By Trish Brooks and Kelsey Chung
Photography and Video By Angie Alducente
Ellen Lewis has been a force in nursing by way of workforce development. Her research interests encompass nursing workforce planning, and she is Project Director of the California Strategic Planning Committee for Nursing. She has been named one of the “Women Making a Difference” by the OC Metro magazine and is a Fellow in the American Academy of Nursing. On a personal note, she likes the color pink, likes to eat mashed potatoes, and has many hobbies, which include reading, walking, and spending lots of time with her grandchildren and going to their swim meets. One granddaughter holds nine national swimming records in her age group!
Ellen Lewis wanted to be a nurse since she was a child. We asked her, “What inspired you to become a nurse?” Professor Lewis replied, “I was very ill as a child suffering from severe asthma and spent a lot of time in the hospital. In those days when a child had severe asthma they were often in a critical situation and hospitalized. In the hospital, children would receive Oxygen therapy and medications. Till this day I have no idea what medication I received. I attempted one time to get my chart after I got involved in the profession to identify what drugs had been administered to me. However, the physician who had treated me had retired and the records were not available. While in the hospital as a child I would observe all the activity and I was fascinated by the nurses and doctors.” We wondered if there was a specific nurse that struck her. “I don’t remember anyone in particular but I just liked the environment,” replied Professor Lewis.
Ellen Lewis went to college at Marquette University in Milwaukee, Wisconsin and is a Marquette University basketball fan (Go Golden Eagles!). We asked her what brought her to California. “I was recruited to be Director of Nursing (DON) at the Medical Center and was the first Director of Nursing hired for the UCI Medical Center after UCI took ownership of the hospital from Orange County. I still have the newsletter article detailing my appointment. You might want to see it. You would get a charge out of it because 25 years ago I was young and beautiful,” stated Lewis. In the following section, Professor Lewis discusses the dynamics of the nursing field, the development of the Program in Nursing Science, and provides guidance to nursing students to make the most of their potential.
Above: Ellen Lewis with her award winning granddaughter. (Courtesy of Ellen Lewis)
We hope that you find this a truly inspirational piece. Professor Lewis encourages all of us to seek out additional leadership experiences in our careers and motivate us to work harder in our careers as nurses.
LifeLine (LL): How has nursing changed during your career?
Ellen Lewis (EL): Originally, education was obtained from a diploma program. We were quite competent when we came out of school to begin to practice because we spent a lot of time in the clinical areas. This was before Medicare reimbursements, and there were hospital schools of nursing. As a freshman you learned the fundamentals of practice by caring for patients in the hospital. The hospital had several wards of older patients who would now be confined and cared for in skilled nursing homes. Those patients also taught us some of life’s lessons. Our junior year we worked the PM shift in the hospital, and in our senior year we were the night-shift. We had a couple of nuns, or nurses who would oversee and supervise us. We would be in one unit and our classmates would be in another unit. This style of education would not be acceptable to students and/or patients today.
LL: What has changed the most in nursing practice?
EL: The complexity of the patient who is hospitalized for a very short period of time has changed. For example, when I first started caring for patients who had suffered from myocardial infarctions, they were hospitalized for a couple of weeks and basically were treated with pain medications, oxygen and rest. Patients were not monitored, nor did the nurse read EKG or rhythm strips. Intensive care units did not exist. Today, aggressive medical/nursing management and technology is extremely advanced and has greatly improved patient survival data.
LL: How have you been able to adapt to/implement changes?
EL: I actually came into the profession when technological advances were beginning to be introduced and implemented. It was exciting and nursing resources were much more available because of fee for service reimbursement. I coordinated the care for the first heart transplant in Wisconsin in the late sixties. New technology and equipment were constantly being introduced into the management of critically ill patients. I remember the old pressure respirators being replaced with volume respirators, like the Engstrom. Prior to volume respirators, many of the patients developed serious lung infections and complications, which at times lead to poor patient outcomes or death. I remember when they brought the first cardiac assist device into the ICU it was pretty challenging, yet very exciting. Blood gases were not drawn at regular intervals on ICU patients until we started using the volume respirators. Therefore, ICU nurses had to have very good assessment skills to determine cardiac function. We used to evaluate the patients’ cardiac output by assessing the three P’s (pulse rate, perfusion, and peeing).
LL: What advice would you give to people considering nursing as a profession?
EL: Pursue a very solid education and then understand that you will be a life-long learner. You are not through learning once you graduate and pass your licensing exam. Every day is a new day, and every day you learn new knowledge. When I entered the profession, knowledge stayed constant for a much longer period of time, but today the knowledge base is growing exponentially. There is so much information you have to know. If you do not have information at your fingertips, you have to know how to access that information. As a nurse you must be able to evaluate the efficacy of that information so that you are providing evidence-based care to your patient. Remember there is a lot of misinformation on the web.
LL: Your research is in Nursing Workforce Planning. What do you feel is the best way to address the nursing shortage?
EL: Maintain a database in California that will describe supply and demand for nurses on a local, state and national level. Then work to develop policy at a local, state and national level that will result in resources to educate the number of nurses needed to meet the demand for professional nursing services in California. The University of California owns and operates five major Tertiary Level Medical Centers and has five medical schools staffed with very knowledgeable, highly competent and skilled medical faculty to educate future physicians. These University Medical Centers need very knowledgeable and sophisticated nurses to care for very complex patients in tertiary settings. It is most appropriate that an adequat
e number of future nurses be educated by the University to help ensure the appropriate workforce for their respective enterprise. Also, we need to ensure that there are sufficient numbers of qualified nurses in the pipeline for nursing graduate programs in the University.
*Program in Nursing Science*
LL: What circumstances led you to develop a Program in Nursing Science at UCI?
EL: Several months after I began my job at the UCI Medical Center, I began to analyze my workforce. I had some wonderful nurses but recognized I had very few nurses with advanced degrees. A lot of nurses were diploma nurses and/or associate degree nurses, and only a very few had graduate degrees. One of the reasons for this was that no publicly-funded nursing education program in Orange County had a traditional baccalaureate program. One small program in Orange County did have a degree completion program for RN’s. Access to programs was extremely limited. My colleagues at UCLA, UCSF and UCSD did have a much higher mix of BSN and Masters prepared RN’s on their staff because they had several BSN programs in their community, and at that time UCLA did have an undergraduate nursing program. It was clear to me that if I were to be successful in changing the nursing services in the Medical Center from a county to a university hospital environment, I would have to change the staffing mix. To accomplish this I would need to increase the number of staff prepared to do that. The staff was comprised of really motivated people and very good nurses, but there was no access to education in the community. I went to UCLA and asked them if they could come to Irvine and conduct a graduate program in Orange County because we had no graduate education here in Orange County. California State University at Fullerton at that time had almost folded, and the closest facility was Long Beach State. UCLA was unsure about coming to Irvine, but over time we were able to negotiate with them, and they agreed to conduct a satellite program in Orange County. We were able to admit thirty-two graduate students in this program overnight. Many of the nurses were from the Medical Center. A lot of nurses at the UCIMC and in Orange County with masters from UCLA went through that program. The hospital provided space to teach those courses.
LL: What steps were involved in creating a nursing science program?
EL: The first proposal for our current program was written in 1992. It was shelved because the economy began to deteriorate, no resources were available in the state, the county was facing bankruptcy, and UCI had no resources to develop new educational programs.
The first proposal for our current program was written in 1992. It was shelved because the economy began to deteriorate, no resources were available in the state, the county was facing bankruptcy, and UCI had no resources to develop new educational programs.
In 2004, the College of Health Sciences was formed, and this created a structure in which a Nursing Program could be developed.
The Orange County community was extremely pleased that this program was being developed and contributed over 2.3 million dollars in resources to help establish and maintain the program over its first few years.
A Nursing Education Advisory Committee was formed, and then the process to develop a proposal to establish a Program of Nursing Science at UCI began. This proposal was approved by the Campus Academic Senate in December 2005, and the program was subsequently established by the Executive Vice Chancellor in January 2006. This proposal defined that a BS, MS, DNP and Ph.D. program would be developed over several years. To implement this program, individual proposals for each degree would have to be submitted to the Campus Senate and Office of the President for approval.
The Bachelor of Science in Nursing Science was approved in May 2006, and the program was implemented in September 2006.
The Masters program was approved this academic year (2008-09).
The DNP and Ph.D. programs are still pending approval.
LL: What was your overall experience in making this a reality?
EL: I really wanted this to happen. I worked long hours, many days, and many weekends over a period of many years. I often would get discouraged and doubted whether it would happen in my lifetime. Some days I had to work hard to keep my dream alive. When I received the memo stating the program had been approved, I exclaimed, “YES!”
*Advice*
LL: How can we become more involved as Nursing students?
EL: Become a part of your nursing student organization. You need to participate in the governance of your program. That may mean serving on a professional committee or anything else you can do to participate in maintaining the program or helping to create change. Get involved in the community in some way. You are role modeling and adding to the conversations related to policy, patient care, and nursing. You are not just promoting your profession, but you are also acting as an advocate of your patient care and for the health and well-being of your communities.
After you have graduated, join your professional organizations. You can’t complain what is happening to you if you don’t participate in the decision making. It’s important. I remember as a brand new staff nurse, I joined the ANA [American Nurses Association] and became involved in how to create change and policy. A lot has changed in the profession over the past several decades. You may feel sometimes, “What can I offer?” but be willing to offer your opinion to the discussion. These small discussions often fuel new policy or purpose that will change your professional being. Be a risk taker.
LL: How can students become involved in research projects? Are there research opportunities for students?
EL: Yes. Work closely with the faculty to learn what projects they are currently focused on and how you might help if you have that interest. If you have another interest, please let the faculty know because they can put you in contact with other faculty on campus that may want your assistance. Also, when you are in the clinical environment, generate questions that could be explored in the Scholarly Concentration courses in your senior year. Several students have received campus funding for their research projects. You could be next.
LL: Do you have any additional advice you can offer us nursing students?
EL: Stay focused. It’s a grueling curriculum, but it’s going to have meaning and better prepare you to care for patents who are extremely complex, whether they are hospitalized or in the community. Most of you will begin your practice in hospitals, and then you will venture out after you develop your wings and develop your interest. Having a very solid core is important. You can learn a lot from your colleagues in medicine, PT, OT, Dieticians and others because the patient is going to benefit when all of you are communicating and executing the patient’s plan of care.
LL: Is there anything else you would like us to know?
EL: Basic scientists study human cells; physicians study and develop expertise, for the most part, related to an organ system. Nurses focus on the whole patient, which includes the family and the community that interacts with the patient. We teach disease prevention strategies, provide services when they are in need of acute or chronic nursing care, and we work to restore the health and well-being of the individual. After the patient receives a medical diagnosis, nurses most often have to help the patient and family understand how they will cope with their illness. Your responsibility is to be sure they have the facts about their medical problem, know and explain what their options may be, tell them how you can help them, and explain what other resources are available to them. It’s an awesome task but very rewarding.
A bit about the authors/photographer of this article:
Trish Brooks is married with three children. She took a break from school to become a flight attendant and “travel the world” and ended up working for a major airline for nine years. She eventually returned to school to pursue her ultimate dream, to become a nurse. Trish would like to work in a burn unit.
Kelsey Chung graduated from Mission San Jose High School in Fremont, California. She is interested in becoming a Nurse Practitioner or a Clinical Nurse, possibly in critical care or in the surgical room. However, as of now, becoming an R.N. and helping those in need is her main ambition.
Angie Alducente graduated from UC Irvine in 2007 with a BS degree in Biological Sciences and a minor in Management. Now she is currently a post-baccalaureate student working towards her BSN. She is interested in becoming a Family Nurse Practitioner, CNA, or a CCRN. At this point in time, she is focused on learning and developing her skills needed to help her patients.
e number of future nurses be educated by the University to help ensure the appropriate workforce for their respective enterprise. Also, we need to ensure that there are sufficient numbers of qualified nurses in the pipeline for nursing graduate programs in the University.