Underwood’s remarks begin at 22:42 in the video.
Thank you. Thank you so much.
Hello, Michigan School of Nursing. I am feeling so joyful to be with you today. It is very special to be back in Ann Arbor. Thank you, Dr. Zielinski, for your kind introduction.
And I want to acknowledge Dean Hurn and the faculty, some of whom who taught me when I was working towards my BSN and the staff here today.
I want to specifically recognize two women who supported me and so many others with their wisdom and guidance, Dr. Jade Burns and Dr. Patricia Coleman Burns. [cheering]
To each of the graduates, what an honor and a privilege it is to be with you today as we celebrate your achievements and welcome so many of you into the nursing profession. You are leaders and best.
So, it's 2005 and I'm in the second semester of my freshman year here at Michigan. It's 8 a.m. on a Monday morning, and I am thrilled to be in class. I'm not kidding. No, really. The course was an honors seminar in health policy and its influences on health disparities. It was taught by one of Dean Hurn's predecessors, Dean Ada Sue Hinshaw, and the former director of our undergraduate nursing program, Dr. Barbara Guthrie. These women were teaching a class for freshmen. I was so impressed. It wasn't only the professors who left an impact.
Up until the moment that I bought the "Policy and Politics in Nursing and Healthcare" textbook, I didn't realize I could combine the two things that I felt most passionately about, policy and nursing, into a career. I can tell you, honestly, that class set me on my path to Congress.
I knew I wanted to be a healthcare provider since I was a kid. I’d tell anyone who I asked that I was going to be a pediatric cardiologist when I grew up. This was, of course, before I could spell pediatric cardiologist, and way before I took organic chemistry. [laughter]
Let me explain. I was born with supraventricular tachycardia. It's well controlled today, but I spent a lot of time at the doctor's office as a kid. And the care that I received as a child has stayed with me all my life.
As I got older, I found that I was equally passionate about making a difference in my community. I've been a Girl Scout all my life. I was even a member of my community's fair housing commission when I was in high school. But I thought public service was an extracurricular activity, something you do outside of school and work. Dean Hinshaw and Dr. Guthrie changed that for me.
Now, let's fast forward to 2017. I was 30, wrapping up my absolute dream job at the Department of Health and Human Services. I had been appointed by President Obama to help guide the federal response to the Ebola epidemic, the Flint water crisis, and other public health emergencies.
I stayed until the very last day of the administration. I didn't particularly know what was next for me, but I knew that I couldn't in good conscience stay at HHS. The incoming administration had made it very clear that their intention was to overturn the Affordable Care Act and take healthcare away from millions of Americans. That's not why I became a nurse.
So, I moved back home to Naperville, Illinois. And friends, I was minding my own business and living my very best millennial life when my representative in Congress made a promise. While the debate over the future of the Affordable Care Act was raging in Congress, he pledged that he would not repeal healthcare coverage for people with preexisting conditions. I took him at his word.
So two weeks later, when that now former congressman voted for a version of ACA repeal that jeopardized the healthcare coverage for 300,000 people in my community — people with diabetes or depression or a heart condition like me — I made a decision. I was running for Congress.
One of the first things that we learn in nursing school is our code of ethics. We are duty bound to advocate for our patients' rights. We are guided by compassion, clinical excellence and a commitment to healthcare as a human right. So when my community's healthcare was threatened, I felt a responsibility as a nurse to step up.
That's not to say I wasn't scared. I was terrified. But our professors didn't only teach us clinical excellence, they taught us to be the next generation of nurse leaders.
As soon as I found out that deciding to run for Congress and actually launching a campaign — well, they were very different things. I didn't have a staff or consultants. I had my friend, Sarah, who stepped up as my campaign manager. We were a team of two and Lauren Underwood for Congress was a very DIY operation.
For months, Sarah and I confronted all of the challenges that come with launching a campaign. We built a website, constructed a policy platform, and we shot a campaign launch video. I remember we didn't sleep the night before we shared our big secret project with the world because among other things, we were hunting for royalty-free background music to use in our announcement video. I told you it was DIY.
I rode the Metro to work the next morning. I felt a shock of adrenaline as I scrolled through POLITICO Playbook and saw my announcement in the news — the secret was out. I had no idea how our campaign would be received, but I had absolute confidence I was doing the right thing. I felt the fear and did it anyway.
In November, 2018 against all odds, my first race for public office ended in a five-point victory. At 32, I became the youngest black woman to serve in Congress. [applause]
Listen, I know that my story is unique, but remember this — you have been prepared for leadership, too. I'm not saying you have to run for Congress. Nurses can be leaders in a clinic, a university, a C-suite, a public health board — the opportunities are endless.
What matters is that you share your expertise. Because listen — our communities need our leadership. Our voices and our expertise are critical, especially right now.
It's a different thing to step into leadership, to have your credentials examined and your background scrutinized. I'm not gonna tell you otherwise. It feels hard because it is hard. But just like I was, you have been prepared to be a leader, and you already have everything you need to make an impact.
Early on at Michigan, I developed an interest in maternal health, infant mortality and health disparities. My honors project explored increasing Medicaid reimbursement for nurse midwife free services. It was an uncommon research topic at the time and my advisor, Dr. Tony Vilero — I have to shout out Dr. V — actively created opportunities for me to present my findings.
As I dug into the data, I found my personal policy mission — saving moms’ lives. Black birthing people are three to four times more likely to die as a result of pregnancy-related complications than their white counterparts. That disparity has only worsened during my lifetime. This inequity doesn't only steal parents' lives — black infants are twice as likely to die in their first year of life as white infants.
The causes of these unacceptable trends are multifaceted. They include both clinical and nonclinical drivers. We see implicit bias and racism in the care that people receive throughout the perinatal period. We see shortages of nurses, midwives, physicians, and doulas, and we see the role of social determinants of health, like housing, transportation, nutrition, and environmental factors that are leading to adverse maternal health outcomes and disparities.
It's an ugly manifestation of institutional racism. These are the very same health disparities that ravaged black and brown communities at the height of the pandemic.
The United States has the highest rate of maternal mortality of any high-income nation. It's shameful.
So, when I was sworn in as a member of Congress, I knew it was my responsibility as a nurse to do something about it. I partnered with a fellow black congresswoman, Dr. Alma Adams of North Carolina, and we gave ourselves the name, the Black Maternal Health Caucus.
And I'll be real, I thought Dr. Adams and I would remain a caucus of two. My friends, the Black Maternal Health Caucus now includes more than 100 members of Congress, Democrats and Republicans. [applause]
Together, we've introduced a package of 12 bills to comprehensively address the maternal mortality crisis in America. You've heard of omnibus legislation, we call ours the “mommy bus."
Last November, I stood next to President Biden as he signed the first piece of the “mommy bus" into law, the Protecting Moms Who Served Act, and it began right here at the University of Michigan, School of Nursing — that's what happens when you step into leadership.
The story of the Black Maternal Health Caucus isn't only about leadership, it's about representation. Representation matters.
Black women and families have always known the severity of the maternal mortality crisis in this nation because they've lived it. I've lived it. And it's a community of black women working together at the highest levels of power who will end this crisis, because for us, it's personal.
I met my friend, Shalon, on the first day of graduate school. Sometimes you run into someone who is undeniably special, brilliant without question. That was Shalon — a published author with a dual doctorate, a lieutenant commander in the U.S. Public Health Service Commissioned Corps, a great friend, a talented chef, and so much more.
She was beyond excited to become a mom. She gave birth to her first child, a baby daughter named Soleil in January of 2017. A few days after giving birth, Shalon began showing symptoms of postpartum complications. When she shared her concerns with her healthcare providers, she was sent home. Shalon went to the doctor three times during what tragically, unacceptably turned out to be the last week of her life. Three weeks after giving birth to her daughter, Shalon died. She was 36 years old.
So remember this — those things that make you different, make your leadership all the more powerful and all the more necessary.
As nurses, we must recognize the power of our voices. As citizens, we must do the same.
It's my responsibility to remind you that without active engagement, American democracy will falter. Our democracy is too precious, too essential to let it slip away.
And because this school nurtured my passion for policy, I want to encourage you to explore your own.
Almost everything you'll do as a nurse, from the treatments you administer to how long a patient can stay on your unit, to how much you're getting paid, to the kind of PPE you have access to involves political decision making.
As nurses, we can more effectively advocate for ourselves, our patients and our communities when we understand how policy decisions shape the care we deliver.
As our student speakers said, we must dare to provide healthcare for all.
Today, I'm asking you to recognize that as a political statement. To make good on that promise, we need nurses to be involved as agenda setters, barrier breakers, decision makers. At this moment in history, your leadership is critical.
I know how challenging the past two years have been and I want to recognize your resolve in the face of unprecedented challenges.
The majority of your clinical experience occurred during a once-in-a-century pandemic. Many of you have grappled with the challenges and inequities of our healthcare system before your career even began. At times, you may have felt your commitment and courage pushed to the limits, and now, you are uniquely prepared to drive transformational change in your communities.
Before I close, I want to encourage you to recognize the community you're graduating with. These are your lifelong friends and colleagues, the people who will inspire you professionally and be by your side on the biggest days of your life.
I met my friend, Lauren Inouye, on the first day of my freshman year. She and I were in that early morning honors seminar on policy that I told you about, though she was less thrilled to be in class at 8 a.m., okay.
Today, Lauren is a leader at the American Academy of Nursing and I officiated her wedding last week.
Suzanne Miyamoto is another close friend of mine from my time in Ann Arbor. She was a Ph.D. student when I was an undergraduate. She's like a sister to me, and Lauren and I are godmothers to Suzanne's daughter.
Jackie Dufek was another one of my favorite friends from the School of Nursing. She and I bonded over our shared love for the "Oprah Winfrey Show" and even made a trip back to Chicago to sit in the audience for a special episode. Jackie is in the audience today.
Those are some of my people. Please look around — these are yours.
I decided to mount my unlikely campaign for Congress because I felt people of conscience needed to stand up for our shared values. I believe that's even more true today and that this moment specifically requires nurse leadership.
Stepping into leadership has a ripple effect. You show others what's possible. You inspire them to tap into their own strength. That's the power that you hold and the responsibility you carry. Remember, we are leaders and best.
Thank you so much, and congratulations. [applause]