An Update on Initiatives at Duke University School of Nursing

Vincent Guilamo-Ramos reflects on opportunities and initiatives for DUSON since his appointment as dean of Duke School of Nursing and vice chancellor for nursing affairs, Duke University, July 1, 2021.

March 16, 2022

It is a dynamic and important time of change in the nursing profession and in the field of health care. Like the Duke University School of Nursing (DUSON), along with our own lives and society at large, the nursing profession is undergoing significant transformation.

The current health care context and delivery systems, including nursing practice, are being shaped by large-scale public health and societal determinants of health, such as widening socioeconomic inequality, climate changes, political divisions, community violence, migration, structural racism, and technology, to name a few. On March 11, 2022, we marked the two-year anniversary of the World Health Organization’s declaration of the global COVID-19 pandemic, a period resulting in significant transformation throughout all aspects of health care. As our health care systems encounter and respond to these transformative changes, more nurses in leadership roles will be required.

Nurse leadership in the coming decade will require nurses trained in policymaking at state, federal, and global levels, and with expertise in programs that address four key strategic areas:

  1. Addressing the social determinants of health with novel, multi-level health interventions designed to mitigate the precise mechanisms by which social determinants of health influence real people, families, and communities;
  2. Designing, evaluating, and disseminating nurse-led models of health care aimed at reimagining health care delivery with greater attention to prevention, overall wellness, disease management, use of technology in health care delivery, and locational preferences of individuals and groups;
  3. Developing, growing, and supporting a diverse and inclusive nursing workforce to ensure the United States and the world at large has well-trained public health and health care delivery professionals to prevent and respond to global pandemics and the ongoing health challenges facing our planet; and
  4. Effectively communicating the value of the health care services nurses deliver, the impact of those services on health outcomes, and the opportunities for rethinking current health care payment models to allow for greater alignment with nurse-delivered services.

These are the opportunities ahead for the DUSON community to prepare future generations of nurse leaders empowered to make tangible impacts throughout our transformed systems of health care. See the sections below to learn more about areas the school is addressing to envision DUSON's future and to amplify our impact.

Now is the time for nursing!

Vincent Guilamo-Ramos signature

Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN
Dean, Duke University School of Nursing
Vice Chancellor, Nursing Affairs, Duke University

In October, the State of the School address sought to highlight a number of DUSON’s recent accomplishments, provide an overview of the current state of health care systems, share a vision for the school’s future, and consider the potential impact of future initiatives, investments, and opportunities. The address provides meaningful context and substantial details on these subjects, and I encourage you to read about this address and view the presentation in its entirety on our website.

As I have transitioned into the role as dean, I am grateful to all those who have participated and shared in listening sessions and town halls around the current state of our school and our planning for the future. I have learned a great deal about DUSON, its commitment to excellence, and its leadership role in nursing education and research.

As we continue to adapt to the routines and conventions brought on by the ongoing COVID-19 pandemic, it is clear that we must lean into the profession and build on DUSON’s excellence to optimize our role as leaders in nursing. DUSON is indebted to its brilliant and hardworking faculty, staff and students for all we have accomplished, and I challenge us all to reaffirm the creative spirit, and commitment to improving health outcomes that helps us all continue advancing DUSON and the field of nursing. As the field of health care demands more of nurses and nurse leaders, it is critical that we seek out and seize the opportunities that reduce health inequities and bolster the support systems to equip and empower DUSON in its leadership role.

So much change in our lives has been shaped by the COVID-19 pandemic—a transformation of norms. From how we do our jobs, where we work, and how we interact with one another, we all have adapted to new and necessary practices that have profoundly impacted the way we carry out our mission at DUSON.

After two full years of finding our way through the pandemic, these adaptations have had a significant impact on the nursing profession. With their passions and ingenuity put to the test, nurses have been integral to supporting patients and promoting public health more than at any other time in recent history. The role of nurses in response to the COVID-19 pandemic is contributing to the transformation of health care.

Through the pandemic, we have observed that, at the same time the public is increasingly interfacing with nurses as front-line health care workers, it is also seeking a more active understanding of the health and clinical science as well as the relational skills associated with the nursing profession. From nurse leadership within hospitals and clinics to nurse-led interventions in communities, society’s increased attention and dependence on nurses is elevating nursing professionals and practice to higher levels of understanding and regard. At this unique moment, we must do all we can to amplify our profession, communicate the justification and motivation for nursing careers, and strive to make real-world impacts.

That starts with us and the experiences of our faculty, staff, and students. Throughout the pandemic, DUSON has displayed an astounding commitment to the school and to our students. Together, we have adapted to new instructional and working situations and have joined together to meet challenges.

We have continued to host thought-provoking events and hands-on learning experiences. Our faculty and staff stay connected and flexible to the needs of our students, demonstrating their commitment to our students’ success. Faculty, staff, and students in our Transition Year Team are collaborating to evaluate how we can best reengage as a community, while those on our Racial Justice Task Force advocate for social justice and assess systemic inequities. DUSON students and faculty have worked to advance the nursing profession and nurse leadership from the front lines, all while treating COVID patients and providing COVID testing and vaccinations across the country.

The COVID-19 pandemic has not only presented us with direct challenges but has exposed and, in many ways, exacerbated contemporary and chronic health and social welfare inequities. It has demonstrated how social injustices and structural racism shape the impact of social determinants of health. It has highlighted the unequal distribution of modifiable health determinants as an underlying driver of health inequities and has shown how social determinants of health cumulatively impact health outcomes throughout the lifespan.

Across the globe, nurses are indispensable in terms of scale, reach and efficacy in the delivery of health care. According to the WHO, despite nurses accounting for the largest group in the health sector at approximately 59% of the global health care workforce, the world lacks a global nursing workforce commensurate with its needs for reaching national and global health goals. For their essential role in delivering integrated, people-centered care, no global health agenda can be reached without the contributions of nurses and the support of a sustainable nursing workforce.

Here in the U.S., nursing has been ranked as the single most trusted profession for 20 consecutive years. Nurse-led interventions that centralize nurses and support them in practicing at the full scope of their training and expertise have proven to be effective, often more so than traditional approaches. Nurses are experts in clinical care and coordination, are adaptable regarding the location and setting of health care delivery, and operate with the perspective of whole person care. For these reasons, nurses—the nation’s largest segment of frontline health care providers—are uniquely poised to challenge paradigms, serve as leaders in transformed models of health care, and drive meaningful and impactful change in our health care and public health systems.

Nursing is at a critical juncture. It is time for nursing to fully embrace the importance of our role in addressing the social determinants of health. At DUSON, we are integrating social determinants of health principles and mechanisms with nurse-led models of care into a framework with applicability and utility. By conceptualizing the application of mitigation approaches aligned with these principles, mechanisms, and models, we are preparing future generations of nurses to embrace leadership roles and implement approaches for addressing the social determinants of health.

At DUSON, nurses and scientists are leading the way in developing models of health care that transform delivery and advance health equity. Across the school, these compelling and innovative models allow nurses to design health care programs distinctly aimed at addressing underlying causes of health inequities.

Moreover, DUSON is already pioneering the deployment of innovative nurse-led models of health care. Four such models that demonstrate DUSON’s leadership in innovating and deploying nurse-led models of health care are:

  1. The Center for Latino Adolescent and Family Health (CLAFH)’s Nurse-Community-Family Partnership (NCFP) Program, in which nurses and community health workers jointly partner with families—a critical factor in the mitigation of household transmission of COVID-19—to increase testing, vaccination, reduce psychological distress associated with COVID, and increase family based behavioral mitigation of risk;
  2. The HEEAT Research Lab, which uses nurse-led interventions and community partnerships to address health disparities within Black communities, specifically disparities in sexual health and HIV;
  3. The Duke Elder Family/Caregiver Training (DEFT) Center, which uses nurse-led interventions to support caregivers of adults 60 and older with the aim of reducing hospital readmission rates; and
  4. The “Improving the Visibility of Women: Patients as Partners in Management of Uncontrolled Hypertension” study, which evaluates community-based nurse-led interventions designed to reduce disparities among adult women with high blood pressure and to improve treatment equity, resulting in an increase in the proportion of women with hypertension in control across racial and socio-economic groups.

This past fall, I invited DUSON colleagues to visit my nurse-led intervention team for the NCFP intervention in my hometown, the Bronx, where we visited the homes of families living in public housing that have been particularly impacted by the COVID pandemic. The NCFP program is a randomized clinical trial (RCT) funded by the National Institutes of Health’s RadX Up Initiative. The premise of the RCT is to evaluate the nurse-led model of care relative to the control condition, which is the traditional COVID prevention and mitigation services offered as part of the health system. During this visit, we partnered with families to provide COVID point of care testing, education regarding reduction of risk associated with household transmission of COVID, and anticipatory guidance regarding what to do should a family member contract the virus. Developing and implementing this intervention in my hometown has served to reinforce my passion and vision for driving nurse-led models of health care here at DUSON and across the globe.

A team from DUSON participates in a nurse-led intervention for the NCFP in the Bronx, NY

The decade ahead will demand a more diversified and equipped nursing workforce that is prepared to provide evidence-based care across physical and digital modalities; promote health and well-being within communities; and address the systemic inequities that have fueled wide and persistent health disparities. Leading nursing institutions will need to advance nurse-driven adaptations in education and practice to meet future workforce and industry needs.  

As we approach the school’s centennial in 2031, DUSON needs a data-driven strategic plan based on a bold vision and actionable objectives that builds on the school’s legacy of excellence to equip and empower the nursing workforce of the future. To that end, we have engaged Slalom, a global consulting firm focused on strategy, technology, and transformation, to help facilitate strategic planning. Slalom has proven success in helping organizations shape their future vision and will be an invaluable resource as we define and implement our aspirations for the future. 

During the planning, which has been underway since January, the DUSON community is providing input through a series of ongoing workshops, interviews, listening sessions, and a survey. The input will inform a five-year strategic plan that builds on DUSON’s excellence and innovative thought leadership to drive measurable impact for its students, faculty, staff, partners, and community.

Opportunities and Vision

Opportunities and Vision in 7 Key Areas for DUSON's Strategic Planning Process

Building on the key priority areas discussed in the State of the School address, the strategic plan will: 

  • Define DUSON’s vision statement to position the school for the future
  • Articulate the school’s differentiators and value proposition
  • Identify and assess gaps between the current state analysis and the future vision
  • Develop future state initiatives to close gaps and define key recommendations

The planning process has four phases: 1) Kick-Off, 2) Discover & Analyze, 3) Define the Future and 4) Prioritize and Plan. The process is off to a strong start, and we are well on our way to completing phase one. The five-year strategic plan will be complete and released in summer 2022. 

For more, please see the “Investing in Ourselves and Our Future” video on our YouTube channel. 

In conjunction with the strategic plan, DUSON must continue to demonstrate that we are a leader in nursing education, nurse science, and experts in clinical care through our real-world impact. For 90 years, our faculty, staff and students have cared for patients, conducted research, created policy, and informed educational processes throughout the world. As circumstances change, so must DUSON adapt to meet society’s shifting needs. To that end, a number of signature initiatives and events have been developed with the objective of translating DUSON’s thought leadership in nursing science, clinical care and education into real-world impacts.

In fall 2021, we launched the Building Upon Excellence Dean’s Lecture Series to bring nursing and health care experts, innovators, educators, and leaders to Duke for symposia on critical topics. These symposia create opportunities for the DUSON community, along with our colleagues and partners across Duke University and the nursing profession, to engage in national and global conversations about ways to leverage nurses in addressing pressing health and social challenges. As part of the Dean’s Lecture Series, we are pleased to bring to DUSON Kody H. Kinsley, Secretary for the North Carolina Department of Health and Human Services; Dr. Peter Buerhaus, nurse and health care economist well known for his studies on the nursing and physician workforces in the U.S.; Congresswoman Lauren Underwood, U.S. representative from Illinois’s 14th congressional district; Dr. Margarita Alegría, Chief of the Disparities Research Unit at the Massachusetts General Hospital Mongan Institute; and other leaders to campus in the 2021-22 and 2022-23 academic years. For event details and registration information, please see the Building Upon Excellence Dean’s Lecture Series webpage.

In September 2021, in coordination with National Hispanic Heritage Month, DUSON launched the Center for Latino Adolescent and Family Health (CLAFH). This new center at DUSON serves to engage in the health care of the Latino community by addressing the inequities facing it and by promoting the overall well-being of Latino youth and their families. With the advantage of a strong partnership with Mexico as a geographic hub for work with Latin America, CLAFH accomplishes its mission through four thematic areas:

  1. Community-engaged research on health promotion and prevention
  2. Evidence-based family interventions
  3. Nurse-led and interdisciplinary interventions, differentiated care models, and decentralized health care delivery
  4. Research impact on clinical and public health practice and policy

In commemoration of World AIDS Day this past December, I was invited by President Joe Biden to attend a White House event where he unveiled his administration’s updated National HIV/AIDS Strategy 2022-2025 and Plan to End the HIV epidemic by 2030 in the U.S. and Territories. Additionally, Dr. Michael Relf, our associate dean for global and community health affairs, was part of the Nasdaq’s ceremonial bell ringing. These events followed a DUSON event with Harold Phillips, director of the White House Office of National AIDS Policy, speaking to our community and guests on how nurses can end the HIV epidemic once and for all.

In January of this year, DUSON cosponsored a conversation between Dr. Dave A. Chokshi, Commissioner of the New York City Department of Health and Mental Hygiene and myself. It was an honor to have the opportunity to speak with Dr. Chokshi about the large-scale, transformative events impacting health care, health equity, models of care, and the effects of COVID-19 on the transformation of health care.

As our faculty, staff, and students continue to drive real-world impact and contribute to broader conversations on the transforming landscape of health care, it is critical for DUSON to sharpen its messaging. To accomplish this, the Dean’s Office has collaborated with the DUSON Communications and Marketing team to better infuse our key messages through communications on the website, social media, email newsletters and school magazine.

More than ever before, alumni engagement and development programs are critical components in shaping DUSON’s vision for the future and in translating DUSON’s impact to the real world. DUSON Development & Alumni Affairs have been instrumental in establishing our strategic initiatives and in coordinating signature events.

In the fall of 2021, the Building Upon Excellence event series created opportunities for alumni, donors, and friends, to engage in critical conversations about the future of DUSON. These events promoted dialogue regarding DUSON’s responsibility as an influential change agent uniquely positioned to shape the role of nursing in the transforming landscape of health care. The series also allowed us to engage with alumni, donors, and friends who will contribute to the future of the school through their advocacy, leadership, and philanthropy. The series served as a bridge to the Building Upon Excellence Dean’s Lecture series, which aims to continue critical discussions and the dissemination of important issues impacting the nursing profession.

Through events like my conversation with Dr. Dave A. Chokshi, Commissioner of the New York City Department of Health and Mental Hygiene, Development & Alumni Affairs continues to diversify DUSON’s audience and increase giving. During this partnership event, we were able to not only engage with DUSON alumni across the country, but with alumni from the Sanford School of Public Policy and all Duke alumni living in New York. I also participated in a panel discussion in partnership with Duke’s Forever Learning Institute that created an opportunity to present the work being done across our profession to address health disparities. It is critical that we continue to seek these opportunities that allow us to increase the visibility of DUSON and advance the nursing profession.

DUSON Development & Alumni Affairs continues to see strategic opportunities for philanthropy that will have an impact within and beyond the school. Gifts secured from corporate and foundation partners, like ViiV Healthcare and the Alpha Phi Foundation, are supporting faculty research focused on nurse-led models of care. Additionally, we continue to work with donors to increase endowment and expendable funds for scholarships that will remove economic barriers for students and allow us to diversify the pipeline for nursing.

As our students grapple with unanticipated expenses, such as food insecurity, temporary housing costs, lost employment, and technology for online learning, they rely on the support DUSON is able to offer through gifts from donors and friends. Never before have these gifts been more urgent, nor has the potential for tangible, immediate impact been greater. We continue to seek opportunities for dialogue with our alumni, donors and friends as they play a critical role in shaping the future vision for DUSON, developing strong partnerships locally and globally, and serving as ambassadors who will elevate the voices of nurses as leaders in shaping the future of health care and health equity.

We are working in a transformative time. Though COVID-19 has exposed and amplified systemic faults and inequities in our health care systems, what hasn’t changed is the factors under which those failures developed. By championing nurse leadership through dissemination and uptake of nurse-led models of care and embracing our place in addressing the social determinants of health, nurses are positioned to challenge those faults and inequities to reduce disparities and improve health outcomes.

We are also working in a critical time. The future of health care and nursing is forming now. The steps we take in addressing the challenges facing the health care industry today will inform the models of care with which we equip tomorrow’s nursing workforce. As DUSON approaches its centennial, we must be intentional and thoughtful in order to have a meaningful impact now and in the decades to come.

In closing, let us not neglect that we are working in an exciting time. The Duke University School of Nursing is an undeniable leader in nursing—in North Carolina, across the country, and around the world. As we strive to advance the profession into a new tomorrow, may we seize the opportunities present now to build on the excellence that has led us to where we are today.

I look forward to the months and years ahead as we continue to advance the role of nurses and nursing in the transforming landscape of health care and in the expansion of health equity.

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