Practice what you preach—or teach—if you are at the Johns Hopkins University School of Nursing.
Profiles by Sara Michael
Many of the faculty, and even some doctoral students, at the School maintain an active nursing practice while balancing a dual career as an educator or completing a terminal degree. How does their passion for practice inform their teaching, and vice versa? What’s the benefit of practicing and then sharing their knowledge and skills? Johns Hopkins Nursing magazine posed these questions to our in-house practitioners. Despite their diverse backgrounds and areas of specialty, some common answers were found.
A national leader in maternal and newborn health, Elizabeth “Betty” Jordan defines clinical practice a bit differently. It doesn’t always involve direct patient contact, she says, but can encompass working with organizations to address health system issues.
“Over the years, my practice has grown from inpatient care, taking care of high-risk pregnant women, and moved along a continuum to now looking at systems issues and how we can improve healthcare systems,” she says.
Jordan works with the Baltimore City Health Department as a consultant for the Fetal and Infant Mortality Team, where she examines how maternal and newborn care is delivered and helps resolve barriers to prenatal care. Why aren’t some women getting prenatal care? What education and resources are available and how are they provided? These are some of the issues Jordan addresses, bringing to bear her expertise in the field.
Jordan’s work at the Health Department gives her fodder for teaching, which has always been one of her passions. For her undergraduate students, she can help shape how they will think about healthcare delivery in the future. With the graduate students, she can demonstrate system change by teaching program evaluation and exposing them to Health Department projects, she says.
“I feel I bring examples from my practice into the classroom, and they are examples I have lived,” she says. “I can really speak to the importance of evaluation of practice and why it’s challenging, but necessary, so that evidence is guiding our care delivery.”
Balancing her role as a faculty member in the Department of Acute and Chronic Care with her duties as a pediatric nurse practitioner isn’t always easy, but it is, in a word, natural for Shawna Mudd.
“It’s really a natural blend. It’s like the circle that keeps going around,” she says. What she teaches in the classroom, she practices. And her nursing career feeds the lesson plan, as she uses her experiences to guide content discussions in her classes.
Mudd has been a pediatric nurse practitioner at The Johns Hopkins Hospital’s Pediatric Emergency Department for ten years. She focuses on improving pain management and asthma care for children. She’s also served as a clinical preceptor for many years, so teaching part-time and transitioning to full-time this past summer was a logical progression for her career.
“It’s a natural flow, especially in an institution where teaching is the culture,” she says of her two roles.
Having a hand in academia—with engaged students asking tough questions—helps keep her practice current with the latest guidelines. If the literature supports improvements or changes in patient care, she can look towards incorporating that into her practice. “It keeps me up to date with practice,” she says. And the students? “They keep me honest.”
Godfrey Katende, MSN, NP
Student, Doctor of Nursing Practice Program
Even from the start of his nursing career, Godfrey Katende set his sights on transforming the nursing practice in his home country of Uganda. Through his practice and his teaching, Katende is blazing paths in Uganda to improve access to healthcare. He is earning his doctor of nursing practice degree from the Johns Hopkins University School of Nursing and says he will stay in Uganda upon graduation. “They need me here,” he says.
With the help of his mother, an experienced surgical nurse, he started two private practices in Uganda, an experience that exposed him to the need for improved primary care to prevent communicable diseases.
He also realized his desire to influence nursing practice through training and education and joined the faculty of Makerere University in 2004. He earned his master of science in nursing degree from the University of Alabama at Birmingham in 2008, then returned to Uganda renewed in his determination to influence practice through education. “I realized that it was important for the nursing curriculum in Uganda to focus on the outcomes rather than the process,” Katende says, adding that he helped revise the curriculum at Makerere University and later in the entire country through his role on the National Council for Higher Education. “This extra role has allowed me to point out competency gaps for those institutions that have presented their curricula for accreditation.” He continues to teach at Makerere University.
At the same time, Katende’s clinical practice has evolved to emphasize evidence-based practice, with a focus on cardiovascular health and hyper-tension. That’s where his country needs him, he says, as these non-communicable diseases have a grave impact on the population. “I feel this is an area I need to explore in collaboration with my colleagues,” he explains.
His practice also helps him maintain his connection to that population. Change can be effected through education, he adds, but “for one to be relevant and responsive to his or her community problems, one must also stay in touch with the practice area where translation is relevant.”
With twenty-five years of experience as a nurse midwife, Ellen Ray identifies more strongly as a nurse, secondary to her role as an educator. She’s a clinician first, she says. “I wouldn’t want to just do education and never have my hands on a pregnant belly again. That completes me.”
But with such a wealth of knowledge, it seemed natural to share that in a classroom setting. She became a part-time clinical instructor in 2003, earned her doctor of nursing practice degree in May, and is now full-time faculty. Ray, who started the first midwife practice at Howard County General Hospital in 1986, has watched the field transform through technology and evidence-based practice changes, and she brings that experience into the classroom. It validates her as an instructor, she says.
Since adding educator to her resume, Ray has taken a more scholarly approach to her job in the Obstetrics Triage Unit at Franklin Square Hospital. It’s easy to get lost in being a clinician, she says, forgetting to read the latest journals or keeping up with healthcare policy. Living partly in the academic world opened doors for her, enabling her to become a better clinician. “I do look at my work differently than ten years ago. I look at the bigger picture. I am not just so tunnel-visioned on a patient. I look at unit protocol, the community, health policy, and how it will affect my practice.”
Still, as her teaching load becomes heavy this semester, her regular shifts at Franklin Square keep her grounded in her first passion. “It’s a little like going to where my comfort is. That’s really a very integral part of me.”
For Kathleen Becker, the way to achieve success in a career divided between academics and clinical practice is to make sure both worlds complement each other.
As an assistant professor in the Department of Community-Public Health, Becker says she tries to teach courses that help build her own scholarship and professional strengths. And her role as an adult nurse practitioner for Health Care for the Homeless in Baltimore similarly informs the lessons she delivers in the classroom, as she can bring pearls of wisdom from her job back to her students.
“I try to make it kind of linear,” says Becker, who has always supplemented her role as a nurse practitioner—first as a nurse manager, and later as faculty. “They build on each other. You can develop a level of expertise; you are researching it and writing about it and practicing it and teaching it.”
For example, Becker has published a great deal on screening and treatment for substance abuse—a major part of her practice. Teaching courses on patient education, health promotion, and disease management, for example, helps Becker keep her knowledge fresh, a major benefit in clinical practice. “It’s a great way to stay up to date and current with as much as you can.”
As Benita Walton-Moss’s research has evolved, so has her clinical practice. With a background in women’s health and substance abuse, Walton-Moss is now primarily focused on cardiovascular health and hypertension, particularly among substance abusers.
And, that’s not an easy population to dedicate your research and practice to, she says. Research tends to leave behind substance abusers, she explains, because they aren’t always reliable research subjects. “But my thought is, because they have these problems, they really need to be included, and you just have to deal with keeping them in the trials,” she says.
That can make her hectic research and practice schedule even more challenging. A family nurse practitioner since 1982, she most recently provided gynecological care for women both at the Johns Hopkins Program for Alcohol and Other Drug Dependencies and the Johns Hopkins Avon Foundation Breast Center.
Currently she is a research nurse at Howard County General Hospital (HCGH) where she addresses problems in clinical practice, using evidence-based practice. At HCGH, she is developing a pain scale for patients who can’t self-report, relying on behaviors such as facial expressions and vocalizations. By making adaptations to an existing pain scale, Walton-Moss and colleagues are hoping to find a reliable and consistent way to measure pain in those patients.
In January Walton-Moss will start a new position at the Johns Hopkins East Baltimore Community Nursing Center. Yet, her research and her clinical practice wouldn’t have quite the impact if she didn’t teach, she says. Her role as an associate professor in the Department of Community-Public Health allows her to process her research differently, and to share her extensive knowledge with others. “It means very little unless you are able to teach that to the upcoming nurses,” she says.
Walton-Moss admits she isn’t the most outgoing person, and large crowds still make her nervous. But she’s grown more comfortable in her teaching role and says it’s all worth some nerves and a hectic schedule. “It’s extremely fulfilling,” she says. “I wish I had more time to do it better, but I can’t imagine doing it any other way.”
If Julie Stanik-Hutt were a full-time nurse practitioner (NP), she might not have traveled to Australia last year. But, with one hand in nursing practice and the other in academia, Stanik-Hutt attended an international meeting there, where she connected with other nurse practitioners in Australia and New Zealand, learning about their educational system. “If I was working as a full-time NP, I couldn’t do these things, these terrific opportunities,” she says.
Stanik-Hutt, an adult acute care nurse practitioner and a critical care clinical nurse specialist, loves the flexibility of teaching, which allows her to explore research and connect with her colleagues at an institution that values professional development.
Her faculty position also complements her desire to share her expertise and make difficult, complex concepts easier to understand—a skill she uses in the classroom and in practice. “I love explaining to students what’s going on, and explaining to families what’s happening in a language that’s understandable,” she says.
Although her roots run deep as an Intensive Care Unit nurse, Stanik-Hutt admits it can be difficult caring for such a complex and sick population, and teaching gives a bit of a respite. Similarly, the comforts of her role as a nurse practitioner can offer a breather from academia.
Stanik-Hutt’s clinical practice at The Johns Hopkins Hospital has also been impacted by her time in administration as director of the master’s program. She says she must always “walk the talk,” such as making sure she connects with primary care providers when her patients are discharged. She adds, “I feel like I have to cross my Ts and dot my Is. If I expect my students to do it, I need to do it.”