For better and worse, Baltimore offers nurses prime training ground for pretty much the entire spectrum of healthcare as its racially, ethnically, religiously, socioeconomically diverse citizenship moves through communities built in expensive homes and neglected neighborhoods, on its streets, in shelters, prisons, and hospitals, in some of the best and worst schools of the nation. The city, then, offers a microcosm of what nurses will face as they begin to stake out new territory the world over.
Dean Patricia Davidson, PhD, MEd, RN, is “putting the community in the curriculum” as well as putting the curriculum to work in the community, singling out the initial Hopkins-taught cohort of Doctor of Nursing Practice candidates at Johns Hopkins Aramco Healthcare (JHAH) in Saudi Arabia—the first ever for that kingdom—as leaning upon a principle honed in Baltimore: cultural sensitivity.
As in many parts of the world, nursing practice at JHAH has the opportunity to develop toward the model in the United States, Canada, and Europe, where advanced nursing practice helps to extend physician care, eases the effects of the shortage of healthcare workers, and creates more attractive career paths for nurses that improve recruitment and retention efforts.
JHAH, which cares for Saudi Aramco’s 350,000 internationally diverse employees and dependents, is eager to provide top-flight healthcare and understands the value of investing in the advancement of nurses, points out Phyllis Sharps, PhD, RN, associate dean for community and global programs. “Considering the diversity of both the cohort and the patient population, we adapted our DNP program to the local environment and send faculty to Saudi Arabia on a regular basis so the students can learn on site.”
"At Johns Hopkins in Baltimore, we know how to build nurse leaders. The innovation here is taking what we know and putting it into that environment. It’s not so different from the PhD Program Partnership between Peking Union Medical College [or PUMC] and the Hopkins School of Nursing,” she explains of the first doctoral nursing program in China, successfully launched despite long-standing tensions between that communist nation and the United States.
“From the outset of our partnership with PUMC, we were sensitive to the political and cultural differences between the U.S. and China,” says Marie Nolan, PhD, RN, executive vice dean, who served as the Hopkins director of a program founded by Dean Emerita Martha Hill, PhD, RN, in 2004. For example, individuals with serious mental illness and their families suffer from an even greater stigma and lack of treatment in China than those in the U.S. and are rarely seen in public. Adds Nolan, “Politics in Baltimore impact healthcare as they do in other U.S. cities or in China. Respecting the ability of the members of the community to identify their own healthcare priorities is essential to creating a path forward.”
GOOD FOR ALL
Associate Professor Jason Farley, PhD, MPH, ANP-BC, lives in two worlds. As clinical core co-director of the Johns Hopkins Center for AIDS Research, he helps nurture a new generation of researchers with an emphasis on interdisciplinary work. Farley also has an adjunct appointment on the faculty at the University of KwaZulu Natal, South Africa, a nation where HIV and tuberculosis are an often deadly combination. Farley feels innovation to address such conditions “goes both directions.”
For instance, “I took our nurse practitioner model that we have [at Hopkins] and tailored it for the South African primary healthcare context, specifically for multidrug-resistant tuberculosis. In that context, the disease was only a physician-managed process. [Since physicians are mainly in big urban hospitals, this meant arduous journeys for very ill patients from surrounding areas.] By designing this program, which is really patient-centered, we could have care by nurse practitioners delivered closer to home. ... The interesting thing is that we returned this model to the U.S. for my HIV nurse practitioner program.”
Success brings its own challenge, Farley explains. The resistance that greeted the TB pilot in 2009 has turned into an embrace, with a growing demand for more. “Now we’re funded by the Global Fund to expand the intervention countrywide in South Africa … the issue is scale-up, getting people trained fast enough.”
THE NEXT WAVE
As the world becomes an ever more interconnected place, it is essential to keep innovation moving through the nursing pipeline. This summer’s Supreme Court decision to uphold the Affordable Care Act in King v. Burwell means that 16.4 million newly insured Americans will keep their health insurance. Combine that explosion of new patients with the Institute of Medicine’s prediction of a shortage of physicians as perhaps one-third of current MDs retire over the next 10 years. The justices merely confirmed that a new day of nursing has arrived. Dean Davidson has rushed to greet it.
“Our new [Master of Science in Nursing: Entry into Nursing] curriculum was part of our anticipation of and initial response to the Affordable Care Act,” she wrote in an op-ed after the ruling. “We’ve just enrolled our initial class of bright, driven students who will receive the education and tools to become the advanced bedside nurses, hospital leaders, faculty, and researchers we need now.”
The MSN: Entry into Nursing, a five-semester journey that takes students “from wherever you are in the world—and in your life—to wherever you want to go,” according to Davidson, is built for career changers as well as those who’ve come to nursing from a very different place.
Sharps, also director of the Center for Global Nursing, cites Returned Peace Corps Volunteers as a key potential part of the next wave of global citizen/nurses. These are students who have lived amid underserved communities abroad, learned cultural sensitivity and “the value of good healthcare” through their travels, and see nursing as a way to get back out into the world and play a bigger part.
“You need to see the connectedness of us all, globally,” Sharps says. “You need to feel at some level commitment to address inequities wherever.”
Baltimore is as good a place as any for innovation to start. Where it ends up could be anywhere in the world.
Read the full article and more in Johns Hopkins Nursing magazineLearn more about the Johns Hopkins School of Nursing.
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