The Truth About Nursing’s letter to the Biden-Harris Covid-19 advisory panel

November 22, 2020

Thank you for your openness to representation of nurses on the Biden-Harris coronavirus advisory panel. Nurses deliver most skilled health care and have valuable insight into what patients and the healthcare system need. So plans for national solutions will be more effective with their input. Below we propose nurses for your consideration, in sub-categories that address particular needs, based on recommendations from the many nurses we have consulted as well as my own experience providing ICU care to Covid patients.

As a preliminary note, while I understand that there are many physicians on the task force, they can’t represent nursing because it is a distinct, autonomous profession with a different scope of practice. In general, physicians focus on the disease process, while nurses focus on how humans react to disease, including patient education. And of course, the U.S. has struggled with Covid-19 relative to many other nations not so much because of the disease itself but because of how humans have reacted to it. 

I understand that some have described the inclusion of different types of physicians on the panel as taking an interdisciplinary approach. However, we believe a truly effective interdisciplinary approach includes other types of health professionals, such as respiratory therapists, social workers, occupational and physical therapists, pharmacists, and of course nurses.

Below we introduce nurses for your consideration who are from different fields and would provide unique perspectives to the Covid advisory panel.

1. Experts in infection control

2. Experts in health care disparities

3. Experts in managing and improving clinical nursing environments

4. Expert in occupational health and protecting the workforce

5. Experts in rural health

6. Expert in mental health support for the public

7. Expert in palliative care

8. Experts in school nursing

9. Experts in vaccine hesitancy, public education and health literacy

10. Expert in pain management

11. Expert in the ethical issues of how to allocate the nation’s health care resources

12. After the Inauguration—please consider current government employees

Final Note – Please consider using the Defense Production Act to protect health workers and the public

1. Experts in infection control

Although there is no shortage of infection control professionals on the current advisory panel, infection control nurses could give a more on-the-ground perspective to better address how people can live more safely with Covid.

Jason Farley, RN, PhD, MSN, MPH, is a John Hopkins University (JHU) professor who mobilized resources to help coordinate the response to Covid-19 in the Baltimore community, including JHU schools and hospitals, while continuing to play a leadership role in international scientific endeavors. His work has encompassed testing, addressing the needs of the vulnerable (e.g., getting pulse oximeters into people’s homes), and the stigma of infectious diseases in the community. 

Ann Kurth, RN, PhD, CNM, MPH, is Dean of Yale University School of Nursing, an epidemiologist and nurse-midwife. She chairs the National Academy of Medicine Board on Global Health, and her research focuses on HIV, reproductive health, and strengthening the global health system. Dean Kurth’s work has been funded by NIH, Gates Foundation, UNAIDS, CDC, and HRSA. She chaired the 190+ member Consortium of Universities for Global Health and has published over 200 peer-reviewed papers. 

George Allen, RN, PhD, is the Director of Infection Prevention at New York Methodist Hospital, and author of Infection Control: A Practical Guide for Health Care Facilities, and Infection Prevention in the Perioperative Setting: Zero Tolerance for Infections, an Issue of Perioperative Nursing Clinics. He is a Clinical Assistant Professor at SUNY and a force for improving policies to address infection control in hospitals.

Sharon Vanairsdale, RN, DNP, is the Program Director for the Serious Communicable Diseases Unit at Emory University Hospital in Atlanta. She manages unit readiness and hospital preparedness for patients with Ebola, Lassa fever, and other special pathogens. She coordinates clinical operations, staff safety, and patient outcomes. She is also the Director for Education within the National Ebola Training and Education Center, a federally funded collaborative between Emory, Nebraska Medicine, and New York Health and Hospital-Bellevue.

2. Experts in health care disparities

Considerable data shows that Covid has had a particularly severe impact on communities of color. Many nurses focus on health disparities, including how to deliver care to underserved populations.

Norma Graciela Cuellar, RN, PhD, is editor-in-chief of the Journal of Transcultural Nursing, Professor of Nursing at the University of Alabama and immediate past-president of the National Association of Hispanic Nurses. She has also researched Complementary and Alternative Health Care, which many members of the public embrace and it would be helpful to have these therapies addressed in regard to Covid.

Sheldon D. Fields, RN, PhD, NP, researches health care disparities, focusing on preventing HIV/AIDS in men of color. He also advised Senator Barbara Mikulski during the passage of the Affordable Care Act. He is Associate Dean for Equity and Inclusion at Pennsylvania State University.

Vickie Mays, PhD, MSPH, is a UCLA professor and clinical psychologist with a public health degree (and in fact, she is the one person on our list who is not a nurse). She directs the 60-person NIH-funded BRITE Center for Science, Research & Policy, working to eliminate physical and mental health disparities and reducing vaccine hesitancy in racial/ethnic minority populations. Dr. Mays has been working with members of Congress on a bill that would require better data on the race and ethnicity of people affected by the COVID-19 pandemic. She is also conducting research on creating better models to predict the spread of COVID-19, in order to reduce the number of infections and deaths in Black communities. 

3. Experts in managing and improving clinical nursing environments

It is common for nurses to be excluded from decision-making panels, even though they are the ones delivering most of the skilled care. An overwhelming number of people who wrote us urged that the panel include direct care nurses and their advocates so they will have a voice in national policy. 

Bonnie Castillo, RN, is Executive Director of National Nurses United, where she is also director of the Registered Nurse Response Network, a disaster relief program that has engaged in recovery efforts after various natural disasters. In 2020, Castillo was named to the TIME 100 Most Influential People of 2020. She would bring the perspective of direct-care nurses

Mary O’Neil Mundinger, RN, DrPH, Dean Emerita, Columbia University School of Nursing, has been a pioneer in the development of nurse practitioner practice and she is one of its strongest representatives.

Hilda Ortiz-Morales, RN, PhD, NP, is a direct care nurse practitioner at an infectious disease clinic at Montefiore Medical Center in the Bronx. Ninety percent of her patients are from diverse backgrounds, and this is a common feature of nurse practitioners’ practice.

Dave Hanson, RN, MSN, is a clinical nurse specialist who works to protect patients by fostering quality care environments where nurses can focus on the care only they can deliver—bringing in ancillary staff to do the rest. He is a dynamic leader with a reputation for team building, a collaborator and an extraordinary role model for nurses who strive to advance the profession and quality of patient care.

4. Expert in occupational health and protecting the workforce

So far roughly 2,000 health workers in the US have died from Covid, including many nurses, and a colleague of mine just last week. We need a strong occupational health focus to protect our health professionals and our healthcare system.

Bonnie Rogers, RN, DrPH, is an occupational health researcher and Chairperson of the NIOSH National Occupational Research Agenda Liaison Committee. She has served on numerous Institute of Medicine (IOM) committees, including Vice Chairperson for the Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A. She is currently a member of the first IOM standing committee on Personal Protective Equipment for Workplace Safety and Health. She completed several terms as an appointed member of the National Advisory Committee on Occupational Safety and Health and was recently elected Vice President of the International Commission on Occupational Health. 

5. Experts in rural health

Many of the communities with critically high rates of Covid infection are now rural ones. Many nurses focus on care for underserved rural populations.

Tania Strout, RN, PhD, MS, is a Native American who has spearheaded numerous community-based studies with high-risk and disenfranchised groups. She is the site director of the NIH Clinical Trial of COVID-19 Convalescent Plasma in Outpatients (C3PO). She is an active clinician who would bring a generalist perspective to the panel, to help shape meaningful policy for clinicians, educators, and community leaders who are directly working with the public. (Please scroll down 85% of the way for her bio https://www.mitemmc.org/mite-academy/fellows/)

Mary Wakefield, RN, PhD, served as Health Resources and Services Administration in the Obama administration, supporting community health clinics. In her final two years she was Acting Deputy Secretary of HHS. She now directs the Center for Rural Health (CRH) at the University of North Dakota, strengthening the healthcare workforce, increasing health equity, and providing care services to patients who are geographically isolated, or economically or medically vulnerable. 

6. Expert in mental health support for the public

Mental health care is critical in addressing Covid, not only because of the virus’s significant neurological effects, but also because the public at large has struggled with the challenges of staying home, lack of contact with family and friends, and overseeing children’s education.

Ukamaka Oruche, RN, PhD developed six innovative educational products for children with behavioral challenges during the Covid crisis, as well as self-care guides for parents, frontline nurses, and underserved communities. The videos can be seen at Be Well Indiana. Dr. Oruche can help guide public mental health wellness in the time of Covid.

7. Expert in palliative care

It’s not clear what was happening in this pit in El Paso, except that the patients surely needed far less CPR and far more palliative care. Hospitals and patients need more help putting a palliative care plan into action when death from Covid is the only realistic outcome. 

Betty Ferrell, RN, PhD is expert in how to provide compassionate care to dying patients and their caregivers. She developed and leads the End-of-Life Nursing Education Consortium, which has trainers in 99 countries and all 50 states. She will be able to offer the Covid advisory panel guidance on how to improve palliative care and make it more widely available.

8. Experts in school nursing

School nurses are among the public health nurses who are most vital to controlling Covid, including through work in infection control and vaccine rollout. Many now work long hours contact tracing for the families at their schools, and there are plans for some to play a key role in Covid testing. Basically, they have taken on the work of the public health department, but without adequate staffing or support. Nursing takes time, resources, education, expertise and perseverance. Nurses who can bring the school nurse perspective to the advisory panel include:

Cathy Riccio, RN, MSN, MS, who had so many enthusiastic letters of recommendation submitted on her behalf. She is a school nurse with a degree in Environment Science who guided principals, teachers and staff in Newburyport, MA, on how to re-open schools safely—from health procedures and building operations to the emotional health of students, parents and faculty. She designed professional development materials in language simple enough for everyone to understand. She does contact tracing, delivers food, and acts as an air quality expert and guidance counselor. So far there has been no traceable spread of Covid within the schools she oversees. 

Robin Cogan, RN, MEd, is a New York school nurse and frequent media contributor. She is a strong advocate for school children and will be able to give practical, realistic advice on how the nation’s schools can administer testing and roll out vaccines.

9. Experts in vaccine hesitancy, public education and health literacy

A large part of nursing care is aimed at developing strategies to educate patients about the disease process and paths to wellness. Because nurses are widely considered to be trustworthy, members of the public might be more likely to listen to health advice from them. And some nurses have focused on working to persuade reluctant members of the public to follow public health guidance. 

Eileen Fry-Bowers, RN, PhD, MSN excels in health literacy and addressing vaccine hesitancy (countering anti-vaccination disinformation).  

Blima Marcus, RN, PhD, is a nurse practitioner and assistant adjunct professor at Hunter College. She is also an excellent advocate and educator on vaccine hesitancy, especially in the Orthodox Jewish community. 

10. Expert in pain management

Pain management is critical for Covid patients. Nearly every ICU patient on a ventilator is on a fentanyl (opioid) IV because being that sick and coping with all those tubes and procedures is painful. After patients recover, many continue to have pain because of the myriad long-term problems Covid causes.  

Sheria G. Robinson-Lane RN, PhD, Assistant Professor, University of Michigan, focuses on pain management, especially in older people—who are hardest hit by Covid and can guide the way forward. 

11. Expert in the ethical issues of how to allocate the nation’s health care resources

The panel would benefit from a nursing perspective in considering how limited resources are allocated, including how to balance support for public health measures and clinical care. In particular, as my own recent work providing ICU care to Covid patients has underlined, the current system is struggling to provide effective care with available resources. Vast sums are devoted to ICU care, but there are still insufficient ICU nurses and equipment to provide effective care to all Covid patients. For example, the survival rates for patients once they go on a ventilator is very low, unless they go on ECMO machines, in which case the survival rate is quite high. But we don’t have many ECMO machines. Should the Defense Production Act be invoked to make more? Would we save more lives if we re-directed some efforts to preventive public health work, such as educating society about protective measures and quarantine practice, contact tracing, coordinating vaccination and promising potential therapies, such as vitamin D supplementation? Nurses think about the lived experience of patients and help them plan how to cope with their new realities. 

Connie Ulrich, RN, PhD, Professor of Bioethics, University of Pennsylvania, provided testimony to the Presidential Bioethics Commission on the importance of ethics education for nursing and how ethics education influences the moral action of nurses with their patients.

12. After the Inauguration—please consider current government employees

Rear Admiral Aisha K. Mix, RN, DNP, MPH is the Chief Nursing Officer of the US Public Health Service. There is no one more fitting to be on the panel than she is.

Rear Admiral Sylvia Trent-Adams, RN, PhD, served as Acting Surgeon General in 2017, and focuses on preventative health.

Christine Grady, RN, PhD, MSN, is Chief of Bioethics at the National Institutes of Health, and Head of the Section on Human Subjects Research.

Members of Congress

There are three nurses in the House of Representatives who could provide valuable input. They are:

Eddie Bernice Johnson, 30th Congressional District of Texas. 

Lauren Underwood, RN, MSN, MPH, 14th Congressional District Illinois. She has put a coronavirus resource guide on her House webpages.

Cori Bush, from Missouri’s 1st Congressional District was just elected.

Final Note – Please consider using the Defense Production Act to protect health workers and the public

Nurses and other health workers cannot get enough N95s to work safely. In addition, if every member of the public had an N95, we could better prevent community transmission. An N95 protects the wearer, not just those around them. At my last hospital, I wore one N95 for 8 weeks straight. Other nurses have cared for patients with only a surgical mask—offering themselves up to the disease. Nobody should be sacrificed to Covid. If we invoked the Defense Production Act to fully address these shortages, we could better protect health workers and the community, and get the virus under control. On the other hand, I urge you not to encourage the manufacture of masks with valves. They only protect the wearer and we have to count on each other to protect us.  Any mask mandate should make it clear that valve masks do not meet the requirements.

Thank you for considering our recommendations for how the Biden-Harris coronavirus advisory panel can better address the needs of the US healthcare system and the residents of our country.
Please let me know if I can assist you in any way.

Best regards,

Sandy Summers, RN, MSN, MPH
Founder and Executive Director
The Truth About Nursing 
Co-author: Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk
203 Churchwardens Rd.
Baltimore, Maryland 21212-2937  USA  
phone 1-410-323-1100cell 1-443-253-3738
ssummers@truthaboutnursing.org
www.truthaboutnursing.org  

The Truth About Nursing is an international 501(c)(3) non-profit organization working to challenge stereotypes. We show that nurses are autonomous, college-educated science professionals who save and improve lives. Each year, the undervaluation and underfunding of nursing leads to millions of needless deaths across the globe. Better understanding of the profession will allow nurses to save all the lives they are capable of saving.