Pediatric pulmonary nurse practitioner Mary Jo McCracken examines her young patient, Anthony Berthiaume. —Photo: Tom Foley

Nobody seems to be talking about a host of complex problems that are driving nurses away from what it is they are trained to do—care for patients. Recent media attention focused primarily on nursing shortages and salaries, and that concerns pediatric pulmonary nurse practitioner Mary Jo McCracken. Shortly after graduating from the University some 25 years ago, she was diagnosed with Crohn’s disease, a chronic inflammatory bowel disorder, and she views life from a different perspective than many health professionals—through the eyes of a patient and a healer.

“Being chronically ill has taught me to practice a broader kind of clinical care,” says McCracken. “I realize just what things are not getting addressed today due to the changing world of health care. I have a better understanding of what is reality for a patient and how I can help families in a complete way.” This kind of care requires time, and time is money.

McCracken works at the University of Minnesota’s Cystic Fibrosis Center, where each day she faces her own health problems as well
as those of her patients.

“I’ve had 28 surgeries and counting,” she explains. “Crohn’s is a chronic illness, (as is cystic fibrosis) and what people don’t realize is that a chronic illness is fraught with psychological and emotional challenges as well as physical ones. These take time to sort out, yet today’s health care economics don’t include much time to listen to patients or call them to see how they are doing and what they need. When I see a family with a child newly diagnosed with cystic fibrosis, I’m not just doing a physical exam. I’m looking at how that couple is coping with their infant. I ask them about their fears, their anger, and their relationship with one another.”

McCracken feels both a passion for her work and frustration at the constant battle of maintaining her holistic approach to nursing. Her days are much longer now in order to provide the level of care to chronically ill patients and families that they need and deserve—care that takes far more time than the official 32 hours per week of her position. She feels the business of health care discourages many young people from entering the profession. Sicker patients, shorter hospital stays, and fewer nurses make it enormously difficult to find time for teaching and providing psychological and social support for patients and families.

“The trouble is, the caring piece of nursing is not valued; it’s not tracked, reported, or measured,” says McCracken. “Yet, it’s pretty hard to say, ‘I’m sorry I can’t listen to you or help you,’ when there is a human being involved.”

So, what is the value of caring? Leon Sabath considers it priceless. An infectious disease specialist and professor of medicine at the University of Minnesota, Sabath had a heart attack that would have ended his life had a doctor not been at his bedside at the moment his heart stopped. Following bypass surgery, Sabath’s oxygen levels started to fall precipitously. Just as the on-call doctor arrived to examine him, Sabath’s heart stopped, and the doctor had to open his chest and pump his heart back to life with his hand.

Today, Sabath can hardly believe his good fortune to be alive. He also knows that the doctor who saved his life would never have made it to his bedside without the skilled nurse who quickly assessed his life-threatening situation and called for assistance.

“Early in my training, long before I became an M.D., I learned how important nurses were to the overall care of the patient,” says Sabath who is now 70. “Then, shortly after I moved to Minnesota 27 years ago, I sat next to a man on a flight to the Twin Cities who was a neurosurgeon at the Mayo Clinic. This man told me that what made Mayo such a superb institution was its nurses. It was the nurses who spent more time with patients than anyone.” Nurses still spend more time with patients than anyone, and Sabath has never for a moment forgotten the value of that.

“It’s a good profession,” explains Mary Sumpman, associate director of administration for the University of Minnesota Cancer Center. “It’s been very good to a lot of us. Nursing has provided many of us with a great education, excellent training, and many opportunities in life. But society is not promoting nursing as a good profession anymore. I think a lot of it has to do with the fact that nursing is perceived as a woman’s profession, and women have a much broader range of career choices today. Lots of careers pay more than nursing.”

Like many others in her profession, Sumpman rarely sees parents encouraging their children to enter health care. She no longer gets as many calls about nursing careers, and she knows that many practicing nurses spend far too much time engaged in clerical and housekeeping tasks rather than clinical work.

“Nursing gives you an opportunity to see the impact of what you do at a direct level,” she adds. “Whether you are curing someone or

Joanne Disch, director of the University’s Katharine J. Densford International Center for Nursing Leadership —Photo: Tim Rummelhoff

making them comfortable, you become a part of people’s lives, and this is very emotionally rewarding. On an intellectual level, nursing requires a lot of critical thinking—assessing a patient’s condition, doing interventions. Nurses are frequently involved in life and death decision making.” She worries that ultimately the public will suffer if that critical thinking talent is not nurtured and protected.

Sumpman agrees that salaries are at least part of what drives nurses or prospective nurses away. Understaffed hospitals and clinics, double shifts, and little power in shaping their overall work environment also contribute.

Joanne Disch, director of the University’s Katharine J. Densford International Center for Nursing Leadership, part of the School of Nursing, acknowledges these concerns and agrees that nurses have become a precious and shrinking commodity. However, nursing is only one of many health care professions experiencing a shortage, and even the most effective recruitment and retention strategies will not provide enough nurses.

Disch views the problem as a three-legged stool, and increasing the supply of nurses is only one leg. The second leg requires a decrease in the demand on nurses, enabling them to practice nursing, not clean beds or run to the pharmacy for drugs. The third critical leg underscores the need to improve the environment of care. An unhealthy environment fosters resentment, job dissatisfaction, and compromised patient outcomes.

In her view, each individual in the profession must discover a way to have a positive impact on the health care environment. “Each of us is responsible for ourselves,” explains Disch. “Although we cannot control much of what happens in health care today, we can control how we choose to respond to it. Every interaction with patients, families, students, and colleagues either adds to today’s nursing problems, or helps maximize tomorrow’s workforce.”

by Mary Farr


Katharine J. Densford International Center for Nursing Leadership

The Katharine J. Densford International Center for Nursing Leadership was created in 1997 to carry on the legacy of health care pioneer Katharine Densford, an internationally known nursing leader who served as director of the nursing school from 1930 to 1959. The center is the first university-based center in the United States dedicated to improving health worldwide through the development, collaboration, and promotion of nurses as leaders.

Funding for the center has come through gifts from alumni and friends, including the Lillehei family. Kaye Lillehei, a 1950 graduate of the school and a student of Katharine Densford, and her family donated $3 million to the School of Nursing to establish a chair in nursing leadership.

“It isn’t often that many of us have the opportunity to create something brand new,” says Carolyn Schroeder, leader of the fund-raising campaign for the Densford Center. “The generosity of our nursing alumni and others truly has been invigorating.”

Joanne Disch, who holds the chair and serves as director of the Densford Center, says that the center’s unique ability is to bring together people concerned with similar issues and to give nurses an equal voice in improving patient care. “The center is a catalyst, a focal point, to help people collaborate and develop strategies for dealing with today’s pressing health care issues,” she says.

One illustration of the center’s impact is the Densford Clinical Scholars Program, where advanced practice nurses form partnerships with faculty members. Last year a clinical scholar team addressed the problem of pain management in children with bone marrow transplants. It found little consistency in how or when medications were being discontinued, a situation that could be dangerous. The team developed and implemented changes for a more consistent practice and is now publishing an article on its findings. In another project to be undertaken in the coming year, two clinical scholars will develop and conduct a children’s survey of health care, something that has never been done.

for more info on the clinical scholars program or the Densford Center, contact Joanne Disch (disch003@umn.edu, 612-625-1187). Later this fall, a Web site will be available.