscored the critical need for volunteer groups that are pre-identified and pre-credentialed. We are encouraging those in the database to join groups such as the Medical Reserve Corps or their state emergency response teams. Q: Since then, you’ve been promoted to chief nurse officer of the U.S. Public Health Service, rear admiral and assistant surgeon general. What are your duties, and who are some of the stakeholders with whom you regularly collaborate? The duties of the chief professional officer for nursing are to provide advice and consultation to the Office of the Surgeon General on policy issues related to nursing. I also represent the Office of the Surgeon General and the U.S. Public Health Service in contacts with groups at the state, national and international levels and with professional societies concerned with nursing issues. I have worked hard to establish partnerships with the nursing professional organizations and the regulatory license bodies because I believe we all have a responsibility to work toward creating a unified voice for nursing in improving the health of the nation. I have traveled a lot in past months to present at conferences and visit nurses serving in underserved areas. I have also worked to serve as a liaison for communication about national initiatives in informatics and to stay involved in the field of informatics, including a role in clinical research informatics at NIH. I value my responsibility to represent the 4,000 nurses who serve either in uniform (1,350) or as civil servants or tribal nurses who work in the U.S. Department of Health and Human Services (HHS) or agencies that HHS supports. I have met with some of the nurses and leaders in many of these agencies about nursing issues. I work with the Nursing Professional Advisory Committee, which is representative of nurses from the different agencies that support the USPHS mission. This group serves as a vehicle to facilitate communication, career development, mentoring, recruitment and emergency preparedness as well as developing leadership in officers who serve on this committee and its subcommittees. I also work with 10 chief professional officers from the other USPHS officer categories (medicine, pharmacy, dentistry, nutrition, health services, engineering, environmental health, therapists, veterinarians, scientists) to advise the Office of the Surgeon General on policy and to lead officers in the transformation of the Commissioned Corps. This board of chief professional officers offers leadership in directing the future responsiveness of the Commissioned Corps of the USPHS to protect, promote and advance the health and safety of the nation. Other stakeholders I collaborate with on a regular basis are the federal chief nurses of the Army, Navy, Air Force, Red Cross and Veterans Affairs to address issues in federal nursing service that we all share. This group advises the president of the Uniform Services University of the Health Sciences and the dean of the Graduate School of Nursing on issues related to the university’s nursing program. Q: You are the chief nurse officer in the U.S. Public Health Service, but your influence and contributions to nursing are not limited to the United States. Recently, you attended two World Health Organization meetings in Geneva that addressed global nursing issues. Tell me about those meetings and your perspectives about health concerns around the world and the role of nursing in addressing those concerns. In May, I attended two World Health Organization (WHO) convened nursing meetings in Geneva, where I joined government chief nurse officers and midwives from 50 countries to discuss shared concerns and health priorities. Our discussion focused on strengthening health systems; HIV/AIDS/TB treatment, control and prevention; making pregnancy safer and advancing reproductive health research; pandemic preparedness; human resources for health; and building health leadership capacity. We then met with presidents of 90 national nursing associations and 40 directors of regulatory bodies from various nations in an inaugural triad meeting. We addressed issues of common interest and shared ideas and collaborative actions germane to government, regulators and professional bodies. The focus was on issues critical to the provision of safe, quality nursing and midwifery care, and included discussion of health worker migration and shortages, scope of practice authorities for new cadres of workers, educational service gaps and safe/positive practice environments. Each country collaborated with its triad and submitted recommendations in each of these areas. Representatives of the Office of the Chief Nurse USPHS, the American Nursing Association and the National Council of State Boards of Nursing comprised the U.S. delegation. The World Health Assembly, which sets the agenda for WHO, followed these meetings. A resolution on strengthening nursing and midwifery, stressing the important contributions of nurses and midwives to global health, was approved at the assembly. The resolution also called for urgent action by member states to support and provide resources needed to strengthen nursing and midwifery services. International interactions provide great opportunities to network and share information with other health leaders about challenges and strategies in health care and nursing. At these sessions in Geneva, I reviewed WHO priorities with my global nurse colleagues and discussed how to work in partnership to achieve them. I returned with a broader perspective of nursing issues common to the world, those unique to the United States and those shared by disadvantaged countries. There are many areas of common concern globally in nursing. Strength, professionalism, caring, compassion, healing and determination are attributes shared by us all. Q: Describe a “typical” day in your new role. I don’t believe I have had a typical day yet. I have learned to multitask at an accelerated rate and simultaneously balance global, national and local issues, sometimes all in the same day. My role has changed in that I have many more stakeholders and customers to serve. Q: How have your new responsibilities changed your perspectives? When I reflect on how I have changed, I suppose I have developed a comfort level with the reality of chaos and uncertainty and the fast pace of change. And I have come to respect the value and need for a physical, mental, emotional and spiritual balance in order to deal with persistent demands and competing priorities. I believe that my capacity for learning has grown, as there has been so much to absorb in so short a period of time, and I have had to expand my capacity to process multiple perspectives of any issue. I have developed a deepened respect for the tremendous complexity of a changing health care system and the role of policy and politics in shaping the future. I also have learned that the capacity for nursing involvement and influence is a huge, yet untapped, resource and that nursing truly holds the key to the future of human health. Q: There is an initiative, currently in
the works, to create an Office of the National Nurse. What would
the role of that office be, and how would it differ from the Office
of the Chief Nurse? There are many similarities as well as differences between the Office of the Chief Nurse of the U.S. Public Health Service and the proposed Office of the National Nurse. The proposed activities of recruiting, fostering nurse educator roles and working to increase health literacy are similar. Both offices, it is suggested, would report to the surgeon general and partner with professional and regulatory nursing organizations. Evaluation of new government infrastructures needs to be done thoughtfully. There is also a need to consider the role of the public health chief nurses at the state level and how their leadership and roles can be leveraged to increase the impact on health. The proposals I have seen do have some good ideas and deserve consideration. Q: You are a pioneer in the field of nursing informatics. How should nurses view the ever-increasing influence of information technology on nursing? Health care delivery is information-intensive. Many of the roles that nurses play in health care require the ability to gather meaningful information, structure it to facilitate analysis and then use it to support the clinical and administrative decisions that nurses make. Access to knowledge and information resources available through the Internet or library databases is critical for nurses—and consumers—to keep abreast of the evolving science and new evidence that supports changes in health care. Nurses need to consider the use of new technologies that facilitate access, processing and management of information as valued tools that support their practice. There is always concern when we mistakenly think that it is all about the technology and doing work faster. In health care, focus on information and how it is used in the processes of care delivery may be overshadowed by the seductiveness of computer technology. Technology and speed are not ends unto themselves. Rather, it is about the crafting of technologies to support the information work of nurses. Q: Are there any information-technology trends in nursing that are of concern to you, trends you find troubling? I am concerned when nurses are not involved in the design and development of computerized systems that are intended to improve quality and safety, and enhance a nurse’s practice. A nurse’s work involves intensive information coordination, integration and communication in a work environment of nonlinear, interruptive activities where the nurse is frequently multitasking. Nurse leadership is needed in the implementation and evaluation of information technology so it can support this kind of complex work environment. Safe practices and innovative processes can be realized when there is a fit between nurses directing the use of technology and technology offering creative, new ways of moving nursing to a higher level of evidence-based practice and clinical decision-making. Q: Nursing informatics is probably most often associated with searching for and utilizing information available on the Internet, but it encompasses more than that. What is nursing informatics, and how will it affect the future of nursing? There are several definitions for nursing informatics. Basically, it is the integration of several bodies of knowledge (computer, information and cognitive science) applied to the science of nursing. It focuses on the information-handling tasks required in nursing and health care. These tasks include identifying what information is needed and how it is collected, processed, managed, stored, retrieved and communicated. Most importantly, nursing informatics is about how data can be transformed into structured and meaningful information that can be used in clinical and administrative decision-making. Informatics is critical to the future of nursing, as it is a powerful tool that will enhance the cognitive aspects of delivering care and using evidence to support decision-making. Informatics can optimize the elements of effective care by enhancing the use, access and understanding of information so that the right outcomes are achieved; the right clinical data are available; the right presentation of data is used; the right decisions are supported and made; and the right processes are implemented. Informatics applications can provide alerts and reminders to foster safe care and help implement the criteria for quality services defined by the Institute of Medicine as safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. As we become more sophisticated in developing and managing databases of clinical information, we will be better able to “mine” the data to discover new knowledge or patterns, symptoms and effectiveness of treatments. Q: The theme of this issue of Reflections on Nursing Leadership is “Fostering leadership through collaboration.” At the last annual conference of the Healthcare Information and Management Systems Society, you made a presentation titled “The Healthcare Partnership: Increasing Communications Among Professionals.” What are some of the communication challenges that need to be addressed? In today’s health care environment, it is rare for any discipline to practice in isolation. Health care providers are interdependent in sharing and communicating different aspects and perspectives of care. The extent to which our information and communication are fragmented directly affects the degree to which care is fragmented. We have many communication challenges. First, we need to expedite the transition from paper-based communication systems to electronic information management. In addition, lack of immediate access to health information, miscommunications and misinformation are all sources of medical errors that threaten patient safety. Electronic systems that are well-designed can help eliminate some of these sources of errors. Next, our technology and the networks over which information is transmitted are not interoperable, so our electronic systems cannot “talk to each other” or follow a patient across different settings of care. We are also challenged by the need to protect the privacy of clinical communications that travel over electronic networks. We lack a common vocabulary or language to describe clinical symptoms, results and problems, and this limits our ability to communicate consistently and reliably. Finally, we need to learn and understand how different health care professionals process information, and we need to focus on interdisciplinary communication and information management. We cannot ignore the need for interpersonal dialogue across providers and in partnership with consumers. Q: You began your civil service career in 1971 as a clinical research nurse at the National Institutes of Health Clinical Center. Obviously, the U.S. Public Health Service was a good choice for you, and you’ve been very successful. For nurses just starting their careers, what would you like them to know about a career in the U.S. Public Health Service? A career in the USPHS offers unlimited opportunities for U.S. nurses to serve their country while improving the quality of people’s lives and making a real difference in public health. A nurse can serve as a commissioned officer or as a civilian federal employee. I actually did 15 and 20 years in both capacities, respectively. My past 20-plus years have been as a commissioned officer. The Commissioned Corps of the U.S. Public Health Service protects, promotes, and advances the health and safety of the nation. With more than 6,000 officers—over 1,300 are nurses—the USPHS is the major health arm of the federal government and the world’s foremost public health service. It is one of seven organizations that make up the uniformed services of the U.S. government and is composed entirely of officers who have been commissioned on the basis of their health-related training. Commissioned officers deliver ongoing health promotion and disease prevention programs and are called on to provide onsite clinical and public health expertise in times of national emergencies and large-scale disasters. The focus is on helping to improve clinical care for an entire community of patients. While there is plenty of one-on-one patient care, there are opportunities to become involved in organized community disease prevention and treatment programs that can make an impact on overall community disease rates. There are generous benefits, including 30 days of vacation and access to military health care. I encourage nursing students or nurses interested in joining the fight for public health, or those who have questions about what we do and how nurses can make a difference with the Commissioned Corps, to call for information at +800.279.1605 or +1.240.453.6125, or visit our Web site at www.usphs.gov. The U.S. Public Health Service is one of the best-kept secrets in terms of opportunities for nurses and students, and we want to change that. I wish I had known more about the USPHS when I was a new nurse. Q: What future do you envision for nurses and nursing? I believe that nursing is the future of human health, and nurses will be called on more than ever to meet the public health challenges of this century. Globalization, advances in science and technology, and demographic transformations offer opportunities for nurses to manage the chronic diseases of an aging and diverse population with the innovative tools of our times. It is the nurse who protects by responding to threats of illness
and disasters. It is the nurse who reaches out to care and comfort
those who are vulnerable and in need. It is the nurse who promotes
health by nurturing the human response to disease and the social
reintegration of people’s lives. And it is the nurse who
advances the quality and safety of care through inquiry and the
application of science at the bedside. RNL References Knabb, R.D., Rhome, J.R., & Brown, D.P. (2005, August 23-30). Tropical cyclone report: Hurricane Katrina. Retrieved September 6, 2006. Swenson, D. (n.d.). Flash flood: Hurricane Katrina’s inundation of New Orleans, August 29, 2005. Retrieved September 6, 2006. |
