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The newspaper of The Johns Hopkins University February 23, 2004 | Vol. 33 No. 23
SON at 20: A Division Steps Into Adulthood

Martha Hill, the School of Nursing's third and current dean, with portraits of the first two superintendents of nursing at Johns Hopkins.

By Greg Rienzi
The Gazette

They sure grow up fast. The School of Nursing is still the youngest offspring of the university, but it's about to leave childhood behind.

This year marks the 20th anniversary of the School of Nursing as a full division of the university. It also marks 115 years ago that the Hopkins nursing education program began. To honor these and other Hopkins landmark events, the school has embarked on its 2004 Milestone Celebration: A Yearlong Commemoration of Our History.

The kickoff event is "Who Will Care for Us?" a symposium this week on the role of nurses in an aging population. The keynote speakers are Claire Fagin, director of the John A. Hartford Foundation's Building Academic Geriatric Nursing Capacity Program, and Bill Novelli, CEO and executive director of AARP. Fagin, who last year received an honorary doctorate from Johns Hopkins and spoke at the School of Nursing Diploma Award Ceremony, is the dean emeritus of the University of Pennsylvania School of Nursing and former interim president of Penn.

Sam Donaldson, ABC News correspondent, will moderate the panel discussion, which will take place from 4 to 6 p.m. on Thursday, Feb. 26, in the School of Nursing Alumni Auditorium. A full list of anniversary proceedings can be found at events/milestone/.

On the eve of the first celebration, The Gazette sat down with School of Nursing Dean Martha Hill, who was named interim dean in June 2001 and dean in summer 2002.

JHU to her core, Hill earned her R.N. diploma, bachelor's degree and doctorate at Johns Hopkins and has been a member of the faculty since 1980. She was one of the first four faculty members hired when the School of Nursing was established as an independent division of the university in 1984. Previously, nursing education at Hopkins had occurred within another university school or in a hospital-based school.

Talking in her office in the Anne M. Pinkard Building, opened in 1998 as the School of Nursing's first permanent home, Hill reflected on the past, present and future of the school, which she said has literally outgrown its footprint and is poised for yet another growth spurt.

Q: Walking down the hall with you just now, people all seemed to know not only you but one another. Is it that tight-knit a community here?

A: We have a very strong community here. There is a sense of pride in being the School of Nursing in this university. It did take a while to get there. We are extremely proud of this building, and we are very proud of the quality of our students and academic programs — and, of course, our faculty and staff. That is why I instituted all-school retreats once a year, and all-school meetings twice a quarter, as a way of bringing our students, staff and faculty together to talk about issues that are common to all of us.

Q: What, in essence, are you celebrating this year?

A: We are celebrating everything [laughs].
   It started out by the fact the school is going to be 20 years old. So, to me, this means becoming an adult. We have had Carol Gray as the founding dean; she got us through gestation, labor and delivery and childhood. Sue Donaldson was the dean in the next phase of life; she sort of got us through that tremendous growth spurt, literally building this building we are sitting in today. The other mandate Sue had been given was to build the research infrastructure, which she did very, very ably. We then leapt into the top 20 for research nationally, and then we went from 15 to nine, all with just 10 faculty writing grants on the research track. That is rather remarkable when you consider many of our peer research institutions are nearly twice our size.

Q: Why are you honoring all the milestones?

A: I see [the school] as someone who is ready to go off to college and learn to be independent. You need to look back and appreciate all those different milestones that were the foundation from which you can now go forward.

Q: Why was the "Who Will Care For Us?" topic chosen to kick off the yearlong celebration?

A: Caring for our aging population is a key secular thread that runs through everything we do at Hopkins Nursing, from training to development, and is universal to all Americans. We are aging, we are caring for aging parents, and a large segment of our health care provider population is moving toward retirement. It's a critical issue we must look at today and find solutions for tomorrow.

Q: This year you started 'Johns Hopkins Nursing' magazine. Why did you launch this publication?

A: The launching of the magazine was a very deliberate strategy to achieve several goals. One of my charges as dean is to enhance the partnership with Johns Hopkins Hospital's Department of Nursing — to bring these two together, the way the School of Medicine is tied to the hospital. So, Karen Haller [director of medical nursing at JHH] and I began meeting, and one thing we quickly realized is that there is no brand name for Johns Hopkins nursing. There is the School of Nursing, and the Department of Nursing. We said, Let's just invent ourselves as Johns Hopkins Nursing and use that as a term that defines the excellence of nursing, education, practice and research here at Hopkins. That being said, we thought, How do we create this sense of self and new identity? It's an ongoing project, but the magazine was one of the first ways to begin to do that.
   Secondly, we had a series of different publications here. Some were targeted to alumni, some to donors, some were targeted to peer institutions. I was interested in gaining efficiency and greater impact by uniting all those publications.

Q: What has the response been to the magazine?

A: The first issue had an enormous positive impact, and the second one was as good or better. The question quickly became, Could you really set the bar very high and maintain it? I think we've done it. Some people have told me, "Well, I picked [the magazine] up and just flipped through it, and I thought I would put it down and read it later, but an hour-and-a-half later I was still reading." We are very excited about continuing this.

Q: Pre-1984, what was the state of nursing education here at Johns Hopkins?

A: There was no school of nursing. What had been the hospital's nursing training school, which was in Johns Hopkins' will, phased itself out in 1973. During these [intervening] years, there was tremendous political pressure from a wide variety of sources, not the least of which were the physicians, who were very distressed by the adverse impact on patients of not having nursing education in the environment. It impacted everything, the whole tone of the place as a teaching institution, and the quality of patient care. It impacted recruitment and retention of nurses. Eventually people stepped up to the plate and said, If Hopkins claims to be an international leader in hospital-based care and medicine, we need to have all the various medical professionals educated together as a team, and that included nurses.

Q: How Hopkins-ized has the School of Nursing become since its inception?

A: The intent was that there be a Johns Hopkins University School of Nursing, and that indeed the nursing dean would have all the rights and responsibilities of all the other deans here. It would have formal degree-granting programs, and the faculty would be standing faculty at the university, meaning they would have to meet all the other expectations and requirements. The vision and intent was that it meets the mark of all the other divisions. There was no interest in being second tier — we had done that for a long time.

Q: Has research always been a primary focus?

A: Yes, but we still have to balance the demands of a clinically expert teaching faculty and our faculty who are, if you will, the scholars. We can't lose sight of our clinical side.

Q: Has there been a significant evolution in the makeup of the student body in the past 20 years?

A: Basically, it's the same. We are still predominately female. Our percentage of males varies from each semester and by program — everywhere from 5 percent to I think we have been as high as 12 percent. We don't quite understand why that is, and we would love to increase our male population.
   Our percentage of minorities has increased, but it has been very steady for the last five to 10 years. We run around 22 percent. We work hard at that and are proud of that. Internationally, we attract folks more at the master's and doctoral level. The numbers could be higher, but it is complicated because of the visa issues and the limit of opportunities they have to stay here.

Q: Are there any former SON deans or nursing superintendents you model yourself after, or admire in particular?

A: Each one of those early women was an intelligent, competent leader. They were all revered for different personal characteristics. In terms of our recent history, Carol Gray I admire for her focus and ability not to be distracted by all the "could be's." She was very successful at leading us in our early years.
   Sue Donaldson is a woman of extraordinary intelligence and vision. She is really an out-of-the-box thinker and risk-taker; she was prepared to catapult us. She was the dean during our early and mid-adolescence, so she in effect said, Let's stretch and flex and get out there. I think of myself as the dean of a school that is getting ready to assume adult responsibilities. What do we want to be, and what do we want to look like? That is what we now have to ask ourselves.

Q: What was the top priority you had when you became dean?

A: One was to have nursing be fully integrated, along with medicine and public health, in the leadership on this campus and in the university. This is the only place in the country, to my knowledge, where you have a School of Nursing, School of Public Health and School of Medicine all ranked in the top 10. We can, and we should, be working more deliberately together as institutions.

Q: What is the next milestone on the horizon for the School 0f Nursing?

A: I think it's first maintaining and reinforcing all we've got. But one thing we are focused on is building capacity for leaders in nursing. One thing I think that is missing is that there are no nurses in [Johns Hopkins'] Society of Scholars. Why is that? It's because nursing education at Hopkins has not had the years of experience, the history, of training at the graduate and post-graduate level. That is where we want to go, so that in 15 years you will see nurses being inducted into the Society of Scholars because they have received graduate or post-graduate training here at Johns Hopkins.

Q: How successful have we been so far to this end?

A: I think we have successfully begun, and you can find examples that are world-class. Just one example is the work we have done in the comprehensive high blood pressure care for young black men. We had all three medical schools and other units involved in this work. If any place should be able to show how you do social and behavioral research that is integrated with clinical research and basic sciences, this place has the capacity to do it.

Q: The 'Wall Street Journal Online' recently published results of its 2003 Health Care Poll. Participants were asked, "How much do you trust each of the following to do the right thing for the health care of those whom they have responsibility for?" In the "a lot" column, nurses topped the list at 65 percent, more so than doctors (61 percent), dentists (56), pharmacies (49), hospitals (44) and others listed. What was your reaction to this poll?

A: I was pleased to see it. I would ask what it would take to get our number up to 85 percent.
   I think as a general statement, nurses spend a lot of time thinking and working on issues of inclusiveness, making people comfortable, wanting to help people and wanting to make a difference. Those are filters that everything runs through. We are more relational and people-focused than focused on molecules or organs. In part, that explains these results. We are the 24-7 group who spends more time with patients.

Q: Who is a Johns Hopkins nurse?

A: Think of Johns Hopkins Nursing like the Olympic flag with the intersecting circles. Some Johns Hopkins nurses are alumni; they came here, and they were educated here, and they are now all over the world. Others are, of course, people who are working here, our students and faculty. Then you have the nurses at the hospital. And we would like to think that people who come to this school for training, who may be less clearly and strongly imprinted, are Johns Hopkins nurses, too.

Q: Do you have a proudest moment in terms of your long history with nursing here at Johns Hopkins?

A: I guess for me it was the groundbreaking for this building. We would not have had a groundbreaking in the first place if there hadn't been a total, total, total commitment for the full development of the School of Nursing.
   We have grown so much and so successfully that we now have to extend the [1998] building in back. There is wonderful support from university leadership in doing this. We have to expand the building if we are going to continue to fulfill our potential. We are never going to be a big school, but right now we don't have an empty office for faculty, and we have students sitting on tables up and down the hall. We are also growing the research program — labor-intensive work — so you have to hire people to do the data collection and interventions. Where are you going to put all those research assistants?
   We just need a little more room, so we can grow a bit more.


A Brief Look at 115 years of Johns Hopkins Nursing

Fulfilling the wishes of the university's and hospital's benefactor, the Johns Hopkins Hospital Training School for Nurses opened in May 1889, five months after the hospital opened its doors.

In a letter to his trustees, Johns Hopkins made plain his desire to establish a nursing school that would "secure the services of women competent to care for the sick in the hospital wards, and will enable you to benefit the whole community by supplying it with a class of trained and experienced nurses."

In essence, today's School of Nursing began.

The early years: The 1893 graduating class of The Johns Hopkins Hospital Training School for Nurses poses with superintendent Isabel Hampton, in dark dress.

The training school's founding superintendent was Isabel Hampton, who in left the school in 1893 and later founded what is now the American Nurses Association.

Hampton's replacement was M. Adelaide Nutting, a member of the nursing training school's first graduating class. Nutting led the school from 1894 to 1907. In 1904, the year that legislation was passed to allow for the registration of nursing school graduates, Nutting became the first Registered Nurse in Maryland.

In 1910, Elsie M. Lawler became nursing superintendent and the school struck out on a lively portion of its history. During Lawler's 30-year tenure, the school became involved with the American Red Cross through the United States Army Nursing Corp during World War I; assisted with the establishment of a nursing school at the Peking Union Medical College in China; opened Hampton House, a residence for nursing students; and, with dedicated space in the hospital for classrooms, upgraded the curriculum and created the public health nursing program.

In 1940, the training school became the School of Nursing and Nursing Services, whose first director was Anna D. Wolf. The Johns Hopkins McCoy College, later named the Evening College, began granting BSN degrees in the late 1940s.

Throughout Wolf's 15-year tenure, and into the 1960s, several efforts were made, and dashed, to establish a university-based school of nursing at Johns Hopkins, which then had an all-male student body.

The School of Nursing and Nursing Services began to be phased out in 1970, and its last class graduated in 1973.

In 1975, nursing education returned to Johns Hopkins under the auspices of the School of Health Services. This nursing program would last only four years.

In 1986, two years after the School of Nursing became a division of The Johns Hopkins University, Sue Appling teaches a class in one of the many buildings the school formerly used. Its first home, the Anne M. Pickard Building, opened in 1998.

In 1983, the School of Nursing was re-established as a degree-granting division of The Johns Hopkins University, and Carol Gray became the new school's first dean.

Initially an undergraduate school, SON began master's and postdoctoral fellowship programs in 1987.

The early 1990s was another active time at the school. It established the Wald Community Nursing Center in East Baltimore, developed the Peace Corps Nursing Fellows Program for returning Peace Corps volunteers, began offering a doctoral program and in 1995 established the Institute for Johns Hopkins Nursing, linking nursing education and nursing practice.

A nomadic entity, Johns Hopkins nursing — in its various incarnations — has had offices and classrooms in various buildings on the East Baltimore campus. In 1998, however, the school opened its first permanent home, the Anne M. Pinkard Building, located at 525 N. Wolfe St., directly across from the hospital's main entrance.

Today, the school enrolls nearly 600 students a year and has 55 full-time and 62 part-time faculty. Its graduate program has been ranked among the nation's top five by U.S. News & World Report. A research institution in the Hopkins tradition, the school conducts major research initiatives in hypertension, cardiovascular health, domestic violence, community health, pain management, maternal health, geriatric health care and a host of other areas.

Maryann Fralic, a professor and director of corporate relations at the School of Nursing, joined Johns Hopkins in 1993 as vice president of nursing at the hospital. Fralic, who serves as executive adviser for the Nursing Executive Center of the Advisory Board Company in Washington, D.C., said that in the annals of nursing education, Johns Hopkins stands very tall.

"When you look at the School of Nursing's history, it is as distinct as the history of medicine as a discipline at Johns Hopkins," Fralic said. "The school has been blessed with outstanding leaders throughout its history. We have never aspired to produce large volumes of students here. Our mission has always been to produce leaders for this profession. We are living that mission. The caliber of students, who come from all over the country, is exceptional, and only becomes more so with each passing year." — Greg Rienzi


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