April 26, 2010
Dean Martha Hill of the School of Nursing
School’s dean foresees growth in enrollment, programs and facilities
This is the fourth in a yearlong series of talks with the leaders of Johns Hopkins’ nine academic divisions and the Applied Physics Laboratory.
Martha Hill, a Johns Hopkins faculty member since 1980, became dean of the School of Nursing in July 2002 after a one-year role as interim dean.
A tireless and passionate champion of the profession, Hill, who earned her diploma from the Johns Hopkins Hospital School of Nursing in 1964, has been with the School of Nursing since its beginning.
She was one of the first four faculty members to join Dean Carol Gray when the new school was established as an independent division of the university in 1984. Previously, nursing education at Johns Hopkins, which can be traced back to 1889, had occurred as a hospital-based school and within the former evening college.
After a series of moves and temporary homes, the School of Nursing built and in 1998 moved into the Anne M. Pinkard Building, the first structure dedicated solely to nursing education at Johns Hopkins.
Today, the school continues to redefine nursing education nationally. Nearly 700 students are currently enrolled in its baccalaureate, master’s and doctoral programs, and Hill hopes to see that number get bigger.
Hill is internationally known for developing and testing strategies to improve hypertension care and control among urban, underserved African-Americans, particularly young men. She is a fellow of the American Academy of Nursing and a member of the Institute of Medicine of the National Academy of Sciences and was recently named an inaugural inductee of the Nurse Researcher Hall of Fame. In 1997–98, she served as president of the American Heart Association, the first nonphysician to do so. At Johns Hopkins, she holds joint faculty appointments in the schools of Medicine and Public Health.
Hill recently sat down with The Gazette to talk about the nursing profession and where the school is headed. Get her talking about the school’s future, and you’re likely to hear a litany of big, glowing adjectives.
Q: You’ve had a long tenure as dean, with no signs of slowing down. What keeps you going?
A: What keeps me going are the vision and the strategic planning we have for the continued growth and development of the School of Nursing. This is a vibrant, transitioning organization with unlimited potential. The best part of being a dean is that you get to create an environment and allocate resources to help people—students, faculty and staff—be the best that they can be.
Q: How would you define your leadership style?
A: Collaborative. Consensus building. Positive. Energetic. Can do, will do. And very committed to the values that we have: excellence, respect, diversity, integrity and accountability.
Q: You were here 25 years ago, when the school was born. Much has changed, I imagine.
A: Almost everything has changed. When we began, there was one nursing administration office, on the second floor of the Billings Building in The Johns Hopkins Hospital. This is where the first four faculty would meet to draft the curriculum and the policies. Just one room. That is how we began. After a year of planning, we were able to attract and recruit the first class of students—all 27 of them.
Q: The construction of the Pinkard Building was certainly a milestone. Any plans for expansion?
A: When we built this building, we had a community of 555 students, faculty and staff. The goal was to put everyone under one roof in a School of Nursing building. We experienced a series of misadventures as tenants, and we needed our own space. It was also psychologically extremely important to have a place that had the name of the school on it. This is something that our alumni had desired for over 100 years. They were very generous in helping build this.
There was a conservative financial approach to the planning of the building and its construction. We made sure that the school would be financially solid, but there was no plan for growth. As of the time we moved into this building, we filled it.
Now our community numbers 810, with 50 percent more students. We are now in very tight quarters and have an urgent need for additional space. We have planned for a new building that would double our space, and we have begun to raise money. It’s a tough challenge to raise money for capital improvements, and certainly a tough challenge for nursing.
With the economic crisis, our fund raising has been greatly slowed down. Right now we are in a holding pattern. What is temporarily saving us are the two houses adjacent to the school, one on McElderry Street and one on Jefferson Street. We have purchased these houses and the Jefferson Street parking lot area, excluding the Children’s House. This secures our future. We have control of that space, and we will build on it. We are also in a partnership with the School of Public Health. They own the strip of land in the parking lot along Washington Street, and an SPH building will be dropped in there, adjacent to and linked with the Nursing buildings. We have architectural plans already drafted. We now need to reboot the fund raising and press forward.
In the meantime, we have moved administration offices into the house on McElderry Street. The house on Jefferson Street we will call the student house; it will house admissions, the registrar, financial aid, student lounges and student study spaces. This allows us to temporarily decompress and reconfigure some of our academic and simulation units.
Q: What sets the School of Nursing apart from its peers?
A: First of all, it’s the Johns Hopkins brand and the reputation for excellence we have as a university. It’s also this school’s reputation for community public health nursing, our access to the No. 1 hospital in the nation and our program of rigorous research and research training.
We also have faculty who have national and international reputations of excellence in their fields. Students will tell you that they came here because they wanted to study with this person, or take a class with a certain professor.
We are known for being a happening place. It’s flexible. It’s dynamic. We’re small compared to our peer schools. The individual attention our students get sets us apart, from the beginning of their admission process all the way through the program. The mentorship and the commitment from everyone here optimize the potential of every student and help them achieve success.
This sort of environment attracts older students. The vast majority of our baccalaureate students are second-degree, and the average age is 26. The maturity of these students creates an environment that is very different from that of other nursing schools.
Q: Switch gears. What sort of impact will the health care bill have on the school and on the profession?
A: We have a strong concentration on the care of underserved, vulnerable populations. That is consistent with our theme and focus on community public health nursing. So the notion of 40 million Americans who don’t have health insurance, and who do not seek health care until they are seriously ill, is a problem. We are very concerned about access to health care and health care interventions.
We see this as an opportunity that these people will have greater access to services. And many of these are nursing services. Nurses are well-qualified and able to meet these needs. We look forward to the expanded opportunity to be able to do this.
We are also very pleased to see the provisions in the bill that pertain to practice by nurse practitioners, midwives, nurse anesthetists and others in terms of reimbursement. The lack of reimbursement is a big problem in diminishing the availability of these services and the capacity for bringing people to practice. So the loan forgiveness, the training support, all those areas that are part of the bill are ones that we are delighted to see.
Q: You recently partnered with the Department of Medicine for its new resident training program in urban health, which seems right up your alley.
A: Oh, yes. We need to be training physicians and nurses together so that they are psychologically and behaviorally prepared to practice together. It’s a very exciting opportunity.
Q: Speaking of collaborations, the school’s name increasingly comes up in partnerships with other disciplines.
A: Interprofessional collaborations are extremely important to me personally and professionally. But it’s also part of our mission. When you have different disciplines working together, the sum is greater than the total of the parts. I am inherently collaborative. I just can’t help myself [laughs].
For example, we are having conversations with Biomedical Engineering. This field should not only mean “bio” and the profession of medicine. Look at all the problems we have in hospitals. Patients falling. Medication errors. Staffing. These all call for engineering solutions, and they are all critical elements of nursing practice. Look at home care—how nurses get in their car and drive from house to house. They need a laptop, cell phone and other devices to input their findings into a patient’s record. They take an EKG in the home and send it to a cardiologist so he or she can immediately read it. All this requires engineering solutions applied to the practice of nursing.
Q: Other collaborations you’d like to mention?
A: We have a dynamite dual-degree program with the School of Public Health. The graduates are now all over the world. Several of our alums are the medical directors of the health programs in U.S. embassies. They are running countrywide programs in Africa. One is running the entire sub-Saharan Africa technical assistance program for Jhpiego. They can do anything in community public health nursing, anywhere in the world. They are beautifully prepared. These are people who come here to gain the skills and knowledge that they need to go and serve underserved areas.
Q: Is this an example of global nursing that you’ve been championing?
A: Exactly. Global symbolizes international health. Now there are people who will tell you that international health means we go there, assist and then come back. The leaders in this new field of global health will tell you that this is a more comprehensive, long-term commitment. It’s mutually beneficial, and it’s domestic as well as international.
We have underserved, low-resource communities here. Look out the window. The skills we have in community health nursing go from local to global. When you go elsewhere and come back, you bring attitudes and skills that you learn elsewhere.
I can tell you that we are very excited about participating in the Center for Global Health and in President [Ron] Daniels’ new initiatives to support greater student involvement in international health. We are going to be launching soon a new program within the school that I’m conceptualizing as a center for academic global nursing.
Q: Tell me about some of the school’s big challenges.
A: Financial aid, certainly. Cost of tuition. The cost of doing business in a research-intensive environment. We are very small in terms of our peer schools. We are one-third or half the size, yet we rank No. 5 in terms of NIH funding. Imagine if we were twice as big [smiles].
It’s that potential that excites me. We have high standards here as leaders in the nursing profession. The legacy of our glorious past, and the potential we have in moving the profession forward in the future, is just wonderful.
We manage a very fiscally conservative organization, but it’s bold and dynamic in terms of our vision, programs and future aspirations.
Q: Have you and President Daniels had much of a chance to get acquainted?
A: We certainly have. President Daniels visited the school for three and a half hours his second day on the job. He’s very interested in what we are doing.
He came from the University of Pennsylvania, which has one of the top nursing schools in the country. He told me when I first met him that the dean of that school told him to tell me he was a work in progress. I laughed and I said I’m very pleased to be the beneficiary of her investment in you.
Ron knows a lot about professional nursing at a research-intensive, private university, which is very helpful in that I don’t have to justify or explain a lot to him. He gets it. He’s very supportive and enthusiastic, and very fair. He wants to be sure when he talks about undergraduate education at Johns Hopkins that it’s not just the Krieger and Whiting schools, but that Nursing and Peabody are in every equation.
Q: What keeps you even-keeled in the face of stress?
A: My family and my friends, my colleagues. To balance a professional and personal life, what has helped me through all my years of research was that the personal friendships and professional relationships overlapped. That creates an efficiency. We call it group therapy and social support.
I also value my personal friends outside of Johns Hopkins. They are very understanding. They know this is a 24/7 job. They know it involves a lot of travel and commitment. They work on the system of no news is good news. Of course, I have always had a husband who is very supportive and proud of my professional work, as are my sons, both of whom have boomeranged back to Baltimore. Having them here is really nice, so I have someone to call if the car battery is dead [laughs].
Q: What one thing can’t you live without?
A: Personal interaction with people. I am inherently a social being, and I thrive on interaction. I thrive on being able to debate, and process ideas and strategies. Moving things forward so that others can benefit.
Q: Anything else you want to talk about?
A: Nursing capacity. Worldwide there is a shortage of nurses, and that is for several reasons. One is that as the population ages and people are living longer with multiple chronic diseases, the demand for nursing care is increasing. Secondly, as technology increases in hospitals and in people’s homes, the need for nurses has increased. Acute care has become more dependent on technology, and people are being kept alive in situations where previously they would not have survived. We need nurses with extremely high levels of skills, especially in critical thinking and clinical judgment. Whether they’re in a burn unit or neonatal intensive care unit, we need nurses who are stunningly well-versed with technology. The better educated the nurse, the better patients do.
Here at Hopkins, we are in the business of preparing leaders. We are looking at the transition from the baccalaureate level to the graduate level. We also have a new clinical professional doctorate program, the Doctor of Nursing Practice. Nurses today cannot be too well-educated. Knowledge about strategic planning, business plans and budgets keeps them at the table in the planning and evaluation of how health care is delivered. They have to be there. If they are excluded, the glue isn’t in the structure.
Q: What are you reading now?
A: I’m reading all three of [School of Medicine Professor] Kay Jamison’s books. I’m reading them because in the past few years I’ve experienced the deaths of several friends. When I heard about her book on bereavement and grief, I wanted to read it. When I got to the bookstore I thought, well, I want to read the ones on manic depression and suicides as well. So I bought all three. I’m going in chronological order.
Learning about death is important for me. We’ve dealt with the loss of colleagues and their family members here at the school. It’s the result of an aging workforce. This will increasingly be part of our lives. To have a better understanding of the process and the impact it has over time will help me, not only as a person and friend but as a leader of a community.