WEBVTT 00:00:02.750 --> 00:00:05.660 position:50% align:middle - [David] I'm honored to be here today. 00:00:05.660 --> 00:00:15.630 position:50% align:middle I know of the important work that each and every one of you do each and every day, impacting your communities, 00:00:15.630 --> 00:00:23.090 position:50% align:middle your states, and through the National Council of State Boards of Nursing, our nation, and indeed our world. 00:00:23.090 --> 00:00:25.640 position:50% align:middle So thank you. 00:00:25.640 --> 00:00:31.031 position:50% align:middle Like all of you, I have a passion for regulation. 00:00:31.031 --> 00:00:37.781 position:50% align:middle In my case, it began, as you heard, with my appointment to the Virginia Board of Medicine, 00:00:37.781 --> 00:00:40.841 position:50% align:middle an interesting role. 00:00:40.841 --> 00:00:50.121 position:50% align:middle I was the only chiropractor on a board with 10 MDs, 1 DL, 1 podiatrist, 1 clinical psychologist, 00:00:50.121 --> 00:00:52.421 position:50% align:middle and 2 public members. 00:00:52.421 --> 00:00:55.911 position:50% align:middle I loved it. 00:00:55.911 --> 00:01:01.402 position:50% align:middle Eight years at the Board of Medicine were followed by becoming president of the Federation of Chiropractic 00:01:01.402 --> 00:01:07.512 position:50% align:middle Licensing Boards, a board member of the National Board of Chiropractic Examiners, 00:01:07.512 --> 00:01:14.242 position:50% align:middle and a number of speaking engagements at meetings of CLEAR, the Council on Licensure, 00:01:14.242 --> 00:01:21.272 position:50% align:middle Enforcement and Regulation, at FARB, Federation of Associations of Regulatory Boards. 00:01:21.272 --> 00:01:27.372 position:50% align:middle And early on that path, I participated in an interdisciplinary work group. 00:01:27.372 --> 00:01:33.331 position:50% align:middle It was a response to a Pew Commission report on healthcare regulation. 00:01:33.331 --> 00:01:38.841 position:50% align:middle And it was led by the National Council of State Boards of Nursing. 00:01:38.841 --> 00:01:45.581 position:50% align:middle I was immediately impressed by the knowledge, the competence, and the dedication 00:01:45.581 --> 00:01:48.661 position:50% align:middle of the National Council. 00:01:48.661 --> 00:01:54.011 position:50% align:middle You may know, and if not, Jim just told you, that all of Virginia's health regulatory boards are 00:01:54.011 --> 00:02:01.870 position:50% align:middle part of the Department of Health Professions, DHP, a large umbrella agency. 00:02:01.870 --> 00:02:09.490 position:50% align:middle When I left the Board of Medicine in the late '90s, I looked at the director's office and I thought, 00:02:09.490 --> 00:02:13.340 position:50% align:middle "I want that job one day." 00:02:13.340 --> 00:02:21.090 position:50% align:middle I seized the opportunity to return to healthcare regulation in 2014 and was appointed director of DHP 00:02:21.090 --> 00:02:23.810 position:50% align:middle by Governor Terry McAuliffe. 00:02:23.810 --> 00:02:27.600 position:50% align:middle And as you heard, a position I held under three different governors. 00:02:27.600 --> 00:02:31.648 position:50% align:middle Although with the change of party, I was only there with the third governor 00:02:31.648 --> 00:02:35.098 position:50% align:middle for about nine months. 00:02:35.098 --> 00:02:38.948 position:50% align:middle I reported to the Secretary of Health. 00:02:38.948 --> 00:02:46.528 position:50% align:middle My first Secretary of Health, orthopedic surgeon, Bill Hazel, who basically hired me, 00:02:46.528 --> 00:02:52.058 position:50% align:middle told me that I was going to a strong agency in the Department of Health Professions. 00:02:52.058 --> 00:02:58.758 position:50% align:middle And he singled out Jay Douglas as a strong leader at DHP. 00:02:58.758 --> 00:03:02.938 position:50% align:middle He was right about DHP and he was right about Jay Douglas. 00:03:02.938 --> 00:03:12.618 position:50% align:middle Jay, thank you for your wisdom, your advice, and most of all, your friendship. 00:03:12.618 --> 00:03:17.878 position:50% align:middle So I'm very pleased to have this opportunity today to talk about healthcare regulation. 00:03:17.878 --> 00:03:27.718 position:50% align:middle And I'm just as pleased to indulge my current passion, Thomas Jefferson and his plantation home, Monticello. 00:03:27.718 --> 00:03:37.119 position:50% align:middle I happened to be reading Annette Gordon-Reed's Pulitzer Prize, a national book award-winning book, 00:03:37.119 --> 00:03:45.539 position:50% align:middle "The Hemingses of Monticello" when I saw an ad to be a tour guide at Monticello. 00:03:45.539 --> 00:03:49.309 position:50% align:middle Well, I was trying to figure out what I was going to do next in my life. 00:03:49.309 --> 00:03:57.969 position:50% align:middle And when I saw that ad and applied, well, that turned out to be exactly what I was looking for, 00:03:57.969 --> 00:04:05.387 position:50% align:middle although I didn't really know what I was looking for. 00:04:05.387 --> 00:04:15.797 position:50% align:middle Being a guide at Monticello is meaningful, challenging, and never dull, wonderful comradery in a guide core 00:04:15.797 --> 00:04:24.037 position:50% align:middle that ranges from age 22 to 82, an eclectic bunch of history nerds. 00:04:24.037 --> 00:04:27.447 position:50% align:middle To be a guide there, there's two weeks of all-day training. 00:04:27.447 --> 00:04:32.157 position:50% align:middle I set off the first day, and I told my wife when I left, 00:04:32.157 --> 00:04:36.557 position:50% align:middle "My plan was to be the A student in the class. 00:04:36.557 --> 00:04:40.867 position:50% align:middle After all, I'd been a history major at the University of Virginia. 00:04:40.867 --> 00:04:47.297 position:50% align:middle Well, there were four of us, and the three women were all lawyers. 00:04:47.297 --> 00:04:54.777 position:50% align:middle And I was quickly humbled by my new colleagues and now good friends. 00:04:54.777 --> 00:05:00.347 position:50% align:middle We all write our own tours at Monticello within certain guidelines and themes. 00:05:00.347 --> 00:05:06.937 position:50% align:middle And like many health professions, we have required hours of continuing education. 00:05:06.937 --> 00:05:15.157 position:50% align:middle And over time, we learned to give a variety of tours, slavery tours, garden tours, architectural tours, 00:05:15.157 --> 00:05:17.377 position:50% align:middle a number more. 00:05:17.377 --> 00:05:19.787 position:50% align:middle So this conference has an amazing agenda. 00:05:19.787 --> 00:05:21.967 position:50% align:middle I hope you know that. 00:05:21.967 --> 00:05:25.137 position:50% align:middle Bringing together Thomas Jefferson and professional regulation. 00:05:25.137 --> 00:05:34.040 position:50% align:middle We have the opportunity today and tomorrow to learn from leading scholars of Thomas Jefferson, Alan Taylor, 00:05:34.040 --> 00:05:36.060 position:50% align:middle Peter Onuf, and Annette Gordon-Reed. 00:05:36.060 --> 00:05:44.640 position:50% align:middle And we also get to learn from the director of UVA Center for Politics, Larry Sabato. 00:05:44.640 --> 00:05:53.520 position:50% align:middle Larry Sabato was president of the Student Council at University of Virginia when I was an undergrad. 00:05:53.520 --> 00:06:01.446 position:50% align:middle I'm pleased and maybe a little nervous to combine these two themes, professional regulation 00:06:01.446 --> 00:06:04.296 position:50% align:middle and Thomas Jefferson. 00:06:04.296 --> 00:06:06.636 position:50% align:middle So here's my disclaimer. 00:06:06.636 --> 00:06:13.856 position:50% align:middle If Professors Taylor, Onuf, or Gordon-Reed say anything that is at odds 00:06:13.856 --> 00:06:19.826 position:50% align:middle with something I say, well, we all know who the real experts are. 00:06:19.826 --> 00:06:25.696 position:50% align:middle So I thought I would talk a bit about Thomas Jefferson and then move into how his ideas intersected 00:06:25.696 --> 00:06:32.071 position:50% align:middle with health policy in his day and the lessons he may still have for us today. 00:06:32.071 --> 00:06:35.811 position:50% align:middle So let's start with what you already know. 00:06:35.811 --> 00:06:41.301 position:50% align:middle In a word or phrase, just kind of shout out something that comes to mind 00:06:41.301 --> 00:06:42.441 position:50% align:middle when you think Thomas Jefferson. 00:06:42.441 --> 00:06:44.681 position:50% align:middle I'll repeat it for the group and for any recording. 00:06:44.681 --> 00:06:45.811 position:50% align:middle Come on. 00:06:45.811 --> 00:06:46.851 position:50% align:middle You guys aren't shy. 00:06:46.851 --> 00:06:48.901 position:50% align:middle - [Woman 1]. 00:06:48.901 --> 00:06:49.171 position:50% align:middle Innovative. 00:06:49.171 --> 00:06:49.721 position:50% align:middle - Innovator? 00:06:49.721 --> 00:06:50.301 position:50% align:middle Innovator, yes. 00:06:50.301 --> 00:06:51.141 position:50% align:middle He's an innovator. 00:06:51.141 --> 00:06:53.511 position:50% align:middle He's an inventor a little bit. 00:06:53.511 --> 00:06:54.631 position:50% align:middle I'll talk about that more later. 00:06:54.631 --> 00:06:54.751 position:50% align:middle What else? 00:06:54.751 --> 00:06:56.381 position:50% align:middle - [Woman 2] Architecture. 00:06:56.381 --> 00:06:58.051 position:50% align:middle - Architecture. 00:06:58.051 --> 00:06:59.081 position:50% align:middle He's an architect. 00:06:59.081 --> 00:07:01.188 position:50% align:middle He's a landscape architect. 00:07:01.188 --> 00:07:07.518 position:50% align:middle And in order to do the kind of incredible stuff he does, he has to learn how construction works. 00:07:07.518 --> 00:07:09.048 position:50% align:middle He's really a contractor as well. 00:07:09.048 --> 00:07:09.148 position:50% align:middle What else? 00:07:09.148 --> 00:07:11.288 position:50% align:middle - [Woman 3] Great quotes. 00:07:11.288 --> 00:07:12.168 position:50% align:middle - I'm sorry. 00:07:12.168 --> 00:07:12.998 position:50% align:middle - Great quotes. 00:07:12.998 --> 00:07:14.248 position:50% align:middle - Great... 00:07:14.248 --> 00:07:15.378 position:50% align:middle - Quotes. 00:07:15.378 --> 00:07:15.768 position:50% align:middle - ...quotes. 00:07:15.768 --> 00:07:21.478 position:50% align:middle Yes, he is incredibly articulate on paper. 00:07:21.478 --> 00:07:26.408 position:50% align:middle In public, he is shy and mumbles. 00:07:26.408 --> 00:07:29.018 position:50% align:middle What else? 00:07:29.018 --> 00:07:31.750 position:50% align:middle Well, I'll go. 00:07:31.750 --> 00:07:32.810 position:50% align:middle He's a writer. 00:07:32.810 --> 00:07:34.160 position:50% align:middle He's a philosopher. 00:07:34.160 --> 00:07:37.420 position:50% align:middle He's a statesman and a diplomat. 00:07:37.420 --> 00:07:42.960 position:50% align:middle He's a husband, he's a father, he's a slaveowner. 00:07:42.960 --> 00:07:46.200 position:50% align:middle He's a revolutionary. 00:07:46.200 --> 00:07:52.980 position:50% align:middle After writing and presenting the Declaration, he said he felt as if he had a halter around his neck. 00:07:52.980 --> 00:07:56.960 position:50% align:middle They knew what was at stake if they didn't prevail. 00:07:56.960 --> 00:07:57.830 position:50% align:middle He's a linguist. 00:07:57.830 --> 00:08:00.670 position:50% align:middle He reads and writes in seven different languages. 00:08:00.670 --> 00:08:04.880 position:50% align:middle He is a bibliophile. 00:08:04.880 --> 00:08:09.630 position:50% align:middle He's a gourmand and a wine snob. 00:08:09.630 --> 00:08:13.830 position:50% align:middle He's a horticulturist, he's a scientist, he's a mathematician. 00:08:13.830 --> 00:08:15.920 position:50% align:middle He's an educator. 00:08:15.920 --> 00:08:17.530 position:50% align:middle I could go on. 00:08:17.530 --> 00:08:22.110 position:50% align:middle There's a story about a traveler who's stopping the night at a Virginia inn, 00:08:22.110 --> 00:08:28.760 position:50% align:middle struck up a conversation with a stranger, a plainly dressed and unassuming stranger. 00:08:28.760 --> 00:08:36.381 position:50% align:middle The stranger introduced one topic after another into the conversation and demonstrated himself to be 00:08:36.381 --> 00:08:39.671 position:50% align:middle perfectly acquainted with each topic. 00:08:39.671 --> 00:08:45.491 position:50% align:middle When the topic was the law, the traveler assumed that the stranger was a lawyer. 00:08:45.491 --> 00:08:49.111 position:50% align:middle But when the discussion moved to medicine, the traveler surmised, well, 00:08:49.111 --> 00:08:53.611 position:50% align:middle actually the stranger must be a physician. 00:08:53.611 --> 00:08:54.991 position:50% align:middle And then it got to theology. 00:08:54.991 --> 00:08:59.731 position:50% align:middle The traveler thought, "Well, this guy must be a clergyman." 00:08:59.731 --> 00:09:06.824 position:50% align:middle Filled with wonder, that one person could be so well-informed by so many things, 00:09:06.824 --> 00:09:11.014 position:50% align:middle after conclusion of the conversations, he went to the innkeeper and said, "Who was that?" 00:09:11.014 --> 00:09:16.784 position:50% align:middle And the innkeeper said, "Oh, I thought you knew this squire." 00:09:16.784 --> 00:09:23.504 position:50% align:middle It turns out the stranger who the traveler had found so affable and simple in his manners was the third 00:09:23.504 --> 00:09:26.234 position:50% align:middle President of the United States. 00:09:26.234 --> 00:09:33.736 position:50% align:middle John Kennedy said in remarks at a dinner honoring Nobel Prize winners, 00:09:33.736 --> 00:09:40.156 position:50% align:middle that that dinner had the greatest collection of human talent and knowledge that has ever been gathered 00:09:40.156 --> 00:09:48.426 position:50% align:middle together in the White House with the possible exception of when Thomas Jefferson died alone. 00:09:48.426 --> 00:09:52.846 position:50% align:middle Thomas Jefferson was deeply influenced by the Enlightenment, the European movement, 00:09:52.846 --> 00:09:58.996 position:50% align:middle beginning in the late 1600s, lasting until the mid-1800s, 00:09:58.996 --> 00:10:05.975 position:50% align:middle that they also called at the time the Age of Reason, using science and rational thought to make the world 00:10:05.975 --> 00:10:08.745 position:50% align:middle a better place. 00:10:08.745 --> 00:10:12.465 position:50% align:middle Jefferson calls Francis Bacon pioneer of the scientific method. 00:10:12.465 --> 00:10:17.215 position:50% align:middle Isaac Newton, mathematician, and John Locke, political philosopher, 00:10:17.215 --> 00:10:21.775 position:50% align:middle his trinity of the three greatest men this world has ever produced. 00:10:21.775 --> 00:10:27.645 position:50% align:middle The Enlightenment motto, "Have the courage to use your own reason." 00:10:27.645 --> 00:10:35.320 position:50% align:middle So did Thomas Jefferson use his own reason about healthcare and medicine? 00:10:35.320 --> 00:10:37.190 position:50% align:middle Absolutely. 00:10:37.190 --> 00:10:44.510 position:50% align:middle He saw the dominant medical treatments of the day, bloodletting, purging, inducing vomiting, 00:10:44.510 --> 00:10:49.400 position:50% align:middle and thought to himself, "No, this doesn't make sense." 00:10:49.400 --> 00:10:58.170 position:50% align:middle In fact, he wrote, "The practice of medicine is worse than total ignorance." 00:10:58.170 --> 00:11:05.446 position:50% align:middle He had this to say about the Philadelphia physician, Benjamin Rush, "In his theory of bloodletting, 00:11:05.446 --> 00:11:13.236 position:50% align:middle I was ever opposed to my friend Rush, who I greatly loved but who had done much harm in the 00:11:13.236 --> 00:11:18.696 position:50% align:middle sincerest persuasion that he was preserving life and happiness all around him." 00:11:18.696 --> 00:11:25.896 position:50% align:middle In his notes on the state of Virginia, Jefferson wrote about hospitals, "The sick, the dying, 00:11:25.896 --> 00:11:32.867 position:50% align:middle and the dead are crammed together in the same rooms and often the same beds. 00:11:32.867 --> 00:11:41.247 position:50% align:middle Nature and kind nursing save a much greater proportion and with much less abuse." 00:11:41.247 --> 00:11:46.677 position:50% align:middle He struck a similar note in a letter to his daughter, Martha, during an illness of one of his grandchildren. 00:11:46.677 --> 00:11:54.387 position:50% align:middle He was glad that she did not "Physic him, but instead left nature, free and unembarrassed, 00:11:54.387 --> 00:11:57.947 position:50% align:middle to repair what was wrong." 00:11:57.947 --> 00:12:07.049 position:50% align:middle But Thomas Jefferson did not reject medicine, ignoring the widespread belief that smallpox 00:12:07.049 --> 00:12:12.139 position:50% align:middle inoculation would spread the disease rather than preventing it. 00:12:12.139 --> 00:12:19.769 position:50% align:middle In Norfolk, Virginia, in the 1760s, there were riots against inoculation. 00:12:19.769 --> 00:12:24.799 position:50% align:middle A physician who was doing inoculation had his house burned down. 00:12:24.799 --> 00:12:32.022 position:50% align:middle Despite this, in 1766, the 23-year-old Thomas Jefferson goes to Philadelphia 00:12:32.022 --> 00:12:33.902 position:50% align:middle to become inoculated. 00:12:33.902 --> 00:12:42.922 position:50% align:middle And after becoming President in 1801, he expanded his commitment to smallpox inoculation. 00:12:42.922 --> 00:12:50.752 position:50% align:middle He had followed the work of the physician, Edward Jenner, and his experiments using the milder 00:12:50.752 --> 00:12:56.472 position:50% align:middle cowpox as an effective immunization against smallpox. 00:12:56.472 --> 00:13:04.003 position:50% align:middle Jefferson promoted the use of this new vaccine, and he directed the inoculation of those enslaved 00:13:04.003 --> 00:13:10.603 position:50% align:middle at Monticello, his sons-in-law, and some of his neighbors, about 200 people in all. 00:13:10.603 --> 00:13:16.753 position:50% align:middle He also tried to promote vaccination among Native Americans. 00:13:16.753 --> 00:13:25.873 position:50% align:middle So what would Thomas Jefferson think about the immunization challenges we face today? 00:13:25.873 --> 00:13:31.880 position:50% align:middle A growing number of people are skeptical or hesitant about vaccines, not just COVID, 00:13:31.880 --> 00:13:35.580 position:50% align:middle but childhood immunizations. 00:13:35.580 --> 00:13:39.110 position:50% align:middle And I'm not just talking about anti-vaxxers. 00:13:39.110 --> 00:13:46.890 position:50% align:middle As pointed out by the National Association of School Nurses, childhood immunization has been so effective 00:13:46.890 --> 00:13:55.290 position:50% align:middle in preventing death and disease that many parents today have not encountered serious diseases that used 00:13:55.290 --> 00:13:57.690 position:50% align:middle to be common. 00:13:57.690 --> 00:14:06.459 position:50% align:middle As a result, increasing numbers of parents believe that vaccine-preventable diseases are mild or normal, 00:14:06.459 --> 00:14:11.569 position:50% align:middle natural, and that vaccines are no longer necessary. 00:14:11.569 --> 00:14:18.319 position:50% align:middle Well, on top of this is the widespread disruption of vaccination schedules by COVID. 00:14:18.319 --> 00:14:27.419 position:50% align:middle I think Thomas Jefferson would have recognized the key roles, the key role that nurses must play in schools, 00:14:27.419 --> 00:14:35.524 position:50% align:middle health departments, in primary care, in all settings, really, in helping people overcome their hesitancy and 00:14:35.524 --> 00:14:43.734 position:50% align:middle recognize again how important vaccines have been and still are. 00:14:43.734 --> 00:14:52.544 position:50% align:middle Thomas Jefferson led a remarkably healthy lifestyle, similar to the ideas of today that are taught 00:14:52.544 --> 00:14:58.114 position:50% align:middle in nursing schools and that nurses try to instill in all their patients. 00:14:58.114 --> 00:15:05.912 position:50% align:middle Despite inheriting a tobacco-based plantation, Thomas Jefferson never smoked. 00:15:05.912 --> 00:15:14.462 position:50% align:middle He decried the cultivation of tobacco saying, "It's a culture productive of infinite wretchedness." 00:15:14.462 --> 00:15:22.832 position:50% align:middle And later, he moved to his income-producing crops to wheat. 00:15:22.832 --> 00:15:31.189 position:50% align:middle The slender 6 foot 2.5 inches tall Jefferson was a zealot about exercise. 00:15:31.189 --> 00:15:36.149 position:50% align:middle He said, "A strong body makes the mind strong." 00:15:36.149 --> 00:15:40.499 position:50% align:middle He recommended two hours of walking each day. 00:15:40.499 --> 00:15:46.229 position:50% align:middle I'm pretty sure that today since he was a lover of technology and of data collection, 00:15:46.229 --> 00:15:50.689 position:50% align:middle he'd be tracking his steps with an Apple watch. 00:15:50.689 --> 00:15:57.929 position:50% align:middle Jefferson understood that a person could improve their capacity to walk, and that walking was a key 00:15:57.929 --> 00:16:01.085 position:50% align:middle to health and longevity. 00:16:01.085 --> 00:16:09.175 position:50% align:middle He wrote to his son-in-law, Thomas Mann Randolph, "A person who has never walked 3 miles will, 00:16:09.175 --> 00:16:15.515 position:50% align:middle in the course of a month, be able to walk 15 or 20 without fatigue. 00:16:15.515 --> 00:16:20.485 position:50% align:middle I have known some great walkers and heard particular counts of many more, 00:16:20.485 --> 00:16:27.285 position:50% align:middle and I never knew or heard of one who is not healthy and long-lived." 00:16:27.285 --> 00:16:32.603 position:50% align:middle His grandchildren said that after long days of reading and studying as a student at William & Mary, 00:16:32.603 --> 00:16:40.733 position:50% align:middle Thomas Jefferson would run a mile or more, and that he once swam 13 times across a 00:16:40.733 --> 00:16:43.633 position:50% align:middle 1/4-mile-wide mill pond. 00:16:43.633 --> 00:16:49.483 position:50% align:middle As he aged and developed arthritic complaints, Thomas Jefferson turned more to horseback riding 00:16:49.483 --> 00:16:51.543 position:50% align:middle for his daily exercise. 00:16:51.543 --> 00:16:53.123 position:50% align:middle He was an expert horseman. 00:16:53.123 --> 00:16:54.873 position:50% align:middle He had fine horses. 00:16:54.873 --> 00:17:02.373 position:50% align:middle He drove his carriage so aggressively his daughter, Martha, did not like to ride with him. 00:17:02.373 --> 00:17:11.843 position:50% align:middle At age 77, he wrote that he no longer walked much but was "Riding without fatigue 6 or 8 miles a day, 00:17:11.843 --> 00:17:14.498 position:50% align:middle and sometimes 30 or 40." 00:17:14.498 --> 00:17:23.973 position:50% align:middle The ever-moderate Thomas Jefferson also said, "We never repent of eating too little." 00:17:23.973 --> 00:17:30.512 position:50% align:middle But what he did eat, what he did eat was a lot of vegetables. 00:17:30.512 --> 00:17:37.712 position:50% align:middle He had his garden terraced a little below the mountaintop for protected southern exposure, 00:17:37.712 --> 00:17:41.002 position:50% align:middle expanding the range of vegetables that could be grown. 00:17:41.002 --> 00:17:51.682 position:50% align:middle And he recorded over 330 varieties of vegetables, over 70 species growing in his 1000-foot-long garden. 00:17:51.682 --> 00:18:00.192 position:50% align:middle He said, "I have lived temperately, eating little animal food and not as an element, 00:18:00.192 --> 00:18:06.300 position:50% align:middle so much as a condiment for the vegetables, which constitute my principal diet." 00:18:06.300 --> 00:18:16.170 position:50% align:middle This was commented on by a visiting Congressman Daniel Webster in 1824, who wrote, "He enjoys his dinner well, 00:18:16.170 --> 00:18:22.470 position:50% align:middle taking with his meat a large proportion of vegetables." 00:18:22.470 --> 00:18:26.470 position:50% align:middle His granddaughter Ellen also said, "He lives principally on vegetables. 00:18:26.470 --> 00:18:33.852 position:50% align:middle The little meat he took seems merely as a seasoning for his vegetables." 00:18:33.852 --> 00:18:41.412 position:50% align:middle I also think that Thomas Jefferson was an early advocate for mindfulness. 00:18:41.412 --> 00:18:49.702 position:50% align:middle In 2012, I had the incredible fortune to be the moderator of a panel discussion in Charlottesville 00:18:49.702 --> 00:18:57.602 position:50% align:middle at the Paramount Theater on healthcare with His Holiness The Dalai Lama. 00:18:57.602 --> 00:19:03.747 position:50% align:middle One of the panelists was Dr. Dorrie Fontaine, dean of the UVA School of Nursing. 00:19:03.747 --> 00:19:06.857 position:50% align:middle Maybe for today's talk, I should have said, Dean of the School of Nursing 00:19:06.857 --> 00:19:09.837 position:50% align:middle at Mr. Jefferson's University. 00:19:09.837 --> 00:19:18.287 position:50% align:middle Dr. Fontaine commented on the training of nursing students at UVA in mindfulness meditation so that 00:19:18.287 --> 00:19:26.377 position:50% align:middle nurses had tools that would enable them to bring their very best self to each and every patient. 00:19:26.377 --> 00:19:34.027 position:50% align:middle And Thomas Jefferson, well, writing to a nephew on the importance of exercise, 00:19:34.027 --> 00:19:40.217 position:50% align:middle he wrote, "The object of walking is to relax the mind. 00:19:40.217 --> 00:19:47.437 position:50% align:middle You should therefore not permit yourself even to think while you walk, but divert your attention by the 00:19:47.437 --> 00:19:49.657 position:50% align:middle objects surrounding you." 00:19:49.657 --> 00:19:53.137 position:50% align:middle It sounds like mindfulness to me. 00:19:53.137 --> 00:19:54.657 position:50% align:middle Thomas Jefferson lived to be 83. 00:19:54.657 --> 00:19:59.067 position:50% align:middle That's pretty good back then. 00:19:59.067 --> 00:20:04.466 position:50% align:middle Having what I think we would all strive for ourselves, our families, our patients, and our communities, 00:20:04.466 --> 00:20:14.706 position:50% align:middle a vigorous life, a life which we enjoy, a life that enriches those around us. 00:20:14.706 --> 00:20:22.346 position:50% align:middle A key value of nursing at all levels is education, certainly for the National Council, 00:20:22.346 --> 00:20:28.566 position:50% align:middle certainly for all the state boards, for nurse educators, for nurses in any clinical role, 00:20:28.566 --> 00:20:31.712 position:50% align:middle actually pretty much for any nursing. 00:20:31.712 --> 00:20:33.262 position:50% align:middle Same with Thomas Jefferson. 00:20:33.262 --> 00:20:36.802 position:50% align:middle A key value throughout his life. 00:20:36.802 --> 00:20:41.982 position:50% align:middle After attending boarding schools at age 17, he began at the College of William & Mary. 00:20:41.982 --> 00:20:50.162 position:50% align:middle He studied under the Scottish scholar, William Small, who Jefferson said, "Probably fixed the destinies 00:20:50.162 --> 00:20:52.252 position:50% align:middle of my life." 00:20:52.252 --> 00:20:55.212 position:50% align:middle He went on to read law under the direction of George Wythe. 00:20:55.212 --> 00:21:03.192 position:50% align:middle And in fact, a person in Virginia can still read the law apprenticed under a practicing lawyer instead 00:21:03.192 --> 00:21:06.682 position:50% align:middle of having to go to law school. 00:21:06.682 --> 00:21:13.702 position:50% align:middle It is said that Thomas Jefferson, at William & Mary, read and studied for 12 to 15 hours a day. 00:21:13.702 --> 00:21:20.262 position:50% align:middle In 1815, he famously wrote to John Adams, "I cannot live without books." 00:21:20.262 --> 00:21:26.362 position:50% align:middle The reason, in the War of 1812, the British burned Washington and with it, 00:21:26.362 --> 00:21:32.224 position:50% align:middle they burned the collection of books at the Library of Congress, 3,000 volumes. 00:21:32.224 --> 00:21:38.644 position:50% align:middle Thomas Jefferson then sold his private collection of books to the Library of Congress, 6,400 volumes, and, 00:21:38.644 --> 00:21:43.324 position:50% align:middle of course, started collecting books again. 00:21:43.324 --> 00:21:48.294 position:50% align:middle Next time you're in D.C., if you haven't seen it, visit the Library of Congress. 00:21:48.294 --> 00:21:50.584 position:50% align:middle It's an amazing place. 00:21:50.584 --> 00:21:58.274 position:50% align:middle And you can see the exhibit of Thomas Jefferson's books in various languages with numerous books 00:21:58.274 --> 00:22:01.949 position:50% align:middle on health and medicine. 00:22:01.949 --> 00:22:10.389 position:50% align:middle Thomas Jefferson believed strongly that the key to a democracy, the key to this experiment in representative 00:22:10.389 --> 00:22:14.929 position:50% align:middle government was an educated population. 00:22:14.929 --> 00:22:23.443 position:50% align:middle He said, "Any nation that expects to be ignorant and free expects what never was and never will be." 00:22:29.107 --> 00:22:32.543 position:50% align:middle Like, I believe the profession of nursing, Thomas Jefferson does not just stop 00:22:32.543 --> 00:22:34.513 position:50% align:middle with identifying a problem. 00:22:34.513 --> 00:22:38.573 position:50% align:middle He doesn't stop even after identifying potential solutions. 00:22:38.573 --> 00:22:41.123 position:50% align:middle He takes specific actions. 00:22:41.123 --> 00:22:47.113 position:50% align:middle Jefferson does much more than just write about education. 00:22:47.113 --> 00:22:53.353 position:50% align:middle After announcing to the world in the Declaration of Independence in 1776 that we are no longer a colony 00:22:53.353 --> 00:23:01.220 position:50% align:middle of Great Britain, one of the first orders of business is for all the states to create their own 00:23:01.220 --> 00:23:04.240 position:50% align:middle laws for governing. 00:23:04.240 --> 00:23:12.970 position:50% align:middle Thomas Jefferson introduces a bill for the more general diffusion of knowledge into the Virginia legislature. 00:23:12.970 --> 00:23:19.080 position:50% align:middle In this plan, primary schools were to be free to students, both boys and girls, 00:23:19.080 --> 00:23:25.830 position:50% align:middle and the best male students were to attend the academies and the university at public expense. 00:23:25.830 --> 00:23:29.900 position:50% align:middle Virginia is not quite ready for that. 00:23:29.900 --> 00:23:37.424 position:50% align:middle But Virginia eventually does adopt the last part of this plan in what Jefferson refers to, tongue-in-cheek, 00:23:37.424 --> 00:23:42.344 position:50% align:middle as "The hobby of my old age." 00:23:42.344 --> 00:23:44.874 position:50% align:middle He designs the University of Virginia. 00:23:44.874 --> 00:23:46.834 position:50% align:middle He selects the faculty. 00:23:46.834 --> 00:23:54.874 position:50% align:middle He writes the curriculum consistent with his views on the importance of religious freedom. 00:23:54.874 --> 00:23:59.434 position:50% align:middle When it opens in 1819, UVA is the first university in the country 00:23:59.434 --> 00:24:02.971 position:50% align:middle without a religious affiliation. 00:24:02.971 --> 00:24:10.371 position:50% align:middle Consistent with his views on the importance of science-based healthcare, 00:24:10.371 --> 00:24:14.071 position:50% align:middle he establishes a school of medicine. 00:24:14.071 --> 00:24:21.731 position:50% align:middle Jefferson, though, always regretted that what he viewed as the most important part of his plan, 00:24:21.731 --> 00:24:27.471 position:50% align:middle broad primary public education, was not adopted in his lifetime. 00:24:27.471 --> 00:24:32.147 position:50% align:middle He told friends working with him in the formation of the University of Virginia, 00:24:32.147 --> 00:24:40.247 position:50% align:middle that if it was a choice between public primary schools and the university, he would choose the former because, 00:24:40.247 --> 00:24:48.377 position:50% align:middle "It is safer to have a whole people respectably enlightened than a few in a high state of science and 00:24:48.377 --> 00:24:52.497 position:50% align:middle the rest in ignorance. 00:24:52.497 --> 00:24:59.437 position:50% align:middle There are so many areas in which Thomas Jefferson would have had commonality with the National Council of State 00:24:59.437 --> 00:25:01.533 position:50% align:middle Boards of Nursing. 00:25:01.533 --> 00:25:08.763 position:50% align:middle The National Council is an organization of state boards, each with its own laws and regulations. 00:25:08.763 --> 00:25:15.513 position:50% align:middle Innovations in practice or regulation arise in one state that if successful can serve as a model 00:25:15.513 --> 00:25:17.353 position:50% align:middle for other states. 00:25:17.353 --> 00:25:25.943 position:50% align:middle Thomas Jefferson embraced the notion of state's rights and he's leery of excessive centralization 00:25:25.943 --> 00:25:28.473 position:50% align:middle of government power. 00:25:28.473 --> 00:25:34.704 position:50% align:middle The power in regulation is not with the National Council, it's not with the federal government, 00:25:34.704 --> 00:25:37.174 position:50% align:middle but with the states themselves. 00:25:37.174 --> 00:25:44.934 position:50% align:middle And cooperation is enhanced, workforce is optimized, and burdens on practitioners lessened 00:25:44.934 --> 00:25:46.044 position:50% align:middle through the compact. 00:25:46.044 --> 00:25:49.144 position:50% align:middle Jefferson would be pleased. 00:25:49.144 --> 00:25:52.514 position:50% align:middle Jefferson had trust in the people. 00:25:52.514 --> 00:25:59.464 position:50% align:middle He would have supported having citizen members on licensing boards as a check on the self-interest or 00:25:59.464 --> 00:26:04.303 position:50% align:middle perceived self-interest on the part of professional regulators. 00:26:04.303 --> 00:26:10.993 position:50% align:middle As you may have experienced, professional members of licensing boards, many, 00:26:10.993 --> 00:26:19.523 position:50% align:middle if not most, who have been active members of their professional associations sometimes need a reminder 00:26:19.523 --> 00:26:25.100 position:50% align:middle that their role is to protect the public, not protect the association. 00:26:35.679 --> 00:26:38.409 position:50% align:middle So let's talk about innovation. 00:26:38.409 --> 00:26:43.539 position:50% align:middle Another commonality between Thomas Jefferson and nursing. 00:26:43.539 --> 00:26:50.309 position:50% align:middle As a guide at Monticello, I notice that with all the cleverness on display, 00:26:50.309 --> 00:26:56.149 position:50% align:middle from the unique design of the house itself, the house, by the way, is a world heritage site since 1987, 00:26:56.149 --> 00:27:03.158 position:50% align:middle the only individual house to receive this honor, to the clock in the entrance hall, 00:27:03.158 --> 00:27:10.048 position:50% align:middle to the double doors that can be closed with one hand, to the wine dumbwaiters built into the dining 00:27:10.048 --> 00:27:19.108 position:50% align:middle room fireplace, to the beds built into alcoves in the wall, to the device that allowed him to make a copy 00:27:19.108 --> 00:27:22.998 position:50% align:middle of a letter while he is writing a letter. 00:27:22.998 --> 00:27:24.808 position:50% align:middle Well, you get the idea. 00:27:24.808 --> 00:27:32.840 position:50% align:middle And what I notice is that guests assume that Jefferson is an incredibly creative inventor. 00:27:32.840 --> 00:27:35.110 position:50% align:middle Incredibly creative? 00:27:35.110 --> 00:27:36.070 position:50% align:middle Yes. 00:27:36.070 --> 00:27:37.250 position:50% align:middle Inventor? 00:27:37.250 --> 00:27:40.230 position:50% align:middle Not so much. 00:27:40.230 --> 00:27:51.890 position:50% align:middle He invented maybe three things, a moldboard for a more efficient plow, for sure. 00:27:51.890 --> 00:27:54.620 position:50% align:middle But what he is is an innovator. 00:27:54.620 --> 00:28:01.729 position:50% align:middle He's one of these people, and we all know them, who always think...who always seem to know what 00:28:01.729 --> 00:28:08.349 position:50% align:middle the latest, coolest, overlooked, most useful of anything is. 00:28:08.349 --> 00:28:12.259 position:50% align:middle For Thomas Jefferson, that would be architectural ideas, 00:28:12.259 --> 00:28:16.709 position:50% align:middle construction techniques, fireplace design. 00:28:16.709 --> 00:28:24.749 position:50% align:middle It'd be things like writing gadgets or scientific instruments or political ideas. 00:28:24.749 --> 00:28:35.502 position:50% align:middle And he often takes those useful ideas of others, tweaks them, or combines them and makes them better. 00:28:35.502 --> 00:28:44.062 position:50% align:middle Political philosopher John Locke wrote about 100 years before our Declaration of Independence that people had 00:28:44.062 --> 00:28:52.422 position:50% align:middle a natural right to life, liberty, and the pursuit of property. 00:28:52.422 --> 00:28:59.272 position:50% align:middle Thomas Jefferson tweaks that a little bit into life, liberty, and the pursuit of happiness that we 00:28:59.272 --> 00:29:02.055 position:50% align:middle all know today. 00:29:02.055 --> 00:29:12.045 position:50% align:middle Jefferson wrote, "The fact is that one new idea leads to another, that to a third so over the course of time, 00:29:12.045 --> 00:29:19.215 position:50% align:middle until someone, with whom none of these ideas are original, combines all together, 00:29:19.215 --> 00:29:24.925 position:50% align:middle and produces what is justly called a new invention." 00:29:24.925 --> 00:29:32.198 position:50% align:middle Nursing is full of innovations and inventions, often practical and clever solution to specific 00:29:32.198 --> 00:29:33.578 position:50% align:middle problems in healthcare. 00:29:33.578 --> 00:29:38.908 position:50% align:middle It's like feeding tubes, crash carts, color-coded IV tubes. 00:29:38.908 --> 00:29:44.738 position:50% align:middle And sometimes nursing has ideas that change healthcare. 00:29:44.738 --> 00:29:51.138 position:50% align:middle Florence Nightingale, asserting in 1860, "The word nursing has been limited to signify little 00:29:51.138 --> 00:29:56.488 position:50% align:middle more than the administration of medicines and the application of poultices. 00:29:56.488 --> 00:30:04.938 position:50% align:middle It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, 00:30:04.938 --> 00:30:12.728 position:50% align:middle and the proper selection and administration of diet, all at the least expense of vital power 00:30:12.728 --> 00:30:17.098 position:50% align:middle to the patient." 00:30:17.098 --> 00:30:25.408 position:50% align:middle So now I'd like to bring up a couple of ideas, a couple of issues that I'm concerned about that I 00:30:25.408 --> 00:30:32.231 position:50% align:middle think Thomas Jefferson would have been concerned about and that I'd like to call to your attention. 00:30:32.231 --> 00:30:41.021 position:50% align:middle Did anyone read in "The New York Times" recently, a week ago or so, an in-depth article on marijuana? 00:30:41.021 --> 00:30:50.311 position:50% align:middle It was titled "As America's Marijuana Use Grows, so Do the Harms." 00:30:50.311 --> 00:30:51.891 position:50% align:middle Scary stuff. 00:30:51.891 --> 00:30:59.451 position:50% align:middle A pediatrician who sees teenagers so dependent on cannabis that they consume it practically all 00:30:59.451 --> 00:31:02.805 position:50% align:middle day every day. 00:31:02.805 --> 00:31:08.495 position:50% align:middle Reports of psychiatrist, which we would call a cannabis use disorder, 00:31:08.495 --> 00:31:16.985 position:50% align:middle reports of psychiatrist treating rising numbers of people whose use of marijuana has brought on delusions, 00:31:16.985 --> 00:31:22.755 position:50% align:middle paranoia, and other symptoms of psychosis. 00:31:22.755 --> 00:31:30.175 position:50% align:middle Emergency departments where physicians encounter patients with severe vomiting induced by chronic 00:31:30.175 --> 00:31:31.933 position:50% align:middle use of marijuana. 00:31:31.933 --> 00:31:39.063 position:50% align:middle A potentially devastating condition, cannabinoid hyperemesis syndrome. 00:31:39.063 --> 00:31:44.603 position:50% align:middle It was once rare, but now it's all too common. 00:31:44.603 --> 00:31:53.713 position:50% align:middle Cases of toddlers and young children who consume edible cannabis in the form of gummies. 00:31:53.713 --> 00:32:00.828 position:50% align:middle A year and a half ago, I spoke at a pain conference on the status 00:32:00.828 --> 00:32:03.358 position:50% align:middle of marijuana in Virginia. 00:32:03.358 --> 00:32:10.608 position:50% align:middle And I met a physician from University of Virginia's Blue Ridge Poison Control Center who was outraged 00:32:10.608 --> 00:32:16.188 position:50% align:middle about what she was seeing due to marijuana. 00:32:16.188 --> 00:32:22.478 position:50% align:middle This topic is of particular interest to me since medical marijuana was approved in Virginia during my 00:32:22.478 --> 00:32:26.188 position:50% align:middle tenure at the Department of Health Professions. 00:32:26.188 --> 00:32:34.027 position:50% align:middle I was directly involved in the legislative process and the implementation of medical marijuana by the Virginia 00:32:34.027 --> 00:32:36.227 position:50% align:middle Board of Pharmacy. 00:32:36.227 --> 00:32:38.257 position:50% align:middle So what's happened? 00:32:38.257 --> 00:32:46.807 position:50% align:middle Well, marijuana remains an illegal Schedule I controlled substance at the federal level, 00:32:46.807 --> 00:32:53.077 position:50% align:middle which has hindered the development of a robust body of research. 00:32:53.077 --> 00:33:01.783 position:50% align:middle In 2017, the National Academies of Science Engineering, and Medicine published in a review of research on the 00:33:01.783 --> 00:33:11.633 position:50% align:middle health effects of cannabis and warned that the lack of evidence-based information posed a public health risk. 00:33:11.633 --> 00:33:19.833 position:50% align:middle But despite the lack of research, medical marijuana is now legal in all but three states. 00:33:19.833 --> 00:33:23.343 position:50% align:middle An adult recreational marijuana is legal in 24. 00:33:23.343 --> 00:33:31.100 position:50% align:middle This is an area that I think would have concerned Thomas Jefferson. 00:33:31.100 --> 00:33:40.310 position:50% align:middle Jefferson decried the fact that medicine in his day was based on fanciful theories such as bloodletting 00:33:40.310 --> 00:33:48.640 position:50% align:middle to balance the humors instead of being based on fact and observation. 00:33:48.640 --> 00:33:57.400 position:50% align:middle In 1807, he wished to see "An abandonment of hypotheses for sober facts. 00:33:57.400 --> 00:34:04.552 position:50% align:middle The only sure foundations of medicine are an intimate knowledge of the human body and observation of the 00:34:04.552 --> 00:34:10.682 position:50% align:middle effects of medical substances on the body." 00:34:10.682 --> 00:34:15.382 position:50% align:middle Secondly, this is not your father's marijuana. 00:34:15.382 --> 00:34:20.282 position:50% align:middle That is, it's not the marijuana that was available when I was in college. 00:34:20.282 --> 00:34:30.721 position:50% align:middle Marijuana in flour form has gone from a potency of around 2% in 1970 to 4% in 1990, 00:34:30.721 --> 00:34:33.731 position:50% align:middle to around 20% or more today. 00:34:33.731 --> 00:34:38.991 position:50% align:middle And it's worse than that. 00:34:38.991 --> 00:34:50.821 position:50% align:middle The dispensaries refine their products so that they are frequently 90% THC or even more. 00:34:50.821 --> 00:34:59.731 position:50% align:middle Third, marijuana, contrary to longstanding belief, can lead to dependency or addiction issues. 00:34:59.731 --> 00:35:06.284 position:50% align:middle "The New York Times" analysis concludes that about 18 million people, nearly a third of all users aged 18 00:35:06.284 --> 00:35:13.284 position:50% align:middle and up, have reported symptoms of cannabis use disorder. 00:35:13.284 --> 00:35:21.064 position:50% align:middle Among 18 to 25-year-olds, more than 4.5 million use a drug daily or near-daily 00:35:21.064 --> 00:35:28.284 position:50% align:middle and 81% of those meet the criteria for marijuana use disorder. 00:35:28.284 --> 00:35:35.649 position:50% align:middle When I arrived at DHP in 2014, I believed that marijuana was generally safe, 00:35:35.649 --> 00:35:42.319 position:50% align:middle appeared beneficial, non-addictive, and should be legalized. 00:35:42.319 --> 00:35:51.409 position:50% align:middle But things changed my mind during my time at DHP as the medical processors, the industry sought changes 00:35:51.409 --> 00:35:56.729 position:50% align:middle to weaken regulation by the Board of Pharmacy, and that led to my current beliefs. 00:35:56.729 --> 00:36:06.402 position:50% align:middle One, medical marijuana can be beneficial for conditions such as intractable epilepsy, pain, and I'm sure more. 00:36:06.402 --> 00:36:10.292 position:50% align:middle For most users, there are no problems. 00:36:10.292 --> 00:36:17.212 position:50% align:middle But for a small but growing number of users, there are significant and very negative consequences 00:36:17.212 --> 00:36:21.862 position:50% align:middle disproportionately among young users. 00:36:21.862 --> 00:36:24.662 position:50% align:middle Number two, marijuana is big business. 00:36:24.662 --> 00:36:32.475 position:50% align:middle For state government, there's a lure of a big-time tax revenue. 00:36:32.475 --> 00:36:39.365 position:50% align:middle Medical dispensaries cater to the market and the market appears to want high potency products. 00:36:39.365 --> 00:36:46.455 position:50% align:middle Prescribers who are involved in the process in Virginia, at least, often do not have the type 00:36:46.455 --> 00:36:52.865 position:50% align:middle of prescriber-patient relationship that's expected for controlled substances. 00:36:52.865 --> 00:36:59.015 position:50% align:middle In recent years, laws and regulations on cannabis in Virginia have been greatly influenced by the 00:36:59.015 --> 00:37:07.322 position:50% align:middle stakeholder advocates overwhelming the influence of state agencies and health experts. 00:37:07.322 --> 00:37:13.462 position:50% align:middle Three, there are few regulatory guardrails when it comes to medical marijuana or 00:37:13.462 --> 00:37:15.862 position:50% align:middle adult recreational programs. 00:37:15.862 --> 00:37:24.542 position:50% align:middle Only 2 states cap levels of THC for recreational adult programs, and only 10 states, remember, 00:37:24.542 --> 00:37:30.112 position:50% align:middle there's only 3 states that don't do medical marijuana, only 10 of the states that do medical marijuana 00:37:30.112 --> 00:37:35.165 position:50% align:middle restrict their medical programs to low THC products. 00:37:35.165 --> 00:37:42.145 position:50% align:middle Only 10 states require that adult-use cannabis products come with warnings such as that cannabis can 00:37:42.145 --> 00:37:51.655 position:50% align:middle be habit-forming, or anything about cannabinoid hyperemesis syndrome or psychosis. 00:37:51.655 --> 00:37:57.525 position:50% align:middle I'm not sure about the labeling requirements for medical programs, but I know that in Virginia, 00:37:57.525 --> 00:38:02.236 position:50% align:middle we don't require any warning labels. 00:38:02.236 --> 00:38:05.036 position:50% align:middle So what's needed? 00:38:05.036 --> 00:38:11.996 position:50% align:middle Education of consumers, education of legislators, education of health professionals, 00:38:11.996 --> 00:38:19.316 position:50% align:middle research and data collection, support for legislative and regulatory guardrails, 00:38:19.316 --> 00:38:27.186 position:50% align:middle advocacy, all things that nurses do so well. 00:38:27.186 --> 00:38:35.190 position:50% align:middle The other policy issue I want to bring to your attention are the health effects of climate change. 00:38:35.190 --> 00:38:40.310 position:50% align:middle Thomas Jefferson, the scientist, was an early meteorologist. 00:38:40.310 --> 00:38:45.400 position:50% align:middle He collected weather information, temperature, and wind direction twice a day every day. 00:38:45.400 --> 00:38:47.470 position:50% align:middle It was cold back then. 00:38:47.470 --> 00:38:52.290 position:50% align:middle Monticello had an ice house where blocks of ice from the Rivanna River would be collected, 00:38:52.290 --> 00:38:59.300 position:50% align:middle stored in cool underground ice house, covered with straw, and used for cooling much or all 00:38:59.300 --> 00:39:00.497 position:50% align:middle of the ensuing year. 00:39:00.497 --> 00:39:05.817 position:50% align:middle Snow would be separately stored in the ice house to cool off drinks. 00:39:05.817 --> 00:39:13.257 position:50% align:middle In my 42 years in Charlottesville, there's never been such a freeze of the Rivanna River. 00:39:13.257 --> 00:39:19.367 position:50% align:middle Thomas Jefferson would have been involved in the science of climate change and its health effects. 00:39:19.367 --> 00:39:23.707 position:50% align:middle Nursing in Virginia is already involved. 00:39:23.707 --> 00:39:28.877 position:50% align:middle The Virginia Nursing Association together with the Virginia Department of Health is looking closely 00:39:28.877 --> 00:39:35.777 position:50% align:middle at climate and health in Virginia using public health data to show how the interrelated issues 00:39:35.777 --> 00:39:42.427 position:50% align:middle of rising temperatures, extreme weather events, air quality, vector-borne diseases are 00:39:42.427 --> 00:39:44.167 position:50% align:middle impacting our community. 00:39:44.167 --> 00:39:49.827 position:50% align:middle And there's a real overlap with health equity issues. 00:39:49.827 --> 00:39:56.897 position:50% align:middle The lead nurses in this project, Virginia Slattum and Tiffany Covarrubias-Lyttle 00:39:56.897 --> 00:40:03.743 position:50% align:middle represent both urban and rural parts of Virginia, and they understand the unique challenges of each. 00:40:03.743 --> 00:40:08.623 position:50% align:middle As nurses, and like Thomas Jefferson, they don't stop with the description of the problem 00:40:08.623 --> 00:40:11.893 position:50% align:middle but have a specific plan of action. 00:40:11.893 --> 00:40:17.753 position:50% align:middle Identify vulnerable communities, assess those communities, educate those at risk, 00:40:17.753 --> 00:40:20.283 position:50% align:middle and become an advocate. 00:40:20.283 --> 00:40:24.923 position:50% align:middle Identifying vulnerable communities is not simply geographic, but looking at the types of workers who 00:40:24.923 --> 00:40:30.848 position:50% align:middle are vulnerable, such as agricultural workers, postal workers, construction workers, 00:40:30.848 --> 00:40:34.758 position:50% align:middle or those who are housing-insecure. 00:40:34.758 --> 00:40:40.408 position:50% align:middle Assessing those communities such as identifying heat islands in urban areas or the lack of health 00:40:40.408 --> 00:40:43.258 position:50% align:middle professional access in rural areas. 00:40:43.258 --> 00:40:51.518 position:50% align:middle Or which chronic diseases in each region will be most affected by rising temperatures. 00:40:51.518 --> 00:40:56.468 position:50% align:middle Education, especially of those most likely to be impacted by heat. 00:40:56.468 --> 00:41:00.552 position:50% align:middle What heat risk...what health risk increase with heat? 00:41:00.552 --> 00:41:06.712 position:50% align:middle How to adapt to heat in the spring and how to manage it when it's hottest in the summer. 00:41:06.712 --> 00:41:13.792 position:50% align:middle How to store medications such as inhalers and insulin so they don't degrade when the temperature is hot. 00:41:13.792 --> 00:41:15.762 position:50% align:middle Skin cancer detection. 00:41:15.762 --> 00:41:19.912 position:50% align:middle Resources available in each community. 00:41:19.912 --> 00:41:25.272 position:50% align:middle And advocacy, how nurses can educate themselves, get involved in research, 00:41:25.272 --> 00:41:29.702 position:50% align:middle work with health systems and legislators. 00:41:29.702 --> 00:41:36.131 position:50% align:middle So there's much more I could tell you about Thomas Jefferson, a brilliant, important, complicated man, 00:41:36.131 --> 00:41:43.061 position:50% align:middle a product of his times, human, like all of us with occasional inconsistency 00:41:43.061 --> 00:41:46.271 position:50% align:middle between his words and actions. 00:41:46.271 --> 00:41:53.881 position:50% align:middle Thomas Jefferson claims to hate politics, but he's elected President twice. 00:41:53.881 --> 00:42:00.366 position:50% align:middle He gives advice to his grandchildren to never spend your money before you have it, 00:42:00.366 --> 00:42:03.626 position:50% align:middle but he dies deeply in debt. 00:42:03.626 --> 00:42:08.116 position:50% align:middle He's a harsh critic throughout his adult life of the institution of slavery. 00:42:08.116 --> 00:42:15.236 position:50% align:middle He calls slavery a moral depravity, yet he owns over 600 individuals over the course 00:42:15.236 --> 00:42:17.756 position:50% align:middle of his lifetime. 00:42:17.756 --> 00:42:22.576 position:50% align:middle But I think I should stop with what I know best, professional regulation, 00:42:22.576 --> 00:42:31.205 position:50% align:middle and leave these more difficult and thorny issues to the real experts you'll hear from later today and tomorrow. 00:42:31.205 --> 00:42:35.535 position:50% align:middle But first, I want to let you know how much I appreciate you having me here today. 00:42:35.535 --> 00:42:43.585 position:50% align:middle I came to this conference a big fan of the profession of nursing, but after preparing for this talk, 00:42:43.585 --> 00:42:45.465 position:50% align:middle I'm an even bigger fan now. 00:42:45.465 --> 00:42:47.225 position:50% align:middle Thank you so much. 00:42:54.259 --> 00:42:57.417 position:50% align:middle And I think we have time for some questions if anyone has any. 00:43:03.168 --> 00:43:11.128 position:50% align:middle I always feel like if I talk long enough, no one has any questions. 00:43:11.128 --> 00:43:11.598 position:50% align:middle Okay. 00:43:11.598 --> 00:43:17.418 position:50% align:middle Well, thank you so much. 00:43:17.418 --> 00:43:19.348 position:50% align:middle - [Claire] I have a question, David. 00:43:19.348 --> 00:43:23.918 position:50% align:middle You know, David, one of your many experiences was also working in the legislature, 00:43:23.918 --> 00:43:25.828 position:50% align:middle and we didn't hear a lot about that. 00:43:25.828 --> 00:43:27.938 position:50% align:middle So perhaps you can... 00:43:27.938 --> 00:43:34.359 position:50% align:middle You know, speaking to a room of nursing regulators and some educators, any thoughts you have related to your 00:43:34.359 --> 00:43:41.109 position:50% align:middle experience in the legislature and the influence of regulators and working together? 00:43:41.109 --> 00:43:42.239 position:50% align:middle - Well, thank you, Jay. 00:43:42.239 --> 00:43:45.729 position:50% align:middle And that wasn't a plant, by the way, you know. 00:43:45.729 --> 00:43:56.739 position:50% align:middle And I think Virginia has benefits from having a system where, in general, the agency heads and the content 00:43:56.739 --> 00:44:03.142 position:50% align:middle experts from each agency are welcomed at committee meetings of the legislature to help inform the process. 00:44:03.142 --> 00:44:13.432 position:50% align:middle And I don't know if that's always true in all states, but I think it's important because if legislators are 00:44:13.432 --> 00:44:18.842 position:50% align:middle talking about a bill on nursing education, they need to have Jay Douglas there. 00:44:18.842 --> 00:44:21.322 position:50% align:middle - Claire Morris. 00:44:21.322 --> 00:44:23.342 position:50% align:middle - I'm sorry, Claire Morris. 00:44:23.342 --> 00:44:26.492 position:50% align:middle Jay Douglas is old news. 00:44:26.492 --> 00:44:33.607 position:50% align:middle So if they're talking about the health effects of cannabis, they want Caroline Juran, 00:44:33.607 --> 00:44:36.277 position:50% align:middle who runs the Board of Pharmacy there. 00:44:36.277 --> 00:44:38.497 position:50% align:middle They don't need another politician. 00:44:38.497 --> 00:44:41.147 position:50% align:middle They don't need necessarily other people. 00:44:41.147 --> 00:44:47.267 position:50% align:middle So developing relationships, learning who the effective lobbyists are because 00:44:47.267 --> 00:44:52.467 position:50% align:middle like it or not, lobbyists kind of make the world go around in the legislature. 00:44:52.467 --> 00:44:56.647 position:50% align:middle Develop individual relationships with legislators. 00:44:56.647 --> 00:45:02.959 position:50% align:middle And if nothing else, developing your own relationship with the legislators 00:45:02.959 --> 00:45:05.079 position:50% align:middle that represent you. 00:45:05.079 --> 00:45:13.099 position:50% align:middle Attending their fundraisers, you know, going to meetings, letting them know who you are so 00:45:13.099 --> 00:45:18.279 position:50% align:middle that when they have a nursing bill come before them, they might think to call you to find 00:45:18.279 --> 00:45:21.739 position:50% align:middle out what you think. 00:45:21.739 --> 00:45:23.429 position:50% align:middle Thank you, Jay. 00:45:23.429 --> 00:45:24.529 position:50% align:middle And thank all of you. 00:45:24.529 --> 00:45:30.837 position:50% align:middle - [Man] I just wanted to ask, it sounded like you had studied Jefferson 00:45:30.837 --> 00:45:35.677 position:50% align:middle for some time, but was there something that you discovered about him after you started working as a 00:45:35.677 --> 00:45:39.967 position:50% align:middle tour guide, a docent there at Monticello, something that perhaps you had not known 00:45:39.967 --> 00:45:43.357 position:50% align:middle about him previously? 00:45:43.357 --> 00:45:47.017 position:50% align:middle - I should have an answer to that. 00:45:47.017 --> 00:45:48.257 position:50% align:middle You know, I've learned a lot. 00:45:48.257 --> 00:45:52.957 position:50% align:middle I mean, it would be a real exaggeration to say that what I know now I knew all along. 00:45:52.957 --> 00:45:57.017 position:50% align:middle It really came through an intensive course of study. 00:45:57.017 --> 00:46:04.528 position:50% align:middle I didn't know going in that Jefferson died in such debt. 00:46:04.528 --> 00:46:08.588 position:50% align:middle I assumed that he invented a lot of stuff. 00:46:08.588 --> 00:46:20.778 position:50% align:middle I would say the main thing I learned about Thomas Jefferson was how even though he is Virginia gentry, 00:46:20.778 --> 00:46:28.968 position:50% align:middle you know, he's the upper crust of Virginia society in the 1700s and early 1800s. 00:46:28.968 --> 00:46:36.999 position:50% align:middle Yet he genuinely feels so strongly that this should be a nation of the people. 00:46:36.999 --> 00:46:39.589 position:50% align:middle That people should be empowered. 00:46:39.589 --> 00:46:42.349 position:50% align:middle That he's genuinely a man of the people. 00:46:42.349 --> 00:46:44.499 position:50% align:middle He dresses simply. 00:46:44.499 --> 00:46:50.739 position:50% align:middle And when he's president, I would say in the White House, 00:46:50.739 --> 00:46:53.009 position:50% align:middle but it wasn't called the White House yet because it wasn't painted white, 00:46:53.009 --> 00:47:00.542 position:50% align:middle it became white after the War of 1812 when it got stained from fire, but when he's in the White House, 00:47:00.542 --> 00:47:02.172 position:50% align:middle he has lots of dinners. 00:47:02.172 --> 00:47:07.472 position:50% align:middle That's kind of how he is successful, is having small groups of people, conversation, 00:47:07.472 --> 00:47:10.552 position:50% align:middle get people thinking how he's thinking, right? 00:47:10.552 --> 00:47:18.312 position:50% align:middle Well, he does what's called the pell-mell style of dining, which means that instead of having people 00:47:18.312 --> 00:47:26.272 position:50% align:middle seated based on rank or privilege at the table, people seated themselves. 00:47:26.272 --> 00:47:30.536 position:50% align:middle Drove the British ambassador crazy. 00:47:30.536 --> 00:47:32.776 position:50% align:middle But he's making a statement. 00:47:32.776 --> 00:47:35.096 position:50% align:middle We are no longer... 00:47:35.096 --> 00:47:37.006 position:50% align:middle We're not an aristocracy. 00:47:37.006 --> 00:47:38.866 position:50% align:middle We're not a monarchy. 00:47:38.866 --> 00:47:40.846 position:50% align:middle We're a government of the people. 00:47:40.846 --> 00:47:48.546 position:50% align:middle And what better way to make a little statement every time people eat there? 00:47:48.546 --> 00:47:49.991 position:50% align:middle So thank you very much.