In an age of headline-making business failures, accounting scandals, and backroom politics, America’s faith in professional ethics and honesty has been shaken to the core. One profession that continues to command respect, however, is nursing.

In recent years, nurses have ranked at the top of the annual Gallup Poll of professions, supplanted in the number-one spot only by firefighters in the most recent poll, conducted shortly after September 11. In the 2001 poll, 84 percent of Americans rated nurses "high" or "very high" for their honesty and integrity. By comparison, pharmacists earned a 68 percent rating, doctors 66 percent.

The high regard for nurses doesn’t surprise Sandra Edwardson (R.N., Ph.D. ’80), dean of the University’s School of Nursing. "Nurses are the human face of health care," she says. "They provide comfort, care, and compassion at a time when people are facing life-altering events, such as childbirth, illness, or death. Nurses are the chief watchdog—the constant in the care situation for the patient and the family. They act as coach, counselor, and advocate. They know best how the patient is doing and what the patient needs."

In her 22 years on the faculty and 12 years as dean, Edwardson has witnessed many changes in the roles and responsibilities of nurses. Today, nurses can be found not only in hospitals, clinics, and nursing homes, but also in schools, industry, home health care, public health settings, and government agencies. They are educators, researchers, scholars, independent practitioners and consultants, salespeople, health system administrators, and health care policy makers. Nurses practice in burgeoning disciplines like gerontology, women’s health, and complementary therapies, as well as in more established specialty areas like maternal and child health, oncology, and critical care. A growing number of nurses with advanced practice (master’s degree) preparation is making diagnoses and prescribing medications and therapeutic devices.

"Preparing students and professionals for the roles they will play and the challenges they will face in improving patient care is the heart of what we do," Edwardson says of the School of Nursing, established in 1909 and the oldest university-based nursing program in the nation. "We want to produce creative and innovative leaders, develop better care practices, address critical issues like underserved populations, and play a key role in improving the work environment for nurses and other health professionals."

A rigorous academic program
To be licensed to practice in the United States, today’s registered nurse has to master a complex body of knowledge drawn from the basic and medical sciences as well as the social and behavioral sciences. The R.N. must be familiar with the latest advances in biotechnology, health care delivery, and ethics and must demonstrate competence in a wide range of clinical skills. In addition, the R.N. has to develop strong analytical, interpersonal, and leadership capabilities.

The baccalaureate program in nursing is a demanding course of study. Just ask senior La Tesha Brown, who came from Louisiana to Minnesota for her schooling at the urging of an aunt and uncle who live in Minneapolis. "The University of Minnesota has tough [prenursing] criteria—harder than programs at other schools I looked at," Brown says. "And the program is competitive. I didn’t get in the first time I tried. I completed an Inter-College Program in health and wellness [B.S. ’00] while I waited to be admitted to nursing."

Prenursing students complete course work intended to give them a well-rounded background for practice, including cultural anthropology or sociology, writing, psychology, growth and development, public health, statistics, nutrition, anatomy, and pharmacology. In the upper division, the nursing program emphasizes development of clinical, leadership, and critical thinking skills, and research is an important component of every course.

Clinical experience constitutes a significant portion of the upper division program. Through laboratory simulations and clinical placements, students practice physical assessment, interpersonal communication, and professional skills while providing care to individuals, families, communities, and populations. The clinical rotations expose students to a wide variety of care settings, including hospitals, clinics, long-term care facilities, hospices, client homes, child care centers, schools, and public health agencies.

Brown—who wants to enter hospital practice and perhaps move on to public health nursing—has completed four of her clinical rotations, all in Minneapolis area health centers. For her current clinical rotation, in public health, Brown visits a different public health clinic each week for 15 weeks, gaining experience working with diverse population groups.

Looking ahead to graduation this spring, Brown feels some trepidation. "I’m a little scared, leaving the comfortable cocoon of the college setting for a world I’m still learning about," she says. "But I’ve grown in so many ways. I’ve learned how to deal with all different people, and my interpersonal skills have improved.

"The B.S.N. [bachelor’s of science in nursing] program is very intense, but the professors, advisers, and student services staff have all done their best to help me succeed. I have a solid foundation of knowledge to build on. What they teach really sticks."

Building a body of knowledge
The discovery and dissemination of knowledge to enhance health care is a key focus of the School of Nursing. Faculty and students conduct research intended to promote and restore health, improve quality of life, and design and evaluate effective health interventions.

To the nurse, research is no dry, scholarly pursuit. It is essential to improving patient care and to advancing the science of nursing. Perhaps recent graduate Melissa Thorson (R.N., B.S.N. ’98) says it best: "One of the strengths of the University’s program is its focus on research. Nurses have to employ evidence-based practices to achieve optimal outcomes. With medicine and nursing constantly changing, we have to keep up with developments or we’ll be left behind."

Thorson, a trauma nurse clinician at North Memorial Medical Center in Robbinsdale, works with a team of surgeons in assessing and coordinating the care of every trauma patient admitted to the hospital.

The School of Nursing encourages its graduates to continue learning and growing, and like many practitioners, Thorson is pursuing graduate study at the school. She is working on her master’s in nursing with the goal of becoming a clinical nurse specialist in adult health. The program is designed to prepare students for advanced practice positions that address complex health issues. Students complete a core of disciplinary, advanced nursing, and specialty course work while learning to further integrate research into their practice.

Recent Ph.D. graduate Cheryl Robertson (R.N., M.P.H. ’88; Ph.D. ’00) is a good example of the creative and productive scholars the nursing doctoral program wants to develop. A passion to understand the experiences of people living through war and terror has taken Robertson to violence-scarred countries around the world, including Uganda, Croatia, Nicaragua, and Cambodia. Ultimately that passion, and the research interests it spurred, drew her to a career in teaching. Robertson joined the nursing faculty as an assistant professor shortly after completing her doctoral studies.

Robertson became interested in refugee health issues after working with Minnesota International Health Volunteers and the Center for Victims of Torture, both based in Minneapolis. She decided to focus her research on resilience and coping in families and communities affected by war. For her doctoral study, she investigated the survival patterns, parenting issues, and cultural context of "ethnically cleansed" Bosnian women who were resettled from the rural community of Srebinica to the capital of Sarajevo in the mid-1990s.

"Women and children are often the overlooked survivors of war and other political violence," says Robertson. "The women I studied lost their husbands, their homes, their extended families, and their communities. They were forced to live in the woods and barely survived.

"We have to provide interventions appropriate to the situation. The refugees need to have access to safety and security. They have to regain trust. They need basic health care and a source of income. . . . After listening to their stories, we can suggest community-based resilience strategies to help them regain their lives."

Robertson currently is involved in an epidemiologic study of the prevalence of torture and associated factors among Somali and Ethiopian refugees living in the Twin Cities. She and an interdisciplinary group of collaborators are in the third year of the five-year study, which is supported by the National Institutes of Health (NIH).

Research and teaching provide an ideal marriage of Robertson’s interests. "But the students are the primary reason I’m here," she says. "Faculty and students are involved in a fascinating smorgasbord of issues. The students have so much potential. It’s really exciting."

In her work as a general medical nurse and a geriatric nurse practitioner, Karen Feldt (R.N., Ph.D. ’96), has seen firsthand the acute physical and psychological effects of unchecked pain. Feldt, an assistant professor of nursing, stumbled into an interest in pain management while working with Professor Muriel Ryden (R.N., B.S. ’53; Ph.D. ’82) in evaluating how to reduce aggressive behavior in a group of nursing home dementia patients. After investigation, the researchers discovered that some of the aggressive residents had recently suffered hip fractures but had received little or no pain medication following surgery.

Feldt turned to the research literature for guidance but was stunned to find virtually no useful studies. In discovering that dementia patients were left out of the literature, Feldt had found her doctoral research subject: a comparison of pain treatment in cognitively impaired and noncognitively impaired patients over age 65 who had suffered hip fractures.

"I found that cognitively impaired patients received significantly less pain medication," says Feldt. "The research transformed my practice of nursing and how I teach about pain. I started prescribing analgesics regularly rather than waiting for my patients to ask for medication. Many cognitively impaired patients are unable to articulate what they are feeling. . . . Here’s one example where research is really making a difference in the trenches."

Feldt, on the faculty of the school’s Center for Nursing Research on Elders, is working with North Memorial Medical Center on refining a checklist of nonverbal pain indicators that she developed as part of her Ph.D. research. The instrument—which includes such behaviors as restlessness, moaning, calling out, and bracing—currently is being tested in health centers around the world. The research is supported by a grant from the School of Nursing’s Densford Clinical Scholar Program, which pairs a nursing faculty member with an advanced practice nurse to explore clinical issues affecting patient care and to develop interventions to improve patient outcomes.

It’s mid-February and Professor Linda Bearinger (R.N., Ph.D. ’90), has just returned from two weeks in Bangladesh. Her latest pilgrimage offered one more opportunity to address her favorite subject: youth development programs for vulnerable adolescents. Invited to Bangladesh by the World Health Organization, Bearinger taught a workshop on monitoring and evaluating the effectiveness of programs designed to meet the development and participation rights of adolescent girls. The workshop was attended by representatives of 20 Asian and African countries.

An internationally recognized authority, Bearinger consults and speaks widely on the importance of health promotion for at-risk youth. Her research centers on protecting vulnerable youth from violence, sexually transmitted diseases, early pregnancy, substance abuse, and other high-risk behaviors, especially among American Indian populations in urban settings and indigenous peoples of Australia and New Zealand.

"In the last five, 10 years, there has been a worldwide shift to thinking of young people as resources to be protected and kept safe," says Bearinger, director of the school’s Center for Adolescent Nursing. "The University of Minnesota has been one of the leaders in promoting strengths in the lives of adolescents—such as connections to schools, families, and adults—and in translating research into policy and practice."

Bearinger, who holds appointments in nursing and pediatrics and completed her doctoral studies in educational psychology, stresses the value of interdisciplinary collaboration in her work: "The adolescent health faculty at Minnesota represent expertise in nursing, medicine, nutrition, psychology, pediatrics, and social work. We have been at the forefront of research in this area because of the many perspectives we bring to the issues."

Extending nursing’s influence
Of the School of Nursing’s many outreach efforts, perhaps none will leave a more lasting imprint on the profession and practice of nursing than the Katharine J. Densford International Center for Nursing Leadership. The Densford Center, the nation’s first university center dedicated to the development and promotion of nurse leaders, was established as a comprehensive resource to support creativity and innovation in nursing and health care and to improve the health and well-being of people worldwide. The center, created in 1997 with the support of a $3 million gift from Katherine Lillehei (R.N., B.S. ’43) and family and contributions from hundreds of alumni and friends of nursing. The center was named after a visionary former director of the nursing school.

The Densford Center has set some ambitious goals. It will serve as a forum for exploring issues and exchanging ideas affecting the delivery of nursing and health care services, bringing together visiting scholars, senior fellows, researchers, practitioners, students, faculty, policy experts, and community leaders. "We want to bring nursing’s unique perspective to bear on local, national, and international issues concerning health and health care," says Densford Center director Joanne Disch, R.N., Ph.D., professor of nursing and Katherine R. and C. Walton Lillehei Chair in Nursing Leadership. "We want to influence agendas affecting patient care and nursing practice. . . . We want to support the development of nursing leaders throughout their careers. And we want to serve as an incubator of ideas and a source of information and expertise for constructive change."

Disch is clear-eyed about the challenges ahead. Improving the work environment for nurses and other health professionals is a top priority. "We have a profoundly dysfunctional health care system," she says. "I think it’s especially hard and frustrating to be a nurse in an acute care facility today because of the intensity of the workload. In many settings, resources have been cut, including support staff. Nurses are having to do the work of housekeepers and secretaries and not their own professional work . . . namely, taking care of patients."

Problems in the health care system frustrate physicians too, Disch says. "And it’s not as if administrators are happy campers either. They’re under tremendous pressure to contain costs and make budget cuts. It’s no fun to be an administrator and have everybody think you don’t care about patients," she says. "Everyone has a role to play in fixing the health care system. We need to come up with some new rules for health care. We need to get back to patient-centered care. We need to encourage more dialogue and collaboration among health care professionals."

That dialogue, says Disch, has to begin among nurses. That’s why the Densford Center invited all 30,000 nurses who work in the seven-county Twin Cities metropolitan area to attend a forum on February 25 to exchange observations on issues that are affecting their work. "We want to have a unified—not uniform—message," says Disch, who is brimming over with the prospect of nursing’s potential. "Nurses are the largest group of professionals in health care," she says, "but you rarely see them on senior management teams or on health system boards. Nurses should have input into decisions about patient care, admission policies, staffing, and resources. . . . Nurses must become full partners in the health care system if patient care is to improve.

"We can improve the workplace. We can improve communication. We can lead in creative and proactive ways. When nurses come together, we can accomplish just about anything."

A changing health care landscape
If anyone has her finger on the pulse of health care today, it’s Marie Manthey (R.N., M.N.A. ’64). Manthey is founder and president emeritus of Bloomington-based Creative HealthCare Management, one of the first and largest health care consulting companies run by nurses in the United States. An internationally recognized authority on health care delivery systems and hospital work redesign efforts, she continues to consult for clients across the United States and abroad. For her contributions to nursing, the University of Minnesota awarded Manthey an honorary doctorate in 1999.

Manthey has been blazing trails in nursing for nearly 40 years. While assistant director of nursing at University of Minnesota Hospitals from 1964 to 1971, she helped develop the care delivery model known as primary nursing, in which a nurse assumes principal responsibility for coordinating patient care. The model revolutionized hospital care and remains the foundation of professional practice today.

Given her broad perspective, Manthey is troubled by trends she sees that are eroding not only the decision-making role but also the humanistic role that nurses play. "One of the problems is that over the last 10 to 15 years the health care system has become completely focused on a business and technology orientation," says Manthey. "The essence of nursing practice is the ability to create a strong therapeutic relationship with the patient, which requires a great deal of clinical and technical knowledge coupled with humane sensitivity. Unfortunately, providing compassion and comfort is often unrecognized and undervalued."

Many nurses are frustrated over heavy workloads resulting from inadequate staffing levels, mandatory overtime, a lack of decision-making authority and respect for their contributions, and salary and benefits that are not commensurate with their levels of education and responsibility. Many of these issues were at the root of the high-profile nurse strikes at two Twin Cities hospitals last fall. "Nurses are very worried that patient care is being compromised by these negative factors," says Manthey.

Nurses must focus on "things we can do something about," Manthey says. "And we have to learn how to deal with . . . tough situations in the workplace without getting frustrated and angry."

Manthey suggests several solutions to relieve workplace stress for nurses and improve patient care. Professional nurses should think more strategically about issues like delegation of duties to licensed practical nurses and nursing assistants, she says. And health care organizations might refine systems for handling patient data and reducing the amount of paperwork nurses must complete, which typically takes a third of their time.

One of the most critical nursing challenges is a shortage of practitioners. In Minnesota, there currently are approximately 3,300 R.N. vacancies, according to the Minnesota Department of Economic Security. By 2008, the department estimates, the state will need 18 percent more nurses to serve an aging baby boomer population and satisfy a ballooning demand for services.

Many factors influence the nurse shortage. Workplace dissatisfaction has prompted an increasing number of nurses to leave the field, or to work part time. At the University of Minnesota and nationwide, the number of applications to baccalaureate nursing programs has been slipping in recent years, largely due to increased career opportunities for women (who constitute over 90 percent of R.N.’s), better salaries in other fields, and the widely recognized difficulties and pressures of the work. With a large number of nurses approaching retirement in the next 10 to 15 years, the shortage is likely to grow.

To address the shortage, the School of Nursing is launching two programs in fall 2002. Thanks to a special legislative appropriation, the school is establishing a satellite of its baccalaureate program, which will enroll 30 students per year, at the University Center in Rochester. A 15-month accelerated postbaccalaureate program for students who have completed degrees in other fields is expected to accommodate 24 students per year at the Twin Cities campus. Although the number of graduates from these programs will be "a drop in the bucket" in terms of the needs, says Dean Edwardson, the plans are a step in the right direction.

Cultural competency is another pressing issue. With a rapidly diversifying population, nurses must be sensitive and responsive to the needs of the diverse ethnic groups they serve. "The School of Nursing is anchored in the practice of nursing in multicultural settings and is very effective in that role," says Gayle Hallin (R.N., B.S.N. ’70; M.P.H. ’77), assistant commissioner of the Minnesota Department of Health. "It needs to produce more culturally competent nurses. The acute shortage of nurses offers an opportunity to extend the boundaries of practice—to attract more minority practitioners and make the work more satisfying for them."

Indeed, the nursing school has stepped up its efforts to increase ethnic diversity among its student body, faculty, and staff. In addition to hiring a minority recruiter, the school has established relationships with student ethnic groups on campus and has developed a mentoring program for students attending Roosevelt High School, a health sciences magnet school in Minneapolis. In creating the Center for American Indian Research and Education, the school is building a critical mass of expertise in health issues of native people. With three American Indian faculty members, a major goal is to attract more American Indian students to nursing.

At a time of rapid change for America’s troubled health care system, nurses are poised to take their rightful place at the table as full partners in shaping the direction of health care practice and policy. Facing the challenges that lie ahead, nurses have unparalleled opportunities to demonstrate their creativity and resourcefulness and to act as a humanizing force for change.

"Nurses, with their emphasis on technical competence and humanistic sensitivity, are positioned to be the key health care workers of the future," says Marie Manthey. "Their core, enduring values of caring and compassion represent the highest order of thinking and human development. Our health care system may well be in crisis, but nurses will help lead the way back to a patient-centered practice."

"The School of Nursing is well connected to the real world, Manthey adds. "It understands the pressures of practice and is responsive to community needs. It is preparing well-rounded nurses and scholars who will respond with imagination and a critical intelligence to the health care needs of our society."

Barbara Silberg (B.S. ’69) is a Minneapolis freelance writer and editor.