Dean's Blog: Catherine Gilliss, PhD, RN, FAAN

A New Day: Catherine Gilliss Returns to Lead UCSF School of Nursing

October 2017

Catherine L. Gilliss (photo by Elisabeth Fall) For this month’s Dean’s Blog, we speak with Catherine L. Gilliss, PhD, RN, FAAN – the new dean of the UC San Francisco School of Nursing. A national nursing leader, Gilliss will also serve as associate vice chancellor for nursing affairs at UCSF. Over the last two and a half decades, she has been dean at Yale University School of Nursing (1998-2004) and Duke University School of Nursing (2004-2014) and was chair of the UCSF School of Nursing Department of Family Health Care Nursing (1993-1998).

Why this job? Why now?

UCSF is a very special place for me; it really launched my career. I was a fairly young student in the PhD program, and UCSF gave me my roots and my wings. I flew away to some pretty amazing places with superb educational preparation underneath me, which helped the institutions I led achieve a fair amount of success.

This also feels very much like a homecoming to me. I came to San Francisco in 1979 and stayed 20 years. My children were raised here and this was our home. My tour of the East Coast was fun, exciting and growth producing – but when I stepped out of the deanship at Duke, I came back to the Bay Area for a sabbatical year, and I didn’t leave. I have been teaching online for the last two years, and I took on some special projects, but I didn’t want to leave. San Francisco is home.

How will your time on the East Coast shape what you do here?

The jobs at private institutions [as dean of the Yale and Duke schools of nursing] were very different from what I’d experienced here as a department chair. I think – and others have told me – that what I learned in the private world might have real importance in the public world, particularly at this time.

Most notably, in the private model there are no funds flowing from the state. Private institutions talk about, “Every tub on its own bottom.” If you don’t find funding, you don’t have anything to spend. I had to create a business model that worked, which meant thinking about accomplishing the socially significant work of educating nurses as a business. The work of the dean included setting tuition rates – to be reviewed and approved by the Board of Trustees – and figuring out the financial equation that would enable us to build a new building or grow a new program or hire new faculty members. I needed to develop plans that would bring in new revenues without burdening our faculty and staff members.

One of the things we did at Duke was to develop continuing education programs designed to meet the needs of health care companies. For instance, we took a topical program – population health management – and engaged our content experts to develop nondegree-based programs that could be taken to the corporate client. We taught large groups of employees in areas that were strategically important to the company. We were still in the business of education, but not degree-based education. And our educational “intervention” enabled these companies to address learning gaps quickly.

At a place like UCSF, where we focus on degree-based education, there is a place for continuing education. Health professionals must engage in lifelong learning to support current practice with changing and expanding knowledge bases. We could consider continuing education as a secondary product of our educational work.

Of course, if we ask our faculty to engage in this new responsibility, they have the right to expect it’s not just an add-on. It’s an exchange for something else they were doing, or they should get a premium for doing extra work. But if we price these types of programs correctly, they can help us add human and financial resources – and opportunities – to our School.

As you begin the job, what are your most important priorities?

My top priority is facilitating a dialogue with the faculty that will result in a strategic direction, but even before that begins, we know that there are a few things we have to do.

We have a mandate for much greater involvement in the UCSF Health enterprise. I don’t know yet exactly how that will play out, but my other title – associate vice chancellor for nursing affairs at UCSF – calls for involvement in the health system. We want our educational programs to be relevant and useful to people delivering care, and we want to be involved in the development of knowledge and delivery of care. [Vice President and Chief Nursing Officer at UCSF Medical Center] Tina Mammone [MS ’06, PhD ’14] and I have been in touch, and we will be working on development of a mutually beneficial plan for greater cooperation and involvement. The School’s faculty members are committed to deeper engagement.

Another priority is further development of our DNP [Doctor of Nursing Practice degree] program. I was an early advocate for the development of the DNP programs, believing that they would advance the preparation of nurses whose careers were committed to clinical care. The DNP programs, which include a heavy focus on leadership and the translation of knowledge into practice, hold the promise to impact service delivery. In fewer than 10 years, the Duke DNP program became the top program in the country, exceeding all expectations. At UCSF, our DNP program ties in nicely with our mandate to work more closely with the health enterprise. Ideally, the program would bring our clinical colleagues into the educational program and our DNP faculty into the health system to support implementation of important translational projects.

Diversity remains a top priority. I want to lead an organization where all people feel included and are supported to make positive contributions. I don’t know all the forms that will take yet, but in other settings, I have developed leadership and pipeline programs that helped to advance the members of our larger community. Nurses can – and should – be a force for combating the divisiveness that dominates social discourse today.

Finally, I and many others believe that if we’re going to find innovative and successful solutions to today’s challenges in science and care delivery, we will need an interdisciplinary approach. Nursing’s voice needs to be at the table. In addition to looking toward partnerships with those with whom we have always worked closely, I would like us to move toward some new and strategic partnerships on campus, in the Bay Area and beyond. For example, UCSF’s recent commitment to neurological health presents new opportunities for partnership in care and in science. Our proximity to Silicon Valley sets up the possibility for partnerships with technology companies. Nurses are well positioned to create applications for use by persons managing acute or chronic illness episodes. And, of course, as managers of care, they understand the needs of providers as well. UCSF also brings its well-developed expertise in symptom management to such a partnership.

Coming in, what most excites you about the School and about UCSF more broadly?

We have a very strong tradition of leadership and scientific success and are seen as a “common good” across the globe. The world wants UCSF’s School of Nursing to continue to be a leader. As the dean, I understand my role to be a steward of that common good. At this point in my career, what could be more rewarding than pursuing those possibilities?

 

Reflections on Being Interim Dean

September 2017
Sandra Weiss

Over the last few weeks, I have been reflecting on my experience as UC San Francisco School of Nursing’s interim dean for the past 13 months. I made it clear from the start that I was only willing to steward the School until we found a new dean, but it has been an undeniable pleasure to represent our School during this time of transition.

While transitions can bring out the best and the worst in people, among our faculty and staff, I saw only the best. Everyone stepped up to the plate, was fully engaged and approached their responsibilities with an eye to innovation and growth. As a result, we never languished or stagnated, but instead strengthened our already existing foundation of excellence and grew in exciting ways. We designed interprofessional and international programs, while also producing cutting-edge coursework. We made recommendations for strategic priorities and a more sustainable business plan. We attained funding for impressive new research and training proposals. A very generous donor gave the School $25 million for a sensational new research center. And we strengthened our partnership with our outstanding nursing colleagues in UCSF’s clinical enterprise.

Our faculty and staff not only excelled in a variety of ways, but also demonstrated a strong commitment to the good of the whole, not just to their own individual goals and achievements. I believe this higher-level commitment is foundational to the advancement and success of any organization or institution. I recently saw an uplifting video of about 20 people creating a human chain that allowed them to reach a sinking car stranded in floods from Hurricane Harvey. Through their collaborative effort, they saved a young child and her father, who otherwise would have drowned. No one individual, not even a few of them, could have achieved this impressive outcome; and watching the video brought to mind our staff and faculty – an impressive group of daily heroes who help our School excel in ways we never could without their collective commitment to a common goal.

Another characteristic of our School’s team that contributes to our success is the tremendous diversity in the background, perspectives and talents of our faculty and staff. That chain of people who saved the child and parent included men and women of varied ages and races, different sizes and shapes, who all cared enough to unite so they could “make the impossible possible.” They all called out their thoughts about the best way to reach the car and how to keep their footing in the moving water. In a similar way, our staff and faculty bring distinct talents and traits that all contribute to the exquisite tapestry that makes our School so vibrant and strong. To me, this is another important factor in a successful organization: We should revel in our different strengths and contributions, rather than expecting a particular template of experience and skills to which everyone should conform. One facet of being dean that has brought me the greatest joy is learning about the nuanced roles and expertise of individuals throughout the School – the ways in which each person is uniquely essential to our ongoing success.

Finally, when I became interim dean, I wanted to increase opportunities for “deep work” among our faculty and staff. The last 13 months have literally flown by, and I’m sorry to say this never came to be. In his book Deep Work: Rules for Focused Success in a Distracted World, Cal Newport defines deep work as professional activities performed in a state of distraction-free concentration that pushes our cognitive capacities to their limit. He proposes that this type of depth is necessary to produce the “best stuff” we are capable of producing and that it is a false belief that we can multitask and think creatively during brief periods of time between other work activities. A residue of the previous task always remains, and recovering from that residue diminishes our ability to work intently on the task at hand. Executives, managers and leaders of all types – including faculty and staff in our School – hold positions in which distraction and the potential for ongoing “residue” are unavoidable. Constantly interacting with others and troubleshooting emerging problems are, by definition, part of the job. But even within such jobs, depth is needed to improve the quality of our work and enhance our satisfaction.

Cori Bargmann, an internationally recognized neurobiologist and geneticist who is president of Chan Zuckerberg Science for the Chan Zuckerberg Initiative, also spoke of deep work at a talk she gave last year. She noted that the initiative wanted to support people in thinking more deeply about what they did, including the results of their research and the intriguing implications of those findings. But it’s not only relevant to science. Deep work is what produces innovation and originality in every walk of life. Newport argues that no job is too mundane to allow for depth and creativity. He notes, “You don’t need a rarified job; you need instead a rarified approach to your work.” He suggests that to embrace deep work can transform a job from “a distracted, draining obligation” into a satisfying and meaningful career.

Ideally, we need to redesign work to achieve less disruption and make more space for creativity. This can also reduce stress by extracting us for a period of time from the myriad of issues and concerns that continually vie for our attention. It’s a struggle for all of us to set aside this kind of time as we juggle and manage multiple responsibilities. I had hoped to increase this potential for all of our faculty and staff while serving as interim dean. While I regret that this has not occurred, I’ll continue to advocate for it as I return to my faculty role. Meanwhile, I encourage each one of us to regularly schedule uninterrupted time to “think big thoughts” without distraction. That said, I’m truly amazed at the profound contributions being made by our faculty and staff, even with little time for deep work. Just think what could be accomplished if we added this to our lives.

Medical Center Investment Shows Importance of Neonatal Nurse Practitioners

July 2017Annette Carley
Michele Foster and Carla Medina

Michele Foster (left) and Carla Medina (photos by Elisabeth Fall) In 2015, UCSF Medical Center provided a strategic financial investment that allowed the neonatal nursing specialty program to reopen at UC San Francisco School of Nursing. This investment is a win-win for both the medical center and the School, because neonatal nurse practitioners (NNPs) are an essential component of the skilled workforce needed to deliver high-quality care to neonates and infants requiring intensive care. As NNPs, we have roles as leaders, clinical experts, educators, researchers and consultants in settings that include the intensive care nursery (ICN), transport, convalescent care, outreach and neonatal follow-up.

Annette Carley Our School was long an active training site for NNPs – and a source of NNPs for UCSF Health – but the program had been on hiatus for two years. The medical center’s investment ensured a dedicated commitment to clinical training through preceptor engagement with UCSF Medical Center NNPs. That is absolutely crucial because NNP training opportunities are limited regionally and nationally due to many recent program closures.

Students here complete a rigorous curriculum with coursework supporting competency in neonatal health assessment, pharmacology, nutrition, physiology and pathophysiology essential to the care of complex ICN patients. Skill-building exercises and the completion of 600 mentored clinical practice hours at local ICNs, including UCSF Benioff Children’s Hospitals, supplement the challenging coursework.

In December 2016, two of us (Foster and Medina) completed this program as post-master’s students, and we are now working as NNPs in the ICN at UCSF Benioff Children’s Hospital San Francisco. Because we had already completed our core master’s degree coursework – and had been ICN nurses for some time – we completed an individualized post-master’s program of study to ensure we could satisfy regulatory expectations for the NNP role.

One major advantage of the program was that it allowed us to continue working while completing our education. Taking on additional courses and clinical residency hours while working was challenging, but supportive faculty at the School and dedicated clinical preceptors at UCSF Benioff Children’s Hospital San Francisco and other training facilities helped us fulfill our dream of working in an advanced practice role.

Thanks to the close relationship with UCSF Benioff Children’s Hospital San Francisco, our transition from students to full-time NNPs was supported by many staff members who had known us during our training. Not only was it a wonderful feeling knowing that we could continue learning and growing professionally in one of the world’s finest ICNs, but we believe the medical center’s support highlights the importance of the NNP role at UCSF – and in all of health care. Programs like ours are essential if we are to continue to provide the type of outstanding care that helps very ill newborns survive and thrive.

Annette Carley is certified as a neonatal and pediatric NP, and has over 30 years of clinical experience in neonatal and pediatric care. Since 1995 she has been affiliated with the UCSF School of Nursing as a clinical faculty member and is currently specialty coordinator for the neonatal nursing specialty and associate director of the School’s Doctor of Nursing Practice (DNP) degree program.

Michele Foster came to the Acute Care Pediatric Nurse Practitioner (ACPNP) specialty program with seven years of experience in intensive care nurseries. She earned an MS degree from the School in spring 2016 and, in December 2016, completed a post-master’s program that trained her for certification as a neonatal nurse practitioner. She works as an NNP at UCSF Benioff Children’s Hospital San Francisco.

Carla Medina began her career at UCSF in the intensive care nursery. She earned an MS degree from the ACPNP specialty program at the School in spring 2016 and, in December 2016, completed a post-master’s program that trained her for certification as a neonatal nurse practitioner. She works as an NNP at UCSF Benioff Children’s Hospital San Francisco.

 

Introducing DNP Education to the UC System

May 2017Annette Carley and Jyu-Lin Chen

When it opens in spring 2018, the Doctor of Nursing Practice (DNP) degree program will represent another important addition to the academic portfolio of the UC San Francisco School of Nursing. We believe the need for a DNP program like ours – the first such program at any University of California campus – has never been more urgent.

DNP Program Director Jyu-Lin Chen (left) and Associate Program Director Annette Carley (photo by Elisabeth Fall)

Amid this period of rapid change and uncertainty, one thing has remained constant for our health care system: We must develop and refine more effective care delivery models to support the goals of greater efficiency and improved health outcomes. To that end, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) has, among other things, called for increasing the number of doctorally prepared nurses. DNP-prepared nurses are a critical part of this effort, because their skill set enables them to do everything from leading within health organizations to implementing and evaluating quality initiatives and participating in translational research that addresses complex health needs.

The increased demand for DNP-prepared nurses also means that very visible schools like ours must leverage our strengths – and the strengths of this entire health sciences campus – to bring innovative approaches that guarantee a quality education and new opportunities for our students. Our hybrid program design includes fully online core courses and small-group, scholarly, project-focused courses that use a variety of distance-based teaching strategies. Three in-person immersions at the beginning, middle and end of the program will build a learning community through peer-to-peer and student-to-faculty interaction and collaboration.

Students proceed through the curriculum as a cohort, but the design is flexible, so they can support their educational goals while continuing to practice. Even as they’re exposed to evidence- and research-based clinical practice and interprofessional skill building, students will choose elective courses that develop expertise in areas such as educational leadership.

Because our evolving health care system needs more nurse leaders in clinical, administrative, health policy and educational roles, DNP programs are growing nationally, and the American Association of Colleges of Nursing (AACN) recognizes these programs as the terminal level of preparation for nursing practice. It is an ideal time for UCSF to introduce our version of a DNP program.

Jyu-Lin Chen is director and Annette Carley is associate director of the DNP program at UCSF School of Nursing. To learn more about the program, email us at DNP@ucsf.edu or visit https://nursing.ucsf.edu/academic-program/dnp-nursing.

Reflections on Interprofessional Education, Practice and Academic Pathways at the SFVA

March 2017
San Francisco VA Medical Center

Guest authors this month are JoAnne Saxe, Anna Strewler and Krista Gager.

Around the country, team-based, interprofessional care is recognized as the ideal approach to many aspects of care delivery. But training a generation of clinicians who are truly prepared to deliver such care continues to present numerous challenges – to say nothing of implementing such care in real-world practice settings.

With this in mind, since 2011, UC San Francisco School of Nursing faculty members have contributed to the development and leadership of the San Francisco Veterans Affairs Center of Excellence in Primary Care Education (CoEPCE), an innovative program that has successfully forged and documented successful new approaches to interprofessional education and training. The program aims to advance the delivery of primary care that is patient-centered and team-based at the VA and beyond. Perhaps equally important, by assisting with the development, implementation and evaluation of this program, the involved faculty themselves have undergone a remarkable professional journey.

How It Works

Led by physician Rebecca Shunk and adult-gerontology primary care nurse practitioner (AGPCNP) Anna Strewler, the San Francisco VA Health Care System CoEPCE is one of seven such centers in the country. Most of the faculty members are affiliated with UCSF; working together, they have essentially flipped the traditional primary care education model on its head.

In traditional primary care education, faculty members educate trainees in their own professional silos through coursework and clinical experiences. In contrast, the CoEPCE brings together trainees from across professions – including second-year AGPCNP students, postgraduate UCSF NP residents and second- and third-year UCSF internal medicine residents, as well as psychology, pharmacy, social work and dietetics trainees. The model provides these trainees with precepted, team-based primary care experiences that allow them to refine how they work together, while building their individual professional competencies. Specifically:

  • The CoEPCE preceptors receive formal mentoring in effective clinician education in an interprofessional setting.
  • The NP students and NP residents are paired with internal medicine residents for a one- to two-year rotation, in which they care for a shared panel of patients along with their other interprofessional trainee colleagues and clinic staff members. Each trainee provider has an individual panel of patients, which combine to form a shared team panel.
  • NP trainees see their own patients and also serve as backup providers for their practice partners while they cycle through inpatient rotations.
  • Case-based clinical learning, patient-centered communication, quality improvement (QI) and panel management training, and team huddles and retreats all help guide the workplace learning experience.

Documenting Results

We consistently document the importance and success of this approach. Among the outcomes:

  • Quarterly surveys have revealed that trainees from all involved health care professions have found supportive and satisfying clinical experiences.
  • Patient surveys show high levels of satisfaction with CoEPCE trainee providers.
  • Involved NP faculty from the School and the CoEPCE use their experiences to drive ongoing improvements in the CoEPCE and the School’s AGPCNP curricula.
    • JoAnne Saxe and Caitlin Garvey have used the CoEPCE core curriculum to redesign a patient-centered medical home course for AGPCNP students.
    • Krista Gager and Saxe co-facilitate a primary care clinical seminar for the CoEPCE AGPCNP students.
    • Gager and Saxe co-lead the CoEPCE performance improvement and patient safety learning experiences with physician Maya Dulay.
    • Anna Strewler and Saxe have enhanced geriatric learning experiences for CoEPCE trainees and all AGPCNP students via case-based discussions and/or standardized patient experiences.
    • Strewler, Gager, Dulay and physician Abbi Eastburn developed and implemented a new curriculum for panel management CoEPCE trainees.
  • Drawing on what they learn about performance/QI, trainees are helping to drive important system changes at the SFVA. To date, there have been 33 completed QI projects, with approximately 50 percent of these leading to sustained improvements in care delivery, including increasing the rate of annual urine drug screens among patients receiving chronic opioids and reducing the inappropriate use of proton pump inhibitors.
  • CoEPCE faculty have published six articles, two books and a white paper about the related curriculum and lessons learned. Additionally, faculty and/or trainees have presented findings about various aspects of the program at several conferences across the United States. (For additional details, go to http://www.va.gov/oaa/apact/docs/CoEPCE_Bibliography_and_Scholarly_Works.pdf.)

Bolstering the VA Workforce

The program has also helped build a new type of workforce for the SFVA, which is deeply committed to sustaining an academically affiliated, interprofessional, practice-based model where patients receive high-quality care – and to hiring UCSF graduates dedicated to supporting this model. Since the program’s inception, 34 NP students have completed the program; 13 have completed the NP residency. Seven of these NP residents now practice at the SFVA, with six working in primary care and directly involved with the CoEPCE as clinician educators. Two of the practicing NPs are precepting NP students outside of the CoEPCE. As for the physician residents, 94 have completed the program, with several taking on faculty positions or fellowships at the UCSF School of Medicine and/or clinical positions at the SFVA where clinical education is a standard component of their role. One of the pharmacy residents, Andrew Lau, is now pharmacy co-director of the program, and several psychology fellows and social work interns have been retained at the VA in primary care.

Influencing Career Development and Day-to-Day Practice

We have all found that participation in this program has been a career builder, with both Anna and Krista using it as a platform to move into leadership positions at the SFVA and faculty positions at the School.

Yet perhaps most interesting is the impact on how we practice each and every day. In brief, by gaining an in-depth understanding of how our fellow professionals deliver care – their priorities, mindset, type of expertise and communication strategies – and by working through the many large and subtle challenges involved in transforming a culture of practice, we find that our work is both more effective and more rewarding. As experience allows this understanding to deepen – as we become better at understanding how, when and where to deploy a particular type of expertise and as we learn from each other – we believe that the impact on patient outcomes will continue to be significant.

We expect to focus in more detail on this idea in future posts, but already we believe the CoEPCE here in San Francisco and at VAs around the country will ultimately transform primary care education and practice, while creating further opportunities for academic pursuits.

JoAnne Saxe is a founding faculty member in the CoEPCE, director emerita of the Adult-Gerontology Primary Care Nurse Practitioner program at UCSF School of Nursing and a health sciences clinical professor at the School. Anna Strewler and Krista Gager are 2014 graduates of the AGPCNP program and the CoEPCE. Both are now volunteer clinical faculty at the School; Strewler currently co-directs the CoEPCE, and Gager is one of the associate directors for this program.

Each year, UC San Francisco School of Nursing is ranked among the top graduate schools in the nation. Please visit the Adult-Gerontology Primary Care Nurse Practitioner section of our website to learn more about our work in this area.

A Focus on People and a Sense of "We"

November 2016
Sandra Weiss

In place of her blog post this month, we speak with Dean Sandra Weiss, PhD, DNSc, FAAN, who in September 2016 was named interim dean at UC San Francisco School of Nursing. Dean Weiss has been a deeply respected professor at the School for many years and has held a number of administrative positions within the University of California. She is the Robert C. and Delphine Wentland Eschbach Chair in Mental Health, co-director of the UCSF Depression Center and a professor in the Department of Community Health Systems.

What are your most important priorities for your time as interim dean?

One of my key priorities has to do with the people that make up the School of Nursing. I want our faculty, staff and students to feel as if they’re seen for and recognized fully for their many contributions. Sometimes we think of the School as an organizational structure rather than as the people who comprise it. But it is our faculty, staff and students who are the essence of the School. They are responsible for everything the School is and can be. It’s vital that we recognize their contributions and that they feel valued for all that they are doing.

My feelings about this are very congruent with the UCSF PRIDE initiative [a renewed push to raise the visibility of the UCSF core values of Professionalism, Respect, Integrity, Diversity and Excellence]. These values have always been a strong part of how our School has operated, but as this campus initiative gains momentum, we will be incorporating these values into many different efforts that further elevate their profile.

Respect for our people needs to be front and center. I want to bring the element of respect to every aspect of how we work with people here. Certainly, part of it is formal recognition, but it’s more of what we do on a daily basis, in our ongoing interactions with people. Do we fully attend to what each person is doing and how she or he makes a difference in the success of our School? And do we comment on these contributions so that people know they are appreciated? Fortunately, I believe all of the people who come into nursing and related health sciences fields inherently have some of this sensibility in them. Each of us can build on this to improve our interactions with others.

A second priority for me is to support an environment where our faculty and staff can think more deeply about their work and ways to best advance the School’s many missions. If we don’t create more contemplative time amidst the pressured expectations of our work, it’s much more difficult for innovative, cutting-edge ideas to emerge. I’ve recently put a work group into place that is identifying priorities for the School. While its primary focus is to enhance our fiscal health, it will also serve as an opportunity to develop new workplace models that can support a less stressed and hectic work environment. I’m hopeful – with the help of other things, like “lean” training – that these efforts will enable us to use our time more efficiently, strategically and thoughtfully, rather than trying to do it all with a sense of frenetic overload. It’s my belief that a focus on our people, instead of setting some external goals that I want to achieve, is the best way to ensure that we continue to excel in research and the science that drives our discipline, that we offer the very best educational programs in the world and that we serve our local, national and global communities with the fervor and commitment they deserve.

Continuing our efforts to diversify our student body and our faculty is also a high priority for me. This necessitates the presence of a climate that is welcoming and supportive and that provides resources to ensure success. We have some remarkable people who are leading these efforts – Associate Deans Judy Martin-Holland and Shari Dworkin as well as our amazing DIVA (Diversity in Action) and Recruitment and Retention committees. Although we are making inroads, all of us know that we are not yet where we need to be.

What existing strengths can we build on?

We have many areas of strength, some of which have been around for a while and some that have emerged in the last few years, whether its aging and palliative care, health care technology, symptom science or health policy. My goal in all of these areas is to encourage people to look across departments and our research institute to identify and pursue possibilities for collaboration. Financial support plays an important role in enhancing collaborations, as an incentive for people to look closely at where their individual efforts intersect with others’ and how their related work may contribute to the School’s overarching goals in new and exciting ways.

And the biggest barriers?

Our biggest barrier is the lack of adequate financial resources, which is certainly not a challenge that is unique to us. That’s why the work group on fiscal health I mentioned earlier is so important. We need to find ways to enhance our resource base and to get the most from existing resources without overburdening our students with large tuition hikes.

To that end, another work group we’ve created is exploring with UCSF Health (UCSF’s world-class clinical enterprise) how our faculty can contribute more fully to the clinical mission of the campus and enhance the School’s clinical income in the process.

What strengths do you, personally, bring to these efforts?

Well, I’ve served in multiple administrative and leadership roles in my career. Hopefully, I’ve learned something from those experiences that I can bring to this position. Also, my primary field is psych/mental health. I have a PhD in psychology as well as a PhD in nursing science, with a specialty in psych/mental health. This background reflects my inherent interest in what makes people tick. I think this background gives me some insight into my own behavior and helps me consider a variety of factors that may improve my work with others.

Also, by temperament, I’m a collaborative person. I learned that from my mother, who was an unbelievable role model. She exemplified a sincere kindness and ability to listen to people that was deeply inspiring to me. She was never telling everyone about herself or how grand she was. I respected those qualities tremendously. I once heard somebody say she was “a mouse” because they perceived her as not being aggressive enough. I disagreed. She was a very strong person who didn’t feel the need to always use her innate power to control the situation. She was highly successful in accomplishing her goals, but in a collaborative, sensitive and very astute way.

Finally, how does being an “interim” dean help or hinder your ability to achieve your vision?

Maybe it’s because I’ve been so much a part of everything that is happening in the School as part of my faculty role, but I don’t even think about being “interim.” That’s the beauty of shared governance (a core approach to governance in the entire University of California system that actively involves faculty in decision-making and leadership roles). There is a sense of “we” and that we’re all in this together, regardless of whether someone’s official role is as “faculty” or “administration.” So I think of my interim dean’s role as just one more leadership role in the School through which I can contribute to our various missions and our success in accomplishing them.

Fall Reflections

October 2016
Zina Mirsky

I’m stepping in as a guest blogger for Dean Sandra Weiss, to do two things this month: recognize a redesign of Science of Caring, and welcome the new school year. As a retired faculty member and administrator, I am quite familiar with and fond of both experiences.

I have been involved in the design of Science of Caring from its origin in print through the current online version, and want to say a few words about what this evolution means to me personally.

We long ago recognized the need to bring the best of UC San Francisco School of Nursing – its faculty, research, students, graduates and staffers – to the public eye. We designed the publication to help do that. It was first mailed quarterly to thousands across the country and the world, and is now available online to many more, with greater frequency. It gives me pleasure to know that this new look continues a tradition of conveying the urgency, relevance, timeliness and productivity of our School. Science of Caring has helped recruit new students and faculty, as people far and wide learn of our interests, research and other activities. Our graduates keep in touch, and we’ve profiled many of them for your reading pleasure. Let us know, please, if you have suggestions or thoughts on specific articles or in general – there is always a place for your voice in each issue.

While the publication is wonderful, it can capture only a fraction of the extraordinary work that goes on at the School, which is why I am so thrilled to welcome our group of over 450 new and continuing nursing students back to campus for the fall quarter. The UCSF community is a remarkable, fascinating and energizing place, and this campus infographic, which provides a breakdown of all students entering in 2016, opens a small window into the richness of this community.

As for our School, the best way to convey its vitality is to describe what I saw recently, when the faculty asked me to provide some feedback on teaching techniques and other aspects of a Master’s Entry Program in Nursing (MEPN) course on sociocultural issues in health and illness. Mind you, it’s been a while since I retired, and longer still since I taught actively in prelicensure education, but I’ve known of the quality of our students via my work on MEPN admission screening committees. What an absolute treat it was to see those students and faculty in action.

The MEPN students bring wide differences in age, gender, and sociocultural and educational backgrounds, but all bring a deep commitment to excellence in their newly chosen profession. They also bring a good grounding in study skills and communication strategies, as well as clear enthusiasm for new learning, which makes their group discussions invigorating. They clearly embrace the worth of cultural humility and social justice, and talk readily about strategies to bring safe and quality outcomes of care to a diverse population of patients. They question each other, and themselves, bringing reflection and thoughtfulness to their discussions.

They are starting their nursing career at a time when nursing has never been more vital, with a clear indication of our professional worth in today’s economic and political landscape. The paths they can walk – and run, more likely – vary greatly from the days when I was a student. They are navigating through many nursing career options, actively considering where they’ve been, where they will go next and the choices for their long-term future. Judging from their approaches to the classroom, they will explore these options passionately and intelligently, and their impact will be felt throughout the School and, later, their communities, I am certain.

Our School has always been a place where students can make the most of the many opportunities in nursing, and I anticipate that these students will bring their own drive to continue this strength. I look forward to learning more about and from them!

— Retired Associate Dean Zina Mirsky

A Note on the Dean's Blog

September 2016
Sandra Weiss

Sandra Weiss, RN, PhD, FAAN, is interim dean of the UCSF School of Nursing while the School conducts a national search for a successor to former Dean David Vlahov. Dean Weiss has been a deeply respected professor at the School for many years and has held a number of administrative positions within the University of California. She is the Robert C. and Delphine Wentland Eschbach Chair in Mental Health, co-director of the UCSF Depression Center and a Fellow of the American Academy of Nursing.

In the months ahead, Dean Weiss expects to contribute her own blog posts as Science of Caring undergoes a redesign. We look forward to her thoughts.

Generating Evidence for Action

August 2016
David Vlahov

While I will miss many aspects of serving this School as its dean, I am also excited to return to my research and other pursuits full-time. Among those pursuits is serving as co-director, along with UC San Francisco School of Medicine’s Nancy Adler, of Evidence for Action (E4A), a national program of the Robert Wood Johnson Foundation administered by UC San Francisco, which provides funding of investigator-initiated research to build a culture of health. I believe building that culture is one of the great, under-recognized needs in public health.

Consider that a visitor from Finland once commented about our country, “It’s amazing how little you are able to do with so much.” This is not a surprising critique coming from someone from Finland, where health care expenditures are significantly lower (9.6 percent of their gross domestic product [GDP], or $3,984 per capita) compared with the United States (16.9 percent of our GDP, or $9,451 per capita), while their life expectancies at birth are higher by 2.3 years (81.1 years in Finland compared with 78.8 years in the US).[i],[ii]

In fact, the US spends a much higher percentage of our GDP on health care than any other Organisation for Economic Co-operation and Development (OECD) nation (47 percent more than the next-highest spender), while we’re ranked only 27th of 38 OECD nations in life expectancy.[iii],[iv]  On average, our life expectancy is one year below the OECD average. In addition, according to the results of a U.S. News & World Report survey, we rank 14th of 60 countries evaluated for Quality of Life.[v]

So, what strategies are they using in Finland and the rest of the OECD countries that we aren’t?

One thing to consider is that while the US and Finland spend about the same percentage on health care and social spending combined (36.1 percent and 40.6 percent of GDP, respectively), Finland spends 31.0 percent of their GDP on social services, while we spend only 19.2 percent.[vi] This seems to support the premise that social spending could be a key factor in better health; and in fact, an analysis within the US by Bradley et al. (2011) found that a higher ratio of state “social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost.”[vii],[viii] 

Moreover, the US is ranked ninth on the OECD Better Life Index, an aggregate scoring system based on 11 factors ranging from housing and income to work-life balance and life satisfaction that are all contributors to overall well-being. These aggregate values allow us to compare national well-being between the US and the other OECD nations. When we compare the US to the eight countries ranked ahead of us (which include Finland), we score significantly higher than average when it comes to housing and income, but below average when it comes to community, environment, life satisfaction, safety and work-life balance.  

Yet another consideration is that even though the US is ranked highest of the OECD nations when it comes to income, we’re ranked 33rd for social inequality within that category. The story is similar when we look at social and gender inequities in health, jobs, education, civic engagement and safety.

Given these numbers, one could deduce that improving US life expectancies and overall well-being depends at least in part on spending a higher portion of our GDP on social services and programs that reduce inequities and address social determinants upstream before they become health problems. That money could be put toward improving community building, environmental conditions, life satisfaction, safety and work-life balance for all Americans, with a particular focus on disadvantaged populations.

However, for the specifics, it’s not enough to look at strategies that work in Finland or any other country, because, of course, such strategies are not guaranteed to improve health outcomes in the US. The question then becomes: What investments in social services and other interventions that target social determinants will work to improve health outcomes of US populations?

Finding the answers to that question is one of the reasons I joined E4A. We’re funding research about the health outcomes of policies, programs and other types of interventions both within and outside of the health care sector, in order to build the evidence base to determine the best strategies to improve health equity, population health and well-being.  We’re particularly interested in evaluating the impact of interventions designed to address upstream social determinants of health. 

So far, we’ve funded 13 research projects with a wide range of foci – from food bank decentralization to a low-income housing redevelopment project and intervening on the economic determinants of health. You can learn more about our funded projects by visiting our Grantees Page.

What do you think are the most promising approaches to improving population health, well-being and equity? We’d like to hear your ideas. Apply for a grant today!

 

References

 

[i] OECD data: health spending. OECD website. https://data.oecd.org/healthres/health-spending.htm. Accessed August 24, 2016.

[ii] Health. OECD Better Life Index website. http://www.oecdbetterlifeindex.org/topics/health/. Accessed August 24, 2016.

[iii] OECD data: health spending. OECD website.

[iv] Health. OECD Better Life Index website.

[v] Best countries: quality of life rankings. U.S. News & World Report website. http://www.usnews.com/news/best-countries/quality-of-life-full-list. Accessed August 24, 2016.

[vi] OECD data: social spending. OECD website. https://data.oecd.org/socialexp/social-spending.htm. Accessed August 24, 2016.

[vii] Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Qual Saf. 2011;20(10):826-831. http://qualitysafety.bmj.com/content/early/2011/03/28/bmjqs.2010.048363.abstract. Published March 29, 2011. Accessed August 24, 2016.

[viii] Bradley EH, Taylor LA. Culture of health: how social spending affects health outcomes. Robert Wood Johnson Foundation website. http://www.rwjf.org/en/culture-of-health/2016/08/how_social_spending.html?rid=s88gyymtNUXPDVwZ-JNU9USGEF1u5oKjEoTEIbK2gC0&et_cid=644614. Published August 17, 2016. Accessed August 24, 2016. 

How to Move the Conversation on the Public Health Crisis of Gun Violence

July 2016
David Vlahov

Over the last weeks, the violence in Louisiana, Minnesota and Dallas shook the nation. Stark images of the shooting deaths of black men through streaming video escalated the issues of firearm fatalities, systemic racism and excessive police violence. The ambush and shooting deaths of the Dallas and Baton Rouge police officers stunned us. We mourn and express our condolences to the relatives and friends whose loss is personal and to communities whose trauma is collective.

However, as health care professionals, we cannot leave it at that; we cannot sit still while efforts to address these calamities continue to be frustrated. Nurses need to be among those helping the nation make sense of the conversation.

The issues are undeniably complex, involving guns, race, class and culture. Our focus in this piece is on guns, but we promise further conversation about race, class and culture in later installments of Science of Caring.

According to the Centers for Disease Control and Prevention (CDC), firearm-related fatalities are among the top five leading causes of injury-related death. Suicides account for 63 percent of fatal firearm violence, but are more common among whites, and the number has been increasing over the past decade. Homicide rates have been on the decline in the past decade, but are more concentrated among black males, where high rates have remained relatively unchanged over time. Mass shootings garner headlines, but they represent less than one percent of all gun-related deaths. 

Then there is the issue of mental illness and guns, which is widely misunderstood. As Dr. Jeffrey Swanson, a professor in psychiatry and behavioral sciences at Duke University School of Medicine, put it recently: “Mental illness is a strong risk factor for suicide. It’s not a strong risk factor for homicide,” though he made it clear that almost by definition, inflicting violence on large groups of people is a type of mental illness. All of these findings appear to have implications for possible interventions, but we need more data to intelligently inform the design of policy and practice.

Unfortunately, there have been no government-sponsored studies about how to prevent firearm deaths and injuries since 1997, when the Dickey amendment was added to a US House of Representatives bill. The amendment stated that the CDC may not conduct any studies that “advocate or promote gun control.” In 2012, that prohibition was expanded to the entire Department of Health and Human Services.

The restriction on research means that it’s difficult to objectively evaluate the potential efficacy of any proposed gun control laws. In 2003, when the Task Force on Community Preventive Services issued its first report evaluating the effectiveness of strategies to prevent violence, it concluded that there was insufficient evidence to make any determination.

In an effort to change the dynamic after the Sandy Hook Elementary School massacre, which took place in Newtown, Connecticut, in December 2012, Vice President Biden called for the Institute of Medicine to conduct a review and provide a report on firearm-related research. I served on the panel that released the report in June 2013, Priorities for Research to Reduce the Threat of Firearm-Related Violence. We highlighted significant gaps in knowledge to formulate prevention strategies and proposed a research agenda – designed to produce results in three to five years – which focuses on the characteristics of firearm violence, risk and protective factors, interventions and strategies, the impact of gun safety technology and the potential influence of video games and other media. Yet with Congress stalled on providing funding, the research has lagged, although some private foundations have stepped forward.

Nevertheless, even in the absence of all the necessary research, there are some commonsense approaches clinicians should be able to bring to their patient encounters. Last year, at least 265 children under 18 years old picked up a firearm and shot someone by accident; 83 of those incidents were fatal, and about half of the fatalities were the children themselves. Given the public health costs, we should be able to have conversations about gun safety with our patients, but legislators block that as well. When Florida legislators instituted a “physician gag law” that forbade even an assessment of gun safety, organized medicine took them to court, arguing that such laws interfere with their First Amendment rights. They lost on appeal and the gag order remains in effect. According to the Law Center to Prevent Gun Violence, similar legislation has been introduced in 14 states, and watered-down versions of Florida’s gag law have been enacted in Minnesota, Missouri and Montana.

Nurses, I’m proud to say, are standing up to these restrictions in many different ways. Recently, American Nurses Association President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, declared after the recent tragedy at Pulse nightclub in Orlando, “Now is the time to enact meaningful gun control legislation at the state and federal level to protect society…. We all must join with other members of our community and at every level of civil society in dialogue and action to address the underlying issues that result in hate and motivate unspeakable acts of violence.”

The Emergency Nurses Association has also taken a strong position that as health care consumer advocates, nurses must educate the public about the risks of improperly stored firearms and support the creation and evaluation of community and school-based programs targeting the prevention of firearm injuries. They also support the establishment of a national database of reportable firearm injuries to make evidence-based decisions regarding patient care, safety and prevention. Moreover, they recognize that the most effective way to keep children from unintentional firearm injury is to limit access.

Quite appropriately, the ENA also points to where the literature is unclear. Despite the organization’s belief in education, they acknowledge that data are limited and mixed on the effectiveness of existing strategies for education of children. Which brings us back to the key point: Ill-advised restraints continue to hamper efforts to develop the evidence base we need for a public health approach to reducing firearm fatalities and injuries. I join with many others in calling for a national database and a robust research effort that can support public health clinicians in our efforts to stop the firearm-related deaths and injuries.

And on the subject of what clinicians can do, I know of a nurse who felt that discussions with patients about gun safety were better left to gun safety experts. I disagree. As nurses, we can’t pass off the responsibility. We are witnesses to the carnage and we see the aftermath. We have a moral responsibility to be actively engaged, both with our patients and in this national debate, bringing not just our clinical expertise and perspective but also our commitment to generating the data that underpins rational policy and advocacy. We should contribute and, at times, lead the conversation on how clinicians can help the cause of gun safety, and we should unabashedly advocate for the health and safety of our patients and our communities. 

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