Strumpf (right) discusses dissertations with Nursing doctoral students Anna Beeber (left) and Meg Bourbonniere. The interim dean of the School of Nursing fights to remind a money-conscious national health care system that nurses save more than just lives.
Photo by Candace diCarlo
Although nurses have long known that they play a critical role in healing the sick, not everyone agreed. Now, Neville Strumpf, interim dean of the School of Nursing, has proof.
In her most recent study, Strumpfs research team documented how elderly patients who had cancerous tumors removed lived longer when advanced practice nurses nurses with post-baccalaureate training in specialty care were on hand to monitor conditions, deal with complications and provide advice to family caregivers.
The study, published in the December 2000 Journal of the American Geriatrics Society, is only the latest of many Strumpf has done showing how nurses, given autonomy and the resources they need to do their jobs, improve the quality and the efficiency of health care.
Strumpfs 30-year career started out with taking care of patients. After earning a masters degree, she worked in public health, still taking care of patients. And then, after earning a Ph.D., she went into research and teaching, focusing on care for the elderly. But I certainly think what I do is still about patients, she said. Im educating nurses to take care of elderly people, and I do research that I believe informs the science and the profession about what the standard ought to look like. I still see it as patient care.
Q. I guess the first thing Id like to ask about is this study the one that shows that advanced practice nurses add years to the lives of cancer patients.
A. Well, it wasnt years, but it was certainly the first clinical trial that actually demonstrated that a group of patients who received specialized care from advanced practice nurse did in fact have a longer survival than a comparison group of cancer patients that did not.
What made this particular study exciting was that even though subjects were randomly assigned to the two groups, it ended up that the intervention group actually had more people with late stage cancer in it than the nonintervention group. So you immediately think, Oh my God, this will be a major confounding variable; how can the advanced practice nurses make a difference in a group that actually has people that are likely to die sooner? So it made the finding especially powerful for that reason.
Q. Youve done other research in the past thats changed the way patients were treated significantly. Would you care to speculate on the likely effect of this study?
A. Ill try to answer the question slightly differently than I think youre asking it. All of the work Ive done has really been related to looking at very frail, very vulnerable populations of older people.
The work that Im probably the best known for is work relating to reducing or eliminating physical restraints with nursing home as well as hospitalized patients. And we did that also in a clinical trial using a [masters-degree-holding] nurse who works very closely with the staff, educating them in more appropriate management and assessment techniques.
And we had very good results from that, that not only showed a) you could do it successfully, but b) contrary to the mythology that surrounded this particular practice, you could do it without increasing the number of serious injuries.
So the bottom line is that the work that I have always been involved in is, What are the ways in which you can apply a more individualized approach to care using techniques that have better outcomes for patients, and the restraints is an example. Making the extrapolation up to the cancer study this again, in my view, is a group of advanced practice nurses who were keenly tuned in to the physical, emotional and other kinds of problems that patients and families were experiencing, and they were able to assess them quickly, to intervene more appropriately and to take actions that had good outcomes.
These problems are not all that complicated. But they can get very complicated if someone without the appropriate clinical skills and judgement doesnt intervene fast enough to put the right solution into place. And wherever we go in health care these days, resources are very constrained and we look for the easiest fix, such as early discharge back home with the caregiver. Except hey, the person is old, frail, just found out they had cancer and theyve had major surgery and no ones there to fill in the gap of how to manage that care. We dont have a system in place that either will pay for or support care that in the end, if we did it, might be cheaper.
Q. Which leads me to ask about the nursing shortage.
A. The present shortage has been building for the past 10 years, and it started building early in the 1990s when there were major efforts on the part of hospitals and it isnt just hospitals to reorganize in such a way that they could save money. One of those ways was to cut back on the number of nurses and to look at, Are there other lesser-prepared workers [who can do the job]?
That sent two messages. One was that there werent any jobs available for nurses, and if you can believe this, in the early 1990s, even graduates from the University of Pennsylvania School of Nursing were having some difficulty finding work. [So] what do we see happen all across the country? Enrollments to nursing schools are falling off. And along with that, guess what else goes up on the publics radar screen? That working conditions are very demanding and very difficult for nurses. Well, of course they are. Hospitals are short-staffed; patients are very sick; theres all kinds of talk about closing hospital beds because theres no one there to take care of patients, and we even hear about mandatory overtime and blah-blah-blah. These dont send messages that are appealing to people contemplating careers in nursing. And then you have the third issue, which is that nursing salaries have been relatively flat over the past decade.
And by the way, none of these things can be fixed overnight. But what I think is most fundamental in turning things around is the conditions under which nurses work also have to change. We have a researcher here, Linda Aiken, whos done a lot of research on why nurses are satisfied or unsatisfied, and of course wages are always a piece of it. But its not the only piece. Its also autonomy in the workplace, satisfaction with the job, recognition, career ladders. All those things have to be in place too.
Q. How do you think the profession and the general public view the Nursing School?
A. We certainly identify ourselves, and I think our peers identify us, as leaders in defining what baccalaureate, masters and doctoral education looks like. A lot of people ask us this, so Im going to beat you to the punch Do we care about bedside nursing and do we care about patient care and do we care about what happens in the hospital and the answer is, Yes, yes and yes. Were about practice. Were about taking care of patients and were about having the standards of care elevated to a professional level.
Im tired of hearing reporters tell me, At Penn, you dont prepare nurses to take care of patients. I think they imagine were preparing people to be administrators, to be teachers, to do very special things outside the hospital. Yes, we do that, but the starting place, the place where most of our graduates go to work, is direct patient care, often in a hospital.
The bottom line of a profession such as nursing, and I would say the same is true for medicine, is patient care. If its not about that, whats it about?
But there are lots of different ways you can enhance the quality of patient care, not only one-on-one in the hospital but also doing research that changes practice. And thats where I am.
Originally published on May 3, 2001