Q&A: Shelly Smith, VCU School of Nursing on Virginia’s workforce and health equity


Nicole Pasia


Shelly Smith, DNP, APRN-BC, is the director of advanced practice programs at the Virginia Commonwealth University (VCU) School of Nursing. Smith oversees VCU’s nurse practitioner, nursing administration, and doctoral clinical tracts. Smith also works with VCU’s Wilder School for Government and Public Affairs to provide a health care perspective to translate research into public policy initiatives.

In this Q&A, Smith spoke with the State of Reform about supporting Virginia’s nursing workforce during the pandemic, improving health equity, and infrastructure for better health services in the Commonwealth.


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Nicole Pasia: Virginia’s health care workforce has faced significant shortages throughout the pandemic. From your work with the School of Nursing, what trends have you noticed, and what are your most significant concerns?

Shelly Smith: “People know a lot about their research and are really passionate about their research, but they don’t see it within the context of the macro system. As we think about health care, I really think about health and all policies: housing, economic stability, food insecurity, even urban planning, because Virginia is a state that has a really interesting geography. We have metropolitan northern Virginia and then we have southwest Virginia that’s extremely rural. So people don’t often see how their research may or may not impact health outcomes. 

Workforce development sort of falls in that [work], too. COVID has brought to light lots of health disparities, but also lots of opportunities for innovation and rapid change. When I think about Virginia’s workforce, specifically as I think about COVID, we have a huge mental health problem that predated COVID. We had a shortage of mental health providers, and then Virginia had to close five state hospitals in July due to workforce shortages in mental health facilities. And we’re seeing a surge and backlog of patients that can’t get access to mental health services. 

And then we coupled that with what we’re seeing with adolescence. We’re seeing more problems with adolescent mental health and child mental health and it’s really pushed us. We have got to find a workforce solution for that because we have an increased patient demand and we have a decreased supply of providers.” 


NP: Can you speak on some of the initiatives you’re following that address those concerns?

SS: “We’ve had some moves in the right direction. We had the Virginia Mental Health Access Program (VMAP), which is partially state and federally funded, as a way to help train primary care clinicians in [providing] mental health services. That’s one step but it’s not going to fill the gap that we have. So I think there’s an opportunity to be innovative. 

The Senate passed a bill, SB 1307, which allows public schools to bill [Medicaid] for health services. That’s a huge step when we think about the hospitals. This evolving place — it’s no longer ‘You get there, you get well and you leave.’ Care has spread out into the community, a hospital without walls. What better place to help children than in their own school system? …

There’s a lot of opportunities around workforce development. Virginia has a budget line amendment so that we can increase our nurse practitioner workforce by financially incentivizing preceptors. We’re working on finalizing what that promulgation will look like.”


NP: In some of my other conversations, I’ve heard a concern for the quality of education Virginia’s medical students are receiving during the pandemic, particularly with virtual or remote learning. How has that impacted VCU? 

SS: “I practice at VCU’s health system and I work in post acute services. I’m noticing … how time intensive [it] was for our care coordinators, our nurses, and our social workers to do COVID teaching … It created this throughput backlog where we couldn’t get patients discharged until they had the teaching. 

And then we have students that couldn’t go into the health system. So I approached our dean and said, ‘Can we build a virtual call center at the School of Nursing?’ So that’s what we did. We partnered with the health system and we put undergraduate and graduate students in our large auditorium at workstations, and had that set up so that they could access [electronic health records] from the School of Nursing and then call the patient’s rooms from our school.

The learners got a lot out of it because it’s a hard skill to learn how to talk to someone on the phone who’s sick and scared. It’s just different than being in their room holding their hand, but it’s a necessary skill, particularly when we think about healthcare moving out of the hospital. A lot of things that we do now are remote, they’re digital health. 

I also think that has helped us recognize in higher education as we train workforce that we need to integrate telehealth and digital health modalities into our curriculum. That’s not something that’s routinely integrated into curricula.” 


NP: I saw you recently moderated an environmental broadband panel at the VCU Virtual Colloquium Addressing Health Equity in Virginia. What were notable points from that conversation, particularly on the intersection between broadband and health care?

SS: “We talked a lot about digital equity. So, it used to be that we thought about the digital divide as being dichotomous: you had access to the internet or you did not. Now we have improved access. Governor [Ralph] Northam’s vision is to have everybody have broadband access by 2025. …

We talked about rather than telehealth or digital health being an add-on into healthcare, we really need to transform the healthcare system so that it’s an integrative approach to person-centered care. …

We got into some conversation with Dr. [Vimal] Mishra from VCU health about remote technologies. We have all these wearable technologies that have a lot of data. How do we capitalize on that, as clinicians, to build health into daily activity? And so I thought our discussion was robust and interesting because of the folks we had in the room. Everybody had a little bit of a different lens about broadband … but what we all kept coming back to was really the idea of digital equity.”

This conversation was edited for clarity and length.