What: Nurses: The Most Trusted Profession in an Age of Mistrust
When: January 31, 2024, 1 PM ET
Who:
Dr. Cynda Hylton Rushton, the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins Berman Institute of Bioethics and the School of Nursing
Where: Newswise Live Zoom Room (address will be included in follow-up email)
Details:
For 22 years, nurses have consistently been ranked the “most trusted profession,” according to the yearly Gallup poll. This year, nurses remain the most trusted profession, with 78% of U.S. adults currently believing nurses have high honesty and ethical standards. However, that is down seven percentage points from 2019 and 11 points from its peak in 2020. Nurses were seen as having “high” or “very high” moral standards by 79 percent of U.S. adults in 2023, but that’s down from a high of 89 percent at the height of the COVID-19 pandemic. The drop reflects patient dissatisfaction, but also nurses dissatisfaction with the profession in a post-pandemic world.
Cynda Rushton, PhD, RN, FAAN, Anne and George L. Bunting Endowed Professor of Clinical Ethics at the Johns Hopkins School of Nursing, leads the R³ Initiative that aims to renew, retain and amplify the resilience of Maryland nurses through a culture of ethical practice. We are now in the long tail of the pandemic and the consequences to the nursing workforce are complex and intensifying, as evidenced by deepening shortages, persistent mental health issues, increasing violence, and moral suffering. It is a pivotal time for nurses to lead the nation forward. What can we do to help this crucial role in healthcare?
The Resilient Nurse, Episode 1: Harnessing Nurses’ Resilience
https://magazine.nursing.jhu.edu/2023/04/the-resilient-nurse-episode-1-harnessing-nurses-resilience/
Transcript:
Tom Canalichio: Hello and welcome to this newswise live event. Today we're talking about the annual Gallup most trusted profession survey. And we have joining us Dr. Cynthia Hilton Rushton the and and George L. Bunting, Professor of clinical ethics at the Johns Hopkins Berman Institute of Bioethics, and the Johns Hopkins School of Nursing. Dr. Rushton thank you so much for joining us. And I would love to ask if you will, please weigh in on how you think this year survey results reflect the general health of our social fabric with even nurses dropping in the trustworthiness rating. But all other professions similarly, dropping? What are your thoughts about what that means?
Cynda Rushton: So, Tom, thank you so much for inviting me to be in this conversation. In many ways, the results are not surprising, I think we have a crisis of trust in our country, writ large. And these results, I think, are a reflection of that erosion of trust in ourselves and in each other, and then our institutions and in the people in them. So I'm not, I'm not really surprised at one level. And in another way, I think most people have been aware of the kinds of sacrifices that nurses have make on a daily basis, but in particular, during the COVID pandemic. And just as there's erosion of trust in people and institutions, nurses are also feeling that erosion themselves. And excuse me, one of the consequences of the pandemic is what I kind of refer to the long tail of COVID, which is this sort of reflection in all aspects of our lives of the consequences of our disconnection with each other, the escalation and violence, the ways in which our human connections have been fractured in one way or another. And I think nursing is a is an example of that. I think many people are experiencing the consequences of not having enough nurses. And so they not be satisfied with with the care that they're receiving under really challenging and, and constrained situations. And at the same time, I also think that because nurses are the ones who are in closest proximity when people are sick, they often bear the brunt of that frustration, whether it's with the institution where they're receiving care or in the community, or their own frustration with the way the world is right now. And the ways in which we are surely at odds with one another. So I guess I'd say in the end, Tama I'm not completely surprised. I also want to say that, you know, it just reinforces again, that nurses have a special place in our society. That is, I think trusted for a lot of good reasons. Nurses tend to be the ones who are there when people you know, you've gotten the diagnosis, well, what do you need most is you need somebody who will help you be able to navigate understand, and, you know, make sense out of a diagnosis or a new way of being in the world. So I think there's a reflection of that, and the and the regard that many people have for the service that nurses do, because nurses really are, I think, a linchpin in our healthcare system. And without them, I'm not sure our health care system would actually be sustainable.
Tom Canalichio: You mentioned how pivotal the role of nurses can be during any patient's health care experience. What is it that you think makes the role of nurses so unique compared to other professions in healthcare?
Cynda Rushton: You know, I've been a nurse a long time, and there are many ways in which other roles and healthcare have some overlap with nursing. But when I think about what's unique about nursing, it is. nurses take a whole person perspective. And it's not just a body part. It is How is this person responding to disease? Your illness? And how how do we help them to to really harness the resources they have? And how do we help them get the resources they need to live as well as they can under change circumstances. And, you know, I've often said, if you have a problem, ask a nurse, because nurses are, we're, we're system thinkers, we're innovators, we figure out how to make things work, even when they don't appear to work. And, you know, while that's a great asset, sometimes it can also be a liability for us, because we can make systems that are not working look like they are, because part of our motivation, you know, for many, many nurses is our patients. And if our patients need something that is often what motivates us to try to find solutions that may not be maybe obvious, nurses are really highly trained. And I think a lot of people don't understand the rigor with which nurses are trained in, you know, many, many, many different aspects of how the body works, but also how to how to really think about people in a holistic way. That training is is intense, and it requires a lot of preparation, a lot of practice, it is a practice. So having a nurse, who has been trained and has developed skills over time is a very valuable resource. It's not a situation where you know, you can just replace a nurse with another body, there is a lot of expertise that accumulates over time that really makes a difference for patient outcomes. Nurses have lots of different roles, too. There's also this idea that all nurses work in hospitals, well, a lot of them do. But there's a lot of nurses who work in the community and schools in in, you know, policy in research. And oftentimes, that perspective of nursing is what really grounds their work no matter what their setting is.
Tom Canalichio: What kind of things do patients get from good nurses that results in these trustworthy ratings that nurses have continued to talk? Well, you know, yours?
Cynda Rushton: Yeah, Tom, I think it'd be great to ask a patient that but I suspect from what I've heard from patients, people value competence, they value somebody who knows what they're doing. And clearly, you know, a competent practitioner is something that makes a difference that you can rely on their ability to both anticipate problems and responds to the ones that are there and also to you know, help us manage whatever the aftermath is. I think a lot of patients trust nurses because they are in close proximity. I've spent a lot of my time 2021 And I possible over and over again and inside the study team has gone comprehensive patient saying and what they say this translate it was held by the psychologist maybe really confusing twins and and a lot of this 10 was the trade in the peaceable the identical strangers, I have people outside and I have everything intimidated by that our study wordy and I think is there a timely moment because to be viable is questions that need to be taught but maybe aren't. And one was a study of twins raised apart circumcised I titled born together so you know, I have a passion in research that my team and I that my mentor for many, many years to help fascinate our findings. And the other blogs that I history I enjoyed writing. gratified to do helps them was a twin holocaust. an annotated lie there photographed in 95 by survivors to Auschwitz members.
Tom Canalichio: Were welcome to send in questions feel free to chat them to me and I can ask Dr. Rushton for you or if you'd like to enable your microphone you can ask yourself Dr. Rushton the pandemic and the pandemic hangover that it seems Many in the health care profession have not been able to really get relief from. In that light, how are nurses coping with these demands? And especially you mentioned this sort of contradiction between being trusted, but not always being valued or given the resources and support that they need to do their job effectively. So this is obviously challenging. How are nurses coping with this? What are you doing at Johns Hopkins nursing to prepare the next generation of nurses for this environment?
Cynda Rushton: Well, it's no secret that nurses have suffered a lot. pandemic, we have had very alarming levels of burnout. In, you know, the most recent survey data, at least half of nurses are demonstrating symptoms of burnout, they are experiencing high levels of stress. In our own research, one in four nurses experienced symptoms of moral injury, the sense of erosion, of their sense of who they are because of decisions that were made by others that they have to then implement. So there's this, it's very complex in terms of the sources of what is eroding their sense of, of purpose. And we also alarmingly have seen more and more violence against nurses. One in four nurses experience physical violence in the context of their roles. Many of them experienced verbal violence, which is alarming when you think about a workforce that's already exhausted and depleted. And my experience of nurses and maybe this is partly my own projection. But, you know, our fuel comes from our patients. And when our patients turn against us in that way, it really leaves us with a gap of why am I here. And so this idea of, you know, how we have, all the blinders have been ripped off, these problems have been present for decades. But the pandemic is really made them very clear. nurses want to be able to use their knowledge, their skills, their compassion, their competence, to benefit people, when you cannot do that, it begins to erode our sense of who we are our identity, our sense of wholeness as a person, or integrity. And this is a place where I think it contributes to another trend is about nurses, looking at their work, and deciding that they're going to leave their job. So the profession, which as an educator is very heartbreaking to me, because training to be a nurse is not a small thing. And the resources that we have by training nurses is a very integral part of our healthcare system. So there's, you know, there's that gap. And one of the one of the pieces of that is, you know, how do we re imagine our social contract with the public, you know, it, there's a side to a primarily female profession, and that is that our worth is evaluated based on our sacrifice. And yet the assumption that there will always be nurses, no matter what is one that I think is an unsustainable assumption, because now what we're seeing is nurses saying, No, I am not willing to work under these circumstances any longer. And when you put that together with the system, challenges of shortages of all kinds, particularly nurses, it intensifies all of these factors in a way that really put us in a in a very perilous position. I think in our country, I think we are at a tipping point where it's not up to the individual to fix these systemic problems. But we've got to engage with the public, with policymakers with leaders in dismantling the things in the system that are contributing to these very patterns in in healthcare and in our society. Because really, and truly the health of everyone depends upon it. So what are we doing at Hopkins? We are as You know, we have been very fortunate to have funding for a statewide initiative of the resilient nurses initiative, which is focusing on two levels of intervention, first of all, to start from the first day of nursing school to give nurses the skills and tools to help them to be able to meet these challenges not to look away not to pretend they're not there not to put the responsibility on them alone. But to give them the capacities and skills to be engaged in the system redesign to be engaged in reimagining the social, what I would call social covenant, which is where both parties make mutual promises to each other to contribute to an outcome, and to be able to give them the skills and tools to do that. And of course, you know, we have just launched our policy initiative in the School of Nursing. So levels of failure, vanish, and that I think, are absolute. But at the same time, I see firsthand the consequences of these long term patterns, and how they're such a distress for many nurses in that gap between what they know they could do, and what they're actually able to do. And helping them to not be overly responsible for fixing that. But to give them the skills and tools to regain their sense of integrity, their moral resilience is one of the ways that we do that. But to be able to help them to restore their sense of agency to choose what's right. And one of the beauties of being a nurse is there's a lot of ways to be a nurse. And we want everyone who's trained as a nurse to continue in some way in the profession.
Tom Canalichio: Question from Nikki at clinical advisor, regarding the recent passage by the US Senate of the train nurses act, with regard to nurses leaving the profession and training young nurses entering the workforce. How else would you describe your your thoughts about filling the nursing shortage?
Cynda Rushton: Well, you know, the nursing shortage is complex. It's not only a supply problem, it is a the ability to sustain nurses once trained in the profession. So there's, there's gotta be, there's got to be investments in in the supply side. But there's got to be equal investment in creating the conditions for nurses to be able to use what they've learned in a way that is congruent with our values, our code of ethics, and their competence to be able to, to provide service to many, many people. And so both of both of those levers have to be, I think, part of the solution. And, you know, we're we're happy for all of the policy investments at any part on that continuum, but I think it's not enough if we only focus on the supply side.
Tom Canalichio: Besides being named the most trusted profession, US News and World Report also recently named nurses as a top 10 health care job and in particular nurse practitioners, as the number one best job forecast for this year. What would you what would you say regarding that? Obviously, it can be quite a contradiction to see. underfunded and understaffed, nursing but also an outlet like US News and World Report predicting that nurse practitioners may be the best job this year. What are your thoughts about that?
Cynda Rushton: Well, Tom, I am a nurse's nurse, so i i I love nursing. I wouldn't choose anything else. I've had many of opportunities, but I wouldn't choose anything else. So yeah, I think it's the best job ever. I think it's one of the hardest jobs ever. And I think that it's also one of the most rewarding because, you know, I have learned everything I've ever learned from my patients. And that is, you know that that's not something you get in every role. And so part of what I think where we're sort of striving for is we want to be able to not have a transactional interaction with the people we're serving, we want to actually know them. And I think for some people and not universal, but many people might gravitate to a nurse practitioner role, depending on the setting, I mean, nurse practitioners function in primary care and in communities and schools and in hospitals. But I think part of the drive there may be having the opportunity to have more meaningful, connected relationships with the people they're serving. We know that nurse practitioners make a huge difference in health outcomes. And that, as I said earlier, much of what people need, even when a diagnosis is made is is not so much further diagnosis. It's managing the symptoms, managing treatments, managing our responses to those treatments, and nurses are absolutely equipped to be the resource that can help people do that. So I'm not surprised, really. And at the same time, I think we can't lose track of what is absolutely needed to create a healthy work environment for nurses in whatever role they're in.
Tom Canalichio: Members of the media in attendance, please do feel free to chat any questions that you have, we will be providing a recording of this discussion for your use, as well as a transcript, and you're welcome to use any of the comments in the discussion in your coverage about nursing. Dr. Russian, tell us a little bit about what can people do for many of us who appreciate what nurses do. And especially during the COVID, there was a lot of public public comments of support. How can patients today as well as policymakers, and, and otherwise, truly make a difference for nurses, especially when encountering them personally in the healthcare setting?
Cynda Rushton: Well, this is a this is a part of recalibrating that social contract. And I had the privilege of doing some work with Susan Reinhart and AARP. And we came up with 10 things the public can do to support nurses, and I'm just going to highlight a few of those. The first one is to really know what nurses do. And you know, there are all the stereotypes about what nurses do, you know, the lady with the lamp, the whole sort of often gendered interpretation of what nurses do, but really start by understanding what nurses do, the ways in which nurses practice and so many different settings, the kind of education that is necessary for a person to become a nurse, and to to really familiarize ourselves and challenge some of our assumptions about, you know, some people think, you know, no matter what a nurse is going to be there, because we have this image of self sacrifice. That's not a sustainable pattern. And it's a piece that our profession needs to really do some self examination around. The second one is, you know, as I mentioned, there's a lot of violence these days. So, just as we need to be aware of how we're interacting with people, in our community, people in our workplaces, people in the areas where where we work, it's really important that we all start with a grounding of mutual respect. And to think about how we might be in a really challenging situation in the healthcare environment, and how we are speaking how we are interacting with the people who are closest in proximity, which is often nurses, how we are actually speaking to them, and to how we are interacting with them, and to expect a kind of mutual respect. One of the things, Tom that you mentioned about, you know, what keeps nurses going is nurses are often kind of hesitant to receive appreciation, but when it comes from the people that we take care of, it means so much. So being able to say you know when a nurse is actually served you in it No way that is meaningful to you, thank you is a really great response. And it goes a long way to, you know, helping to acknowledge the work that nurses do often in really challenging circumstances. And on the other side of that, when there is a problem to be sure that you're sharing it with the right person, nurses are often not the people in many of these health systems who are making the policies. So if there's a policy, then take it up with a person who actually can do something about it instead of, you know, sort of taking it out on the nurse. I think another piece that's really important right now in our world is factual information. And I think sometimes during the pandemic, in particular, and I think this was a really a real, really hard thing for nurses to hear is when patients questioned their competence when they questioned their information. And it's hard to know now, what is actually factual, but I think the public can do their part in not relying only on Dr. Google, but to actually try to to, to get reliable information. And nurses can often help in that, to help interpret information. We don't have all the answers, no one does. But it's important that that the public use reliable sources of information and to ask questions. In my work over the years, I've found that helping people ask good questions, about their treatments, about their conditions, is a way to to really more fully understand what our choices are. And nurses can often help in that process of asking questions that are meaningful to patients or their families. And it also empowers patients to ask the questions that matter to them. So there's a couple more, you know, in terms of being partners with nurses and and being an ally. And of course, one of the most important ones in a year of elections is to ask our candidates, what their views are on health and health care and support for nursing. And how we can, you know, really intensify our alignment of purpose, you know, nurses and patients have a lot in common, we want the same outcomes. And if we could stand together around some of these key issues, I think we might actually begin to see a shift. At least that's my hope.
Tom Canalichio: Question from Nikki, clinical advisor, regarding the drive for full practice authority for nurse practitioners. I might, I might ask you to describe some of those specifics, too, that might not be familiar to everyone what nurse practitioners can or can't do. But particularly Nikki wants to know what you think about how this could help the nursing shortage, especially in rural areas?
Cynda Rushton: Well, I think that's a really great question. They you know, there have been a number of future of nursing reports that have recommended that nurses be able to practice at the at the full scope of their license. Our scope of practice is determined by state laws. And so it's often a state by state determination. And yet, as you point out, Nikki, rural areas are places where nurse practitioners can make a huge impact on health care and health outcomes. And so one of the Levers I think, from a policy point of view is how do we begin across the country to more standardize our scope of practice, so that nurses are able to take advantage of those opportunities, especially when you marry that with that being the number one role to be in in health care? It seems like that, alongside that, that interest in that role would be a really important way to actually build capacity in this country for better health outcomes. We know that patients especially those that don't have easy access, wait until they're very sick before they seek care. At that point, it's much harder sometimes to treat and sometimes to get outcomes that are desirable by anybody who's involved in those cases. So I think there's a there's a real argument for building capacity for removing barriers to access, and for allowing nurses to to really function in the way that they're trained to do. So. Nikki, I hope you'll beat that drum in and help us get there.
But it seems like that, alongside that that interest in that role would be a really important way to actually build capacity in this country for better health outcomes. We know that patients, especially those that don't have easy access, wait until they're very sick before they seek care. At that point, it's much harder sometimes to treat and sometimes to get outcomes that are desirable by anybody who's involved in those cases. So I think there's a there's a real argument for building capacity for removing barriers to access and for allowing nurses to to really function in the way that they're trained to do so. Nikki, I hope you'll beat that drum in and help us get there.
Tom Canalichio: Well, thank you, Dr. Rushton for your time and expertise commenting on this topic, nurses continue to be one of the most trusted professions and continues to top this annual survey from Gallup. It's really wonderful to hear about what's going on to equip the next generation of nurses coming out of Johns Hopkins School of Nursing to succeed in this very challenging field. But but clearly a very important one. And I would say, from my own personal experiences, I bet many people would that nurses have been the most caring and supportive part of any health care experience I've had, having surgery, seeing doctors for any reason. And I think most people probably feel that way. So great work to you and to all nurses around the world and keep keep it up. And we appreciate you.
Cynda Rushton: Well, Tom, thank you so much for shining a light on this, you know, nurses. We're a we are a group of people who I think sometimes can be taken for granted. And I think what's important here is to is to really understand how important that contribution is, and how all of us really have a stake in making sure we have a healthy nursing workforce. If you haven't, if you don't have a health issue right now, you probably will at some point, and you're going to be really happy that you have invested in in a healthy nursing worse workforce. So thank you couldn't agree more.
Tom Canalichio: Thank you so much for your time, Dr. Rushton members of media, thank you for joining, we'll share the video and the transcript. And we will also share contact information. If you'd like to get in touch with Dr. Rushton and we'll share Sidney who is the communications person at Johns Hopkins nursing that can help you get in touch for any follow up questions that you might have. Once again, Dr. Russian, thank you very much.
Have a great day everyone.
Thank you, you too. Bye bye.
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