Dr. William L. Holzemer is Dean and Professor at the School of Nursing, Rutgers, The State University of New Jersey. He is a recognized expert in academic nursing and HIV/AIDS care providing global leadership to the World Health Organization, the International Council of Nurses, and many Universities around the world. Dr. Holzemer has served as consultant and external reviewer for governmental agencies such as the Finish Academy of Nursing, the Japan Academy of Nursing, African Nursing Honor Society, the Medical Research Council for South Africa and others. He has also previously served as President of the American Nurses Foundation (ANF).
How did you get involved in a career in nursing?
I am what you call a second degree student. I had already finished my undergraduate education before pursuing nursing. I was an evaluator on a nursing project and became interested in the field and decided to go back to school. During my time as an evaluator I was doing educational evaluation and simply grew interested in the clinical outcome evaluation.
How did you become interested in HIV/AIDs?
It was serendipity. I finished my training in the early 1980s as the HIV epidemic started in the United States, and I wanted to get into clinical research. I was living in San Francisco, one of the epicenters of HIV/AIDs, and it all came together. I have now been doing work with HIV/AIDs for over 25 years. It started with symptom management and then moved on to medication management when pills became available. I then began to focus on quality of life, depression, intervention for medication adherence, and stigma reduction in both the US and in Sub-Saharan Africa. I have done work in Africa primarily on symptom management and HIV Stigma, and how it affects peoples’ access to care.
What are two or three Changes would you like to see in how Nurses are trained today?
One thing is that I wish we could get the entry to practice be at the baccalaureate level at the minimum as opposed to the community college level. More than half of new nurses are training at the community college level and earn Associate Degrees. These graduates are then challenged to return immediately to earn a baccalaureate degree since many clinical settings are interviewing only baccalaureate degree graduates. The practice of nursing at the baccalaureate entry to practice level will be more into the community, including home care, long term care, and skilled nursing faciitities. Baccalaureate programs are redefining themselves for this new future.
Research demonstrates that higher levels of nursing education yields better patient outcomes ofboth morbidity and mortality. Therefore we need to move to an all baccalaureate prepared work force.
At the graduate level, we are educating Advanced Nurse Practitioners and the the amount of clinical training required to prepare them for primary care is extensive. Our funding model is an old model and does not take into account this new demand. Consequently we need to locate significant new resources to support the training and residency opportunities for advanced practice nurses.
I have seen that you have spent some time as a professor at St. Luke’s College of Nursing in Tokyo. I was wondering how the nursing profession differs between those the two countries, and is there anything that the Japanese do with healthcare that the United States should take notice of?
The citizen of Japan have much better health statistics than we do, especially longevity. I think the big difference is the context in which healthcare takes place. Japan has 100%. Everyone also has 100% insurance. There are amazing social programs there to support the disabled. We have some of those programs, but nowhere near the level that Japan does. The presence of a fully educated and insured population changes healthcare outcomes. Social determination of health in this country is like Japan, but it’s affected in a different way.
The nursing profession in Japan has grown tremendously They have gone to all baccalaureate training (eliminating the nursing diploma and the Community college programs altogether) and have upgraded nursing education substantially by opening over 100 PhD programs for nurses across the country to help prepare future nurse faculty and leaders. Their nursing is more powerful at a national political level than in the United States as well. They still have their challenges though, it is still a male and physician dominated culture, so there is a bit off a tradeoff that does occur.
What are the biggest challenge nurses face today?
The biggest challenge is not so much in nursing; it is the crisis in healthcare. It is the insurance systems and population based care, eliminating fee-for-service, that is turning medicine upside-down. The knowledge, skills, and expertise of nurses can provide tremendous leadership during this period of transition. Even though we spend more money on health care than other developed countries, we have worse outcomes than the top developed countries in the world. Healthcare is having a challenge restructuring quality, access and cost and nursing is contributing significantly to this new model of health care.
Do you have any final thoughts to share?
I think nursing is a fabulous profession, one that provides tremendous and diverse career opportunities that also provide you a connection to your humanity and those around you… I don’t think it has ever been a better time to be a nurse.