Episode 4: Nursing in a Post Pandemic World

Cara Lunsford (00:04.489)
Okay, Ernest, we are officially live and I'm going to have you introduce yourself and we are going to then we are going to jump into this like hot topic of post pandemic nursing. But as you mentioned to me a little bit earlier, you were president at the ANA during COVID.

Ernest J. Grant (00:08.632)
Okay.

Cara Lunsford (00:31.888)
So you have an incredible wealth of information to share with us. So I'm going to go ahead and let you kick it off with a little bit of intro about you and nursing and how you got here and then we'll jump into the meat of it.

Ernest J. Grant (00:47.726)
Okay, absolutely. Well, first of all, thanks for having me. I am Dr. Ernest Grant and currently serving as the Vice Dean for Diversity, Equity, Inclusion and Belonging at the Duke University School of Nursing. I started my nursing career long, long, long time ago in the mid 70s and actually had no idea about going into nursing. actually wanted, usually I tell people,

My ambition in life at that time was to be an anesthesiologist and drive a lime green 1968 Mercury Cougar. So I think when your audience finished listening to this podcast, they will go and look up that car and they will see that it was and I think still is the bomb and I still want one of those cars. But it was a high school guidance counselor who suggested, I came from a very poor family.

the youngest of seven kids in the rural mountains of North Carolina. And it was my high school guidance counselor who suggested that maybe I try nursing and that I could become a certified registered nurse anesthetist. And then if I still wanted to go on to medical school, I could work my way through medical school by working as a nurse anesthetist. It sounded pretty good. So I started in nursing school as a, I was in a LPN program.

And about three months into that program, I totally forgot about medical school, realized that nursing was my calling. However, the role of the LPN at that time, we're talking the mid 70s. So you get some idea of how very old I am. The, no, Yes, just experience. Yes, seasoned, I would say. But.

Cara Lunsford (02:30.426)
You're not old. You're just, you're just experienced.

Ernest J. Grant (02:40.706)
The role of the LPN at that time was very limited and I wanted to be able to do more for my patients. And so I realized that in order to do that, I needed to have a baccalaureate degree. So I started working on my baccalaureate degree and then subsequently masters and PhD. I spent 36 and a half years working in burns and critical care at the burn center at UNC hospitals. Loved every minute of it.

and would go back to doing that in a heartbeat. But I also got very active within the nursing profession for several reasons. One, I wanted to try to encourage more men and ethnic minorities to enter the profession. I wanted the public to understand who we were as nurses and what we bring to the table, and also encourage nurses to advocate.

for the profession. So those are pretty much my three goals as I began my active career, being active within the profession as well. So having served as the president of the North Carolina Nurses Association, I also started working at the national level. And finally on June 18th, 2018, I broke the glass ceiling and became the first male

President elected to the office of President of the American Nurses Association. At that time, it was 122 years old. So it only took 122 years. Yeah, yeah, yeah. And the third African American to serve as president. So, but, and of course, a few months later, a little bug came along called COVID. And that sort of changed the trajectory a little bit as well of

Cara Lunsford (04:16.484)
It only took 122 years.

Ernest J. Grant (04:34.759)
the goals and objectives that I had, but we weathered that and learned quite a lot and here I am.

Cara Lunsford (04:41.633)
Talk about being hazed into a profession. mean, you really, COVID like hazed you into that position.

Ernest J. Grant (04:44.888)
Mm-hmm.

Ernest J. Grant (04:49.538)
Yes, it did. Yes, it did. I think one of the challenging things about COVID is, well, actually there were plenty, but the first one was obviously caring for my fellow nurse colleagues and recognizing their needs at that level when you're president of a national organization, particularly one like the ANA.

You meet with a lot of people in all different realms and positions. so hearing from nurses across the country, what was going on, meeting with members of Congress to tell them that one, the stockpile that was there was not working as well as they had planned because the supplies were not rotated in the way that they were supposed to have been rotated. So the mask that they would send out to

members of the healthcare team to begin to use, they had dry rotted. There was a lot of counterfeit masks coming into the country that did not meet NIOSH standards and other things that were going on. So.

Cara Lunsford (06:01.424)
What does that mean? Cattle fit mask. I haven't heard of that. Oh, counterfeit. I can't, I thought you said cattle fit. And I was like, cattle fit. was like, is this for like cows? Although it wouldn't have surprised me. All the nurses listening are like, yeah, it felt like I was being fitted with.

Ernest J. Grant (06:03.918)
counterfeit. In other words, yes, counterfeit. No, no. Sorry. We can say that. Yeah, it still wouldn't have worked. I guess that's my, yes, that's my, that's my accent there. But it was, but yes, letting them know that there were a lot of counterfeit masks being

shipped into the country, which again would further expose members of the healthcare team because they did not meet NIOSH standards. So they might as well just had not had any masks on at all during that time. And also just educating the public, once the vaccines were approved and I participated in the clinical trials for the vaccines. And so I wanted to be able to say,

Cara Lunsford (06:43.577)
Right.

Ernest J. Grant (07:01.848)
that they were safe and that I personally had participated in the clinical trials and knew that they were safe. So that left a little bit of credibility, not only to, again, my fellow nurse colleagues, but also to the public and then particularly to people of color who tended to have a little bit of hesitancy regarding trust of the healthcare system. So.

So yeah, that was just part of that. And that's the reason I have all this gray hair. My hair was all black at that time. Yes, it's like being the president of the United States. Absolutely. So, you know, but I tell people this is earned wisdom.

Cara Lunsford (07:33.392)
It's like being the President of the United States, right?

Cara Lunsford (07:43.724)
for sure. Absolutely. Well, so I think a lot of things that you said were really interesting, right? So I mean, one of the things was that.

Ernest J. Grant (07:46.018)
Yes.

Cara Lunsford (08:00.496)
I think that like nurses, especially during that time, were very frustrated. I'm currently, I'm in a writing clinic, okay? And it's at Cal State University of Los Angeles, and I'm working with a bunch of nurses, and we are all writing about our time during experiences during COVID.

Ernest J. Grant (08:06.818)
Yes.

Ernest J. Grant (08:20.654)
Experiences,

Cara Lunsford (08:25.06)
And it's all going to be read at a theater. And it's so interesting to go around the table and hear everyone's experiences. There's someone at our table who worked in infectious disease, who's been a nurse for 36 years. And her experiences. And.

Ernest J. Grant (08:38.414)
Mm-hmm. Mm-hmm.

Cara Lunsford (08:46.744)
You know, then there was people who were working in public health. was people who were working at the bedside in critical care. There was a new nurse who literally had just graduated from nursing school and dropped right into an ICU. And you can only imagine, right, how bad that would be. And so just all these different perspectives. But one of the things that.

Ernest J. Grant (08:59.672)
Yeah. Yes.

Yes.

Cara Lunsford (09:12.558)
you know, keeps coming up in this writing conference or this writing clinic that I'm in is how things just changed constantly. Right. And. Everyone who's worked at the bedside has been fit tested, right? We've all done fit testing. And we know that, you know, N95 mask is rated for 90 minutes or, you know, and that.

After that, it's not really working. And so then you've got masks sitting in a paper bag, right, for days. And you're reusing it. And the confidence level, right, is just dropping. And so now you've got all these health care workers who are asking themselves, all these years I've been told

This is how it's done. This is how it works. Now, suddenly, this is sufficient enough or I, you know, I can't bring a mask with me if I if I get access to a mask. That was a lot of stuff that I was hearing, too, is that some nurses would actually secure some N95 masks or that they would get access to them and they try to bring them with them. They weren't allowed to have it. And how how was that for you as as the president of the A &A?

Were you hearing a lot of, I'm sure you were hearing a lot of similar concerns.

Ernest J. Grant (10:42.67)
Yeah. Well, absolutely. One of the things that I did as president, I had a group of 60 nurses around the country that I spoke to at least once a week. And they were in all areas, know, critical care, know, emergency room, community, know, nursing instructors and et cetera.

and in different areas of the country. And because I wanted to know what was going on in their neck of the woods, because I figured if you're seeing it in Iowa, then chances are we're gonna see it on a national level and we need to be prepared for that. And so addressing the issue with the N95s and the reuse, yes, of course, had been, everyone has been taught that, as you said, they're only good for about 90 minutes and then you discard them.

But then working with health officials and those of the COVID task force and looking at some of the studies that were being done and looking at the size of the virus and et cetera. And the way that some of the masks were re-sterilized or being able to be re-sterilized and being tested again for their efficacy. That was some information I was able to pass on to nurses to help.

boost their confidence in that. But yes, rightly so, nurses at the beginning when hearing that what you've been taught and then suddenly, the mere fact that suddenly, well, this has changed. And that was almost something like on a daily basis you were seeing or hearing things change. And so it did sort of cause the credibility factor to be brought into question. But I think though the one

constant, hopefully that I was able to provide, you know, being the leader of the nation's wealth at that time, 4.8 million registered nurses was to say, no, we're working closely with, you know, officials at the CDC, officials at the, you know, the COVID task force and et cetera. And yes, the more we learn about this virus every day, then yes, that does cause changes in the way that we approach things.

Ernest J. Grant (13:00.894)
But it's a way of being able to educate and explain to nurses that because of what we just discovered, this is what we can do, as opposed to, I think, other individuals who were out on the forefront and the various task force. They perhaps did not go into a very thorough explanation. And so that left a lot of doubt for some people.

Hopefully, I I felt that my being able to really just get down to the nitty gritty and saying, yes, because of what was discovered or a later or a different approach that was investigated and proven to be effective, this is why we can at this point still continue to reuse those N95s or again, because of other sterilization methods that were brought about as well.

that that made them still effective for second and third use as opposed to just the 90 minutes and throwing them away. Plus keep in mind too, there was a significant shortage of those as well. There was reports of hospitals that would bid sometimes, I know in one case one hospital bid something like $4 million to purchase some masks.

only to be outbid 10 minutes later by yet another hospital. And again, and some of these were some of those counterfeit masks that I had talked about earlier. So again, notifying members of Congress that you've got to do something to stop these counterfeit masks from coming into the country. Otherwise the situation is going to get much worse. So again, being able to alert them about that was something that was very, very helpful as well.

Cara Lunsford (14:52.292)
Yeah, was a really odd time of opportunism where there was all of these bad actors out there really trying to prey on this need and.

Ernest J. Grant (14:53.838)

Mm-hmm.

Ernest J. Grant (15:01.102)
Yes.

Cara Lunsford (15:08.694)
So I'm glad that there was someone like you who was advocating to Congress and talking about that because I used to get it was bizarre, but I used to get WhatsApp messages all the time from random people in other countries sending me notifications that I could, you know, I could buy masks from them for, you know, X number of dollars or I could buy them in mass quantities and

Ernest J. Grant (15:21.164)
Mm-hmm.

Cara Lunsford (15:38.578)
and there was all these shipping, you know, and I'm sure that they thought, well, I'll buy them and then I'll go ahead and I'll upsell them here, you know, or I'll, it was a really weird, very strange time.

Ernest J. Grant (15:54.946)
Very, absolutely. And of course, on top of that too, you had people who were deniers that this was even happening. Or people who would start other rumors and things that, so it was pretty hard to, and one of the things that I would truly stress for people is to, who you could believe, who are some of the trusted sources.

that you needed to get your information from as opposed to believing what you perhaps may have read or seen on social media and things of this sort. that, again, it was almost like there was a denial of science or evidence-based science or evidence-based practice that we knew. And that too contributed to a lot of distrust that people had. Not only

the general public, also some members of the healthcare team as well. And by being a trusted source, hopefully we're able to dispel those differences that people had or the doubts that people may have had.

Cara Lunsford (16:57.39)
Yes.

Cara Lunsford (17:09.764)
Did you ever hear about the town hall that LA County General Hospital was having? So this is so interesting. And I would encourage all of our listeners to check this out if you have an opportunity. It's on YouTube and you can go back to April, March, April of 2020.

They they put on a town hall. They had some of the they had the largest number really of of covid patients. You know, it was even of monkeypox when monkeypox hit the scene. They because they were county general. Right. So LAC USC put on a town hall and they were educating like all three thousand of their staff.

via this town hall. And I learned about this at my writing clinic, because there was a couple of nurses from LAC USC. And they were talking about how their infectious disease director was on it. Their CMO was on it, their CEO. And it was fascinating. I haven't had a chance to even go look it up. But apparently, if you go to YouTube,

you look up LA County USC town hall, they have and they've kept it going. They've actually kept this town hall going, which is so interesting because they continue to inform their staff. And I thought, well, I wish I had known about that because I would have gone and visited it. It was an open public town hall that anyone could have joined. So

Ernest J. Grant (18:40.782)
Okay.

Ernest J. Grant (19:00.846)
That's great.

Cara Lunsford (19:01.452)
Yeah, so I'm sure throughout the nation, there was probably other people, other organizations doing similar things. I think one of the problems, and especially as we kind of start talking a little bit more about post-pandemic, you know, there's a lot of trauma that happened for our nurses. I'm definitely...

Ernest J. Grant (19:10.851)
Yes.

Cara Lunsford (19:28.258)
experiencing and re-experiencing it now through this clinic, this writing clinic that I'm in, which I really do recommend that nurses, if you're listening to this, I have found so much, it's been very cathartic, very healing for me to write about my, to write my stories. Yeah.

Ernest J. Grant (19:44.29)
Yes, it is. If I may. during COVID, the country shut down, I remember exactly, Friday, March 13th. And literally, one of the things we did at ANA was that, obviously, closed the office. But by Monday, opened up virtually, had educational resources online for nurses.

Cara Lunsford (19:48.227)
Absolutely.

Ernest J. Grant (20:13.484)
you know, talking about how to don and doff, you know, gown, mask, gloves, you know, things of the sort, how to take care of an intubated patient if they were going to be, you know, nurses who weren't in the ICU. But a little bit later on, you know, we also began this Pulse of the Nations Nurses series. And one of the things that came out of that, several things, but the most important one, and I remember it was in May when the first report came out.

There was clear evidence that nurses were suffering a lot of mental anxiety. Obviously being asked to work double and triple over time, seeing death and dying on levels that you've never seen before, in hospital wards that normally didn't experience death and dying and now they are at all levels and et cetera, is just really heart wrenching.

The American Nurses Association along with the Emergency Nurses Association, the Critical Care Nurses Association and the Association of Psych Mental Health Nurses created this well-being initiative and part of that, one of the things like you were talking about, the writing that you're participating in, that was one of the things that we encouraged nurses to do as well in order to deal with the behavior.

issues that they were suffering. Also, there was a lot of things that I learned, like some nurses, there were volunteer counselors who were willing to listen to nurses' stories, but we found out that nurses were sort of reluctant to do that because if it showed up on their insurance, or it's a possibility that they may lose their license because it would say that you have sought counseling, even though it's

It may not be in relation to what was going on. It could have been either something going on in their personal life, like a divorce or whatever, but we automatically just think that, counseling, there's a mental health issue, like if for the person perhaps is suffering from anxiety or maybe bipolar or something like that, when in actuality it's distress or it was the distress of the...

Ernest J. Grant (22:39.244)
the job and what was going on. Other things as well, that's where we started the of the campaign of telling nurses, put your own mask on first before helping others. In other words, take care of yourself, make sure you're getting enough rest, make sure that you are eating properly, look out for those little signs of, I turning to alcohol too much or if I'm a smoker, am I smoking too much or do I find that my...

temper is very short. I get very short with my colleagues and etc. All these are things that nurses needed to pick up on and obviously do something about. And of course that still goes on to this very day. Because COVID is still active. It's not, obviously, and thank God, it's not as prominent as it once was, but people still do come down with a COVID infection. But it is...

It was just the country, or the globe actually, had never experienced anything like this. mean, obviously they attributed the Spanish flu as something close to this. That happened 100 years before as well. And I was able to go back and look at the records of who was president at that time and what she did. And turns out she was an old army nurse.

had sort of a playbook and we sort of followed that playbook as well. But nothing to, when you look at modernity and how things has changed from 100 years ago, we need to be able to adapt. And of course, this leads us to where we are post-COVID, what's going on. Nurses are still having those behavioral issues. Nurses are coming under attack.

And as a result of this, the whole country sort of seems to very on a short fuse when you hear that nurses are being abused by patients, by family members, by their colleagues, that nurses are wanting to leave the bedside at a much faster pace than they did in the past. Or older nurses like myself are choosing to retire early.

Ernest J. Grant (24:59.702)
All that's contributing to a workforce shortage and other workforce issues that we still need to address. And even though we may think that, well, we accelerated telehealth and telemedicine, yeah, that's good, but it still is not as good as being able to do that one-on-one, do that hands-on with the individual. In most cases with telehealth and telemedicine, you're just seeing the person from the neck up. You're not really able to do...

the physical hands-on things that could also help you when it comes to diagnosing or assisting with diagnosing a particular illness or something that you may see. So yes, it does help as far as with increasing access to care, but is it giving you good quality care that you really need to have if you were in the room with that person?

Cara Lunsford (25:51.759)
Yeah, I think it's a supplement. Yeah, right. It's it's it's important that we take these opportunities to integrate new technologies and and use them where they're appropriate. Right. Not to supplement. You don't want to supplement everything. You don't want to replace everything. Right. It's you have to use it where it's going to be well suited and.

Ernest J. Grant (26:04.727)
Absolutely.

Ernest J. Grant (26:11.938)
Absolutely.

Cara Lunsford (26:19.728)
and then freeze people up. I think that that's the idea really is that we wanna make sure that we're freeing up our healthcare workers, our clinicians, to be able to do what they signed up to do, to do that job.

Ernest J. Grant (26:35.19)
Absolutely. This needs to be, well, it needs to be viewed as a tool and not as a replacement, but as a tool to help us to achieve what we need to achieve as far as with providing better care for the individual. And it's better than nothing. When you consider the number of hospitals that are closing that we're hearing now, and which may

create quite a challenge when we think about access to care, particularly in the rural parts of the country. You know, somebody that maybe had the ability to, maybe there was a hospital within a 15 to 30 minute ride from their home. Now they may have to ride over an hour and a half to two hours. So yeah, using telehealth may work in that particular situation. But the main thing is we still need to be able to get

know, physical, you know, healthcare providers within the community, as well as, you know, get rid of, excuse me, or increase, well, I should say, get rid of the drug store deserts that don't exist, you know, putting drug stores and grocery stores in those rural communities as well, and partnering with people, with leaders in the community so that we can meet the needs of, you know, whatever the community may be so that they're not abandoned or that we don't see them.

Cara Lunsford (27:51.045)
Right.

Ernest J. Grant (28:04.238)
when it's too late, when something like a 25 or 50 cent a day pill could have prevented an illness. And suddenly we see them having a stroke or something like that that could have been easily prevented had we been able to have more access to care.

Cara Lunsford (28:25.168)
Yeah, if we were just able to intervene. This is why I really think the whole nurse practitioner route is so important. providing them with the ability to practice with some level of autonomy is so important because they are the ones that want to get into those areas where there is a lack of access.

Ernest J. Grant (28:35.032)
Yes.

Ernest J. Grant (28:40.663)
Absolutely.

Ernest J. Grant (28:51.702)
Absolutely.

Cara Lunsford (28:52.268)
It's the NPs, it's the PAs. They're the ones that want to stand up the clinics, you know, and especially in communities that are lacking access to real care and especially preventative care, right? And because ideally there was a time.

Ernest J. Grant (29:12.334)
Yes.

Cara Lunsford (29:19.524)
long, long time ago when, when you ended up in a hospital, was because you were very, very sick. And the only people who went to hospitals were people who were very sick and possibly dying at risk of dying. And somehow along the way that shifted and people found themselves going into an emergency room.

Ernest J. Grant (29:27.342)
Good.

Ernest J. Grant (29:35.0)
Yes.

Ernest J. Grant (29:40.43)
Yeah.

Cara Lunsford (29:46.105)
with a cough and a cold and they just didn't have access to preventative care and to primary care. And so I think nurse practitioners are going to be part of that solution. So what are your thoughts on that?

Ernest J. Grant (29:47.288)
Mm-hmm.

Ernest J. Grant (30:00.334)
They are. yeah, absolutely. mean, even here in my own home state of North Carolina, there are three counties in this state, very poor rural counties, but the only healthcare that is given is provided by nurse practitioners and PAs. And the hospital, the nearest hospital in some cases is like an 80 mile drive away. So yeah, it is a proven need that, you know,

those providers do serve a much needed need and a much needed population that our physician colleagues perhaps do not want to do. And that's the thing I really think we need to stress to our physician colleagues is that nurse practitioners and PAs, they do not want to take your job. They want to work with you to provide the care that is so sorely needed. But when...

You know, like here in North Carolina, we've been trying to pass a bill that would allow nurse practitioners to have, you know, full practice authority. And this is year seven. You know, and each year, you know, we thought we had it last year, but there's one person in the legislature who happens to be a physician who's holding up the, you know, the whole thing. But yet you would think that they would realize that, you know, think of all the hundreds of thousands of people.

that could be better served had that bill passed. So we're still trying to get it passed again this year. And I'm sure it's just one examples of that all over the country. But when you look at states that have that and look at the, and actually the pandemic getting back to that, it was a perfect example or perfect experiment of how successful

allowing nurse practitioners and PAs to have full practice authority because remember they implemented, know, an emergency, you know, care thing which allowed, you know, NPs and PAs to have full practice authority. And, you know, the biggest fear that a lot of people, you know, always said was, oh, if that happens, there's going to be utter chaos. There's going to be people dying right and left and, you know, this and that and et cetera. It never happens.

Ernest J. Grant (32:22.508)
you know, what better experiment could you ask for, you know, that, you know, they would think that, they're going to be, you know, prescribing, you know, misorders and things of this sort. Not one case did that ever happen. You know, yes, people were dying, but they were dying because of COVID, not because of, you know, the way that, you know, people were thinking they may have been misdiagnosed or mistreated by an NP or a PA. So.

So we have the data to prove that it works. We just need to get, obviously, as you know, it comes down to a matter of dollars and cents and et cetera, but we need to get payers to begin to really want to reimburse more for what nurse practitioners and nurses in general bring to the table. That's another one of our big issue is that nurses, we're counted as a

as a commodity, being put under the room and board, there's something wrong with that. I've long said that we should be able to charge for what we bring to the table, just like our physician colleagues, just like our physical therapist or respiratory therapist or occupational therapist. We go to school just as long, if not longer than they do. We are a true profession. We have our own body of research.

Cara Lunsford (33:26.308)
Yes.

Cara Lunsford (33:37.786)
Yep.

Ernest J. Grant (33:46.862)
things of this sort, our own standards, our own code of ethics, but yet we are treated as a commodity and there's something wrong with that picture when we're that way.

Cara Lunsford (33:56.206)
It's very...

It's very odd. know, I spoke with Rebecca Love. I interviewed her commission. One of my favorite people. always say she I've known her for years and years and and and she speaks faster than any person I've ever met on the planet. I don't know how her brain, how her how her mouth keeps up with her brain. But she she has so much she has such a wealth of knowledge around the history.

Ernest J. Grant (34:01.218)
Mm-hmm. One of my favorite persons.

Ernest J. Grant (34:13.186)
You

Yes.

Ernest J. Grant (34:26.2)
Mm-hmm.

Cara Lunsford (34:27.986)
of nursing to what you just said. If anyone's interested, they can go back and listen to the episode, Commission for Nurse Reimbursement. We did it here on this podcast with Rebecca. And it's so fascinating. It's still one of our top performing podcasts, if you can believe it. Yeah, because nurses want to know that...

Ernest J. Grant (34:28.888)
Yes.

Ernest J. Grant (34:46.554)
great. I can't.

Cara Lunsford (34:52.408)
Well, why am I a cost to the system? Why am I not a benefit to the system? Why can, if we are a business, right? If healthcare is a business and that doesn't seem to be changing anytime soon, then why would they not want to say, okay, here's the value around having a nurse. You know, here's how much the hospital was able to,

Ernest J. Grant (34:54.178)
Mm-hmm. Mm-hmm.

Ernest J. Grant (35:01.696)
Mm-hmm. Mm-hmm. Yep. And it is. Yes.

Cara Lunsford (35:22.062)
receiving revenue.

Ernest J. Grant (35:23.512)
Yeah, or save because of things that nurses have done or prevented from happening and et cetera. Absolutely, we're more than worth our weight in gold. It's just the fact that for some reason, it's just been put into our, or out there that, no, you work for this amount and et cetera.

Cara Lunsford (35:25.71)
or save.

Ernest J. Grant (35:51.84)
And never was that more proven. You know, nurses were able to prove their worth than during the pandemic. You know, the mere fact that, you know, and it's weird because at the first part of the pandemic, you know, the country loved us. You you got the applause at that night and, you know, great job and everything else. And then somewhere near the end of that, again, there was that change as they began to have a change in whether or not to believe science.

and is this working? Yeah, it got politicized, absolutely. It absolutely did. And as a result of that, nurses began to suffer more the physical harm. And we've got to change that.

Cara Lunsford (36:22.106)
Well, it got politicized, didn't it? It got politicized and it was a.

Cara Lunsford (36:37.316)
Yeah, as opposed to looking at it as a public health crisis, which is what it was. Yeah, it was it was politicized and then there were people on just one side or the other. And and and that just added to, think, more of the moral injury that so much of these nurses experienced. And and, you know, it's not lost on us that nurses have been experiencing trauma and moral injury and and all of this burnout.

Ernest J. Grant (36:40.27)
Yes.

Ernest J. Grant (36:58.231)
Absolutely.

Ernest J. Grant (37:03.608)
Mm-hmm. Mm-hmm.

Cara Lunsford (37:07.25)
out for years and years and years prior. really, this was just the icing on the cake, right? Like this was really just the straw. Yeah.

Ernest J. Grant (37:09.07)
since day one. Yes.

Ernest J. Grant (37:16.002)
Yep.

Yeah, true, true. But I still would, even though we're painting a of a gloomy picture, I still would encourage people to go into the profession. It's the best thing that I ever made, the best choice. I have never regretted choosing, actually, as I tell people, nursing found me. I didn't find nursing, but I've never regretted being a nurse.

And one of the things that, you know, I've been a nurse, what, almost 44 years now. And, you know, I can ask, well, I do ask myself this question at the end of every day, you know, did I make a difference today? And I can truthfully say every day that I can answer yes, whether I was at the bedside, whether I was, you know, in an administrative position, whether I was, you as I am now as a educator.

you know, still making a difference in some way or another, you know, either advocating for the profession, advocating, you know, behalf of nurses or advocating for the, you know, the people that, you know, that we serve, you know, and getting that out there, you know, just having my voice heard and encouraging other people to have their voices heard as well so that we can continue to make a difference and get people to.

continue to appreciate who we are and what we bring to the table, even though for the past 23 years in a row, we've been voted the most honest profession. Honesty is one thing, it's a matter of being respected and being paid for what you bring to the table.

Cara Lunsford (38:56.175)
Yes.

Cara Lunsford (39:03.628)
Absolutely. Because we've been given more and more responsibility. I've interviewed so many people, people who have been in the profession for decades like you, Dr. Grant. And then I've talked to people who have been in the profession only for a few years. But when I talk to the people who have been in this profession for decades,

They will say, slowly but surely, I've been given more and more responsibility. And even people that I've talked to who have been nurses for 50 years who will say, there was a time when you couldn't even call it blood, or you weren't allowed to take a blood pressure, or the physicians were incensed at the idea of a nurse being able to take blood pressure.

Ernest J. Grant (39:55.534)
Mm-hmm.

Cara Lunsford (39:56.785)
that's a medical thing. That is not something that they do. And now you look at what nurses do and the number of times that, that nurses are the ones, know, making recommendations and catching errors and all the stuff that, that we do. And then more and more things are just, you know, the nurse will do it. The nurse will do it. The nurse will do it. And, but the respect.

the pay hasn't matched the level of expectation and the level of workload, yet the same outcomes are expected and the same patient satisfaction is expected. you know, have you watched, Dr. Grant, did you watch the pit?

Ernest J. Grant (40:35.79)
Absolutely.

Ernest J. Grant (40:49.378)
No, I haven't yet.

Cara Lunsford (40:50.352)
Okay, so I've been told now for a came out on Jan in January of 2025. It's on Max. And this is not an ad for for the pit. You know, just in case anyone's wondering, they're like, boy, they're getting paid to advertise the pit. No, we're not. But

Ernest J. Grant (40:57.454)
Mm-hmm. You okay?

Ernest J. Grant (41:05.15)
Yeah.

Cara Lunsford (41:12.384)
I was told by all my colleagues, you gotta watch the pit. You gotta watch the pit. And most of my colleagues being actually non-clinical over at Reliance. So finally, last weekend, I binged it. I watched the whole thing, okay? So every episode is an hour of a 12-hour shift in the ER in Pittsburgh. And I can't tell you how realistic this is.

Ernest J. Grant (41:19.63)
Yes.

Ernest J. Grant (41:28.354)
Okay.

Ernest J. Grant (41:32.394)
Mm-hmm. wow.

Cara Lunsford (41:41.75)
It is, I'm sure it's gonna win lots of awards. It even.

There was a period of time where I wasn't sure I could watch it. I was like, maybe this is a little too close to home. I felt a little PTSD kind of welling up inside of me. But the thing is, it was fascinating because, and I think you'll find it really interesting because they touch on everything. They touch on violence in the workplace. They touch on just the dynamics between nurses and doctors,

doctors and doctors between interns, med students, all of that. They touch on the staffing. They have an administrator who keeps coming down and talking about patient satisfaction and the chief in the ER who's saying, you want patient satisfaction? I need staff. You I need staff. You can't have patient satisfaction without staff.

Ernest J. Grant (42:20.067)
Mm-hmm.

Ernest J. Grant (42:39.734)
And your staff, yes.

Cara Lunsford (42:45.712)
And I thought, thank God somebody made this. Yeah, because I think that it's important that the public, because you were talking a little bit about how the public perceives us, how hospitals treat their staff.

Ernest J. Grant (42:48.758)
Yeah, that's great. It sounds great. It sounds... I definitely will have to watch that.

Cara Lunsford (43:06.352)
All of this is so important. If the public wants to have care in the future, because the next biggest public health crisis is going to be nurses leaving. That is going to be the next public health crisis. Yeah.

Ernest J. Grant (43:16.142)
Yes.

Ernest J. Grant (43:26.508)
Well, it's already happening. We know that there's, within the next five years, there's going to be a need for at least upwards of about one and a half to two million registered nurses. We only graduate about a quarter of a million every year. And most of them are not staying at the bedside. You're lucky if they're there for a year. And then again, like I said, people my age who are choosing to retire.

The average age of the nurse at the bedside is about 56, 59 years of age. So yeah, that's it. And as hospitals and healthcare expands out into the community, they're still, as they have either standalone clinics or build satellite hospitals and et cetera, as they try to bring healthcare into the rural communities, you're gonna need people to staff those positions.

You know, so there is still that need. And, you know, one of the things I tell my students, particularly those who are thinking about coming or going to become nurse practitioners, I try to encourage them to become geriatric nurse practitioners because every day for the next 30 years, 10,000 Americans are going to be turning 65 and we're living longer. You know, so we're not, you know, like my grandparents or great grandparents who, you know, lived to be like.

know, late 60s, early 70s, we're living longer into the 80s, the 90s, and 100s, and we're healthier. You we're not bedridden. They're gonna walk in with a laptop or whatever else, and just like other patients that we see now saying, this is my problem, this is what you're gonna prescribe for me, and then expect to walk out the door and go play around the golf or something.

Cara Lunsford (45:11.375)
Yep.

Ernest J. Grant (45:15.982)
So yeah, there is that increased need and we definitely need to do something about that to help meet that need.

Cara Lunsford (45:24.058)
So if you had to, I'm gonna make you paint a picture. So let's jump forward 10 years.

Ernest J. Grant (45:30.497)
Yeah.

Ernest J. Grant (45:35.523)
Mm-hmm.

Cara Lunsford (45:38.255)
What do you foresee happening? What do you see in terms of more community-based health care? Do you see that being more home health, more hospitals that have their own home health? Do you see more clinics that are run by NPs? How do you see AI?

coming on the scene, like where do you see that filling the gaps? What does that look like to you if you had to look ahead 10 years?

Ernest J. Grant (46:16.238)
That's really great question. I think, well, in 10 years, one, I hope that there are more ethnic and minority nurses that are there and more men within the profession. And that the profession is more highly regarded than it is now, currently now. I think embrace, embrace of innovation and technology that is nurse driven.

because nurses, are agents of change. We find those little workarounds, if you will, that present challenges. And so I see us embracing, like AI, other things like that to help us be able to work smarter and not harder, but again, use that as a tool for what we still need to do.

I still see that there's gonna be the need for that hands-on person-to-person interaction between the nurse and the patient. So I really don't see that, even as we perhaps embrace more robotics and things like that, I really don't see the replacement of the human being. There's nothing like the human touch and nothing like the touch of a nurse that we can bring to the bedside as well. So I still think that our job is gonna be...

continue to be highly respected, still going to be highly needed. We just may be working or coming about things a little bit differently. I don't know if we would have that proverbial seat at the table. seems like, and one of the things I'm famous for saying, the seat's not there, bring your own. So I think that we as a profession, being the largest member of the healthcare profession,

there's something wrong that we don't have a voice in how our profession is practiced. So we need to be able to be in that C-suite and advocate for what it is that we need in order to provide healthcare, either in the acute care setting, I agree with you, it's probably gonna be more community-based, because I think payers are finally, as they are now, beginning to realize, hey, it is important that we invest in preventive healthcare.

Ernest J. Grant (48:37.626)
We save a lot of money on the end when you look at insurance companies for senior citizens, getting them involved in the silver sneaker program or maintaining their health or calling them in and saying, yeah, we want you to come in and get an annual physical or whatever, or we'll send a home health nurse out to your home to do a home evaluation. Are there things there that may subject you to a potential injury?

know, throw rugs or things that you could easily trip over now that you're older as opposed to when you were younger and were able to do that. What about the, you know, the temperature of your hot water heater? Have you turned it down because your skin's gotten thinner and yeah, you may have gotten just used to how hot your hot water is, but you know, sometimes, you know, with thin skin, you're gonna get a burn and you know, so, or let's look at your, look in your cabinet and see.

one, are your essentials lower so that you don't have to climb up on a step stool? Or if you are supposed to be on a special diet and I'm looking in your cabinet and I see, let's say if you've got diabetes and I look and I see you got all these carbs and things like that, maybe it's time to do some other education. It's not like as though we're invading your home or whatever, but it's to try to get you to understand this is gonna help you live longer. And I think using that perspective,

of long, you know, healthy life as opposed to a long chronic illness life is going to get the attention of the public to want to get that buy-in. And of course, being nurses in the most trusted profession, that's gonna help with that or help that go a very, very long way. You know, so that's where I see things in say 10 years from now. And I also, you know, hopefully we'll see more nursing research that

Cara Lunsford (50:22.765)
I agree.

Ernest J. Grant (50:32.726)
will again continue to create these evidence-based practice that just makes things that much more smoother and easier as well.

Cara Lunsford (50:45.828)
Yes, yes, absolutely. I definitely think that there's this.

world where the combination of wearable devices, right, the the fit bits of the world and then the the rings that people are wearing and and that combined with our smart technologies and that combined with virtual nursing and telehealth types of options and and more of these nurse practitioner and PA led

Ernest J. Grant (50:58.815)
huh. Yep. Yes.

Ernest J. Grant (51:06.274)
And I'm.

Ernest J. Grant (51:14.754)
Yes.

Ernest J. Grant (51:20.387)
Yes.

Cara Lunsford (51:22.791)
clinics that are drivable to the patient and more accessibility is that if we can really focus on, like what you said about allowing that technology to take away some of those menial tasks, some of the stuff that is not necessary for providing well-being, know, caring for the heart, caring for the spirit.

Ernest J. Grant (51:25.986)
Mm-hmm. Yeah. Well... Yeah.

Ernest J. Grant (51:48.888)
Yeah. Yes. Yeah.

Cara Lunsford (51:51.791)
Right. Because that's what you need a person for. A person needs to care for the heart and the soul of a person. And. I think it's really sad when there's things that have kept people out of this profession, like Oasis charting. I can't tell you the number of times when I went into home health, if somebody said my first question would be, are you Medicare? And they'd say yes. And I'm like, I can't do an Oasis start of care. I won't do it. And.

Ernest J. Grant (51:55.532)
Absolutely. In the spirit. Yes, absolutely.

Ernest J. Grant (52:07.978)
huh.

Cara Lunsford (52:19.446)
They'd say, well, you know, we'll have people help you and we'll have someone in the office fill in the blanks for you. And and I'd say, my gosh, the last thing I want to do is come home after having driven around and seen eight start of cares is to come home and do. Yeah. And do two hours of charting for each person. And because that is what keeps people out.

Ernest J. Grant (52:23.854)
Yeah.

Ernest J. Grant (52:36.366)
Mm-hmm, yep. And try to remember what you did.

Yeah. Yeah. Yeah.

Cara Lunsford (52:48.336)
of these professions and really good nurses who should be out there doing this type of community care. They don't want to do it because they're like, oh my gosh, I'm going to get this kicked back to me and it's going to get kicked back and you're going to want me to update this. You want me to update that? You change this, change that. And before I know it, I'm not even getting paid for that. So I definitely agree that like, you know, and I hope it's before 10 years.

Ernest J. Grant (52:58.958)
paperwork.

Cara Lunsford (53:15.716)
And I think it probably will be in some ways, a lot of the technology is moving so fast, but we've always been historically kind of slow at adopting technology. I think there's still places out that are doing paper charting.

Ernest J. Grant (53:15.736)
Yeah.

Yeah.

Ernest J. Grant (53:25.39)
Yeah, True.

Ernest J. Grant (53:31.896)
yeah, there are, there literally are and it's a shame that they haven't gotten that way or caught up with us.

Cara Lunsford (53:38.958)
Yeah. But but I think that this has been such a such a fantastic conversation. You have clearly such a wealth of knowledge. I could probably talk to you for two days and learn so much from you. So I'm I'm just deeply grateful that you shared your time with me, Dr. Grant. And and so wonderful. You are welcome back on this podcast anytime you want.

Ernest J. Grant (53:58.584)
Thank you, it's my pleasure.

Ernest J. Grant (54:04.75)
We can make that happen, not a problem.

Cara Lunsford (54:10.756)
Well, it's been fantastic and I hope you have the best rest of your week possible. For those listening, is Wednesday, but who knows when you listen to this, it's probably gonna be a Thursday, but it is a happy hump day to us. Well, Dr. Grant, do you have anything else you'd like to say to anyone before we go?

Ernest J. Grant (54:25.24)
Yeah.

Yes, it is.

Ernest J. Grant (54:34.35)
No, just thanks to everyone for listening in and I'd love to hear some of their thoughts and comments as well. It's nice to, again, see what's going on in other parts of the country and what people are thinking and who knows. There may be some fantastic ideas out there that we can adopt that may actually be those force of change too that we talked about.

Cara Lunsford (55:00.784)
Yep, absolutely. Well, if you're on Spotify, you can definitely go down and you can comment. And we like to check to see if anyone's making comments about an episode. so feel free to do that. And thanks again for being here, Dr. Grant.

Ernest J. Grant (55:18.166)
Okay, thank you. Thanks for having me. Bye-bye.

Cara Lunsford (55:21.581)
Okay, so don't go yet. Don't leave.