To the Nurses Today… And The Nurses Yet To Be

In early May, I had the pleasure of giving the virtual commencement speech to the graduating class of the University of Illinois College of Nursing. It was an honor to speak to the next generation of nurses as they step into a world forever changed by the COVID-19 pandemic. In a normal year, it takes hard work to complete a nursing degree; during a pandemic, it takes extra dedication to pursue your studies online.

As a nurse myself, I’m proud of the accomplishments of these 400 new nurses and look forward to providing them with resources and information as they start the next phase of their career, and for many years to come.

Please join me in wishing a warm welcome to these new graduates as they enter a world that needs and appreciates the hard work of nurses more than ever.

Video Transcript (below):

I’m Patti Brennan, Director of the National Library of Medicine. I want to add my congratulations to the choruses of friends, families, and colleagues on your accomplishments being acknowledged this day of the graduation at the University of Illinois College of Nursing.

Almost 200 of you are entering the profession for the first time, and another 200 are receiving graduate degrees in recognition of your advanced education in nursing specializations.

I want to speak today to the nurses who you are right now, the nurses who you will become, and the nurses who you will need, and finally to the nurses,  yet unborn,  who will serve society in the future.

To the nurses who you are today:  

Your nursing education experience was like no other over the past 100 years!  You’ve learned how to learn via Zoom and TikTok, transform nursing interventions into telemedicine delivery, and develop novel skills engaging patients not only as informants but as partners in care. One of the few positive outcomes of this coronavirus pandemic is the societal recognition of the essential value and contributions of nursing. So, you are entering a world that both needs you greatly and is readily accepting of the contributions you could make. 

I hope you will take with you the joy of friendships you made during your educational time here at U of I College of Nursing: the excitement of learning, the meaningful contributions of patients who accompanied you on your learning journey, and the hope that suffused your faculty members as they guided you on your journey. I trust that the foundation of your education here will give you a firm basis, grounding you in trust, supporting your explorations.

You are entering a world that needs nursing more than ever before. I urge you to use the professional education you have had to support doing the urgent tasks in front of you while remaining true to nursing’s social contract. The hallmark of a professional is doing a task that looks like something someone else could do, but is done with the sophistication of specialized knowledge and skill that grows from the deep foundation, the future vision, and the broad perspective that we draw from our profession. It’s not enough to act, we must BE nurses.

To the nurses you will be in 2031:

What do you see when you look back across the decade since graduation? Have you achieved pay equity? Did you accomplish the next level of education that you envisioned as you completed your degree today? Did you find satisfaction and depth in the area of nursing you originally selected, or did you explore several areas before finding your niche? Or maybe, did you find a way to express the values and knowledge of nursing through another profession such as law or design? Wherever you are in ten years, I hope you look back in wonder, awe, gratitude, and satisfaction.

How does the world around you look in 2031? Has our treatment of Mother Earth improved so that the UN’s 17 Goals for Sustainable Development have actually been met? Have we achieved social equity and removed health disparities engendered by structural racism? Was the coronavirus pandemic the last pandemic of the decade or was it the start of a pandemic decade? Has someone made driverless cars practical or figured out how to get rid of all of those cords on our computers?

To the nurses you will need in 2071:

Right now, I’m just about the age that you will be in 2071. I am so confident of the importance of our profession to society and of our value to it that I am sure there will be nurses out there in the future ready to serve society.

These are the nurses who will be there to care for you—I will be long gone by then. So, I’m going express my hopes for the ways nurses approach patient care and knowledge discovery with some personal reflections. 

I hope that these nurses will remember that confidence is often accompanied by uncertainty, and that nurses must consider both as they diagnose and treat the human response to living.  

I hope they will remember that many of my age want nurses to know that we feel like we did 30 years ago, think we look like they did 20 years ago, have had meaningful and interesting career and life contributions, and bring the wisdom of aging and the freedom of age. All of this makes us even more desiring of good nursing care. Nurses should let us know how to find them, how to recognize them, and how to benefit from their expertise.

I’m less afraid of dying than I was earlier in my life in part because I feel like I could live forever, or at least another 30 years, in good health with the love and support of my friends and family.

I want the nurses who care for you when you are my age to respect that goal of mine and use it to shape their practices. Like the future you, know that even now I want your guidance to help me live as fully as I can.

I don’t want nurses to be afraid to bring up hard topics—social disruption, social isolation, loss, loneliness, hopes—because all of these shape how we approach my health. We can be better partners if nurses are as brave as we need them to be.

To the nurses of 2121 yet unborn:

These are the nurses who will be there to bring nursing into the future. What legacy will you leave them? How will you help shape the future nurse? What can you do to create in them the very excitement that you feel today?

Can you share your experiences, remove barriers, open pathways of influence, give them shoulders to stand on? Can you help those nurses yet unborn know that it is better to ask a question than to answer any single question?

Can you inspire them to discover and not just remember? And more importantly, can you help them build partnerships and pathways with people who bring the best of nursing to complement and extend the best that is in that person?

What can you do to prepare the world for nursing? To make the very best practice environment for nursing? What ways can you engage with architects, home builders, city planners to make the world not only a place that nurses LIVE in, but is livable because of nursing? Over 30 years ago, a great nurse thinker identified that it is a critical function of nursing to create an environment that supports development. What will you do to build that environment so that the nurses of 2121 can live as nurses, being nurses?

Congratulations and celebrations to all of you—faculty, students, administrators, family, and friends. Another journey is complete, and another is starting.

Thank You, My Nurse Colleagues

Writing these blog posts gives me a chance to showcase some of the great work done by our team at NLM, and reflect on the roles I play as part of the NIH leadership team, Director of the National Library of Medicine, a mother-daughter-sister-aunt-friend, and an advocate for self-care management education and support for all people. Yet, nothing compares to the opportunity that this blog gives me to reflect on my chosen profession, nursing.

This year for National Nurses Day, I want to acknowledge the enormous contributions made by all health care professionals in response to the COVID-19 pandemic, particularly by the nurses and members of nursing care teams. I want to express my sorrow and deepest sympathies to the friends, families, and co-workers of nurses who faced health issues or died from work-acquired COVID-19 infections. I am grateful to front line care providers, ranging from nursing home aides to emergency department staff, particularly the nurses whose creative problem solving and attention to complex patient needs helped so many over the past year.

Nurses are well known for their ability to innovate—finding just the right way to make one patient more comfortable or address the respiratory distress of another. The perplexities brought about by the unfamiliarity of the coronavirus infection required innovation at warp speed in nursing units across the country.

I thank you, my nurse colleagues, for what you did over this past year and what you continue to do in the face of tremendous personal risk and self-sacrifice. May your accomplishments give you the strength you need to continue, and your contributions be acknowledged and treasured by those for whom you care.

For my part, I’m not on the front line physically, but the role NLM played this past year was focused on finding ways to support people who are on the front lines of this pandemic. Whether it was providing patient-specific COVID-19 information through our MedlinePlus Connect service, or expanding access to and making available coronavirus-related journal articles to support evidence based practice approaches, NLM has been here for YOU!

We collaborated with publishers to drop paywalls, so that the literature could be available to anyone who needed it. We accelerated processing of genomic sequences to speed up the process of tracking variants and identifying new drug targets. Our team at NLM helped mount the NIH’s response to the COVID pandemic with new research programs, particularly designing advanced data systems to make sure we learn as much from this experience to prepare for the next. While literature cannot provide the comfort of a hug, it can provide ideas that can aid in supporting someone through the process of grief.

My thoughts turn to my nurse colleagues who have witnessed so much death this year—among your patients, co-workers, and communities at large. I extend my wishes for resilience and comfort. I can offer little, but the acknowledgement that your experience of COVID-19 was so different from mine, and the assurance that NLM’s programs of research and offerings of significant literature resources will continue to make available the information needed for practice, and the learning that comes from practice.

In April 2020, as the pandemic was emerging, our colleagues from the United Kingdom offered some helpful hints in this Journal of Clinical Nursing article, one of the freely accessible articles made available through NLM’s Public Health Emergency COVID-19 Initiative. The authors encouraged nurses to address their own psychological and safety needs through peer and team support. This includes looking after each other’s well-being and encouraging temporary and long-standing teams to check-in on each other—particularly at the beginning of a shift, where such contact can activate a sense of social support. The authors also exhort that the stress response to staffing shortages, a sense of futility, and unrelenting grief is normal and will resolve – and yet each person responds differently, so make sure you check in with yourself!

For every one of you who greets each workday with the worry of exposing your family to COVID-19 or putting yourself in harm’s way, I thank you for persisting, and for what you are doing for patients. I trust that the next few months will be a time for resetting your practice to something that is manageable and less fraught with risks.

As we celebrate Nurses Day, we do so with sadness arising from the strains experienced by our profession over the past year, the loss from too many deaths, and the exuberance of the enduring strength of nursing! My hope for Nurses Day 2022 is that our common paths lead to a healthier, safer world. 

Please let me know how NLM can join you on this journey.

Learning from my Irish Heritage

Today is the Christian Feast of Saint Patrick, one of Ireland’s patron saints who lived during the fifth century. Celebrated today around the world as St. Patrick’s Day, this observance has evolved into a celebration of Irish culture and is a day of fun and family for those who are Irish or wish they were! As one of the 70 to 80 million people around the world who claim Irish roots, this celebration offers a chance for me to reflect on my own Irish heritage and what I have learned from it. And as those who have read this blog before know, family is of preeminent importance to me as a source of joy, strength, and comfort — all of which I have drawn on throughout my life.

Ireland is best known for its music and mythology, sports, scholars, and, most relevant to me, deep allegiance to kin groups. I can’t claim any skill on the feadan (tin whistle) or the cláirseach (the 30 string harp), although I enjoy a céilí (a celebration), and I do have some familiarity with the mythology, particularly the Morrígan, the Celtic triple war goddess of old, Queen Maeve, the strong-willed, ambitious, and fearless legend, and the warrior queens of the North. In terms of sports, I’ve learned enough to enjoy a hurling match and can follow Gaelic football. Ireland is known as ‘the land of saints and scholars,’ and my Irish heritage has provided me with a genuine and deep-seated love of learning that has been integral in my life.

Valuing my Irish heritage means also looking clearly at what makes Ireland what it is today.

The response to oppression gave rise to nationalism and a drive to be an independent sovereign state, leading to independence in 1921 (only 100 years ago!) and militance with sometimes tragic results advanced in the name of freedom. The Good Friday Agreement of 1998 brought about the end to one kind of violence. The Good Friday Agreement brought a measure of quietude to the challenges of expressing different views, yet more than twenty years later, differences still persist. And the recent investigations into mother and baby homes engendered an awareness of the need for the apologies to survivors of this awful period in Irish history.

Some believe the “Irish temperament” is a mixture of stubbornness, personal warmth, and a wit that shines through adversity. I certainly hope I have all three of these, perhaps a bit more of the latter two than the first. However, having a bit of stubbornness is important, particularly as the director of NLM, which serves as NIH’s center for biomedical informatics research and the world’s largest biomedical library. Being stubborn, coupled with warmth and wit, has helped me guide the NLM as it approaches its 3rd century in existence. It has helped me serve as an advocate for the technical infrastructure necessary to secure our resources and to make them permanently available around the world. It has provided me with the tenacity needed to hold firm to the values of what libraries mean to society – institutions rooted in collecting and disseminating the literature of the world with integrity and without censorship.

What this means to NLM is that we must continue to hold to our enabling legislation of 1956, to acquire, preserve … materials pertinent to medicine and … make available… materials in the library. As Joyce Backus, our former Associate Director of Library Operations, was fond of saying, “science is self-correcting,” meaning that we don’t need to exclude materials that are no longer aligned with our global perspectives, but we do need to continue to gather and make available the full range of information.  

So, I hope you join in the celebration of all that is Irish on this St Patrick’s Day and remember that history is complex — and the purpose of libraries, including the National Library of Medicine, is to reflect the progress and perspectives across time, rather than a snapshot of a particular point in time.

How can we help you in this celebration?

Dismantling Structural Racism

NLM stands with NIH Director Francis Collins in establishing new ways to support diversity, equity, and inclusion, and identifying and dismantling any policies and practices that may harm our workforce and our science. This work is just getting started and I encourage you to respond to a Request for Information that NIH issued seeking input on the approaches NIH can take to advance this goal. Comments can be submitted through the submission website and must be received by April 9, 2021.

The NIH has long supported programs to improve the diversity of the scientific workforce. Yet those efforts have not been sufficient to achieve racial equity across the biomedical research enterprise. This month, NIH launched an effort to end structural racism in biomedical research through a new initiative called UNITE. UNITE is an acronym that reflects the multidimensional approach that NIH is taking to address this complex problem.

UNITE:

  • Understanding stakeholder experiences through listening and learning
  • New research on health disparities, minority health, and health equity
  • Improving the NIH culture and structure for equity, inclusion and excellence
  • Transparency, communication, and accountability with our internal and external stakeholders
  • Extramural research ecosystem: changing policy, culture and structure to promote workforce diversity

NLM is committed to improve diversity, equity, and inclusion with regard to structural racism and all aspects that make us who we are and take into account from where we came. We are grounded in the belief that advancing diversity, equity, and inclusion improves the quality of science and engenders more robust knowledge representations and more culturally-competent means of supporting investigations and delivering health information.

Through our intramural research and extramural programs, we are supporting research to identify and mitigate bias in data sets and analytic tools, and enhancing the diversity of young scholars preparing to enter the fields of biomedical informatics, computational health, and data science.

In addition to actively participating in NIH-wide diversity, equity, and inclusion efforts, we are turning to the NLM staff to garner ideas about how NLM should specifically create an environment that promotes diversity and inclusion within our Institute. Last week, more than 150 people attended a special conversation between NLM staff and leadership where we learned many things and shared ideas ranging from improving recruitment to understanding implicit bias.

The NLM leadership has taken up the challenge and will work with our creative staff to set a path forward to promote inclusive excellence, and create a workplace that is diverse, inclusive, equitable, and respectful of the talents of everyone.

NLM is committed to supporting NIH in identifying and dismantling any policies and practices that may harm our workforce, our science, and society at large. This is just the beginning of our journey to improve the NIH and everyone’s health by ending structural racism in biomedical research. 

I invite you to join us in this journey too.

Vaccines, Vaccinations, and NLM

As I write this message, I am one of the more than 25 million people in the U.S. who have received both doses of the coronavirus vaccine. I received my first dose of the Pfizer vaccine on February 4, and my second dose on February 25. NIH is distributing vaccines to employees based on priority group following general guidance from the CDC, but I became eligible first through my health plan. I’m sharing my story with you today and highlighting how the NLM has and still plays a role in vaccines and vaccinations during this time of the COVID pandemic.

Getting a spot in the COVID vaccine line will become one of the shared stories of this pandemic. As story tellers, we will likely exchange tales of how each of us got that prized place, particularly for those of us who received the vaccine in the first few weeks of distribution.

Here’s my story: As a resident of Washington, DC, and someone who is over 65 years of age, I became eligible pretty early – January 11. At the time, DC released appointment slots through its public web site. What if you don’t have a computer, typing skills, or access to the internet? Can the public library help here? Of course! In addition to providing internet access and coaching support from library staff, some public libraries are becoming sites for the distribution of the COVID vaccine. Each Monday and every other Thursday, as more appointment slots were released, I dutifully logged into the DC vaccination registration website, entering details and hitting refresh. Unfortunately, the available slots ran out quickly with each attempt. It was indeed frustrating. Through my health plan, I was entered into a vaccine registration list. As an NIH employee, I got my name on a list too. I was probably number 15,543 at NIH since I am healthy and able to work remotely, but I became eligible through my health plan in late January and was spared the déjà vu of type, refresh, repeat!

NLM played a big role in helping get this vaccine to me and people around the world.

We played a key role in making sure the genomic basis for vaccines and therapeutics were freely available to the public. In January 2020, NLM released the first fully annotated SARS-CoV-2 gene sequence to the public through our GenBank database, the world’s largest database of publicly available genetic sequences. Because NLM maintains extensive data repositories of nucleic acid sequences – the building blocks of genes – researchers were able to search NLM’s entire Sequence Read Archive (SRA) to better understand and characterize the biological properties of SARS-CoV-2 in record time. 

NLM created a dedicated website, the Severe acute respiratory syndrome coronavirus 2 data hub, for researchers to search, retrieve, and analyze data for more than 150,000 digital genomic sequences of the virus. In addition, we partnered with publishers around the world to make available for computerized data mining the full text of over 100,000 articles related to the coronavirus, helping scientist to identify key biological targets. Our ClinicalTrials.gov repository includes over 400 studies designed to develop, evaluate, and determine the effects of various COVID-19 vaccines.

Screen shot of MedlinePlus COVID-19 webpage

Our MedlinePlus consumer health information site contains specialized information about COVID-19 vaccines, clinical studies, and the vaccine distribution process. MedlinePlus helps people find information (in English and Spanish) about the COVID-19 vaccination program in the United States, and is a resource where people can find reliable, up-to-date information about how to protect themselves and their loved ones against infection while awaiting the vaccine. Linking to health information from the NIH and other federal government agencies such as the FDA and CDC, MedlinePlus provides access to fact sheets, statistics and research, journal articles, and even videos to help people learn more about COVID-19 vaccines.

What makes NLM unique is not just that it contributed to the process that helped make vaccines available, it’s that NLM has been helping scientists, clinicians and the public understand, prevent, manage, and cope with infectious diseases and health problems for nearly 200 years.

To Prevent Influenza!, 1918
National Library of Medicine #101580385

NLM identifies, selects, and archives a remarkable volume of content documenting these pandemics, from the scientific journals to the public health announcements. We were here 100 years ago, preserving information about the 1918 influenza pandemic, and we’re on track to be here in 100 years when future scholars and members of the public want to peruse the records of the COVID-19 pandemic and other health challenges faced by society.

The NLM serves scientists and society by providing trusted health information to understand, prevent and treat illness in support of public health. How can we help you?