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- William Paterson University
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Preparing Nurses for the 21st Century
by Barbara Bakst
William Paterson University nursing student Anne Marie Drummond and nurse Jennifer Deraney ’95 sit in front of a large monitor in the offices of Valley Home Care in Paramus, where Deraney is coordinator of the congestive heart failure unit. On the screen is a live, real-time video of a patient they are monitoring through the home care agency’s telehealth program.
Still
in its infancy, the telehealth program enables patients and their nurses
to communicate live using video and audio enabled technology. The patient’s
telehome care unit, which uses a standard telephone line, weighs 12 pounds
and has a four-inch screen. It is a videophone attached to a blood pressure
machine and stethoscope. Simple to use, it has only three color-coded
buttons: green to answer the call, yellow to use the stethoscope, and
blue to start the blood pressure monitor. A small camera provides such
a clear picture of the patient that wounds and skin tones can be assessed
clearly via the machine.
The unit in the home care office
is a personal computer loaded with the software necessary to view the
patients and document assessments. A small camera sends the patient a
picture of the nurse. The nurse views the patients on an eight-inch screen.
Documentation of vital signs and the nurse’s notes can be completed
as the tele-visit occurs and graphed and printed when the nurse desires.
While technology can be alarmingly
impersonal, the telehealth care unit offers a surprisingly friendly connection
between the patient at home or in an assisted living facility and the
telehealth nurse who can be many miles away. The tele-home care units
do not replace the home visits that require hands-on care, but they can
alert the nurse quickly to a patient’s changing condition and cut
the number of home visits decreasing health care costs.
“The technology has enabled
us to catch signs of congestive heart failure early,” says Deraney.
“By combining the telehealth program with traditional home care visits,
we can treat patients quickly and avoid hospital admissions.”
Technological advances such as the telehealth program are causing dramatic
changes in the fast growing field of home health care, according to Aine
Lynch ‘81. Lynch, an assistant professor of nursing at William Paterson,
divides her time between teaching home care and other nursing courses
at the University and working with Valley Home Care, which is an affiliate
of the Valley Health System in Ridgewood.
“Home care is the wave
of the future,” says Lynch. “Patients are being released sicker
and quicker. HMOs limit the number of days a patient can stay in a hospital.
Five years ago a person having bypass surgery would stay in the hospital
a minimum of 10 days. Today they are out in four to five days; in a year
or two it will be three days. Home care nurses now have more responsibilities
and need increased knowledge. That is why I take my students with me when
I do home care visits. They observe as I do complete assessments of the
patients to determine what services they need.”
In the 35 years since the University began offering a bachelor of science
degree in nursing, the profession itself has changed substantially. Today’s
nurses require a wider breadth of knowledge and must develop the critical
thinking skills needed to be leaders in their field of health promotion.
“In the old days nurses
only worked in hospitals but now the pool of nursing has spread over greater
opportunities,” explains Dr. Janet Tracy, professor of nursing, who
recently completed a three-year term as chair of the department. “Today,
nurses can fill positions in HMOs, insurance companies, surgical centers,
clinics, assisted living facilities, nursing homes; even corporations
often have nurses.”
With considerable pride, Tracy says, “The William Paterson-educated nurse is the one needed in today’s world,” adding that the market requires highly trained and educated nurses who are able to coordinate all the pieces of patient care. “The revolution in technology, medical discoveries, and ever-growing production of complicated new drugs, requires today’s nurse to constantly keep up-to-date. Every year we evaluate our curriculum and textbooks. But that is not enough. Most of the antibiotics our students will administer when they graduate have not been invented yet.”
| Jennifer Jacobsen ’00 decided to become a nurse when her brother was left a paraplegic after a diving accident. “I saw how important nurses were. The experience sparked my interest. Nursing is such a diverse field, a wonderful career.” Just 24, Jacobsen has already made her mark: a protocol she developed for pressure ulcers at the Wound Care Center at the Morris County Rehabilitation facility as part of her senior leadership project was adopted by the center. |
Preparing nurses for the twenty-first
century takes on added importance in view of the current – and unprecedented
– nursing shortage throughout the United States. While shortages
in nursing personnel have occurred on a cyclical basis for decades, the
crisis in 2001 is especially severe. In New Jersey alone, predictions
indicate that hospitals, nursing homes, and nursing agencies will be unable
to fill 14,000 positions by the year 2006 if the drop in nursing enrollment
and the exit of nurses from the profession continues.
Tracy reports that this most
recent nursing shortage dates back to 1994. “HMOs began dictating
how much hospitals charged for care, so the hospitals responded by cutting
back on nursing staffs, which represent their largest expense,” she
states. “Also, career possibilities have opened up for women, many
with higher pay and a more glamorous aura, which has led to a decline
in the number of students enrolled in nursing programs.”
Another problem is the aging
of nursing professionals. “The average age of a registered nurse
today is 44,” explains Tracy, who, at 54, is the youngest tenured
nursing faculty member at the University. “We’re an aging group.
We need more people just to replace ourselves, and today nursing is so
much more complicated.”
When the University founded
its Department of Nursing in 1966, the curriculum included general courses
on nursing of adults, newborns and maternity patients, and children. Today’s
program, which is accredited by the Commission on Collegiate Nursing Education,
provides students with training in urban and suburban settings, and offers
a wealth of specialized courses, ranging from nursing technology and nursing
of the elderly to critical care nursing and holistic health practice.
The teaching staff includes 16 full-time and 11 half-time highly credentialed
professors. The program, which has a current undergraduate enrollment
of 350 students, also provides an opportunity for RNs holding an associate’s
degree from one of the New Jersey cooperating community colleges to achieve
bachelor’s degrees based on transfer of their college credits.
Tracy points out that the nursing
program is affiliated with 57 cooperating agencies located in surrounding
Bergen, Essex, Hudson, Morris, and Passaic counties which provide students
with clinical experiences in a variety of hospital and other health care
settings. Current partners include community and inner-city hospitals
and medical centers, as well as public health agencies, mental health
clinics and institutions, nursery and day-care centers, prenatal and ambulatory
care clinics, and nursing homes.
“The variety of settings
affords our students a wealth of opportunities to gain on-site experience
connected to their studies, and to interact with clients of all ages and
from diverse religious, socioeconomic, and cultural backgrounds,”
she adds.
“Each
student must have six of their eight semesters in clinical experiences
during their four years,” Tracy continues. “Beginning students
practice on mannequins and each other in the nursing labs at the University.
By the end of the second semester sophomore year they spend one day each
week in a clinical area which increases to two days a week in their junior
and senior years. They work at various agencies doing patient care, teaching,
and all kinds of research. In addition, they work on community-based projects
and activities in other health care capacities.”
A graduate program in nursing was initiated in 1996, and today the University has one of the largest master’s programs in the state. Directed by Dr. Connie Bareford, it has a current enrollment of 100 students and offers 12 to 14 courses every semester.
“The program is unique
in that it is the first in New Jersey to offer a master’s degree
in community-based nursing,” says Bareford. There are three tracks:
clinical practice, education, and administration. “Students are prepared
to take their certification examinations and are trained to run clinics,
nursing centers including same day surgery centers, home care agencies,
and family health benefits settings where the whole family can come for
care.”
The University is committed
to continually advancing the program’s offerings on both the undergraduate
and graduate levels. In particular, new developments in technology are
leading to changes in the nursing curriculum and teaching strategies.
Bareford is now teaching Advanced Nursing I, a core course of the graduate
program, via the Web. Each week there is a discussion forum based on reading
assignments, which focus on clinical and managerial issues related to
caring for adults in community-based settings. “Students can talk
to me and other students via e-mail, ask questions and receive answers,”
Bareford says. “The feedback from students taking the online course
has been extremely positive. They like the flexibility of working from
home and not coming to campus.”
The Nursing Department is also
integrating new courses into the curriculum in topics of up-to-the-minute
importance. In response to an increased emphasis in the health care industry
on the connection between spirituality and healing, Dr. Ruth Harrison
has created a groundbreaking course, Spirituality in Nursing, which is
one of the first of its kind in the nation. In fact, the Joint Commission
on the Accreditation of Health Organizations (JCAHO) now requires health
care organizations to demonstrate how they are helping their patients
meet their spiritual needs.
“Research shows us that
old-fashioned values like love, compassion, and caring make a difference
for patients,” says Harrison. “In order to meet those needs,
we as nurses must understand our own feelings about spirituality and be
aware that everyone’s definition of spirituality is individual. It’s
really about the art of nursing.”
Harrison defines spirituality
as “an active process which enables one to relate to self, others,
a higher power, and nature in a loving way, and provides strength in adversity
and purpose and meaning to life.”
The discussion-based course, which Harrison initiated in the fall 2000
semester, focuses on a wide range of topics, including individual definitions
of spirituality, the search for meaning, the implications of culture,
and how a nurse can help a suffering patient find meaning in the experience.
“Nurses are often with
patients in very difficult moments,” Harrison explains. “A nurse
who is caring and compassionate at the right time can make all the difference.”
As an example, Harrison relates an experience she shared with University
student Karen Remington, who was working in the neonatal intensive care
unit at Morristown Memorial Hospital. One of Remington’s patients
gave birth to twin sons, one of whom was stillborn. “We know how
important it is to have closure when you lose someone,” Harrison
says.
The mother had been provided with photos of her stillborn child, but had been advised by her doctors not to see him. Harrison went with Remington to talk with the mother, who decided she wanted to say good-bye to her son. They arranged to have the dead child brought to her wrapped in a blanket so that she didn’t have to see the child if she didn’t want to. “The woman held the baby in her arms, told the baby she loved him, gave the baby a name, and cried. We cried with her,” says Harrison. “It allowed her to let her feelings come out, and the next day she was smiling because she had a chance to say goodbye to her son. It was one of those sacred moments.”
| Caswel Young ’01 has witnessed the current nursing shortage first-hand. An RN, Young worked as a supervisor in a nursing home and in medical-surgical and critical care units in a number of hospitals before entering William Paterson in 1999. “Nurses are overworked, overburdened,” he says. “Hospitals are cutting back. Only full-time nurses are covered by health insurance, so hospitals try and hire more part-time nurses.” This year, Young attended a board meeting of the New Jersey Nurses Association. “I was literally taken in by the discussion of issues affecting nurses,” he says. “With an election coming up, this is a critical year. We need candidates who are sensitive to the needs of nurses. Nurses have no power to improve conditions. I want to change that.” |
The opportunity to make a difference
in someone’s life, as Harrison and Remington did, and in a variety
of settings, is the message that University nursing faculty are seeking
to communicate as they recruit students to study nursing. Janet Tracy
serves on the New Jersey Board of the Atlantic Health Care System to look
at nursing shortage issues, and has been active in career fairs to interest
high school students in nursing. She also serves on the New Jersey Board
of Baccalaureate and Higher Degree Programs, and is looking into developing
a Web site to inform the public about the nursing shortage.
Linda Parry-Carney, an assistant
professor of nursing at William Paterson, is secretary of the New Jersey
State Nurses Association (NJSNA) and a member of its Board of Directors.
She is being groomed to take over the presidency of that organization.
Her major concern is the shortage
of nurses, which she describes as extremely serious particularly in acute
care, home care, and nursing homes. She is involved in workplace advocacy
and legislative and regulatory issues. “It is important to lobby
legislators and the governor’s office to let them know what is going
on,” she says.
Parry-Carney was active in working for the Mandatory Overtime Bill which
was conditionally vetoed by Governor Christie Whitman and remanded to
the Department of Health and Senior Services which is now conducting hearings
on the hours worked by nurses.
“One of the major problems
is that after nurses have worked an eight-hour shift, hospitals often
ask them to stay and work an additional shift. If they refuse, they can
be fired. Nurses have no power. They may have a family that needs them
at home, other responsibilities, or maybe they just need a good night’s
sleep,” she says.
As the nursing profession faces
a multitude of problems and challenges, the William Paterson Nursing Department
is helping to push the frontier of change ahead with its future-oriented
curriculum and its leadership in expanding the role of nurses.
“Nurses today need to be sophisticated team workers and case managers who can call the shots, coordinate the patient’s care, and pull the team together,” says Tracy. “Those are the nurses we are educating and will continue to graduate at William Paterson.” W
Charting
a Statewide Agenda for Student Nurses
Nursing Scholarships Aid Recruitment
Efforts
Barbara Bakst is a freelance writer and former director of public information and director of advancement communications at William Paterson.WP
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