Prelude to Renewal

May 2018
Catherine Gilliss

Organizations develop and change over time, just like people. Evolution is shaped by the outside world as well as the interiors where we value, believe and act collectively. The qualities of organizations vary according to your perspective. We know this because we have begun a process of organizational self-examination.

At UCSF’s School of Nursing, we are in the early stages of a process of renewal that will soon move into development of a strategic plan. The point of strategic planning is to set priorities for decision making about resources (time, money, human capital), but the process begins with an inward reflection. Borrowing on Peter Drucker (Five Most Important Questions: Enduring Wisdom for Today’s Leaders, 2015), we begin by considering four questions: 

  1. What is our mission? 
  2. Who is our customer? 
  3. What does our customer value?
  4. What are our results?

And the answers to these four offer direction to the final question:

  1. What is our plan?

Discussion of mission – in accordance with our vision and values – grounds our work and sets some basic boundaries. For instance, as we enter our planning process, we will need to balance what experience has taught us about the role of practice activities in our core mission with our clear charge to educate and to develop knowledge.

The question “Who is our customer?” is complicated, as is the language used to describe the beneficiaries of our effort. Is our customer a composite of students, learners, trainees, patients and clients – or is it “the public”? As a public institution charged with educational and knowledge development responsibilities, we often experience the two responsibilities to be in conflict (e.g., How can I finish that manuscript while teaching so many courses?). 

What our customers value has changed over time, and those changes have demanded changes of us. Our students are more diverse than ever, expecting that we understand their background and are competent to address the differences, whether they be financial, cultural, learning differences or physical differences that require accommodations. Our customers’ expectations for research include greater levels of patient engagement, public access to data, compliance with a growing set of regulations, and more design and analytic sophistication than ever. In the provision of health care, we see expanded levels of patient self-determination, which require new ways of interacting with those we serve. Over time and taken collectively, these shifts are significant influences on the ways in which we work.

Not surprisingly, some of our results are more encouraging than others. We enjoy continued success in scientific productivity and are turning attention to succession planning in our research. Our educational programs, while high quality, use delivery models that limit access to a growing number of prospective students, which, in turn, limits our ability to prepare the future health care workforce. Our diverse body of faculty, staff and students are eager to grow, contribute and find their way in a world that is increasingly fast-paced and confusing. Sometimes that complexity and the pace are dispiriting.

Back in the early 1990s, when Marilyn Chow was honored as our Distinguished Alumna, she reminded us of the fable about the frog who did not jump from the boiling water when the temperature increase was gradual, in contrast to the frog thrown into boiling water, who immediately jumped out. Our water temperature is rising now, and that must be the impetus for us to jump out of the pot and plan our future

That matters because for more than 100 years, our School has been among our profession’s leaders. Nurses and nursing science will continue to play a central role in how we deliver health care in this country and around the world; therefore, institutions like ours must stop periodically to incorporate how the world has changed into everything that we do. That doesn’t mean that we abandon our core values, the ones that have driven nursing from the outset – those remain our touchstone – but it does mean that we have to create room to grow and change. We expect that in the coming year, the stories we tell of the exciting work of our extraordinary faculty, staff and students will reflect that growth and change.

Catherine L. Gilliss, PhD, RN, FAAN

Dean and Margretta Madden Styles Professor of Nursing

Associate Vice Chancellor, Nursing Affairs, UCSF



Leadership, “Gretta” Style

March 2018
Catherine Gilliss

In February 2018, I was named the inaugural Margretta Madden Styles Dean’s Professor of Nursing. This professorship, named in honor of our former dean and one of nursing’s greatest leaders, is the first Dean’s Professorship to be established on the UCSF campus. I am deeply, deeply honored to be so recognized – particularly in the name of “Gretta” Styles.

I first met Gretta when she was a young associate dean at Duke and I was a freshman student in nursing. She advised me on the courses required for my first year of studies. I next met her a little more than a decade later; she was the dean of the UCSF School of Nursing, and I was an entering doctoral student. While a student, I enrolled in “the Dean’s course,” a Cole Hall favorite, in which Gretta brought contemporary leaders into our classroom for discussions on their current projects. She spoke knowledgeably and easily with them (before a class of about 200 students) as we witnessed real leadership in action.

Although Gretta was the first dean I knew at UCSF’s School of Nursing, I would argue that her legacy was among the most long-lasting. She established, with the help of newly recruited Susan Gortner, the first school-based and centralized set of services in support of our research activities. She put in place a leadership team of chairs who were all doctorally prepared.

Gretta also led the way in establishing a process and criteria for the credentials nurses would hold in recognition of their expertise. That work would ultimately lead to the establishment of the American Nurses Credentialing Center. She chaired the California Board of Registered Nursing, and she ran for and won the presidency of the American Nurses Association (ANA). Her distinguished and intellectual brand of leadership was both valued and a break with tradition. After a successful set of terms at ANA, she was elected president of the International Council of Nurses. Her commitment to global health lives on at UCSF and through the work of her daughter, Meg Styles, president and founder of the Gretta Foundation, which supports the education of nurses in sub-Saharan Africa.

But Gretta did not simply rack up leadership titles. She selected opportunities that she believed could make a difference. Along the way she modeled the impact strong leadership brings when married to opportunity. May Gretta Styles continue to serve as an inspiration to all of us!


“we are the ones we have been waiting for”

February 2018Anjali Asrani and Denisse Porter
Anjali Asrani (top) and Denisse Porter

Advocacy and leadership are core principles of the nursing profession. It is with these principles in mind that a group of students from UC San Francisco School of Nursing have formed Nursing Students of Color (NSOC). This new organization aims to press ourselves, the university and, by extension, the greater health care system to live up to our professed ideals. We expect this post will be the first of several from NSOC addressing why our organization is necessary.

A Mission to Erase Health Inequities

we are the ones we have been waiting for” is the final line of a poem by June Jordan, commemorating a protest by tens of thousands of women and children against the infamous pass laws of South Africa’s apartheid government. The idea expressed in that line is at the core of NSOC. It reminds us that change begins now, with us – and that if we want to address health inequities, we must take action to undo the structural barriers that work against students of color throughout their academic and professional pursuits.

The inequities we see in health care today are a product of our nation’s institutions, which are rooted in histories of racism, oppression and inequality. The ever-present cracks in our nation’s foundation have become increasingly visible in the last year, whether it was a racist march in Charlottesville, Virginia; United States Immigration and Customs Enforcement (ICE) raids across the country; or numerous iterations of immigration and travel bans targeted at Muslim communities.

At UCSF, we know that diversity and meaningful representation of the communities we serve are integral to providing better health care. However, the disturbing inequities of our country’s history are also deeply embedded in our country’s health care culture, and become visible in myriad ways as they rise to the surface. For example, in the 19th century, J. Marion Sims conducted horrific experiments on Anarcha, Betsy, Lucy and nine more unnamed enslaved women, without their consent or anesthesia. Sims’ actions and findings led him to be regarded as the “father of modern gynecology.” Today, we see how this attitude toward African Americans and women plays a role not only in disparities in African American maternal and child health outcomes when compared to the rest of the population, but also in the ways communities of color receive inequitable treatment, including inferior access to health care and treatment options and, often, poor communication with their providers.

As a health sciences institution, UCSF is committed to recognizing both explicit and implicit biases, but recognition alone is not enough. We need to find ways to sustainably and meaningfully translate recognition into better health care delivery and outcomes for communities of color. This involves remodeling our educational and health care institutions in ways that shift systemic barriers to health equity in both systems. Such a transformation calls for our institutions to not only admit students from diverse backgrounds, but also create spaces that are welcoming – that hear and place value on those students’ voices and perspectives.

Nursing Students of Color Organizes at UCSF

Nursing Students of Color members, from left: Claudia Barrera, Talita Wells Oseguera, Denisse Porter, Florence Chien, Kaitlyn Basnett, Haila Albgal, Gloria Gonzalez, JoiLyn Camyl Anderson, Sabrina Wood, Khaled Zaki, Cora Lee Garcia, Anjali Asrani These beliefs inspired the creation of NSOC, an organization we hope will raise awareness of and tackle the issues we face within UCSF, as well as in the communities we pledge to serve. NSOC is a newly registered campus organization that began as an effort to address the disparities in health care our communities face, and bolster efforts to broaden the representation of diverse communities of color in nursing and health care by building social and policy-based mechanisms of support. NSOC members include nursing students from the School’s Master’s Entry Program in Nursing, master’s and doctoral degree programs, who come from a variety of backgrounds and communities. Because of the diversity within our organization, we focus not only on our common goals and challenges, but also on building bridges and bonds across communities of color at the School.

To ensure students and communities of colors’ concerns are represented within the context of UCSF, NSOC has committees that focus on:

  • Providing individual support via academic resources, career mentoring and alumni networking for current students.
  • Developing and providing safe spaces to discuss and challenge issues around institutional and structural racism within UCSF and the health care environment.
  • Ensuring representation of students of color on issues that impact UCSF students and communities of color.
  • Supporting and mentoring prospective nursing students of color through the application process and increasing the enrollment and retention of students of color at our School of Nursing.

Our plans for the coming year include social gatherings, networking and mentorship activities, and developing a speaker series. We also hope to collaborate with the School’s faculty and staff on all aspects of our mission.

We envision a world where people of color live self-determined and healthy lives, and where inclusion is fundamental to achieving academic, workforce and health equity. Please join us in helping to build this world together. To learn more about NSOC and join our email list, visit us at

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 [email protected] or visit

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

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