Nursing's Dream Team:
In its first decade,
There is a new phenomenon shaping up on the East Baltimore
campus, one that uses the impetus of market-driven changes in
medicine to create new systems of health care delivery, new
paradigms of efficiency, new models of patient care.
They call it Power Nursing.
"Oh it's just a term we use jokingly among ourselves," says School of Nursing dean Sue Donaldson with a chuckle. She pauses a moment to consider, and then starts talking earnestly about the brave new world of nursing at Johns Hopkins. As she talks, she becomes increasingly animated and excited by what she is saying, an occurrence not uncommon among nursing professionals at East Baltimore. Everyone, it seems, is excited by what is happening there these days.
"I suppose by power nursing we mean these types of activities that are moving nursing forward to address its societal mandate," Donaldson says. "It's the accumulation of knowledge through research, the promotion of new technologies and new ways of doing things and the need to do all of this on an international scale. That's power nursing."
The term may be somewhat tongue-in-cheek, but the transforming changes it describes are very real. And, according to many, they are occurring at a tremendous rate.
"I would say that the core elements of nursing have remained consistent over the years, and that is the commitment to quality and excellence in patient care," says MaryAnn Fralic, vice president for nursing at the hospital. "However, at the same time, the environment has changed dramatically. The speed of that change, and the depth of the impact have been quite profound. It is naive to expect that we can continue to practice and to teach nursing in the same manner as if these changes are not occurring."
Chief among those changes is the market-driven reduction in the length of time patients now spend in the hospital. "Open heart surgery patients used to be here for eight days; now we are approaching four," Fralic says. "One of the challenges facing the profession is to make linkages with patients both before and after the hospital stay. How can we best prepare for patients that come in in the morning, have an operation several hours later, and are sent home in a day or two? How can we still meet very aggressive clinical outcomes for patients who are here today, gone home tomorrow?"
A key factor in responding to these changes has been an increased focus on research, an avenue of pursuit well suited to the existing Johns Hopkins culture. "The changes in health care have created an increasing emphasis on measuring and predicting health outcomes, which is often the focus of nursing research," says Martha Hill, associate professor of nursing and director of the school's Center for Nursing Research.
Hill's expertise in outcomes-focused research in hypertension led her to become deeply involved with the prestigious and influential American Heart Association, where she was recently elected president for 1997-98, the first non-physician to hold that post in the organization's 72-year history.
In the last decade, the National Institute for Nursing Research was established at the NIH. Since that time, says Hill, nursing research has truly come into its own. "Nothing opens up the doors like money," she says. "Nursing research lies at the intersection of the biological and behavioral sciences. It's not enough just to look at what happens in the lab or in the hospital. We also need to conduct research into what happens in the home and the community, such as studying the faculty practice of Marion D'Lugoff at the Rutland Center in East Baltimore."
One way in which Hopkins Nursing has taken a prominent national leadership position in a very short time is through the unusually effective collaboration fostered between the School of Nursing and the Hopkins hospital clinicians. "This is a sense of collaboration that is actively fostered," said Kathleen Sabatier, director of the Institute for Johns Hopkins Nursing.
Established just within the past year, the institute is a joint venture between the School of Nursing and the hospital's Department of Nursing, designed to share the innovations in practice, science, and scholarship of Johns Hopkins Nursing, both within the East Baltimore campus community and with other healthcare professionals worldwide. One of the key functions of the institute is to ensure that the latest research is applied in practice, and developments in practice are familiar to those engaging in research and teaching.
"We'd like to blur the lines as much as we can between practice and education," Sabatier says. "We should be participating in both on both sides of the street. The institute represents a marriage of the academic cutting edge with excellence in practice."
As the research-driven knowledge base of nursing grows, and the advancements of technology and the need for ever-greater efficiencies place increasing demands on nursing professionals, the need for advanced practice nurses--those with the equivalent degrees of a master's or higher--will, it is predicted, soon become critical.
"This is undoubtedly one of the ways nursing has changed a great deal in the past few years," says Jacquelyn Campbell, the Anna D. Wolf Endowed Professor of Nursing and director of the school's doctoral program. "In practice nurses have become much more autonomous. They are now decision makers, sometimes on a large scale. It has become more and more apparent that we need more doctorates in nursing, both in research and in teaching. The knowledge base has grown and the level of expertise required is simply much higher than it once was."
Advance practice nurses are the nursing leaders of tomorrow, and the school and hospital both have placed special emphasis on recruiting, training and retaining nurses with advanced degrees. "Years ago the head nurse earned the position by seniority," says Karen Haller, director of medical nursing at the hospital. "Now there are high standards to qualify for the position of nurse manager. The demand for these nursing leaders far outstrips the supply. There is a shared belief at the hospital that the role of the Hopkins School of Nursing will be to supply leaders for tomorrow, and in fact, in the master's-level course I teach called Professional Issues, we make this expectation explicit."
"We want our students to be leaders," agrees associate professor Fannie Gaston-Johansson, who holds the Elsie M. Lawler Chair of Nursing and directs the school's international and extramural programs. Gaston-Johansson recently helped the school establish a multiparty international exchange program that will partner the Hopkins nursing program with members of the European Union.
"To be a leader you have to be well grounded in what you're doing and you have to have a vision," she said. "Our students need the broadest possible perspective, and you can't do that just by staying in Baltimore. We want to prepare Hopkins nurses for leadership positions in the world arena."
All of which reflects the emerging sense of international prominence that Fralic and Donaldson--the chief proponents of power nursing--envision for Hopkins nurses. "What MaryAnn and I are trying to strive for," says Donaldson "is that when the words nurse and Hopkins are associated it always means the best. We're not just here to develop professionals. We're here dedicated to affecting and improving health care for all people. That's what it means to be a Hopkins nurse."
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