50 Years of Excellence in Education
Unwavering Dedication to Teaching Skilled, Compassionate Nurses
The School of Nursing evolved in response to the needs of the people of the state of Texas. In the decades following World War II, an acute shortage of nurses prompted state officials and nursing leaders to examine resources, concluding that education—new programs and new facilities—was the answer.
In 1956, a Texas study found that nursing needs were great, and resources were meager in the state, and yet, no recommendations were made. In 1963, Gov. John Connally described the state as “a depressed educational area” and asked for emergency legislation. To determine Texas’ education needs, a committee chaired by prominent San Antonio builder H.B. Zachry was appointed. The nursing subcommittee on nursing education was chaired by Sister Mary Vincent O’Donnell, RN, CEO of Santa Rosa Hospital in San Antonio.
The findings of this subcommittee became a landmark in the state’s position on nursing education. Notably, the subcommittee recommended that all nursing education take place in academic institutions. Also, they recommended additional graduate programs, continuing education programs and nursing doctoral programs.
In 1969, after intense lobbying efforts, Gov. Preston Smith signed an enactment of a bill authorizing the School of Nursing in San Antonio.
BECOMING A REALITY
Founding Dean Margretta Styles, Ed.D., RN, FAAN, established the school along with four original faculty members: Debra Hymovich, Nancy Maebius, Suellen Reed and Ruth Stewart. With the dean and faculty in borrowed space, students were taught in borrowed classrooms in the medical school.
Uniquely, the San Antonio nursing school was founded under a statewide network, headed by Dr. Marilyn Willman, called The University of Texas System School of Nursing. During this time, each of the nursing schools in the statewide system taught a common curriculum, making it feasible for students to transfer across campuses and allowing for wide dissemination of ideas, expertise and methodology.
When the school opened for classes in 1970, a baccalaureate degree in nursing was offered. The school had 16 faculty and 42 students in dedicated space, a learning lab, and a film loop projector for visual reinforcement of learning. By the fall of 1972, a master’s degree in nursing was offered with 28 students enrolled.
Also in 1972, groundbreaking for the first nursing building was held. Faculty and students moved into the new $3.8 million facility in 1974. In 1996, faculty and students moved in to the 41,600-square-foot building expansion. A $27 million renovation began in 2017 in both buildings, and the recently completed project promotes student/faculty interaction while offering the most advanced audiovisual and laboratory learning environments.
The Family Nurse Practitioner program, which opened in fall 1974, was one of the first in the country to be approved by the American Nurses Association and was funded by the Kellogg Foundation.
In 1976, The UT System Board of Regents reorganized the systemwide school, and San Antonio’s School of Nursing was placed administratively within The UT Health Science Center at San Antonio, which is now known as UT Health San Antonio.
While doctoral courses were offered as early as 1976, these were affiliated with the UT Austin program, which was among the first in the nation. In July 1990, a Ph.D. in nursing was approved by the Texas Higher Education Board to be offered at UT Health San Antonio. This B.S.N. to Ph.D. program was a partnership between the Texas Tech University Health Science Center School of Nursing in Lubbock and the School of Nursing.
In 1991, eight students were enrolled on the San Antonio campus; by 1993, 19 students were enrolled in the collaborative program. Courses were shared by faculty and students from the two campuses and videoconferencing became a staple for classes. Faculty and students travelled to the partnering campuses to co-teach and take the courses.
The benefits of the collaborative Ph.D. program strengthened the capacity for both campuses to establish a local doctoral program.
Profound changes in the increasingly complex health care systems have mandated change to improve quality of care while reducing costs, improving access, eliminating disparities and promoting safe practice.
In 2004, the American Association of Colleges of Nursing (AACN) differentiated the doctoral research degree (Ph.D.) from the practice-focused doctorate (D.N.P.). The D.N.P. program prepares experts in specialized advanced nursing practice with a focus on transformative evidence-based practice. The D.N.P. is designed as the highest possible degree for nurses committed to clinical work in an advanced specialty area. The D.N.P. is an outgrowth of increasingly complex health care systems that require nurses to understand leadership, policy, economics, quality and safety issues; apply and translate research into practice; and to be leaders of multidisciplinary practice initiatives.
|“The rewarding outcome of 50 years of educating nursing students is the thousands of UT Health nursing graduates who have been or are now helping patients in a variety of positions throughout Texas and the nation. Many of our nurse graduates care for patients, and many hold senior positions in hospitals, clinics, community facilities as well as educational institutions. This is a legacy for which we can all be rightfully proud.”
—Patty L. Hawken, Ph.D., RN, FAAN Former Dean and Professor Emeritus
The school embraces excellence in learning and teaching. From its beginnings 50 years ago, the program has evolved to meet the needs of individuals, families and communities in an increasingly complex health care environment. Through our response to change, we have maintained our commitment to educating the next generation of compassionate, culturally proficient nursing professionals at all levels of nursing education.
With baccalaureate, master’s and doctoral programs, the School of Nursing, as its mission states, develops diverse nurse leaders to improve health and health care through education, research, practice and community engagement.
The school educates students to serve as direct care providers, clinical leaders, administrators, nurse practitioners and nurse scientists. These tiers of education provide a ladder for advancement of nurses to full potential.
Bachelor of Science in Nursing From the beginning, the undergraduate program provided an opportunity for students to enter nursing education at the junior level, having completed pre-nursing prerequisite courses. Nursing courses included nursing theory and practice across fundamentals, medical-surgical nursing, maternal-child nursing, community health and psychiatric-mental health nursing with emphasis on leadership and nursing science. Many key elements of this forward-looking curriculum continue in today’s undergraduate program. Students can earn clinical or research distinction on their transcripts. The upper-division B.S.N. program has a traditional track and an accelerated track. The 22-month traditional track is designed for students earning their first baccalaureate degree and can be completed in four semesters of full-time study. The 15-month accelerated track is an intense program, which also includes four semesters of full-time study, designed for students who earned a bachelor’s degree or higher degree in a field other than nursing.
Beginning in the summer of 2019, the School of Nursing is emphasizing primary care experiences at the undergraduate level. Professor Norma Martinez Rogers, Ph.D., RN, FAAN, and her team received a $2.5 million grant from the Health Resources and Services Administration (HRSA) to support revisions to the school’s curricula to place more emphasis on primary care nursing. Following recommendations from the Josiah Macy Jr. Foundation’s 2016 Annual Report, the program is dedicated to increasing the number of primary care health professionals to meet America’s health care needs. The grant helps the school build a nursing workforce to serve the needs of patients who are at a disadvantage due to adverse social determinants of health.
Master of Science in Nursing The M.S.N. is a traditional program for students who have a B.S.N. degree. Available majors are Administrative Management (AM) and Clinical Nurse Leader (CNL). The nurse practitioner specialties will be transitioning to the D.N.P.
Post-Graduate Certificate A Post-Graduate Certificate option is available for M.S.N.-prepared nurses interested in obtaining a secondary specialization. Available specializations include: Adult Gerontology-Acute Care Nurse Practitioner, Family Nurse Practitioner, Pediatric Nurse Practitioner Primary Care, and Psychiatric Mental Health Nurse Practitioner.
Doctor of Philosophy in Nursing The Ph.D. in nursing prepares students for careers as independent clinical nurse scientists and academicians. Admission can occur at the post-B.S.N. or post-M.S.N. levels. The doctoral program is rooted in theory and research to add to the underlying science of nursing. The degree is granted through the Graduate School of Biomedical Sciences.
Doctor of Nursing Practice The D.N.P. degree had its first five graduates in 2013, which is the same year it was accredited by the Commission on Collegiate Nursing Education. The D.N.P. program offers three post-master tracks in Advanced Practice Leadership, Executive Administrative Management and Public Health Nurse Leader. The D.N.P. curriculum emphasizes core leadership courses in public policy advocacy, improving organizational effectiveness, health informatics and financial and business management; scientific inquiry based on translational science and evidenced-based practice, population-based research; and advanced specialty clinical practice.
As part of the evolution of the curriculum, the school has moved the nurse practitioner tracks into the D.N.P. program. Beginning fall 2019, the D.N.P. will be offered as a B.S.N.-to-D.N.P. program. In the D.N.P. program, students identify health care practice gaps and use best evidence to make improvements. Prior to graduating, students identify a problem within the health care system and create, implement and evaluate solutions.
The B.S.N. to D.N.P. program prepares them for nurse leadership and clinical practice. Students can choose from five areas of specialty practice: Adult-Gerontology Acute Care Nurse Practitioner, Family Nurse Practitioner, Psychiatric Mental Health Nurse Practitioner, Pediatric Nurse Practitioner Primary Care and Public Health.
It is clear today that the impact of the reports by the Institute of Medicine, the National Academy of Sciences and AACN on nursing education has been immense. The School of Nursing responded with deep revision of the undergraduate and graduate curricula to address the needs of the nursing workforce in today’s health care world and in the future, using the AACN essentials as guides. The school’s B.S.N., M.S.N., D.N.P. and post-graduate certificate programs were accredited for a 10-year period through 2028.
The curriculum continues to evolve in response to health and health care needs and to the continuing expansion of knowledge and technology. It remains flexible, so it can be reshaped quickly as needs change.
Nursing education is accomplished through classroom, clinical and simulation experiences. The School of Nursing was the first in the area to develop and test new models of clinical nursing education—beginning in 2011 with the dedicated education unit (DEU) followed by the student nurse internship program in 2016. These academic-practice collaborations greatly enhance the student learning experience, accommodate increased student enrollment, balance a chronic faculty shortage, and ease student entry into professional practice after graduation.
In the DEU model, the school and the health care facility partner to teach students using a collaborative academic-service model. Experienced nurses volunteer to be preceptors for students and work together for the entire clinical rotation, in tandem with the faculty. The school’s experience with DEUs is showing mutual benefits for students, clinicians and faculty. Jennie Shaw, M.S.N., RN, CNE, associate professor/clinical, who oversees the DEU, evaluates the impact on the student learning experience and the benefits to the health care institution across medical-surgical, mother-baby, and pediatric courses.
Another successful collaborative model, the Nursing Internship Program, began in partnership with the Methodist Healthcare System in 2016. The Nursing Internship Program at Methodist Healthcare System was created in the fall of 2015 after Cynthia O’Neal, Ph.D., RN, associate dean for undergraduate studies, traveled to El Paso to learn about an internship program with Jamie Lingsch, M.S.N., RN-BC, vice president of clinical and professional education for Methodist Healthcare System, and Annie Garcia, chief nursing officer of Methodist Texsan Hospital. The program provides undergraduate students opportunities to gain invaluable experience during a paid internship that culminates in employment as a registered nurse.
Undergraduate students in their seventh semester can apply to the program. Nursing faculty and Methodist nurse managers interview the high-achieving students and question them about their interest in particular units, five-year goals, work styles and ability to handle stress.
The students complete their immersion hours with the same preceptor as the internship preceptor, their leadership/management hours in the same facility, and their RN competencies and orientation objectives during the internship. Students receive payment for their internship hours and sign a contract for a two-year commitment to Methodist Healthcare System after they graduate. They are hired into an RN position at the end of the internship in the unit where they interned. The first nine students began the program in January 2016 and completed it when they graduated in May 2016. Since then, 122 students have completed the program with 16 interns in the spring 2019 group. Methodist has a 99 percent retention rate of interns with 100 percent passing the NCLEX.
In 2018, the academic-practice concept was expanded to include veteran health care. The Department of Veterans Affairs granted the South Texas Veterans Health Care System (STVHCS) funding for five years for an internship called the VA Learning Opportunities Residency (VALOR) Program. The VALOR Program is for outstanding nursing students who have completed their junior year. During the internship, two students each year provide health care services to veterans at the system’s Audie L. Murphy Memorial VA Hospital, which is adjacent to UT Health San Antonio.
The program supports successful transition of undergraduate students to B.S.N.-prepared registered nurses at the VA. The program is helping the system reach the recommendations in the IOM’s 2010 report of increasing the number of nurses with baccalaureate degrees from 50 percent to 80 percent by 2020.
VALOR collaboration between nursing faculty and nursing staff preceptors receives positive reviews by nurse managers, faculty and students, yielding highly qualified new graduates who are confident in their skills and familiar with the VA system. VALOR Program Coordinators Victoria Dittmar, M.S.N., RN, CNE, clinical faculty coordinator for the VA/UT Health Dedicated Education Unit, and Wesley Richardson, Ph.D., M.S.N., RN, CNL, track coordinator for the school’s Clinical Nurse Leader Program, work with Nancy Cuevas-Soto, D.N.P., RN, NEA-BC, STVHCS chief of nursing education, on the VALOR internship.
The School of Nursing continues to excel in interprofessional education initiatives. In support of UT Health San Antonio’s Quality Enhancement Plan (QEP), which is known as “LINC: Linking Interprofessional Networks for Collaboration,” three faculty in the nursing school were recently awarded inaugural LINC Seed Grants for innovative interprofessional education (IPE) projects.
Associate Professor Marie Danet Lapiz Bluhm, Ph.D., RN, M.S.C.I., holder of the Roger L. and Laura D. Zeller Distinguished Professorship in Nursing in Memory of Doris L. Heizer, RN, and her interprofessional team received one of the seven LINC Seed Grants for her project, “Promoting Interprofessional Collaborative Education (PrICE) for Veterans Project.” Carole White, Ph.D., RN, Nancy Smith Hurd President’s Chair in Geriatric Nursing and Aging Studies, and her team received a grant for an interprofessional project, “We Care: Learning Together to Support Family Caregivers.” Adelita Cantu, Ph.D., RN, associate professor, and her interprofessional team received a seed grant for their project, “Trifecta: When Social Determinants of Health, Interprofessional Education and School Based Prevention Program Meet.”
Interprofessional education is not new to the school. In June 2018, the School of Nursing and the School of Health Professions’ Department of Physician Assistant Studies partnered on several pre-clinical skills lab interprofessional opportunities. The school welcomes Joseph Zorek, Pharm.D., as an associate professor and as UT Health’s first director of Linking Interprofessional Networks for Collaboration (LINC).
The School of Nursing enthusiastically embraces interprofessional education, and we look forward to serving as a catalyst for building an IPE workforce.
“An initial dedication to excellence in curriculum development and teaching laid the foundation for 50 years of success at this school. The new nursing program for the first class of baccalaureate nursing students emphasized integrity, diversity and caring. The continued commitment to excellence over these 50 years has advanced the health of our community and the nursing profession.”
— Nancy K. Maebius, Ph.D., RN Founding Faculty Member
The success of the School of Nursing is predicated on the excellent clinical care that is provided by the professional nurses as they graduate. An ongoing interest in student success has led the school to develop programs that support students through each stage of application, admission, matriculation and successful graduation from our programs to reach their goal as professional nurses.
Foundational to our current student support center, Dr. Martinez Rogers, professor of nursing, designed and implemented the Juntos Podemos (Together We Can) program. Because program completion rates for Hispanic nursing students fell below the rates of their peers, Juntos Podemos offered a mentoring program designed to assist students. The program reduced the negative effects of educational and social disparities that some experienced in nursing school. Mentors and mentees experienced academic success as well as development of leadership skills and cultural proficiency. A remarkable 98 percent of students who participated in Juntos Podemos were academically successful.
STUDENT SUCCESS CENTER
In the summer of 2014, the UT Health San Antonio School of Nursing—a Hispanic Serving Institution with a majority under-represented student enrollment—approved a comprehensive student success initiative to address specific challenges faced by students through effective strategies chronicled in higher education research. The school enrolls a significant undergraduate population of first-generation and low-income students who face unique challenges upon matriculation into nursing education.
David Byrd, Ph.D., associate dean for admissions and student services—along with Vanessa Meling, Ed.D., assistant dean for academic enhancement, and Darpan Patel, Ph.D., associate professor/research—received a $2.5 million Title V grant from the U.S. Department of Education for the center. The Student Success Center offers a variety of student services, programs and facilities that are available to help students transition successfully to the professional environment and receive maximum benefit for the total nursing school experience.
The Student Success Center provides students with a full spectrum of academic support beginning with first-semester peer mentoring and continuing with academic preparation for their licensure exam after graduation. Most of the services are located in a centralized center in the School of Nursing.
The center offers a variety of services, including academic coaching, supplemental instruction, personal tutoring, peer mentoring, and undergraduate research programs that facilitate engagement with faculty and staff. The center also assists students with academic enhancement workshops to address common problems (including test anxiety, note taking, reading strategies and scholarly writing) that students might face.
THE WAY WE TEACH
The picture of teaching and learning in 1969 has changed remarkably in 50 years. Not only have the curriculum and educational goals changed to respond to societal needs, the teaching/learning strategies have greatly evolved. Since the pioneering days in America, students in classrooms functioned around chalkboards, textbooks and paper essays. Nursing education used these basic tools as well.
The impact of the science of education and the evolution of technology in recent years have drastically changed nursing education. Rather than book-based, learning has drastically swung to advanced technology and interaction. Primary resources are now digital and online with immediate access. Online courses provide a direct learning process comprised of information from articles, videos, images and web links, communication such as messaging and discussion forums, and strategies to measure students’ achievement.
Faculty interact, direct and provide feedback to students. Today’s technologically savvy students can sit down with their laptops or smart phones and study anywhere together.
Group-based activities to reinforce learning and communication skills have replaced isolated study. Large, open and flexible classrooms accommodate today’s student-centered curriculum and enable group-based activities to reinforce learning and communication skills.
Group learning in open classrooms is accommodated in the newly remodeled School of Nursing. Self-directed learning encourages student skills in searching for answers independently or collaboratively instead of rote memory and being lectured facts. These critical thinking skills serve the professional nurse beyond school.
Students are encouraged not only in development of clinical judgment and skills but are also guided to develop commitment to the professional, ethical and compassionate practice of nursing throughout their career. In January 2019, the first official event celebrating the School of Nursing’s 50th anniversary year established a new tradition: the White Coat Ceremony for first-year students. Nearly 120 incoming Traditional Bachelor of Science in Nursing students and 286 current Traditional B.S.N. students took part in the ceremonies. The White Coat Ceremony “serves to welcome students to health care practice and elevate the value of humanism as the core of health care,” said Eileen T. Breslin, Ph.D., RN, FAAN, nursing dean.
One area of major change in the education of nurses is in the clinical skills laboratory, where students acquire technical nursing skills. In the school’s earlier years, teaching assistants guided small groups of students through the steps of skills using rubber body models, Resusci Anne, or perhaps even a Raggedy Ann-style fabric doll. Students repeated skills until their performance was acceptable; this was the time-honored strategy that was best practice for many generations of students.
Technology has changed how nurses and students acquire hands-on skills and critical thinking abilities during their education. Faculty use computer programming to set the scene for clinical care in mock clinical settings. High-fidelity simulation manikins in adult male, female, child and infant forms are programmed to present clinical scenarios, to which students respond by assessing the health problem and providing direct care. The manikin responds to the care with the health condition getting better or worse. Student actions can be recorded for later to refine and reinforce the care choices made during the clinical episode.
CENTER FOR SIMULATION INNOVATION
Because of a communitywide effort in 2012, the school opened the Center for Simulation Innovation, a state-of-the-art 7,281-square-foot clinical simulation center equipped with specialty rooms, simulation manikins, and video recording capability to provide near-real clinical experiences. This instructional mini-hospital and home health setting provides hands-on teaching for students to develop their ability to appraise and respond to unique clinical situations and reflect on whether they did the right thing at the right time. High-tech manikins are integrated into this high-fidelity clinical environment, creating a virtual hospital. The hospital setting includes an ambulatory care suite, a medical-surgical unit, intensive care unit, trauma center, maternal-child center, and pediatric care suite.
Sophisticated patient scenarios are programmed, and students practice physical assessment and decision making as well as technical skills. The advantages of this new learning environment include the opportunity to practice with no risk to live patients. Faculty can assess and build students’ strengths prior to their entering the clinical setting and can present students with a broader range of clinical challenges.
The upsurge in technology has made possible applications in teaching and learning that were inconceivable a decade ago. In 1989, under the guidance of Jo Ann Crow, Ph.D., the school created the first Student Computer Lab with a grant from the Helene Fuld Foundation. This placed the power of computers in the hands of faculty and in front of each student, albeit at a desk. Students used Computer Assisted Instruction programs to individualize further learning. Educational discussions moved from 2-inch by 2-inch projected slides to PowerPoint to online tests and into fully integrated courseware that supports a wide array of learning resources, links to the rest of the world, discussion boards, and a venue for sharing class assignments. Students now can learn anywhere—courses are web enhanced and can be accessed through laptop computers, tablet computers, and today’s hand-held wonder, the smart phone.
Innovative approaches in education capitalize on engaging the learner in an experience or an assigned role. Total immersion into an altered sensory and cognitive reality helps develop a deeper understanding of a patient’s limitations, creating a reference point for individualized care. In addition to the simulation center, another example is the virtual dementia tour, which is part of a program called Caring for the Caregiver that is being developed in collaboration with the Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases at UT Health San Antonio. Participants wear obscured glasses, headphones emitting white noise and sensory-dulling gloves as part of this empathy training.
Students also learn through a poverty simulation program to grow deeper understanding of the challenges low-income people face and the decisions they make as a result. This understanding can aid in building trust and cooperation between provider and patient and can ultimately save lives. Nursing students take on the roles of widows, teen parents, disabled workers and single parents in an exercise designed to give them a glimpse into the lives of people struggling to make ends meet.
Essential to clinical excellence across a nursing career is the continuing education to stay abreast of developments. Professional development courses have been supported and offered to our nursing community as a commitment to the profession.
Today, the School of Nursing’s Department of Lifelong Learning continues to be accredited by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation, aligning with UT Health San Antonio’s commitment to provide continuing education to support lifelong learning. The department works with UT Health faculty and external clients from across the U.S. to provide the highest quality continuing education to nurses throughout Texas, the U.S. and internationally.
As the next decades bring ongoing and new challenges, the school remains committed to preparing caring and compassionate nurses and leaders to meet the challenges of environmental, societal and professional influences, exceeding expectations for excellence.
Our commitment is to educate the next generation of compassionate, culturally proficient nursing health care professionals at all levels of nursing education. More than 11,000 graduates of the School of Nursing are shaping health care practices of today and transforming the future of nursing and nursing care for tomorrow.