The Expanding World of Nursing
By Holly Miller
Roommates Natalie Grear of New Castle, Ind., and Stephanie Wuest of Whiteland, Ind., share more than a campus address. Both are juniors, both are majoring in nursing, and both made their career choices early — at age 5. “I wore a nurse’s uniform for my Halloween costume every year,” recalls Grear with a laugh. “Me, too,” admits Wuest. “Whenever anyone asked me what I wanted to be when I grew up, I always answered, ‘a nurse.’” Just three semesters shy of graduation, they’ve never wavered from their resolve to someday add “R.N.” after their names.
Well, almost never. “Nursing is incredibly difficult,” says Grear, whose sister, Alicia, earned her AU nursing degree two years ago. “We all complain, but we all keep going. That’s how it works — sort of a love-hate thing. When I’m in a clinical setting I think, ‘This is where I’m supposed to be.’ I feel completely fulfilled. But the tests are hard, the assignments are huge, the responsibility is great….”
And the days are long. Beginning in the sophomore year, nursing students juggle traditional classes with twice-weekly hospital clinicals and squeeze in monthly visits to local churches where they serve on parish healthcare teams. Natalie travels to St. Mary’s Catholic Church and Stephanie reports to First United Methodist Church to take blood pressure readings, conduct screenings, teach CPR, and interact with members of the congregations. Later, as seniors, the students will complete health-related projects based at their assigned churches. Natalie already is working with parish youth on an abstinence program. “The church community is a very good simulation of a large community,” explains Dr. Andrea Koepke, director of the AU School of Nursing. “It’s a safe environment, and congregations are more than willing to welcome our students.”
Added to the classroom and clinical obligations is another requirement. As a wrap-up to their college experience, nursing students spend three weeks in a culture very different from what they’ve encountered in Central Indiana. This spring’s choices are Russia, Honduras, or inner-city Indianapolis. Past years have seen nursing teams work at Mother Teresa’s Home for the Dying in Calcutta, an orphanage in Korea, and clinics in Uganda and Honduras. The students, under the supervision of a faculty member, observe health-delivery systems and conduct onsite research projects. “For example, they might study parenting styles, health-prevention programs, handicap accessibility, or nutrition patterns,” says Koepke.
The international experience is life-changing for many students who are about to embark on their careers. “As nurses, you’re not just dealing with white, Anglo-Saxon, protestant Hoosiers,” says Dr. Paula Boley, who is preparing to take her fourth group of students to Russia in May. “The United States has always been a melting pot of cultures. During the 1990s we’ve had an influx of Hispanic families as well as refugees from Bosnia and the Middle East. We think the best way for students to become culturally sensitive is to have them spend time in a culture other than their own. This gives them a sense of what it feels like to be in a minority.”
The aggressive curriculum — in the classroom, in clinical settings, and in foreign environments — is designed to expose future nurses to the range and rigors of the healthcare profession. It gives them a generous dose of the diversity they likely will encounter after they graduate and pass the nation’s tough licensing examination. “An advantage of starting the clinical work in the sophomore year is that students don’t lose a lot of time and money if they decide nursing is not for them,” says Koepke. Sometimes the reality check begins earlier, when high school seniors explore the nursing major during student-recruitment weekends on campus. “We ask them, ‘What do you think nursing is?’ They need to know it’s more than the emotional aspect of caring for and loving people. It requires critical and creative thinking as well as scientific and analytical skills.”
Jobs Forecast: Healthy Depending on the ups and downs of the job market, AU’s nursing program has experienced spikes and dips in enrollment since its introduction in 1973. The launch of the major was in direct response to a need for nurses in the community. Saint John’s Hospital in Anderson had closed its diploma program and had asked the college to fill the void. The two-year associate degree met with immediate success and produced 75 graduates in its first class. Many of the early alumni are still active in the field and give the program high marks for equipping them with the right skills in a compressed amount of time.
“I’ve assisted in orienting many graduate nurses over the years, and none have been as prepared to join the practice as I was when I graduated from Anderson,” says Madelaine Davisson Personette ASN ’82. Now assigned to the emergency room at Rush Memorial Hospital in Rushville, Ind., Personette has worked in the oncology department, the intensive care unit, and in home healthcare. “My education has always seen me through even the most difficult situations,” she says.
About the time Personette was launching her career, the nursing department faculty and the university administration were discussing the possible expansion of the program. Community colleges such as Ivy Tech had begun to offer two-year nursing degrees, which resulted in a competitive situation. This prompted AU officials to consider adding liberal arts components to the program and creating a Bachelor of Science in Nursing degree (BSN). Their exploration included researching national trends in healthcare, determining the needs of students at a church-affiliated school, and thinking about how a four-year program might carry out the university’s mission of service to the community and the world.
A two-plus-two configuration — an associate’s degree combined with two years of additional courses — served as a transition to the BSN program that accepted its first students in the fall of 1988. By the time the initial BSN class was preparing to graduate, the nursing staff was preparing to move from Byers Hall to their upgraded facilities on the second and third floors of the renovated Hartung Hall.
Dr. Pat Bennett, director of the School of Nursing at the time of the move, recalls the relocation to the new quarters: “For almost a dozen years we had occupied Byers Hall, the venerable old house on the hill that an architectural survey had cited as the building most in need of repair. Our new home, which faculty members helped design, included a simulated hospital unit and a computer lab with interactive programs that exposed students to a range of healthcare situations. Most important, our relocation to the center of campus sent a positive message — the AU nursing program is a valued part of this liberal-arts institution. We aren’t isolated, as some nursing programs are; we have constant contact with students and faculty members of other departments.”
The timing of the move was perfect. The popularity of the major soared, in part because of the heightened visibility of the department and in part because of a national shortage of nurses. Today, nursing ties with business and only trails education in the number of AU students enrolled in its program. While students in other disciplines may fret about finding jobs in a soft economy, nursing majors are encouraged by employment predictions. According to the U.S. Department of Labor, nursing tops the list of occupations with the greatest growth potential in the next decade. Starting salaries range from $30,000 to $45,000, with some hospitals offering signing bonuses. The healthy job forecast is no secret to savvy incoming freshmen.
“We had to turn away qualified students this year,” says Koepke. “We simply ran out of space.”
More Education, More Opportunities As the need for nurses has expanded, so has the demand for nurses with specialized skills. Mindful of this, Koepke and her colleagues successfully applied for a grant from the Independent Colleges of Indiana to determine the feasibility of offering a combined Master of Science in Nursing and Master of Business Administration degree (MSN-MBA). “We took a survey of schools around us and found that none filled the administration niche,” says Boley, who serves as graduate coordinator for the AU School of Nursing.
Although the 54-hour program that emerged from the study is the equivalent of two demanding graduate degrees, it met with quick approval from the field. Nurses in administrative positions throughout Central Indiana affirmed that they wanted a better understanding of fiscal management, marketing strategies, organizational behavior, healthcare finance, and business plan development. Koepke anticipated that the first graduate class would attract five or six students, but she optimistically budgeted for eight. The final enrollment of nine women and two men was a clear indication of the need for and acceptance of the combined degree.
“When I heard about the program my thought was ‘Wow! Two degrees would enable me personally to grow in understanding the business side of nursing and open doors in the future,’” says Laura Rigsby, clinical manager of the Observation Unit at the Community Health Network, North Campus. The idea also appealed to her classmate, Ginger Breeck, women’s and children’s education coordinator at Community Hospital Anderson. “I had been looking at getting a master’s degree in nursing when this opportunity came up,” says Breeck. “The MBA makes so much sense because healthcare is a business.”
The 11 members of the first MSN-MBA class met last summer for their initial set of graduate nursing courses in facilities provided by Community Hospital North. In the fall semester they sat side-by-side with college business graduates pursuing the standard MBA degree. This blend of students ensured that the business portion of the joint-degree curriculum was in no way “watered down” to accommodate the nurses. The academic expectations were the same regardless of profession or undergraduate discipline. The result? The classes — managerial accounting and organizational behavior — were challenging for all.
Rigsby remembers a particularly bad day when “I was struggling with accounting and feeling maybe I should give up. In my whining, my children asked me why I had decided to do it in the first place. I told them at the time it was presented to me, it seemed like all the pieces fit, and that God had plans for this degree to serve His purposes. My oldest son — 22 years old — looked at me, smiled, and said, ‘Well, keep praying about it!’ I took his advice, prayed, and realized that things are not always easy when you are following God’s plan.” She persevered and already is seeing the benefits. “I’m learning so much,” she says. “The technology class has done wonders for my zeal to learn and use computers to help my staff, the hospital, and myself. I don’t know yet what God will do with these degrees, but I know that in the future I will be able to work in marketing, finance, operations, and education inside and outside the healthcare profession.”
Motivation for pursuing the MSN-MBA degree varies from student to student. Some want to move up a notch within their organizations; others already are in administrative jobs but want to hone their skills to increase their effectiveness. At least one, Paige Dooley, had already earned her MBA from AU but decided to return to the classroom to pick up the MSN portion of the program. “I realized after completing the MBA that nursing is what motivates me,” says Dooley, resource coordination administrator for Community Health Network. “Helping others and providing leadership is the career path I have chosen. I feel privileged to be a part of the first graduating class for the MSN at AU.”
In an indirect way, the launch of the new graduate program serves as an inspiration for the undergraduate students. It reminds them that their chosen career is changing rapidly, and that a range of new opportunities exists but may require additional education. Many healthcare professionals in the future will need to be bilingual — fluent in the language of business and in the language of medicine. “Nurses today see themselves not just as the handmaiden of the physician,” says Boley. “We can sit at the decision-making table too.”
As juniors in the nursing program, Natalie Grear and Stephanie Wuest already are sampling various clinical settings and assessing their levels of interest along the way. Wuest has found that she enjoys nursing research and may try to get an internship this summer in that area. She’s also thinking about law school and how that might lead to a career as a legal nurse. A trip to Ghana last year as part of a medical team reminded her of her enthusiasm for missions work. “We saw about 2,000 patients,” she says. “It was raw Christianity — trust and love. We met all kinds of people, listened to their stories, gave them medicine, and loved them.”
The close nurse-patient relationship also appeals to Grear, whose long-term plans include graduate school to prepare her for a career as a pediatric nurse practitioner. “I was in on a birth,” she says, recalling a recent incident when she was assigned to a hospital obstetrical department. “I had been with the patient all day while she was in labor, so I decided to go back to the hospital after my shift because I didn’t want to miss the birth. The parents insisted on taking a picture of me with the baby. It was like I was part of the family.”
