Nurse Shanita Williams is a program officer at the Health Resources and Services Administration (HRSA) for the National Center for Interprofessional Practice and Education (NC-IPE) cooperative agreement award in Rockville, Md. On Nursing Notes Live this month we learn how inter-professional collaboration between nurses and other health professionals impacts patient care. Shanita and host Jamie Davis talk about her nursing career path and the importance of providing a nursing perspective to hospitals to improve teamwork and patient outcomes.
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Jamie Davis: Hi, Shanita, welcome to Nursing Notes Live. It’s great to have you here on the show. I’d like to start off with our first question – I always ask our nurses here on the show – and that is tell us a little bit about why you wanted to become a nurse.
Shanita: Hi, thank you. When I think back about why I wanted to be a nurse, I always think about having pain and someone giving me a Tylenol and wondering, “How does the Tylenol know where to go where my pain is?” That was always in the back of my mind. How does the medicine work? And then as I got older and started to make a decision about where I would go, what would I be professionally, I had always thought I would be an engineer. I happened to be in a university that had a really strong nursing program and many of my friends were a part of that program. I would hear stories about while I was in engineering they were in nursing but we would tell stories about what we were doing in the classroom. And their stories of interacting with people and the cost of what was nursing science was so much more interesting than my story. So just hearing those stories made me want to have that experience. I have an opportunity to work with people and to treat people and make people feel better. That was sort of the foundational reasons why I went to nursing school.
Jamie: I know you work in a public health aspect of nursing now with the federal government, but tell us a little about your path for nursing? Where did you get started and how did you progress through your education to the point where you have a PhD at this point?
Shanita: Sure, I started in a BSN program actually, a four-year degree. So my first degree was a BSN. I went to nursing school straight out of high school and I spent one year on an engineering track and then switched. I still graduated pretty much on time. Then I went to work on a MedSurg unit. The hospital quickly realized that I had more questions about why people were coming in with the illnesses and conditions that they had. I was curious about that. I ended up going back to school within a year and doing my Masters in Nursing. Both of my Bachelor’s and Master’s were at the University of South Carolina in Columbia. I went to my Master’s program fully expecting to have a clinical nurse bachelor’s degree to get that. And then I got exposed again through my peers, got exposed to the whole concept of a family nurse practitioner and immediately fell in love with that concept, at that way of that profession. The fact that they were in the community dealing with people in a primary care setting felt more natural, a natural fit for me. So I switched my major, even in my Master’s program, pretty much the same way I did in my Bachelor’s program. Switched my major over to the family nurse practitioner. My first job after graduating was in a pediatric practice. I spent a year in Myrtle Beach, South Carolina doing great work. I thought was way too easy. It was way too much fun. I felt like playing with children. I thought it has to be more difficult than this. So I stayed there only a year and then moved to Atlanta, Georgia to work with a group that did healthcare for the homeless. And so that was a complete opposite of my first job where we did primary care services to homeless in a mobile van. To me that felt like it was sufficiently hard enough. It was a completely different experience although it was a wonderful experience. I think one of the things I quickly learned was that many of the nurses in that role were doing a lot of frontline work and doing a lot of important work, but I still was very curious about how to get credits for that work. How to invest more so that we could get – at the time, this was back in the early ‘90s. We were not getting reimbursed. So we were going out in those outpatients or in those homeless clinics, we would do primary care. We would step out of the way and the physician would bill for our services where we could get billed or the physician would step in and advocate for grant funds for us to continue the work. So we were sort of pushed out of the limelight. For that, that triggered for me the need to go back to school again so that I can be in a position where, for me, at the time, it made sense to pursue a PhD. I was thinking of getting more on the education side and preparing nurses to think in more advanced roles versus just being focused on the clinical work, which is very important. So after that experience, I was planning on going back to school, but I wanted to see if I could really be good at teaching. So I took the University position in a small liberal arts college. It is in the north of Atlanta. I taught and started back for my PhD program and then I ended up getting my PhD. That’s how I ended up with my PhD in nursing. What I did not anticipate was – I did not plan on getting the MPH but I did have a mentor who urged me to go immediately into a post-doc program. Her position was that the PhD was the beginning, not the end of the journey. So I was strongly encouraged by my mentor. Part of my story is that mentorship is crucial. I ended up getting a postdoc fellowship at the National Cancer Institute in Bethesda, Maryland. Part of that fellowship required that we all went and got a Masters of Public Health because they were expecting fellows in all disciplines but they want everyone to have the same core experience. So the Masters of Public Health was considered that core experience for all of their fellows. And that’s how I ended up with my Master’s in Public Health on top of my PhD in Nursing. From there, I ended up on epidemiology track because I got exposed to Epi doing that MPH work at Johns Hopkins. I stayed on that track for a long time till I came back to nursing in the Federal government.
Jamie: Yes, it sounds like you just continually challenge yourself. And I wonder if you have a few thoughts to share with our audience of nurses and student nurses about the importance of continuing to find not just positions you enjoy but positions that challenge you as a nurse.
Shanita: That’s exactly right. I think that’s so important. I would challenge all nursing students and nurses that are actually working out in the trenches on the front lines that the beautiful thing about nursing is that there is so much space and room for opportunities and for flexing – the flexibility is incredible nursing that you don’t see in many other professions. As opportunities present themselves where you start to feel that – I always tell students the moment you feel like you’re mastering a domain, the moment you feel like you’re becoming an expert, it’s time to do something different so that you feel challenged and so that you flex those weak muscles per se. So you have an opportunity to continually grow and not get stagnant. At some point you become an expert and then it slipped past you that you become content and maybe a little out of date. You never know. It’s a thin line. So yes, you have a unique opportunity in nursing to flex and do all sorts of different things and they combine different professions into a coherent body of work. Even though I move constantly in different areas in nursing, I have a core commitment to vulnerable and underserved populations. I was able to maintain that core commitment even though I moved in different spaces within nursing.
Jamie: And even as you progress – and you talked a little bit about mentoring, that’s a topic we talk a lot about here on the show – and it’s interesting that you said how important mentoring was to helping direct you on your path even at a high level of education. Even at that point, you can give back and become a mentor for others and stay connected and challenge yourself in that way as well.
Shanita: Absolutely. And I take mentoring seriously. Every opportunity that I have, and every opportunity that presents itself, I try to step up to the plate. I always say that many times you don’t choose your mentor, your mentor chooses you. It could be a bidirectional process. I think mentoring is important because sometimes when you are pursuing goals or you’re working at it, it’s hard to hold your head up and see the next way for because you’re in the thick of it. It’s hard to see above and see what direction to take. Mentors are so important with seeing somewhat in people, especially young people or people who are in a new area what they can’t see for themselves and directing them. So if you have someone who is comfortable in their own roles – and I think the best mentors are comfortable in their own roles – they’re not threatened, they’re content with the work that they’ve done and that you can trust them and that they are invested in the next generation or the next way forward in pushing people that way or they have a vision that they have for the profession and they see people who can execute that vision. I think if you can identify someone like that or they can identify you, that’s a great opportunity to move the entire profession forward. I don’t think we can progress as a profession without the active and engaged mentorship.
Jamie: Now you work at the Health Resources and Services Administration in the federal government, often known as HRSA. You are the lead for the National Center for Interprofessional Practice and Education. Tell us a little bit about how your role promotes the nursing perspective.
Shanita: The National Center for Interprofessional Practice and Education is one of our major investments. So HRSA is the lead federal agency that is responsible for making sure that the nation has an adequate supply of well-trained qualified health professionals. That’s our role. Within the Division of Nursing in Public Health where I sit, our responsibility is to make sure that the nation patient has an adequate supply and distribution. Making sure that we have the quality health professionals, specifically nurses, in areas where they need it most. With the Affordable Care Act coming online, we realized that we may not have enough nurses or have enough nurses in the right places to meet the demands of a newly-insured population. We anticipated that. What we did was start making investments and making sure that nurses that are trained and nurses that are currently working in the field they have the skills to be a part of a more efficient way of delivering care. Because the decision was made that delivering care with NT was an efficient way to deliver quality care. It was an improved quality of care experience for people and their families as well. So we want to make sure that if team-based care, interprofessional care, was the future in which care will be delivered and experience, that we will have nurses as part of that equation. We wanted nurses involved. We wanted nurses not only to be on team and have a defined role on teams that can be compensated for and accounted for, but we also wanted them to be in a position to lead teams. Our National Center for Interprofessional Practice and Education contributed to that work by saying that not only do we need to have practicing nurses or new graduates on teams but we need to have our institutions actively preparing students to be a part of those teams. The National Center’s role is to make sure that there is work in the gap, what they call the “nexus”, that the schools are preparing nurses and other health professionals to be on teams and that when these students graduate or when these professionals who may go back for – to get further education and go back, that once they graduate they have a place to practice so that you don’t gain all of these interprofessional skills and then you go into a work place and no one is practicing that way. Making sure that this is a bidirectional process where the schools are preparing nurses to work in teams and then that the practices out there in the community are practicing in a way that can give those students and other health professionals the experience that they need to deliver care this way.
Jamie: Now I talked to a lot of nurses on my various shows about different things regarding building the nursing leaders of the future and how that’s become such an important part of nursing education right now that as nurses come out of even Associates degree programs, that there is an expectation of the RN to be a leader in their unit and that progresses more into the BSN programs and the Masters programs and Advanced Practice programs. How do you see this teamwork coming about from the other side? You’re working on the nursing side of things, what about the other disciplines: the physicians, the Allied Health professionals that are part of that team? I guess there are other areas of HRSA that our working with those areas to bring them to the table and talk about teamwork.
Shanita: Absolutely. The entire agency is focused on teamwork for our health professionals. Even within our Division of Nursing in Public Health, we support initiatives that focus on nurses of being on teams but also the team does mean that there are other health professionals. What we do collectively is ensure that all professionals have a defined role. We always say to our professionals, and specifically to our nurses, be able to clearly define what it is that is unique and that’s making a contribution to the outcomes that you’re anticipating. We’re moving as a profession. The healthcare is moving, is being transformed away from fee-for-service to more of a value-based care. So you’re paying for value. You are paying for an improved experience, increased positive outcomes at a lower cost and that has an ultimate impact on the population which people will buy. If you are not contributing to that overall outcome, improved experience, the improved outcomes itself, then if you can’t say what it is that you do uniquely to contribute to that as part of a team, then you want to be left out of the equation. Part of what nurses are, and other health professionals are required to do to be able to communicate not only with each other but also to the individual, the families that they are working with, what is their role on the team, how they’re going to contribute to improve outcomes and also be able to respect and value and communicate the role amongst each other, the team members themselves. All of that is important or the whole team concept falls apart of. So having a clear sense of your role, having an ability to communicate it, having an ability to execute your responsibilities and be accountable for that to the fullest extent possible of your license, pretty much is what we say, then that’s critical when we’re talking about team-based care.
Jamie: Are there specific resources available at HRSA that nurses or other health professionals can go and look at to learn more about working in teams in this interprofessional cooperation that you’re trying to foster?
Shanita: Absolutely. At HRSA we have a collaboration with SAMHSA, which is our sister agency – Substance Abuse and Mental Health Services – to also focus on teams that integrate mental health and behavioral health into primary care. We have a tremendous amount of resources on our SAMHSA, Center for Integrated Solutions website. Also with our National Center for Interprofessional Practice and Education, they also have a website that’s dedicated to helping professionals who want to learn more about being a part of a team or who wants to learn about making sure that we are getting back to holistic care, we’re not dissecting people into a physical part and a behavioral part of their – separating the needs of an individual but treating the whole person and the family. We have those resources available. Absolutely.
Jamie: As we wrap up here, why don’t you share with us your thoughts for that nurse out there that’s been listening to this and suddenly realizes that they might have an interest in getting into epidemiology and public health nursing? What kind of skills do they need to develop? What kind of things that you need to think about if they want to transition into that area of the profession?
Shanita: So I will say – and I encourage nurses to really think about this because this is the next big thing in nursing, is really reclaiming public health – we are the ones, nurses that really started out defining what public health was. Epidemiology is very close to public health where we have from the very beginning of our roots in nursing – from the beginning we understood not to focus on the individual sitting in front of us, but understood that that person came from an environment, that they came from a community that may be invisible to us but was influencing what we were seeing. With epidemiology, again I’d say that’s very close to public health is that you’re looking for patterns and also you’re looking to the environment and looking to not only the physical environment but the social environment and looking for other contributors to what you’re seeing in front of you. That that person that you’re seeing individually as a nurse in a healthcare setting, whether that’s an acute care setting or a primary care setting – that that person is just one representative of something larger that’s unseen. By focusing on epi, refocusing away from the individual and looking at the context in which they come to you and looking at the biggest social and economic and environmental issues that are influencing an individual’s health because usually individual is a symptom of something larger. We need nurses to take their individualistic perspective and expand it. Start thinking about community. So I’d start thinking about the public. Epi gets you closer to that. If you’re interested in that, think about getting a Public Health degree or either a certificate in Public Health where you don’t have to get a degree, but to get exposure to how to think about the public and how to think about the environment – the social and economic and physical environment – that the person exists in and their families.
Make sure you check out the entire August 2015 issue of Nursing Notes where we learn how inter-professional collaboration between nurses and other health professionals impacts patient care. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our panel of nursing experts including Heidi Sanborn, clinical assistant professor at the Arizona State University College of Nursing and Healthcare Innovation in Phoenix, Ariz. and Mary Meyer, a clinical associate professor and director of the clinical learning laboratory at the University of Kansas Medical Center in Kansas City, Kan. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes as well as our new podcast player on DiscoverNursing.com!