A Decade of GW Nursing

Dean Jeffries toasts faculty member in front of Innovation Hall
05/06/2020 16:17

On a warm evening in Ashburn, Virginia last September, Dean Pamela Jeffries led students, faculty and staff in a toast as the school’s name was unveiled atop Innovation Hall.

Ten years prior, when the GW School of Nursing formed to become the university’s 10th school, faculty shared a small cluster of offices in that building. Founding Dean Jean Johnson sensed, though, that someday the building would bear the school’s name. A decade later, it did. While the school’s infrastructure growth far exceeded expectations, GW Nursing’s impact is best measured in nurses educated and careers advanced.

Dr. Jeffries, Ph.D., RN, FAAN, ANEF, FSSH, believes in leveraging technology to achieve educational mobility and career advancement. Having worked on her own Ph.D. dissertation remotely while living in Indonesia, Dr. Jeffries knows that high-quality education doesn’t require a traditional library-and-classroom setup. Since even before the school’s inception, GW Nursing faculty have explored how new technologies could make education and career advancement accessible to students throughout the United States. “We’re 10 years old so we can be nimble,” Dr. Jeffries said as she outlined part of what she sees as the future of nursing education. “Someday students will have augmented reality goggles and immersive training can happen anytime, anyplace.”

School's Roots

Dr. Jean Johnson, Ph.D., RN, FAAN, in the 1970s was one of Washington, D.C.’s first nurse practitioners and became program director of the NP certificate program in what is now the GW School of Medicine and Health Sciences. That certificate program evolved into a master’s program in partnership with George Mason University in the 1980s. While working as a scholar-in-residence at the Robert Wood Johnson Foundation (RWJF), Dr. Johnson developed a sense of both the 1990s nursing shortage and the national health care landscape. She returned to GW in the early 2000s with a plan to start a nursing program. The first class–six master of science in nursing (M.S.N.) students–started in 2006. GW had enrolled nursing students before–as part of a program affiliated with GW Hospital prior to the Great Depression. But nursing and nursing education had changed drastically since the beginning of the 20th century, with scientific and technological innovations reshaping the landscape of the health care industry. And in the classroom, faculty are now teaching graduate students online, allowing for educational mobility throughout the world. A partnership with the United States Navy in the mid-1990s introduced Dr. Johnson to online education. As the senior associate dean for health sciences, she was creating a bachelor’s program for Naval corpsmen. “You do understand this has to be available to people on surface vessels and subs,” a naval officer told Dr. Johnson. 

“The internet was just emerging, but I had faculty members who were risk takers and wanted to figure out how to use this new technology to advance education,” Dr. Johnson said. She recruited Laurie Posey to GW Nursing after having worked with Dr. Posey, Ed.D., at RWJF, where they launched a program focused on increasing the number of physician assistants, NPs and midwives in rural areas by virtually educating those already living there. While early efforts were limited and text-based, “I made a commitment to provide education to people despite geography and a commitment to providing education to people in underserved areas,” Dr. Johnson said.

Faculty continue this commitment to educating those in underserved areas. Funded by the largest grant in GW Nursing’s history, Professor Christine Pintz is overseeing the NP-TECH initiative, an online supplement to NP education that prepares practitioners to consider social determinants of health when treating patients and to use technology in providing high-quality care. Through various simulations, the NP-TECH initiative provides students some of the experience of working in underserved areas, Dr. Pintz said.

GW Nursing’s doctor of nursing practice (D.N.P.) started in 2008, and its bachelor of science of nursing (B.S.N.) program followed two years later. Dr. Johnson and faculty designed the B.S.N. program, which was the school’s first in-person offering, with health care simulation in mind. “Simulation was the only way to go. When you can see and directly observe as a faculty member, you can see the decision-making process students go through. ... Simulation is standardized learning, and you know students ‘get’ certain things,” Dr. Johnson said.

GW Nursing grew quickly: from six students in the health sciences M.S.N. program in 2006 to 188 only four years later when GW Nursing became a separate school. Dr. Johnson attributes the rapid growth to the “commitment and passion” of a faculty and staff who felt it was important to develop strong academic programs and a well-recognized school of nursing. Dr. Johnson, Professors Emeriti Ellen Dawson and Stephanie Wright and Ronna Halbgewachs became the core group that drove the formation of GW Nursing as a separate school. Dr. Dawson became the inaugural senior associate dean for academic affairs, with Dr. Wright following in that position. “Dr. Dawson’s expertise in curriculum development and her leadership of the faculty were critical elements in building the framework for a school. She was also an incredible personal support and my go-to person,” Dr. Johnson said.

By the end of the decade, enrollment in the M.S.N. program plateaued around 500, with infrastructure and student services staying apace. B.S.N. enrollment experienced even more dramatic increases, nearly doubling to 109 in 2011, and also reaching a plateau near 500 late in the decade after the addition of a summer enrollment start.

With all three programs growing rapidly in a relatively short period of time, school leaders worked to maintain a high level of quality in the curriculum to ensure students graduated as capable health care providers. “Student success is our responsibility. How do we help them? We are accountable for the success of every student admitted. We’re putting conscientious and meaningful effort into students first,” Dr. Jeffries said.

Infrastructure changes reflect this approach. The first floor of that former office building now offers study rooms and open space that regularly fills with students sharing lunch or working between classes. Other, arguably more impactful changes, underscore the success of our students. By 2018, GW Nursing produced more new nurses each year than any other school in the state of Virginia. A majority of those new nurses, 94%, stayed in the area after graduation, finding nursing jobs in Washington, D.C., Virginia and Maryland.

Among M.S.N. graduates, 61% opted to stay in the area after graduation.

School Advances Nursing Education

While producing new practitioners, faculty members are also shaping how nursing education is delivered. With expertise in both online learning and health care simulation, Dr. Jeffries was a natural successor to Dr. Johnson. “Dean Johnson had built the foundation, and I could see so much potential. I came here because I felt like I could contribute to our profession and build a top school of nursing in the nation’s capital,” Dr. Jeffries said.

Dr. Jeffries took over leadership of GW Nursing in 2015, the same year The NLN Jeffries Simulation Theory was published. This theory helped legitimize simulation education in nursing education, setting forth guidelines that simulation should be collaborative and transparent—the student, simulated patient (if one is used) and faculty should know exactly what’s expected and what the objectives are.

After coming to GW, Dr. Jeffries oversaw several renovations and expansions of the school’s state-of-the-art simulation space, including the addition of the objective structured clinical examination (OSCE) lab. The school infused its entire curriculum with simulation pedagogy—every clinical course has some sort of simulation experience embedded.

In her two-and-a-half years as the school’s simulation director, Crystel Farina, Ph.D.(c), RN, CNE, CHSE, has overseen the growth in infrastructure, both lab space and upgrading 80% of simulators from no-fidelity, static manikins to all moderate- and high-fidelity patient simulators. “But what is not visible is what has been happening on the programing side of simulation. We have implemented an evaluation plan of all the simulation scenarios for the graduate and undergraduate programs,” Ms. Farina said.

Faculty are continuing their own education to better deliver 21st-century nursing education. Many faculty members have taken a debriefing workshop and attended the school’s simulation pedagogy courses offered through the school’s division of Ventures, Initiatives and Partnerships.

The National Organization for Nurse Practitioner Faculties (NONPF) and GW Nursing, hosted Thought Leaders’ Summit on Simulation in NP Education in January 2019, examining existing evidence, discussing the challenges of evaluation and formulating next steps.

“Simulation is not just about manikins. It continues to be about the pedagogy. In the NP world, they need to perform diagnostic reasoning, holistic patient assessments, and other advanced practice patient care competencies. Whether you put them in a virtual case or with standardized patients, that’s a proven pedagogy, and students want that. Patients should demand that,” Dr. Jeffries said.

At its 2019 Simulation Conference, the school announced an NP Simulation Consortium, dedicated to creating a collaborative network and professional community of educators dedicated to high-quality simulation NP education, research and practice.

These efforts have paid off. GW Nursing was among 16 nursing programs nationwide to be named a 2018-2022 Center of Excellence by the National League for Nursing (NLN) in 2018. NLN’s Center of Excellence in Nursing Education designation acknowledges outstanding innovation, commitment and sustainability of excellence. NLN recognized GW Nursing in the category of “enhancing student learning and professional development” for its enduring commitment to best practices in pedagogy and investment in 21st-century technologies. Faculty dedication to improving nursing education extends beyond its simulation expertise.

“People cannot continue to teach the way they were taught,” said Angie McNelis, associate dean for scholarship, innovation, and clinical science. “In nursing, we’ve been doing the same exact thing for 100 years. Our faculty are pushing the envelope. We are not OK with the status quo. Students want active learning, and they want technology-enabled learning,” said Dr. McNelis, Ph.D., RN, FAAN, ANEF, CNE. Dr. McNelis’s own leadership and work advance the science by developing evidence to direct transformative changes in education across pre-licensure, graduate and doctoral education.

Majeda El-Banna, Ph.D., RN, CNE, studies students’ perceptions, satisfaction and achievement in a flipped classroom model and strategies for learning in accelerated second-degree B.S.N. programs.

Catherine Cox, Ph.D., RN, CEN, CNE, CCRN, and Gretchen Wiersma, D.N.P., RN, CPN, CNE, assess undergraduate nursing education with a particular focus on veterans succeeding in nursing school and successfully transitioning into practice.

Karen Kesten, D.N.P., APRN, FAAN, CCNS, CNE, CCRN-K, received a Nursing Outlook Excellence in Education Award in 2019 for Retirements and Succession of Nursing Faculty 2016-2025.

Other faculty members work to improve life for nurses in the workforce and nursing’s standing as a profession.

If you’re a nurse who’s grabbed a nap in a hospital sleep room or switched from 12-hour shifts to eight-hour shifts, then you’ve likely benefitted from the work of Associate Dean for Research Jeanne Geiger-Brown, who found that 12-hour shifts contributed to job dissatisfaction, patient care errors and drowsy-driving car crashes.

Woodhull Revisited, a study released in 2018, found that nurses remain significantly underrepresented in health care and health policy stories even 20 years after the original Woodhull Study. These findings helped drive a movement among nurses to find their voices and advocate for themselves and their patients.

School Grows Research Realm of Influence

While improving its profession is an important legacy, the largest body of GW Nursing faculty research aims to improve quality-of-life for different populations.

Ashley Darcy-Mahoney, Ph.D., NNP, FAAN, is a 2017 Josiah Macy Scholar and the 2014 March of Dimes Nurse of the Year. As a researcher, she leveraged technology in creating Talk With Me Baby and its Spanish-language counterpart Háblame Bebé. Research shows that the number of words a baby hears during the first three years of life is the best indicator of success in school and in life. These apps are designed to help parents close the “word gap,” and prepare their children for success. Some of the school’s researchers come from other disciplines, including health policy, public health, law and biostatistics.

“Different disciplines and views are important to health care research and our teaching,” Dr. Jeffries said.

Caring for patients at the other end of their lives, Associate Research Professor Dale Lupu is leading a project that aims to revolutionize the type of end-of-life care available to older kidney disease patients. Currently in its second phase, funded with $2.4 million from the Gordon and Betty Moore Foundation, Dr. Lupu’s Pathways Project questions whether a quality improvement approach to spreading supportive care best practices at dialysis centers and affiliated clinics will measurably increase the provision of supportive care best practices.

Other professors are working to improve the quality-of-life for different populations. Professor Tony Yang is leading a study, funded by the Robert Wood Johnson Foundation Policies for Action program, that examines the impact that state laws enacted or repealed between 1997 and 2017 to pre-emptively prohibit tobacco control measures have had on public health in the United States.

Dr. Yang, along with a team including Assistant Professors Sherrie Flynt Wallington and Daisy Le, community partners and local health departments, received a $1.5 million grant from the Office of Minority Health of the Department of Health and Human Services to evaluate and reduce the incidence of liver diseases attributable to the hepatitis B virus, which is responsible for half of the deaths from liver cancer and a third of the deaths from liver cirrhosis.

N. Maritza Dowling, Ph.D., is a biostatistician who employs a longitudinal assessment of cognitive decline in older adults and the application of novel statistical approaches to model the complex interplay between risk and protective factors in Alzheimer’s disease-related brain changes and biomarkers for disease prognosis. Her research also aims to optimize cognitive outcome measures for early diagnosis and patient selection in clinical studies of Alzheimer’s disease-modifying therapies.

The work of numerous other faculty members improves care for underserved populations, in keeping with the school’s vision: Compelled by the belief that all people deserve quality health care, we aspire to be trusted advocates for the advancement of societal well-being in the clinic, community and statehouse.

Preparing for the Future

Awareness of underserved populations and improving well-being for all is not only an externally focused effort at GW Nursing. Sandra Davis, Ph.D., DPM, FAANP, CRNP-BC, was the school’s first black faculty member when she started working at GW Nursing in 2011. She is now the school’s assistant dean for diversity, equity and inclusion, a role originated in 2017.

In its first year, GW Nursing’s student population was 67% white and only 10% male. The student body in 2020 is 48% white and 13% male, making it more diverse than nursing’s national average. “Diversity is so important for us in nursing because we need to mirror the communities we serve,” Dr. Davis said. “Nursing faculties should be diverse to better serve as role models for our underrepresented students,” she said. As role models, faculty members may share similar experiences with underrepresented students and can therefore offer more appropriate support and help. And because nursing is traditionally a profession for women, men are an underrepresented group.

“Men bring a very valuable contribution to the field of nursing. Nursing is for everyone,” Dr. Davis said.

With a faculty and student population now growing more reflective of the general population, Dr. Jeffries sees continuous innovation on the school’s horizon. “Our efforts toward preparing a diverse workforce and ensuring health equity for all will continue,” she said.

Technology can also play a part in closing gaps in health care. Nurses will need to understand data as digital health becomes more critical at the point of care. Eventually, nurses will be interacting with artificial intelligence systems as they care for patients, she said. “We must keep abreast of the changing health care landscape. Data analytics and telehealth are key; nurses must have competency in these areas,” said Dr. Jeffries.

Advancing the profession also plays a part in better serving patients. “Nurses are the largest health care workforce group. As leaders, we monitor workforce needs, note shortages and examine what we can do in nursing education to best fulfill the care needs for our patients, families and communities,” Dr. Jeffries said.

Because nurses make up such a large percentage of the health care workforce, their perspective is an important one. The dean plans to continue GW Nursing’s work toward infusing its curriculum with lessons on health care policy and advocacy, as the Woodhull Revisited study revealed is still so necessary. “Nurses need to have a voice, and help shape the policies needed to transform health care and ensure health equity,” she said.

Throughout its brief history and into the future, GW Nursing will use all available tools – whatever those may look like in 2030, 2040 and beyond – in preparing highly qualified health care providers with the knowledge and skills to both care for patients and shape the health care landscape effectively.