Robin Cogan, Nurse Influencer, School Nurse, Camden School District & Faculty, Rutgers School of Nursing.

Hello, from sunny Austin, Texas, and welcome to the Healthcare Soothsayer Podcast. I'm your host, Dr. Bonnie Clipper, and yes, I am a nurse. I have worked for more than 30 years as a nurse, chief nurse executive, innovation strategist and speaker. I am grateful for the opportunities to have created nationally recognized programs and for building the framework to bring 4 million nurses from across the country into the innovation space. I get to connect regularly with healthcare leaders and frontline professionals to talk about ways to improve patient outcomes, access, cost efficiencies, and clinical workflows. I have taken the message of nursing innovation international and look forward to continuing this message to transform healthcare. This podcast will bring you thought leaders and ideas that you may not have heard otherwise. This is their opportunity to share with you what they see in their crystal ball through their unique lens and perspective and healthcare and what we can anticipate as a result. Today with me, I have Robin Kogan, school nurse, nursing faculty at Rutgers University, Unviolence Prevention Activist, and active blogger at the Relentless School Nurse. Robin, welcome. Thank you, Bonnie. I'm really excited to talk with you today. And I'm excited to talk about the space that you're in and what you see coming down the road or around the next corner. So I want to dig in and just hear from you what you see coming. Well, it's interesting you ask me about both things because that's actually something that school nurses do exceptionally well. We look at what's right in front of us and what's way down the road in the future. So what I see right in front of me in my role as a school nurse is this excitement and enthusiasm around vaccines. And what I want to promote, and I'm not alone in this, I'm definitely standing side-by-side with my school nurse colleagues, is vaccine confidence. The idea that our families and that when vaccines are available to children, which I really hope is sooner than later, and our staff will take advantage of this incredible scientific breakthrough and get the COVID vaccine. That's what's right in front of me. And what's down the road? I've been thinking a lot about what school is going to look like moving forward. So those are really neat thoughts because I think we begin to take perhaps maybe one a little bit more for granted than the other. So let's talk a little bit about vaccine confidence and about how you think we can sort of amplify that message and maybe even ways that we can sort of get through to skeptics if that's possible. Yeah, and so my thought around it is that if we take all of the, and now granted, there are some nurses, of course, that may have their own vaccine hesitancy. But let's say in the bigger picture, more than not, are willing and able and wanting to promote vaccine confidence, and therefore the public participating in getting vaccinated. And if we each, in our own way, use our initial sphere of influence, which would be like literally on the ground level, our families, our immediate family, our extended family, our friends, imagine those more than five million nurses, the web of influence that we would have if we each reached out on our own. And then infuse that vaccine confidence to hopefully answer questions, get excited about what is possible, and hopefully that positivity will spread. Because what we need at this moment, from what I understand from the experts, and I'm talking about Dr. Fauci, Dr. Ja from Brown, is that we need up to 90% participation in the vaccine program. Well, that's kind of a staggering number. Have we had 90% participation in anything before? We have not, and we have only eradicated one other virus in that smallpox. We've been able to control other outbreaks, and we certainly had wonderful success in vaccination programs. Look, I think our students, I was reading an article, our students today are vaccinated against 14, what had been, you know, devastating childhood illnesses. They are not vaccinated against 14 of those, and so, you know, adding the COVID virus to that list would just be incredible. And, you know, for us, children are not included yet. Only children 16 and older, I believe, are able to get the Pfizer vaccine. But from what I understand, the Moderna vaccine, that while it's not for children under 16, they are doing studies based on even younger subsets of age groups. So, we still have a bit of a way to go before our kids are included. Now, certainly, you know, I'm speaking from the school nurse lens. So, I, in the school community, we need our staff vaccinated. We need all of our staff vaccinated. We need our community vaccinated because what's happening is that schools are so going through so much to keep our kids and staff safe, but then, you know, as I say, the last school bell lens, and it's like all bets are off, and people across the country are not necessarily following the known mitigation strategies that we know work. And that is impacting schools being able to stay open safely. So, let's sort of shift gears and then talk a little bit about that second issue that you brought up. It sounds like schools are going to look and feel much different than they have in the past. What, what's your gut tell you about that? Where are we headed? Yeah, you know, it is, it is the, there's so many unknowns about the future, right? But school, first of all, this pandemic has shed light on things that we knew where they are all along. We've been, how many years and decades have we been talking about social determinants of health? But it seems that the coronavirus in this kind of collective trauma that we've all been through has clearly raised issues of inequality, of racism, of, you know, food insecurity, housing insecurity, to such an epic proportion that, finally, I think, we have no other, we have to take a major reckoning with what's happened over the course of the pandemic. You know, we have more than one epidemic happening in this country at the same time. We have the epidemic of COVID. We have the epidemic of racism and all of that, of what that means in terms of inequality in this country, in equity in this country. And certainly, when I look at schools, what, what was very glaringly obvious is that, you know, our students don't have the same access to the internet. All things like, why isn't the internet seen the same way that we look at other utilities like gas and electric and water? It's that necessary to function in this world. But yet, there weren't, you know, so many schools districts, first of all, we were not prepared to shut down for nine months or eight months or however long it's been. That's number one. You know, in schools, we have emergency planning, emergency disaster planning, but that's a temporary state. This is an uncertain length of time that we are in this space. Because even though some schools have reopened in a hybrid capacity, they've been open, they've been closed. Very few schools have remained open at full census, right? I mean, there are, in New Jersey, where I am, more than half of the school districts are still remote and have since last March, including my school district. So, there are so many issues that have come to light because of COVID, because of this, as I said earlier, this collective trauma that has hit all walks of life, but some clearly, some communities, especially communities of color, much more than others. And I happen to work in one of those communities. And so, it, you know, things that we've known all along in our work just, they're just amplified in this glaring, really, national emergency that we're living through. Well, I think you've highlighted some really interesting points. I mean, one of the ones that sort of jumps out at me is social determinants of health. I think as nurses, we've been talking about this for probably 10, 15 years. And I was a chief nursing officer for almost 20 years. And it felt as though that was really a data collection exercise, right? And we asked those questions on our admission assessments, and it felt as though it was a really around data collection, because I think the efforts to try to improve the inequities, while they were there, I'm not sure they were very impactful up to this point. Well, I think that the action behind the data points is where people were unsure of next steps. And some, you know, I look at this, a similar to, I'm sure you're familiar with adverse childhood experiences, right? The ACEs study and looking at the impact of early childhood adversity on health outcomes. A lot of pediatricians are hesitant to collect that data because they don't know what to do with it. If they find out that they're, that the child that they're working with has, let's say, their sexual abuse in the household, their household dysfunction, there's, you know, a myriad of other issues. And so I look at social determinants of health the same way. So what are the next steps? Because the truth is that health happens in the community. That's where health happens. Illness happens in hospital settings and acute care settings and long-term care settings, but health happens in the community. So if we're, if our community is not well, you know, our residents will not be well. Our children will have issues. I look at Camden where I work and one in three of our students has a diagnosis of asthma. Now that is outrageously high for any community. So we have to, you know, we have to take an honest account of what is happening. These are definitely, you know, based on structures of racial inequity that have been accepted unfortunately for decades. In fact, I had a nurse friend call them social determinants of death. Wow. That's a pretty powerful way to frame this, but I think it's, it's not inaccurate, right? We know that there are issues out there and we know that we have to improve these issues. So while it doesn't sound good, they're there, right? Exactly. We can't take off the blindfolds, people. These issues are there. I'll walk you to someone's house and show you the social determinants of death that people are dealing with. I mean, this is real. So yeah, no, I think that you're exactly right and we have to get comfortable with the uncomfortable. Otherwise, we're not going to change it. We have tolerated the intolerable for so long and that's along the spectrum of nursing, right? That's, I mean, that applies to so much of nursing, but ultimately it really applies to those that we care for. Well, absolutely. And, you know, it stymies me. So I love what you were talking about in terms of the internet should be treated like utilities and it should be available to everyone. It stymies me that it isn't and why we haven't done that. So I don't know what the hold up is or what the problems are. I truly have not dug into that deep enough, but even if we were to start there and put tremendous focus on that and bringing equity in terms of having internet service so that people could access materials for learning, materials for researching about, you know, medications or perhaps even ways to communicate with their family a little bit. To connect, exactly. I mean, there's so, you know, we cannot function in the society without access to the internet and a device that connects us and, you know, a hotspot. And so one of the things my school district did was really acknowledge the lack of not only internet access, but devices that students did not have. And we needed to make distance learning work. So there was, you know, there were tremendous angels out there who made very generous donations to provide Chromebooks for kids and hotspots for kids. But this shouldn't be a one-off. This should be standard operating procedure for schools because moving forward, which was part of this discussion, right? What is school going to look like? School does need to be face-to-face. School is about building community. School is about those deep relationships that students have with their teachers, with their friends, with their, you know, the rhythm of the school year, all those things that we're missing right now. But the bigger umbrella here is safety, is school safety. And that is something that, honestly, Bonnie, prior to COVID was already feeling very insecure. School safety because of gun violence, because of school shootings, because of hyper-realistic active shooter drills, for me, to me, all of these things are interrelated. And they definitely relate back to COVID. In terms of looking at, what does school safety mean now? You know, that's a fascinating point. So Robin, I'm sure you've done check-ins with your academic partners, your education partners, teachers. What are their thoughts right now on what COVID has done to us from a safety perspective? Well, I understand that I do work in a community where gun violence, unfortunately, is commonplace. And one of the, I call them the six W's of COVID, and those are things like wear a mask, wash your hands, watch your distance when you are in your child or your child is sick, stay home. When the health department calls, please answer the phone and cooperate. But the six W is Windows and Doors. And Windows and Doors are now supposed to remain open for circulation, right, to make sure that we have proper air circulation. And actually, in school, Windows and Doors are locked because of school safety. So which one is it? So that's a concern to teachers. Right, that's a concern to teachers. And my, you know, we have been remote now since March, and teachers are doing an incredible job staying connected to their students. Teachers are really working very hard, you know, to try to help their students, their children navigate these very uncharted waters and sometimes very choppy waters. But overall, I feel like, you know, as issues come up, we're doing our best to address them. Is it ideal? Oh gosh, no. Not ideal. Nobody would want this. But yet, we want everyone to be safe. And that, that safety thread is what has driven my school district to choose to stay remote up until this point because they were, to me, respectful, so respectful of the families. They really wanted feedback from the families and the families acknowledge that our buildings are old. The infrastructure has not been invested in. We don't have high quality HVAC systems. We're very concerned about that piece of this whole safety puzzle. We didn't have enough PPE at first. And the biggest issue is that parents, more than 50% of the parents, did not feel safe that their children, to send their children to school. They wanted them to work from home, to learn from home. And I always like to remind people that while the brick and mortar buildings might have closed in March, learning continues. Yes, it looks completely different than anything we've ever imagined. And for some students, it really hasn't worked well. And for some students, it's been a godsend. So you know, this is another piece of the puzzle. What will school look like in September? You know, it's, it's worth a deep conversations about what can we learn from COVID, the positive, the silver linings that we can bring back into our school buildings, you know, when, when school. These schools reopen in a full capacity, in a, in a more, in a post-COVID world, let's say. Well, and I think it's going to force us to grapple with things that maybe we haven't been as proactive about in the past. And mostly I would suspect that that has a lot to do with, with funding, right, with the money to sort of take a look at this and, and be a little bit ahead on the curve in terms of what education it's going to look like. Absolutely. This is, you know, this is certainly related to funding and related to innovation and related to saying what's important, what's important. What's really important is that we, that our kids feel loved, that they feel heard, that they feel in a safe space so that learning can happen, you know, when we are feeling traumatized and triggered by all of these things that have happened, learning doesn't occur then. Learning occurs when there is mutual, you know, when there is this safe space of feeling like students believe that they are cared for, that's when true learning can occur. Otherwise, we're teaching to a test or we're teaching to some standardized expectation. It's not true learning, right? It's not really building a community. It's not looking at students' strengths and working from their strengths. It's, it's feeling probably a very antiquated view of what public education is that really needs to be revised and I think that's the bottom line, you know, education has not changed. I mean, look at nursing education. We've had to disrupt nursing education, right? I feel like the, the disruption of our, of education needs to happen at the lower grade level. Well, and certainly there's nothing better than a pandemic to do that for us. It's been an amazing catalyst and I'm delighted to hear you say that the district has gone straight to the end users, which are essentially families and students to really get some input from them. So that, I think, is really highly encouraging as we rebuild these systems and education that are going to look and feel a little different. At least I hope they do. Going forward. I don't want to go back to the same old, same old definitely not and and I think it speaks to the, the really important conversation around what is the definition of an expert? I really believe that that definition needs to be revised because to me, the expert in my world anyway of school nursing are my students and my parents. Yes, I have an expertise in school nursing, but the, each person is an expert in their life, in their culture, in their family, in what works for them. And so, you know, I am very encouraged by the, the inclusion of the most important voice in all of this and that's a voice of the parent and the child. Well, I am so thankful for the work that you are doing, Robin, because I think it's incredibly important for us to learn the lessons that we can learn, to change the things that we can change and certainly to have as much courage as possible heading into the future that is a little bit unknown for all of us at this point. So, thank you again for all of your work. Oh, thank you, Bonnie. And thanks for inviting me. I love talking to you. Yeah, it's always a pleasure and I always learn so much when I talk to you. My emphasis was never on pediatrics or school nursing, so you are just a wealth of knowledge and I'm grateful to that. Thank you. That makes me feel good. You made my day, Bonnie. Thanks. Excellent, Robin, when you made mine, where can people find you on social media? Yeah, please follow me on Twitter. My Twitter handle is @RobinCogin and I, and please visit me at RelentlessSchool Nurse.com. Awesome. And thanks again for your time, Robin. And thank you for listening and be sure to use innovation to your advantage. Thanks so much for listening to Health Care Soothsayers. I really do appreciate it. If you liked what you heard, please rate, review and share it with your network. That is how we grow and learn. If you have ideas for show topics or guests, please reach out to me directly at ThoughtLiterRN on Twitter. For information about this show or any of the others in the Touchpoint Media Network, please check them out at touchpoint.health.