Posted: February 20, 2021
Dr. Camille Burnett hopes that in four years nursing schools will be graduating students who view the field through a wider lens and a longer scope.
Today’s graduates, she says, are well equipped with clinical skills but should also be well trained as advocates, policymakers, and reformers prepared to shape the future of not only nursing but of public health and social justice, as well.
“I’d love to see nursing focus on the conditions that are causing sickness and orient themselves to practice with a broader social justice lens centered on root causes and the social determinants of health,” says Dr. Burnett, PhD, MPA, APHN-BC, RN, BScN, DSW.
“In 2020, two public health crises have converged—COVID-19 and systemic racism. Understanding that health care is a right for all and championing public health efforts, especially for underrepresented populations, is more critical than ever. And who better to understand and address these structural health issues than nurses?”
Dr. Burnett, an associate professor for the University of Kentucky’s College of Nursing, points out that most nursing students’ clinical experiences have become hospital-based. “In turn, we direct students’ attention down a very narrow hallway that shows them to ‘focus on the hospital, focus on disease,’’ she says. “I want to see nurses get back to the root of our practice, which is social justice and advocacy, like nursing pioneers Mary Seacole and Florence Nightingale.”
In addition to her role as an associate professor and Cralle Day Endowed Professor in the Center for Research on Violence Against Women, Dr. Burnett, is a strategic advisor for community engagement and academic partnerships with the UK’s Office of the Provost, a research affiliate at the Center for Health Equity Transformation and the Markey Cancer Center, and co-director of special populations for the Center for Clinical and Translational Science.
In the United States, she says, we do a good job of talking about disease, prevention, and screening, all of which she deems important. But according to Burnett and the CDC, a growing body of research highlights the importance of “upstream” factors that influence health and the need for structural interventions to address them. Dr. Burnett says nurses should be at the forefront of those health equity and policy discussions, which must include root causes such as poverty and race.
COVID-19 shines light on need for public health
The basis of public health is to attend to the health of communities, populations, and individuals. “It addresses areas such as chronic illness, injury prevention, and infectious disease through various prevention and promotion measures,” she says. And with the COVID-19 pandemic, the critical role of public health has become increasingly visible and urgent.
The spread of COVID-19 has emphasized, in stark relief, the inequity of the current health and public health system.
“People die when they don’t have equal access to health care,” Kentucky Gov. Andy Beshear said during a 2020 press briefing, as he addressed the virus’ effect on the state’s African American population.
Dr. Burnett says the virus has underscored pervasive structural and social inequities, such as who has access to care, who gets testing; who continues to work and who is able to work from home; and who is at greatest risk of death and disproportionately dying.
“COVID-19 is forcing us to urgently refocus and reprioritize public health, while reconciling with years of its chronic underfunding and neglect,” says Dr. Burnett. “We need a resurgence of public health and public health nursing now more than ever to address the consequences of COVID-19, prepare for future health crises and prioritize equal access to healthcare for all.”
Public health from a two-country context
Raised in Canada, Dr. Burnett began her academic career at the University of Western Ontario and eventually came to the United States in 2012 as an assistant professor and later as academic director of community engagement and partnerships at the University of Virginia. Her background, she says, allows her to speak about health care reform and public health issues from a two-country context.
“I have seen, lived, worked, and been a patient in a universal healthcare structure,” she says. It’s not a hypothetical. My experience affords me with a unique platform and perspective on how to address public health issues in America.”
When she first moved to the U.S., Dr. Burnett visited a health department and was shocked to find only six nurses among the staff. The two public health units in Canada where she had worked had well over 100 nurses, she says. “Not just teams upon teams of nurses but also public health promoters, tobacco enforcement officers, nutritionists and family home visitors.”
Dr. Burnett says health and public health have to be a national and deeply funded priority that is recognized in all policy, from housing to income to the environment. Nurses, she says, can lead this effort together to improve public health. “Not in a reactive way but in a proactive way. We need to hit those ‘non-traditional’ spaces where our voices should be amplified to be more effective to determine what the future of nursing looks like … we need to be in front of the parade shaping our future, not behind it,” she continues. “More importantly we have to prepare our nurses now for that future.”
Back to basics
Dr. Burnett says the most important tool in shaping the future of nursing is education. That education includes revisiting the basics of nursing practice and reprioritizing advocacy, policy, health equity and social justice.
“Some of the most important work I do with my students takes place outside the classroom,” says Dr. Burnett.
“Students engage in learning about the history of their community to help contextualize and understand the root causes of the issues that their clients face,” she says. “They become immersed in communities, in neighborhoods and in agencies, where they can begin to connect the dots between the determinants of health and disparate health outcomes.”
For example, Dr. Burnett has had her students attend public health-related community meetings in small groups and identify an issue and a strategy to address it. The students must figure out who the key stakeholders are and whom they would need to talk to move the issue forward. They follow up with a short paper about the strategy they’d use to address it.
“It gives them a chance to practice that experiential piece outside the classroom, while being guided and mentored,” she says, adding that as future policymakers, it’s key for students to be able to succinctly identify and summarize an issue and advocate for a solution .
At the graduate level, those assignments are more in-depth and build on the expectation of a nurse’s role in shaping policy.
“If you haven’t had the opportunity to lobby or advocate as part of your practice, then it’s going to be much harder to get involved in change because you haven’t been exposed to it.” UK, she says, is fortunate to have high-profile, senior nurse policy leaders, but that is not the case for every school. “We should all aspire to graduate larger cohorts of nurses with health policy and advocacy experience who can help mentor future nurse leaders and shape the overall future of nursing and healthcare.”
Nurses need a seat at the table
However, nursing doesn’t need to wait to be called on to address the future of healthcare. Based on what we already know, she says, “The U.S. spends much more money per capita of GDP on healthcare than any other developed country, and we have the worst outcomes.”
“That is not sustainable, and it’s not working. Something else needs to be done.”
Dr. Burnett sees future nurses participating in the creation, leadership, and delivery of a much more upstream system that places greater value and resources in public health.
Healthcare, she says, is political, and the future of nursing and healthcare require an abundance of nurse leadership in policy and advocacy to address and meet the needs of the patients and communities that they serve.
“Nurses must have a seat at the table with decision-makers who are shaping the future of healthcare. And with nursing and public health at the forefront of people’s minds, now is the time to seize this opportunity, pull up a chair and affect change. We need to leverage our traditional areas of expertise and expand our proficiencies to help bring about and influence the structural changes necessary to reduce health disparities and improve access to quality healthcare for all.”
The above article was written by Rena Baer and appeared in the University of Kentucky College of Nursing's Winter 2020-2021 edition of Engagement.