When the first University of Texas at Austin nursing student enveloped herself in a decontamination suit and oxygen mask for a mock emergency involving hazardous materials, it became clear that this is not your Florence Nightingale nurse.

Students enrolled in “Disaster Nursing” perform a HAZMAT exercise that will prepare them for a real chemical or biological contamination incident.

Training to treat victims of weapons of mass destruction and taking courses in genetics and health care ethics are just some of the ways nursing has changed for those learning how to care for the sick and infirmed.

While Nightingale’s 19th century approach to nursing care revolutionized the way nurses were educated and cared for their patients, her principles were fairly simple: “You are required to be sober, honest, truthful, trustworthy, punctual, quiet, orderly, clean and neat.”

Of course, good nurses abide by this motto today. But there is much more as the profession continues to evolve. The university’s School of Nursing has led the effort nationwide in new courses, research and community involvement.

Not even Nightingale (1820-1910) herself could have anticipated the creation of a course at the university called “Disaster Nursing.”

The post-Sept. 11 look to the school’s curriculum content was created in the summer of 2002. The school was one of the first in the country to offer a course on how to tend to victims of a mass casualty event.

Students learn everything from how to decontaminate victims at an incident site to how to recognize and treat the psychological impact of a mass casualty event on victims and health care professionals. Also included are instructions on how to perform effective triage, appropriately handle human remains, transport victims and complete recovery operations, including reports and debriefings.

Entry team member Michele Mata is fitted with an oxygen mask and tank. In a real-life situation, the entry team would have the highest risk of exposure and require the most protective gear.

During the class, a mock disaster response drill is held on the patio of the nursing school. Students, wearing protective clothing, participate in a simulation of a patient extraction from a contaminated site.

“We always have taught public health nursing, emergency room nursing, etc., but now it’s a whole new ballgame,” said Dr. Marilyn Pattillo, who first taught the class.

“Nurses are everywhere—in schools, in public health, hospitals, offices, industries and businesses—and we need to know what to do,” she said. “If a mass casualty event occurs, every nurse should be available to employ emergency response skills.”

Another fairly new course—in genetics—will be required for incoming undergraduates in nursing beginning in fall 2004. As a result of the Human Genome Project and other genetic research efforts, there has been an explosion of knowledge about the role of genetics in health and illness, said Kay Taylor, one of the nursing faculty who will teach a genetics course.

“These genetic advances and their clinical applications have created a new era in health care,” Taylor said, adding that scientists are now able to understand the basic genetic defects underlying many diseases and genetic testing is available for several common disorders.

The new genetics course is designed to help students integrate basic genetic science into clinical practice, including an examination of the compelling ethical, legal and social issues raised.

The school also was the first in the country to require its students to take a Spanish course so that they can better care for a changing population.

“The nursing profession has changed beyond a staff position at a hospital,” said Sarah Peters, head of career counseling at the School of Nursing. “Nursing graduates can become clinical nurse specialists, nurse practitioners, nurse anesthetists and nurse midwives as well as scientists and researchers.”

Courtney and Amanda Holmes graduated last May from the School of Nursing and are now working in local Austin hospitals.

Fortunately for Peters and the students, the demand for nurses has only grown over the years. Every single student who graduates from the school gets a job, sometimes with a signing bonus.

Young women and men go into nursing almost as a calling. Touring the School of Nursing building across Red River Street from the Frank Erwin Center, you can hear a constant refrain: “I became a nurse because I love people.”

Take Courtney and Amanda Holmes. The identical twins from El Paso graduated last May and are now working in local Austin hospitals, following a long tradition of going into nursing. Their 93-year-old grandmother was a nurse and their cousin also is one.

“I truly feel as though nurses are Earth’s angels,” said Courtney. “When people are in the hospital, they feel helpless, vulnerable and scared. I feel as though we are a source of strength for these patients.”

“Our grandmother has always told us about her rewarding experiences as a nurse, and she was the one who inspired me to pursue nursing,” said Amanda.

Although the role of a nurse has always been important, Amanda believes there is now greater responsibility due to modern medicine and changes in technology. In addition, the population is growing older. This also puts a greater demand on nurses, she said.

“But still, I feel like I have an innate enthusiasm for caring for people and I think that’s the major reason I love nursing,” said Amanda. “I feel rewarded when I help people.”

Nathan Jones graduated in 2002 from the School of Nursing with plans to work in pediatrics in New York City.

The feeling resonates with faculty members as well. “I like dealing with people,” said Dr. Betty Skaggs, director of the school’s Learning Center, which helps nursing students apply technology to their field. “I actually feel that it is an honor to be a nurse.”

The school has 925 enrollees (224 of whom are graduate students), taught by 64 faculty members. Last spring, the school graduated 116 undergraduate and graduate students. Students may apply to the school only after completing 60 hours of prerequisites. A faculty committee reviews their applications, essays and volunteer work. Once accepted, the students complete four semesters of work for their bachelor’s degree.

“We have a group of students and faculty to admire,” said Dr. Dolores Sands, who has been dean of the school since 1989. “In the 21st century, service professions such as nursing will determine the quality of American life.”

For “non-traditional” older students, the university has the only program in Texas for degree-holders seeking a nursing degree—called the Alternate Entry Master’s Program. In 15 months, students may take the registered nurse licensure, and in three years they graduate with a master of science degree in nursing. The program, in place for 14 years, is showing the highest interest this year out of all the programs, with double its normal applicant pool.

The nursing building looks like any other on campus, except for a few missing floors and simulated hospital rooms. Floors 1 and 2 on one wing simply are not there; the three floors above sit on giant pillars like some enormous concrete beach house. Classrooms and labs abound, but make a wrong turn, and suddenly you’re in a hospital room, filled with beds, charts, and equipment, where students are poking needles into mannequins.

Beyond the lab’s importance in teaching students how to move patients and other basic procedures, it’s crucial for developing confidence.

Dr. Dolores Sands has been dean of the School of Nursing since 1989.

“Right now, they’re all thumbs, but by the time they test, they’ll be much more confident,” said lab director Kathy Hansen.

“Generally speaking, the students walk in still feeling like novices, still feeling like civilians, interlopers,” said Dr. Chuck Perkins, who retired from teaching last spring. “The role doesn’t fit really well. When they leave the class, they really start feeling like they’re actually nurses.”

Once in the clinical portion of the program, students begin doing clinical course rotations at hospitals.

While turning out dedicated nurses is an obvious and indispensable part of the school’s mission, the university is unique in that it also is a major research school.

Nursing research was in its infancy when Sands became dean. She was determined to make the school’s research program among the best in the nation.

“The dean was very forward-thinking,” said Dr. Sharon Brown, a nursing professor and associate vice president for research at the university. “It’s the kind of thing that has been going on across the country at one level or another, particularly at the major academic institutions.

“But it is a rare situation to find a dean like Dolores Sands who not only has the vision, but also the willingness to commit resources and is unwavering in that commitment.”

The efforts have paid off as the school has been ranked No. 10 in nursing school money received from the National Institutes of Health (NIH) for 2002, the highest ranking for a nursing school not linked to a health science center or medical school.

Total funding for NIH research in the School of Nursing now exceeds $19 million.

Melanie Bloom from the College of Education helps clinical nursing instructor Patsy Rider with Spanish vocabulary.

Additional awards granted already this year by the NIH indicate the amount received in 2002 will increase by about 20 percent in 2003.

School of Nursing research topics funded by NIH in 2002 include caregiving, education and group support for Hispanics with diabetes, memory in at-risk elderly, obesity, breast cancer support groups, health risks behaviors in youth, quality of life for those with chronic illnesses, end-of-life care and health disparity research. Studies funded in 2003 include topics of fibromyalgia and asthma in children.

The school also is only one of eight in the country that has two major NIH funded centers—the Center for Health Promotion and Disease Prevention Research in Underserved Populations and the newly created Southwest Partnership Center for Nursing Research on Health Disparities.

“Because the school is located on an academic campus and is not linked to a health science center or medical school, there are unique opportunities for the faculty to provide leadership in health research and to establish collaborative research teams with colleagues from other disciplines,” said Dr. Alexa Stuifbergen, associate dean for research.

Gwynne Richards meets with a patient at the Children’s Wellness Center, a school-based and university nurse-managed health center in Del Valle, Texas.

Another outgrowth of the school’s redirection toward research has been a $5 million endowment for nursing research provided by Gordon and Mary Cain in 2001.

Much of the research at the school provides services for people who otherwise wouldn’t have them, such as free health supplies and consultations. Brown predicts that her research, studying Hispanics with diabetes, has provided free services to 1,000 people in the last nine years in Starr County in the Texas Rio Grande Valley.

In addition, the school also manages two health centers for children and women as part of its mission of giving back to the community.

The school-based and university nurse-managed Children’s Wellness Center in Del Valle, Texas offers health care to thousands of children in the rural community regardless of ability to pay.

Another teaching center is the Community Women’s Wellness Center, which provides breast and cervical cancer screening for more than 500 Travis County women per year. The women have limited incomes or lack health insurance.

Dr. Susan Grobe, the center’s project director, sees the value of the program on a daily basis.

“These are women who don’t have the opportunity to get mammograms because they can’t afford them,” Grobe said. “It’s necessary that we reach these women to make sure they are able to get early screening for cancer, and that they obtain the necessary follow-up care in today’s complex maze of services for the underserved.”

The field of nursing has changed and will continue to do so, said Sands.

“Many dramatic changes in American society—increases in the number of elderly, major technological advances, the rise of newly identified viral diseases and severe repercussions from unhealthy lifestyles—will affect nursing.

“Armed with this knowledge just makes us more dedicated in our efforts in preparing nurses for the future,” she said.

Nancy Neff

Cora Bullock

Photos: Marsha Miller