Unknown Speaker 0:00
Welcome to MSU Today I'm Bill Beekman, Vice President and athletic director. And our guest on the program today is Dr. Randy Rasch, who is the Dean of Michigan State University's College of Nursing. Welcome to the program. Randy. Thanks, Bill, good to be here. So tell us about it. To me, it's a having worked a little bit with the College of Nursing. In some of my past roles, it seems as though the profession of nursing, you know, really has evolved over the years and as sort of as we think about the, the way that care is provided. And, and and the continuum of care that you see from at various points in the healthcare system. So how has how has, has the nursing profession evolved over the last number of years? And what do you what do you see as the future of the profession.

Unknown Speaker 0:57
So I think the basics are pretty much the same. But I think one of the things that's happened in the pandemic, is that more people are much more aware of what nursing is about. And I say that, I think one thing when people hear nursing, what they hear what they visualize is what they see nurses doing, you know, getting patients up medications Bad's all of those things while you're in the hospital. But I think what's happened in the pandemic, is, people are beginning to hear what nurses have to know, and how they have to think. But I think the other thing is, is he just said, Bill is the continuum, across the health, you know, inpatient, outpatient, and so there, and I would say that, what's going to happen is that the outpatient part outside of hospitals, is going to grow. So probably most of our listeners have had family members, or they themselves have been in the hospital. And they've been there a couple of days, and then they're released. And, you know, years ago, you would have been there a week or so and had opportunity to really get prepared to be released. And so where we're moving now is for nurses really to be able to say, this patient, in as far as nursing is concerned, isn't ready to go. Or if you're getting ready to send them home, we need to be connecting to make sure that nursing care is provided at home, or so that they in their family members know what to do and can provide that care as well. And that has an impact on patients, of course, because who wants to turn around and get readmitted to the hospital, right? So the outcomes are a big piece. What people don't realize is that if you are returned, if you return to the hospital within a certain amount of time, it's big money because the hospital loses money, and they're penalized for it. So the strength of nursing i think is beginning to be what is the continuum of care that nurses provide. And whether it's a nurse in the hospital that's providing it when you leave home, or they have connections and can refer you for care, once you go home, or they are able to teach you what you need to do has a huge impact. So I think more and more people are experiencing when that doesn't happen and experiencing when it happens. And and we are beginning to get a better sense of what it is that nurses do. I will say that that's been true for years, because I began my career. I you know, I worked in the hospital for about maybe eight months. And then I went to work as a public health nurse in Benton Harbor, Michigan. And that happened to be a combined agency. It was a great experience. So as a public health nurse, but we were also home health nurses for for Benton Harbor for for the rest of the county. And we were divided into districts. So by your address, that's the nurse she got. And so I did public health and home health in the same area, we would admit people to home health and when they were discharged from home and health, we would keep following them as public health nurses. So that was years ago. I think that that's beginning to be strengthened and more and more nurses in the future is that more and more of our education has to emphasize that continuity of care because think about it. If you're working on a hospital floor or working in an inpatient unit, there are other nurses around you back to you from call on. But if you're working in homes and going from home to home, it's you so much more emphasizes the independence and most nurses know that know the information and know the care that they need to provide. But if you haven't experienced it, you don't really know that you know it. So we need to put that more in our education now.

Unknown Speaker 4:50
So it seems as though the when we think about and maybe it's so maybe this is just my personal opinion. variance that's coming out. But, but but as our parents age, and as the population ages, then it seems as though health care takes a little bit of a shift towards an older population. And and my sense is that, yeah, obviously people want to stay in their homes and apartments as long as they can. And probably from a healthcare perspective, that's the most efficient way to, to provide them with care. Yeah, hospital bed being really, really expensive. And even as an intermediary bed, you're not being inexpensive. So how has how has healthcare shifted as our population is aged? And what do you think the impact of the pandemic will be on that sort of shift in healthcare?

Unknown Speaker 5:54
So I think it's, you know, the population is aging faster than, as I say, the young uns are coming along, to take care of us. And so that that's been going on for a while, I think that healthcare has not done a very good job of, of dealing with that. So our healthcare, you know, in general, is is geared towards acute care, not chronic care. And one of the things we've always learned in nursing is outcomes, not not just the financials, we're getting to pay attention to that. But nursing has always been focused on improving outcomes. So some of what you just said, if you think about it, you're more comfortable at home, right? Yep. So why shouldn't we be working for you to stay at home longer? And I think one of the things I would say is, the first thing is that, usually when we think of an aging population, we're thinking of people who are maybe close to the end of their lives, and I'm talking like months or so. But most people age pretty successfully. And if we can have the support out there, they can remain at home. And I think one of the things I would say about nursing care then is, like I said, in acute care, you see nurses focusing on certain things, but really what nurses are about is learning who you are, who your family is, how do you live? And how do you maintain that lifestyle? How do you remain successfully at home, even when you're able to get up and drive and all of those things, say, you're diabetic, and you need to be watching your what you eat, and exercise and all of that. What a good nurse does is learns what it is that you eat, and helps you know that comfort food, and how to help you eat that comfort food, which is a quality of life thing, right? If you can't eat what you enjoy, what's the point of living? And I'm kidding, but but really, in a way I'm not? much? Yeah, yeah. So how do you eat what you normally eat? And how do you help people learn to prepare the food and eat it in a way that's going to be healthy? And most nurses can do that. And if it gets really tricky, we can always refer to our colleagues who are dietitians, and nutritionists, elbows who can really get down to the nitty gritty, gritty, if that's needed. So the main thing is how to be at home healthy. If you have chronic conditions and illnesses, how do you adapt to that in a way that you can be as healthy as you possibly can? And I think the other thing that we have got to pay attention to is that, and this is a question that I asked students all the time.

Unknown Speaker 8:37
But if you're born, one of the things we know is you're gonna die. But we have been socialized to think of a death of death as a catastrophe. And certainly, sometimes death is a catastrophe. But the thing we know is we're gonna die. So we think of it as something that normal when it's a natural part of living. So the thing that I always say to students is, if you have a patient who is within two hours of dying, can they be healthy? And from a nursing perspective, the answer is yes, of course they can. Now the circumstances is how do you help them be as healthy as they can when they're dying? And some of that sections existential and spiritual, and all of that, but really helping family and patients accept that that's what's going on. And most people you know, when you're when they know that and they're supported for it, you see people die peacefully, that sort of thing. So managing physical discomfort is a part of that as well. But, but i've you know, I'm just taking you from birth to death. When I was a public health nurse, we also cared for babies who were in danger of not thriving because of whatever their condition it might be their condition or just might be that their mother or their parents. Taking care of them didn't know what it was that they needed to help this baby grow and develop. And so we used to have, we used to sign those babies up for home health. And we went in and help mothers learn how to feed them, how to clothe them, how to do all those sorts of things. So that you got, you know, you have babies who are growing and developing very well. I think the other key piece about nursing is, I was just telling this to our university attorney, and another attorney, but I was always said to students, a good nurse is like a good lawyer. And then they all look at me like I've lost my mind. But then I say, what does a good lawyer do? A good lawyer can tell you what your legal situation and circumstances are. And then they tell you your options, in terms of making the decision about what you need to do legally. And when you make the stupid decision, they don't abandon you. And so my point in nursing is you meet patients and families where they are. And so you help them think about their opportunities for health promotion, health, maintenance, how to maintain their, you know, maintain their lifestyle with a chronic disease, and you tell them the pros and cons of all the choices they can make. And then if they don't make the best decision, you don't abandon them, you stay them and support them. So we've all heard about health care providers firing patients, that should not happen, unless it's some extreme thing that's dangerous to the to the provider, you don't fire people you meet them where they are, and where they live, and you help them do the best they can. And all that while you help them to know better as Maya Angelou said, when you know better, you do better. So the role of a good health provider and a nurse role of a nurse is to help you do that, when you make this decision. You think, Okay, that was stupid. But you don't say that. But you might say, you know, that's not the best decision, here's why. But if that's what you're going to do, let's figure out how we're going to do it. And there are lots of reasons that people make those decisions. And that's why you have to meet them where they are, it's because of their living circumstances, you know, often or the way they're thinking or whatever it is that what you're telling them just doesn't seem possible, or seems overwhelming. So you help them to make the best decision they can under their circumstances, and you support them, whether they're in a hospital, whether they're at home, you do that. And the other thing you do is you help the other health care providers that you work with, know that so that they can begin to adapt what they're trying to do with these patients as well.

Unknown Speaker 12:50
So in the, in the context of the pandemic, we've all been faced with a lot of Decisions, decisions to get into social distance or physical distance, to try and stay home and sort of generally stay away from folks, when we go out to wear a mask, all those kinds of things. And you see in society different, the pandemic, to me is has sort of been fascinating in that everybody has an a perspective, everybody has an opinion. But everybody has sort of come to it a little bit differently. And as you say, it's um, you know, it sort of comes to people and where they are and, and everybody's perspective, everybody's worldview is, is maybe a little bit different. And so I was I just happened to be looking earlier today that Michigan's rate of vaccination for one or more shots was at 49 point, something just shy of 50%. Which kind of surprised me, I would have assumed it would it would have been higher given the the point where we're seemingly, the the supply is exceeding the demand where you can, it's relatively easy to get a shot now, what would you say to folks that are, that are that are in that 50% that are that haven't gotten a shot yet.

Unknown Speaker 14:24
I would say at your health. The first thing to remember is your health. So you're talking to somebody who really early in my career was a public health nurse. And so one of the things you know, most people who have children know that their children need to be immunized. And if they're not immunized, it's it becomes a problem when they go to school. So as a public health nurse back in the day, every year about August, we would be there would just be this influx of kids to be immunized because they were going to have problems going to school and what you would recognize out of that Is that there were children who should have been immunized long before that, because they start those when your baby at about two months. And so there's this whole, I think there's a couple of things. One is the conception, the idea that getting a shot like a vaccine is going to prevent an illness. And you know, it's that just connection to that, that it's hard to, for some people to think that but there's also this trust. So there a lot of things that we knew before the COVID-19 vaccine came up. One is this false rumor that getting your child immunized is going to increase their risk of autism, which was a lie. And it was something that got published that was immediately debunked. But you know, and in the African American community and communities of color and other and not just communities of color, but folks just don't get their flu vaccine every year. And they'll say things to you like, Well, I know somebody who got the flu vaccine, and then they got sick. Well, they probably were protected by flu vaccine, you know, they got, it's like, okay, they got sick, but was it? When did they get sick? And then it's understanding how all that works. And I think the other piece that we've had is that we've had misinformation, and let's not get into that, and why but we've had misinformation. And then the other thing is that they're a part of that misinformation is that this vaccine, the science behind it seems new, although the science behind it is is older than that. But it has not been used for vaccines before the people hear all of that. And I have to say, I'm really disappointed in health professionals, physicians and nurses who perpetuate this as well, we should know better. But um, so I think there's a lot of question about, you know, there's a misunderstanding about immunizations in the first place in in different parts of the population. And so there was already that and a mistrust. And then when something new comes along, what we have is people not getting access to the information to say, this is safe, and it can protect you and and you know, we're really, at we're doing 50%, about 50% isn't, isn't great, we want to be at 90% of immunization, because when that happens, then you have the population being protected. If you're immunized, you're protected. But if half the population isn't protected, then it means that those folks are still at risk. So the idea by behind and I'm gonna throw this out, and I shouldn't but but but people should hear it. herd immunity means that this percent of the population is immunized is protected. And the safest way to get that is to get the vaccine. Right. There's this Yeah, herd immunity can happen if a certain number of the population gets sick. But we've had what, three, 3 million, 6 million people die? Is that how you get to herd immunity? No, you get to it the safest way. So there are two things is it to get immunized yourself for your own personal protection. But it is a public health issue. So you also get immunized so that your fellow citizens and residents of this country are also protected.

Unknown Speaker 18:42
So do you have a sense of so I got the vaccine in both doses. And I was I probably didn't want to be the first person. But I was pretty comfortable being like the 20,000,000th person I figured by then it was, you know, something was either gonna go wrong or it wasn't and I was in a really safe place. And so now that I've got it, I think the the, as I understand it, it's medicine suggests that it will last for some period of time, but it may be the case that that we all need to get get another one. And do you have a sense of where the medicine is at in terms of thinking that through? Or Or do we not really know that yet?

Unknown Speaker 19:32
I don't think we I don't think we really know that. But I want to say something. This is misinformation again, when people say somebody got the vaccine and then they died or whatever. So what we know by looking at those is that it is maybe one of the safest things that you can do. And what people don't realize is every time you get any kind of health care intervention, there's a risk right treatment for cancer is about killing cancer cells. But when you when you do that what used to happen is you killed safe cells, good cells to the the progress that we're making is that it's much it's more and more, were able to target those cells, right? There's always a risk. So there is a risk with vaccines, but they're one of the safest things that you can do. When everybody's on medications and stuff, there's a risk, but they don't think about it. Yeah. And it's because you don't die right away from it. But there's always a risk. So let me go back to the question you answered. And I suspect but I don't know. But everything, you know, I'm not an expert in the area, but thinking public health wise, my guess. And I'm, it's a guess, because we don't know, my guess is that we're going to end up having to get vaccines again. So what we know now is the vaccine we have now protects us, we know that the UK variant, right, was something new, but it was protective. We now know that the Delta variant which is coming out of India, and now is the fastest

Unknown Speaker 21:16
infection in in the UK and is coming here, I think we're at about 10% here. But my understanding is that that infection rate doubles every two or three weeks. So we know the Delta variant is going to double. We also know from what I you know, look at and listen to and read. We also know that the vaccine we have right now protects against the variant. But it's much more contagious. This variant is as much more contagious, so that around 50% of the population that's not immunized is not going to be protected. And they're more likely to catch it because it's even more infectious than what we had about a year ago. So I suspect that this is going to happen. Like I said, I'm guessing, I'm guessing, I'm guessing, but this this virus changes enough that I think we're going to end up with a variant where we're going to need another vaccine. So if you think about the flu, the reason we get and I would have thought that this was pretty well known. But when I talk to people, they go, Oh, yeah, we sort of know that. But I still talk to enough people who don't know it. So we get the flu, we have to do a flu vaccine every year, because the science predicts which flu virus is going to be infectious in the next year. And so the vaccine is a combination of what they protect that flu variant is going to be. And so they're pretty much right, right? So we get immunized against the flu, and we usually protected. If they miss that one that they didn't predict, is more virulent than the others, then we're might be at risk for more people getting the flu. So I suspect, I don't know. But I suspect that what we're going to be doing is monitoring, testing, and all of those things that we should have been doing in our public health system anyway. But I think we're going to be at a point where we're highly vigilant to what are the variants? And does the current vaccine address it? And do we need a new one to cover the new the new variant, and essentially, that's what's happening with the flu vaccine that we got with have with the flu isn't produced in the same way. But the science and the process and the practice is very similar in terms of protecting the population. So you know, people, I just heard all kinds of stuff when I was, you know, I would listen to people about free speech and all this kind of stuff. Public Health is about the protection of the population. So back when typhoid Mary was running around rampid. The Public Health Initiative was to keep Mary, secluded and separated from everybody else. That's what that practice is about. It's about an abrogation of freedom. It's about protecting your health, and the health of every citizen and resident in this country, including people who come to visit and people who come to leave to leave. And I think the other thing we have to pay attention to is that I just uh, just over a year ago, I guest edited a special edition of nursing clinics of North America and a special edition before this, before Coronavirus hit. That Special Edition was on infectious diseases. And the last, the last ish the last night issued by the last article in there was about emerging infectious diseases because we live in a world population, everybody flies everywhere. And people come here. And so what happens is, we are sometimes exposed to things that we weren't exposed to. When the new world first happened, the natives that lived here died of things that the Europeans would get over in no time at all, because they'd never been exposed to it. But But, but I wrote an intro to it, and I've can't remember, but it was something about ancient diseases and new frontiers or something. And when you when you look at the Bible, or old literature from that time, we didn't know what infectious disease was, we based it on looking at somebody and they had sores or whatever, and it just looked not good. And we thought they had diseases. You know, it might have been a bad case of acne, which is not infectious, but that's how it was viewed. And that's why you read all those things in the Bible and other literature about how his handle about Florence Nightingale's time we discovered germ theory and begin to get a real sense of how germs, viruses, and bacteria can infect us. What we know now, I think this is Justin, it's been a while, but in Science Magazine, there was a story about melting ice. And it's about prehistoric ice melting that has prehistoric bacteria and viruses in it, as I recall. And I'm trying to remember, but I think what I read said that they were alive from 1000s, millions of years ago. My point is, we should always be vigilant, this pandemic hit. But if you know, there was a joke going around on on Facebook, my sister sent this to me that said, Every time there was an election, there was a new infectious disease. Okay, that's kind of funny. Seek Ebola, you know, every year, there'd be something. But the truth is, there's gonna be something and our system was in place to catch it before it happened. Ebola, Ebola could have been a mess, right. And that was that was actually that was nurses who were saying, something's going on here. Something's going on here. And no one believed them. And then finally, somebody did. But those are all examples of things that could have gotten really out of hand. So our public health system is really built to try to catch these things beforehand. And it is probably the protection of all of us, you know, we don't want the United States citizen tree and people who are here disappearing because some disease wasn't handled, when it could have been. So did I answer your question?

Unknown Speaker 27:39
Absolutely. And one of the one of the reasons I always enjoy our conversations, is that your your passion for what you do, absolutely comes through. And so as the last question, what, what inspired you to become a nurse what caused you to go into this profession?

Unknown Speaker 28:02
Well, it's funny, we sort of started out with this, and I'm gonna blame my father, if I get teary eyed so out of my family, my brother, my sister, and my mother. My father was the one that cried easily, and I do as well. So I always thought that I was going to be a physician, and I went to Andrews University Academy, which is also where I went to college. And our guidance counselor was a nurse. He was a nurse anesthetist. So I said to him, if I become a nurse, can I go on to medical school? He said, Yeah, you just have to be take the prerequisites for medical school. So I started nursing, which happened in my sophomore year. I didn't know what nursing was until I started it. And as I went along that thought, you know, I'm like this, I'll just stay doing this. And the other thing that happened for me then was, I liked working in the hospitals. I liked providing that care. The problem was, they never had enough nurses to do what I had learned to do. And I was able to do that by going into the community. I have been. I was just telling Barb Gibbon, who's our distinguished university professor retired, I said to her, you know, I look at my colleagues, during that spanned Dimmick, and all I can say is, I'm so grateful that I made the decision to become a nurse, and to see what our colleagues are doing and what all of that I'm just proud to stand beside them, even if it's in the role of being a dean and not out there actually doing it. But I became a nurse because I was exposed to health care early and exposed to what nurses do early because I was involved in it. And when I finished decided I'm not going to go to medical school, I'll do this. So you know, I went back to school a couple of times, and I'm at this point. But I can tell you the other thing that we're seeing is that because in this past year, while we've heard nurses talk about negative experiences, so many of them have talked about what they're doing with patients, how they're thinking about it, all of that, that it is inspiring another whole generation to think I want to do that. So we're seeing students graduating from high school coming to issue, our application rates for those students are up by 38%. Wow, we also have a program for those individuals who have a bachelor or higher degree in another field, they can come back and become a BSN prepared nurse along with a 38%, those people who have a bachelor's degree or higher, that application rate has gone up by 28%. And people have said to me, Oh, is that the 5g effect, and I go, will file choose about medicine. And I think that that's attracted a whole cadre of people to think medical school. And I do think it is attracted some people to think nursing. But I think what we are hearing from the people who've applied, what our folks are hearing, when they talk to them, they're applying because they begin to understand what nursing is about, because they hear it in the news all the time. And, and they go, Oh, I want to do that. But I think the other thing that's happening, and this has to do with you hearing the reports about people, the statistics are showing that people are about to quit their jobs. I think it's like I forget, I can't remember the percentage, but it's unprecedented the number of people that are planning to quit, quit their jobs in the next six months or so. All of them aren't going to go into nursing, but that second group that have a bachelor's degree or higher, one of the things is they made a decision to do what they're doing now. But all of a sudden, they're thinking, you know, I want to do something that I feel is more meaningful for me not to say that they weren't doing something meaningful, meaningful. But I think this whole people dying, and all of that makes you stop and think what am I doing in life, you know, we're gonna have people with the NBA going back to art school to be artist, we're gonna have people deciding, I'm going to be a lawyer, I'm going to be a social worker, and a certain group of them are deciding, I'm going to be a nurse, because I hear what that is. And that's what I want to do. So I was inspired, I think, because I grew up in a religious tradition that I grew up in a religious tradition that taught us what our what ever discipline we were learning. But they also socializes to think, no matter what your ambition is, your purpose is here to serve.

Unknown Speaker 32:58
And so I grew up with that background, which is probably how I got attracted to healthcare. And then after getting attracted to healthcare, you know, a series of events leads you to the point was, oh, I'll be a nurse. And once I did it, it was the right decision for me, and I look back over many years now. And I'm just incredibly grateful that I made that decision, and incredibly grateful that I've had the opportunity to serve both patients personally one on one. I don't think you know that when I left Michigan, I went to Vanderbilt University and became a family nurse practitioner, and went to work in the Tennessee Department of correction, where I stayed for about six years ended up in the central office where two nurses, both family nurse practitioners, I was one of them, developed a system of health care for the disini, Tennessee Department of correction. And when the rest of the department was in worse trouble with the federal court system and health services was released. Jamie Brody and I looked at each other when Yep, time to go and off, I went for the PhD. But um, but it is been a life of services at different levels. And that I will say the other thing, because I think this is true of other people who don't necessarily early go into nursing, they might go into business, they might go into law, they might go into English, or whatever. But the other thing that people I think, who think of it as service, have faith in their fellow human beings. And for the most part, and I would, I wouldn't have been able to do public health, I wouldn't have been able to work in the department of correction for those years. If I didn't have basic faith in human beings, and that was both the inmates and the correctional officers that work there. People are basically good our citizens, the people who live in this country with us are basically pretty good. We need to remember it. We may not think the way they do We may not agree with everything. But we have to remember that all of us are basically people of goodwill. And when you hear when you hear people talk in the being interviewed people on the street or whatever, yeah, you hear some mess. But thoughtful people, what you hear is they believe the best of all of us. And that's the way we go forward. And this pandemic, and any kind of health thing and health, you know, health is more than just what we think of health. It is all those determinants of health, education, work, all of those kinds of things. And we have to just call ourselves to a better nature, some on a preaching thing now. But But, but that's how I guess I would want to end this. That's how I got into nursing. Others might not get into nursing, but whatever we get into, we have to remember to have faith in our fellow human beings, and how is it that we can serve each other?

Unknown Speaker 36:00
Well, Randy, thanks so much. It's a it's been a joy having you on the program. And we're we're joined today on MSU today by Dr. Randy rash, Dean of the College of Nursing at Michigan State University. And unfortunately, our time is up. But we've just really scratched the surface of what the College of Nursing has to offer. We didn't get a chance to talk about research. And Dr. Given you mentioned, is is one of one of my favorite folks from the college. And so we will have to have you back again to to explore so much of what you do is Dean, but thank you so much for joining us today.

Unknown Speaker 36:42
Well, thanks for having me. And I look forward to coming back because you're right. We need to talk about research. We need to talk about advanced practice and, and and nursing service. I've been privileged to serve on three task forces with the governor that the governor has pointed to me too. So it's another example of what nursing can do. So I look forward to coming back and thank you guys for having me here today. Thanks so much, Randy. Take care of Bill

Transcribed by https://otter.ai