Changing lives through community nursing

2. Bob Atkins tells us how community nursing changes lives

Dr. Robert Atkins, a former school nurse and nonprofit leader in Camden, NJ, is executive vice dean of the School of Nursing at Johns Hopkins University. He advocates for community-based nursing and is dedicated to increasing the participation of diverse nurses in the nursing workforce by creating new pathways for education and more affordable options for their education. Following is a condensed version of our conversation. The full interview is available here.

How did your experiences as a school nurse affect your career path?

The middle school kids I worked with were like those I’d grown up with in Cherry Hill, which is only a couple miles from Camden, but very different in terms of life chances. I got very interested in the lives of these kids and started a youth development nonprofit program with a professor from Rutgers, Dan Hart, which we ran for 20 years. I realized community-based nonprofits can make a huge difference in the lives of kids. It also made me focus on the barriers that impede kids growing up in Black and brown communities of great disinvestment like Camden. These barriers include lack of access to healthcare and dental care, food insecurity, and housing instability. There was a lot of absenteeism, and things like this really diminish life chances.

What brought you, most recently, to the Johns Hopkins School of Nursing?

Sarah Szanton, dean at the Johns Hopkins School of Nursing, has a vision for increasing the number of nurses working in the community [as opposed to hospitals or other clinical settings]. For me it was clear that to do that successfully we’d have to change our educational system to provide nurses with the skills to be effective and utilized in the community. Over the past almost 2 years we’ve thought about how to reimagine educational pathways so nurses can work in any setting where a nurse could serve the community. We’ll always need nurses in acute care systems. And we don’t want to rob Peter to pay Paul. We want to make a bigger [nursing] pie and have more of that pie go toward communities.

What convinces you that this is the right direction for nursing and what would a community nurse workforce look like?

Historically, nurses started in the community. We were in homes. We were in schools. We were in neighborhoods. As more hospitals were built, they needed nurses to provide bedside care and hospitals started nursing schools to provide staff for their hospitals. Colleges and universities now provide most of the nursing education in this country. However, they retained most of the architecture of the hospital-based nursing schools. We’re trying to reimagine a new architecture for nursing schools now.

Any system that serves communities, that’s where nurses should be. Everyone will have to deal with getting food, or housing, or education at some point. Wherever health resides, nurses should be there. We have to think broadly about health — so libraries, schools, public housing, or food banks are also good places for nurses.

Nursing schools will continue to teach what nurses need in terms of technical skills. But we must also give our graduates the confidence that they have everything they need to be successful in the community. Things like skill-building to be a community partner, how to lead thinking about what happens around health policy, or think more deeply about research and scholarship. We want nurses to think about the different systems they will encounter and how these systems all interconnect. That’s much more complicated than just the kind of the mechanical, technical skills typically provided.

What other steps are necessary to grow this workforce?

A lot of people want to be nurses — they just don’t know it yet. And we haven’t done a good job of communicating to them, “This is actually where you want to be. You would love to use your head and your heart and your hands every day.” Because that’s what nurses have the privilege of doing. And people want you in their communities, their homes, and schools because they trust you.

We need to change the narrative about nurses. Most people have the sense that nursing is only dealing with blood and other bodily fluids. That could be one part of it, but what they don’t see is that you’re dealing with human beings and forming relationships through nursing.

We also have to create a pathway. We, in healthcare systems and universities, need to think about frontline healthcare workers, who are overwhelmingly Black and brown, and how to create a ladder for them to go from being frontline workers doing the backbreaking part of healthcare and giving them a pathway into nursing, as we did in a pilot program at Robert Wood Johnson Foundation. This is an equity issue. If you want to change somebody’s health, get them a job that pays $40 or $50 an hour instead of $10. That changes not only their life, but it also changes the lives of their family members, where they go to school, what kind of foods they eat.

We also need to make this nursing school enterprise more affordable. We turn away tens of thousands of qualified applicants, yet we have a nursing shortage. And part of it is because the way we’re set up doesn’t allow us to take as many students in as we should be able to take in. And some of it is because we have an old way of thinking — an old architecture that doesn’t serve where nursing should be in the 21st century.