Inside the Nursing Program at the Nation’s Largest HBCU - Dr. Tiffany Morris, Director of Nursing at the North Carolina Agricultural and Technical State University

Michael Carrese: Hi, everybody. I'm Michael Carrese welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare.

Today, we're going to bring you another in a series of conversations with leaders in nursing education around the United States, in which we're taking a look at current challenges,

innovations, and trends in the sector. For that, I'm happy to welcome Dr. Tiffany Morris to the show. She's a veteran nurse educator who recently started a position at North Carolina

Agricultural and Technical State University as Director of Nursing and the Clara Adams Endowed Professor in the School of Nursing in the Hairston College of Health and Human Sciences.

Dr. Morris brings more than thirty years of experience to the role, which she assumed in July. Previous leadership positions include being the inaugural department chair and an associate professor in the nursing program at Elon University School of Health Sciences and serving as a clinical assistant professor and interim dean in NCAT’s school of nursing, so this has been a bit of a home coming for her. Dr. Morris holds master's degrees in nursing and education and a doctor of nursing practice in executive leadership. And for a research interest, she focuses on end-of-life care as a health disparity among African Americans. 

So, Dr. Morris, thanks so much for being with us today. It's a pleasure to have you. 

Dr. Tiffany Morris: Thank you for having me. 

Michael: So, I'd like to start, as we always do, with learning more about our guests and,

in your case, what first got you interested in nursing? 

Dr. Morris: I always love this question because at thirty years into nursing, I have not changed my mind. One of the things that influenced me the most was my aunt, who was a nurse, and I watched her in her white cap -- because at that point they had their white cap and they're all white -- and it was very impressive to me to see her care for people in uniform, believe it or not. So, when I was younger, I always wanted to either be a teacher or a nurse, and I found a way to do both. But it was having that example, that visual example, from a family member that really got me interested into becoming a nurse.

Michael: And when you started your nursing education, did you sort of feel it click....that it fit, that it was the right place for you?

Dr. Morris: I often tell people that I am on calling in that career. Nursing truly is a calling. It's a mission. And people often say, “Well, why not be a physician?” I think different career paths are appropriate for individuals, but I wanted to be that person that made a difference, that pulled the covers up at night for patients, that fluffed their pillows, that, you know, was there to hold their hand when they were dying. I know that some people are afraid of that, but that really made the difference for me. It was the being in person and knowing that I had a part in their healing process, and that's just been amazing for me.

Michael: That's beautiful and we'll get to end of life stuff a little bit later, but I'm also curious to know -- because we have a younger listening audience and they're curious about career paths -- did you know kind of early on that you wanted to be a leader, that that was a path you wanted to follow, or how did that unfold? 

Dr. Morris: I love this question because I think with this generation now, sometimes you have to allow your career to mold and shape and guide. I can tell you when I first became a nurse, what I thought I was going to do was to be a nurse practitioner. Because again -- you can tell

I love the hands-on -- but about two to three years into my career, I had the advantage of taking students in for clinical work, being a preceptor and one thing sort of led to another. I was promoted because with nursing, if you show up, you do a good job, you show that you have critical thinking skills...it kind of just followed me, if you will. Leadership was what I kind of fell into. But then, I will tell you this, once you found yourself in leadership positions, I embraced it, and then I chose to continue in that path.

I did not see myself as a leader, to be honest. I had my mind made up of doing something else, but it has been an amazing journey. 

Michael: I'm curious about people who are leaders because there's difficult parts of the job, obviously. I mean, sitting down with somebody and having a conversation about maybe where they're falling short and all kinds of other personnel problems. What's your approach to it so that it isn't as much of a challenge, perhaps, getting through the day-to-day? 

Dr. Morris: So, I have embraced the philosophy there's a difference between leadership and management. You manage processes and you lead people. So part of my philosophy is when you encourage people, you tell them the things that they're doing well, when you have to sit down and tell somebody that things may not be the way that the standard is set or whatever, it's a lot easier for them to hear because I have not spent the entire time telling them that they haven't met the bar. In fact, I've encouraged them with so many kudos and “you've done this” and “this is what I like” so I've learned how to embrace the side of leadership that really is positive, telling people what their positive attributes are. So, when it's that one thing that can be changed, I'm not saying it's always worked, but for the most part, people are easy to hear because they know that the heart in which I am relaying it is for their betterment and growth.

And I've really embraced the leader part, not the manager. I think people manage people and they should not. They lead people, manage processes. 

Michael: That's a great way to put it. So, I'd love to get an overview of the nursing program there at North Carolina Agricultural and Technical State University and what you think its particular strengths are.

Dr. Morris: Thank you. So, our nursing program has your traditional bachelor’s of nursing program, that's your four years, people that come right out of high school. We have what we call the accelerated nursing program, twelve months. That's pretty impressive. It's accelerated, not abbreviated. So, anyone with another degree, bachelor's degree in any other field, and they've met our admission criteria can become an RN in twelve months. 

Michael: Wow.

Dr. Morris: Yes. January through December. And then we have what we call the RN to BSN. So, students that have an associate degree come back and this is another twelve-month program all online and they can get their bachelor's degree. So, that's a great way to get an overview of the nursing program. So, we have a bachelor's degree and sneak peek, we hope to be starting a doctorate in nursing practice program in psychiatric mental health beginning August of ‘24. We're waiting on final approval and a DNP in psychiatric mental health nurse practitioner as well. 

What makes our program unique? I think it is because we are an Historically Black College and University. The opportunity to serve students who are normally underrepresented and be able to produce other healthcare providers that look like the people that they're serving is

an amazing opportunity and I'd like to think that our brand is that care and our brand is producing opportunities at HBCUs that they may not otherwise find in other places. 

Michael: So, I know experiential learning using virtual reality and simulation is an interest of yours. I'm wondering what you can tell us about what the Hairston College of Health and Human Sciences has to offer to students who are in the field. 

Dr. Morris: Sure. I want to first talk about what the School of Health and Human Sciences and the School of Nursing offers in that area. Thank you. We have a state-of-the-art facility in partnership with some other schools. It's called the Union Square Campus, where we have high-fidelity simulation mannequins. We have the Anatomage Table. That's new and upcoming in the world of healthcare. And we have, located on our campus, a facility called Heinz Hall, where we have the Apollo mannequins, high fidelity. 

What I like about it -- because you've read a lot of the articles where it talks about the medical models don't represent the population -- but our lab has a full lab of people of color, which is exciting for our students to see because mostly, you know, all of the models look the same. We have a birthing mannequin, pediatric, newborn and an adult, and we can provide acute care experiences in both areas. So, not only are we blessed with one area of simulation, we have two. 

Michael: Oh, that's wonderful. You mentioned a sort of table there. I'm not sure if I'm familiar with that. You said it's newer? 

Dr. Morris: Oh, the Anatomage. See how my voice went up and I was excited about that? So, in some places they actually have what we call silent teachers -- people donate their body to science -- but that is a tedious process and a lot of laws regarding preserving bodies and those things. The Anatomage Table actually is a real person that donated their body to science, but it's all digital. So you can do what we call slice and dice: you can put your finger on the heart and it's like a digital board and you can expand that and look into the person's heart and remove the muscle layers and get down to the very arteries and veins. So, this is like having your own body, if you will, right? Most people would have silent teachers, but it's in a digital format, so that is pretty impressive as well. You can trace the blood flow through the heart and the body...things that you may not be able to see. It's like dissecting a body, but we do it digitally. 

Michael: Wow. Things have changed in medical education in your time, haven't they? 

Dr. Morris: Absolutely. 

Michael: Well, and not only the technology. I mean, when you were running through the various programs you offer and the accelerated formats and the online formats... that is a real change from just even ten, fifteen years ago. 

Dr. Morris: Absolutely. I think one of the challenges for individuals was learning to embrace that students could actually learn in an alternate format, and we've had great results. In fact, all of our students have a 100% job placement and are highly sought after. Because remember, these students already have a degree, so their level of maturity exceeds that of the traditional undergraduate. They've had careers, so they already have the soft skills, the ‘commitment to the grit,’ as I say, and so they come in and they learn what they need to do, and they're ready to start their careers. 

We have a program, as do a lot of nursing programs, where they spend their last 120 hours of the semester actually shadowing the nurse, taking care of patients. They're on a unit. That equates to about forty hours a week for three weeks where they are the nurse. They're taking care of the patients, more than one. So, when they get out, it's already kind of a jumpstart on their orientation to a unit because they're actually giving the meds and doing the procedures and calling the doc. It's amazing now how nursing has transformed and I think will continue to transform. 

Michael: That sounds almost like a mini-residency. 

Dr. Morris: I love your example of that. I may have to take that, that mini residency, but it is. It's a preceptorship. In fact, when I left UVA, my preceptorship was on a women's health unit and they hired me. I’d already had three weeks of orientation and I was accelerated. They hired me and I was out on my own probably in about two weeks - and that was back in ‘93. But it made me comfortable. It made the unit manager comfortable, she already knew what my skills were, the other faculty knew what my skills were and the unit workers, and so it really made the transition a lot safer for the patients because I was comfortable as a new grad and could really accelerate my skills. 

Michael: So, one thing I know from a previous conversation we have is you folks are pursuing an R1 research status and, you know, nursing involvement in research is something that's really, I think, often overlooked. At least you don't hear a lot about it. So, tell us about your program there and why you're going for that status. 

Dr. Morris: Absolutely. To my knowledge, there's not another HBCU in the nation that has R1 status, but it’s not just about the status. I don't know how anyone does healthcare research, any kind of physical research, without involving the nurse. We look at the patient holistically, spiritually, mentally, emotionally and so nurses are right at the core of what I feel medicine does and so it allows us to work with our colleagues in kinesiology. We have colleagues in social work. We have colleagues in psychology. Even with engineering...when you think about creating medical equipment like biomedical engineering.

One of the things that we're champions of is diabetic research and research on aging. We have a Center for Diabetes Research here at North Carolina A&T and our nursing program is heavily involved with looking at diabetes research. So, again, we're the ones that are helping to monitor the blood sugar. We're the ones that do the food and nutrition counseling. We're the ones that talk to them about diabetic foot care so it is a seamless relationship. I think the synergy is there between nursing and our other programs at North Carolina A&T.

Michael: What does R1 mean practically? Does it give you access to more funding or? 

Dr. Morris: Yes. It means that we're producing more PhD graduates, more researchers, and we've obtained more funding, and the Carnegie classification, as you said, helps us position ourselves so that we can get more grants from maybe some of these industries and these top organizations that will invest in us to help produce the type of research needed to make a difference in healthcare and other areas. We have our agricultural department here as well. 

Michael: So, as you know, one of the biggest challenges facing the health system is a shortage in workforce, nursing particularly. I'm wondering how you see that through the lens of a nurse educator and how you're preparing your students to work in an environment where there's not the kind of staff levels you'd prefer to have?

Dr. Morris: I'll start that answer by saying, is it the chicken or the egg? Which one came first?

Because in my business, we have to produce adequate numbers of nurses to enter the workforce, but in order to produce an adequate number of nurses, we have to have faculty because the ratios to student learning in North Carolina are ten to one: that means one faculty for every ten students. So, if I have a hundred and eighty students, I need eighteen faculty for clinical education.

Well, we don't have faculty because the pay for nurse educators is not adequate. The clinical world pays more money, so it's just this cycle. And if you get a nurse who's willing to come into education, you still want them to be able to be in the prime in their career. I'm careful how I word that. In the prime...like not ready to end their career. You want the clinicians who are now active and have the current knowledge and so attracting those individuals is going to take more money. So, it's a conundrum all the time. But we are doing well at North Carolina A&T. Right now, we have two faculty vacancies because the university has invested in ways to help us to retain and attract the brightest faculty and our state legislature just did a mandate for nursing faculty to get an increase. 

Michael: Oh, wow. That's good. 

Dr. Morris: Oh, that was very helpful. And so we're making strides and with that increase, I'm able to increase our admission this year. Last year, I think we admitted around sixty five. This year, our goal is ninety-five to a hundred in that upper division cohort. 

Michael: Well, that's a big jump. 

Dr. Morris: It is. It is because we hired four new faculty starting in the spring. So, when you think about that ten to one ration, that's forty to fifty more students you can bring to your program, so it's important that we have the faculty and the manpower to be able to produce.

Then the other thing that keeps us from producing more nurses are our clinical agencies because you have to have somewhere for the students to train. 

Michael: Right. 

Dr. Morris: And you overwhelm those units. You bring ten students to the floor and you've got ten nurses. I mean, it's just difficult because it also burns the nurses out to have students, you know, because that one faculty doesn't go to every student. We have to rely on the nurses on the floor to help us do the procedures. So, it's a cycle. 

Michael: You’ve got to have manpower in education if you want to have manpower out in the clinics, you know? 

Dr. Morris: Yes.

Michael: So, I know that having a diverse health care workforce -- a workforce that's equipped to provide culturally appropriate care -- is a big priority of yours. Tell us how that factors into the learning program that you're providing your students. 

Dr. Morris: Excellent. So, I think some people think because we're an HBCU that we've maximized culturally appropriate care, but it's not just about ethnicity. You know, it's about gender preferences. It's about cultural beliefs about Western medicine. For example, some people in other places would not prefer that a male healthcare provider take care of a female or we always have to talk to the husband to get the care done. So, one of the things that we emphasize here, is it's not just about ethnicity, and because we are African American healthcare providers, it doesn't mean we know everything about everybody's culture. There's dietary preferences.

We do emphasize the fact that we must consider the person holistically. We try to provide simulation experiences that are culturally appropriate. Like in a scenario, it's not just going to be this forty-five-year-old male with such-and-such condition. We try to add in things about, for instance, he's a Native American and has a shaman -- you know, a medicine man -- and they don't want him to take this medication. So, how do we handle that? Or this person prays at eight, twelve and four. You're going to have to work around that when you go to do their meds or give them a bath. So, we try to incorporate those scenarios in our training simulations at North Carolina A&T.  

Michael: I'm also curious -- because obviously as a clinician in a long career, you're going to encounter lots of different ethnicities, potentially -- what's the key to starting to bridge that gap? Are there some techniques, some basic steps you can take to start down the right path in terms of providing culturally appropriate care? 

Dr. Morris: Number one, listen. Listen and try to eliminate the bias. Do not assume you know anything. Ask. I can give you a great example, education. People assume people can read. If you don't ask a person about when they finished high school and so they take these discharge instructions into the patient and they just give them to them...well, how do you know that person can read? What is the way that we're going to figure that out? So, one of the ways you ask the question is ‘what's your preferred way to learn?’ Is it video? Is it me talking to your instructors or reading? If, for instance they say they would prefer if you demonstrate something, it might indicate to you that they can’t read. 

I tell my students, you just need to listen and don't make any assumptions. You have to ask questions. Don’t worry that you think the question seems silly or they're going to be embarrassed by the question, because you're going to miss something because you made an assumption. So, that's the way we start is you listen and ask questions and be unassuming. 

Michael: That'd be good for people to adopt in every profession, right? 

Dr. Morris: Unassuming, yes. 

Michael:  I did mention your research on end-of-life care at the beginning, and I'm just curious about what exactly you're looking into and what you can tell us about what's being done to address that problem, or what your research is suggesting should be done about it. 

Dr. Morris: Thank you. So, specifically in the African American culture, when you talked about culturally appropriate care, one of the things that my research finds and continues to find and is supported by other researchers is that spirituality plays a major role in how African Americans view end of life care. This is faith versus fact and the misconception that when they accept hospice, they're giving up or losing faith.

So, what the interventions are that I'm doing -- and I'm glad you asked because I have a presentation this afternoon -- but the research suggests that if you get their spiritual leader involved, the pastor, to sanction hospice and say it's a good thing, you're not giving up on God, you're not losing faith, then congregants were a lot more at ease and willing to accept. Then what we put the emphasis on was it's about how you live, not how you die. So, you had to change the framework to say, we want you to live the best you can until you can.

In our local hospice, they've done a lot more marketing around faith, a lot more marketing around the spiritual. In fact, my husband, who's a pastor, is on one of the boards for the local hospice. And I think that that research, because they were my mentors and working with them and partner found the value in, we need to have clergy on board, giving us ideas about how do we reach that population? 

So, spirituality is still a big deal spirituality. If you think about it, people pray and meditate versus taking medications and stuff. There's all types of research out there about prayer and meditation and so somehow we have to bring medicine and the spirituality together to see how we can use both of them to care for patients, not in isolation. 

Michael: That's really fascinating. It's making me think of an experience I had shadowing a nurse manager at an academic medical center on the overnight shift. She had to solve every problem that popped up, and there were lots of them! One of the problems was a person had died, but the family wouldn't believe it. They didn't believe the patient’s nurse, so they brought the doctor in but they didn't believe the doctor, either. This charge nurse knew that if they brought the priest in, they’ll believe the priest. So, sometimes it's just about finding that right avenue. 

I'm afraid to say we're just have a couple minutes left and we love to have our guests provide advice to our audience, which is a lot of learners in medicine and nursing and so forth and also early career professionals, about how to approach their careers at what is a really turbulent time in healthcare. 

Dr. Morris: Great question and I've been meditating on this myself -- because again, thirty years in the game -- I didn't always value the three-to-five-year plan. But I do think it's important for people to just think about in the next three years, where would I want to be? Write down a few goals and kind of watch yourself develop. I wouldn't go past five because healthcare is evolving and there are opportunities, even like nurse practitioners and advanced health PAs.

But I never thought about just the first three years and believe it or not, retrospectively looking at my career, I wanted to be a clinical instructor and within the first five years, I was. Like, I looked at my three-to-five-year goals and I've met them and probably would have done maybe even a better job to actually document and write them down. I know we always hear people say, write it down, but it is extremely important to jot down your goals for three to five years. I know after the scripture, write the vision and make it plain. So, you need to look at what is it that you want to do, write it down and work toward it. 

And the last piece of advice is to enjoy what you're doing. Nursing, healthcare, anything to do with the service industry is very difficult, but find the joy. Find that one thing that keeps you coming to work every day and try not to let those other things invade your spirit, if you will. You asked me about managing versus leading...the leading part I love, the managing part I deal with as it goes, but I come in every day because I know I can have a positive influence on the people that I work with And I know that's a good thing.

Michael: Well, that's great food for thought and also great that you provided some actual practical steps that people can take. I'm afraid we're going to have to leave it there, but I want to thank you so much, Dr. Morris, for taking the time to be with us. It's been a great pleasure to hear about your work and we wish you all the best in your new role there. 

Dr. Morris: Thank you so much. And I've enjoyed talking with you.

Michael: I'm Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.