Building a New Appreciation for the Value of Nursing: Jennifer Mensik Kennedy, President of the American Nurses Association

Hillary Acer: Hi, I'm Hillary Acer welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

We've had the pleasure of speaking to nursing leaders at a variety of health systems and at nursing schools on past episodes of Raise the Line. But today we're going to zoom out for a big picture perspective on the profession and its current and future challenges and opportunities with Jennifer Mensik Kennedy, president of the American Nurses Association, which advocates for the nation's 5.5 million RNs. 

Prior to assuming the presidency last year, she held various other leadership positions with the ANA and was an associate clinical professor at the Oregon Health and Science University School of Nursing. She's also a fellow of the American Academy of Nursing and was named by Modern Healthcare as one of the 100 most influential people in healthcare in 2023. 

Dr. Mensik Kennedy, who earned a PhD in nursing, is a sought after presenter and prolific author whose books include Lead, Drive and Thrive in the System, and the Nurse Manager's Guide to Innovative Staffing. Dr. Kennedy, thank you so much for joining us today.

Dr. Jennifer Mensik Kennedy: It's nice to be here. Thank you for having me.

Hillary: We always like to start by learning a little bit more about your journeys into healthcare, and I'd love to hear what got you started.

Dr. Mensik Kennedy: So, healthcare wise, up until sometime in middle school, I really wanted to be an astronaut and I was going to be an Air Force pilot. Between ninth and 10th grade, my mom actually went back to school when I was in high school and she was going to become a nurse and somewhere between ninth and 10th grade I decided that seemed like a really good idea. However, what I was going to do in my 10th grade brain -- I had mapped out the entire process -- I was going to be a nurse practitioner, and that was more than 30 years ago that I was thinking that. 

I didn't go the full route of nurse practitioner, but I did become a nurse. I had a lot of experience. We went to school in a very small town and there was a critical access hospital and I got the pleasure of working in the nursing home in the summers, working in the hospital kitchen and got exposed to healthcare from that perspective. And so it made it an easy choice for me just to continue on. I really liked helping people, so it was a natural decision.

Hillary: From astronaut to nurse. That's a pretty big jump, but I'm sure we can find the connection. And since that start in nursing, you've held a variety of leadership positions. Obviously you've escalated into one of the most important leadership positions at the American Nurses Association and you've also worked in clinical and nonclinical settings throughout your career. A lot of our listeners are nursing students or early career professionals. Walk us through your journey in nursing as well as into leadership. How did you get started in your nursing career and then how did you progress to taking on leadership positions within these various organizations?

Dr. Mensik Kennedy: Oh, thank you. That's a great question. I grew up in a small town and we had a local community college and I was lucky enough that we had a program in Washington State called Running Start. So I was able to take some of my community college prerequisites for nursing when I was in high school so even in my senior year, I actually had applied into an ADN program. I had mapped out that I was going to do my ADN and then go get my RN to BSN and then go to the NP program. I did part of that and so I went to the ADN program. I became an LPN, which it's a step program. So I was an LPN, and then I continued on to be an RN. So, I was able to work as an LPN in my RN year of my community college degree and continued on.

I went then to get my BSN at Washington State University in their RN to BSN program. The interesting thing is this is kind of one of the points in which I changed my direction. I was supposed to be a nurse practitioner up to this point. In my RN to BSN program, we had a leadership course and I was looking at all the articles that I was reading and they were really fascinating to me about health systems and change. What I noticed about the authors was they were nurses with MBAs and up until that point I just didn't even consider or think that a nurse would have an MBA. 

 

It was at that point I decided I didn't want to be a nurse practitioner any longer, but I was going to go get my MBA next instead. And so ended up moving down to Arizona for the next quite a while and got my MBA in healthcare management. It was in a general program that wasn't just for healthcare individuals, but for anyone who wanted to get MBA that focused in healthcare. I was one of three nurses and then there were a bunch of other individuals who were never necessarily clinicians. 

 

So, that struck me in my MBA program…how valuable it was that I had my nursing background and my nursing knowledge and that I knew what needed to be done and I had this extra additional knowledge base with my MBA. I was a little taken aback or scared by the number of people who'd never taken care of patients who thought they knew the answers to changing healthcare. Not that they can’t -- I know lots of great people who are not nurses who are wonderful leaders in healthcare -- but I think that really helped prompt me to even want to continue my education. I decided to get my PhD from the University of Arizona in nursing with a major in health systems and a minor in public administration.

 

That really kind of ties together really well, but it also helps to build on my formal knowledge related to leadership and management and continuing to build my nursing skills. So I went to school nonstop from high school all the way through my PhD. I never stopped. And I guess for listeners particularly, some people might advise people to stop or take a break or get experience versus a nurse, and I had people tell me that, but I knew better. I knew myself and I knew that I needed to get my PhD so that I can make the changes that I wanted to make in the world. So, I just kept going to school and I'm very, very glad that I did. I graduated with my PhD in 2006. It was eighteen years ago. I've been able to really feel like I make a difference with those degrees in education. So, that's kind of my educational background. 

Clinically, I worked in a lot of different places…a critical access hospital, pediatric home care, adult home care and hospice. I really love home care and hospice. That's probably my most favorite area because I felt like I had true independence as a nurse and really was able to display my autonomy in decision-making as a registered nurse. Home health has always been something near and dear to my heart. But I worked as a float pool nurse on telemetry and acute care in the hospitals. And honestly, I worked in direct care through my MBA program and partway through my PhD program just because it was easier to go to school with the hours than to try to actually be a formal manager. But partway through my PhD program, I started in probably my second managerial position and that was a director of home care and hospice. I had the home care and hospice clinical experience, so that was really my foray into leadership and management at that point.

Hillary: Wow. It was such an interesting journey to get there. And what I want to capture is just how much it seems like you paid attention to the things that were pulling your interest, that even though you had a set plan and these ambitious goals that you were interested in the leadership course, so you kind of changed directions and got the PhD in the MBA instead of the NP, and of course have had tremendous impact. 

That's probably a good message for some of our listeners…just to really listen to the things that are most exciting to them to follow. I love that. I also spent a little bit of time in Arizona, so I'm glad to hear that you were in my home state for a period of time. Nice and warm. The other piece that I find really interesting is the home care and hospice, and that was something that you really zoned in on as an area where you had independence as a nurse. I find that tends to be something that maybe is not at the forefront or hasn't been at the forefront of healthcare, and maybe that's more of a western healthcare system problem. But I'd also love to know, just because that space is something you're passionate about, if you've seen any improvements in that, whether it's from granting more independence to nurses or how we've shifted care in home care or hospice settings.

Dr. Mensik Kennedy: Absolutely. I think home health and hospice have grown more. Nursing really originated into the community, and we did a lot more private care. Then we went into the hospitals, and so now we're kind of shifting back out of the hospitals. I think there are a lot of unresolved issues for home care and hospice that we need to focus in on. Sometimes acute care gets the majority of focus because more than 50% of nurses work in acute care settings, so we tend to gravitate to the largest group to help resolve issues and problems. 

But there are a lot of changes, and I think there's a lot of what I see as really unique programs that provides nurses with opportunities which may not be the traditional home health and hospice paid by insurers. I see nurses do private practice or privately bill and doing their own businesses as care managers or case managers for families and communities.

I've seen programs such as Navi Nurses, which actually has an American Nurses Foundation grant, in re-imagining reimbursement processes where nurses are making home visits to patients post-acute, but outside of that traditional insurance program. So, there are a lot of really unique opportunities right now, and we're continuing to work and build on what can we do and how do we help nurses but also help the public recognize the economic value of nursing. We also want to help provide the structures so that nurses can bill for the services that they provide, as opposed to the current mechanisms which don't really recognize the fact that, for instance, in home health, nurses are the ones making those visits but the payment structure requires a physician to sign off and paperwork. So, I think we're starting to see changes that really help get patients the care they need and decrease some of those bureaucratic layers in getting care from nurses.

Hillary: That's really interesting. I think we've started to see some trends in that direction, and even with increasing numbers of programs or allowing PAs, NP’s, and increasingly nurses to have more authorization and hopefully more, let's say power in a sense, in their own care delivery. It's definitely an area that we're watching closely and hoping to fill in some gaps, at least from an educational training standpoint of how can we help to raise the line and increase that healthcare capacity. 

So, getting back to the American Nurses Association, for our listeners who may not have a good sense of what the organization stands for and what its mission is, can you describe that a little bit more?

Dr. Mensik Kennedy: Yeah, absolutely. The American Nurses Association is a professional organization to advance and protect the nursing profession. It prioritizes high standards of nursing care, promoting a safe and ethical work environment, improving the health and wellness of nurses and advocating on healthcare issues that affect nurses and the public. You can't tease those apart because when we improve the work environment and help promote nursing, that in turn makes a difference for the public and our communities and our patients that we serve.

Hillary: Yeah, I see. Nurses are kind of the backbone of our healthcare systems in many ways, just given the sheer numbers and how critical they are to care delivery. And beyond that, we talked a little bit about some of the issues facing the nursing workforce right now, but of course, as somebody who's relying on the healthcare system for myself and my loved ones, I'm very worried about some of these issues like burnout and staffing shortages, even things like climate change. What are some of the issues that you are thinking about and what are some of the issues that the ANA is maybe particularly concerned about at the moment?

Dr. Mensik Kennedy: I'll give you a couple and then I'll go into detail on some of those. Some of the pillars and some of the things that we focus on are advocacy, staffing challenges, workplace violence, DEI, burnout and wellbeing. Advocacy is kind of an umbrella thing, but we really, really work to share with other nurses that advocacy is a key pillar of nursing. I think so many times nurses advocate for their patients, but they don't necessarily advocate for themselves as much as they could. And advocacy isn't necessarily going to lobby day or going talking to your legislators, but it's about even educating individuals, educating your neighbors, and really helping people to understand the issues that impact healthcare and patients and nurses. So, we focus in on empowering and equipping nurses with tools to be advocates for themselves, which does include how to lobby and how to speak to representatives because it's important that we get the word out.

When we talk about leadership, there's so much work for all of us to do that I alone cannot do it. Our state representatives and our state presidents can't do it alone. We really do need everyone in every area to help speak up and talk about these challenges. Staffing is a really good one because I can talk about the research. We know the research shows that unsafe staffing negatively affects patient outcomes and the wellbeing of nurses. And we have the National Workplace Survey of Nurses that said that at least 31% of nurses are required on a weekly basis to work beyond their scheduled shift. So, that has negative impacts on their wellbeing, but also on patients. 

But what really changes the story is when nurses provide their story and when nurses speak to what they've experienced. People listen to that. And so when it comes to advocacy, being able to speak on your own personal challenges related to staffing really makes a difference and related to staffing, we've known about staffing issues for decades. On all of our issues today, there’s nothing new, nothing surprising. We've known about the solutions for decades, but yet we, for some reason or another, have not put those solutions into play. Organizations haven't adopted the solutions. Had we done it, we wouldn't see how horrible and terrible things are today. 

What I'm worried about is that although we’re on the backside of the COVID pandemic, we'll have another pandemic, we'll have more issues. Are we prepared again to go through what we did? Did we learn anything? Did we change anything? So, I really implore leaders and nurses to really act upon this right now and don't move on and say, ‘okay, it's behind us’ but rather what can we do to make sure we're really prepared for next time? 

I would point people to the American Nurses Association think tank and task force recommendations. We actually had wonderful groups of organizations come together and provide documents to say, here's all the things that you could do in your organizations today. And while some of them have, of course, an acute care focus, there's a lot of items that any organization type -- nursing homes, home care agencies, clinics -- could put into place that really would make a difference in the work environment for their nurses.

Hillary: That sounds like a great resource, and we'll definitely link to that so folks can check it out if they're interested in learning more or hopefully being an advocate for change in their workplace. You mentioned this collaboration between different organizations, and I know that the ANA also plays a role with student organizations. Tell us a little bit about how you work with other organizations, how you bring them together and what some of the goals of collaboration are.

Dr. Mensik Kennedy: Thank you for that. So, we work with students. I was just at OHSU in Portland, Oregon this last May, and got to sit down and speak with nursing students there and talk about issues related to DEI and staffing and workplace violence and how they're being prepared and what their thoughts are. So, that's been wonderful. And of course, being able to go to the National Student Nursing Association conference every year has been a highlight for me. 

But oftentimes I do hear nurses say, why can't we all speak as one? Or, there's so many different organizations we ever get together and talk. Those are great questions because we do get together and talk. I think about the Tri-Council for Nursing which consists of the president and CEO of the American Nurses Association, the American Organization of Nurse Leaders, N-C-S-B-N, the American Association of Colleges of Nursing and the National League for Nursing. We meet quarterly in person in Washington, DC and we talk about the issues that are going on, what we're seeing out there, what's going on at a federal and state level from an advocacy perspective. We do have conversations about where things are going and what we can do as a whole group. 

I always say, of course, every organization has its own mission and vision like the American Nurses Association, and we have our own constituents, and as we represent all nurses -- we have a large platter in which to try to make a lot very broad, large changes -- but it's important to make sure we do bring people to the table such as those groups so that we can all speak with one voice when it's appropriate to speak with one voice. I think we're in a time politically, when you think about the federal government, where there's a lot of lack of consensus building. I guess I could put it, ‘it's either my way or no way.’ It's really important that we always work with individuals and groups.

When we can come to consensus, that's fantastic. We respect each other enough to know that we're on consensus here, but we can't come to consensus here and I'm going to continue to advocate for this over here, but that doesn't mean that I dislike you and that we continue. So I think that's important for all nurses and all organizations to remember and value consensus and that no one's ever a hundred percent on the same page with each other, but the continued partnership is absolutely invaluable.

Hillary: I think that's a great reminder for everyone, including Osmosis. We've always tried to partner with other organizations and find the common ground. It sounds like this collaborative group that meets quarterly in DC and helps to advocate on behalf of nurses and really push the major issues is helping, hopefully, to get these issues to progress faster. I think what we're hoping for is that the next generation of nurses can help to carry this forward. And we're seeing at least across Osmosis data that the next generation is more collaborative, they are more online, they're more willing to put forth their activism efforts and bring those to the table right at the beginning of the conversation. So, I think we're really excited to follow how all of these changes end up impacting the nursing world as well as the broader healthcare world, and hope that these things do progress faster.

Dr. Mensik Kennedy: I would add the majority of our ANA board of directors at the national level is millennials or younger, and so I think people might find that of interest. There's a few of us Generation X leaders, but most millennials. People wonder sometimes, I think to your point, where are the younger nurses being leaders? They're there and very active.

Hillary: Even just to that point, the need to be able to work across generations too is so important. We saw that maybe first with technological changes, and we're seeing that I think with political and societal changes. So yeah, just being able to work with people you may not agree with or people that may not have exactly the same priorities in mind. I think that's a skillset that certainly nurses need to know in their daily work, but obviously benefits the broader good if we can figure this all out together. As we look ahead to not just the future generations but the future of nursing, what is your personal vision or the ANA's vision for where nursing heads in maybe the next ten years?

Dr. Mensik Kennedy: Wow, so that's a great one. I think for me, I would love to be able to say we're going to pass all the legislation that we've been trying to pass for the longest of times. But my vision for nursing really is around the value of nursing. The Gallup Poll has come out and we're the most trusted profession for twenty-two consecutive years in a row. Sometimes what I say is we might be the most trusted, but we're sometimes not always the most respected and that's because less than 5% of hospital boards have nurses on them. When we need to make decisions and be the final decision maker on staffing levels in the hospital, nurses' voices often are not heard or at that table to make those changes. 

In acute care, nurses are seen as an expense and not a revenue generator. My vision is that we are changing that narrative; that we see the value of nursing in all of those situations; the value that every hospital and healthcare organization has a nurse on their board; the value that all organizations have shared governance and have nurses making decisions related to staffing levels; that we don't talk about nurses as expenses. We really need to start to look at how can nursing be just as independent as all the other disciplines and bill for those services, or at least demonstrate that economic value? That they shouldn't be part of the room charge. Or if they're taking care of patients in a transitional care setting or in a community setting, that the care they provide isn't rolled up underneath the provider who's billing but it's very clear in our billing system in the United States what nurses are doing and how often they're doing it and who they're doing this with.

Nursing lacks National Provider Identifier (NPI) numbers, so I would ask everyone to go out and get your NPI number. Actually, the American Nurses Association has a video that shows you how to get your NPI number. My vision would be that every nurse has an NPI number and that every nurse's NPI number is connected to the patient record so that we can pull reports and look at the volumes and the different care activities that nurses are doing. Because in the United States’ healthcare system, value is tied to dollars. And as much as we may want that to change, I think it's going to be conducive for nurses to be able to be more visible in the billing system so that we can demonstrate all of the care that we're doing right now in the healthcare system and how valuable we are.

Hillary: I'm so glad you pointed that out because it's an issue that I'm not actually even that aware of, and I'm guessing there's probably a lot of people who aren't. It sounds like there's maybe a data or a tracking issue, but there's also kind of on the flip side, an incentive issue and how we're allowing hospitals to bill or things like that. So, if somebody wants to learn more about this, I'm guessing the ANA is a great resource, but perhaps we can link to more resources about that on the podcast show notes. 

As far as your background as a writer and an author, you've written a number of books as we discussed in the intro, but this one in particular, the Nurse Managers Guide to Innovative Staffing seems to apply to some of the larger trends and challenges and really cover hopefully some of the ways to solve that. So, can you provide a few examples of the staffing models that you think would be helpful or of the ways that healthcare groups can look at innovative staffing?

Dr. Mensik Kennedy: Absolutely. I've actually just finished the third edition with my co-author, Brienne Sandow, who is a CNO/COO from St. Luke's in Boise, Idaho. I want to note too, with all my books, all of my royalties go straight to the American Nurses Foundation. I completely believe in donating to the Foundation and supporting other nurses, so all my royalties do go there. But in the book, we look at the models. I think particularly this goes back to COVID because we were short and things had changed. People started dusting out old models and because people may not have ever heard of them, people were talking about old models of care as though they were new and innovative. 

There hasn't been a large amount of new things out there, but one thing that it's really important that's in my book --but also is actually one of the think tank task force recommendations from the ANA's work -- is implementing a “tribrid” care delivery model.

What this does is it offers a holistic approach using three components, which are onsite care delivery by the nurse, IT integration and patient monitoring equipment with AI, and ambulatory access and virtual remote care delivery. The American Nurses Association Membership Assembly in June of 2023 passed some policy recommendations particularly around virtual nursing in the topic around AI, and made it clear that virtual nursing and this type of remote technology should be supplemental to nursing and should never supplant an actual nurse. There's so much we can do to focus support on the nurses directly providing care. I think we're in a situation right now where there's so much AI can do, and AI is this giant buzzword and how can AI change care delivery models? But yet the weird thing is we focus on how it can replace nurses versus focusing the AI energy, I call it, on the waste areas in healthcare.

Specifically, there was an October 2023 Commonwealth Report of high US healthcare spending and it basically said that the United States spends twice as much money in healthcare than some of the other leading nations. Where does that money go? And they said 15% of the difference is in administrative cost of insurance, another 15% was administrative costs borne by providers. So 30% is administrative costs…paperwork and things. So, let's take AI and let's focus it on resolving that 30% basically of waste. 

The same report said that salary differences between nurses in the US and other nurses in the world accounted for only 5% of the difference. And so here we are spending a lot of time and focus on how can we replace nurses or take over nursing care when we really should be focusing on that 30% of administrative waste with AI. So, when I talk about tribrid care delivery models and utilizing remote and virtual technology, let's do it in a way that helps supplement what the nurses are doing, but not replace what nurses are doing.

Hillary: Yeah, I think that's such an important point. The nurses are such a core part of that care delivery, and I don't think they're being utilized as fully as they can be because of these administrative burdens that they are faced with amongst other healthcare providers. So, I'm personally very excited. We've got a couple of other partners in the ed tech and health tech space, and we're watching some folks very closely in trying to figure out how to streamline notes or how to provide answers to clinicians faster if there's something that they're working on that might be novel or rare or something like that. So I think we're very excited in that administrative piece as well and hope that it starts to be tested and used responsibly and carefully as it goes to the market, but also really focus in on those areas of waste as you discussed. I certainly don't want to have an AI robot treating me anytime soon, but would love it to take care of the extra paperwork. So yeah, we'll see where all of that goes, but I appreciate the need to differentiate between replacing nurses versus really enhancing the way that they can deliver care.

In fact, this technology replacing people topic goes back to when online learning was becoming a big deal. There were actually a lot of other companies talking about replacing lectures and replacing faculty. Of course, that's not the goal of Osmosis. We want to supplement, we want to make sure that the student who goes to lectures and listens to a lecture but doesn't understand everything can go back to an Osmosis video and watch it and test themselves or, ideally, pre-watch a video, pre-read a text, and then show up to lectures more prepared. So similar themes, interestingly.

At our core, we are an education company and we are really interested in where the future of healthcare is going and what are the educational topics that are being missed in school, whether that's for capacity reasons, time crunch or pressures on everyone in their one to four years of schooling. So, what are some of the topics that you would like to educate nurses on more or maybe see all of healthcare receive education on?

Dr. Mensik Kennedy: I think it's such a great question. So much we learn and so much we want to fit into education. I was just talking to some faculty members who, for the sake of time remove courses from the program thinking that they could sprinkle the content amongst all the classes. But that never ends up actually happening just because it gets lost. I really think there's so much to be done. 

There needs to be more continued focus on DEI and including where we can in nursing education, but in the continuing education opportunity. This is from basic nursing education, curriculum development, faculty, recruitment, retention, all the way through all of the settings in which nurses work. I also think it's about the allyship and teaching people on how they can be allies in this work. In order for us to really make a difference in diversity education and creating anti-racist practices, we're really going to need different types of education and focusing more particularly as some states and some governments decide they don't want this type of education necessarily taught.

I also think we need to focus in on nurse burnout and wellbeing from an educational perspective, and not only from an educational perspective, but learning it, talking to students about what they have experienced or what they're saying is happening in the hospital. When you get to the hospital as a professional, we talk about burnout and wellbeing, but that wasn't really practiced in the nursing program. Aa student there wasn't time for wellbeing, and there was so much to do. So how do we start in the nursing programs and really look and help people manage their education, balance their education and their life without burning them out in nursing school so that we can start to teach them how to really embody wellbeing there and then own that throughout their life? So, I think having more education about wellbeing and how they can live in nursing school and in their practice would be, to me, really important.

Hillary: That's great. I haven't mentioned this yet, but I teach yoga outside of Osmosis, and so I'm a huge advocate for mental and physical wellbeing and how important it is. Osmosis actually had an early partnership during COVID with Arianna Huffington's Thrive Global. They had an initiative called First Responders First, and they actually focused just on this issue. We have a course that is very short that is not known to everyone yet, but hopefully we're still getting the word out. Perhaps there are further partnerships that we can dig into and continuing education models that we can look at to make sure that nursing students are getting this education earlier and are being supported earlier. Of course, that has to be coupled with the advocacy and the policy changes, as you mentioned earlier. The 30% of nurses being asked to work extra hours each week is a staggering statistic that obviously needs to be addressed. So, hopefully we can come at it from multiple angles.

Dr. Mensik Kennedy: Absolutely. We need to, yeah, it's going to take multiple angles and many nurses working all of those angles.

Hillary: Well, you're leading the charge and we're very excited to see where that goes. The last question that I have for you today is your go-to advice for current and future nursing students or early career nurses.

Dr. Mensik Kennedy: So my go-to advice is to be reflective of your own experiences and to know yourself. Many times I talk to individuals who were told not to do this or not to do that by another type of individual because it wasn't the way that person did things. I go back to advice people had given me that I didn't listen to. Just because someone gives you advice doesn't mean you should take it. It means you listen to it. Knowing yourself is important because I didn't think I needed to continue to sit at a school and wait to get more experience to go back to school. I continued through because I knew myself and I knew myself differently than maybe the people giving me advice. 

So, I want nurses in nursing school and I want early careerists to really think about what it is it that they want and who they are as themselves as a person. It's good to get all sorts of advice, but if you really want to do something, don't let it stop you or don't let it derail you from what you want.

Hillary: That's really great advice to close up today's conversation. I know there's a lot of people who are going to be guiding and mentoring these students along their journeys, but ultimately they're going to be the ones to live with their own decisions and show up to work in whatever career they decide to go for. So, reflecting and really taking the time to understand themselves and their own needs, passions, desires, interests, et cetera, is really great advice, so thanks for sharing that. And Dr. Kennedy, thanks so much for being with us today. We really appreciate your time.

Dr. Mensik Kennedy:  Thank you for having me, and thank you for getting this message out.

Hillary:  I'm Hillary Acer. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.