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As Seen by the Dean

Jean Johnson discusses the School of Nursing's innovative teaching and policy agenda—from the importance of quality care to making a difference in medically underserved communities.

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William Atkins

by Jamie L. Freedman

In just three years, GW's School of Nursing has earned a place among the nation's top nursing schools.

Since 2010, Dean Jean Johnson has guided GW's newest school to national prominence: U.S. News & World Report ranked the School of Nursing among the top 10 percent of U.S. nursing schools and rated it 16th out of 101 nursing schools nationwide for online graduate nursing education.

GW Magazine sat down with Dean Johnson, who joined GW in 1981 as a geriatric nurse practitioner, for a look at the school's leading programs and initiatives, as well as a peek at what's on the horizon at the School of Nursing and for the nursing profession.

Q: Let's begin by addressing the current and future importance of nursing to health care overall.

A: Nurses are the cornerstone of our health care system. We have around 3 million nurses in the United States playing a vital role in every clinical setting—from acute care hospitals to hospice care to home care to outpatient care. And job growth is on the rise—the U.S. Department of Labor has projected that we will need 700,000 new nurses this decade to meet increasing demand.

There are a number of reasons for the escalating demand for nurses. First of all, the nursing work force is marching along in terms of age. There are going to be a tremendous number of retirements in the next three to five years. We are also facing a nationwide shortage of primary care providers, and policymakers and communities are increasingly looking to nurse practitioners as part of the solution.

The Affordable Care Act will provide at least 40 million additional Americans with insurance, and that will have tremendous implications for the number of nurse practitioners and nurse midwives that we must prepare. We also have a huge wave of baby boomers entering old age that are going to need health care coordination and home care services, which fall under the umbrella of nursing. Finally, with changes in organizational structures and reimbursement to hospitals, health systems will be looking for ways to decrease inpatient hospitalizations, keep people as healthy and functional as possible, and ensure that there is an efficient and coordinated system of post hospital services, and all of these involve nursing.

Dean Johnson signs a memorandum of understanding with Richard Teaff, president of Dabney S. Lancaster Community College in Clifton Forge, Va., to allow DSLCC students or alumni to earn a bachelor's or master's degree in nursing from GW while still serving the communities they live in.

William Atkins

Policy work around these and other topics, such as quality, is a top priority for the school—and our work encompasses research, analysis and providing credible information to nurses, health care leaders, policymakers and others.

Q: How does health care quality rank as a priority?

A: Many of our current projects focus on quality improvement. For example, we recently hosted a national meeting on patient engagement, featuring prominent presenters in the field who are leading the way in helping nursing as a profession create a road map for developing effective partnerships with patients. Nursing is already the most trusted profession year after year as reported by Gallup Polls, making nurses natural coaches and mentors to help patients be engaged in their care.

In addition to integrating patient safety throughout all levels of our curriculum, we have established a graduate program specifically in health care quality improvement. The program was initially established with the National Committee for Quality Assurance; their staff became GW faculty, teaching the courses relating specifically to that field of study.

At GW, we empower our students to raise their voices and say, "Stop this surgery; we can't go forward," and that is huge, because 100,000 people a year die needlessly of medical error. All providers need to be empowered to raise an issue. In the airline industry, safety improved when pilots, co-pilots, and navigators became equally empowered to raise issues, and health care will become safer when all providers are empowered to do the same.

Q: What is the School of Nursing doing to increase access to primary care in medically underserved communities?

A: To increase the number of primary care providers in Virginia, the School of Nursing signed an innovative statewide agreement in January that guarantees admission into GW's nursing programs to students with associate's degrees from accredited community college nursing programs across the state. It is amazing to think that more than half of the counties in Virginia—our School of Nursing's home state—are designated medically underserved communities. The agreement, described as a model for the nation by Virginia Secretary of Education Laura Fornash, enables Virginia community college graduates to earn a bachelor's or master's degree in nursing from GW while continuing to live in and serve their home communities, since almost all of their course work is completed online and their clinical work takes place in the communities in which they already serve (see story on page 11).

The statewide community college agreement followed the launch last year of a successful partnership with Dabney S. Lancaster Community College in Virginia's Shenandoah Valley to expand advanced nursing education in rural Virginia—a region where many people lack access to primary care. The program, which prepares students to become either family nurse practitioners or nurse midwives, is thriving.

Another place where we are making a difference is in Haiti, the poorest country in the Western Hemisphere, where people living in rural areas have very little access to health care. Our nursing school faculty members and students have participated in three medical missions to Haiti over the past two years, coordinated by Project Medishare and the International Medicine Programs Office in the School of Medicine and Health Sciences. We join GW medical students and public health students for the missions, which take place twice a year.

One of our goals is to give every nursing student the opportunity to participate in an international experience. We are starting small, with a commitment to Haiti, and are going to systemically create partnerships in other areas of the world.

Q: The School of Nursing is home to one of the nation's premier skills and simulation laboratories. What is the importance of simulation to nursing education?

A: The School of Nursing's skills and simulation lab is a premier and sophisticated facility that prepares students for the moment-to-moment decision making required in real clinical situations. In the lab, our students practice procedures on high-technology mannequins that they will eventually perform on live patients, making them much better prepared to go into a clinical setting than any nurse of my generation. When I was a nursing student, I learned how to do an injection on an orange. And then I went into a patient room and gave a patient an injection. I was so sweaty palmed and so worried about the patient because doing an injection on an orange is not like doing an injection on a patient!

When I walk into the newest part of our "sim" lab, I swear that I am walking into a hospital. Students practice real-life scenarios on complex patients in the lab and have to make quick decisions. In one scenario, a post-surgical patient who is doing reasonably well suddenly develops shortness of breath and an arrhythmia. The students who are taking care of the patient need to figure out what is going on and what to do. Students can later watch recordings of themselves in the lab to catch any mistakes they may have made, which is a great learning experience for all.

Q: What, to you, are some of the biggest issues in health care at the moment?

A: The most important health care issues are staying healthy, demanding high-quality, patient-centered health care, and ensuring that the costs of health care are more transparent. Staying well is absolutely the key: Exercise, eat well, sleep, do not smoke, wear seat belts, and wear helmets when you are biking.

Health care cost is a huge issue at the moment. We know the prices of most of the products and services that we buy. If you take your car to be repaired, for example, the mechanics must let you know what they need to do to fix the car and how much it will cost. This is not true about health care. There are many reasons for this, but as consumers take on a larger part of the cost of health care, knowing what those costs will be is essential. Consumers need to have information about both the cost and the quality of services to make informed decisions. Health care costs cannot keep increasing at the rate that they have been; if they do, 100 percent of the GDP will eventually be consumed by health care alone! We must make the health care system more effective and efficient, and nurses have a huge role to play in making that happen.

Q: What are some of the other projects and initiatives shaping the School of Nursing's priorities?

A: We spend a lot of time looking for scholarship funds because they really do make the difference in determining whether many great people can attend our program.

Another one of our top priorities is offering innovative academic programs that meet the evolving needs of nurses and our health care system. For example, we are developing a BSN program that will enable military personnel and veterans trained as medics and independent duty corpsmen to apply their extensive clinical experience to becoming nurses.

We are also launching a Doctor of Nursing degree program in executive leadership that incorporates entrepreneurship and is in partnership with the School of Business. I am really excited about the program because there are so many nurses with great, creative ideas who are anxious to gain the entrepreneurial skills to turn those ideas into a business, patent, or new program or service within a health system.

Another program that we plan to explore is a master's degree in global health nursing in partnership with the School of Public Health and Health Services, and the Elliott School of International Affairs. Five years down the road, we're looking at launching a PhD, hopefully in collaboration with the School of Public Policy and Public Administration. And these are only the things that we know about at this point. There will be many other opportunities and challenges, and that's what we love.