On Stepping Forward and Stepping Down
Linda Norman joined Vanderbilt University School of Nursing in 1991 as its assistant dean for administration. Within a year, Norman was appointed associate dean for academics, selected by then-Dean Colleen Conway-Welch to execute the school’s academic mission. For the next two decades, Norman steered the School of Nursing’s educational direction, shaping academic programs, revising curriculum, starting and co-directing doctoral programs, and hiring and mentoring faculty. In 2013, following a national search, she was named dean. Eight years later, on June 30, 2021, she will step down as VUSN dean. Vanderbilt Nurse sat down with her to talk about nursing, education, VUSN, and her final Vanderbilt years shaped by COVID-19.
You had been at VUSN for 22 years before being named dean, so you knew the school pretty well. What surprised you when you took on the job?
I was surprised—and pleased—by the type of interface that you have with the rest of the university. At Vanderbilt, it’s the dean who is interfacing with nine other deans and the university leadership. It was interesting learning about more of the inner workings of the university as a whole. It was nice to have other dean colleagues to collaborate with personally and to determine how VUSN could work with their schools.
Within the school, it was awareness of the responsibility you have when you sit down behind that desk, and realize, “Oh, my gosh, you are responsible for the School of Nursing.” You’ve got a thousand students. You’ve got almost 200 faculty. You’ve got almost 100 staff. And you’re the one that is supposed to be responsible for knitting all that together and to promote what you’re doing not just on your university campus, but also what you’re doing at a national level.
How has VUSN changed since you joined the school in 1991? What has stayed the same?
When I first came, we admitted about 75 new students in our special two-year program for people without a nursing background and we admitted fewer than 75 new people who came with a BSN. We had no doctoral students. We now have almost a thousand students, about 750 people pursuing master’s degrees, about 150 pursuing the doctor of nursing practice and about 30 with the PhD program.
In 1991, we had one nurse practitioner program. It was the family nurse practitioner and the rest of our programs were clinical nurse specialties. In the early ’90s, as the nurse practitioner movement was taking hold, we converted all six of our clinical specialist programs to advanced practice nurse practitioner, which required revising our curriculum and clinical education. Then we increased the number of our programs to 14. Our nurse-midwifery program came in the early ’90s as well. We’ve expanded our educational programs as health care needs have changed.
All of that was driven by our commitment to health and to improving health care delivery. Underlying that was our commitment to improving nursing, whether through our research, academic programs, practice or informatics.
The core of how and why we’ve changed since the early 1990s is that we have kept that mission of improving nursing as part of improving health care delivery. When I came here, we had a slogan, “Traditionally ahead of our time.” I think we’re still that way. We keep the tradition of our discipline, but we try to be on the cutting edge of what’s going on within health care delivery and in education.
You accomplished a lot in your 30-year Vanderbilt career. What three things are you most proud of?
The construction and opening of the new School of Nursing building are probably the best. That came from many years of us being really frugal and saving money, putting it away. When it came time to be able to plan our expansion, we had the funds to do it. So, while the building was started in 2017, it was a long time coming. And it’s fabulous. It has smart classrooms, a state-of-the-art simulation lab, and cutting-edge technology. While this hasn’t had much use in the past 14 months, it’s also designed for wellness and self-care. It has lighting that reacts to human circadian rhythms, the monumental staircase to encourage walking, a rooftop outdoor area, and a spacious atrium dedicated to Dean Colleen Conway-Welch that’s meant for socializing and communicating. So that’s one.
Another is developing the block curriculum for our specialty programs in the early ’90s. Back then, if people wanted to come to VUSN, they had to move to Nashville or live within a commutable distance. Well, people who had BSNs also had jobs and families, and they couldn’t move here. We had a problem with enrollment. So we put our classes in a different format where the students only come to campus three to four times a semester for four to five days at a time, and the rest of their course of study is distance learning. The outcome is that every year, we have students who come from over 40 states. It has allowed us to be more influential on the national front.
It also changed the scope of learning. About half of our students live in Middle Tennessee. The other half come from other states. When they’re together, the non-local students get to know what’s going on—patient-wise—in Nashville. And the Nashville people get to see what’s going on all across the U.S.—what’s happening in rural Colorado, what’s happening in Alaska (and every year we really do get somebody from Alaska). They exchange information about different populations that they normally wouldn’t encounter. So it has enriched the curriculum. When our students finish, they can go anywhere because they’ve had this kind of experience. That’s also put VUSN on the map as a distance learning leader. We used technology to deliver coursework. It has exponentially improved over all this time because we began in 1996. We were a pioneer nationally. And certainly with COVID, we have been able to share a lot of the things that we’ve been doing related to a technology-enhanced education. So that’s another.
The third is what we’ve done related to scholarship. Over the last eight years, we have exponentially increased the number of tenure-track faculty and they are conducting groundbreaking research. Simultaneously, we developed a clinical scholarship program for non-tenure-track faculty so they have an opportunity to get internal funding to explore areas of scholarship. We’ve had almost 25 percent of the non-tenure-track faculty participate in it. The number of national and international presentations, as well as publications, by our faculty has been on a steep curve upward. Our faculty are impacting nursing, health care and science. Now we’re on a mission to increase the number of senior researchers that we have. I think increasing research and scholarship is a significant VUSN accomplishment.
The Vanderbilt School of Nursing stepped forward to help the university respond to the COVID-19 crisis and played an important part in the successful Return to Campus plan. How did that come about?
When the pandemic hit back in early spring 2020, Interim Chancellor Susan Wente asked me if I’d chair the university’s public health COVID-19 task force. “We were charged with advising the university and determining best practices for safety protocols. That was a challenging time, with all the schools transitioning to remote learning; students, faculty and staff working from home; and the university consulting closely with us, our colleagues at the Medical Center, and local and national public health officials. Then it morphed into advising regarding on-campus protocols and discussions on whether in-person classes were going to occur for the fall.
I am a member of a coalition of peer nursing school deans from across the country. Several of the other deans said they were helping their universities with contact tracing. I thought that was something our faculty and students might like to do.
I told one of our vice chancellors that the School of Nursing would be happy to help with contact tracing if the university would like to have help. Well, as we began to look at it, he said that they needed more than just help with contact tracing—that they really needed a group to take it on and lead it.
So I had a conversation with Pam Jones, our senior associate dean for practice and community partnerships. I didn’t want to commit VUSN to something that was beyond our capabilities. And Pam said, “I think we can do this.”
When we were setting this up, we looked at what other universities were doing. They were partnering with their health departments for the contact tracing, but the time delay between when somebody got their positive test result and when a contact tracer was able to connect with them was often five days or longer.
We set it up so our contact tracers are able to talk to students within 24 hours of when they get their positive result. We’ve been able to protect the university population and get people who are close contacts into quarantine quickly so that we can decrease the spread of COVID-19.
Pam became co-commander of the university’s Public Health Central Command Center, and set it up so we have a whole division now within our practice entity that handles contact tracing for any student who tests positive for COVID or who has been exposed. The university has teams that work on getting the students tested and facilities set up to isolate or quarantine them, and our VUSN nurse practitioners and students handle contact tracing, and check on anyone in quarantine every day. This nursing model makes our care different from typical contact tracers. We’re asking “Other than physically, how are you doing? How are you coping with being in quarantine? Are there other needs you have?” Then we can link them with other resources on campus. That has been reassuring to parents, because there’s somebody knowledgeable checking on their student every day.
On the education side, what were the challenges the School of Nursing faced?
In March when the university said to go completely online, we had to shut down all our clinical practice because most—almost all—of our clinical agencies said they couldn’t handle students. We had to figure out how to keep our prelicensure students engaged in clinical decision-making and clinical learning in a virtual environment. And I have to say, I’ve never seen so much creativity in my life! Thank heavens that we have that great simulation lab in the new building because it was utilized quite a bit.
Our faculty figured out how to flip the clinical decision-making using clinical simulation. Typically, in simulation clinical learning, the student would be in the same lab with our great computerized mannequins and the faculty would watch what they were doing. The faculty turned it around so the student had to tell the faculty via Zoom what they would have been doing had they been here. They kept developing their clinical decision-making skills, and their studies kept moving along on schedule.
We were a little worried about whether the students would have the necessary skill set when they were able to get back into the clinical environment later that semester. We found that there was no gap. The proof of the pudding was when the students took their licensure exams. Our licensure exam pass rate was as good as, or better than, what we had in the past.
The other part is that all our lecture classes had to be converted to virtual. In order to keep students physically distanced, our classroom seating was reduced—for example, our 225-seat classroom could now only seat 56. So most of our lectures are still delivered virtually. Zoom has been our best friend.
I believe some of these changes will be permanent. The faculty and students have looked at what types of things work well in that virtual environment. We also are evaluating how many times we need to have our specialty-year students come to campus. We had been doing it three to four times a semester. Faculty members are looking at whether that’s necessary.
How has the pandemic changed the overall role of nurses, and the nursing profession, for the long term?
On a global level, nurses have been recognized as the health care provider who is with patients all the time. That’s regardless of whether they’re in the ICU, a regular patient care unit, or clinics. I think the value of nursing as far as its contribution to patient care has gone up exponentially.
I believe that people have realized what nurses really do. In the past, they might have thought, “Oh, nurses don’t do a lot of decision-making.” Or that nurses only operate on what the physician says. That has been dispelled through COVID. We’ve made strides in dispelling some of the myths about nursing care.
Nursing research has also received greater attention. There’s been an increased interest in research, in what patients are experiencing with it and with long-term effects. Nurses look at how people cope with health and illness. Nurses who are in COVID units have a good viewpoint of what’s happening to the patient, be it the physical things or the results of the different types of treatments occurring. I think, truthfully, this is going to give a lot of understanding about palliative care. We’ll learn from those nurses working with patients that they knew were not going to make it. We can learn what interventions were most important, such as, what was done to help the person when their family couldn’t be with them. What are those lessons learned that helped as people were going through their end-of-life experiences?
The pandemic may also impact policy. Some states loosened oversight for nurse practitioners so they could practice independently due to COVID. We have some Vanderbilt nurse researchers who delved into what happened with nurses who had that oversight removed and how that affected their practice. Now we’re going to have more evidence as opposed to opinion about what nurse practitioners can do independently.
Additionally—and our nursing informatics friends will be happy to hear this—nursing will be looking at what data is absolutely essential to collect, whether in inpatient or outpatient settings. The information could change situations where patients have to come into the office for things like getting their blood pressure checked. Maybe they don’t need to have so many office visits with utilization of telehealth and new devices. I think nurses are going to be heavily engaged with engineers in design, and I am looking forward to that.
What would you like your legacy at Vanderbilt to be?
I think, perhaps, that I’ve been able to value and expand academic opportunities, practice opportunities, and research and scholarship—those are the things that I’ve worked on since July 1, 1991.
What happens July 1, 2021?
I’m going to do a sabbatical for a year, and the nurse part of me is going to do a deep dive into all the data that we’ve collected from our COVID experience with our student population here at Vanderbilt. I will be working with partners on that.
The fun side is that Don [Dean Norman’s husband] and I are going to be able to travel when we want to, not just according to the Vanderbilt schedule. We love to travel. We hope one of these days we’re going to be able to get back on that Viking River Cruises boat and do the Danube trip that we have put off now three different times. We’re looking forward to getting to do the travel that we like.
Accolades & Accomplishments
- Brought more than 25 years of experience as a nurse educator to VUSN when she arrived in 1991.
- Secured nearly $5 million in gifts to underwrite the construction of the School of Nursing Building.
- Led the school to improved rankings during her tenure as dean, with the Master of Science in Nursing program moving from a U.S. News & World Report ranking of No. 15 in 2013 to No. 8 today. When U.S. News began ranking Doctor of Nursing Practice programs in 2017, VUSN’s DNP program was listed at No. 10, but now ranks No. 6.
- Chosen as a Fellow of the American Academy of Nursing in 2004.
- Received the National Black Nurses Association’s Trailblazer Award in 2005.
- Spearheaded a partnership with Morehouse School of Medicine to introduce students in its Undergraduate Health Sciences Academy to health careers. The program aims to increase diversity in health care providers.
- Launched the VUSN Dean’s Diversity Lecture series to introduce students and faculty to international authorities with expertise regarding diverse populations. Among topics were care for transgender people, reaching Hispanic/Latinx communities, and recruiting LGBTQ people for research studies.
- Serves on the board of the Friends of the National Institute of Nursing Research, an organization that raises awareness and support for the NINR.
- Served as a member and chair of the Deans’ Nursing Policy Coalition, an organization of prestigious nursing school deans who interact with policymakers on the federal level.
- Responsible for more than $14 million in external funding of curriculum design and nursing education.