Health care becomes a more bottom-line business every day and nurses, like everyone else in the field, must adapt to this new reality.

"Traditionally, nurses cared for patients," said Stella Shiber, associate dean of nursing in the School of Nursing. "Now they must put a dollar figure on the patient's needs and present that to the person paying the bills."

Shiber is part of a team from the School of Nursing and the School of Continuing Studies that has developed a new certificate program called the Business of Nursing. The first course in the program starts in January 1998, running on Tuesday nights for 10 weeks. Students must start at the beginning of the four-course, nine-month sequence, which runs through mid-November.

The changes in the health care industry, said Shiber, mean that nurses now need different skills. Formerly, they advanced through levels of clinical ability and learned administrative skills as needed during their careers. Now, in addition to their abilities to evaluate a patient's illness, they need to place that illness into a business context.

"A nurse must put together a business plan," Shiber said. "What are the costs of a given course of treatment? Where is the best place to provide care? It's important for a nurse to speak the languages of insurance and management."

So far, the program has received over 200 inquiries from nurses who want to learn those new languages, said Patricia DeLorenzo, a senior program director in the School of Continuing Studies, who oversees the new program. Applicants must have a bachelor's degree in nursing, or the equivalent, and some clinical experience. DeLorenzo said that prospective students come from a variety of nursing backgrounds, such as hospitals and freestanding clinics.

Shiber expects that students will come from many nursing specialties, and will have clinical or management experience or both. She expects that many applicants will either already have a master's degree or some experience in management. Credits earned in the Business of Nursing certificate program can be applied later toward a Hopkins master's degree in nursing management or business.

Shiber said that, except for some summer or combined nursing MS/MBA programs, there is no other equivalent to the new Hopkins certificate program.

The first course--called Emerging Health Care Systems and Concepts--will be taught by Karen Haller, director of Nursing in the Department of Medicine and associate professor of nursing. Over the 10 sessions, Haller and invited speakers, who are experts in their fields, will cover everything from a history of health care systems to medical informatics to legal and ethical issues.

In addition, bringing together nurses from different health-care environments will itself prove educational. "It will give them an opportunity to talk about where they are now and where they are going," DeLorenzo said.

The nursing program is modeled on the existing Business of Medicine program, although with a different focus.

"Doctors are also reacting to the new health care environment," Shiber said, "and they need to regain control of their medical practice."

On the other hand, she said, nurses want to function effectively in their traditional role, dealing with patients in a variety of settings and serving as their advocate. Historically, that care and advocacy required minimal consideration of cost.

"Now you can't do that," Shiber said. "We have to give a business focus to their nursing careers. It's no longer possible to function in the many different roles that nurses fill without this better understanding of business and how to interface with financial organizations."

The program will use a hands-on approach to eliminate the mysteries of management accounting and computer systems. The sequence of four courses in the program includes Emerging Health Care Systems and Concepts, Managing Financial Outcomes, Managing Clinical Outcomes, and Synthesis and Integration of Nursing and Business.

The program is organized as an executive-level course, so all course materials, textbooks and CD-ROMs are included in the $4,800 tuition. No more than 20 or 30 students will be admitted to each program.

Starting in September 1998, Hopkins will offer the program again in Baltimore as well as at the Montgomery County Center in Rockville. More information on the program is available from Patricia DeLorenzo, 410-516-4221.