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Forging New Paths in Nursing: A Conversation with Dean Jane Kirschling By Janet Edwards

School of Nursing Dean Jane KirschlingSchool of Nursing Dean Jane KirschlingIn her dual roles as the new dean of the University of Maryland School of Nursing (UMSON) in Baltimore, Md., and as president of the American Association of Colleges of Nursing Board of Directors (AACN), Jane M. Kirschling, PhD, RN, FAAN, monitors the pulse of a workforce that boasts 3.1 million members, the largest of any health care profession.

While recognizing that nursing must continue to diversify its ranks in order to reflect the changing face of the broad community it serves, Kirschling is confident proper pathways are in place to achieve that important goal. She is also boldly optimistic about recent innovations in advanced practice education, research, data sharing, and technology. Prescribing nursing for those seeking career flexibility, she insists the field deserves a fresh look from new and returning college students.

Continuing a long and accomplished career that spans psychiatric nursing, palliative and end-of-life care, and a decade of research in workforce development, Kirschling is now dedicated to ensuring the next generation of nurses is well trained and highly educated.

Kirschling was appointed dean of UMSON and director of interprofessional education in January 2013. She received her bachelor’s degree in nursing from Viterbo College in LaCrosse, Wis., and her master’s and doctoral degrees from Indiana University School of Nursing (IU-PUI) in Indianapolis, Ind.

Recently, Dean Kirschling spoke with INSIGHT Into Diversity’s editor, Janet Edwards. She shared some thoughts about the work being done at the University of Maryland School of Nursing, and about the current health of the nursing profession.

You’ve been charged with taking the UMSON ‘to the next level.’ How will you approach this challenge?University of Maryland School of NursingUniversity of Maryland School of Nursing
The University of Maryland School of Nursing has a long tradition—we’re approaching our 125th anniversary in 2014—of preparing nurses not only for entry into practice, but also for graduate study, whether that be advanced practice, nursing science, or doctoral programs. My charge from our University president, Dr. Jay A. Perman, is to continue to strengthen the excellence of our academic programs.  

Being within a research-intensive environment, there’s also a strong commitment and desire at UMSON to advance the science that informs health care in this country and to generate knowledge through collaborative work between scientists in the other disciplines represented in all health professions.

What is UMSON doing surprisingly well that other schools would be smart to emulate?
At the national level, it has been recommended that advanced practice nurses — certified nurse-midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists — become educated in the Doctor of Nursing practice (DNP) program.  

In fall 2014, UMSON will open its BSN (Bachelor of Science in Nursing)-to-DNP degree program. This is a very new movement and is extremely important because the complexity of health care will continue to escalate. There is a broadening of knowledge and skills that advanced practice nurses need for the future to best meet the health care needs of the populations they’ll serve.

The other piece that UMSON is well positioned to do — and that we have a long history of doing — is that, because of our proximity to Washington, DC, we have a rich tradition in terms of health policy. It’s always very exciting when our students not only spend time with the Maryland legislative body, but also interact and interface at the federal level with representatives of the House and Senate to advance health care in this country. We educate nurses who are very interested in, and capable of, working in the policy arena, whether they are setting policy or representing us as elected officials.

UMSON is known for being the first school to establish a graduate level program in nursing informatics. Why is this emerging field so important?
One of the realities of health care delivery is that a tremendous amount of information is generated within the industry. The question is, how is that information used to inform the care that is provided in this country and best practices? Our informatics program gives the nurse who has been working in the field, and who knows firsthand the individual patient experience, the ability to look at the aggregate of the individual and all patients to use this extremely powerful tool, that being data, to inform care for the patient as well as potentially drive practice change.

Students practice skills in a clinical lab at the University of Maryland School of Nursing.Students practice skills in a clinical lab at the University of Maryland School of Nursing.How are nursing and diversity connected, especially in regard to the nation’s demographic shifts toward greater ethnicity and aging?
Diversity in nursing is extremely important because we look for people who look like us. We want to receive care from people we are most likely to be comfortable with, who understand the values and culture that we bring, and who can help us interpret what’s happening with the health care we’re receiving. Historically in nursing, we haven’t been able to do that because we were predominantly a white woman’s profession. 

I also think that it is about being able to have quality of care—knowing that you’re getting the best care possible, and also feeling that you’re not being singled out in some way to get inferior or lesser care.

In 2004, a commissioned report titled, Missing Persons: Minorities in the Health Professions, found that minorities were severely underrepresented in the health care workforce, including nursing. Nearly a decade later, how much progress have we made?
The nurse scholars program through the American Association of Colleges of Nursing (AACN) encourages persons of color to come back to nursing school through second-degree programs. It’s a national model.

We have to encourage all students to think about a health professions career, and to look at nursing as a career that has rich opportunities. There isn’t just one way to be a nurse in this country. There are multiple ways to do it and there are tremendous opportunities. We need to have an inclusive environment so that all people recognize the opportunities. Then we have to nurture those students, encourage them to pursue graduate education, and help them to excel.

I became a nurse in 1980. My graduating class had very few men. I was educated in Wisconsin and I don’t remember having minority classmates in my undergraduate program. Today, at UMSON, in terms of our baccalaureate program, one-third of the class is made up of minorities. That’s positive change. It probably isn’t enough, but we’ve had to find ways to encourage persons other than Caucasians, as well as men, to come into the discipline. It’s a process of continuous building. Currently, 14 percent of our baccalaureate enrollment consists of men. We are also seeing more diversity in our master’s Clinical Nurse Leader (CNL) program for persons with previous degrees in other fields. Enrollment in the CNL program currently consists of 40 percent minorities and 15 percent males.  

How does nursing today differ from a generation ago?
From a nursing perspective, or any health professional’s perspective, there’s tremendous variability and flexibility in terms of where you’re going to do your work. You may start in a hospital setting with medical-surgical patients, or start in an emergency room, or you may start your career doing community-based care.

The other piece is the tremendous ability to shape your career; you’re not locked into one single path. You can change the area you practice in three or four times over the course of your career. There’s a mobility that you sometimes don’t get in other careers. We need to do better in getting that message out as an attractive option.

As you think about the changing demographics, one of the struggles for men is that it’s hard for a high school male to say that he wants to become a nurse because it’s still very much perceived as women’s work. One of the very positive changes we’ve seen is a real commitment across the U.S. to open what are called second-degree programs.  

These programs are designed for people who already have a degree or multiple degrees but they now want to change their career to nursing. We see larger numbers of men coming into those programs, which is a really positive change because it helps change the face of nursing to be more inclusive.

Also, research has become a viable option for nurse scientists. That most likely wasn’t the case a generation ago.

How can the nursing industry best meet demands for a more diverse faculty across nursing programs?
The ability to continue to prepare the next generation of nurses is totally dependent on our ability to have a sufficient number of nursing faculty members who are qualified and available to teach that next generation.

If you think about the pipeline, not only when we go into a clinical care situation do we do look for people like us, but when we’re thinking about going into a profession — thinking about, ‘do I want to be a nurse?’ — we need minority role models because our students look to the faculty to provide role models. This is an important piece in fostering and encouraging people to become nurse educators.

Why is it so difficult to fill nursing faculty positions?
There are some amazing advantages to being a nursing faculty member, but there are a couple of drawbacks. The competitiveness of salary is the biggest drawback. If you look at your salary as an advanced practice nurse, then look at the salary of a faculty member, there’s a discrepancy; the salary of the faculty member is considerably less.

An advantage is the ability to shape one’s career around juggling the multiple demands of family and outside commitments; there is a degree of flexibility that teaching provides.

Also, health care today is extremely fast-paced. Demands that are placed on people who are providing direct patient care are pretty intense. The work that we do in academia doesn’t necessarily have the same sense of urgency as direct patient care. It’s a different environment; the work by its nature is different, and some people find that to be very attractive.

Core competency standards: have they changed in the past decade, especially in regard to a changing demographic?
Our curricular work is guided by the Essentials documents put forward by AACN. Nurses have to be prepared to provide quality care that is sensitive to the issues of race and ethnicity. For example, when I went through a health assessment course in my nursing program in the late 1970s, a white, middle-aged male was the norm—everything was based on being able to look at white skin and say is this normal or abnormal. If you think about assessment today in light of our increasingly diverse population we have a responsibility to prepare students to be able to assess appropriately what is happening with all persons. That has to be emphasized in the curriculum. When making a clinical diagnosis, skin that has one pigment may require a more complete understanding for people of different ethnicities; there may be other appropriate benchmarks in assessing a different person. That’s a dramatic, very basic illustration, but it is important that nurses have the ability to assess every individual and to do that appropriately, with the necessary knowledge.

What attracted you to nursing and what do you continue to find most exciting about it?
I was on the back end of that era when (as a woman) you became a nurse or you became a teacher. I chose to become a nurse because I had an inclination toward science. I stayed in nursing school because I absolutely fell in love with psychiatric nursing and its complexities. My life took an interesting turn when I was headed to graduate school to specialize in caring for the chronically mentally ill. I experienced some personal losses in my life, and that got me interested in end-of-life care. Opportunities aligned themselves and I ended up doing palliative care and end-of-life care.

Then, I went on to become a nurse educator and that’s been my career — preparing the next generation of nurses and being able to support new nurses throughout the lifelong learning process. I’ve had an incredibly rich and full career. My energy is now devoted to the pipeline in nursing, making sure we have a well-qualified, highly educated nursing workforce to meet the future needs.

Nurses need to remain open to possibilities. They need to listen to those who are around them and not necessarily be so quick to  say, ”No, no, I can’t do that,” because a nursing education offers so many career options. I could never have predicted where my career was going to end up if we were talking in the late 1970s. There’s no way in the world I would have said I would be a nursing faculty member or the dean of the University of Maryland School of Nursing. I am truly honored to have this opportunity and to build on the amazing strengths available in the School and University.

Janet Edwards is the editor of INSIGHT Into Diversity magazine.

Pubished in our April/May 2013 issue.

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