(May 2020) - Shiv Gaglani, the co-founder and CEO of Osmosis, hosted OADN CEO Donna Meyer to discuss the realities facing early-career nurses and discuss the impact of the COVID-19 crisis on the nursing workforce.
SHIV GAGLANI: Hi. I'm Shiv Gaglani, the co-founder and CEO of Osmosis. Today I'm really happy to be joined on Raise the Line by Donna Meyer, who's the CEO of the Organization for Associate Degree Nursing. Before assuming leadership of OADN, five years ago, she spent more than three decades as a leader in health sciences education and also has a background in pediatric nursing. Donna, thanks so much for being with us today.
DONNA MEYER: Thanks so much for having me. I'm really looking forward to the opportunity to have a chat this afternoon.
SHIV GAGLANI: We're really excited about the work that you and your team at OADN are doing, and like Osmosis, it's very clear that you are super mission-driven and value-aligned. I have a couple of questions so that our audience can get to know you and OADN better. The first is very high-level. Could you tell us more about yourself, your career, and your current role at OADN and what OADN’s mission truly is?
DONNA MEYER: As far as my career, as it was mentioned, I was a pediatric nurse. I worked at St. Louis Children's Hospital in the infectious disease unit. Right now, what is happening it’s dear to my heart because I feel for those nurses. Almost every day at the hospital, I was wearing total garb when I was a nurse practicing, but then what happened is that I became really interested in education because we had a lot of students that came and rotated through the clinicals, so I really became interested in that, then went into a faculty role, although I still stayed working as a nurse, and then ultimately director and then a dean of Health Professions at a college in Illinois.
I've been very passionate about— I'm still passionate about nursing and I think that's what is so very important. Also, I've done some mission trips to Guatemala that I think are really important for nurses to do or take in. I've been at OADN for five years, although I was past president there and actually in volunteer positions. OADN is really the only national nursing association that truly advocates for community college nursing programs across the country.
At this time, we are still educating about 51% to 52% of the nursing workforce when they begin practicing. Of course, we totally encourage and want our graduates to continue their education to get bachelor's, master's degree, become nurse practitioners, nurse anesthetists, get their doctorate, but it is a really important pipeline to have nurses begin at the community college because, as we know, the United States is extremely rural. We have lots of areas, and those community colleges are embedded in those communities.
SHIV GAGLANI: I had no idea about the statistics. That's really, really impressive. I know you already mentioned that given your background as a person who specializes in infectious disease nursing and pediatric nursing, that COVID-19 and what your colleagues are dealing with is very close to your heart. I'm curious, how is this pandemic impacting the work that you all do at OADN and what resources have you all created to help those in your organization deal with that?
DONNA MEYER: First of all, one of the first things we did, like many organizations, we created a COVID landing page that has many, many resources and it's not so much that we totally created resources. Sometimes it's better to collaborate and partner with the experts, so we've been working with experts in simulation to provide webinars. We've actually partnered with the American Association of Colleges of Nursing, which is Baccalaureate and higher education in doing webinars for all of our members, both from the universities as well as the community colleges.
We have resources on simulation. We actually partner with many different organizations that provide simulation tools and virtual simulation, making sure those are all available on a kind of one-stop landing page for our members as well as putting up information about advocacy and work from the national councils, State Boards of Nursing and anything we can. We've also provided some different town hall forums, and we're going to be doing another one next week also for our members in a way to communicate.
SHIV GAGLANI: That's a lot. You guys have been busy for sure. All those resources sound fantastic, and I've personally gone to the site and visited them. I’ve spoken to Brian on your team as well and he’s been really helpful with regard to resource sharing. One other thing that is very much on top of people's minds is that in the last month, we've seen over 20 million people in the U.S. filing for unemployment, and some people are wondering whether this is maybe a good opportunity, not only to wait to get their jobs back, but to think about reskilling or upskilling and I'd like to know your thoughts about whether this pandemic represents an opportunity to attract more people to go into the field of nursing and get their associate’s in nursing?
DONNA MEYER: I think it's going to be interesting to tell. Right now, it's challenging to know. I think there are people out there that are saying, “Oh, I wish I could do something.” I've talked to people who said, “I wish I was a nurse so that I could help more,” so I do think there will be some of that. I'm also really concerned, though, that some of the people who have been on that frontline as nurses might say, “Maybe I'll stay in the profession, but maybe I'll do something different.”
I think that there are two ways to look at it. I also know that our programs are working diligently to make sure that the people that are supposed to graduate in May indeed graduate because we know there's going to be a great need for the nursing workforce, so they are working hard to make sure they meet their outcomes and can get ready to take their National Council Licensure Examination.
SHIV GAGLANI: Actually, that's how we first got connected. I remember we saw that you and OADN had co-signed a policy brief around the fact that so many nursing students would not be able to finish their degrees because of the pandemic. That actually is a good transition to the next question I have, which is given that you all represent so many faculties, schools, and nursing students, what are some of the considerations that they have had to go through in these recent weeks or will have to go through in the next few months as well, to actually finish and to become productive contributors on the frontlines?
DONNA MEYER: One of the biggest things is the transition in the educational mode as far as— They had to do more simulations in clinical, which they weren't prepared to do. They were prepared to continue to go to the hospital, the community setting, the long-term care setting. Some are still able to do that, but they had to augment the education with simulation. That is a challenge in itself, because every state looks at things differently for your nursing education programs and how you're approved.
So for example, in one state they might allow 50% simulation whereas another state would allow 15% or 20%, so one of the things we had to really talk to our members is about making sure they communicate with their State Boards of Nursing and their accrediting body to make sure that maybe they could ask for waivers so that they could do more simulation. That is one thing.
The policy brief that you're talking about and that the National Council of State Boards of Nursing spearheaded along with 10 other nursing organizations, was trying to have students become employees and then they would also gain academic credit, so I thought that was a wonderful thing to do because it's helping those students get the experience, also getting them some income. It's helping the healthcare facilities with more employees, people who already have the knowledge and expertise.
SHIV GAGLANI: That's a really good point and something that we're talking a lot at Osmosis, which is how many of the changes that we're seeing happening in real-time, things that would normally take months, if not years to get through, but are now happening in the span of days or weeks.
How many of those changes are going to persist after COVID-19, after all the craziness dies down, versus will we go back to a new normal? In your opinion, having been through other crises, but maybe nothing like this before, what are some things you're thinking about that will be persistent versus things that will go back to normal?
DONNA MEYER: It's very interesting. OADN has a research committee, and they had their call yesterday. I was on the call. I try to as much as possible get on the committee calls, and we actually had a conversation about that because this committee is made up of deans, directors, and faculties of OADN schools. And we were talking about the fact that they've gone online, which they hadn't done.
The fact that students will demand more of this online because maybe it's easier for them in some ways. They can do their online education at 2 o'clock in the morning as opposed to going to a nursing class at 11 o'clock in the morning. What will that transition be? Our idea was that we want to start looking at some research, perhaps because we’ve had the traditional student, and now, we have this data that's going to be coming out.
We know that there are many nursing programs that are online, but they're not pre-license training per se like we are. They are for RN-to-BSN, master's or doctorate in nursing practice, and that type of thing, so I do think there might be some shift where there'll be a little bit more online possibly, and maybe you can augment with simulation and things. I still think there's going to be that face-to-face, hands-on type of experience because it's very important, but I think we're going to see more innovation and more flexibility, although I have to say that I feel like the community colleges have always done a really good job at that.
SHIV GAGLANI: We work with a couple of community colleges, and I definitely agree. That's where a lot of the innovation seems to be as well as a lot of the very earnest, genuine educators that we've met. You also mentioned that there is a double-edged sword maybe where— Because of COVID, more people may want to come into the professions of nursing and other health professions, but also because of COVID, there may be more burnout or people have realized that the risk is very high; among the students, the debt that they're incurring is very high.
I'm curious— The world has changed in the sense that people are looking at health professions in a way that I don't think they had been looked at before. The true importance of that career has come to light. Do you think that there'll be policy changes that maybe would address the issues that were persistent before COVID, like burnout of nursing, nurse turnover? What have you seen there?
DONNA MEYER: We have had some issues with burnout and nurses leaving the profession and that type of thing, so I think it's going to make people more aware of that. The American Nurses Association— we're an affiliate of the ANA— they've done an exceptional job, and I think they continually will definitely do that and really monitor this and see what needs to be done at a policy level.
We're more in the education piece of it. They're more in the healthcare spectrum and practice piece. I think we're going to...they've done a lot on the PPE shortage. We did too, in a small way by doing a call to action, trying to get our community colleges to donate equipment to their local healthcare facilities, whereas the ANA is really looking at the policy part of it. We support that because we're an affiliate of the ANA.
SHIV GAGLANI: Ultimately, all of your learners will eventually become members of them, so it makes a lot of sense. We've done some stuff on the PPE side as well. We've worked with Thrive Global, which is Arianna Huffington's group that has something called First Responders First. We've done a lot of awareness campaigns to get money donated for PPE, so that's great to hear.
Student debt is a big issue. In my world, where we started with medical education, the average medical student graduates with $200,000 median debt. There's a lot of evidence that that shifts people's desire and what careers they want to choose, whether they want to practice in a rural or urban setting and that kind of stuff. I'm not as familiar with OADN's view on student debt, but I'm curious, is that an issue that associate’s degree in nursing faces right now?
DONNA MEYER: Student debt is always an issue because, first of all, we have a lot of students within community colleges that are a first-generation college student. We're trying to serve a very diverse population, and even though our tuition dollars is less at a community college, for example, I'm going to say that depending on which community college and where you're at in the country, you could get a nursing degree for $10,000.
You could become a registered nurse, graduate from a program for around there anywhere, which is obviously a lot less than at university, so the use of the community colleges are so important for them to begin their education. And again, as I said at the beginning of the comments, we still want them to continue their education.
Even though it’s maybe around $10,000 to $15,000, somewhere in there, there's still debt involved, and there are so many issues for some of these people. Some are single parents. I had students that were really living out of their cars and that type of situation when they were going to school. I had a great student that was a young man who had three children. His wife had just left him, and he's got three children and was trying to go to school to provide food, basically, for his family, so it's all relative as far as that debt.
There is debt, but fortunately, at a community college, it's not going to be into $100,000 debt, but again, that's why sometimes students want to start at community college. They can go to work as a registered nurse, make a good income, and then hopefully continue their education so their debt will not be quite so high.
SHIV GAGLANI: Definitely. Thanks for sharing those stories. On the debt side then, one of my hopes is that after all the COVID craziness passes that the federal government looks at this too and says, “Look, when we needed them to help, the healthcare professionals were there for us, so now we’re working to alleviate their debts so that people aren't even worried about debt if they decide to dedicate their lives to nursing or medicine or other careers like that?”
On the debt, we've seen other careers or other fields like software data science start pursuing these tools called income share agreements where they don't have to pay anything upfront, but then once they get placed in a meaningful high-paying job, there is a small percentage of their future income that then gets paid back to the school that trained them. Have you heard of any of these things in nursing?
DONNA MEYER: There are some federal programs through the Health Resources and Services Administration, HRSA, for nursing, especially when it comes to faculty, nurse practitioners and some of those advanced degrees where if you work in an underserved area, a percentage is then canceled and that type of thing when you work with both, where the school provides you those tuition dollars and then it's canceled. There is that type of program.
For graduates of associate degree programs that work in healthcare facilities, there is tuition reimbursement, especially for advanced degrees to get your bachelor's degree, so it might be either a percentage or some hospitals will say, “We'll give you $5,000 a year to continue your education,” so there are different programs and many of the healthcare facilities have those tuition reimbursement programs, which are excellent and really do help that associate graduate to continue their education. They have this for bachelor's degrees too, for maybe to help you to get your master's and other degrees.
SHIV GAGLANI: That's great to hear. I just have two more questions. The first is as far as nursing faculty go, I've heard reviews and seen some headlines before about there being a shortage of nurse educators. Where is that currently? What's the truth around that right now?
DONNA MEYER: It's very true. It's very true. I would say every school, whether it would be a community college or a university, they're always looking for faculty. Part of it is because of having to have more education to become a faculty member. Also, there is a discrepancy in pay from clinical pay to working in academia, so that's somewhat of an issue that comes up a lot of times. Also, not only a faculty shortage but deans and directors in the community colleges. That's a real issue, having a dean or director to oversee the program.
It's a huge amount of work, a lot of responsibility. That is something that we're really working on. I said, when I was talking about people perhaps being burnt out after this COVID crisis, they will hopefully become faculty if they choose, but we want them to stay in our profession because it's such an amazing and very important profession, and I think everybody sees that as we go through this crisis.
SHIV GAGLANI: Definitely. Thanks for clarifying that as far as the shortage of faculty, deans, and directors. My final question is given that our audience at Osmosis— We have over 2 million health professional students and practicing health professionals— What advice do you have for current students or people considering careers in associate's degree nursing? What advice would you give them at this point, if they're deciding to pursue it or not?
DONNA MEYER: First of all, nursing, and I know I'm biased, is an amazing profession. It’s amazing because there's so many different things you can do in nursing. You can be, as people say, a bedside nurse, which is wonderful and provides so much, but you could get into education and become a nurse practitioner. There are nurses that get into pharmaceutical sales. There are so many things you can do at nursing, obviously.
It's a very respected profession. As they say, it’s the most trusted according to the Gallup Poll, so we always want to put that out there, but also what my advice would be, first of all, that you talk to the school, go visit the school, make sure they're accredited by a national nursing accrediting body.
Sometimes people don't look into those things. I want to specify a national nursing accredited body because I will tell you that not all schools are accredited, especially from the nursing side, so that's an important thing for people to know. Ask about their NCLEX pass rate, which is a pre-license training program that has public knowledge but ask about that.
Ask about your student-faculty ratio in the clinical setting. Really important things. Ask about where they do clinicals, what type of relationships do they have with their clinical sites? There's a lot of questions that I think they should ask, but definitely, accreditation, costs, student-faculty ratio, types of clinical experiences, might even start asking about the percentage of simulation. There’s a lot of different things.
SHIV GAGLANI: That's great. What I love about that answer is that you started with the very high level of why it's so important, why it is so rewarding to be a nurse. You were also very tactical, the reason why I can tell you're an educator, but they are things that they should be looking out for so that they make the most of their education. That's all the time we have today, but I'd really like to thank you, Donna, for taking so much time to speak with us about your career and OADN as well.
DONNA MEYER: Thanks so much. I just have to remind everybody that this is the Year of the Nurse and who would have thought that in our Year of the Nurse, 2020— This is because it's Florence Nightingale's birthday and she's for 200 years, so May 12th is our big day, and I think it's extremely appropriate in some ways that we've been through this crisis as it really shows the very importance of our profession, so thank you so much for having me today. I really appreciate it.
SHIV GAGLANI: Thank you for sharing that milestone, too. With that, I'm Shiv Gaglani. Thank you again for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together. Thanks. Take care.