East magazine Summer 2008
Cover Story

Why We're No. 1 in Nurses

With more than 1,000 students, the College of Nursing has grown rapidly
to become
the biggest in the state. But growth hasn’t changed the expectation
that an East Carolina
nurse be smart, savvy and dedicated
to improving health care in the rural east.

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By Marion Blackburn


hey wore crisp white uniforms, prim caps and a pin bearing the motto, Servire,
Nursing students may be the hardest working ones on campus. Spend a Day in the Life
of a typical student and learn why
when the first graduates of ECU’s new School of Nursing received their diplomas in 1964. The 17 graduates, all women, shared the belief that nurses should be scholars, as well as care givers.

Today, the College of Nursing, East Carolina’s oldest professional school, provides the state with more nurses—women and men—than any other four-year institution. Of the roughly 24,000 nurses currently working in North Carolina who hold bachelor’s degrees from a North Carolina institution, about one in every nine got their degree from East Carolina. In many counties east of I-95, half or more of the nurses went to ECU, according to figures from the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.

East Carolina’s nursing programs have experienced phenomenal growth in recent years, in enrollment and academics. More than 200 new nurses were expected to graduate this year, making it one of the largest classes ever. And if precedent holds, 96 percent of them will pass the state exam on their first try to become registered nurses (R.N.s), the highest passing rate of the 15 schools in the state that educate nurses, according to the Sheps Center.

The College of Nursing has the state’s only nurse midwife concentration, which is part of a robust graduate program, a doctoral degree, a dynamic Center for Nursing Leadership and a sparkling new home on the Health Sciences Campus. But nursing remains true to its original aim of improving health care in the rural east.

While the mission “to serve” still guides the college, much has changed since it opened in 1960 with a dean, five instructors, a handful of students and one office. These days it is a powerhouse, widely respected for the quality and number of its graduates and with a new college designation reflecting a half-century of growth and innovation. U.S. News & World Report lists the College of Nursing ninth in graduate nursing distance education nationally, plus it recently received a new million-dollar endowment, the Richard R. Eakin Distinguished Professorship.

Yet some things haven’t changed, says acting dean Sylvia Brown ’75 ’78. “What we do here at the college has an enormous effect on the community beyond our immediate area,” says Brown, who also serves as associate dean for graduate programs. “We take very seriously our commitment to serve. Our school has always been deeply engaged with our community and with the profession at large. We have aimed to be visionary in what we’ve done, from the start.”

In the years ahead, vision will be more important than ever because the college is being asked to produce more nurses, college and university educators and leaders for an ever-more complex health-care environment. And the job of a nurse is getting harder as they care for patients who often are older and sicker, and who require more complicated treatments, than just a few years ago. Expectations are growing for nurse managers, too, who will be expected to have more advanced degrees and professional skills.

The College of Nursing moved into the 303,000-square-foot, $60 million Health Sciences Building in 2006

Room, at last

In its earliest days, the school occupied just a few offices on campus and later, a university-owned house on Eighth Street. Faculty worked in closets and for a time conducted student conferences in a bathroom. “It was the only place to have a confidential meeting,” remembers Lona Presser Ratcliffe ’66, who arrived as a student in 1962 and now serves as clinical associate professor. “One person sat on the toilet and the other person sat on the side of the bathtub. That was what you did if you needed privacy.”

Conditions improved when nursing moved to the Rivers Building, where it was housed for about 40 years. But space there became cramped and facilities outdated. Plus, Rivers is located on the Main Campus and not on the Health Sciences Campus, where nurses often are assigned to clinicals. In 2006 the university opened the 303,000-square-foot, $60 million Health Sciences Building as nursing’s new home, a spacious facility it shares with the College of Allied Health Sciences and the William E. Laupus Library.

This building has eight labs where students learn basics like taking blood pressure, along with advanced skills such as providing intravenous medications. If in the old days nurses used foods such as oranges or hot dogs to practice giving injections, today they can learn in the college’s simulation labs with computer-operated mannequins.

A traditional wet lab in the building will allow more bench, or basic sciences, research. The college’s new Eakin Professorship will likely be used to attract a researcher, possibly with external funding in place, to get the lab fully operational.

In the building’s large lecture halls, students learn about illnesses such as heart disease, diabetes, pulmonary disease and other chronic conditions that plague eastern North Carolina. They learn about wound care, pharmaceuticals and wellness. They learn, too, the importance of considering the big picture when providing care. That’s so they can coach new moms, guide family members in caring for elderly relatives, emphasize the importance of treating high blood pressure and safeguard, as much as possible, the health of those who look to them for day-to-day care. They have two years to learn all that.

Despite its rigors, enrollment in nursing programs is at a record high, with 1,021 enrolled this spring. Those numbers include about 100 male students at all levels. In 2007, the College of Nursing awarded Bachelor of Sciences in Nursing degrees to 222 pre-licensure students and 34 R.N.-to B.S.N. students, 83 master’s of science in nursing degrees and four doctorate degrees.

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Wanted: More nurses

Even as enrollment climbs in the College of Nursing, the pressure is on to grow even faster. State leaders, including the UNC Board of Governors, have asked its schools to produce more nurses for clinical service, education and leadership. One major goal is to double the number of nurse graduates throughout the UNC system by the 2009–10 school year. Programs for registered nurses who wish to receive bachelor’s degrees, known as R.N.-to-B.S.N., were asked to increase graduation by 50 percent.

ECU nurses already are making a positive difference. As many as half of all baccalaureate-level nurses working in some eastern North Carolina counties graduated from ECU. Many of these small communities are served by nurse practitioners, who have two or more years of additional educational preparation beyond their four-year degree. They are vital providers in poor, rural counties.

The college is on track to meet its growth goals. During the 2007-08 school year the school admitted more than 275 pre-licensure, or undergraduate-level students, up from about 150 in 2000-01 academic year.

Yet, opening the door to more students cannot mean lowering the bar. Students who apply generally have a B average or higher in some of the university’s toughest courses—chemistry, anatomy and physiology, microbiology, nutrition, statistics and ethics. Students apply during their sophomore year and the program begins in the junior year and includes clinical rotations in health-care settings.

During the junior and senior years, students face a rigorous course of study, says Karen Krupa ’73 ’76, a long‑time faculty member and director of undergraduate student services.

“It’s our goal to assure students are well-qualified to enter the nursing profession when they graduate,” says Krupa. “If you don’t want them to take care of your own mother, then we don’t believe they should be nurses.”

Physical space also sets limits on growth, and even in its new location the college is facing a possible need for more room if its programs are to keep expanding. Compounding an ongoing nursing shortage is another, nationwide shortage of nursing instructors, especially doctorally prepared faculty.

Distance education, clinical learning

The college has vigorous online programs for nurses seeking to advance their education. Internet classes make sense in this profession where shifts generally last 12 hours, day or night.

All master’s degree options are online, except for the nurse anesthesia concentration which requires intensive, in-person training. The online nurse practitioner options prepares nurses as primary care providers or in neonatal intensive care. The nurse midwife option is unique in the state.

Beyond course work, though, are clinicals, the real-world settings where nurses gain most of their practical education, whatever their degree program. All nursing students spend two days a week in a hospital, medical office or other health-care settings. Not only do they learn the technical skills nurses perform, they also come to understand the larger picture—that their patients are part of families and communities, and that their needs go beyond their physical health. During the week, nursing students also attend the lecture, or didactic, classes that add to their knowledge. Clinicals allow them to live a nurse’s life, with its highs and lows—the joy of a newborn baby, chronic illness and trauma, sickness, old age and even death.

ECU has agreements with health-care providers throughout the area that allow nursing students to learn on site, as far away as Charlotte or as close to home as Greenville’s Pitt County Memorial Hospital.

Distance education will likely have a larger role in clinical education, too. An online clinic with virtual patients promises to help learners in isolated communities gain the experience they need. This virtual world will be especially important for nurse practitioners, who must become familiar with diabetes, high blood pressure and heart disease, while understanding their patients’ diverse ethnic and cultural backgrounds. Practical experiences in small communities may be limited.

“We know what some of the big health issues are and what are the basic kinds of problems,” says Dr. Alta Andrews ’74, associate dean for community partnerships and practice who helped develop the virtual clinic. “The chances that all of these clinics would have this kind of diversity was unlikely. All practitioners need to have specific national protocols, so we set up a clinic they all can attend—from home.”

The college’s master’s and doctoral programs are helping stem another, hidden, shortage of nursing instructors, enabling them to teach at the community college and university level.

undefinedTeamwork, team leaders

Not long after graduating with her nursing degree in the late 1970s, Elaine Scott did something she’d wanted to for some time: she burned her nurse’s cap. She bristled with the expectation that as a nurse, she should avoid making decisions.

Today, Scott directs the Center for Nursing Leadership at the College of Nursing, a pioneering initiative to empower future nurses to do just the opposite.

“We burned our caps as a way to purge ourselves of being part of the old way of nursing,” says Scott, who in 2005 was one of the first graduates of ECU’s nursing Ph.D. program. “The old model was that those of us providing care did what we were told. There is so much more knowledge now. No one can know all there is to know. It’s important to have a partnership if we’re going to be most effective for our patients.”

As director of the center, she initiated special classes that allow future nurses to think through tough questions and better understand the traits that will help them, or hold them back. She often uses executive personality tests to help them learn mature approaches for leadership.

Why is leadership more important than ever? Scott believes the quality of nursing care is directly related to a patient’s health outcome. She points to recent studies showing that patients fare better when nurses have a higher education level, more experience and a satisfying work setting.

“If you’re in the hospital, the person who’s most likely to notice when something’s not right is the nurse,” she says. “We’re there 24 hours a day.”

In a region where towns are isolated and patients may be poor, she knows that nurses must consider a patient’s overall situation.
“You have to think, ‘Does this person have food, medicine and a way to get back to the hospital?’” she says. “Who’s going to give this person a bath? We have to think about all areas of a patient’s life, and work with other providers to make sure we have all the elements, such as physical therapy, a patient will need at home.”

“If you have strong nurse leaders, then they are more equipped to facilitate patient care,” Brown says. “Strong leaders will positively affect the overall quality of care that hospitals and other health facilities can provide. And better educators provide the strong theoretical knowledge nurses need to base their care practices on.”

The future in focus

As it looks toward its 50th anniversary, the college is placing research at center stage. Basic sciences and evidence-based practice will work hand in hand as nurse researchers develop new approaches that promise to advance and improve patient care.
Martha Engelke, associate dean for research and scholarship, says the college’s new Eakin Professorship will ideally be filled this year by a faculty member who is also a researcher.

“We are recruiting for a nurse scientist who is working in a traditional area of research and can use the wet lab in our new building,” Engelke says. “We would like for that nurse scientist to be someone who can collaborate in bio-behavioral research, to help us find links between what‘s found in the lab and understanding people‘s behavior.”

Other research benchmarks include the 2007 Magnet Prize, a prestigious award given by the American Nurses Credentialing Center. The prize recognized work by the College of Nursing and Pitt County Memorial Hospital in caring for morbidly obese patients who undergo weight-loss surgery. Led by Mary Ann Rose, the National Association of Bariatric Nurses began at ECU’s College of Nursing in 2004, where it resides today and promotes research that will improve care for morbidly obese surgical patients. The medical school has been a leader in developing and performing gastric bypass procedures and nurses have served a vital role in its success.

With a stronger focus throughout the university on research and scholarship, the nursing college is also placing more emphasis on them.

“Our doctoral program is an important part of the overall growth that’s ahead for the College of Nursing,” Engelke says.
“Our research mission is consistent with the university’s larger goals of scholarship and discovery, but our program will always be distinctive.”

undefinedNurturing the nursing program

housands have gone on to successful careers after graduating from nursing school at East Carolina, such as Diane Poole ’81 ’88, executive vice president and Mary Chatman ’90 ’96, who is a vice president and Chief Nursing Officer at Pitt County Memorial Hospital, part of University Health Systems of Eastern Carolina, a seven-hospital network. Other graduates are shining in business and industry, such as Gale Adcock ’78, the director of corporate health services at SAS Institute in Cary who oversees a $4.2 million budget and a staff of 59.

Also among the college’s distinguished graduates is Phyllis Horns ’69 (right), the dean of the nursing college who now is also serving as interim vice chancellor for the Division of Health Sciences and interim dean of the Brody School of Medicine.
Horns’ career in academics began soon after she completed her bachelor’s degree and was asked to teach at ECU. Later she left to pursue a doctoral degree in nursing at the University of Alabama, and was tapped as its assistant dean for undergraduate studies in 1981.

She became dean of ECU’s School of Nursing in 1990. Under her leadership the college saw an explosion in growth at all levels, adding a Ph.D. program, enlarging its master’s degree options, initiating ambitious online programs and moving into a new building on the Health Sciences Campus.

“I feel humbled by all we have accomplished,” Horns says. “I feel proudest, though, that through all of these changes we have held tightly to our values and belief that our graduates should be the best in their field. The reputation of our graduates in the work force is top notch and our faculty genuinely value that. We have found a way to have growth and quality, and that’s a point of pride for me.”
She has seen remarkable growth in East Carolina’s nursing programs—and in the profession.

“The rate of growth of knowledge in this field is incredible,” she says. “We know so much more than we did 30 or 40 years ago, and our programs have evolved to stay in tune with the latest advances in health care. We’ve shifted our focus from being primarily knowledge based to placing more emphasis on problem solving and critical thinking. Our graduates must have sound knowledge, but they must be problem solvers, as well.”

Remembering her own nursing education in the mid-1960s as “pretty simple compared to what students have to learn now,” Horns said nurses are expected to master the same basic skills along with new, high-tech ones, hundreds of medications and new therapies. “The amount of knowledge that a nurse has to have is significant,” she says. “And our health-care consumers are a lot more informed, too.”

She reflects modestly on her own steady rise to the top, and says she still feels she is a nurse at heart. “No one really goes into this field so they can become a dean or a vice chancellor,” she said. “It’s because we’re interested in human service. And, in my case, I’ve had the leadership experience that’s needed for successful administration.

“In the end, everyone must work together, because our work has a direct effect on patient care,” she concludes. “We can’t afford to be associated with an institution that isn’t committed to quality. It’s too important for our patients.” —Marion Blackburn