Today, UCI Medical Center in Orange, California, is well known as a successful teaching and research hospital. It is part of UCI Health, based at the University of California, Irvine, which includes, most recently, the Sue & Bill Gross School of Nursing, a research-intensive school with competitive student admissions. The hospital’s Magnet designation means that it performs at a standard by which patients can expect to benchmark the quality of nursing care as defined by the American Nursing Credentialling Center (ANCC). But in 1984, when Ellen Lewis arrived from Milwaukee County Regional Medical Center to take up her new role as UCI Medical Center’s director of nursing and senior associate director, the hospital was considered locally to be the care center of last resort, known by the unflattering nickname of “The Farm.” Its patients were, by and large, people with nowhere else to go.
Lewis’s administrative directive was to develop and implement the nursing standards expected at a university-level medical center.
“There were some great nurses working at the hospital,” Lewis recalls. “The staff were wonderful, but the level of qualification was extremely low when bench marked against other states, or even against Northern California.”
Lewis’s broad remit was also to investigate the feasibility of setting up a school of nursing at UCI, for which she knew she needed to demonstrate that nursing education and standards of patient care are inextricable from one another. Despite an immediate imperative to cut costs at the medical center, she set about recruiting a post-master’s clinical nurse specialist to every department, to role-model professional nursing.
“In California, every congressional district has a community college, and truly, there was a belief that that’s where nursing belongs. People think nurses just do bedpans. I have been asked by senior people at UCI, ‘Do nurses do research?’”
Ellen Lewis
Sourcing such nurses required a wide net: in the 20 years between UCI’s founding in 1964 and Lewis’s arrival in 1984, Orange County’s population had almost doubled – an increase of one million people – yet not a single educational institution in the county offered the opportunity for nursing qualification beyond community college level. The result was that any nurse who wished to develop their knowledge beyond a two-year RN certificate, or research any aspect of patient care, had to move elsewhere – and did.
“In California, every congressional district has a community college,” says Lewis, “and truly, there was a belief that that’s where nursing belongs. People think nurses just do bedpans. I have been asked by senior people at UCI, ‘Do nurses do research?’”
UCI’s founding chancellor, Daniel Aldrich, was emphatically not such a person: a school of nursing had always been part of his vision for the campus, as it was for the Irvine family who had sold their land to the University of California for a symbolic $1.00.
Aldrich and Lewis agreed that establishing an advanced nursing degree program within the existing UCI medical school would be a sensible first step towards meeting urgent local need for nurses’ education. And Lewis’s strategy of placing a qualified nurse specialist in every hospital department worked. The impact on standards of patient care was immediately apparent, winning the backing of hospital physicians for well-qualified nurses and for nursing education at UCI.
Thus began Lewis’s campaign to establish not just a program but an entire infrastructure for nurse training, education, and research that would make highly qualified care available to all citizens of Orange County, regardless of status, and provide a career path and opportunities that would help the county attract and retain the best of the profession. That effort has taken more than 30 years and involved many passionate advocates. Throughout those years, progress towards the ultimate goal – a school of nursing at UCI – was far from assured.
Nursing is everything for everyone. It’s a career that is rewarding. And it’s essential for good health. I don’t know where we would be as a society without the sheer hospitality of nursing.
Rev. Chineta Goodjoin
Pastor, New Hope Presbytarian Church
Susan Tiso, who retired as a professor from the Sue & Bill Gross School of Nursing in 2021, joined UCI from California State University, Long Beach in 1995. By this time, Lewis had succeeded in establishing a state-funded post-master’s family nurse practitioner program led by Mary Knudtson as part of UCI medical school’s department of family medicine. They were soon joined by Tiso’s former student, Susanne Phillips. To augment admissions, the program joined forces with California State University, Fullerton after the first few years, finally going solo with UCI’s own program in nursing science in 2007.
As Tiso points out, raising standards and providing opportunities to nurses have always been central functions of university nursing, but throughout the course of her career, nursing education has also needed to keep pace with rapid growth in the complexity of patient care.
“Healthcare becomes more complex with the increasing number of medications, drug interactions, and chronic diseases with intersecting problems – nurses need the science behind that,” she says. “Ellen [Lewis] had the foresight to say we need nurses educated at the baccalaureate level. She did a lot of work on what the workforce shortage was going to look like.”
Finding funds for teaching and research, Tiso explains, isn’t the only aspect of nursing education that requires investment: compared to doctors, nursing students themselves are overwhelmingly more likely to originate from less well-off families, and the financial obstacles they face in becoming better nurses can be all too real.
“We’ve had students who have pulled themselves out of very challenging situations to be here,” she says. “Students who’ve been homeless, who’ve been raised with absent parents, who’ve pulled themselves up to come here because they have a passion for it. Nurses in graduate programs are trying to work, they’re often taking care of a family, they’ve maybe got elderly parents – and nurses are the ‘go-to’ person for care in a family.”
Feizal Waffarn, a consultant neonatal ICU physician and benefactor who serves on the Sue & Bill Gross School of Nursing’s dean’s cabinet, describes further how nurses from lower income groups may be lost to education unless there are funds available to help support their time at university.
“If a newly certified registered nurse goes and gets work, she’s bringing home money her family needs,” he says. “If she stays at university and gets better qualified, that immediate income is effectively lost: it’s called ‘lost opportunity costs.’ This is why donor support is so important for schools of nursing like UCI. We want to make sure the most able nurses have the opportunity to get qualified to their maximum potential.”
Nurses are the backbone of the healthcare system and are present throughout a patient’s illness trajectory, whether that ends in recovery or death. Nurses not only possess the technical skill to render very complex care, but they must also develop skills in self centering and be able to remain fully present with patients in the most intimate circumstances that they ever face in life. I can’t think of a more honorable profession than nursing.
Paige Burtson, PhD (‘19), RN, NEA-BC
Senior Director of Nursing, Inpatient Oncology, Jacobs Medical Center – UC San Diego Health
In 2007, UCI’s program in nursing science began under the direction of Ellen Olshansky, who remained for seven years. The program provided an undergraduate degree course, a master’s program and, from 2013, a PhD program – all, as Olshansky says, “…without the predicted resources. The 2008 financial crash affected everything, and it was not possible to get funds for everything that we had been going to do.”
Despite its accumulating success, the significant funds needed to develop the nursing science program were not forthcoming. The future of nursing at UCI appeared to hang in the balance until, in 2016, a $40 million gift pledged by the William and Sue Gross Family Foundation changed everything. At last, 33 years after Lewis’s appointment to UCI Medical Center, her original aim was fulfilled. In 2017, the Sue & Bill Gross School of Nursing was founded at UCI.
The founding dean, Adey Nyamathi came to the school from UCLA to be greeted by, “a very passionate, very small group of faculty,” who had kept both their research and several thriving degree programs running in the intervening years, “bringing in students that were exceptional,” she says.
Nyamathi’s own career as a researcher – for which she is this year being honored with “Living Legend” status by the American Academy of Nursing – engrossed her completely: “I actually never thought about being a dean,” she says. Yet her research focus also meant she was ideally suited to build the new school’s research capacity, recruiting, and supporting exceptional academic and clinical faculty, and thus simultaneously enhancing student recruitment.
Nursing research differs from medical research in that it is specifically about wellbeing and care. As growing numbers of people live with complex combinations of physical and mental conditions, such care has increasingly left the hospital setting and involves patients’ real-life circumstances. For many patients, those circumstances are difficult and becoming more so, meaning that nursing research investigates areas that are ever more urgent for large numbers of individuals as well as for society as a whole.
“Nurses do seem to gravitate towards health disparities research,” Nyamathi says. “Finding solutions and improving the lives of populations that deal with the most significant disadvantages. Community nursing has always been my passion, and I’ve always been interested in supportive health promotion – how can we help people make the best choices? We’re changing the way healthcare is delivered.”
Nurses are united in their conviction that, wherever and however they work, care and compassion have always been and will always be the heart of the profession – which is exactly why research-based practice matters to nurses so much.
Mark Lazenby, the school’s current dean and Nyamathi’s successor, clarifies further: “Nurses’ compassion means wanting and needing to provide the best care possible – to promote or restore health or enable people to have peaceful deaths. Where will improvements in nursing care come from, if not from nursing research? Faculty at university-based schools of nursing educate their students on how to conduct research and quality improvement projects in real-world settings that elevate the level of nursing care for everyone, everywhere. What could be more compassionate – or more necessary – than that?”
