Linda Scott grew up in a family that valued achievement. So she didn’t accept a high school guidance counselor’s judgment that she was better suited for secretarial classes than college prep, the new dean of the UW-Madison School of Nursing recalled.
“My mother came to school and had a conversation with a few people and I was allowed to move into science courses. I had someone tell me I wasn’t college material, and now not only do I have one degree, I have three,” Scott said from her office at Signe Skott Cooper Hall.
Helping a more diverse mix of students recognize and develop their capacity for a profession in nursing — a field of both science and art — is Scott’s vision for the institution as it heads towards its centennial in 2024.
I’m always hearing about nursing shortages. What does the picture look like now?
There are typically nursing shortages and we’re going into an unprecedented one, especially in Wisconsin. Given the mean age of nurses and nursing faculty and expected number of retirements, by 2040, we’ll see a 35 percent gap between the demand for nurses and the actual supply. So in Wisconsin, we’ll be around 23,000 nurses short to meet healthcare needs of the state.
Why is it so difficult to get people into nursing?
The challenge is that there’s a nursing faculty shortage. The mean age of faculty is approximately 58, so about half of nurses will retire in the next 10 years. There is also a limitation on the number of clinical sites; when you are an applied discipline, you have to provide clinical experience.
So it’s not a shortage of prospective students.
Here at UW-Madison we admit 152 students a year to our pre-licensure program, which is a large number, but given that we have 350-400 students who apply, we can’t admit all of those who are qualified based on capacity.
What is the school doing to try to produce more nurses?
One of the things we’re trying is starting an accelerated second degree program for individuals who have a degree in another field and want to become nurses. About 60 individuals in our traditional program have bachelor degrees or higher. And by moving them into a program that accelerates their education and enables them to get into the profession faster, we also open up those seats for first-degree seeking students.
Are there areas of practice where the nurse shortage is particularly acute?
The rest of society is aging just as nurses are, so there is significant need in the care of older adults. An area of desperate need is in psych-mental health. As we see individuals with more chronic conditions, they may also have mental health issues from depression or anxiety. And the number of individuals with post traumatic stress disorder is increasing.
What about diversity among nurses practicing today and those coming up through school?
There are a lot of documents that talk about the need to have a workforce that is representative of the individuals who you care for. Unfortunately when you look at the overall population of nurses, the proportion of nurses of color or male nurses is pretty low.
About 85 percent of nurses are white and female. So how we actually maximize recruitment of and retention and graduation of individuals of color is very important. And if they don’t get the undergraduate education, we can’t get them into graduate education so that we also have faculty of color, which is really important.
So how diverse is the nursing school now? What are your plans to develop greater diversity?
About 12 percent of our students now are students of color. We definitely don’t mirror the overall population, so that is a goal. We had a meeting last week talking about a holistic admission process which is a strategy that can be used to improve diversity. I was involved with that process at University of Illinois Chicago, where we were the second nursing program to be formally trained in looking at individuals from a holistic perspective.
A holistic admission process looks at attributes other than grades — experiences and qualities that a person can bring that are reflective of your mission. It can identify individuals who will be successful as nurses, rather than just as students. That’s very different. We’re looking at bringing that process here to UW-Madison and building on strategies we already have in place in our outreach and engagement with the community.
What are some barriers you see that stop people of color from entering the field?
There’s always the stereotype that nursing is all about bedpans and being subservient to the physicians, and not really seeing nursing as it truly as, a professional career. Other issues for individuals come from social determinants – they may not have focused on science and college-prep courses, or had help to be persistent in college in general, let alone pursuing a rigorous science based degree.
So we try to make sure that there are role models out there, that we talk to younger generations, no matter who they are, to break down misperceptions about what the possibilities are, what it means to be persistent and how not to let barriers get in the way of realizing your dreams.
What about other groups?
Diversity is not just racial ethnicity, it’s also gender diversity, sexual minorities, those with some type of disability. How do we get diversity of perspective?
Has the gender barrier broken down?
I think nursing is more attractive to men than in the past, but there is still a glass ceiling. You see men come into nursing because they want areas like nurse anesthesia, or they see it as part of a precursor to med school. Or because they didn’t get into med school, instead of its being a destination career
When you mention nurse stereotypes, I recognize them, but in medical settings, the nurse can be the one who really talks with a patient. It is nurses who hold the hand of someone who is frightened, who make a connection.
It is relationship that sets us apart — the therapeutic relationship, being able to recognize there are other things going on beside the medical issue, that there are underlying medical conditions, that there are mental components. That’s what nursing is about.
That’s not bedpans.
No, it’s not. You know how to start an IV, but also why the patient has an IV and what’s running in it, and while you’re doing it, you’re talking to that person you’re seeing the level of anxiety and having a conversation. You’re doing a different kind of intervention while you’re doing a medical intervention.
What skills or knowledge are required of nurses today that the public may not realize?
I think people may not realize the theory and evidence-based part of nursing that drives our practice along with the art of nursing. We need both. Our professional is about the science and the art.
Your office provided me with data showing the school of nursing was awarded about $1.16 million in federal research funding in 2015, ranking it 36th nationally. Is that number where you’d like it to be?
We definitely need to build our research enterprise. We have individuals on our faculty who are making a difference in care of the older adult, transitional care (ensuring the coordination and continuity of care between settings) symptom management and child health. We’re poised to do really good things.
Why is the research important if you’re producing good nurses?
We’re an evidence-based profession; you want research to guide the practice. We have good research that needs to be translated into practice to have good outcomes of care. And it’s what helps attract students to us. We have a national and international reputation for excellence in education, research and practice.
I read that one area of your research was nurse fatigue. Was that fatigue over the years or from pulling doubles because there are not enough nurses to take the next shift?
Both. A nurse typically works 12 hours, and they need to have 30-60 minutes to travel to and from work. Now we’re at 14 hours. There’s on average at least an hour or so of overtime daily. So we’re at 15-16 hours. Then come people’s other responsibilities. Adults need seven to eight hours of sleep, but most nurses average five or six hours, so you can get an acute sleep debt. It just takes a one- or two-hour sleep debt to affect how you perform each day; do that five consecutive days and you have chronic sleep debt.
This is common?
This very common. But nurses aren’t alone in that. We’re a 24/7 society.
Yes, but fatigue-caused errors by nurses can more serious consequences than those of some other kinds of workers.
Exactly. So my concern is how do we mitigate that so we have an alert nursing workforce.
What are some of the things that can be done?
Respite from the job — sufficient breaks, strategic naps. Most jobs require individuals to stay awake at work, so falling asleep is grounds for dismissal. But what if we thought about how to provide a planned respite from the work role, a 20-30 minute nap?
Allow it, encourage it, have an environment that supports it. We could actually improve alertness in the work environment
Have any hospitals done that?
I’ve done a couple of studies that show it is possible to translate this into health care — it is done mostly in the industrial sector — and see mostly positive effects. The hospitals where I had done it, they had suspended their human resource policies for firing for sleeping on the job during the study and then put them back in place once the study was done. But was can also work to ensure mandatory breaks, so that instead of working through lunch and dinner periods, nurses are required to take a break.