Dentist assumes NINR interim director post

8Oct - by Sandy and Harry Summers - 0 - In PETITIONS

Search for permanent director continues

Despite protests by thousands of nurses, and constructive interactions with NIH director Francis Collins, a dentist and a biologist have now assumed the interim leadership positions at NINR. The search for a permanent director is underway. Join our campaign for NIH to appoint a nurse as interim director as soon as possible!

NINR campaign
October 5, 2019 — Following our tweet-storm and the launch of our campaign on August 27, more than 4,300 nursing supporters have urged the National Institutes of Health to appoint a nurse to lead the National Institute of Nursing Research (NINR), instead of the dentist who assumed the interim director job on October 1. The NIH’s second search for a permanent NINR director is underway. We urge everyone to continue watching and urging NIH to place a nursing leader in charge of NINR as as soon as possible!

See a full description of the elements of our campaign below–including links to the September 13 Business Insider story on the campaign that was reprinted around the world, a new account of our September 20 phone call with NIH director Francis Collins, and our latest letter to Dr. Collins dated October 1.

A Chronology of Our Campaign So Far

8/27/19 – The Truth About Nursing begins a campaign to protest the appointment of a dentist and a biologist as interim NINR leaders.

9/13/19 – Business Insider publishes a substantial story about our campaign that soon appears in the Netherlands, India, Australia, Germany and China.

9/14/19 – Nurse.org, the ANA and Becker’s Hospital Review pick up the story.

See the detailed communications between the Truth About Nursing and NIH Director Francis Collins

 

9/3/19 – Truth About Nursing Letter #1 — The Truth About Nursing requests a phone call with NIH Director Francis Collins

From: ssummers@truthaboutnursing.org
Sent: Tuesday, September 3, 2019 11:36 AM
Subject: Requesting a phone call

Dear Dr. Collins,

I would like to talk with you by phone regarding the appointments of a dentist and a biologist to oversee nurses at the NINR. Even these interim appointments suggest that the NIH thinks nurses lack autonomy, education, and competence.

Hopefully you have received the 1,000 letters to your inbox by now and can see just how wrong nurses think these appointments are.

The message that these appointments send to the wider community about nursing is damaging. There is a global shortage of nurses in large part because people think nurses have no autonomy, are unskilled, and exist to follow physician commands. This leads to underinvestment in nursing practice, education and research (e.g., the NINR gets less than a half of one percent of the NIH budget). And that leads to patients and the public getting too little nursing—both in the US and globally. Since health care errors are the third leading cause of death in the U.S., and nurses are the professionals who identify and intervene to prevent most errors, it is vital that we address the underlying causes of the global nursing shortage. Disrespect is the most fundamental cause. Nurses endure disrespect on a daily basis, but we hope that government institutions like NIH can model better conduct. That’s why these appointments are so disappointing.

Do you have time to talk later today or tomorrow?

Thank you.

Sandy Summers, RN, MSN, MPH
Founder and Executive Director, The Truth About Nursing

 

9/17/19 — NIH Letter #1 — NIH Director Francis Collins sends a response to the Truth’s campaign

On Sep 17, 2019, at 12:55 PM, Collins, Francis (NIH/OD) wrote:

Dear Ms. Summers:

Thank you for your recent email expressing your interest in and support for nursing science and the National Institute of Nursing Research (NINR). I recognize the concerns raised by your organization, The Truth About Nursing, regarding the leadership transition at NINR. I am writing to you personally share NIH’s plans for NINR. NINR is, and will remain, a vital part of the NIH community. Its work to support the practice of the nation’s largest healthcare profession provides the critical link between the laboratory and the clinic to patients and families. For over 30 years, under the leadership of outstanding nurse scientists, NINR has been the largest federal supporter of nursing research, providing research grants and training opportunities for nurse scientists across the United States. The work of NINR-supported scientists has led to critical discoveries in areas such as symptom science, wellness, and end-of-life and palliative care.

Patricia Grady, Ph.D., R.N., F.A.A.N., led NINR for over two decades, and upon her retirement in 2018, I initiated a search for the next NINR Director.While the search has required more time than I would have hoped, I am sure you would agree that it is more important that we identify the absolute best candidate for the job. I am confident that we will identify an experienced nurse leader with a bold vision for setting NINR and nursing science on a dynamic course for the future, and I share your organization’s desire to see this position filled as quickly as possible. To this end, I recently charged a new search committee to identify a pool of strong candidates from the nursing science community to be considered for this important position. The vacancy announcement was posted on the NIH website on September 13. Please encourage your constituents to spread the word about this important position and to consider applying.

For the past year, Ann Cashion, Ph.D., R.N., F.A.A.N., has done an exemplary job as the Acting Director of NINR. Her leadership of NINR during this transition period has been greatly appreciated and will be missed. Following Dr. Cashion’s departure later this month, and until the new NINR Director is identified, I want to ensure that the work of the Institute continues unabated under experienced NIH leadership. That is why I have asked the Principal Deputy Director of NIH, Lawrence Tabak, D.D.S., Ph.D., to serve as the interim NINR Director while we commence this search. I have also asked the Associate Deputy Director of NIH, Tara Schwetz, Ph.D., to serve as the interim NINR Deputy Director, managing the day-to-day operations of the Institute. As of August 26, Dr. Schwetz has been working closely with Dr. Cashion and current NINR staff to ensure a smooth transition and continuity of leadership. Both of these individuals have been willing, at my request, to make major time commitments to these interim roles.

The involvement of senior NIH leadership in running NINR until we appoint a permanent Director is reflective of our firm belief in the importance of nursing science, both now and in the years to come. Throughout this period of searching for the next Director, the Institute, its mission, and its functions will remain largely unchanged. NINR will continue to implement its current Strategic Plan, and NINR’s capable staff will continue their important roles in facilitating the work of NINR-supported scientists across the United States.

Thank you again for your commitment to nursing and nursing science and for your organization’s efforts on behalf of the nursing profession. It is through the support of the nursing community that NINR and nursing research will continue making important contributions to improve the health of all.

Sincerely yours,

Francis S. Collins, M.D., Ph.D.
Director

 

9/19/19 — Truth About Nursing Letter #2 — The Truth provides more detail on how poor public understanding of nursing undermines the profession. The letter includes survey results showing that responding nurses overwhelmingly believe NINR should be led by a nurse

Dear Dr. Collins,

Thank you for your letter.

I appreciate that you are concerned with building a strong NINR and finding the right leader for the permanent director position. We certainly will continue to do what we can to encourage qualified nurses to apply. However, as I explain below, we still have concerns with the interim appointments, both in terms of whether non-nurses are qualified for them and the damaging message sent to the public when nursing leadership positions are filled with non-nurses, even temporarily.

We understand that there have been challenges at NINR in light of the resignation of the current interim director and the apparently inadequate results of the first search for a permanent replacement. And we understand that in times of crisis, it is natural to turn to trusted colleagues. We have nothing against Dr. Tabak or Dr. Schwetz as health professionals in their fields, in which they appear to be highly qualified. But of course, our concern is that they are not the right people for these specific nursing leadership jobs.

As we have explained, nursing is an autonomous health profession with a unique conceptual base and scope of practice. Although it is certainly related to medicine and other health fields, it has a distinct holistic and preventive perspective, with a focus on patient advocacy. The research interests and expertise of nurses reflect those core elements of the profession. One example that may be of interest to you is nurses’ research in the area of music therapy. In fact, nurses have been pioneers in a number of critical health fields, from pain management to informatics.

By autonomous I mean that nurses make independent assessments about patient or population health, make plans to improve that health, and take action through clinical care, education, advocacy, and research. Some people confuse having prescriptive authority with autonomy, but only a minority of health problems require prescriptions. Nurses save lives and improve health in myriad ways that do not require prescriptions. And nurses in clinical settings report to other nurses, not physicians.

Aside from whether non-nurses are actually qualified for these NINR positions, a primary concern we have with the appointments is how they affect public understanding of nursing, which in turn affects nursing across the board. Poor understanding adds to the global nursing shortage and undermines nurses’ claims to adequate resources for education, clinical practice, and of course research.

Since 2001, we have worked to change how society views nursing. The same stereotypes come around on a short cycle, like a qualitative study that only needs 10 subjects before we’ve exhausted all the damaging ways people think about nursing. In fact, this is exactly how many healthcare journalists it took to exhaust the stereotypes when nursing researchers asked them why they use nurses as sources in only 2% of their articles. That was the Woodhull 2 study that came out last year. Lack of public understanding of nursing is a global problem fueled by people who have the media spotlight, people who make high-profile decisions, such as these NIH appointments.

When members of the public see a dentist and a biologist leading NINR, even temporarily, they receive the message that nurses are unqualified to run their own Institute. This reinforces what Hollywood and even the news media often conveys, that nurses are unskilled, low-level handmaidens who exist to serve physicians.

This misunderstanding extends to members of the health care community. Many physicians have internalized these stereotypes, and they may believe that nurses do report to them and should not question their prescriptions on patients’ behalf. Hospital administrators, with little real understanding of nursing, invest vast resources in physician training and practice, while stretching nurses—the reason hospitals exist—so thin that a third of them leave their jobs within the first two years. Fifty-eight percent of nurses leave their jobs because of ill treatment. They are disrespected, bullied and harassed by the people they work for indicating hospital administrators don’t think nursing matters.

The stereotypes affect even the views of nurses themselves, many of whom fail to fully embrace their autonomy. Popular culture is so powerful that nursing professors and nursing organizations have a hard time instilling in nurses the idea that they are autonomous. Although it is novel to have a dentist and biologist be in charge of nurses, it is consistent with the message of nursing subordination that still prevails in too much of society.

This misunderstanding of nursing not only damages the nursing profession, it damages public health by denying patients adequate nursing care that they need to get and stay well. You have probably seen the research showing health care errors as the third leading cause of death in the U.S. Nurses are the health professionals most likely to identify and prevent potential errors. Strong nursing is vital in the effort to reduce errors. But nurses today often lack the resources and respect to do what they are capable of doing to protect patients and advance health.

I also note that the recent levels of NINR funding, while much appreciated, remain consistent with the idea that nursing is of minimal importance compared to other health disciplines. NINR will receive $163 million for 2020 out of a $34,400 million NIH budget, which is less than half of one percent of the NIH budget–the same paltry percentage it has been for decades. In our view, this does not adequately serve public health. Nurses are a more valuable part of the solution than $1 out of every $200. I urge you to consider increasing the size of the NINR budget to 20% of the NIH budget. That would better reflect the potential contributions of nurses, the largest group of health professionals.

We note that the new job description for the permanent NINR director position has gone up, and while it certainly contains many helpful elements, it still does not require the permanent director to be a nurse. We wanted nurses’ opinion on this, so the Truth About Nursing just did a 3-question survey of our supporters a couple days ago. 454 people responded. Here are the results:

Survey results

1) Should it be a requirement that the director of the NINR is a Registered Nurse?

 NumberPercentage
Yes45199.3%
No30.7%

2) What is the minimum education in nursing the Director of the NINR should have?

 NumberPercentage
Should not have to be a nurse20.4%
LPN/LVN20.4%
BSN / Master's entry level4911%
MSN/Advanced practice nurse level11024%
Doctoral level in nursing29164%

3) Select the doctorates you think would qualify the NINR Director to hold the job (select all that apply).

 NumberPercentage
Omics266%
Biological sciences6013%
Behavioral sciences7216%
Health sciences9020%
Social sciences5913%
Nursing40088%
None of the non-nursing specialities above, it should be nursing only18441%

The consensus from respondents is that it is vital that the NINR director be at least an advanced practice nurse, even if the doctoral research degree is in another health discipline. This should be the case even if they serve in a temporary capacity. Indeed, as your recent experience has shown, a great deal of time may pass without a permanent director.

Thank you for taking the time to consider the depth and nature of nurses’ concerns on both the interim and permanent positions.

I look forward to talking with you soon.

Best regards,
Sandy Summers

  

9/20/19 — Summary of phone call between NIH Director Francis Collins and Truth About Nursing director Sandy Summers

September 20, 2019 — This is a summary of today’s 45-minute call with NIH Director Francis Collins and Truth About Nursing executive director Sandy Summers.

Dr. Collins said there were a lot of very good points in our letter, that he had learned a lot about the challenges nurses face with public understanding, and that he was truly distressed that we had arrived at a situation in which so many nurses were up in arms about the appointment of a dentist to lead NINR. He said he was really sorry this had turned into such an issue, which he did not expect.

We asked Dr. Collins if there was any way he could drastically increase the abysmal funding of NINR, which has long received only about 0.5% of the NIH budget. He was sympathetic to our concerns, but said he has no authority to change that, because the line items setting how much each of the Institutes is allotted are decided by Congress. Dr. Collins said that NINR approved about 1 in 5 grant applications, which is in line with the other institutes.

Dr. Collins said that we have a good case for more funding for nursing at NIH, and that we might start with the Chairs and Ranking Members of the Appropriations Committees in the House and Senate. So we asked if he would join our request to Congress for increased funding for NINR, and Director Collins said he would be glad to. He also lamented the untapped reserve of really interesting, forward-looking research not even coming to NIH because some felt there was no point in bothering, due to insufficient funding to NIH across the board.

Dr. Collins also said that he was sympathetic with respect to the bad image of nurses in the media, but he assured us that most researchers at NIH have been happy to work with nurses. He was happy to hear that we are developing the Coalition for Better Understanding of Nursing to bring nursing groups together to work on these issues.

Dr. Collins gave some background on how dentist Lawrence Tabak came to be appointed interim director of NINR. Dr. Collins called it an unfortunate series of events. When former NINR Director Patricia Grady, RN, PhD, had resigned, her deputy Ann Cashion, RN, PhD, took the interim director job. But the deputy position was not then filled. So when Ann Cashion resigned as interim director, there was no deputy to take her place. The NINR scientific director would normally be the next person in line to take a director position, but the current NINR scientific director, Jessica Gill, is busy with her own research, and she did not wish close down her experiments to take on the interim director role.

Dr. Collins said the first search for a permanent NINR director in 2018 had led to a number of very strong candidates. However, he said at least some leading candidates declined the position because of what they viewed as a low salary. The Truth About Nursing has found online records suggesting the NINR director’s salary was $215,000/year in 2015. (We confess to being confused about why even nursing leaders would consider that to be a low salary, especially for a government job, and in light of how underpaid most elite nurses are given their qualifications).

Dr. Collins assured us that when he had decided to select NIH Deputy Director Lawrence Tabak as interim NINR director, people within NINR told him that it was a relief, because there would be steady hands in charge while the second search for a permanent NINR director was underway. Dr. Collins said that several nursing deans he talked to about it told him the appointments of the dentist Tabak and the biologist Tara Schwetz as interim deputy would be fine. We said that was good to hear, but we also suggested that it seemed possible that some nursing deans might be reluctant to speak candidly on such a matter with the NIH director so as not to risk jeopardizing critical research funding.

Dr. Collins said that he wanted everyone to know that he has no intention of diverting resources away from NINR. He has no plan to degrade nursing at NIH and wants to make sure people know there is NOT a plan to merge NINR with the dental institute.

We turned to the upcoming second search for a permanent NINR director. We raised our concern that the posting for that position does not require that an applicant actually be a nurse. Dr. Collins asked whether it would be sufficient if a non-nurse candidate were really expert in nursing research. We answered with an unqualified no, arguing that no one really knows what nursing is without first becoming a nurse. He seemed to accept this, but he said now that the job posting was up, he couldn’t alter it without taking it down and reposting it, and he didn’t want to delay the application process any further. On that point, Dr. Collins said he is pushing the search committee hard to move swiftly on the second search and get a permanent director in place, to reduce the time the interim director has to serve. We indicated that that sounded like a good idea but still had reservations that the interim director was a dentist.

Overall, we had a very congenial conversation. We learned about each other’s experience, work, and perspective, although we did not reach a final resolution on the issues.

  

9/22/19 — Truth About Nursing Letter #3: The Truth sends follow-up questions to the NIH Director

From: ssummers@truthaboutnursing.org
Sent: Sunday, September 22, 2019 8:51 AM
To: Collins, Francis (NIH/OD) [E]

Hi Dr. Collins,

It was good to talk with you Friday and get a better sense of your perspective. Thank you for explaining how things got to be the way they are at the NINR, and for listening to our concerns. I wish we had had more time to discuss strategies for going forward. You seem like a thoughtful person, and I understand that you find yourself in difficult circumstances with the interim NINR replacement. Still, as we discussed, many nurses will continue to feel disrespected as long as there is not a nurse as interim director. And our concern about how the appointment affects public understanding of nursing will remain.

I have a few follow up questions.

1) I know you said there was relief at NINR and among some nursing deans that Dr. Tabak and Dr. Schwetz were going to be the interim leaders of NINR. That is good to hear, and I don’t doubt that Dr. Tabak and Dr. Schwetz are respected health leaders. Having said that, I would imagine that nursing deans whose faculty likely receive NIH research funding would not have much incentive to register strong objections. As you know, I am an advocate, not a researcher, so I have the luxury of speaking more freely. You also said Jessica Gill was too busy with her research to take on the role of interim director. Do other nurses with research doctorates work at NINR, or even at other parts of NIH? If not, how would you describe the qualifications of those NIH nurses who might be next best qualified after Dr. Gill? Knowing a little more about that would likely help me evaluate and convey the basic situation to our supporters.

2) Are you permitted to select an interim director of NINR from outside the NIH? An RN, PhD who has worked on NINR grants wrote to me saying she would love to be interim director. If the interim leaders could potentially come from outside the NIH, would you like me to collect some names and brief summaries of qualifications of interested candidates?

3) You mentioned that you thought the salary range for the NINR director might have been a limiting factor in the recent hiring process. Of course, the obvious question is whether the salary might be raised. Among other things, the social disrespect for nursing means nurse leaders are routinely given far lower salaries compared to leaders from other professions at the same level. I am wondering if this is the case here. If it is not possible to raise the director’s salary, would it be possible to make the salary range public during the initial application period? I know this is done with many federal jobs, so candidates would have a sense of it from the start. I realize some good candidates might see it and not apply at all. However, that could result in a more efficient search, with less time devoted to evaluating candidates who will ultimately withdraw anyway when they learn the salary range. And it also seems possible that competitive candidates who would accept the available salary may not even apply because they wrongly assume it is lower. The language on the job description and the hidden salary makes me think the salary is $80,000.

4) When we were talking about the permanent director position, you queried whether nurses would find it acceptable if you hired someone who had the necessary expertise in nursing research yet was not a nurse. Non-nurses simply don’t know what nursing is, so there is no chance such a person could be qualified to lead any sort of nursing endeavor. And it is probably apparent, but I am confident, as our survey found, 99.3% of nurses would find such a choice to be extremely troubling, for the reasons we have discussed. You indicated that you are not permitted to change the current job posting now that it has been posted. Even so, would it be possible to publicly indicate that you intend to hire someone who at least has a graduate nursing degree, even if that person’s research doctorate is in a different health field? I believe that would go a long way to reassure the nurses with concerns about the NINR position

Thank you again for listening to our concerns. I really enjoyed talking with you and I hope we can work collaboratively to find a way forward.

Best regards,

Sandy Summers

 

9/24/19 — NIH Letter #2: NIH Director Collins responds to the Truth’s letter

From: “Collins, Francis (NIH/OD) [E]”
Date: September 24, 2019 at 10:53:29 AM EDT
To: “ssummers@truthaboutnursing.org”

Dear Ms. Summers:

In follow up to the questions posed in your most recent e-mail:

1) Dr. Gill was tenured last year as a senior investigator in the NIH intramural program. She has graciously stepped into the role of acting Scientific Director of NINR. This is a key role which oversees Nursing Science conducted within the intramural program at NIH. In this role, Dr. Gill is also a member of the NINR executive committee and will thus be able to advise Drs. Schwetz and Tabak about any scientific issues that emerge at the Institute level. To ask Dr. Gill to take on an even greater administrative role as Acting Director of NINR would be unfair to her own research program, which is her area of greatest focus right now. In instances where there is no Deputy Director of an Institute ready to step into the acting role, Dr. Tabak, as Principal Deputy Director of NIH, serves in this capacity. He most recently did this for the National Institute of Minority Health and Health Disparities, prior to the arrival of the current Director, Dr. Eliseo Pérez-Stable. Unfortunately, at NINR a series of unforeseen events resulted in vacancies at both the Director and Deputy Director levels, which is why we also needed someone with Dr. Schwetz’s experience to step in as acting Deputy Director during this transitional period. Dr. Schwetz began her NIH career at NINR and knows their staff and mission well.

2) Only a federal employee can serve as an NIH interim or permanent Institute Director. The job of an Institute Director is complex and requires substantial administrative experience that requires time to learn. Please encourage anyone interested to apply for the permanent NINR Director position. It typically takes between 12-18 months for a new person assuming the directorship of an NIH Institute to acclimate and feel confident in this role.

3) All federal salaries are public information. Senior leadership position salaries are driven by relevant experience, parity issues with incumbent Institute Directors, and cost of living differentials depending on where the candidate is relocating from.

4) We are very aware of the unique and key role the permanent director of NINR plays within the nursing profession and the general biomedical research community. However, unless there are requirements related to specific clinical licensure, which is not the case for Institute Directorships, we do not restrict applications for senior leadership positions by degree attainment. That being said, we think it highly likely that the next Director of NINR will have a nursing degree.

Let me reiterate my thanks to you for your commitment to nursing and nursing science and for your organization’s efforts on behalf of the nursing profession. It is through the support of the nursing community that NINR and nursing research will continue making important contributions to improve the health of all.

Sincerely yours,

Francis S. Collins, M.D., Ph.D.
Director

  

10/1/19 — Truth About Nursing Letter #4: The Truth follows up and seeks a more rigorous search for a temporary NINR director who is a nurse

From: ssummers@truthaboutnursing.org
Date: October 1, 2019 at 3:58:19 PM EDT
To: Francis Collins

Hi Dr. Collins,

Thank you for your Sept. 24 response and for answering some of my questions. I appreciate that your situation with regard to the interim NINR leadership positions is difficult. I hope I can share a few more thoughts, pose a few followup questions, and offer a few suggestions. In particular, even recognizing the challenges you have explained, I urge you to fill at least the NINR interim director position—which may not be filled permanently for well over a year—with a nurse.

The history of nursing has been a struggle for autonomy and understanding from colleagues

I hope you will bear with me for a little more background. The struggle for nursing autonomy has been with us since the beginning. When Florence Nightingale and her nursing colleagues arrived in Crimea in the mid-19th Century, they had to negotiate hard with physicians for the ability to provide autonomous nursing care to British soldiers, without misguided physician interference.

Early in my own career, I practiced at a hospital in the U.S. Virgin Islands with other travel nurses. Too many of our physician colleagues were dangerously incompetent. One surgeon, upset that his patient scheduled for an orchiectomy was rejected by the OR because his bleeding times were too high, came to the ICU and removed the patient’s infected testicles right there in his ICU bed, without anesthesia. Another patient was rejecting his transplanted kidney, so the surgeon opened him up in the ICU without anesthesia and removed his transplanted kidney. He died three days later. Because physicians controlled the hospital, the nurses there weren’t able to practice with real autonomy, so they couldn’t adequately protect patients from the physicians. A courageous nurse friend tried to protect her patient–a tourist with an acute abdomen scheduled for exploratory surgery–by advising her to fly back home to the U.S. mainland instead of undergoing surgery. The patient asked the surgeon why the nurse would suggest she go back to the mainland. The surgeon pressured nursing managers to fire my friend, and they did.

These struggles for autonomy in nursing, and the related harm to patients, continue today. This past weekend at a wedding, I met a senior nurse who had been driven out of the workforce by physicians who did not understand the nursing role or nursing autonomy, and who had pressured hospital administrators to target the nurse after she advocated for patient safety. At my speaking engagements, I usually ask the audience (mostly nurses) if they have ever had a physician throw anything at them. About half of the hands go up. Practicing to the full extent of nurses’ education and ability remains a central issue for the profession, even a decade after the landmark 2010 Institute of Medicine report on nursing identified that as a key national health challenge going forward. (The name “Institute of Medicine” is its own problem, suggesting nursing is a subset of medicine, instead of its own autonomous profession.) It is critical that NIH use its leadership role to move the health care system beyond this distressing situation.

The effects of these appointments on NINR and its grants

After discussion with some nurse colleagues about these appointments, I have actually become more concerned about the potential effects of even temporary non-nurse leadership on NINR. My colleagues have told me that NINR grants have recently become more narrowly focused on biological projects, rather than those that encompass the essence of nursing—the larger human response to health threats. Some colleagues say that non-nurse primary investigators have been receiving NINR funding for such projects. You might be interested in a quick summary of Nightingale’s goals (5/8ths of the way down in a table). On the subject of research, she argued that “the nurse should be the primary investigator of nursing phenomena.” In my view, having a nurse continue in NINR leadership could help protect NINR from being consumed by non-nurse professionals and their research objectives.

The effects of these appointments on nurses

As you may have seen from the thousands of nurses who have signed the petition protesting these appointments, nursing’s issues with autonomy and respect are deeply demoralizing for nurses today. Historically the challenges have been with physician colleagues, and although it’s a new idea to place a dentist in a position of authority over nursing, some may see this decision as yet another one made by a physician, confirming an enduring power imbalance that undermines nursing and public health. It seems clear that many nursing leaders see the appointments as an attack on their professional integrity. These leaders struggle to persuade direct care nurses and nursing students to stand up and advocate for patients, which is already a challenge given prevailing social structures. Personally, the appointments feel like a huge step backwards, perhaps to the 1950s, when nurses were expected to stand when physicians entered a room.

The effects of these appointments on public understanding of nursing

And as I have explained, the appointment of non-nurses to direct NINR contributes to damaging stereotypes of the profession. It suggests to the public that the U.S. government does not view nursing as a strong, autonomous health profession, but one directed by physicians and others, and that nursing does not include elite scholars who are capable of directing a research institute.

Going forward: Have administrative abilities been prioritized over professional qualifications?

I realize that administrative ability is an important aspect of these positions, but it seems to me that it has been give undue weight, to the point where the pool of people from which the interim leaders were chosen did not include those with the most fundamental qualification: nursing expertise. I recently learned that almost 100 people work at NINR. Can there really be only one RN, PhD there (Dr. Gill) who is qualified for this interim position? I see that Marguerite Littleton Kearney, RN, PhD, is also at NINR—might she be a candidate for the interim job? Alternatively, are there no such qualified nurses at any of the 26 other NIH institutes and centers? I urge you to look across NIH with the goal to find the nurse who is best able to provide NINR with nursing vision and direction, which would also make clear to all involved and the public that nursing is an autonomous health profession. Perhaps some qualified nurses lack the administrative capacities needed, while others, like Dr. Gill, may wish to focus on research. But if such a person were named interim director, perhaps another RN, PhD could assist with the research, while Drs. Tabak and/or Schwetz assist with the administrative duties.

Conclusion

The appointment of a dentist to lead NINR, even temporarily, is a real crisis for nursing. I am confident you had no such intention, but many nurses see the appointment as an infuriating reminder of the history of disrespect and marginalization of nurses by physicians, some of whom still believe they can exercise professional authority over nurses. Please respect the autonomy of nurses and try to find a nurse at NIH who can lead NINR. Nurses and the patients are counting on you, and NIH, to show leadership in recognizing the value of nursing.

Thank you,

Sandy Summers, RN, MSN, MPH
Executive Director, The Truth About Nursing

 

October 20, 2019 — Truth About Nursing Letter #5: The Truth follows up

Dear Dr. Collins,

I hope you are well.

I am following up on my letter of October 1 about the NINR leadership position. I am sure you realize that nurses continue to feel very strongly that even the interim NINR director position should be held only by a nurse. Once again, we urge you to consider whether another nurse at NIH could fill this position while the search for the permanent position continues, perhaps with Drs. Tabak or Schwetz providing administrative support. 

I appreciate your openness to our input, and I hope you will be part of the solution to the global crisis in nursing. Every day a dentist heads NINR, the public receives the message that nurses do not control their own profession. 

Thank you,

Sandy Summers, RN, MSN, MPH
Executive director, The Truth About Nursing

NINR campaign

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