to a Friend
years, the unpartnered paradigm ruled in health care, says
Marla Salmon, dean of the Nell Hodgson Woodruff School of Nursing.
Working well together meant honoring well-defined roles. Research
questions were framed according to the questioner's discipline.
Any effort to blur territorial lines set off burglar alarms.
With so little value placed on collaboration,
each rising generation of clinicians, scientists, and policymakers
was seldom taught how to negotiate, navigate, nurture, or evaluate
partnerships. After all, there was plenty to do within each discipline.
Who needed the hassles of those different professional languages,
cultures, and politics across campus, town, or globe?
Today, Salmon can't think of
a single major health challenge that could be solved without people
moving beyond their own boundaries and working together in ways
that don't have the structure, predictability, and comfortable
familiarity of self-contained disciplines, institutions, or traditions.
That kind of interdisciplinary, interinstitutional thinking—a
"partnered paradigm" in Salmon's words—is
central to the School of Nursing's own strategic plan, the
Woodruff Health Sciences Center's strategic plan to transform
health and healing, and the cross-cutting themes of the University's
road map for the future.
For Salmon herself, the concept of partnership was instilled in
her as she grew up watching her physician father and nurse mother
working together in their rural general medical practice at a time
when the relationship between both professions was under-rated,
misunderstood, and definitely underoptimized.
Today, the School of Nursing is viewed within and beyond Emory as
a leader in collaboration. More and more faculty members hold secondary
appointments in other schools. Nursing and medical students train
side by side in real-time patient simulations, enhancing future
clinical practice. Academic partnerships include a course on designing
the ideal patient care environment, the first step in what Salmon
hopes will eventually be a joint degree program with the Georgia
Institute of Technology. Also planned are collaborative programs
with Emory's Candler School of Theology that will broaden
students' perspectives on quality of life for terminally ill
patients. These are in addition to the interdisciplinary offerings
already in place. Still other opportunities abound.
the health care divide
As emergency rooms careen toward the breaking
point, with jammed waiting rooms and frequent diversion of ambulances,
a handful of nursing schools are training emergency nurse practitioners
(ENPs) to help meet this growing challenge. By the end of 2006,
21 ENPs graduated from a new degree program at Emory; another two
dozen are enrolled in the tough four-semester program.
One of many collaborations between
Emory's nursing and medical schools, the ENP program is directed
by nursing instructor Michelle Mott and Dr. Katherine Heilpern,
associate professor of emergency medicine. In addition to many classes
(all students complete the family nurse practitioner program as
a base), students spend almost 800 hours paired with emergency medicine
physicians and nurse practitioners in emergency rooms at Grady Memorial
Hospital, Emory Crawford Long Hospital (ECLH), Gwinnett Health System,
DeKalb Medical Center, and other participating institutions.
The adrenalin rush of emergency care
is not new to most ENP students, with many already experienced in
emergency room, intensive care, and acute care situations. They
study triage— evaluating and sorting patients into nonurgent,
semiurgent, and urgent cases. They learn to
stabilize and manage emergency patients, whether medical (heart
attack, diabetic ketoacidosis, pulmonary embolism) or trauma (car
accident, gunshot wound, injury), and to manage the ever-higher
number of patients who use the emergency room for primary care needs.
Having ENPs in the emergency rooms
helps streamline patient flow—with fewer waiting for hours
in crowded hallways—and improve hospital efficiency. Seeing
what these ENP students are learning has given physicians and hospitals
increased appreciation for what nurses can offer, says Mott. In
fact, preceptors hire many of their students almost immediately.
Other students have moved to rural areas in Georgia, with one on
the way to Alaska, where their training allows them to stabilize
patients far away from quick emergency room care.
Only three years old, the ENP program
is already evolving, with collaborations involving the Georgia Poison
Center, more emphasis on pediatrics and geriatrics, and increased
preparedness for avian flu, bioterrorism, and other wide-scale threats.
Every new component means more partnerships across the health care
continuum and better care for those who need it most quickly.
At the other end of the health care
spectrum—keeping chronic diseases on an even keel—Emory
nursing instructor Kathy Matthews collaborated with Dr. Richard
Gitomer, clinical chief of general internal medicine for The Emory
Clinic, to create a new model of care. Funded by the Robert Wood
Johnson Foundation, the pilot project focuses on diabetes, which
now affects 7% of the U.S. population and continues to rise.
Currently, says Matthews, patients
with diabetes often navigate a maze of physicians, perhaps one to
manage blood glucose, another to deal with the hypertension and
hyperlipidemia that often accompany diabetes, and still others to
work with risks of complications in the heart, kidneys, nervous
system, eyes, and feet. What sometimes gets lost in the journey
is a focus on patients' roles and responsibilities and what
they need to manage their own disease.
The model that Matthews and Gitomer
use places patients at the center of a wheel; the spokes are the
health care providers needed in the individual patient's care,
from dietician to subspecialist. Electronic medical records enhance
team members' ability to monitor and participate in the patient's
care, stepping in as their expertise is needed. For patients to
fully benefit from this expertise, however, they must understand
the underlying disease process and how behaviors affect health.
Patients must know, for example, how to check and care for their
feet and when they need a neurologic exam. Nurses' expertise
fits especially well with this new model—not just providing
essential health-related information but also helping patients figure
out how to use information, develop strong coping skills, and become
more involved in setting, monitoring, and working to control disease-related
This nonhierarchical model capitalizes
on the strengths of all team members, allowing them to do what they
do best and enhancing their partnership, says Matthews. Patients
quickly recognize they gain an important perspective from the nurses
who help them remain at the center of their own health management.
the sciences and beyond
Interdisciplinary" is definitely part of Dr. Sue Donaldson's
new title at Emory and the mantra for her lifelong mission in nursing.
Donaldson is the first Distinguished Professor of Nursing and Interdisciplinary
Science, a position created last year within the School of Nursing
and the Woodruff Health Sciences Center to advance interdisciplinary
training and research opportunities in the basic sciences.
Many such partnerships between the
medical and nursing schools already exist in clinical areas. Donaldson's
charge is to transform nursing's engagement in science.
time is right, and Donaldson is the right person, says Salmon. Donaldson
is a member of the prestigious Institute of Medicine, a fellow of
the American Academy of Nursing, and former dean of the Johns Hopkins
School of Nursing, where she created the research infrastructure
in their school. "Sue's commitment to head our new program
to transform nursing's engagement in science has added greatly
to the national ‘buzz' about what is happening here
at Emory," says Salmon.
nursing and basic science together comes naturally to Donaldson.
A master's-prepared nurse with a PhD in physiology and biophysics,
she has held joint appointments in physiology and nursing throughout
her career, while working within nursing education to set up doctoral
programs in nursing. Her new laboratory in the Whitehead Biomedical
Research Building focuses on the cellular and molecular mechanisms
of muscle contraction, work that includes studies of muscle atrophy
after stroke, with aging, and in children with muscular dystrophy,
and other studies of muscle restoration with exercise.
already feels at home. Her new office even looks like her last one,
pictured in a framed photograph over her desk. Emory's School
of Nursing building is modeled after the one Donaldson argued for
and oversaw being built while dean of nursing at Hopkins. After
a site visit to Baltimore by Salmon and other administrators, Emory
hired the same architect. "I feel I've drawn another
line between these two great institutions," says Donaldson.
part of her right-at-home feeling may be working once more with
Emory Vice President for Health Affairs Michael Johns, former dean
of medicine at Hopkins, and with longstanding research colleagues
among Emory's senior physiologists and Georgia Tech's
bioengineers and other scientists. But the main reason she is certain
she came to the right place, says Donaldson, is how the School of
Nursing supports what she most values: the exciting possibilities
of interdisciplinary work.
first step for Donaldson is to consult with Dr. Kenneth Hepburn,
associate dean for research, and Dr. Marsha Lewis, associate dean
for education, to create new options in the nursing school's
PhD and postdoctoral programs, both already structured to be interdisciplinary.
Because nursing's perspective of health is broad, focusing
on quality of life and experience even when a person is very ill
or dying, research opportunities are equally broad, and Donaldson
plans to use the resources of the entire Emory campus and those
of research partners like Georgia Tech. The new and highly interdisciplinary
Predictive Health Initiative with Emory and Georgia Tech was a particular
draw. It is the perfect framework, she says, for expanding nursing
research in conjunction with medicine, public health, and other
research has made major advances in recent years, with many findings
now used as a basis for research in other disciplines," she
says. "The next frontier for nursing—what we are going
to do here at Emory—is to immerse ourselves in work with basic
scientists. The research that results may not look like nursing
per se, but it will be imbued with the nursing perspective of improving
health and quality of life across the entire human experience."
seat at the table
Partnership undoubtedly begins at home. Michael Johns, CEO
of the Woodruff Health Sciences Center, regularly holds court
at a long conference table, surrounded by academic deans and
directors, chief officers of Emory Healthcare components,
and other health sciences administrators. The purpose of these
regular leadership meetings, in his words, "is to share
responsibility for the whole with those who have responsibility
for parts of the whole."
It is critical, he says, that
the School of Nursing have an equal seat at that table. "Marla
Salmon represents nursing's unique perspective extraordinarily
well; she's a force and sometimes also our conscience."
For example, while the leadership
team was planning the new hospital to be built on campus in
the next decade, Salmon kept asking how to incorporate the
community into the facility. As a result, the hospital is
being designed as a place where people can come to learn more
about their health, become more involved in care for themselves
and their families, or simply enjoy healthy foods in a pleasant
Whether the subject is improving
safety and quality of care, focusing on research to change
treatment and delivery of care or, better yet, prevent disease
and disability from ever occurring, nursing keeps the perspective
on the total patient in a way that enhances what we all do,
says Johns. "Our partnerships with each other make us
better partners with our patients, colleagues, and the communities
across the water
Most visitors to the Caribbean see white beaches and friendly people.
Faculty and students in the School of Nursing also see a worsening
nursing shortage, as epidemics and faltering economics challenge
fragile health care systems worldwide.
The British Virgin Islands (BVI) to
the east of Puerto Rico illustrate both the nursing shortage and
how School of Nursing partnerships with the region's nursing
leaders are helping turn that problem around. With a population
of only 25,800 people, the BVI has no nursing school. Most islanders
who decide to be nurses or broaden their nursing education travel
to the United States. For every 10 who arrive, however, only two
or three can resist the siren call of higher pay, easier working
conditions, and more advanced technology here. The Caribbean nursing
shortage now averages 35%.
nurse who proudly returned home is Bernet Scatliffe, 04MSN, a graduate
of the health care leadership program and the chief nursing officer
for the BVI. Scatliffe says the power of the partnership between
the School of Nursing and Caribbean nations lies in its vision,
practicality, and networking strengths.
takes place at the highest level. Senior government health leaders
from across the world gathered in Atlanta this fall for the third
global forum hosted by the Lillian Carter Center for International
Nursing. The inaugural forum, held in 2001, marked the first time
many chief nursing officers had come together to look for common
ground to address problems back home. The 2004 forum achieved another
milestone by bringing chief nursing officers and chief medical officers
together for the first time. The 2006 forum, hosted by Salmon and
Dr. Jeffrey Koplan, Emory's vice president for academic health
affairs and former director of the CDC, provided top-level government
nursing and medical leaders with new knowledge and insight to address
the shortage of nurses and other health workers.
also takes place nurse-to-nurse, says Scatliffe. Community health
nurse Noelene Clarke returned from the nursing school's summer
teaching institute "with eyes opened to what nurses can do,
given training and opportunity. She's ready to help change
what we do here, and she knows she has partners in the School of
Nursing who will help her." Scatliffe herself calls for advice
and encouragement from nurses she met during her Emory experience.
course networking works both ways. While studying at Emory, Scatliffe
helped organize the visit of a dozen School of Nursing students,
and their faculty supervisors, to conduct a comprehensive screening
of BVI children in secondary school. Considering nursing resources
in the country, the health ministry had expected the project to
take months. With help from Emory nursing faculty and students,
the project took a week. Nursing students gained a firsthand appreciation
of the impact of the nursing shortage on smaller islands and the
creative ways nursing can be practiced with limited resources. Scatliffe
foresees other projects, such as pap smear clinics, that could be
completed in a short period of time.
love of community
The average life expectancy in Atlanta is 78. If you are homeless,
it is 42. That disparity, the disproportionate amount of poorly
managed chronic disease, and a sense of abandonment and despair
among the homeless makes them a natural focus for the School of
Nursing's mission of social responsibility. For years, nursing
faculty and students have worked in shelters and through social
agencies such as Café 458. The new Gateway Center in downtown
Atlanta makes possible longer-term involvement and service learning
The school is one of 50 formal partners
in the Gateway Center, the centerpiece of the Regional Commission
on Homelessness' effort to reduce chronic homelessness, designed
as a "gateway" to connect the homeless with community
services to help them move toward self-sufficiency.
the direction of nursing instructor Monica Donohue, community health
nursing students complete a five-week clinical rotation at Gateway,
providing much-needed services, such as foot care or blood pressure
screenings, for the hundreds of homeless clients who pass through
the center. Students also care for patients recently discharged
from acute hospital settings who arrive at Gateway's 23-bed
respite facility. But the keystone of the students' rotation
is a requirement to develop and deliver a project to benefit clients.
This past year, a team of students designed a health education program
around the complex, ever-shifting situation of homelessness.
really challenged our students," says Donohue. "They
were able to create a street-workable program only after they turned
to the clients themselves and got a clear picture of what their
lives were like and how they thought they could fit hygiene, nutrition,
even appropriate exercise, into their lives on the streets and in
shelters. That partnership with clients was an invaluable lesson."
Wrobel is former associate vice president for health sciences communications
and a frequent contributor to Emory's health sciences publications.