Join our Facebook group
Twitter bird

Letter from The Truth About Nursing to the NIH Director

September 19, 2019

Dear Dr. Collins,

Thank you for your letter.

I appreciate that you are concerned with building a strong NINR and finding the right leader for the permanent director position. We certainly will continue to do what we can to encourage qualified nurses to apply. However, as I explain below, we still have concerns with the interim appointments, both in terms of whether non-nurses are qualified for them and the damaging message sent to the public when nursing leadership positions are filled with non-nurses, even temporarily.

We understand that there have been challenges at NINR in light of the resignation of the current interim director and the apparently inadequate results of the first search for a permanent replacement. And we understand that in times of crisis, it is natural to turn to trusted colleagues. We have nothing against Dr. Tabak or Dr. Schwetz as health professionals in their fields, in which they appear to be highly qualified. But of course, our concern is that they are not the right people for these specific nursing leadership jobs.

As we have explained, nursing is an autonomous health profession with a unique conceptual base and scope of practice. Although it is certainly related to medicine and other health fields, it has a distinct holistic and preventive perspective, with a focus on patient advocacy. The research interests and expertise of nurses reflect those core elements of the profession. One example that may be of interest to you is nurses' research in the area of music therapy. In fact, nurses have been pioneers in a number of critical health fields, from pain management to informatics.

By autonomous I mean that nurses make independent assessments about patient or population health, make plans to improve that health, and take action through clinical care, education, advocacy, and research. Some people confuse having prescriptive authority with autonomy, but only a minority of health problems require prescriptions. Nurses save lives and improve health in myriad ways that do not require prescriptions. And nurses in clinical settings report to other nurses, not physicians.

Aside from whether non-nurses are actually qualified for these NINR positions, a primary concern we have with the appointments is how they affect public understanding of nursing, which in turn affects nursing across the board. Poor understanding adds to the global nursing shortage and undermines nurses' claims to adequate resources for education, clinical practice, and of course research.

Since 2001, we have worked to change how society views nursing. The same stereotypes come around on a short cycle, like a qualitative study that only needs 10 subjects before we've exhausted all the damaging ways people think about nursing. In fact, this is exactly how many healthcare journalists it took to exhaust the stereotypes when nursing researchers asked them why they use nurses as sources in only 2% of their articles. That was the Woodhull 2 study that came out last year. Lack of public understanding of nursing is a global problem fueled by people who have the media spotlight, people who make high-profile decisions, such as these NIH appointments. When members of the public see a dentist and a biologist leading NINR, even temporarily, they receive the message that nurses are unqualified to run their own Institute. This reinforces what Hollywood and even the news media often conveys, that nurses are unskilled, low-level handmaidens who exist to serve physicians.

This misunderstanding extends to members of the health care community. Many physicians have internalized these stereotypes, and they may believe that nurses do report to them and should not question their prescriptions on patients' behalf. Hospital administrators, with little real understanding of nursing, invest vast resources in physician training and practice, while stretching nurses—the reason hospitals exist—so thin that a third of them leave their jobs within the first two years. Fifty-eight percent of nurses leave their jobs because of ill treatment. They are disrespected, bullied and harassed by the people they work for indicating hospital administrators don't think nursing matters.

The stereotypes affect even the views of nurses themselves, many of whom fail to fully embrace their autonomy. Popular culture is so powerful that nursing professors and nursing organizations have a hard time instilling in nurses the idea that they are autonomous. Although it is novel to have a dentist and biologist be in charge of nurses, it is consistent with the message of nursing subordination that still prevails in too much of society.

This misunderstanding of nursing not only damages the nursing profession, it damages public health by denying patients adequate nursing care that they need to get and stay well. You have probably seen the research showing health care errors as the third leading cause of death in the U.S. Nurses are the health professionals most likely to identify and prevent potential errors. Strong nursing is vital in the effort to reduce errors. But nurses today often lack the resources and respect to do what they are capable of doing to protect patients and advance health.

I also note that the recent levels of NINR funding, while much appreciated, remain consistent with the idea that nursing is of minimal importance compared to other health disciplines. NINR will receive $163 million for 2020 out of a $34,400 million NIH budget, which is less than half of one percent of the NIH budget--the same paltry percentage it has been for decades. In our view, this does not adequately serve public health. Nurses are a more valuable part of the solution than $1 out of every $200. I urge you to consider increasing the size of the NINR budget to 20% of the NIH budget. That would better reflect the potential contributions of nurses, the largest group of health professionals.

We note that the new job description for the permanent NINR director position has gone up, and while it certainly contains many helpful elements, it still does not require the permanent director to be a nurse. We wanted nurses' opinion on this, so the Truth About Nursing just did a 3-question survey of our supporters a couple days ago. 454 people responded. Here are the results:

1) Should it be a requirement that the director of the NINR is a Registered Nurse?

Yes 451 99%
No 3 0.7%

2) What is the minimum education in nursing the Director of the NINR should have?

 Should not have to be a nurse 2 0.4%
 LPN/LVN 2 0.4%
 BSN / Master's entry level 49 11%
 MSN/Advanced practice nurse level 110 24%
 Doctoral level in nursing 291 64%

3) Select the doctorates you think would qualify the NINR Director to hold the job (select all that apply).

 Omics disciplines 26 6%
 Biological sciences 60 13%
 Behavioral sciences 72 16%
 Health services 90 20%
 Social sciences 59 13%
 Nursing 400 88%
 None of the non-nursing specialities above, it should be nursing only 184 41%

The consensus from respondents is that it is vital that the NINR director be at least an advanced practice nurse, even if the doctoral research degree is in another health discipline. This should be the case even if they serve in a temporary capacity. Indeed, as your recent experience has shown, a great deal of time may pass without a permanent director.

Thank you for taking the time to consider the depth and nature of nurses' concerns on both the interim and permanent positions.

I look forward to talking with you soon.

Best regards,

Sandy Summers, RN, MSN, MPH
Founder and Executive Director, The Truth About Nursing

See the NIH Director's letter to which we are responding

book cover, Saving lives


A Few Successes —
We Can Change the Media!

Educate the world that nurses save lives!


Save Lives. Be a Nurse. bumper sticker