The first class of Colby-Sawyer nurses received their degrees in 1985. What began as a small program with four faculty and 11 graduates has grown and adapted to the ever-shifting landscapes of both higher education and the healthcare industry. To commemorate 30 years of nursing at Colby-Sawyer, I sat down with Dr. Susan Reeves ’88, dean of the School of Health Professions, associate academic dean for Dartmouth-Hitchcock Partnership Programs and Gladys A. Burrows Distinguished Professor of Nursing.
Tell me about your path to Colby-Sawyer. There was more than one. Years ago, nurses were trained in hospital-based diploma programs founded on an apprenticeship model. In the late 1970s, this model started to change as nursing came to be seen as a discipline and a profession. Preparation shifted to institutions of higher learning at either the associate’s or baccalaureate degree level. This is the backdrop to my first path to Colby-Sawyer.
I entered the Mary Hitchcock Hospital Nursing Program knowing it would close with my graduation in 1980. Fortunately, the hospital’s forward-thinking CEO, Jim Varnum, and the director of nursing, Marilyn Prouty, saw both the need for nursing to be housed in an institution of higher learning and for the hospital to develop a relationship with a nursing program. Jim contacted Colby-Sawyer and proposed creating a four-year baccalaureate nursing program, which was developed by Doris Nuttelman, EdD, RN She still lives here in New London and returns to campus every spring for our pinning ceremony. The program launched in September 1981; I graduated in the Class of 1988.
And your second path to Colby-Sawyer? That started in 2003. I am a cancer nurse by clinical training, but since the late ’80s, I have been in administration. In fall 2003, I was an operating vice president for the hospital. I loved my job but felt something was missing, and then I happened to see that Colby-Sawyer was looking for someone to teach biomedical ethics. While I taught that course, the program chair left – Colby-Sawyer was expecting more than 60 entering students who had declared an interest in nursing – and had no permanent chair for the department.
This was a time of tremendous growth, challenge and opportunity for the program. Rapid growth meant the program needed faculty, classroom space and clinical opportunities, so they contacted the hospital for assistance. As an alumna who had also taught, I was asked to take on the role of half-time chair for2004-2005. By 2007, I was the full-time chair and building healthcare programs that would meet the needs of our students while breathing new life into the partnership with the hospital.
Why does a nurse need a liberal arts education? I am a strong believer in liberal arts education. It is critical; all the skill sets that are developed are what nurses will continue to need in their work. Critical thinking, for example, is an essential skill for a nurse. It is not enough to know anatomy and physiology – you need to be able to critically think if you are going to discern how different conditions present themselves in a patient.
Have you seen this interdisciplinary partnership in action? One of my favorite stories to illustrate the value of a liberal arts education comes from a visit by our program accreditors. The team went to Dartmouth-Hitchcock to talk to students in their clinical classes about the ways in which their liberal arts education impacts their clinical work. My job was simply to take the team around and say nothing; my heart was in my throat as I wondered who the surveyor would talk to and how the students would respond.
In the pediatric unit, we approached a student caring for a child after a surgical procedure. The child was in a significant amount of pain, and the surveyor asked, “How do you use your liberal education in the arts and sciences to help you with a situation like this?” Without missing a beat, the student responded, “It is interesting that you ask that because I am using skills developed in a drawing course I took to distract the patient from the pain.” This student’s integration of nursing and art is emblematic of what we cultivate in our program. Our nurses are never done learning; they think deeply about the issues they will confront and how their core skills will ground them as they work through challenges.
Many health care professionals have noted that higher education is going through a period of rapid change similar to what their industry went through a decade ago … what might higher education learn from the health care industry? Like health care about 15 years ago, the public views higher education as a commodity, one that must be evaluated according to the same criteria as any other commodity. This commodification created three forces that converged on healthcare and are now converging on higher education: a public intolerance for high cost, a demand for greater transparency around quality, and a critique of long-held practices that are seen as good for the guilds in higher education but not for the public.
Regarding the first and second forces, we have to analyze the relationship between price, cost and quality. It is nearly impossible for a consumer to understand and make decisions about either health care or tuition bills. The difficulties continue when the public asks questions about quality; the health care industry went through this already, and the public’s relationship to the health care system has shifted from one of trust to one of increased transparency and mandated data-driven quality assessment from regulatory bodies. Now, when a patient needs a procedure, they ask questions about the best hospital and physician for the procedure; they demand the information they need to make this choice. A similar push for assessment is being felt in higher education.
Where does higher education stand now in this push? Higher education is still in the early stages of responding to this public intolerance for high cost and demand for transparency around quality. Rather than challenge and change these pricing strategies, colleges are providing the tools that a consumer needs to figure out what they will actually pay. On questions of quality, those in higher education have to move past critiquing proposals for measuring quality. To a public fed up with current practices, it just doesn’t matter that the data being used is not nuanced enough to capture the complexity of higher education.
Regarding the third force, we have to analyze the practices in higher education which are not good for a public demanding lower costs and increased transparency. Like physicians who reacted in horror when they were referred to as employees and judged according to performance indicators, our initial reaction in higher education to these converging forces is ‘we are not a commodity, we are a profession and you can’t demand this of us.’ We must realize that this is not enough. We must follow the lead of health care and show a willingness to ask difficult questions and propose tough answers. We have to satisfy a public that is demanding a different accountability framework.
What is the way forward then? It is so jargon-filled that it has almost lost meaning, but the way forward is in this discussion on value, where value is defined as quality divided by cost. We need to change this equation so that higher education, and Colby-Sawyer itself, is always increasing our value. We are going to have to figure out how, with less cost, to deliver more quality where quality is defined by the consumers who want to invest in our product. I know we can do this. We are a community that has consistently shown itself to be committed to doing things right and well. It is the culture of Colby-Sawyer to be resilient in the face of adversity, to persevere with the resources we have, and to continue to provide the best possible value to our students and their families.
Associate Professor of Social Sciences and Education Eric Boyer joined the faculty in 2008. He holds a B.A. from the Indiana University of Pennsylvania and a Ph.D. from the University of Minnesota.