Transcripts For CSPAN3 Sarah 20240705

Going to introduce both and then hand over the mic for conversation. Sarah digregorio aria is the critically acclaimed author of early an intimate history of premature birth and what it teaches us about human and taking care. The revolutionary story of nursing. She is a freelance journalist who has written on health care and other topics for the New York Times, Washington Post and the wall street journal, slate insider and catapult. She lives brooklyn, new york, with her daughter and husband. David marchese is a staff at the New York Times magazine, where writes the talk column. His work has appeared in new york, rolling stone, the American Music writing spin. Gq he lives with his family. Montclair, new jersey. Welcome, sara. Thank you so much for that kind introduction, and thank you so much to all of you for being here today. It really does mean a lot to me to see you here. My community in brooklyn means so much to me. Im just really overwhelmed with gratitude today to be able to do this work and then also to be able to here with you guys. It i am i am grateful to you you so much for being here. So first im going to do just a little bit of reading and then david and i are going to chat so i also just want to say there are some nurses in attendance today. You dont have to raise your hands. But i before i ask a round of applause for the nurses, i just to say clapping is not enough yet i still would like to clap for nurses who are in attendance say thank you for. And also we should pay you better, give you a better staffing. So first of all, i just you. I came at this topic really as someone who has needed health care and someone whose family has needed care. And so me, i started from a place of kind of personal experience, emotion that i had for nurses. And this that i had when i thought my time with, my parents in hospitals and with my daughter, the hospital, you know, there are so many things that go wrong in a Health Care Setting. Right. And for me the image that comes to mind, sort of being lost in a labyrinth, being lost in a labyrinth with, you know, your most beloved people trying to get the care that they need and trying to get providers to to see you and, to hear you and to find your way through that labyrinth. And sometimes that can be so difficult, as many of you know. But when i was thinking about, you know, what goes right, you know, we all know we we know that so much about the Health Care System is broken. But what goes right and the things that that i were these encounters with nurses that were really these moments of clarity for me because i felt seen and heard and i felt that these were helping us even when that help didnt involve a cure even when there was no fix still they were nursing us and. That meant really everything. Sometimes. And so thats where i started and and also the knowledge that, you know, we dont see the nurses expertise and practice discourse and analyzed in the news or in cultural reporting as much as we should and so i thought, you know there was this huge opportunity to bring stories forward. And so thats really where i started and was a learning experience for me. And so i just also want to sort of like establish for everyone who doesnt know that nursing is an independent scientific discipline so it doesnt exist relation to medicine and physicians and it is its own discipline with, its own sort of set of both its own expertise and own perspective. And so first i just want to read to you just a little bit about how nurses themselves conceptualize their profession and how they conceptualize it as separate from medicine. And so nursing and medicine. So medicine as practiced by physicians or what we sometimes call doctors, is they are complementary and disciplines, but they are not the and one is not above the other, but in fact, ideally they are both. Theyre to serve the patient. So i just because i didnt know this stuff when i started, i just want to of read to you a little bit in nurses words how they how they conceptualize their profession. Can you all hear me okay . Wonderful. So. Nurses conceptualize profession in a multitude of ways. But ill emphasize how nursing is from medicine. In her memoir, year of the nurse, cassandra alexander, the difference between medicine and nursing like this quote they the doctors learn where the patient and demarcate where they want them to be. It is the nursing actually gets you. There are. Hands are on the pumps and ventilators. Everything we do is an attempt to heal you. And then i like this also from a different nurse quote. This is the difference between medicine and nursing, said pollack kagan, professor emerita at depaul university. Medicine is a cure. It has a small repertoire of skills. I am not demeaning it. If you need brain surgery, if you need orthopedic surgery, you need that and you want the best to do it. But then who takes care of the person . 24 seven after the surgeon goes in and does for 4 hours, physicians have a very narrow scope. They hate hearing this, but its the truth. Ask any nurse nurses are the ones who heal the patients actually help heal along with the person themselves and their family being in a mutual process with people, their and their communities. Thats what nursing is. And that is one thing that sort of came forward in to a lot of nurses and resonated with my own experience is that nursing is about a relationship like nursing cant exist without a patient so its like in that relationship tween the nurse and the patient is where the healing is and thats where the expertise of nurses is expressed is in that relation between the the patient and the nurse. And i think thats such a powerful way to think about it because. It really thats like thats the power of relationship. Thats how we can thats thats that is the power, the healing power of relationship. And that being seen by someone who has the expertise to help you. And then finally, i wanted to just bring forward what teddy potter said. So this is so you might see a liver specialist. This is me speaking or the theory, the narrator. You might see a liver specialist, a neurologist, a gastro and a psychiatrist. And each of them might carefully attend to their particular system. But good luck getting them to talk to one another or to you about the overall picture of your health, the discipline of nursing can fit those pieces back together and ways to treat the full human being which can improve outcomes in concrete. As potter explained, this is teddy potter, who is a professor of nursing at the university of minnesota. She said, our mind body, were all whole people. And when you see your physician, you not feel like your needs are being met. Yes you may have received responsible care. It not negligent. It wasnt malpractice, but it missed what you actually need. And so its seeing the whole over and over and over again and thats what nurses do. So i just want to kind of like establish that because you know, the way that nurses conceptualize their profession was not something that i was super familiar with when i started writing this book, even as someone who has, you know, written about health care extensively the past and finally, before we talk, before david and i chat, i just want to read to you a little bit from the first chapter. And its really about why i think so important that we understand ourselves as understanding nursing as something that has existed in human societies and is actually one of the things that has made us human. So nursing is a thread running through all human history. Nurses were at the events that defined our world. They were key to the success of the byzantine and roman and indian empires. They were instrumental in the founding of the worlds major religions. They were tried as witches. They were forced underground, but they never stopped passing down what they knew, even when it was dangerous they were arrested for providing birth control, jailed for trying to vote. They act on their expertise, even when enslaved, they broke down. Jim crow. They went where they were needed. They fought for everyones right to a good death. They brought their knowledge to the halls of government. Human societies simply could not have developed and functioned the way that they have without nursing. So if you imagine that nursing arose in relatively recent times as, a profession dedicated to assisting physicians, hospitals, you have a backward nursing came first. Historians and anthropologists often point to pivotal moments that distinguish the evolution of early humans. When we started making tools or decorative objects or using fire to cook or when we cooperated by sharing food. But what about the impulse to staunch someones bleeding. What about helping someone give birth . What about sitting up with someone who is dying . These are interactions define humans as much as the use of tools, fire and agriculture. 4000 years ago in a neolithic Stone Community in what is now bucklin village vietnam a baby boy born with a rare congenital condition in which neck vertebrae are fuzed. As he grew, the boy curled his spinal column became progressively compressed. He was paralyzed from the waist down with very little use of his upper body, his head twisted to the right, and he could not feed himself chewing, swallowing were probably difficult. Nevertheless, even after becoming almost completely immobile as a teenager, he lived until his midtwenties, someone or many someones must have nursed him intensively. They brought him food and water, fed him, bathed him. They would have had to help him with positioning and tend to his skin to prevent pressure sores and infections without nursing care. He would have died within days. When the young man died, he was buried in the fetal position because of the curve in his spine. When archeologists found him in 2007, they noticed he was the only one in the community buried in this way. Then he saw the neck vertebrae and the extreme then they saw the fuzed neck vertebrae and the extreme slender ness of his leg and arm bones that comes with paralysis. Lorna tilly, an archeologist on the dig, had previously worked in nursing and the young mans body, spoke to her. She started to piece this case together. Other evidence of prehistoric nursing tilly became captivated by what these bones were saying. But when she looked back at previous archeology studies, she found that while survival from illness or injury was sometimes there was often little to no analysis or even acknowledgment of prehistoric nursing care that would have made this survival possible. Informed her work in both archeology and health, she developed a model called the bio archeology of care a framework for understanding how our earliest ancestors nursed each other in anthropology news. Tilly and her coauthor argued for the importance of understanding ourselves way. They said, quote our past contains important lessons for our present. If we are willing to Pay Attention and archeology will focus on Health Related care, completely overturns the notion that society has evolved by embracing a winner take all survival of the fittest approach to health and welfare policy, a defining hallmark of the human species is our capacity to support each other in times of need. So i think this is so powerful because there are different that we can think of ourselves right . Can think of ourselves as peak as a species for whom it is natural to try to dominate each other and get one over on each other or. We can think of ourselves as people are really. We are meant to care for each other and we are meant to to organize ourselves that way. And i just, i, i want leave you before i Start Talking to david from one quote from actually the last page. That is my favorite thing i think ever written about nursing. It comes from mark lazenby, who is the dean of the professor or sorry, hes the dean of the university of california, Irvine School of nursing. Hes he said nursing is a profoundly radical profession that calls society equality and justice to trustworthy and to openness. The profession is also radically political it imagines a world in which conditions necessary for health are enjoyed all people. Thats my favorite thing. It imagines a world in which the of health are enjoyed. The conditions necessary for health are enjoyed by all people. So thank you. Listening. And now im going to talk to david david. Hi, sarah. Hi david, congratulations. Youve written a great book. Thank you so much. I want to start by asking something that sort of in the context two things you just said that have to do with sort of the breadth and hugeness of the subject of nursing. Were you know, you youre writing about something that defined could be defined both, as you know, relationship and and also in terms of care, the thing that makes us human now if you had said you were pitching a book editor im going to write about a subject like a relationship or the thing that makes us human. I think they would have said too big of a book and but only that but sort of chronologically the subject of nursing, the way you lay it out goes from prehistory to now so its kind of a huge subject and youve written youve synthesized it so smartly and and what feels like comprehensively. And i wonder if you can talk about sort how you saw your way into into the subject given how kind of unwieldy it could be. Yeah. Now thats a really good question because it is unwieldy and it felt unwieldy the whole time to be honest, i where i started was when i pitched the book a cultural history of nursing which you know didnt exist for a general audience. And so, you know, there is a pretty obvious gap in the book market. There. So many interesting stories tell and i started out by thinking that needed to tell it chronologically like okay i want to tell a comprehensive history of nursing from prehistory to today and im going to somehow make that readable and i you i quickly realized that that that was impossible like impossible like you cant as you say, nursing is like it is a huge topic. And, you know, i could not write a comprehensive history of nursing. So i started to about that a little differently. And i realize what i really wanted to write about was not a history of nursing, but a history of the power of nursing and the history of the trend like transformative nursing and ways that nurses have changed the world and what nursing has meant because you there are certainly like really important nurses that i cover quite and if you really going to write you know a comprehensive of now you wouldnt do it that way. And so i started think about well what am i really interested in im interested in nursing in peoples lives and thats why i ended up doing away with the with the like kind a logical approach and i started to think about it in terms of how nurses interact with people, different points in their life, course. And so thats why i, you know, i ended up organizing it around and nursing and community and then nursing and addiction care, nursing at the end of life, nursing care. And that ended up being like a much much easier way for me to get my around it also because then instead of the whole book chronological, i could think about domain that was talking about i could think about weaving in history to that but also bringing in contemporary nurses who were doing you know transformative work. So i let myself i let myself i let the idea that i could possibly write a comprehensive book about nursing, let that go. And and thats sort of i landed with this book and what you just said about thinking about the or contextualizing it in the sense of in peoples lives brings to mind for me theres a in there from monica macklemore where she described whos a nurse and she describes nursing as sort of being about transition about helping people through Life Transitions which is such an interesting way of thinking the job and certainly one that i think the layperson would not have arrived at by themselves. And im wondering if you can talk about sort of how you saw that play out, how that definition was brought to life for you. Yeah, i love that. She said, because youre right, its really its not necessarily an intuitive way to think about it. She was making a distinction between, you know, people think when you think of nurses, perhaps as a layperson, you might think like, oh, the nurse comes in, does a task for me. So the nurse is going to check my Blood Pressure or if im in labor, the nurse is to check my the fetal the fetal heart rate. Theyre going to check reading. And she was the distinction that those strata that they use that nurses use to do their work, that all of these sort skills and tasks that they have, those are strategies but that the real of nursing is that they are guiding people through these transitions. So some of the transitions are like the most profound life that we have. So for instance, if youre giving birth or youre being i mean, thats a transition from being not being a parent to being a parent from being in the uterus, being out in the world, dying. Obviously, a major both for the person dying, also for the family and in the book about hospice care, you know, helping manage the transition, i saying goodbye to their loved one. So there are skills that nurses have to do that work. But then what they are really doing is managing that transition with the family and whatever that means. And i think, you know, one of the more simple transitions is even just like a from an illness to a well state or from, you know, a state you have just been, say, diagnosed a chronic disease that maybe doesnt have a cure a lot of the nurses i spoke to were helping people manage a transition to sort understanding their new body, understand how to take care of themselves with this sort of new reality. So youve just been diagnosed with diabetes or, you know, some other condition that cant be cured, but that you do need to sort of transition your life to live with that. I remember when mira first came home from, the nick you we had a visiting nurse. To me i know notes that maybe make sure i didnt like really lose it but she was there the way mira so you know that for me like her coming day was helped me tremendously in managing the from an icu setting to being parent at home which. I dont even know like if you said to me how she do that, i dont know. Like i dont know what she just really kind of like came in and was like, well, let me weigh the baby. She was like, how are you . Oh, hows going with the pumping . Oh, that sucks. You know . I mean, like, she was just really but she made she normally it for me and she wasnt shocked by me, my baby or anything that had to us. She was like, yep, this happens. Its going to be okay. And i think that thats yeah, i mean, this like that kind of transition where theyre guiding through those things and given how both misunderstood nursing is and how underappreciated is, did you find that there was there were commonalities in the sorts of things the nurses you were reporting on really to convey to you . Like what did what was your sense of what they wanted the world to know or just a journalist to know about what they do. Yeah, i thought about this one. I think a lot of nurses expressed to me that it is tiring to get accolades and be on a pedestal without having any sense that their labor is. Appreciate but not appreciated actually is understood. Appropriately compensated aided and and given working conditions that that they need to actually do it. And so that manifests self differently for lots of nurses on the setting that they work in. But i think there is this like pervasive sense among nurses that people have absolutely no idea what nurses actually do. And so people were eager to convey to me like, you know, i think there was some skepticism understandably im not a nurse and people talk about nurses. And i think a lot of nurses dont get a chance to express their expertise themselves. There was a study thats called woodhull study that in media, nurses are quoted in to as experts in 2 of health care stories. Meanwhile, nurses there are like 3. 5 times as many nurses as physicians, and they provide the vast majority of patient care. They are. They are not understood as experts. The i think its fair to say in like the general imagination. And so, yeah, i mean that theres anger about that there a weariness about that and i think what nurses want the nurses i interviewed wanted me to understand that they dont want accolades or to be put on a pedestal they they to be understood as the experts that they are and then they want the working that make it possible them to do their jobs. Well, do you think physicians, what nurses do, how actually. Yeah, i mostly, i know that physicians know that they cant do it without nurses for sure they know that there is a, you know, i think it depen goes on obviously depends on the person depends on the setting but. There is a sense physicians also appreciate nurses but structurally and also there is like a growing movement in in health care in general to say that they have like a multidisciplinary re approach. So like, oh, lets break down the silos, lets break down the hierarchies. Now were having a multidisciplinary approach where were all Just One Team and its the physician the nurses say the respiratory therapists, theyre the physical therapists, whoever else on the team. But think you will find that that is more a catch phrase at this point and maybe something that is talked about in academic settings more than is actually put into practice. Its hard for people to give up power when theyve had it for so long physicians have been at the top of the hierarchy for a very long. And so yeah, you know, do they know but do they still think i mean speaking generally because i do love physicians were all friends here. Friends here are three physicians in the room. Im not sure that they would like to it. Im not sure that they would like to powershare to it. And the question of power comes up in the book in various ways. And at various times. And im wondering in the book touches on this a little bit, too. But are there ways in which its clear that the pandemic has changed of the institution or structures around nursing . So i think a couple of things one is that the problems that were having now with Nurse Staffing existed way way way before the pandemic. And in fact there has been this idea that we are in a nursing since literally dawn of the modern hospital in the united states. So hospitals have always, oh, there arent enough nurses, we just dont have enough nurses. Meanwhile, what actually meant was they nursing care for free. They wanted nurses who would essentially work for free. So what is a nursing shortage . Really depends on. You know, it depends on how youre thinking about it. But we certainly are in a Nurse Staffing crisis right now that has been made much worse by the pandemic. Nurses are quitting. Nurses. I think that there is less of a willingness to go to get along. From what ive heard in interviews, nurses are simply walking away. And so thats a structural change is pretty serious and is probably going to get worse and affect really all of us. I do think that there is an opportunity here, which is that, you know, its possible that things are broken before and now things are broken that there may be an opportunity, you know, rework things in a way that would be healthier. So, for instance, i think that this is a really potent moment for nurse. We all just that nurses successfully struck whenever that was like three months ago they only on strike for a couple of days they won all of their the all of their demands which is always primarily more staffing what nurses are the nurses are often asking for more compensation, but it really is always primarily they want more staffing because the work of nursing in a hospital is unbearable. If there are not enough nurses and you know, i think its sort of like a really wobbly moment structurally and knows whats going to happen next. Its, you know, things are i spoke to a guy who is a at the national at and you the National Nurses united the National Nurses and he was like you know i just dont i dont know whats going to happen are as bad as theyve ever been. But also, you know, things feel kind of potent now. So its its really wobbly and i think theres a tendency to probably think of nurses as sort of like a monolithic group who, you know, are all politically and ideologically aligned in same way. But given just the sheer number of nurses and the fact that they too are human beings, that obviously cant be the case. And im wondering where you see sort of tension within nursing or where there be kind of broader disagreement about the direction or even the of it . Yeah, its really interesting because i think nursing as a mainstream profession has often been forced into as a place where they have to sort of avoid controversy and uphold status quos and. There is certainly a population of nurses who who not want that and one example of this is actually just in terms of thinking about nurses and midwives role in providing reproductive care like full spectrum reproductive care, its very difficult for nurses and midwives to get training on abortion care even before roe fell. Its not something that is often with in Nursing School and that is a function of, a certain segment of sort of the nursing establishment wanting to avoid controversy. There is a demand put on, i think like feminized professional caregivers to be nice, sort of stay above the fray. So we cant be political and and so there are a lot of nurses, though, who find to be unethical because, in fact, patients need care and nurses want to provide the care that patients need. And some patients need abortion care. Patients contraception. And so there is like a theres a segment of nurses who a lot of whom i spoke to for the book who really want to challenge nursing, accept the inherent political nature of. And i think that that is a big rift in nursing right now. I also think you know theres theres been an effort to reckon with the past and present racism in nursing thats been you know something that has been pushed forward by people who think that this is important that we have sort truth and reconciliation in of how nurses of color were treated in the and in the present. Thats been tricky for for nursing as a whole to deal with. And so i think that there i think that there is this sense i think that the Common Thread there is. The idea that nurses are asserting, you know, this that the idea that nurses. Dont hush up this like the idea that that nurses should be a certain kind of often woman who, you know, doesnt who doesnt get you into politics sort of stays above the that kind of conception of nursing is has never been true necessarily. And are really trying to push towards really like embracing the power of nursing, which is really about how we care for each other, which is inherently yeah, and sort of that hit that of thinking of nursing sort of like what sort of a morality to the profession is something that you trace really clearly in the book and i thought a lot of the historical portraits of nurses were really fun and so many of these people, not just fun but interesting but in so many of these people could have been the subject of biographies on their. And im wondering if there was a particular or historical nurse who you felt like you connected with the most or you had had more space to write about, more whos touched you like . My favorite favorite is lillian. So lillian wald was a nurse here in new york city. She she was just like this extraordinary figure. She was she at the time, nurses trained in. So she was training in a hospital and then she graduated from her nursing program. And she actually went straight med school, which was for a woman at the time. But in the meantime, a friend of hers had asked her, hey, you go to the Lower East Side and maybe teach the immigrant there something, you know, could you teach them about sanitation or nursing home . And she was like, okay. So she went and she was a class on how to make beds. It was very difficult at that time to keep anything clean and there was no running water. The east side was incredibly, incredibly crowded. It was more than twice dense as it is today. And theres actually some people say it was actually the most crowded place in the world at the time. A lot of italian immigrants rushing, immigrants, people were coming by the every day. So lillian wald came from a a pretty affluent family in pennsylvania i believe. So she she was a, you know, a very person. She didnt really what was going on outside the hospital. She went to the lower side to give this class about bed making. And as shes doing this. This little girl bursts the room and shes crying and she my mother is bleeding and shes bleeding for two days. And doctor came and went because we couldnt pay and can you help me . And so lillian wald followed this girl was a rainy day in and you all you know like a rainy day in new york in march. So but it was even, you know, the werent paved, you know, at that time animals would die in the street and just be left there. So shes following this little girl through the Lower East Side. Gets to apartment and the mother has given birth and shes hemorrhaging and shes been hemorrhaging for days. The bed is soaked in blood somehow. Lillian wald, save this womans life, she stopped the bleeding and she said this family, like kissed her hands and was so they were they were overcome by the fact that she had actually helped them, because you can imagine that they absolute lutely knew women who died this way who who hemorrhaged to death after giving so lillian walt said that this was her baptism of fire that once she she saw this family lived and she saw how the physician had come and gone because couldnt pay and she couldnt go on the way that she had thought would sort of keep going with her life, go to med school, this, that, the other. So she decided with a from Nursing School that she was going to move the Lower East Side. They rented an apartment on allen street. I think and it was it had one of the one of the only indoor bathrooms at the time like 14th street and, and they decided they would just go live and that they would provide nursing care either for free or as pay. Pay what you can. And they were busy from morning until night. They lived not holding themselves apart, but they lived there as part of the community. They enjoyed living there. They invited the children to dinner and they really even though they, you know, they were radicalized by the sorrow that they saw all around, they also loved being part of the community. And she wrote that the reason that im able to say all this because she wrote she wrote about this and i just you there were there were things in her book like for instance an Orthodox Jewish family that wanted keep the the tradition of the sabbath but had no food and so they they kept a pot boiling the stove like the tradition of the im sorry shabbat dinner sorry they wanted keep the tradition of the shabbat dinner but they had no food and so they would keep a pot with just water boiling over the fire that this was this was what they could do. So she writes about this. Then she because there was they were providing care where there was no care. I mean, there was no care for people. They ended up she and her her Nursing School friend ended building something called the house on henry street, which is one of the settlement houses that provided sort of wraparound services. And she established first visiting nurse service. And by like the 20 years she had hundreds of nurses and they, they were in different spots all over the city and they thousands of patients and their outcomes were excellent, like excellent. They often know children would get pneumonia often they would die of pneumonia. They had no antibiotics and. The hospitals at that time had Something Like a 20 to 30 mortality rate for children with pneumonia. And she had, i believe it was like a 9 mortality rate for children with money were cared for at home by her visiting nurses. And its just like such a vision for what is possible. And she kept the sort of the humanity of everyone and that that was sort of like the at the forefront of her mind. So she like her accomplishments. And i like love her and accomplishments are i mean, the list them is almost absurd. She she established first public playground. She said that play was a matter of dignity children she came up the idea of the school lunch the school nurse in special education she she offered the house henry street to host the founding of the naacp i mean she was just she she her vision nursing was so vast because it encompassed sort of like the conditions of living and what do people deserve like everyone deserves to live safety and she i just i her just incredible that is my so a lovable character really lovable and she she was obviously a pioneer in her time and you know not so much comparing hurt to a particular nurse now but im thinking about this next question in the context of something you said during your introduction of where you described nursing as sort of an independent science that, you know, has its own methods and where where do you see like the the leading of that science right now . Where is the the pioneering happening in those terms. Yeah, thats really interesting. So i say theres a lot i mean, there is lot going on and and nurses are often interested in things like improving workflow very, like practical, practical aspects of care delivery. Right now there is, there is some work around ai in hospitals, but nurses very mixed feelings about that. The idea that some of you have seen like the robot like follows the nurse around that for many nurses evokes. The idea that hospitals are trying to sort of like push them out and hire robots dont need to be paid. So you know theres you know, theres theres a lot of Different Things going on. I would say that when nurse does do research, at least in my experience, theyre using the scientific and sort of theyre they are researching Health Care Topics just like sort of anyone else who researches health topics. But theyre doing it with nursing perspective, which is different because it is often more focused on the individual, their context and sort of how something work in reality in peoples lives. So ill give you an example. Well, its also just its very its more i would say in general, its more engaged in community. So theres a nurse whos at emory university. Shes a ph. D. And she is doing research on how the combination of Global Warming and exploitative working conditions impacts the Kidney Health of agricultural. So essentially the whats is that Agricultural Workers who are who are incurring who are essentially getting heat stroke every day. And so becomes a chronic condition for them and it damages their kidneys and it can cause death in the long. So shes doing Research Really making those connections is the connection that happens with the working conditions is that one way to slow or mitigate this kidney damage is being provided very basic like rest shade and water. However, Agricultural Workers do not have the right to water rest and shade. Osha recommends there are three states now that do require it, but in general you can know employers dont have to. Employers can hire a bunch of people to pick plants in 100 degree weather and they not required to make sure that they have water or any access to shade whatsoever. And so i think that her nursing perspective is in understanding that you know how the way how how the working conditions interacts. So its not just about understand adding kidney function and, heat related illness, its about understanding how that interacts in the world and how and you know, i think its just its like a really, really powerful way of thinking about doing research. The other thing that she does is she asks the Community Members . Well, what are your what do you want out of this research . So its not just like, hi, im the researcher. Im here to take your data and go away with it and youll never hear from me again. So she instead asked them, like, what do you want of this . And they said, well, we want actually, like physical. We never get to go to the doctor i dont know if i have high cholesterol this that the other. And so when she collects data from them she sits down with them and she tells them their cholesterol, tells them what their Blood Pressure is because they want to know that. So i think thats like a very specific nursing way of doing research and this is probably just the last question before we open it up to questions. But we got the thumbs up. All right. But just in this conversation, sort of the the focus on, the i guess you could call it like the direct showing of care has been from the nurse to patient and and or the nurse to the community. And obviously, nursing and nurses requires the job, requires taking on it is carry heavy burden like both emotionally and medically and this is maybe an overly vague question but whats your sense of how they how nurses deal with that . Like how they take care of themselves and i dont mean like, you know, making sure they get the proper appreciation from people. But like, how do they how do they deal just the nature of how difficult their job is . I get the sense that part of it is, at least ideally the sense of that they understand each other and that theyre in it together and sort of i think that there is something about that shared experience that what heard from nurses is that you know, its impossible for anyone else to understand what weve through in particular the last three years. But its impossible for or you know they can tell us or they can tell their family. But really, we dont know what its like to be there and to be doing those things. But that other nurses know. And so i think there is a real sense of Group Cohesion on some level and a sense of of pride in that. I think theres a sense of pride in that. And, you know, but to be honest with you also, a lot of nurses shared with me, that they dont feel that theyve been able to take care of themselves. I mean. That theyre really struggling. And i that it you know, it depends on, you know, where are and what theyve been through and the culture of the place where they work. I think that that is one reason why nurses are quitting is that the things held them before are maybe not quite enough in cases anymore. And so yeah think that thats, you know in some cases im not sure that they do have what they need. Yeah i actually want to end this part on a more optimistic note than that. But so when you earlier talked, you know, the possibility of this moment is a particularly potent one for nurses. Tell me what makes it feel potent like where sort of the the where is optimism and the positive . Yeah, no, i think there is a lot optimism. I mean, theres a lot the thing about it is like there is actually so much power in nursing in so many ways you know just the idea that the the higher the level of nurse in a hospital the more likely you are to be discharged alive. I mean thats important. You know i think that there hopefully a growing understanding that that nurses that nursing is a discipline that is like really has what we need right now. I mean i do sort of feel like we are we are we have a lot different kinds of problem ems right now and all of them kind of come down to a crisis of caring for each other and if we can look to nursing even as society. And if we say actually were going to invest this and we understand that what need is this . Then maybe that kind of, you know also indicates a better understanding of the ways that we actually all need to take care of each other like that. What do we owe each other . I think that the pandemic like fractured around these ideas of like, well, i dont owe you this care. I dont you that and and maybe right now we can be like actually we do owe each other this care. Like we owe it to nurses, but we also owe to each other. Like we owe each other care. And i think that thats, thats like it sounds very simplistic. It is kind of like the way forward. Like what else . You know, what else is there. So on that note, lets take questions i have to make i can bring it around. Yes, i here to make you. Yeah. Okay. So my question is is this better . Okay, good. Thank you. Thank you. My question is the nursing industry has always been in the shadows weve only known about how hard this work and how much they care when were in the hospital. So my wife and daughter had to be in the hospital for a long time and, you know, we it was there that, oh, my gosh, you you realize how much valuable these nurses are. But im surprised the leaders of the nursing Organizations National agencies, organizations, havent taken the opportunity opportunity for the public to join their fight because dont join during the pandemic we really saw that nurses gave the sacrifices and they they worked well beyond i imagine so im curious about the leaders havent brought that to the public and said listen i its a threat and you see how we the human beings humanist you know so why havent they brought that to the public and said, listen, before the wave, before we all get back to the old, you know, way of life, you know, five years now, this is the time when they could seize moment and say, listen, guys, you saw a sweat and you source crying. You seen us die literally. So we need your support. Yeah. And we and we love your, you know, your support and your appreciation and yeah, thats a really good. I, you know, for some reason the national or i guess ill just be specific the a e the the American Nursing Association has not is their strength is not communication and i dont know that is they are very risk averse very very risk averse and. You know a lot its its interesting because so the i would say the nursing and then you has done a much better job making a case to public that actually nurses and the public are in it together you know that really like its this is not about like when when they make a case for staffing for instance when the unions a case for that they i think do a slightly better job of reaching out to the public and being like you you need better staffing because if if we dont have better staffing you are not going to get the care that you need. But honest, they dont know the answer to your question about. You know, why are why we so in the dark about how important nursing is and really understanding what nursing work. I think we know its like nurses in the collective imagination are a little bit like mothers not its nursing is not a female profession not inherently done by or feminine people at all. It is historically and always been done by people of all genders. But i think there, you know, theres a willingness to kind of be like, oh, we love them. And like, you know mothers day and national and like nurses week, its like on the same we its kind of like this idea that well give them flowers. We wont really understand what they do or create the societal conditions that make their work possible and why has the a e been to sort of break through that . I dont know the answer. I dont think they have been willing to be. I think that this is a public message on becomes a political message and they dont want to make a political like for instance, the anna did not endorse a candidate in the 2020 election for the First Time Since 1988 because they said that would be too divisive. I mean, i think that there is a way that, for instance, and this kind of is, you know, beyond your question, like there is a way to say, well were not partizan, but lets line up what an Evidence Based Practice is and whats in Evidence Based Practice, and lets see which, candidate is more in favor of Evidence Based Practices. That would be a pretty easy call in 2020 election. So, you know, but i guess to your point, the point im trying to make is that its hard for them to be brave and im not sure why that is. Maybe a nurse has some insight. I dont know if this one is better. Yes it is. There we go. Okay. Well, theres steve right there. Yeah, hi. I am a registered nurse. Ive been a nurse. Over 26, 27 years. Part of the reason for the nursing shortage were very we dont together very much in most a very Diverse Group where you can work in many different environments. I spent the last 25 years also working in health, which is the very different Work Environment opposed to hospitals, which ive also worked in hospitals. No one even mentioned how bad Nursing Homes are. Far as staffing, i worked in them for many years also. But the issue is too is in numbers now. When i work with the union ufcw, they would never the nurses its it is not enough of you we 80,000 teachers theres only 3000 nurses so were not really going fight for you and most of our staff would just say, oh well, just accept it. And thats how we did it. And plus, theres so many different areas that we can work in. So were all sort separated in our own little boxes and the areas so part of the reason thats why we come together as one force thats thank you for that. I we have one other nurse over here in the corner my coworker susan. Hi, susan. Questions. Or comments . Yep, yep. Sorry. Okay. Here in new york, experience itself and Global Health was i think that theres a vast fragmentation terms of the Political Climate amongst nurses. You just have varying different areas how nurses see and see health care. All of us are ultimately dedicated to giving the best care to our patients. But as someone whos recently in the salem health projects, the city doing the vaccination campaigns and all of the midtown hotels ive seen a vast in the amount like in the way nurses approach public health. And so i think that is one of the factors also just affecting how health is provided overall because think especially in these emergency situations like how weve seen in new york were at the precipice of dealing with one of the most profound crises ever and we are seeing all of we have seen. Over 50,000 Asylum Seekers come this city and their health care has all been put on new york city without any of having and realm how to provide that. So ive ive been on the forefront of seeing thats transpired and i think theres just a array of how nursing is perceived and how how its overall dealt with in the city. You have a vast realm. People who think that everyone deserves care regardless of their status. And then you have other people who are very ill. And ive seen it nurses as well who are very angry about outside people. You know, immigrants, Asylum Seekers receiving care, people. Our own city arent receiving care. I think overall theres a vast theres just a vast spectrum in terms of nursing care overall. Everyone is ultimately dedicated to giving the towards our patients. Its ultimately the focus but it does vary based on what we can provide just based on limitations and the circumstances. I think new york city has also just been in an incredible crisis, an Incredible Health care crisis since covid from going from pandemic to covid care, asylum care to needing to care for all of all of the ive worked in Community Health my entire life over a dozen years. And we seen a vast change in the need for Community Health over since covid hit. And i think that has drastically changed the course Community Health nursing as well as private Health Nursing because. We are seeing changes in know what were dealing with it like the ground right without Additional Resources or support. Yeah yeah i hear you i hear you. Sara. I from your experience and i can direct this to some of the the nurses here as well, what can patients and really less patients because they dont necessarily have the agency at the moment but their families when someone is being taken care of by a nurse or when someones at a hospital, what can they do . Make the nurses jobs easier . And i its more than a box of godiva chocolates as theyre leaving have gotten any feedback. Thats a good. I have heard from some nurses that they are not supposed to tell or their families what their ratio is at the moment. So oftentimes they are caring for too many patients and they are not supposed to say that to theyre not you know, if youre like, hey, i really need help from my mother right now, the nurse is often told not say im so sorry, but i have ten patients and its not safe me to be taking care of more than and so i think maybe just being aware of that you can if if you have a rapport with them ask them you know whats whats whats your work like today like do you you know, how many people are you taking care of . Is it . Is it a lot and sort maybe make that opening for them to of you know let you in what the reality is for them then. I think that you know a a lot of nurses have said things, you know, and this is in the research as well that patients and families can be quite abusive towards them. Violence towards nurses is a problem and so i think when you in a Health Care Setting just approaching everybody with an understanding that people are doing everything they can with to do with too few resources and then you know, also, of course, as a family member, you you know, not you, it doesnt mean shouldnt advocate for your person like asking questions, advocating them to get the best care, but doing it with with that, understanding that they may be working in a situation is totally untenable. And i think that would go a long way, just sort of like that. Were all educated about this and then, you know, we if you know if you can bring it up to, you know, later when you know youre not dealing with a sick family member, you know, emailing the at the hospital and without like outing the nurse, being like, you know, i, i really i know how important are staffing is to Patient Outcomes and i really i just want to express how you know that i as a Community Member i hope that you are staffing nurses to an evidence based ratio. So i think if we make it clear to hospital administrators and other in power that we understand power of nursing to be like that, the importance of nursing. That, you know, they kind of rely on the fact that we dont know that i think because know the Research Like hospitals that outcomes are are very very dependent on the level of Nurse Staffing and yet they still try to cut nurse why because they they they that we dont know is my. We have time for one more quick one think this is yeah this is going to be super quick and that is also surveys are what a good thank you for bringing that up folks get all the time written up and based on whats on surveys and also when things are good as well. So awesome. So definitely complete the survey and let the employers know how great your nurses by name. Thank okay we do that we do have to move on to the next segment. I can i can one more im just i mean this is about the future so what is Research View regarding telehealth is still very popular, especially after the pandemic obviously. So what what are the nurses roles in this telehealth, you know. Yeah, yeah, its a great question. Like any other technology where can be used in a really way or it can be used to cut corners and and not provide good patient care. For instance, there is a really Organization Called hey jane, which is a an organization that staffs quite a lot of Nurse Practitioners and you can get medication abortion through telehealth from them. So if you are in a state where that is legal. You can go online to jane and you can either do this like async honestly or synchronous. So you can have a like a telehealth meeting with a Nurse Practitioner to get your medication, abortion or can even just text with the nurse. And there is obviously theres a whole evidence based clinical process that they go through to sure that you are a safe that having a medication abortion will be safe for you. The reason i bring this up is because like, you know, a lot of people dont want to go to an abortion clinic, then walk past the protesters. They may be active duty. They may not want anyone to know they, may live in a part of the country where its pretty scary for them to go and get inperson Clinical Care for an abortion. So this is a great example of how telehealth can be super, super patient patient friendly, person centered and the safest you know the safest way to provide care sometimes and there are nurses who are doing that a on the flip side, i have had nurses tell me that there is this Movement Towards discharging patients early with different sort of Monitoring Technology and that that technology will then be monitored in a, a Central Location by Health Care Professionals in a location where labor is quite cheap. So thats so in other words instead of staying the hospital two extra days to have nursing proper nursing care, maybe youll go home with a you with with a say a heart rate monitor and theres going to be someone in a warehouse somewhere who gets alerted if something goes wrong with your heart rhythm. And then someone else will get alerted and then, you know, eventually youll get the care that need. And nurses have brought that up with me as something that is a way to cut nursing like cut nurses jobs and sort of do kind of monitoring remotely in a way thats really not focus on the best patient care, but more focused like the goal of that is to is to reduce costs. So telehealth is just a tool or a sort of all of this technology is its a tool that can be used in great ways or its a tool that can be used in in ways that dont further the health of of public. Thank you. Okay. So with that, lets give a round of applauseall right. Good afternoon. Im pete. Daily ceo and publisher of the Naval Institute and i our audience both here in the jack Taylor Centers lockheed auditorium and our remote