Dr. Marione Broome is the Dean and Vice Chancellor for Nursing Affiard at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health Systems. She has also served as dean of Indiana University School of Nursing in the Past. She is widely regarded for her work done as a pediatric nurse, having worked a lost with how children deal with pain. She has published over 100 papers and over 5 books. She is also editor-in-chief of Nursing Outlook. We are excited to feature her today in our Leaders in Nursing Education Series!
How did you decide on a career in nursing?
I am one of those people who wanted to be a nurse from when I was seven. There was a book series called Sue Barton, RN. I read the entire 7 book series and I knew I wanted to care for others, despite my family encouraging me to go med school, as well asmy high school career counsellor. This was during the years when most women chose to be a nurse, secretary, or teacher. Women were just beginning to move into medicine. But I was just very interested in the ‘care’ aspect of nursing. This was also the era when many nurses still chose to be trained in hospital schools of nursing- I chose to take the BSN route, which for me was the most appropriate and applied and was accepted into the Medical College of Georgia program.
How did you get involved in pediatric nursing?
I was in the Army Nurse Corps after graduation to ‘pay back’ a 3 year service obligation. They paid for my final two years of college. At the time I thought I wanted to be a psychiatric mental health nurse. When I reported in to begin my time on active duty, the chief nurse said no to that request. She told me I was assigned to the pediatric ward where they had a real need for nurses at the time. She gave me an opportunity 3 months later to change, but I didn’t want to do that- by that time I found I was really good at working with ill children and their parents. That one assignment changed my career path. In addition, I learned a great deal about leadership during my 3 years of service in the Army that shaped my career.
When I completed my 3 years in the Army, I was selected as the Chief Nurse for a federally funded Child and Youth Project at the Medical College of Georgia in Augusta, GA. During my first year in that practice leadership role I was also asked to take on supervising a clinical group of students in the School of Nursing. They were expanding their program and I took a group to the pediatric ward. I did that and I fell in love with clinical education. I thought to myself “I would much rather be doing this than supervising highly competent interdisciplinary teams delivering care to children and families”. I thought “I want to shape the next generation of nurses”. That sounds idealistic, I know. So I applied for a full-time faculty position, and then worked part time in the pediatric intensive care unit, which was just starting up there in mid-late 70s. I loved that cross settings work and from that experience and from my experiences caring for children while in the Army, I grew interested in pain in children. Back in the late 70s, pain was not mentioned in nursing or medical textbooks. People didn’t believe children experienced pain, or if they did they didn’t remember it and they didn’t think that there were any long lasting effects of untreated pain. So I decided, after being encouraged by my professors in child development at the University of Georgia, to study that pain experience and what effective interventions might reduce the child’s distress when in pain.
Can you share a bit on your background and the journey you took before becoming a dean of a nursing school?
I completed my PhD at UGA by the time I was 33. Research just suited my personality. I loved questioning the status quo. I love solving problems, even to this day, and it was a great role to be able to focus on research as an academic faculty member. A lot of this was timing in my life. At the same time, there were several other individuals in nursing, medicine and psychology in the early 80s who started seeing that children did suffer in pain and started writing about it and researching it. I was just there throughout the 80s and 90s at the right time to be funded by the NIH and studying pain management interventions, in my case using parents as coaches and ditraction during painful procedures. It was a wonderful 20 years as a funded researcher. Over time being a researcher and leader in research on national level gave me opportunity to develop many of the skills I need as a dean, gave me some national presence as well, and the opportunities to work with individuals in interdisciplinary groups to see other perspectives and get my courage up to say things that I wasn’t always quite comfortable in saying. For instance, there were times I was on a grant review committee or award selection committee where I was the only woman and/or only nurse. It’s not the most comfortable position, but you learn to survive and speak up. That skill has served me really well as a dean at Indiana University for 10 years and will now here at Duke.
Because of my experiences as a researcher, I was hired as an associate dean at University of Wisconsin-Milwaukee where I conducted research for 5 years at the Wisconsin Children’s Hospital as a research chair-the first position of its kind in a Children’s Hospital (now there are several across the US). That was when I also began to conduct research about ethical issues related to doing research with children. After that we moved and I was associate dean for research at University of Alabama – Birmingham where I learned I had skill as a leader and not just a researcher who lead teams-that I can mobilize people around a vision and move things forward. I went there in 1999. The research programs at the UAB School of Nursing grew and it was like Camelot because the place had many great researchers in nursing and other health fields. It was just wonderful- with 10-12 nurse researchers were studying important problems and who had many linkages across campus and across groups. It was an exciting time to encourage people to take their ideas and get them funded. It was really awesome. What I learned that I can bring people together and make a common vision. I also learned that unless you can control the resources you can only take things so far. I wasn’t the dean and the dean and I had different perspectives on the direction of the school related to research. I had no intention of being a dean even though I loved being an associate dean of research. I liked to work with faculty like me who had a goal-to create knowledge that could be used to improve the health and well-being of patients. I liked working with researchers because they had a plan, set goals and when the plan wasn’t funded and things went differently than expected they knew how to change. It was a comfortable role for me.
I didn’t know much about curriculum or pure academic (ie. teaching) roles in nursing. And I never had being a dean on my goals list. But, Indiana University was very aggressive trying to recruit me and it was around the time that I realized that unless I control over resources I could only take the research mission to a certain level. I interviewed in late Fall , 2002 and the rest of history. My daughter was a junior in High School and it would have been very difficult to move her- and I didn’t want to miss being involved in her senior year. But Indiana University said they would wait a year for me to join the school! So of course I agreed to be the next Dean of Nursing. Indiana University was a wonderful environment for me, with the many (8) health deans working closely together. During the time I also worked with Dr. Linda Everett, Vice-President for Patient Care Services at Indiana to University Health system build an academic-practice partnership that had some wonderful outcomes for nurses in both settings. In fact, Fall, 2013 the partnership was selected by Sigma Theta Tau International for an award. IUSON was a large school and great place to be a dean of. I learned a lot of lessons as a leader there. All faculty do not have the same goals and values, and I had to learn how to work and lead people with different goals and perspectives on nursing education, research and practice to achieve excellence whatever their primary focus is in their academic role.
What does your current day-to-day look like and what are the most rewarding and challenging aspects about being a dean of a nursing school?
I have only been at Duke for 3 months, so it is different in some ways compared to Indiana and similar in others. At IUSON, after 10 years, I had hired many of the faculty and staff and knew them and their strengths very well. I have to get to know the faculty and staff here quickly. So my current day-to-day at DUSON has been spent in one-on-one meetings with the 90 faculty. I should have those meetings completed in December. I will then start to meet with small groups of staff members to get to know them better. I also have meetings with leaders in the health system, university and School of Medicine as well. I should finish those up by February. I think all of those relationships are so important. My experiences have taught me that relationships are bedrock of any progress in an organization. If people don’t know who you are or how and what you think, they make things up, or they don’t think of you at all. Individual faculty want to know if you are willing to link them with others who can support their aspirations, or whether or not you will mobilize school assets to be in alignment with the larger systems- both the university and the health system, which benefits the school and faculty and staff in so many ways. So my schedule is very busy and very varied. In some ways the thing I love about the role is that every hour is different. There is no room for being bored. For instance, I just finished meeting with a post-doc who is doing some great work and submitted for an NIH award,. If it gets funded that would be great for him and for us. This morning I also had a meeting with the Chief Medical Officer of the health system and this afternoon, I have to present to a campus committee about our diversity initiatives in the school. Yesterday I met with the Chancellor’s board of visitors at Duke Medicine and met with 3 different faculty to hear about their individual career aspirations and their aspirations for the school. Every hour in this job is different and personally I love that. I can think and move quickly in this job. I like to be prepared for meetings with others so I can be most constructive and helpful. I like the diversity of things that come across the dean’s desk-that diversity helps me to stay fresh, to grow and to pull on all of my experiences in my career to address issues and problem solve when the issues come up.
The most challenging leadership opportunity in my position is the people. But, it is also the most rewarding because the diversity of the talent of nursing faculty is truly amazing. Here many people are committed to the clinical enterprise, and they like teaching and doing research. Others are focused on developing knowledge and the next generation of nurse researchers and faculty. Others enjoy teaching and being a master educator. People have various interests and expertise and you have to value and balance all of that and work towards a shared vision for the common good. I think the diversity of talent is pretty cool and a distinct advantage given all the change we are facing as a profession. With the dynamic forces of change occurring in health professions as well as higher education leading high performers can be a challenge. I am in meetings all the time as a dean where you are exposed to information and know what changes are coming. I am constantly wondering ‘How do I connect the faculty and staff to those changes? How do I interpret the change in a way that will mobilize the faculty and staff and not paralyze the organization? What strategies work best to get them engaged in leveraging their strengths?”
Angela McBride is a great mentor and a top leader in our field. She was someone I followed as dean at IU. Early on in my deanship there she said something that stuck with me. “Marion you have had a great career but it is not about you anymore. Now it is about the school.” I took that to heart. To do that it means that my real job is to think about how to celebrate the diversity in the school and keep everyone moving forward. To connect with people one-on-one as much as possible so I can keep them engaged with exciting initiatives. Everyone should focus on their own passion and strengthening their expertise with an eye on the goals of the organization. Faculty and staff should ask themselves regularly “What is the school’s strategic vision and mission?” After that “What is mine?” If the two are not aligned there will be an issue of how the individual will fit in. If I can engage the faculty and staff in creating the vision and mission and goals we can move the school forward …. Progress then will take care of itself, but you have to be close to people in the organization faculty and staff. If you don’t, you move out too far ahead of them so there exists too much of a gap to move things forward. So relationships and constant communication is key.
My personal rewards as a leader are many. One primary one is in my role as editor of a premier nursing journal, Nursing Outlook: The Official Journal of the American Academy of Nursing. In that role, even though I give considerable thought and preparation to writing my editorials I can say what I want to…what I believe is important for others in the field to think and dialogue about. This is the personal intellectual side of me that I can do separate from being a dean, and I need that.
What are two or three changes would you like to see in the way Nurses are educated?
I would actually say it depends on the school, but I think the top 30 schools, most of which are connected to academic medical centers, have a different mission than the others. Overall I would like to see more connections and linkages with healthcare systems in schools of nursing-both acute care and community based systems. At a lot of places, things are very separate and the faculty are guests within the system-not leaders. It is sometimes less separate in academic health centers because faculty engage in interdisciplinary research or work part-time as nurse practitioners in health systems. In these cases-if the faculty are actually connected to the practice setting, they can’t help but see and live the changes going on and are in a better position to translate what is going on in practice for students. Those kind of linkages would benefit every one of the 700+ schools.
I think we need to always try new ways of educating the next generation in all degree programs. We often use the same models we have been using since the 1970s, with classroom and clinical repeated on a weekly basis. Although there are some innovative approaches being used (e-portfolios, flipped classrooms, simulation) in many cases only tweaks have been made to how we educate. Some programs are front loading content and immersing students in clinical areas afterwards, or using simulation on a large scale basis to prepare students prior to being immersed in clinical, but those are rare. I also think it is important for deans to share their budgets, income and expenses for each program, with faculty. There are sacred cows around the education so people are not willing to let go of things. Some of those sacred cows (ie. specific hours of clinical practica required) are very expensive and not based on evidence, yet we continue to allow accrediting bodies dictate what and how we do things in graduate education. Given the competition for clinical preceptors across health professions this kind of situation can lead to lower numbers of graduates as clinical placements sites continue to shrink and one to one precepting is mandated for clinical education. I would also like us to think about broadening our PhD education model. Instead of focusing on just research methods, statistics and data analysis, , we should focus a bit more on broadening the curricula to include leadership, teaching and policy. Those competencies are expected of new faculty yet we often ignore professional skills sets anyone with a PhD needs in addition to research methods expertise.
Are there any final thoughts you would like to add?
I think leaders are not born, they are made. But I think you have to be intentional in helping the next generation to leverage their strengths as leaders. I think we are doing a better job identifying leaders and exposing them to leadership experiences as part of specific programs. We are also better at putting them in touch with one another and building cohorts of emerging leaders who will support each other as they mature. But we waited a long time before we pushed these initiatives and need to expand our investment in these areas.