The Definitive Form of Civic Engagement: One of Our Own Runs for Congress

Susan Adams, PhD, RN, NP, is running for the open congressional seat in California’s newly configured 2nd district, which is around Marin County and environs. We had an engaging phone interview in January 2012.

Susan Adams

Tell us about the moment in your busy life as a nurse practitioner (NP) and grandmother that propelled you to run for Congress?

Timing. I’m deeply committed to improving my community. I have already served at the local level for 9 years, currently chairing the county Board of Supervisors. Since California has just drawn new congressional districts, there is no incumbent. It’s a wide-open seat, and it seemed like the right time. My family has lived in this district for multiple generations, and my message about “healthy planet—healthy communities” is resonating.

What is your day-to-day life like now?

I start each day in quiet meditation, asking for the tools I need, including the courage, the wisdom, and an open, loving heart to serve in this way. Then, it gets very BUSY. Since I am a county supervisor, my weekdays are spent meeting with constituents and solving problems. I put 1200 miles on my car each weekend because the new district is really spread out, stretching from the northern end of the Golden Gate Bridge to the Oregon border. I am on the campaign trail, listening to people and their issues. This has allowed me to learn a great deal about all kinds of problems, ranging from small potholes to issues related to health care and access to employment.

What part of running a modern congressional campaign do you love?

The short answer is the stories. I get to engage in the most fascinating conversations. No matter what happens with the election, the campaign is making me a better policymaker. I am really seeing the impact of the recession up close, that is, how the imposition of state and federal mandates has unintended consequences on the local level. I am learning so much and sharpening my ability to telescope—that ingrained nursing skill that allows us to see the big picture as well as the finer, more nuanced view from the ground. I am becoming deeply familiar with all kinds of challenges, especially those encountered in rural areas. People really love their communities and have creative ideas on how to solve problems locally. Campaigning is quite fascinating.

What’s your kryptonite for campaigning? By that I mean the things you experience that deaden you inside?

Fundraising would have to be my kryptonite. It takes a huge amount of money to run a modern campaign. We have got to eliminate corporate personhood. Raising money is really difficult, and this is the most demanding part of running a campaign for me. We have many self-funded millionaires in Congress and others with huge campaign war chests. It is my hope that the nation’s NPs will pull together and support a fellow NP running for Congress. If each NP hit the donate button on my website and submitted $25, I could run a great campaign. On the positive side, nurses comprise 2% of the voting population, so I am hoping to get support from as many of them as possible. Small amounts of money from 3.5 million nurses would really help me get elected! We need to recognize our power.

Currently, 20 physicians and seven nurses are members of Congress. What unique contributions do you think clinicians bring to Congress?

As an NP, I bring a health lens to every issue I address. My framework applies to everything, whether it is infrastructure, health care, education, or strengthening the economy. In each instance, I ask, “How do we build a healthy community?” My PhD in nursing taught me how to find information and how to synthesize and incorporate this information to solve complex health problems. For example, I believe in “therapeutic justice”; this means that we have to address the huge numbers of people in our prison system that suffer from addictions and other mental illnesses so they are not simply warehoused and then repeatedly recycled back to the penal system. I believe in a healthy planet, healthy living, and healthy communities. As county supervisor, I helped create a health-and-wellness center using tobacco-settlement dollars. In addition to being walkable and “bikeable,” it includes a meditation garden with wraparound services, such as specialty care, social services, primary care, and mental health—basically, all the services that a patient could need in one setting. I also helped to fund organic school gardens to address the food deserts in our impoverished communities.

What would you advise an NP with political ambitions to do?

Get involved. Work on a local health commission that reports to your local government. Run for local office, or work on a campaign in order to really learn how electoral politics function. It is important to have a mentor, that is, a person who inspires you. In my case, I had a number of strong female mentors. For example, I worked on Senators Barbara Boxer’s (D-CA) campaign; she had strong support from nurses and won her congressional seat. I watched Senator Boxer start at the local county level, and it lit my fire. NPs in particular have a strong skill set that can be used to approach community problems with a health-related lens. We think about the health aspect of issues in a way others don’t. So, don’t underestimate what you bring to the table.

Besides running for office, what else do you see as a remedy for apathy or indifference when it comes to advanced practice nurses (APNs) engaging in the electoral process?

We must move away from just complaining. If we are not being heard, stand on a chair and get a bullhorn! As nurses, we don’t recognize the power we have, never fully corralling our political strength. We are the profession most trusted by the public. We must build on that trust by taking small steps and engaging with our elected officials. We must have a fire lit in us that inspires us to bring the problems we face in practice to the attention of policymakers. So, as part of our core role as NPs, we need to leverage our expertise, identify role models, and engage with policymakers. In my graduate-level health-policy course, I teach nurses how to be heard. Students have real-life assignments. They meet a local politician about a healthcare topic. It takes the fear out. They write a letter to the editor and get in front of a city or county public forum to discuss an issue they care about. It is not uncommon for these nurses to be asked to joint commissions they have addressed. So, it takes starting with small steps and spending some time and energy—we must value our power.

What would you tell the nation’s APNs who are feeling either marginalized or frustrated by the slow pace of change in improving healthcare costs, access, and delivery in the country?

Government works at two paces—slow and extremely slow! It takes patience and persistence. For example, in my community, it took 8 years to get the mining industry, which was spewing silica dust into the air, to comply with existing laws on air quality. Although we had to go through lengthy court battles, in the end our firm and steady emphasis on the health and wellness issues brought them into compliance. On the other hand, it took only 2 years—quite fast in policy terms—to get the health-and-wellness center up and running.

APNs have to know where they want to go, develop a thoughtful strategy, and be persistent. We have a responsibility to educate other policymakers on the data and on programs that reduce costs and improve quality, such as reducing recidivism through therapeutic programs that empty jail beds. We need to use our nursing skills to persuade others to invest scarce resources differently.

The governor of Virginia said that “the United States has the best health care in the world.” How would you respond?

The data and every quality measure say otherwise. When we compare what we spend on health care to expenditures of other developed nations and the relative outcomes, our healthcare costs are 2–5 times higher, while our life expectancy is 3–5 years shorter. Although we have the best technology and science in the world, 45 million uninsured Americans do not have access to that technology and science. Even more Americans have inadequate healthcare coverage or access to services. Our national security is at risk. Looking at the H1N1 outbreak, we did not have the containment, control, and tracking capacity to prevent the outbreak from spreading throughout the whole country. Canada, on the other hand, was able to intervene quickly and effectively to contain an outbreak of severe acute respiratory syndrome, or SARS.

You have a strong track record on environmental and fiscal responsibility issues at the county level where you have long served. We at NP World News are interested in your priorities for health care.

I have three health-related priorities. First, I want to make sure that the good policies in the Affordable Care Act (ACA) are implemented. The number one reason for bankruptcy in this country is people getting sick—this is a tragedy. I will push for universal health care, Medicare for all, if you will. We have strong data indicating that healthcare homes integrating specialty care are effective in reducing costs, hospital admissions, and emergency department visits. They improve the quality of care and the experience for the patient. I want to promote bulk purchasing to save money. We must emphasize prevention and early detection and not invest so much of our resources at the end of life. I want to see some of the great nuggets in the ACA carried out. My second priority is “therapeutic justice,” in which we treat repeat offenders to allow them to function at their highest level and to reduce recidivism. We must stop warehousing drug addicts and the mentally ill in expensive jails and prisons and see that they get needed care. As an obstetrics-gynecology NP, my third priority is to fight to protect women’s reproductive rights.

Running for Congress is the ultimate act of civic engagement and cannot be easy. How is your family dealing with your campaign? What kind of personal toll does it take? How are you practicing self-care?

I advocate for healthy living, so I practice it myself. I’m a vegetarian, and every day I take time for contemplation, asking for the wisdom and ability to serve in this capacity. I ride my bike to work. Although I exercise regularly, the time available for this has been reduced and will likely drop off considerably as Election Day approaches. I like to think that I have some fitness stored up that I can call on! I am happily single, and two of my adult children are working on my campaign, which has been a wonderful experience. I see my grandkids regularly. This is an intense period of my life, but I believe in health and wellness and incorporate this belief into my life.

How do you plan to work effectively in such a divided Congress?

You have to influence one person at a time. I have a way of finding common ground through one-on-one conversations. If we can get people to agree on five areas surrounding any policy issue, we have common ground and can make great progress. Common ground is what connects our hearts and souls, and I am really good at finding it.

When you get to Congress, what will be the very first thing you will do?

Find my office! I want to end with the plea that nurses find their voice. Less than 17% of Congress is female, and we need to balance out the gender inequity in our legislative branch. As nurses, we have the skill set, and we are masterful in communication and problem-solving skills. I hope you will help me in this effort, but if you cannot get behind my agenda, please find a candidate that you can support.

More information on Susan Adams can be found at www.susanadamsforcongress.com