A Place for Innovation

As the leading nursing research institution in Wisconsin, the School of Nursing requires an equally innovative environment that stimulates productivity, creativity, connection, focus, and well-being. Signe Skott Cooper Hall, home to Badger nursing since 2014, stands as one of the most innovative and advanced teaching and academic research facilities in nursing across the nation.

The five-story, 166,348-square-foot building is LEED (Leadership in Energy and Environmental Design) Silver-certified and meets the highest current standards for green engineering and sustainability, reflecting the School’s commitment to environmental health. The copious amount of natural light and green spaces also support physical and mental well-being for students, staff, faculty, and visitors.

Cooper Hall can also adapt to the ever-evolving needs of the nursing profession and health care with its high-tech classrooms and conference rooms, dozens of research project offices, and a large, flexibly designed third and fourth floor layout that accommodates office spaces and six signature research areas.

Words alone are not enough to convey everything there is to love about Cooper Hall. Take a peek inside to learn more about what makes it a key component to the innovative teaching and research happening at the School of Nursing.

File: A-Place-for-Innovation-Spread.pdf

Three Elected into the National Academies of Practice as Distinguished Nursing Fellows

School of Nursing Faculty Recognized for Achievements and Contributions to Health Care

Three faculty members at the University of Wisconsin–Madison School of Nursing have been recognized for their ongoing contributions and professional achievements in health care with elections into the National Academies of Practice (NAP) as Distinguished Nursing Fellows.

In recognition of their significant and enduring contributions to professional health practice, Gina Bryan ’99, MSN’02, DNP’12, APRN, FNAP, FAAN, Traci Snedden, PhD, RN, CPNP, CNE, FNAP, and Susan Zahner, DrPH, RN, FNAP, FAAN, were welcomed into the NAP’s Academy of Nursing during a special induction ceremony on March 5 at the NAP Annual Convention held in San Diego.

Fellowship is an honor presented to those who have excelled in their profession and are devoted to furthering leadership in practice, scholarship, and policy in support of interprofessional care. Those elected join a distinguished team of professionals focused on advancing interprofessional health care by fostering collaboration and advocating for policies in the best interest of individuals and communities.

“The mission of the National Academies of Practice is to advance health and well-being through collaboration and coordination of various professions,” said Snedden. “As a pediatric clinician and leader with decades of experience caring for children and adolescents in critical care, emergency, sport, and school settings, I have a strong understanding of the impact of high quality, interprofessional collaborative health care on pediatric outcomes. I am honored to be named as a Distinguished Scholar [and] Fellow of the National Academies of Practice in Nursing.”

photo of Gina BryanBryan is a clinical professor and the director of the post-graduate psychiatry program at the School of Nursing. She teaches in the graduate nursing and pharmacy programs. She serves on research teams in the UW School of Pharmacy and the School of Nursing, and maintains an active clinical practice at Tellurian, Inc. in dual diagnosis treatment. Bryan serves on the National Academy of Science, Engineering and Medicine’s CARA task force. She also served on the Wisconsin Commission on Substance Abuse Treatment Delivery to research hub-and-spoke delivery models for opioid treatment as well as to identify key implementation considerations. Bryan’s scholarly interests focus on novel health care provider collaborations to improve access to medication assisted treatment for the treatment of substance use disorders, access to naloxone, and interprofessional education for professional health care students.

Snedden’s career represents broad interprofessional contributions in pediatric injury, more specifically concussion. As a pediatric clinician with decades of experience caring for children and adolescents in critical care, emergency, and sport and school settings, her contributions are evident in clinical practice, research, education and outreach, service, and school-based policy. She collaborates with athletic trainers, school nurses, physical therapists, and various MD specialties across the country to provide high-quality, coordinated interprofessional care post-concussion. The assistant professor also presents at national and international conferences, publishes in peer-reviewed journals, and had an op-ed in USA Today that highlighted equity issues in female concussion. She mentors students from several practice disciplines and serves on the executive board for the Brain Injury Association of Wisconsin. She has received multiple interprofessional awards for her commitment to pediatric injury.

Zahner is Associate Dean for Faculty Affairs and Vilas Distinguished Achievement Professor at the School of Nursing, with an affiliate appointment with the School of Medicine and Public Health. She has thirty years of professional experience in public health, nursing, and academic leadership. Zahner conducts research on local public health system performance and workforce education and practice. She also directs the Wisconsin Public Health Research Network where she leads a team developing an online residency program for new public health professionals. Zahner has taught community health nursing and program planning, evaluation, and quality improvement. She mentors PhD, Doctor of Nursing Practice (DNP), and master’s degree students in nursing and public health programs.

The mission of the NAP is to serve as distinguished professionals advancing interprofessional healthcare by fostering collaboration and advocating policies in the best interest of individuals and communities. Election into the prestigious NAP in Nursing is a lifelong appointment.

Founded in 1981, NAP is a non-profit organization built to advise governmental bodies on our healthcare system. Distinguished practitioners and scholars are elected by their peers from 15 different health professions to join the only interprofessional group of health care practitioners and scholars dedicated to supporting affordable, accessible, coordinated, and quality health care for all.

Ageism in Research and Health Care

Lisa Brazke and older patient

By Diane Farsetta, Center for Aging Research and Education
This story originally appeared at CARE

University of Wisconsin–Madison School of Nursing Assistant Professor Kristen Pecanac, PhD, RN studies interactions among healthcare practitioners, patients, and family members as they make treatment decisions in hospital settings. 

She says the peer review process has provided her with clear examples of ageism.

“I did a study where I looked at conversations between physicians and older adults during daily rounds,” says Pecanac.  

“There was one conversation where there were really, really long pauses. The physician would ask the patient a question and they weren’t responding. I was in the room, so I could take notes. I could see the patient falling asleep. Early in the conversation, asked how they were doing, they said, ‘I couldn’t sleep, I was really anxious.’” 

“When I submitted the paper for publication, I received a lot of interesting comments from reviewers,” says Pecanac. “They said this wasn’t a great example because ‘obviously, the patient doesn’t have the cognitive capacity to engage in this conversation.’ When even in the transcript that I provided, the physician said, ‘I know we’re bothering you when you’re really tired.’” 

Kristen Pecanac
Kristen Pecanac

“Everything was centered around the patient being tired. But the reviewers were saying, ‘That’s another issue with older adults—how much can they actually engage in these conversations?’” 

It’s not the only example Pecanac has of ageist reactions to her research. And she’s not the only School of Nursing faculty member whose research challenges ageist assumptions. 

“Part of my work has been to show that the cognitive changes that occur with aging are not such that people aren’t able to follow medication regimens, lifestyle regimens, or other treatment,” says Associate Professor Lisa Bratzke, PhD, RN, ANP-BC, FAHA. “But reviewers have assumed that older adults are not going to be compliant.” 

“I’ve also had reviewers say that older adults aren’t able to do MRIs, because they can’t lie still and understand what they’re supposed to do,” says Bratzke. “That they couldn’t lie flat for 45 minutes due to arthritis or heart failure or whatever. When in reality, claustrophobia has been a much bigger deterrent from MRIs than any aging-related issues.”

photo of Lisa Bratzke
Lisa Bratzke

Their experiences illustrate the broad reach of ageism, from health research to care provision, to health policy and funding decisions, to the dearth of providers specializing in older adult care.

Psychiatrist Robert Butler, MD, who coined the term ageism in 1969, defined it as “a personal revulsion to and distaste for growing old, disease, disability; and fear of powerlessness, ‘uselessness,’ and death.” 

Studies by Yale School of Public Health Professor Becca Levy, PhD and others have shown that holding negative age stereotypes decreases health-promoting behaviors, worsens health outcomes, and increases healthcare spending. 

Ageism can also obscure the dangers of supposedly vetted treatments. 

“I was taking care of a woman in her 80s who became depressed,” says Louise Aronson, MD, MFA, a professor of medicine at the University of California, San Francisco and author of Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life. She was speaking during a webinar on “Confronting Ageism in Health Care,” organized by Kaiser Health News and The John A. Hartford Foundation. 

 “I was a relatively new doctor. I prescribed her one of the new medicines,” says Aronson, referring to SSRI antidepressants. “The big excitement was that these were newer and safer. They didn’t have side effects!” 

“So I gave [an SSRI prescription] to her. She got worse and worse,” says Aronson. “The medicine I had given her had lowered the sodium in her blood—something that we now know commonly happens with these medicines, but that we didn’t know happened at that time because there were no older people in the studies of these drugs.” 

Ageism can also decrease quality of care. 

Sarah Endicott
Sarah Endicott

“There are numerous examples of health consequences of ageism from the healthcare provider side,” says School of Nursing Clinical Professor Sarah Endicott, DNP, PMHNP-BC, GNP-BC. “Neglecting to ask patients about their sexual lives or substance use based on ageist ideas can have very real, detrimental health effects. These include missed treatment opportunities, delayed care, drug interactions, and missed diagnoses.” 

“I see it from the patient side, too,” says Endicott. “When I worked in primary care, I’d have older adult patients come in and dismiss their own symptoms for so long, thinking it was normal due to their age. We then miss a crucial window of time to intervene early, before people suffer lasting consequences. For example, a patient who ignores or dismisses shoulder pain may end up with a frozen shoulder or chronic osteoarthritis, when intervening early with therapy may have prevented functional decline.” 

Ageism can also skew funding priorities. 

“We can’t give people the strengthening exercises that would prevent falls, but if you fall and have a fracture, you can get emergency care that will cost many thousands,” says Aronson. “You will get a surgery that will cost tens of thousands. You will have hospital and rehab stays, driving the bills to hundreds of thousands. Whereas the actual rehab you needed to prevent not all but many falls would have just cost hundreds of dollars.” 

“Then there’s the famous argument that older people use up too much of the healthcare dollar,” adds Aronson. “It’s life stage appropriate. We have three major stages of life: childhood, adulthood, and elderhood. When have you ever heard someone say, ‘Those children are using up too much of the education dollar. Why are they all so stupid? Why do they require so much education?’” 

While ageism can take many forms, its impact on individual and community health, the healthcare system, and research is always negative. 

The FrameWorks Institute, a social science research firm and part of the Reframing Aging Initiative, suggests three strategies to counter ageism, based on their research: 

  • Appeal to values of justice, pointing out that older people often aren’t treated as equals in our society; 
  • Give examples of ageism and positive responses, such as older patients’ pain not being taken seriously, which could be addressed by expressing concern and asking about potential underlying causes or ways to alleviate symptoms; and 
  • Use language that emphasizes shared interests, such as “as we age” or “what we need when we’re older.” 

Morgridge Center-led Study Aims to Support Underrepresented Students’ Participation in Civic Engagement

Photo of Earlise Ward

By Erin Gretzinger, Morgridge Center for Public Service

In an effort to understand and support civic engagement among underrepresented minority students on campus, Morgridge Center for Public Service staff have launched a research study that aims to enhance civic engagement programming at UW–Madison.

Photo of Earlise Ward
Dr. Earlise Ward, School of Nursing professor and faculty director at the Morgridge Center for Public Service

The study, headed by Faculty Director Dr. Earlise Ward and Graduate Project Assistant CC Vang, hopes to gain a better understanding of how underrepresented racial and ethnic minority students are participating in civic activities and identify ways to support students’ civic engagement.

Vang says the goal of the research is to better civic engagement outreach and outcomes at UW–Madison. While the study’s primary focus is to improve the programs housed in the Morgridge Center, Vang says the research will help other university units plan strategically and strengthen civic engagement efforts across campus.

“I hope that this study can provide perspective to broaden the definition of civic engagement to consider culture and different communities,” Vang says.

To get a “pulse” on the civic activities of underrepresented students, Vang says they are doing a phenomenological study, which means the research will focus on the essence of civic engagement for racial and ethnic minorities on campus and the lived experiences of those populations.

CC Vang
CC Vang, the graduate project assistant at the Morgridge Center

Students can get involved in the study by taking a 15-minute online survey or participating in a 15-minute interview in person or over Zoom. Vang encourages students to do both the interview and the survey to provide the strongest results, but any input will advance the goals of the research.

“If you’ve ever felt that you have something to share or talk about your experience at UW as it pertains to civic engagement, this is a great opportunity for you to share your voice,” he says.

Vang was inspired to dive into this research because of his undergraduate experience in a Black Greek-letter organization, where he saw how pertinent community engagement was to the mission of the Divine Nine. The Divine Nine refers to the nation’s nine historically Black Greek-letter fraternities and sororities — six of which are currently active at UW–Madison.

Smiling fraternity brothers in front of lake wearing Kappa Rho sweatshirts
The members of Kappa Rho Chapter of Phi Beta Sigma Fraternity Inc., one of the Divine Nine organizations on campus, celebrating their founders day in 2017.

Through this experience, Vang says he saw different cultural relationships with community engagement, and how the perception of community engagement often leaves the ways underrepresented groups participate out of the picture.

He hopes the study can help students from underrepresented groups see the professional and personal value of the ways they participate in civic activities, and he believes the study will help broaden the understanding of how UW–Madison students engage with the community.

“Community volunteering and civic engagement isn’t just one a particular thing, it’s so encompassing, and I think that everyone could benefit from having a sense of what that can look like for each community,” he explains. “It’s about inclusivity. It’s about making UW–Madison a better place for all students, and that begins with figuring out what students haven’t been considering historically and what students still haven’t been, and to use that as a lens to engage in this work.”

Vang says encouraging and supporting civic participation from underrepresented populations is not only important for the UW campus, but also for the betterment of democratic efforts across the UW System and Wisconsin.

The study will conclude on Nov 1. Students from underrepresented minority groups can take the survey online or email to schedule an interview with Vang to contribute to the results.

Vang wants to remind students that any experience is a valuable perspective, and he hopes students realize the impact their voices can have on the study.

“Know that when you share your story with us, it is going to lead to outcomes and it’s going to have implications on campus,” he says. “Your efforts are part of a larger vision, a larger picture.”

School of Nursing Welcomes Seven New Faculty for Upcoming Academic Year

Bucky Badger visits Signe Skott Cooper Hall

The University of Wisconsin–Madison School of Nursing welcomes seven new faculty members ahead of the 2021-22 academic year. The appointees bring with them a wide array of expertise, including one tenure-track member and six new clinical faculty members.

Tenure-track Faculty

Angela Fernandez, PhD, MPH, LCSW, joins the School as an assistant professor and a member of the campus Native American Environment, Health, and Community faculty cluster. A member of the Menominee Nation of Wisconsin, her research program is built on national and international social work and public health practices with Indigenous, Latinx, and other diverse communities in a variety of health care and community-based settings. Her research examines the role of cultural practices that are dependent upon nature contact in the prevention of chronic and co-occurring diseases among Indigenous communities. Dr. Fernandez received her master of social work, master of public health, and doctorate in social work from the University of Washington, and she comes to UW–Madison from her postdoctoral research fellowship at the University of Michigan School of Social Work.

Clinical Faculty

Katherine “Katie” Collins, DNP, MSN, AGPCNP-BC, FNP-BC, joins the School of Nursing faculty as a clinical assistant professor. Collins received her doctor of nursing practice from the Family Nurse Practitioner program and her master of science in nursing from the Adult Gerontology Primary Care Nurse Practitioner program at the University of Illinois Chicago. She has substantial experience as a staff nurse in hospital, primary care, and specialty care (allergy, asthma, and immunology) settings, including working as a nurse practitioner in a federally qualified health center. Her scholarship interests are related to improving domestic violence screening and quality of life for cancer patients, as well as climate change and planetary health, and serving underserved populations. Collins will be teaching in the accelerated bachelor of science in nursing program this fall.

Joining as a clinical instructor, Alyssa Haure, MSN, RN, comes to the School of Nursing from a faculty clinical coordinator position with Herzing University. An experienced teacher, Haure has taught growth and development, health assessment, and adult health in didactic and experiential settings. In addition, she has substantial experience as a nurse in emergency, medical-surgical, and urgent care settings.

Leah Roscoe ’06, MS, RN, FNP-BC, returns to her alma mater as a clinical instructor. An alumna of the traditional bachelor of science program, Roscoe went on to receive her master of science in nursing from the Family Nurse Practitioner program at the University of Colorado Denver. Roscoe comes to the School of Nursing from the UW Medical Foundation (UW Health), where she worked as a nurse practitioner in diabetes and endocrinology outpatient and on the diabetes management service inpatient. Her substantial experience as a registered nurse in urgent care and medical/surgical nursing will also contribute to her expertise in teaching experiential courses in the School’s undergraduate programs.

Anna Kohl ’04, MSN, RN, joins the School of Nursing as a clinical instructor. After earning her degree through the UW–Madison School of Nursing’s traditional bachelor of science in nursing program, Kohl went on to earn a master’s degree in nursing and health care administration from the University of Phoenix. Kohl has professional practice experience in cardiac intensive care, palliative and hospice care, and urgent care. She also has experience in program management and professional leadership. She has academic teaching experience with Herzing University and will be working with the School’s experiential courses in the undergraduate program.

Anna Watson, MSN, RN-BC, who joined the School of Nursing in May 2021, teaches experiential courses in the accelerated bachelor of science in nursing program. After earning her bachelor of science in nursing from North Dakota State University, Watson went on to obtain her master of nursing education from Chamberlain College of Nursing. She has professional practice experience in medical-surgical nursing, with specialization in trauma, renal care, and wound care. She has taught nursing courses at both Carrington College and Herzing University.

Beth Zahn, MSN, RN, CNE, joins the School of Nursing as a clinical instructor this fall. Zahn received her bachelor of science in nursing from UW–Milwaukee, and her master of science in nursing from the University of Phoenix. She is certified as a nurse educator and has extensive teaching experience at UW–Milwaukee College of Nursing, Alverno College, Madison Area Technical College, and Gateway Technical College. Her professional expertise has come from her work as a staff nurse in medical-surgical, visiting nurse, and rehabilitation care settings. Zahn will be teaching in the undergraduate program this fall.

Andrea Gilmore-Bykovskyi Recognized with Rising Star Award in Health Services and Aging Research

Source: The American Federation for Aging Research

Andrea Gilmore-Bykovskyi, PhD, RN

The American Federation for Aging Research (AFAR), a national non-profit organization whose mission is to support and advance healthy aging through biomedical research, recognized the outstanding contributions of Andrea Gilmore-Bykovskyi, PhD, RN, with the 2021 Terrie Fox Wetle Rising Star Award in  Health Services and Aging Research.

This award honors a health services researcher in an early or middle phase of their career who has already made important contributions with work that respects the value of multidisciplinary health services science and that  is likely to be highly influential in shaping practice and research for decades to come.

Dr. Gilmore-Bykovskyi is the Deputy Director, UW Center for Health Disparities Research (CHDR); Informatics Lead, Care Core, Wisconsin Alzheimer’s Disease Research Center; and an Assistant Professor, University of Wisconsin-Madison School of Nursing. She is also Affiliate Faculty, Division of Geriatrics, Health Service Care Research Program, in the University of Wisconsin School of Medicine and Public Health, Department of Industrial and Systems Engineering, and UW-Madison College of Engineering.

Dr. Gilmore-Bykovskyi is recognized for her dementia-focused health services research program, investigating social and behavioral communication patterns among individuals with moderate to advanced dementia, and the role of temporally situated observational measures and inclusion of persons with dementia and their caregivers in this line of research. Dr. Gilmore-Bykovskyi is currently leading a large observational study to investigate episodes of lucidity in advanced dementia, as well as considerations for strengthening progress in outcome evaluation among persons living with dementia through multidisciplinary and community-informed health services research.

The award is named in honor of Terrie Fox Wetle, PhD, who has devoted her professional career to three related domains. She has been a tireless advocate for inclusion of aging-related health services research in Public Health. She has lovingly and effectively mentored hundreds of new investigators in a broad array of disciplines. As inaugural Dean, she built a thriving School of Public Health at Brown University, while leading efforts to improve aging-relevant content in public health curricula. Professor Wetle sets an example of visionary leadership, mentoring and administrative excellence. In her honor, AFAR established the Terrie Fox Wetle Rising Star Award in Health Services and Aging Research in 2019.

“The needs of America’s growing older population demand innovative health services,” notes Executive Director Stephanie Lederman, EdM, AFAR . “The visionary work of Dr. Gilmore-Bykovskyi and Dr. Wetle exemplifies applying research to improving the wellness of seniors and communities. AFAR is proud to support the future of health services and aging research with this award.”

Nominations for the award are by invitation and are judged by an independent panel of leading aging researchers. The award is a framed citation and carries a cash prize of $5,000.

Dr. Gilmore-Bykovskyi will receive the award and present a lecture at the Annual Meeting of the Gerontological Society of America in November 2021. She will discuss progress in investigating social and behavioral communication patterns among individuals with moderate to advanced dementia, particularly in minority and diverse populations.

We’re Speaking

Through research and practice, nurses advocate for themselves and each other

By Jenny Price

Stethascope in the shape of a megaphone

Katie Pavek ’08, PhD’21, was six months into her nurse residency at UW Health University Hospital when she hit a wall. She felt burned out and started to question her career choice.

Pavek eventually learned she wasn’t the only one who felt that way, and that research confirmed nurses often struggle at this pivotal point in their transition to practice. “Nobody was really talking about it,” says Pavek, who recalls thinking, “Why are we all suffering in silence?”

When she started in 2015 as a full-time clinical instructor in the School of Nursing, this memory came roaring back as Pavek witnessed the same stress and anxiety in her students and began to fear they were ill-prepared in some ways for the transition to their chosen profession. “I was counseling them more through that than I was through the actual course content,” she says. “That was my ‘a-ha’ moment.”

Burnout is one of the leading causes for nurses to leave the profession, which contributes to the national workforce shortage. The pressures of the pandemic, which made nurses more visible than ever, are expected to make it worse. But nurses in the field and scholars in the School of Nursing are pushing for policy reforms, researching the root causes and effects of the critical issues facing the profession, and implementing new evidence-based tools to improve working conditions and patient outcomes. Silence is not an option. Neither is suffering.

“Advocacy is a pillar of our profession, whether we are advocating for the patient or we’re advocating for the profession. Without that, we actually lose a vital part of our practice.” — Dean Linda Scott

“Advocacy is a pillar of our profession, whether we are advocating for the patient or we’re advocating for the profession,” says School of Nursing Dean Linda Scott, PhD, RN, NEA-BC, FNAP, FAAN. “Without that, we actually lose a vital part of our practice.”

Last fall, Scott was among a group of 11 nursing school deans from around the country who pushed for action to address well-being, resilience, and suicide prevention among students. The American Association of Colleges of Nursing (AACN) adopted their resolution, encouraging academic leaders to offer programs, screenings, and support for nursing students, faculty, and the campus community to help manage mental health and prevent suicide and burnout.

Prior to the pandemic, nurse suicide rates were higher than the general population, and Scott says attention to the issue is even more critical as the crisis lingers. “You can imagine what those statistics might be now after having been in a pandemic more than a year and knowing that we’re still not out of this,” she says. “No matter how resilient you are, there will still be moments where individuals are at risk.”

It has been about 20 years since Scott began studying nurse fatigue to understand the relationship between errors and nurses regularly working long shifts and overtime, a body of work that showed the need for increased nurse staffing and better fatigue management. Research remains a critical piece of advocacy, Scott says. “To make informed decisions, you need the evidence,” she says. “What research does is generate that new knowledge and provide evidence to help truly advocate for policy change.”

Research Meets Practice

Hospital-based nurses experience the highest rates of turnover in the profession, but the existing methods for measuring their occupational stress are decades old, Pavek says. So, she is digging into whether those tools reflect current nursing practice and are still valid and reliable. She is also trying to identify profiles of nurses who have high levels of stress and coping abilities in order to compare their characteristics with nurses who also have high stress but low coping abilities.

“If we can identify these kinds of profiles of nurses, we may be better positioned to identify them upstream and help them navigate occupational stress or stress in general by developing more appropriate coping strategies based upon their profile rather than a one-size-fits-all approach,” she says.

For some nurses, a mindful breath before entering a patient’s room may be helpful, but for others it may not. Pavek sees that as the next phase of her research: how to build more tailored interventions for stress management.

There is a wide spectrum of how nurses experience stress, says Élise Arsenault-Knudsen, MS’10, PhD’19, who works as a clinical nurse specialist at UW Health. “Some people can bounce back in five minutes; some people take five hours; some people might need a week off,” she says. “But right now, we don’t have great processes to accommodate that level of individualization.”

Arsenault-Knudsen recalls a conversation with a nurse manager who recounted the reality of nursing care — that when a patient codes and dies, whether expected or unexpected, the process nurses follow immediately afterward doesn’t change. “You do postmortem care, you take care of what needs to get done, that room gets cleaned, and that nurse has another patient to take care of,” she says. “There’s not often really time for recovery and processing those emotions.”

One of the ideas that the pandemic has reinforced is the image of the “super nurse,” says Arsenault-Knudsen, which speaks to how nurses in our society are held up as heroes; but that can work against them exercising self-care and advocating for workplace changes that promote well-being. The construct, outlined in a 2015 paper by School of Nursing Professor Linsey Steege, PhD, and Jessica Rainbow, PhD’18, now an assistant professor at the University of Arizona, is a major barrier to addressing fatigue.

“In my opinion, this image of nursing should be challenged; we don’t need to be perpetuating this,” Arsenault-Knudsen says. “If you think that you are supposed to — as a new nurse — aspire to be the superhuman, then that’s a tall order.”

In her role at UW Health, Arsenault-Knudsen helps nurses conduct and use research to bolster their practice. In her role, she oversees a UW Health committee for nursing practice guidelines; one guideline that was adopted even before the pandemic provides a set of recommended strategies to prevent and mitigate nurse fatigue. During her graduate studies, she did research on nurse fatigue with Steege, and says she learned the importance of systems-level changes to decrease fatigue and burnout among nurses.

“You could have a perfectly well-rested, well-hydrated, well-fed nurse who’s done all of their mindfulness and resiliency training,” Arsenault-Knudsen says. “[But] if nurses, no matter where they are, show up to an environment where there’s a number of things that cause them to have to work unnecessarily harder, either in a given day or over time, you really start to see that wear on an individual nurse, but also on a nursing workforce more broadly.”

In the last several months, she’s seen the visible exhaustion on faces of nurses she’s known for years who are typically upbeat, bright-eyed, and optimistic. For her, that adds to the urgency to accelerate research and findings to make sure that systems can take up new practices to improve outcomes for nurses and patients. “I think one of the neat things about working at UW Health is the Academic Practice Partnership that we have with the School of Nursing and the ability to go across the street to one another and say, ‘Okay, well, what do you know? And what do we need?’”

Arsenault-Knudsen co-authored a study with Steege and fellow PhD candidates Hyeonmi Cho, PhDx’22, and Sarah Brzozowski, PhDx’21, that found the number of patients a hospital nurse or unit discharges in a 12-hour shift was a significant predictor of fatigue by the end. This kind of work can help predict fatigue levels among nurses and develop systems to proactively monitor and manage it, but much more research is needed, Arsenault-Knudsen says.

“We don’t have a robust body of evidence to go from to say, ‘If you do these five things, you will have decreased fatigue,’” she says. “One of the fundamental reasons for that is because we’re still humans caring for humans, and so there are so many different variables to consider.”

Systems Change

Brzozowski, a PhD candidate in the School of Nursing who has also studied fatigue, is the daughter of a nurse who told her not to follow in her footsteps. She didn’t listen.

She has devoted her research to creating systems that better support nurses. “At the center of that is the patient,” she says. “If you can do that, it only increases the quality and the outcomes for the patient.”

After studying Spanish and business as an undergraduate, Brzozowski returned for a nursing degree, inspired in part by the nurses she met while volunteering at the hospital where her mom worked. “One thing that stood out to me was how humble nurses were,” she says. In her current professional role as director of Magnet® and Nursing Excellence at UW Health, her job is to recognize nurses for their work. “It’s the most amazing job ever,” she says. “You talk to a nurse and they’ll say, ‘Well, that’s just what I do.’”

Brzozowski’s dissertation is focused on professional nursing practice, leadership, and job satisfaction in primary care across the country. And because leadership models have not been tested in primary care settings, she’s also looking to understand what practices can — or can’t — be translated and transferred from one setting to the next so leaders and nurses have what they need to be successful and patients have great outcomes.

Brzozowski, who also has an MBA and is fascinated by organizational culture, conducted a study where she interviewed direct care nurses throughout the region about what they do and what tools they need to be successful, as well as their perspectives on their work environment and leadership. “If nurses share their voices to help us better understand their needs, we can build off of that,” she says. “This allows leaders to better understand how nurses are perceiving a situation or feeling about things, and what actions need to be taken to remedy them.”

Give Voice to Advocacy

Scott embarked on her research into nurse fatigue after the Institute of Medicine released its 1999 report — called “To Err is Human” — that revealed there were almost 100,000 deaths associated with preventable errors. The path of Scott and the nurse scholars that have come after her show how research can fuel advocacy by building a case for changing both organizational and legislative policy.

When Scott began, there was only anecdotal evidence about the connection between errors and how many hours nurses worked, but her research documented the relationship. “The more hours they worked, the greater the risk for error,” Scott says. “In order to really truly advocate for policy change, having that type of data really helps to move those changes forward.”

And Scott also says the biggest change she witnessed over time is how nurses have found more ways to advocate beyond the patient’s bedside. That includes efforts by some School of Nursing faculty members to push for changes to Wisconsin law to allow advanced practice registered nurses to offer care to the full extent of their education, training, and experience. In the 20 counties where there is not a practicing psychiatrist, a change to full practice authority for nurses would provide patients with much-needed options for mental health care.

“We have always been rated the most trusted profession among the public, but yet nurses don’t tend to be at the decision-making table — whether it’s in the boardroom or in the political arena,” Scott says.

Scott says School of Nursing students begin building that mindset through participation in events where they can influence policy, such as Nurses Day at the state Capitol. The event typically draws 1,000 RNs, APRNs, student nurses, and nursing faculty who receive training to prepare for group meetings with legislators. DNP students learn how to write policy briefs and how to advocate at that level, she says.

“You’ve got two minutes for that elevator speech — how are you going to grab the attention of a legislator and hopefully sell your case?” she says. “It’s making sure that we use our voice in that way.”

Advocacy in the Age of COVID-19

Researchers document the toll

A new study from School of Nursing researchers reported for the first time on the poor sleep, elevated fatigue, and psychological problems of hospital nurses during the COVID-19 pandemic in the U.S. “The levels of post-traumatic stress, depression, and anxiety are worrisome,” according to the study released in November. Nursing staff experienced poor sleep, fatigue, and multiple psychological problems during the COVID-19 pandemic, researchers reported. Staff who were involved in the care of coronavirus patients, worked more than 40 hours per week, and skipped 30-minute breaks showed generally worse self-reported outcomes. The researchers, including Professor Linsey Steege, PhD, and PhD candidate Hyeonmi Cho, recommended that nursing administrators:

  • Monitor for fatigue and distress on nursing units
  • Revisit current scheduling practices
  • Reinforce rest breaks
  • Provide access to mental health and sleep wellness resources with additional support for their frontline nursing groups

No One’s Punching Bag

Katie Pavek ’08, PhD’21, sometimes bore the brunt of frustrations from depleted families and patients when she worked as a nurse in general medicine and geriatrics. “I’ve been called about anything you can think of,” says Pavek, now a clinical instructor in the School of Nursing.

Pavek was grateful for more experienced mentors on her unit who set an example for how to set boundaries. “In no other profession would you walk into somebody’s office or workplace and chew them out or swear at them or call them names, and it would be OK,” she says.

“Ninety-nine point nine percent of the time, I would politely excuse myself in the situation and give them time to calm down and come back, and there’d be an apology the minute I walked in the room.”

In a new study Pavek co-authored with Hyeonmi Cho, PhDx’22, and Professor Linsey Steege, PhD, on workplace verbal abuse experienced by nurses, 80 percent of participants reported experiencing verbal abuse from patients or their families. The authors note that nurses are viewed by patients and families as people who will “listen to anything.”

Nurses in their 20s reported more verbal abuse from physicians than their counterparts in older age groups, and those who experienced verbal abuse from physicians or other employees were less likely to feel comfortable reporting safety problems. The study recommends more interventions and education, especially for early-career nurses, and more efforts by nursing leaders to monitor instances of abuse and resolve them.

Pavek says she works to help nursing students understand that “we’re not punching bags,” while also having the compassion to recognize when people are struggling to find the balance between taking it in stride and sticking up for themselves. “As long as your patient is safe, you can always walk away,” she says.

Looking at Health Through a Different Lens

Nicole Thomas

A conversation with PhD student, Nicole Thomas, and faculty advisor, Prof. Lisa Bratzke

By Alexander André

Nicole Thomas
Nicole Thomas, PhD student, RN

As high school was coming to a close, Nicole Thomas, PhDx’23, RN, project assistant at the UW–Madison School of Nursing, wasn’t sure what path was in her future. She was working as a personal care giver in community-based residential homes. While much of that experience felt right, the way forward wasn’t clear. “From early in childhood, I recognized I was a bit of a caretaker. That was just an inherent part of my nature,” explains Thomas. “I was that type of person that just wanted to extend myself to help people along the way.”

Lisa Bratzke
Lisa Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA, Assoc. Professor, School of Nursing

Thomas ended up finding a pamphlet about practical nursing, and things just clicked. “I started my journey as a nurse, and I absolutely loved it; from that point I realized, ‘Yep, this is what I’m going to do!’” Her journey has brought her through many different perspectives of nursing, from bedside to research. Under the advisement of Lisa Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA, Thomas is using her PhD program to develop research in the burgeoning field of epigenetics and the intergenerational transmission of trauma.

What led you to pursue your PhD?

NICOLE THOMAS: I know a lot of people approach their nursing careers and education differently, but starting out as a personal care worker, and then a CNA, then a practical nurse, then an associate degree nurse, and then a BSN has allowed me to see the effects of nursing care through different lenses. It’s been a good evolution to help understand how the different social dynamics that are occurring in the world can lead to the embodiment and manifestation of health.

The path to my PhD really started in my last position, which was research oriented. The principal investigator (PI) was a maternal fetal medicine doctor, and her study was looking at the health of women with postpartum hypertension. Based on her hypotheses and research design, she implemented a postpartum program for remote patient monitoring of women at risk for severe high blood pressure. My job was to monitor the patients daily, and then implement interventions based on our nurse-driven protocol.

Though we didn’t have a lot of women of diverse ethnic backgrounds in the program, from an anecdotal perspective, it often appeared that participants who identified as women of color to have higher and more aggressive blood pressures. Often what I was implementing also didn’t seem to have the same effect on these participants as it did for the white participants with the same diagnoses, with or without similar socioeconomic status. This kept happening, and I started asking questions about why this was happening.

Although some may find this controversial, I view race as a social construct, not a biological factor, so why am I seeing increased incidence of women of color exhibiting these symptoms seemingly more severe, especially when from similar socioeconomic backgrounds? I started doing my independent research after speaking with my PI, who introduced me to the weathering hypothesis. The weathering hypothesis was formulated by Arline Geronimus, Sc.D., and it discusses how the effects of systemic and interpersonal racism can be embodied within people, and essentially manifest symptoms. That was really my “a-ha” moment.

How are you applying your experience to your research?

THOMAS: Essentially, I have taken the experiences that I’ve gained at the bedside and my prior research position, and decided to look into how they relate to Native American women in the United States. I’m really interested in learning how current societal constructs can perpetuate the effects of historical trauma, the subsequent effects on health, and the pathways in which traumas can transmit to future generations.

There are theories saying that genetic changes and epigenetic changes may occur from historical and other types of trauma, which can be passed down from potentially heritable and non-heritable pathways. My interest focuses more so on the potential epigenetic changes resulting in non-inheritable pathways of trauma being reproduced and ways to mitigate these risks by assessing the upstream determinants of policies in and outside the health sector contributing to this cycle. I’m interested in looking at why and how disparate outcomes are occurring from a different lens, an indigenous lens. I am approaching this research from specifically an indigenous lens, with decolonized approaches, to match the resiliency, life experiences, and the epistemology of a culture that may not be in alignment with westernized medicine. It’s a really interesting topic for me that I’m hoping to become more of an expert on.

LISA BRATZKE: The other thing [Nicole] is looking at is health equities, and what she’s finding is that some of what typical western medicine considers good health outcomes may not encompass outcomes important to many Native American people. We don’t even have the tools necessarily to measure what these good health outcomes could look like because no one’s really taken the time to learn what good health outcomes are within that native population. That sets a whole other sort of wheel in motion around health care, and what we need to be advocating for and thinking about when we’re taking care of our patients.

“Being an advocate is always something we’re doing for our individual patients, but I also think that nurses have the ability to affect change within their communities, at the national and even global level by advocating for equitable health practices to be implemented within policies.”
— Nicole Thomas

How important is advocacy to nursing, and how are you incorporating it as you work on your PhD?

THOMAS: I think that nurses in general have the term “advocate” embedded within them! That is what we do in bedside nursing. Being an advocate is always something we’re doing for our individual patients, but I also think that nurses have the ability to affect change within their communities, at the national and even global level by advocating for equitable health practices to be implemented within policies.

For me, I feel that any type of policy is a health policy, even if originating outside the health sector. All policies have the risk to overflow into other areas of life, which could then affect people’s health. I don’t have a wealth of policy knowledge, but what I’ve observed over the years is that elected officials are typically going to represent the concerns from their constituents who represent the majority. Yet, as nurses, we know and see that much of the health policy formation that is most needed is usually for our underrepresented populations.

If patients are underrepresented in health care settings, it’s my assumption that they are likely underrepresented constituents as well. My logic guides me to believe that this is a barrier for policy formation among the underrepresented. As nurses, and as one of the largest workforces, I feel it’s important for us to act as unified representatives in our community to represent those groups who don’t have the support in numbers behind them.

I think some areas that have been under-investigated in native populations may be related to the upstream determinants of health. By identifying what upstream barriers are occurring from a socio-political standpoint, we can advocate, support, and implement more effective policies that enhance health and look at their potential outcomes holistically.

BRATZKE: Advocacy is really a huge part of why Nicole’s research is so important, because she’s not only teaching patients how to advocate for themselves, but also encouraging communities to form solidarity and advocate for their neighbors. There are different populations that are more vulnerable than others, and different populations that are less likely to advocate or be able to advocate for themselves.

Part of nursing research is to build the science, and when you build the science, you’re better able to advocate for newer or different treatments. Things like precision medicine; as we’ve been able to build the science, we’re better able to advocate for our patients in terms of what they actually do or do not need.

THOMAS: We have the knowledge of the health of populations because we are working with patients at the bedside and seeing how policies may be affecting their lives directly and indirectly. We have that insight, that powerful insight, that allows us to speak to and advocate for people who may not be able to make those connections, and we have the ability to articulate to representatives on the hill.

I think that nursing is an important discipline that is able to transform health in the United States. I’m proud to be a part of that; I’m proud to be at this university.