Ethical Considerations

May/June 2019 | Volume 37 Number 3140

Nursing Economic$

Twitter has opened up a world of possibility to build a network of colleagues across sectors. After the shooting at my niece’s school in Parkland, FL, I became much more outspoken on social media about the issue of gun violence as a public health crisis (Cogan, 2018). In my social media activism, I connected with a group of physicians who were also speaking out about gun violence prevention.

The power of social media connected me to the work of AFFIRM Research and Dr. Megan Ranney. Through months of tweeting and sharing resources, a relationship was forged that somehow broke through the anonymity of the Internet and created a professional and also a personal connection. I am a school nurse being welcomed into a physician-driven organization. It has been a career privilege to work side by side with some of the leaders of the movement to address gun violence as a public health crisis. In early February 2019, I attended an in-person meeting with AFFIRM and those organizations that support the

urgency of funding firearm violence prevention. I was the only nurse. This must change.

Through my advocacy work, I reached out to several national nursing organizations, expressing the importance of supporting the work of AFFIRM Research and asking for public support. My disappointment at the lack of response rivals my elation at being offered a seat at this table. But I do not want to be the lone nurse in this work. Where are the national nursing organizations? Where do they stand on the issue of gun violence as a public health crisis?

Nurses are in a unique time of transformation and interdisciplinary collaboration to solve some of our biggest public health challenges. Let’s not miss the opportunity to work with physicians, scientists, public health professionals, and researchers. This is our moment to join in collaborative efforts to face the most urgent needs of our community and proactively address the “wicked problems” that impact our world. We need to answer the call with a resounding yes! We are in a public health crisis and who better than nurses, steeped in

Creating Partnerships that Reflect the Collective Will of Healthcare Professionals: An Interview with Megan Ranney Robin Cogan

The gun violence epidemic continues to trend upward in the United States with scant research on injury protection and prevention. In this interview, Megan Ranney, emergency room physician and co-founder of the American Foundation for Firearm Injury Reduction in Medicine, discusses the challenges and opportunities for firearm injury research, and the critical role nurses can play in achieving solutions.

Megan Ranney

May/June 2019 | Volume 37 Number 3 141

evidence-based practice, to help solve the epidemic of gun violence.

Megan Ranney, MD, MPH, FACEP, is Associate Professor, Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School of Brown University; Director and Founder of the Brown Emergency Digital Health Innovation Program; and Director of Special Projects, Department of Emergency Medicine. Dr. Ranney’s career focus is on developing, testing, and disseminating digital health interventions to prevent violence and mental illness. She is currently principal investigator or co-investigator on six federally funded grants and has over 100 peer-reviewed publications. She holds numerous national positions, including serving as an elected member of the Board of Directors of the Society for Academic Emergency Medicine, Chair of her Governor’s Task Force for Gun Safety, and as an editor for Annals of Emergency Medicine. She is also Chief Research Officer and Co-founder of AFFIRM (American Foundation for Firearm Injury Reduction in Medicine), a non- partisan non-profit organization committed to funding and disseminating firearm injury prevention research. She also leads courses for undergraduates and medical students at Brown University. She has received numerous awards for technology innovation, public health, and research. She is active on Twitter @meganranney.

In this Nursing Economic$ interview, Dr. Ranney shares her

personal and professional reflections about creating partnerships that truly reflect the collective will of healthcare professionals. Nurses, are we ready to join the call to action?

Changing the Curve on Injury Epidemics

Robin Cogan (RC): What is the overarching goal and mission of AFFIRM?

Megan Ranney (MR): AFFIRM is a non-partisan, non- profit organization created in the face of continued federal inaction on firearm injury prevention funding. Founded by myself and Dr. Chris Barsotti (AFFIRM Chief Executive Officer), we are made up of a Research Council (containing many of the nation’s leading violence prevention researchers), an Advisory Board (with Robin on it!), and, as of March 2019, the partnership of over 17 healthcare organizations. AFFIRM’s mission is to end the epidemic of gun violence through research, innovation, and evidence-based practice.

As you know, there has been limited funding for firearm injury research for the past 22 years. In 1996, a junior representative from Arkansas, Jay Dickey, put a rider on a bill – the now infamous “Dickey Amendment” – that resulted in moving all the money out of the Centers for Disease Control and Prevention (CDC) that had been previously spent on firearm injury prevention research. Since 1996, the CDC has had $0 in appropriations for firearm injury prevention research; the

National Institutes of Health have spent less than 2% of what would be predicted based on the number of people who die from firearm injury each year. And as a result, the state of the science for gun violence prevention is pretty much where it was in 1996, when the Dickey Amendment was passed. Yet society, and patterns of injury, have changed tremendously – and both the number and rate of firearm injury and death have increased substantially. Our goal at AFFIRM is to mobilize Americans across the country to create solutions and hope, together. We don’t need to wait on someone else to make a difference; this is a solution that we can all invest in.

Some examples of immediate actions include: • Educating. • Helping people to share

stories, through blogs, infographics, and a new podcast.

• Sharing research results and reasons why more research is needed.

• Developing research awards that people can apply to.

• Providing donation opportunities, to allow average Americans to make a difference.

• Launching a series of AFFIRM Across America events in the fall. RC: What drives your

personal and professional sense of urgency about gun violence prevention research?

MR: I am driven by my clinical work: I am an emergency physician and take care of victims of gun violence

Nursing Economic$

May/June 2019 | Volume 37 Number 3142

far too often. I see both the immediate impact on the body, and its long-term physical and mental effects. And I see the effects on families, communities, and healthcare providers: PTSD, substance use, burnout.

I am driven by my research: I am a fellowship-trained injury prevention researcher. I know that we have successfully changed the curve on injury epidemics in the past. I know that we can do the same for gun violence.

I am driven by my personal life. I am a mom of two, and fear for my kids’ future. Like so many of us, I’m also a friend or family member of those who have been directly affected by gun violence.

Finally, I am driven by the silence. Up until this year, healthcare professionals were largely silent about the effect of firearms on Americans’ health – and about the moral and scientific imperative to stop this epidemic. Federal funding for firearm injury research remains abysmally low. I, along with many others, am proud to help lead the movement toward change, by raising and distributing money within AFFIRM.

Creating Partnerships in Health Care

RC: What would a partnership with nursing look like? Why is it important to collaborate with nurses?

MR: My grandmother and my aunt are nurses, and their combination of emotional intelligence and intellectual rigor

influenced my decision to go into health care. Every day, in the emergency department, I am reminded that the quality of health care is only as good as the quality of the nurses I work with. So, it would be crazy to think that we’ll solve an epidemic like gun violence without nursing being part of it. Your voice, what you see, your perception of the issue and of possible solutions, and your research skillset, are a critical part of the solution. My goal is a full partnership – sometimes you lead, sometimes I lead, sometimes we just put our heads down and work together.

RC: AFFIRM is intentional about working cross-sector and including voices from multiple disciplines. You spoke about the “collective will of healthcare professionals.” What steps have you taken to create partnerships that reflect this collective?

MR: At AFFIRM, we know that solving a societal issue of this magnitude takes literally all of us. Research is the first step – but it can’t stop there. We also need to implement change based on this research. To effectively create change, we need representatives from every part of health care in the room. Together, we can design, study, and then push out protocols that better care for those who are left behind after a shooting; and, better yet, protocols that can identify patients at risk and help stop shooters before they shoot. This is why we have put such an emphasis on creating partnerships with healthcare professional organizations: we need to have all of us at the

table. (I would love to have more nursing organizations as partners – please feel free to reach out to me if you’d be interested in joining us.)

Prioritizing Research

RC: Given the decades of limited research on gun violence prevention, how do you begin to set a priority agenda for funding this research?

MR: The research agenda is already large – there’s the 2013 Institute of Medicine (now National Academy of Medicine [NAM]) agenda; there’s the 2016 American College of Emergency Physicians agenda; there’s the agenda created by Kaiser after the 2018 conference that they held at NAM. The questions in all these agendas remain to be answered. The question of how to prioritize is a tough one.

At AFFIRM, we feel the priority needs to be on, first, developing and disseminating great interventions to prevent injury among the highest-risk patients. And, second, on moving the needle: creating innovative new ways to create change. For instance, our Research Council members are creating predictive scores for risk of shooting, apps to help suicidal patients make decisions about safer storage of guns, and social media programs to measure anxiety after a school shooting.

Other groups may have different priorities, and that’s okay. It takes all of us.

An Apolitical Stance

RC: Why is it important to

Nursing Economic$

May/June 2019 | Volume 37 Number 3 143

maintain an apolitical stance in AFFIRM?

MR: For 2 decades, firearm injury prevention research has been labeled as inherently political. As recently as March 2019, in a hearing before Congress, some people asserted that firearm injury research is inherently biased. Let me be clear: Nothing could be further from the truth. Firearm injury researchers don’t think guns are “bad” any more than we think cars are “bad.” Instead, we want to find ways to identify who is high risk (just as we know, for instance, that drinking and driving is inadvisable) and to help them stay safe (just as for cars, we changed the windshields and the steering wheels to reduce the risk of injury). There’s no value judgment. There’s just a desire to mitigate injury.

To do this well, we need Americans (and, more specifically, healthcare professionals and researchers) from across the political spectrum. When we make it political, we leave out some of the most important voices – and we doom the potential for creating real change.

RC: A Tweet shared more than a year ago, continues to reverberate on social media. Please share the back story of how you decided to ask this question and what the answers meant for your work as a researcher/scientist studying firearm violence prevention? Here is a link to the Twitter thread where readers can view the stories that were shared as a result of this one Tweet:

https://twitter.com/meganranney/ status/968324464713887746

MR: After each mass shooting since Sandy Hook, I and many others have called for change. After Parkland, I and many others were looking for something concrete to do. One thing that we, as doctors and other healthcare professionals, can do – in the absence of research, in the absence of funding – is to share our stories, and (in a HIPAA-compliant manner!) the stories of our patients and our communities. The average American doesn’t understand what it means when I say, “more than 100 Americans die each day from firearm injury.” And the average American mostly thinks about mass shootings when they think about gun violence. This thread was a first step in helping to humanize the victims and those they leave behind. The responses – the daily tragedies experienced by Americans across this country – are what motivate me, every day, to keep doing this work.

A Public Health Effort

RC: The enormity of the public health epidemic of gun violence must not be a deterrent in working collaboratively to make our communities safer. There is a saying in public health that you can’t boil the ocean, but we can each boil our part of the ocean. Supporting the work of organizations like AFFIRM is one step nurses can take to provide the public support that is needed to fund firearm violence prevention

research. Individual nurses can reach out to their national organizations and ask them to publicly support AFFIRM and its research. To date, only two national nursing organizations are in discussions with AFFIRM; none are official partners.

Some of the feedback that I have received when asking national nursing organization leaders to take a public stand is that they are choosing to focus primarily on nursing-related issues. Another message was that they have to be cognizant of the entirety of their constituency and that gun violence is a political issue. The proverbial table is set for a national presence of nurses to join in the public health effort of addressing gun violence pre - vention, your seats are waiting. $

Robin Cogan, MEd, RN, NCSN School Nurse Camden City School District Camden, NJ Adjunct Faculty Rutgers School of Nursing – Camden Camden, NJ Notes: For more information, please visit: https://affirmresearch.org The National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the roles that health systems can play in addressing the epidemic of firearm injury and death in the United States. To read the proceedings and explore a digital overview of the workshop, please visit nationalacademies.org/PreventFirearmDeath Rep. Robin L. Kelly (D-IL) introduced H.R. 1114 - To require the Surgeon General of the Public Health Service to submit to Congress an annual report on the effects of gun violence on public health. The proposal has 48 co-sponsors.

Reference Cogan, R. (2018). Why I became a school

nurse activist. Nursing Economic$, 36(2), 57-58.

Nursing Economic$

Copyright of Nursing Economic$ is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.