Beyond Cherry Ames
By John Allen
Facing a worldwide nursing shortage, uw–madison isn’t just making more nurses — it’s trying to reinvigorate the profession. Is grad school the answer?
You may not know it, but there’s a terrific shortage of nurses all over the world. ... In my home town alone, there are three jobs waiting for me: in the Hilton Hospital, the clinic, and in the new nursing home.
— Cherry Ames, Dude Ranch Nurse, 1953
Facing a worldwide nursing shortage, uw–madison isn’t just making more nurses — it’s trying to reinvigorate the profession. Is grad school the answer?
You may not know it, but there’s a terrific shortage of nurses all over the world. ... In my home town alone, there are three jobs waiting for me: in the Hilton Hospital, the clinic, and in the new nursing home.
— Cherry Ames, Dude Ranch Nurse, 1953
No one defined the term student nurse quite the way Cherry Ames did.
Created by author Helen Wells in 1943, Ames was originally conceived to encourage girls to enter nursing during the shortage that erupted along with World War II. Through Cherry Ames, Student Nurse and 1944’s Cherry Ames, Senior Nurse and Cherry Ames, Army Nurse — and then two dozen more children’s novels in the next twenty-four years — Cherry became an icon to young Americans. With her spunky attitude and ever-ready bottle of antiseptic, she brought, in Wells’s words, “the world of miracles and life” to people everywhere, from battlefields to cruise ships, from arctic islands to dude ranches. Wherever the job-hopping, mystery-solving medic went, she showed nursing as an adventure, and thus inspired a generation of girls to enter the profession.
But Melanie Krause ’06 wasn’t one of those girls.
It’s not that Krause — a freshly minted RN — isn’t aware of the adventurous side of nursing. As a student, she’s seen the insides of hospitals, clinics, and nursing homes. When she hasn’t been in class these last four years, she’s been working at an assisted-living facility for patients with dementia. She even spent two weeks on the South Pacific archipelago of Vanuatu, where “sterile procedures as we know them don’t exist,” Krause says. “I mean, they roll their own cotton balls there. The [operating room] was something like eighty-nine degrees. It really made me see how OCD we are about germs in America.”
Created by author Helen Wells in 1943, Ames was originally conceived to encourage girls to enter nursing during the shortage that erupted along with World War II. Through Cherry Ames, Student Nurse and 1944’s Cherry Ames, Senior Nurse and Cherry Ames, Army Nurse — and then two dozen more children’s novels in the next twenty-four years — Cherry became an icon to young Americans. With her spunky attitude and ever-ready bottle of antiseptic, she brought, in Wells’s words, “the world of miracles and life” to people everywhere, from battlefields to cruise ships, from arctic islands to dude ranches. Wherever the job-hopping, mystery-solving medic went, she showed nursing as an adventure, and thus inspired a generation of girls to enter the profession.
But Melanie Krause ’06 wasn’t one of those girls.
It’s not that Krause — a freshly minted RN — isn’t aware of the adventurous side of nursing. As a student, she’s seen the insides of hospitals, clinics, and nursing homes. When she hasn’t been in class these last four years, she’s been working at an assisted-living facility for patients with dementia. She even spent two weeks on the South Pacific archipelago of Vanuatu, where “sterile procedures as we know them don’t exist,” Krause says. “I mean, they roll their own cotton balls there. The [operating room] was something like eighty-nine degrees. It really made me see how OCD we are about germs in America.”
That’s the kind of resume that would have impressed Cherry (who was also an Island Nurse, in 1960 — right after her stint At Hilton Hospital and before her job as Rural Nurse). But it’s not enough for Krause. Though there’s a terrific shortage of nurses all over the world, she doesn’t intend to address it by becoming another Cherry. Rather, with the encouragement of UW-Madison’s School of Nursing, she’s putting only one foot in practice while keeping the other in the classroom. Unlike the other 129 members of her class, she’s headed straight into graduate school.
“Sure,” she says, “I could get a job anywhere I want and make sixty or seventy thousand dollars. But I feel I owe a debt to my profession. There’s a shortage of nurses, but there’s an even more severe shortage of nursing faculty.” To help fill that shortage, she began pursuing her master’s degree while still an undergrad and hopes to finish her doctorate by 2010.
Krause is part of the school’s early-entry PhD program, a unique plan that balances an undergrad’s emphasis on the clinic with time in the research lab. Begun in 2003, it’s one of the school’s efforts to ease the nursing crunch by creating more university-level nurse faculty. Where Cherry Ames inspired a generation of girls to take on the adventure of nursing, the UW hopes to create a cadre of faculty and researchers that will inspire a generation of nurses to reinvigorate their profession.
“Sure,” she says, “I could get a job anywhere I want and make sixty or seventy thousand dollars. But I feel I owe a debt to my profession. There’s a shortage of nurses, but there’s an even more severe shortage of nursing faculty.” To help fill that shortage, she began pursuing her master’s degree while still an undergrad and hopes to finish her doctorate by 2010.
Krause is part of the school’s early-entry PhD program, a unique plan that balances an undergrad’s emphasis on the clinic with time in the research lab. Begun in 2003, it’s one of the school’s efforts to ease the nursing crunch by creating more university-level nurse faculty. Where Cherry Ames inspired a generation of girls to take on the adventure of nursing, the UW hopes to create a cadre of faculty and researchers that will inspire a generation of nurses to reinvigorate their profession.
THREAD THROUGH THE labyrinth of hallways on the second floor of the Clinical Sciences Center, and you might eventually find the offices that house the School of Nursing. There Katharyn May, the school’s dean, is well aware that there’s a terrific shortage of nurses all over the world. It worries her
“There’s a growing perception that nursing is a non-desirable field,” she says. There’s a widespread perception that nurses’ salaries are low and that their working conditions are difficult — perceptions that are compounded by popular media. Looking at the portrayal of nurses from ads and album covers to popular television shows such as Grey’s Anatomy, May sees nurses shown in extreme stereotypes, if they’re shown at all. “Nurses are either invisible, unthinking paper-pushers, or they’re highly sexual: randy women in white, short-skirted uniforms.”
At the same time, popular culture has taken to using the title nurse fairly liberally. Although there are several different varieties of nurses (with qualifications for each varying from state to state), graduates from the School of Nursing train to become registered nurses (RNs) — the most common class of nurse and the backbone of patient care in American hospitals. RN qualifications are clearly defined. In Wisconsin, registered nurses must hold either a bachelor’s or associate’s degree and pass the National Council Licensure Examination to receive their credentials from the state’s Board of Nursing. However, in common usage, the title nurse is often misapplied to other staff — such as medical assistants, phlebotomists, or nurse’s aides — who don’t have the same education or training.
“There’s a growing perception that nursing is a non-desirable field,” she says. There’s a widespread perception that nurses’ salaries are low and that their working conditions are difficult — perceptions that are compounded by popular media. Looking at the portrayal of nurses from ads and album covers to popular television shows such as Grey’s Anatomy, May sees nurses shown in extreme stereotypes, if they’re shown at all. “Nurses are either invisible, unthinking paper-pushers, or they’re highly sexual: randy women in white, short-skirted uniforms.”
At the same time, popular culture has taken to using the title nurse fairly liberally. Although there are several different varieties of nurses (with qualifications for each varying from state to state), graduates from the School of Nursing train to become registered nurses (RNs) — the most common class of nurse and the backbone of patient care in American hospitals. RN qualifications are clearly defined. In Wisconsin, registered nurses must hold either a bachelor’s or associate’s degree and pass the National Council Licensure Examination to receive their credentials from the state’s Board of Nursing. However, in common usage, the title nurse is often misapplied to other staff — such as medical assistants, phlebotomists, or nurse’s aides — who don’t have the same education or training.
These perceptions, May believes, have damaged nursing’s status, and are fueling the current nursing shortage. With a weakened reputation, the field has had a more difficult time attracting new initiates over the last ten years, especially when those in its traditional base — middle-class women — have many more professional opportunities than they did in past generations. Currently, there are some 2.3 million RNs around the country, but that number is dropping. During the last decade, the number of new registered nurses — those taking their licensing exams for the first time — fell by nearly 10 percent nationwide. At the same time, some 16.1 percent of all RN positions were vacant at the end of 2004, according to a survey by the Bernard Hodes Group, a recruiting organization.
But these statistics aren’t what truly worries May. Nurses, she notes, always seem to be in short supply. “Throughout the twentieth century, there were episodic and cyclical shortages,” she says. The numbers that really scare her are ages.
This year, the first members of America’s enormous Baby Boom generation will turn sixty, heralding the onset of a vast rise in demand for healthcare services. Meanwhile, the average age of America’s RN population is forty-eight, with just 8.1 percent of working RNs under the age of thirty. Fully half of the nurses employed today will be eligible for retirement within five years. The situation is even more dire for faculty — the average age of a nurse completing a PhD, according to May, is fifty-two.
“We’re facing a perfect storm,” she says. “In the past, nursing shortages were solved by supply and demand — as demand went up, wages rose, and more people entered the profession. But now demand is rising, and so is attrition.”
But these statistics aren’t what truly worries May. Nurses, she notes, always seem to be in short supply. “Throughout the twentieth century, there were episodic and cyclical shortages,” she says. The numbers that really scare her are ages.
This year, the first members of America’s enormous Baby Boom generation will turn sixty, heralding the onset of a vast rise in demand for healthcare services. Meanwhile, the average age of America’s RN population is forty-eight, with just 8.1 percent of working RNs under the age of thirty. Fully half of the nurses employed today will be eligible for retirement within five years. The situation is even more dire for faculty — the average age of a nurse completing a PhD, according to May, is fifty-two.
“We’re facing a perfect storm,” she says. “In the past, nursing shortages were solved by supply and demand — as demand went up, wages rose, and more people entered the profession. But now demand is rising, and so is attrition.”
This means that even though salaries are rising as hospitals scramble to fill more nursing positions, schools can’t graduate enough RNs to meet the need. The UW School of Nursing, for instance, continues to turn away more qualified applicants than it can accept, despite the fact that it expanded its admission to take in 130 students a year, up from 100 in 2000. In 2002, it began taking on an additional twelve to fourteen students each year at the school’s Western Campus —at Gundersen Lutheran Medical Center in La Crosse, Wisconsin. But May knows that more students would strain her school’s teaching resources. The relatively short career span of most nursing PhDs, and the high level of interactivity required in the nursing program — the school aims to have one full-time-equivalent instructor for every sixteen students — means that it will be difficult to produce the number of nurses who will soon be needed.
May isn’t the only one who’s worried. The Wisconsin state legislature recognizes the shortage of nurses and faculty, too. Last year, thirteen members of the assembly and two state senators cosponsored what must have seemed a commonsense effort to help alleviate the faculty deficit. Their plan, Assembly Bill 869, sought to make it easier for schools to hire nursing instructors by setting a cap on the amount of education that the state’s Board of Nursing can demand.
“The board,” the bill stated, “may not require that more than 75 percent of the faculty at [a nursing] school hold master’s or doctoral degrees in nursing.” Call it the Cherry Ames solution — by encouraging more nursing schools to hire bachelor-level instructors, it would favor experience over theory, practice over research. But the bill didn’t pass. Though it found support among some hospital administrators, it struck nursing advocates as a threat to the work they’ve done to elevate the standing of their field.
May isn’t the only one who’s worried. The Wisconsin state legislature recognizes the shortage of nurses and faculty, too. Last year, thirteen members of the assembly and two state senators cosponsored what must have seemed a commonsense effort to help alleviate the faculty deficit. Their plan, Assembly Bill 869, sought to make it easier for schools to hire nursing instructors by setting a cap on the amount of education that the state’s Board of Nursing can demand.
“The board,” the bill stated, “may not require that more than 75 percent of the faculty at [a nursing] school hold master’s or doctoral degrees in nursing.” Call it the Cherry Ames solution — by encouraging more nursing schools to hire bachelor-level instructors, it would favor experience over theory, practice over research. But the bill didn’t pass. Though it found support among some hospital administrators, it struck nursing advocates as a threat to the work they’ve done to elevate the standing of their field.
People think that nursing is just a practice profession,” says Krause. “And I don’t want to take away the importance that experience has. But if you look at the past and what nursing science has done, you find that research has an everyday impact.” She can rattle off a number of ways in which empirical studies have improved patient care, from the cleaning of tracheotomies to the healing of pressure ulcers — commonly known as bedsores. In each case, nursing research disproved traditional methods of treatment. “Logic, experience, and common sense aren’t always the best guides,” she says.
This is a position that the School of Nursing has cultivated throughout its history — promoting the advancement of nursing as a science, even in times of shortage. In 1940, for instance, when Helen Wells was first thinking up Cherry Ames stories, the UW responded to the looming World War II nursing deficit by lengthening the time it took to become a nurse — in that year, it eliminated its longstanding three-year diploma program, forcing all nursing students into the bachelor’s degree curriculum, then a five-year commitment.
“This school is about more than producing nurses,” says May. “Our particular responsibility, as a research-intensive school, is to create leaders — to educate the nurses who will educate other nurses and adapt the discipline for the future.”
That’s why the School of Nursing is banking on students like Melanie Krause. Although it’s begun a variety of initiatives to increase the number of nurse educators and so address the nursing and nursing faculty crunch, the early-entry PhD program is different. By catching potential researchers while they’re still students, it seeks to elevate the importance of science and research within the profession.
This is a position that the School of Nursing has cultivated throughout its history — promoting the advancement of nursing as a science, even in times of shortage. In 1940, for instance, when Helen Wells was first thinking up Cherry Ames stories, the UW responded to the looming World War II nursing deficit by lengthening the time it took to become a nurse — in that year, it eliminated its longstanding three-year diploma program, forcing all nursing students into the bachelor’s degree curriculum, then a five-year commitment.
“This school is about more than producing nurses,” says May. “Our particular responsibility, as a research-intensive school, is to create leaders — to educate the nurses who will educate other nurses and adapt the discipline for the future.”
That’s why the School of Nursing is banking on students like Melanie Krause. Although it’s begun a variety of initiatives to increase the number of nurse educators and so address the nursing and nursing faculty crunch, the early-entry PhD program is different. By catching potential researchers while they’re still students, it seeks to elevate the importance of science and research within the profession.
Assistant professor Barbara St. Pierre Schneider tries to be very exact when she talks about the early-entry PhD program. “It’s accelerated,” she says, “but only in the sense that nurses will go through the program faster than they would on the traditional route. That doesn’t mean it’s a fast track. It’s intended to provide the same focus and depth that any other PhD program would.”
By that, she means any doctoral program — not just one in nursing. Since nursing has traditionally been based more in clinical work than in research, post-graduate education hasn’t been seen as an immediate need. Most nurses leave academia for periods of practice before returning to graduate school, which is why nursing PhDs are so much older than their peers in other fields.
“When I was an undergrad, I was very much interested in research. But there was no mechanism like this in place then,” says Schneider, who was the prime mover in getting the school to offer the early-entry PhD option. With its clinical emphasis, the culture of the nursing profession tends to push nurses to get field experience before returning for further education or research. “Getting a doctorate took ten to fifteen years, at least. You’d have to practice for years before getting your master’s, and then again before even thinking about a PhD. It all takes a very long time.” Through the early-entry program, however, nurses have a more standard academic track, one that will let them explore post-graduate study at the beginning of their careers and give them an opportunity to build a large body of university work.
By that, she means any doctoral program — not just one in nursing. Since nursing has traditionally been based more in clinical work than in research, post-graduate education hasn’t been seen as an immediate need. Most nurses leave academia for periods of practice before returning to graduate school, which is why nursing PhDs are so much older than their peers in other fields.
“When I was an undergrad, I was very much interested in research. But there was no mechanism like this in place then,” says Schneider, who was the prime mover in getting the school to offer the early-entry PhD option. With its clinical emphasis, the culture of the nursing profession tends to push nurses to get field experience before returning for further education or research. “Getting a doctorate took ten to fifteen years, at least. You’d have to practice for years before getting your master’s, and then again before even thinking about a PhD. It all takes a very long time.” Through the early-entry program, however, nurses have a more standard academic track, one that will let them explore post-graduate study at the beginning of their careers and give them an opportunity to build a large body of university work.
In recruiting its early-entry students, the School of Nursing looks for more than a healthy GPA and an interest in research. It looks, in particular, for students who are able to connect nursing with other fields — every early-entry student must pursue a secondary academic discipline in addition to nursing — and to connect one-on-one with a faculty member. “The basis of the program is mentorship,” says Schneider. “We want each early-entry student to form a close relationship with a professor.”
It’s demanding, which is why, when Melanie Krause first heard of the program, she wasn’t sure that it was what she wanted at all. “Initially I wasn’t sold on the program,” she says. “When you’re nineteen, an additional four years of school seems like a long time, and you want to graduate and get out in the world. But the more I thought about practice, the more I began to wonder whether it would be enough for me — whether being a staff nurse would provide the kinds of opportunities and challenges that I want.”
Krause talked about her uncertainty with her adviser, Sharon Nellis, and about her experiences in her job at the Fitchburg assisted-living facility, where she loved working with the elderly. Nellis told her about Barbara Bowers, a professor whose research focuses on care systems for older adults. Bowers was looking for undergraduates who were interested in her area — a rarity among today’s students.
“You’d think there would be a lot of interest [in elder care],” Bowers says, noting that, as America ages, such services are becoming more vital and complex. “But students who want to do this are few and far between. Pediatrics and obstetrics get the most students, and there’s a lot of interest in oncology, which [with its high profile] is glamorous. There’s also a fair amount of interest in hospice care. But older adults are a huge area of need, and one of the least popular areas to go into.”
It’s demanding, which is why, when Melanie Krause first heard of the program, she wasn’t sure that it was what she wanted at all. “Initially I wasn’t sold on the program,” she says. “When you’re nineteen, an additional four years of school seems like a long time, and you want to graduate and get out in the world. But the more I thought about practice, the more I began to wonder whether it would be enough for me — whether being a staff nurse would provide the kinds of opportunities and challenges that I want.”
Krause talked about her uncertainty with her adviser, Sharon Nellis, and about her experiences in her job at the Fitchburg assisted-living facility, where she loved working with the elderly. Nellis told her about Barbara Bowers, a professor whose research focuses on care systems for older adults. Bowers was looking for undergraduates who were interested in her area — a rarity among today’s students.
“You’d think there would be a lot of interest [in elder care],” Bowers says, noting that, as America ages, such services are becoming more vital and complex. “But students who want to do this are few and far between. Pediatrics and obstetrics get the most students, and there’s a lot of interest in oncology, which [with its high profile] is glamorous. There’s also a fair amount of interest in hospice care. But older adults are a huge area of need, and one of the least popular areas to go into.”
As Krause began working with Bowers, she discovered that graduate school wasn’t an obstacle — it was the opportunity she’d been looking for. “I kind of fell into it by accident,” she says. Supplementing her nursing studies with an emphasis in industrial engineering, she intends to study ways to improve nursing systems and policies. “I really want my career to mesh nursing practice with my ideals,” she says. “And I think I can do that by finding ways to define quality nursing.”
Bowers has been able to introduce Krause to the world of nursing research — not just to methodology, but also to the network of researchers. “I try to look for opportunities to enhance Melanie’s education and networking,” Bowers says. “It’s important for her to be introduced to a variety of different researchers around the country and the world.”
In return, Krause gives Bowers an assistant whose enthusiasm invigorates their endeavors. “Melanie’s very high energy,” Bowers says. “She’s extremely bright and very excited about her work.”
This close relationship may make a rich experience for participants, but it also means that the program can only accommodate small numbers. In its first three years, just seven students joined, and Krause is the only person in her class to take advantage of the early-entry opportunity.
“We had four students join last year,” Schneider says. “To me, that’s a lot. We have a relatively small department, and we want the program to be very meaningful for students. That means they take up a lot of faculty time.”
Still, Bowers contends that the time investment is necessary to nursing, both as an academic discipline and as a profession. “With the huge shortage,” she says, “it’s absolutely vital to our profession to get younger people on the grad-school track.”
Bowers has been able to introduce Krause to the world of nursing research — not just to methodology, but also to the network of researchers. “I try to look for opportunities to enhance Melanie’s education and networking,” Bowers says. “It’s important for her to be introduced to a variety of different researchers around the country and the world.”
In return, Krause gives Bowers an assistant whose enthusiasm invigorates their endeavors. “Melanie’s very high energy,” Bowers says. “She’s extremely bright and very excited about her work.”
This close relationship may make a rich experience for participants, but it also means that the program can only accommodate small numbers. In its first three years, just seven students joined, and Krause is the only person in her class to take advantage of the early-entry opportunity.
“We had four students join last year,” Schneider says. “To me, that’s a lot. We have a relatively small department, and we want the program to be very meaningful for students. That means they take up a lot of faculty time.”
Still, Bowers contends that the time investment is necessary to nursing, both as an academic discipline and as a profession. “With the huge shortage,” she says, “it’s absolutely vital to our profession to get younger people on the grad-school track.”
Throughout the spring of 2006, the members of the School of Nursing’s senior class found a new perspective on the shortage that grips their profession: opportunity. The world was eager for their services — hospitals, clinics, nursing homes, and more. Career opportunities were the conversational topic of choice.
“It was almost an obsession,” says Krause. “It’s all people could talk about, the jobs they were interviewing for.” But since she’s chosen to forgo those opportunities in favor of the long, slow work of graduate school, she wasn’t part of that excitement. “I’m okay with that,” she says. “I’m taking a different path. It may not be as lucrative or reliable as going into practice, but what I’m doing is important.”
“It was almost an obsession,” says Krause. “It’s all people could talk about, the jobs they were interviewing for.” But since she’s chosen to forgo those opportunities in favor of the long, slow work of graduate school, she wasn’t part of that excitement. “I’m okay with that,” she says. “I’m taking a different path. It may not be as lucrative or reliable as going into practice, but what I’m doing is important.”
John Allen is associate editor of On Wisconsin Magazine.
Find out more about the School of Nursing.
What does it take to be part of the early-entry PhD program?
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