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Start out as a nurse and become a health policy expert!

February 26, 2009 -- Recent press items have reported that President Obama has named North Dakota nurse and rural health expert Mary Wakefield to head the Health Resources and Services Administration (HRSA). HRSA is federal agency that works to improve access to care by underserved populations, in part by overseeing roughly 7,000 community health centers. The agency is part of the Department of Health and Human Services, and it will reportedly receive $2.5 billion of the new economic stimulus package to improve health care infrastructure and training. Obama's choice and the press coverage send a great message about the contributions of nursing leaders, though some items suggest troubling underlying assumptions. The Washington Post and Reuters pieces provide a good look at Wakefield's new job and her qualifications. The Associated Press and Houston Chronicle items also have helpful elements, but they include subtle suggestions that her expertise is not a natural outgrowth of her nursing (perhaps it's something she developed after she stopped being a nurse and got serious). However, there is nothing incompatible between nursing and leadership, and the kind of community health work Wakefield does is a major part of the nursing tradition. We congratulate Dr. Wakefield on this exciting new position.

The Post 's February 20 story, Philip Rucker's "Mary Wakefield Picked as HRSA Chief," describes Wakefield as a "leading expert in rural health care," and it lists some of her prior positions, including as director of the Center for Health Policy at George Mason University and chief of staff for two U.S. Senators from Nebraska. The White House says Wakefield is regarded as an "expert" in no less than five named areas, including patient safety and Medicare payment policy. The report explains where she got her bachelor's and master's degrees "in nursing," as well as her doctorate. It also quotes a similarly helpful part of Obama's statement (from the White House press release):   "As a nurse, a Ph.D., and a leading rural healthcare advocate, Mary Wakefield brings expertise that will be instrumental in expanding and improving services for those who are currently uninsured or underserved."

The shorter Reuters item "Obama names nurse to head healthcare access agency" makes some of the same helpful points. It adds the fact that Wakefield currently heads the University of North Dakota's Center for Rural Health, a curious omission from the Post piece. The Reuters article also notes that those living in rural areas "often have poor access to quality health services because they live far from major hospitals." It might have added that a critical factor is lack of access to primary care, a gap that advanced practice nurses often work to fill. The piece also briefly mentions the nursing shortage, though it does not say if it's doing so because the shortage adds to the problems in rural health care, or simply because Wakefield is a nurse.

Other items also contained helpful information, but added troubling elements. The Associated Press report "Obama to name director of health centers agency" by Ricardo Alonso-Zaldivar has good basic information. It notes that HRSA runs the Ryan White HIV/AIDS program, which provides care to more than half a million low-income patients. But the report also refers to Wakefield as a "nurse by training," as if to distinguish that background from her current expertise and achievements--implying that she must have done something else to become a health care leader. In fact, improving access to care and rural health have long been key parts of nursing. The version of the AP item we saw includes no specifics about Wakefield's education.

The Houston Chronicle 's "Nurse chosen to lead HRSA" also provides a good overall account, but it has an even more troubling reference to Wakefield's status as a nurse. The article offers some of the key basic information, and even includes comments from an interview with Wakefield, who explains that her first priority will be to apply the stimulus funds: "Right now, in these times of economic downturn, these programs are pivotal. They reach communities across the country and touch lives in ways that can make a huge difference." Unfortunately, the piece also says Wakefield "started out as a nurse and became a health policy expert." Of course not all nurses are "health policy experts," but this phrasing clearly suggests that Wakefield is no longer a nurse at all, as if there were something incompatible between practicing as a nurse and being a health expert and leader. We doubt the piece would have used this phrase if she was a physician.

In fact, in her new job, Mary Wakefield will still be a nurse, using nursing expertise.



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