Leaders in Nursing Education

Dr. Victoria Niederhauser, Dean of University of Tennessee, Knoxville College of Nursing

Thasin Jaigirdar
Sep 28, 2015

Dr. Niederhauser is currently Dean and Professor at the University of Tennessee, Knoxville College of Nursing. Prior to her current position, Dr. Niederhauser has held various leadership roles at the University of Hawaii at Manoa, School of Nursing & Dental Hygiene. She has also held academic appointments at George Mason University and George Washington University. The focus of Dr. Niederhauser’s scholarly activities are in the area of child and adolescent Health Promotion and Disease Prevention, with an emphasis on immunizations and childhood obesity. She has received numerous research grants to study parental barriers to childhood immunizations and has published extensively in this area.

Dr. Niederhauser published the book “Core Review for Pediatric Primary Care Nurse Practitioners” in 2007 and has authored over 45 articles and book chapters on child health and educational issues. Dr. Niederhauser is a Robert Wood Johnson Executive Nurse Fellow, completing the 3-year fellowship program for nurses in executive leadership roles in 2011.

How did you first become interested in nursing as well as pediatric nursing?
From the time I can remember, I wanted to be a nurse. I think this decisive career pathway was developed through the role models in my life. My grandfather was a surgeon, my mom a physical therapist and my aunt was a pediatric nurse. In the 1950’s my aunt left Babies Hospital in New York City to become a nurse in Alaska. She travel throughout the state, lived in rural villages, and started her own business to help people do a better job of parenting children. She lived a life of personal and professional adventure; her stories and experiences inspired me to want that kind of career and life for myself.

Early in my career, I came to realize the impact nurses can have on children and families. And I loved the tremendous resilience that children have managing and coping with illness. When I became a Pediatric Nurse Practitioner, I knew that I could influence the health and well-being of children and families through my wellness teaching and guidance. What could be more gratifying than setting a child on the right path to a life of health and wellness?

How did you grow interested in nursing education?
Throughout out my entire career opportunities to take amazing roles presented themselves to me, like becoming a nurse educator. After I completed my Master’s degree and pediatric nurse practitioner program (PNP), I traveled across the country and ended up in Hawaii. Initially, I was seeking a position as a PNP, but no positions were open (at that time, only 2 PNP were employed on the islands). I happened to see an ad in the newspaper for a nursing faculty at the University of Hawaii, I interviewed and was hired on the spot! After my first semester teaching eager nursing students, I realized that I really enjoyed the privilege of influencing the next generation of nurses. The autonomy of the position, the ability to be creative, and the variety of the work day also were very appealing to me. Within 6 months of starting to teach nursing, I was hired as a part-time PNP and continued to practice as a PNP and have a faculty appointment throughout my career.

What changes would you like to see in nursing education and how nurses today are trained?
Up until about 10 years ago, nursing education programs taught nurses the way the nurse faculty were educated. With advances in understanding how people learn and the new technology and teaching tools, we are beginning to see changes that I believe will better prepare nurses for today’s health care systems. We know that an active, engaged student learns and retains information better. We know that teaching in the context of the patient, family, health care system promotes deeper understanding. We know that being able to access current, accurate information is an essential tool for learners. And although there have been some changes in how we educate nurses, there are still more advances needed. We need to continue to explore ways to measure learner competency in pre-licensure nursing education, in the licensure examination and for practicing nurses. The hallmark of excellence in care for patients and families hinges on strong collaborations, innovation, and cohesive teamwork of the health care team. And now it is widely recognized that these are also crucial elements in educating the next generation of nurses, advanced practice nurses, nurse leaders, and nurse scientists. We need to fully integrate inter-professional education efforts into health careers education during pre-licensure nursing program and continuing through the on-boarding into health systems and throughout their employment tenure.

The Healthcare Industry as a whole has been slow to change compared to other industries. What do you think is necessary to facilitate change?
Today’s challenges in health and health care will not be resolved with yesterday’s solutions; and those who find innovative approaches to solving critical health issues will improve care in hospitals, communities, and other health settings. We know change is necessary to improve the health care system. Change can happen incrementally or it can happen disruptively fast. In the past, we experience incremental changes with occasional periods of higher acceleration. To facilitate positive change, I believe we need to bring together unlike-minded people with different perspectives and not be fearful of positive disruption and accelerated pace of change.

In which direction do you believe nursing education is current going into?
In education, we are going to see more focus on competency and learner outcomes, and how you demonstrate those competencies in creative ways versus conducting multiple-choice testing. Competency-based licensure exams and continuing education for practicing nurses will be the standard in the future. I believe we will see changes in inter-professional education. The shift will occur from a nursing school with only a few courses shared with a medical or pharmacy school to see a fully integrated model of inter-professional education.

What was the transition to the administrative side like?
It happens often in nursing. If you are a good nurse, you are asked to be a charge nurse. If you are a good charge nurse, you become a head nurse or director. It’s also the same in nursing education. Good faculty members are asked to assume an administrative role. The transition from bedside nurse to nurse leader or nursing faculty to faculty administrator takes a whole different set of skills. And I believe that developing those leadership skills needs to be an intentional journey of self-discovery and acquiring new competencies. When I was promoted to Department Chair in the College of Nursing, I saw the opportunity to develop my leadership skills through the RWJF Executive Nurse Fellows program. I was fortunate to be selected as one of 20 nurses to attend this 3-year national leadership development program for nurses. I learned so much during those years and developed a national network of leaders whom I rely heavily on still today! I enjoy the administrative aspects of nursing academics. To be able to influence the next generation of nurses, advanced practice nurses and nurse scientists is an honor and a privilege.

What skills are necessary to cultivate strong leadership?
For me, as for many leaders, I believe the core of a good leader lies in understanding yourself. Self-knowledge, including strengths and development needs, can help you to build strong teams, deal with situations better, and view the world from different lenses. It can also help one to see how their strengths can turn into weakness, if overused. When something does not go as well as intended, I first turn inwardly and think about what I could have done differently in the situation. Another key leadership quality is emotional intelligence. Being able to put oneself into another person’s place, the ability to be authentically empathetic, and understanding what might motivate others, are key to managing people and relationships.

From your perspective, what are some of the qualities of the best nurses you have worked with/trained?
I believe one of the highest qualities of an excellent nurse is compassion. Nurses enter their patient and families lives at the most vulnerable times and they care for people in the most challenging of situations. People face all kinds of challenges, including doing harm to oneself or others. Those nurses, who on a daily basis, care for each patient as a valuable, unique human being, are in my opinion, health care heroes. Other equally important qualities are integrity, humor and the ability to critically think about every situation.

What type of work did you do as Dean of Academic Affairs at University of Hawaii at Manoa?
The role of the Associate Dean for Academics in nursing programs is to ensure academic quality and integrity for the Colleges of Nursing. In Hawaii, my role was to ensure that the college was in compliance with national standards, use evaluation as a tool for program improvement, and work with faculty and staff to obtain excellent student outcomes. During my tenure as the Associate dean for Academics, we planned and implemented a new undergraduate nursing curriculum. There were several drivers for this change including: we believed that changing the pedagogy would produce better learning, we wanted to become more effective in training higher numbers of nurses, and we wanted to create access for educational progression for all nurses in the state. We partnered with our community college partners to build a new curriculum based on active learning within the context of the health care environment. In the end we became a faculty of the state because we shared a lot of resources, ideas, and learning methodologies across our programs..

There is a trend now to have Nurses pursue more terminal/advanced degrees. Can you share your perspective on this?
Nationally there is a strong push for nurses to advance their education to a BSN level or higher. Multiple studies demonstrate that hospitals with a greater percentage of nurses with BSN degree or higher have better patient outcomes. Our goal is to have 80% of nurses at the Baccalaureate level or higher by 2020.

We educate advanced practice nurses (APN), including Nurse Practitioners, Nurse Midwives, Nurse Anesthetists, and Clinical Nurse Specialists, to be good clinicians and they also need the knowledge and skills to lead transformations of the health system. Therefore, we are advocating for APNs to obtain the Doctor of Nursing practice degree; this degree provides advanced education in health care economics, health policy, leadership, and epidemiology.

Less than 1% of all nurses have a PhD. In order to advance nursing science, we need more nurses to consider becoming nurse researcher. We also need more nurse scientists to help advance the nursing discipline including symptom management, end-of-life-care, health promotion, disease prevention, and theoretical underpinnings of the profession.

Do you have any final thoughts regarding the nursing profession as a whole?
Nursing has never been a job for me; it been my life’s work for the past 38 years. I found the same adventuresome career with opportunities abound for those willing to take risks as my Aunt Carol did 60 years ago!