“A lot of people want to be nurses — they just don’t know it yet. And we haven’t done a good job of communicating to them, ‘This is actually where you want to be. You would love to use your head and your heart and your hands every day.'”
– Dr. Bob Atkins
Interview with Bob Atkins
Dr. Robert Atkins, a former school nurse and nonprofit leader in Camden, NJ, is executive vice dean of the School of Nursing at Johns Hopkins University. He advocates for community-based nursing and is dedicated to increasing the participation of diverse nurses in the nursing workforce by creating new pathways for education and more affordable options for their education.
You started your career as a school nurse. How did you land in that position?
During nursing school, I was working in West Philadelphia with a nurse practitioner who was running an adolescent health clinic. This was a great opportunity to work in a community and get to know adolescents and all about adolescents. It helped me realize that this was the kind of nursing I wanted to do, as opposed to working in a hospital. After graduating from nursing school, I went to the Board of Education in Camden and said, “I want to be a nurse.” The supervisor of school nurses took a liking to me and said, “I’ve never hired somebody right out of nursing school or who’s not certified in school nursing, and I never hired a man, but I’m going to hire you.” I was placed in a middle school in East Camden. I just fell in love with the school, the kids, and the community — and the opportunity to be in a place where I was surrounded by this adolescent energy.
How did that experience affect what you did next?
These kids were like those I’d grown up with in Cherry Hill, which is only a couple miles from Camden geographically, but very different in terms of life chances. I was really struck by that. I got very interested in the lives of these kids and started a youth development nonprofit program with a professor from Rutgers, which we ran for 20 years. This got me thinking more about how community-based nonprofits can make a huge difference in the lives of kids. It also made me focus on the barriers that impede kids growing up in Black and brown communities of great disinvestment like Camden. These barriers include lack of access to healthcare and dental care, food insecurity, and housing instability. The kids in my school were in and out of school. There was a lot of absenteeism, and things like this really affect life chances.
For part of your career, you worked on the Robert Wood Johnson Foundation’s New Jersey Health Initiatives project. Any key takeaways from that time? And what brought you, most recently, to the Johns Hopkins School of Nursing?
At Robert Wood Johnson, I thought a lot about what philanthropy can do to really move the needle. It’s actually hard to do philanthropy well. You can always write checks, but how do you engage with communities as a partner? I learned that to be a real partner you have to figure out how to do things with communities as opposed to doing to communities or doing for communities. As far as coming to work here, the dean at the Johns Hopkins School of Nursing was contemplating the best way to get nurses to work in the community [as opposed to hospitals or other clinical settings]. For me it was clear that to do that successfully we’d have to change our educational system to provide nurses with the skills to be effective and utilized in the community. The dean loved that idea, so she hired me to be the executive vice dean. Over the past almost two years we’ve thought about how to reimagine educational pathways so nurses can work in any setting where a nurse could serve the community. We’ll always need nurses in acute care systems, and we’ll always have patients who are critically ill. And we don’t want to rob Peter to pay Paul. We want to make a bigger [nursing] pie and have more of that pie go toward communities. Whether we call it neighborhood nursing or census tract nursing, that’s the direction we’re going in.
What convinces you that this is the right direction for nursing and what would a community nurse workforce look like?
Historically, nurses started in the community. We were in homes. We were in schools. We were in neighborhoods. Then nurses got sucked into positions at hospitals and nursing schools restructured their education to serve the hospitals’ needs. We’re trying to rethink this now.
Any system that serves communities, that’s where nurses should be. When you think about people’s lives, everyone will have to deal with getting food, or housing, or education at some point. All these things connect with health, so the important question is, “How do we embed nurses in those conversations?” Wherever health resides, nurses should be there. You have to think broadly about health—so libraries, schools, public housing, or food banks are also good places for nurses.
Nursing schools will continue to teach what nurses need in terms of technical skills, like how to give immunizations, run an IV, do health assessments, or communicate health information. But what we must do to enhance their capacities as community nurses relates in part to mindset — giving our graduates the confidence that they have everything they need to be successful in the community, and such skill-building as helping them understand how to work with the community as a partner, how to think about what happens around policy, or think more deeply about research and scholarship. We want nurses to think about the different systems they will encounter and how these systems all interconnect. That’s much more complicated than just the kind of the mechanical, technical skills typically provided.
What other steps are necessary to grow this workforce?
A lot of people want to be nurses — they just don’t know it yet. And we haven’t done a good job of communicating to them, “This is actually where you want to be. You would love to use your head and your heart and your hands every day.” Because that’s what nurses have the privilege of doing. And people want you in their communities, their homes and, schools because they trust you.
Part of communication involves changing the narrative about nurses. People think they know what nurses do, from what they’ve seen on TV. When they see nurses on TV, they’re typically in a hospital, and they’re subordinate to physicians in a lot of ways. And most people have the sense that nursing is only dealing with blood and other bodily fluids. That could be one part of it, but what they don’t see is that you’re dealing with human beings and forming relationships through nursing. Even from the beginning of the 20th century, nurses were looking at systems and identifying how people were falling through the cracks. A more recent example is how during the pandemic nurses in communities stepped up to get people vaccinated against COVID.
So one real question is, “How do we change the conversation around nursing?” As we get better at telling these stories, we can see attracting more nurses to work in different spaces outside the acute care system.
The other part is to create a pathway. We, in healthcare systems and universities, need to think about frontline healthcare workers, who are overwhelmingly Black and brown, and how to create a ladder for them to go from being frontline workers doing the backbreaking part of healthcare and giving them a pathway into nursing, as we did in a pilot program at Robert Wood Johnson Foundation. This is an equity issue. If you want to change somebody’s health, get them a job that paying $40 or $50 an hour instead of $10. That changes not only their life, but it also changes the lives of their family members, where they go to school, what kind of foods they eat.
We also need to make this nursing school enterprise more affordable. How do we get more people and get them out into the community? We turn away tens of thousands of qualified applicants, yet we have a nursing shortage. And part of it is because the way we’re set up doesn’t allow us to take as many students in as we should be able to take in. And some of it is because we have an old way of thinking — an old architecture that doesn’t serve where nursing should be in the 21st century.
What is something you’re optimistic about?
There’s just so much we’ll be doing to partner with others in the community, like with community health workers, doulas, and promotoras (health advocates). We’re going to work with social workers and psychologists in the schools. We’re excited to find all these different partners because that’s what we mean when we talk about neighborhood nursing. It’s really about how we pull these partners together and how nurses can play a role as the connector in this hub.