98-01-16:  LANCASTER READS STRONG VITAL SIGNS FOR NURSING



By Katherine Jackson



Jeanette Lancaster, the Sadie Heath Cabaniss Professor and dean of the
School of Nursing, came to U.Va. in 1989 after serving as dean and
professor at Wright State University in Ohio. A former psychiatric
nurse, she sees nurses as increasingly important providers of
cost-effective primary care. Lancaster's objective is to train highly
skilled nurses who will continue to play a major role in bringing
health care to all Americans during the next century.

As the small woman with the grand vision strides through McLeod Hall,
one thing is clear: the old way of doing things is not going to be
sufficient for the future. Lancaster expects to see U.Va. become one of
the top 10 nursing schools in the country. It already ranks among the
top 25.

Lancaster's enthusiasm has sparked new and innovative ventures at the
school. Under her leadership, three endowed nursing professorships have
been created. U.Va. became the first nursing school in the U.S. to be
recognized by the National Alliance for the Mentally Ill for teaching,
research and service activities with psychiatric patients.

Lancaster also has seen the school grow to include nurse practitioner
education in both primary and acute care at the masterıs level.

An authority on community health nursing, Lancaster says providing more
efficient health care will require outreach to underserved populations,
especially women, children, minorities and the elderly in rural
communities.

She travels frequently on behalf of the Campaign for the University and
enjoys sharing her vision of nursing education at U.Va.

"Every time I meet alumni on the road, I gain a fresh appreciation for
the loyalty and genuine love these women and men have for the
University. It is easy to ask people to invest in the School of Nursing
because what we offer is high quality and a good investment for them."

Q.  What made you decide to become a nurse?

A. I decided to become a nurse at age 5, when I was hospitalized to get
my tonsils out.  I wanted to be just like one of those nurses who took
care of me. I chose psychiatric nursing for my specialty because as an
undergraduate nursing student, I thought the pain of mental illness was
the most severe. My doctorate is in public health because I wanted to
blend my interest in mental health with a focus on prevention.

Q.  Should we expect to see more nurse practitioners working in
collaboration with physicians? Will the trend continue into the next
century?

A. Nurse practitioners are being used today in both primary and acute
care, working with physician specialists. They are registered nurses
with advanced academic and clinical experience, which enables them to
diagnose and manage most common and many chronic illnesses. Nurse
practitioners treat patients either independently or as a part of a
health care team. Some of the most interesting examples are primary
care practices in rural areas in which a physician and a nurse
practitioner manage a large group of patients.

An acute care nurse practitioner might work with a transplant surgeon
or other specialists.  In that setting, the nurse practitioner would do
a lot of the pre-surgery preparations, teaching, and a significant
amount of post-operative care, including hands-on care.

In the future we will be including more community-based educational
experiences in our programs and more content on delegation,
supervision, management, financing and health policy. We will
increasingly work collaboratively, especially with physicians, in order
to use medical teams more effectively to deliver care in an effective
and cost-sensitive fashion. ... We have established nursing clinics in
public housing. We have begun teaching part of our undergraduate
pediatric nursing course in the schools. [We are] working with agencies
like the Thomas Jefferson Health Department, Region 10 for mental
health services and the Jefferson Area Board on Aging.

For a person who likes working in an environment characterized by
change and uncertainty and who is a good critical thinker as well as a
creative, innovative planner and team player, nursing is just the place
to be.

Q.  Tell me about the quality of students enrolling in U.Va.'s nursing
school.

A. For the fall, we had 147 applicants to our first-year class for 40
spots. Of those who were admitted, their average GPA in high school was
3.8 and their SAT scores on average were 620 verbal and 600 math. We
also take second-year transfers, and these students come either from
within U.Va. or from outside, with a number each year coming from
community colleges. This fall, we had space to admit 10 external
transfers, and there were 53 seeking admission. Similarly, in our
undergraduate program for college graduates, we had 71 applications for
28 spots.

Our school typically has around 500 students with about 300 in the
undergraduate program and 200 in the masters, postmasters and Ph.D.
programs.

Q.  What does the job market look like for your graduates?

A. Despite articles about hospital downsizing and mergers, the market
is robust for nursing graduates. This year our bachelor-degree
graduates had jobs much earlier than they did in 1996.  What we are
hearing around the country indicates that we are on the brink of
another nursing shortage.

Typically the cycle goes like this: there is about an equal number of
available nurses and jobs. A change occurs in health care financing and
hospitals begin cutting back. The media addresses the downsizing and
the applicant pool drops. Schools decline in enrollment and do not
produce enough graduates to meet the market demands, and another
shortage starts. This happens about every five to seven years.

With the aging of our country and the advances in medicine that have
allowed us to live longer often with chronic illnesses, the push to
move patients out of hospitals quicker means the demand for nurses will
again increase. In some of the Southeastern states, hiring bonuses
began again last year, and there is an increase in the recruitment of
foreign-trained graduates. [Editor's note:  As a recruiting tool, U.Va.
offers $1,500 sign-on bonuses to new critical care nurses for its
surgical intensive care unit.]

Q.  What is the American Medical Association's position on nurses
providing care that traditionally has been given by physicians?

A. The reaction of the medical profession to the inclusion of nurse
practitioners in their expanded roles is as varied as the people they
serve. Many physicians work collaboratively with NPs and have learned
role differentiation that makes the best use of each of their talents.

The need in our country to provide quality, affordable, accessible
health care is enormous. There is enough [work] for both physicians and
nurses. The key, I think, is in the collaborative training of these two
professional groups, who will be bound together throughout their
careers.

Q. How does a typical day get under way for Jeanette Lancaster?

A. I really like what I do. I get up almost every morning wondering
what interesting thing is going to happen. Typically I'll wake up at
5:30 a.m. I'll exercise while watching the news or, weather permitting,
I'll  jog outside while listening to novels on tape.

Now  I am reading John Grisham's The Rainmaker. Depending on whether or
not I jog, I'm at work between 7 and 8 a.m. My daily schedule varies.
Each day is a mix of meetings, individual appointments, e-mails and
telephone calls. A good bit of my time is spent fundraising, and that
can involve state and regional travel.

Q.  Tell me about your recent trip to Ghana. [The trip was part of the
WHO/U.Va./World Bank initiative to assist countries in sub-Saharan
Africa with health care.]

A.  My trip to Ghana in mid-November was useful and interesting.
Ghanian nurses and physicians are well-educated, talented and
exceedingly dedicated and hard-working.

They work under conditions that by our standards are so lacking. There
is only one baccalaureate nursing program in Ghana and no graduate
nursing program. Right now their greatest need is to educate a core of
faculty members with master's degrees in nursing, i.e., one in each
specialty area, so they can begin their own masterıs program at the
University of Ghana. We hope to be part of the solution for them.

The kindness, warmth and generosity of the nurses there was incredible,
and I think our faculty and students will benefit by working with the
Ghanian nurses.

Q.  What do you consider your most significant achievement at U.Va.?

A.  This is so hard to answer. There is  really little that I can do
alone. The successes in this school have come from the hard work of
teams of people. In recent years, we have developed a first-rate
development and alumni program. We have raised $6.2 million thus far in
the campaign and have doubled our original campaign goal.

We have increased the amount of money that comes in for sponsored
research to the point  where we rank ninth in the country among nursing
schools in the level of NIH funding. Given that we are a small school
of nursing with 500 students and about 50 faculty, our ability to
attract research funds is exceptional. This is due to the hard work of
a core of talented and creative faculty.

Our school has a strong and collegial relationship with the Medical
Center. We continually develop new initiatives to strengthen both our
educational programs and the quality of our graduates, many of whom
seek employment after graduation at the Medical Center and throughout
the UVa Health System.

Q. Describe your management and communication style.

A.  Because my original specialty training was in psychiatric nursing,
I pay attention to my style.  Some days this means that I am the first
to know when my behavior has not been as inclusive, thoughtful and
deliberate as it should be.  A few years ago, the nursing school hired
some consultants to help us look at our culture and the way we work
together. I spent a day with the lead consultant whom I asked to help
me see how I functioned with others. The consultant confirmed what I
knew, that  I am driven by the need for efficiency and effectiveness. I
want to move things along.

I  began listening to the metaphors that I think tell about myself.
...  I hear myself saying things like, "It's time to fish or cut bait."
One of the things that I tell my staff is that we need to close the
communications loop. With my tendencies toward efficiency, I might be
half way down the path, and I'll get distracted and Iıll be on another
path. And we may not have not completed that first journey. Sometimes I
move ahead before all the ground has been plowed, and others are not at
the same place. ... That was something very specific I  paid attention
to when I hired an associate dean.  I needed someone who was able to
talk through things. ...  I need to surround myself with people who are
interested in processes and pay attention to details.

I meet with my management team face-to-face and via e-mail. I'm an
extrovert. Using the Briggs-Myer personality scale, of our four-member
team, two of us are extroverts and two are introverts, which is a good
balance. Of course, if we were all extroverts, weıd never get anything
done. There isnıt enough air time.

Q.  What U.Va. courses have you taught?

A. Since I have been at the University I have taught a wide range of
courses often teaching where and when we had a staffing need. This will
be my third year teaching a fourth-year "Issues and Trends in Nursing"
course. By working with undergraduates I have a keen understanding of
our graduates, and I have an opportunity to talk with them about their
chosen profession and the skills they will need in order to be
successful.


QUOTE FROM JEANETTE LANCASTER, DEAN OF THE SCHOOL OF NURSING


"For a person who likes working in an environment of change and
uncertainty and who is a good critical thinker, a creative, innovative
planner and team player, nursing is just the place to be."



Profile


Name: B. Jeanette Lancaster

Born: Jonesboro, Ark.

Education: Bachelor's degree in nursing in 1966 from the University of
Tennessee; master's in nursing in 1969 from Case Western Reserve
University; Ph.D. in public health in 1977 from the University of
Oklahoma

Family: Husband, Wade, who teaches marketing for the government of
Saudi Arabia about 10 months out of the year at the Institute of Public
Administration; two daughters -- one is a health care attorney in
Knoxville and the other works for a health care consulting firm in
Atlanta.

Pets: Simon the cat. "She is especially Lawn-friendly," Lancaster says.
"Recently her friendly nature led her to spend an entire day in the
Teaching Resource Center on the East Range. The door had been left open
during a meeting, and Simon went in and reclined on the couch until I
received a call. ... Simon had been there all day. Because Simon likes
to visit, she wears a collar bearing her name and phone number.

Hobbies: Reading, usually read business books and novels. Jogging.
Traveling -- "I like to travel to unusual places. This year my entire
family traveled to Costa Rica. This year I am going to Saudi Arabia and
the United Arab Emirates for vacation."