Nursing and Long-Term Care: Conversation with ANA President Dr. Ernest Grant

Integra X Files was thrilled to sit down recently with Ernest Grant, Ph.D., RN, FAAN, 36^th (and first male) president of the 125-year-old American Nurses Association (ANA), which represents the interests of 4.3 million registered nurses. The ANA advances the profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on healthcare issues that affect nurses and the public.

Having this opportunity to speak with leadership in the nursing industry brings the important perspective of “nurses as customers” to our long-term care pharmacies. Dr. Grant acknowledged that the COVID-19 pandemic created an atypical and quite challenging tenure for him – along with some very valuable lessons and silver linings. He shared these during a wide-ranging and insightful conversation, which you can also listen to on the Integra X Files podcast.

Healthcare Access and Crisis Preparation

COVID-19 shined light on inequities in healthcare access and the nation’s vulnerability to a rapid, widespread disease crisis – from counterfeit PPE to heavier mortality rates among minorities. Grant recommended both nursing and pharmacy survey our lessons learned: “What went right? What went wrong?” from the standpoints of operational efficiency, patient care advocacy, regulation, and more. He reminds us that in an increasingly interconnected world, healthcare issues that arise anywhere on the globe will become healthcare issues the U.S. will face.

Long-Term Care Staffing Shortages

Assuredly on the horizon is massive growth in the U.S. senior population, with 10,000 Americans turning 65 every day for the next 30 years. Grant joked that he tells nursing students, “If you’re looking for job security, become a geriatric nurse practitioner.”

Humor aside, Grant called for more funding for nursing education, because the country will need 1.5 million additional nurses by 2025. The pandemic drew licensed nurse practitioners away from clinics and long-term care facilities back into hospitals or traveling positions because of dramatically better pay, and solutions must be found for reinvigorating staffing – including paying nurses as providers rather than including them as room and board. Traditionally, LTC has been an unfortunate afterthought, but this vulnerable population must receive the workforce its growth will require, particularly in light of new staffing requirements from CMS.

Provider Mental Health

Staffing shortages exacerbated by COVID-19 were only one of the pandemic’s tolls; mental health was another. Grant explained that the ANA’s advocacy for nurses includes their health, as illustrated by the Healthy Nurse, Healthy Nation program. Originally intended to improve the health of the nation by starting with nurses – in areas such as weight, sleep, and resilience – the pandemic created greater urgency around mental health efforts. The ANA also partnered with the American Nurses Foundation, American Association of Critical-Care Nurses, American Psychiatric Nurses Association, and the Emergency Nurses Association for the Well-Being Initiative. Among its many web-based tools are stress rating scales with suggested actions for relief, the chance to write about experiences, and to talk with other nurses.

Grant said one of the biggest challenges is getting healthcare providers to recognize their need for mental health support – captured by the phrase “Put your own mask on first.” He encourages providers to realize untreated mental health issues create distractions from patient care and a difficult work environment for colleagues. ANA works across organizations to downplay any stigma from seeking help, including fear of negative consequences to insurance or state licensure.

Professional Freedom and Recognition

Related to mental health and burnout, Grant stated that nurses are learning that they cannot personally do it all. Acknowledging this frees them to provide more proficient and effective care, which may require greater freedom of practice.

Nurses are not always practicing to the top of their education, prohibited due to regulations from performing tasks for which they’ve been educated. Grant said the widely successful loosening of constraints during the pandemic strengthens the argument for fuller practice authority and the ability for nurses to delegate tasks as appropriate.

Pharmacists’ Support for Nurses

When asked what other clinicians, such as pharmacists, can do to support nurses, Dr. Grant emphasized the importance of good communication throughout the healthcare team to achieve an efficient, civil work environment. He said we should regularly discuss how to shift tasks among team roles for greater efficiency and cost savings, explore whether routines exist simply because they always have rather than because they make sense, and whether communication is breaking down due to large organizational size or other barriers.

Providers should also consider hosting political representatives and other decision-makers in their facilities to give them a first-hand view of the work done there, serve as sources of knowledge for them, and advocate for their profession’s best interests. Patient care will only benefit.

X Factor for Nursing and Long-Term Care Pharmacy

• Look for opportunities to collaborate, communicate, and express value and respect across disciplines.
• Said Grant, “We’re all part of the team, and we all want to help our fellow man in their time of need.”