LM: My name is Lucretia McClure. I’m Librarian Emerita of the Edward G. Miner Library at the University of Rochester Medical Center. I’m delighted to introduce Dr. Loretta C. Ford, an internationally known nursing educator and the individual who came to Rochester to establish the School of Nursing in 1972. Loretta, what attracted you to Rochester?

LF: Well, there were several things. First of all, it was very difficult to leave Colorado. It’s my husband’s home and, uh, we really enjoyed being there. But Rochester offered us opportunities and, uh, great potential, not only for nursing and nursing education, in general. Um, so, um, it was the reputation of the Medical School and some of the physicians here that I knew. Dr. Haggerty, Dr. Hocolman, um, course Dr. Orbason was the Dean at that time and Jim Bartman who I worked with many years was the medical director of the Hospital. And, so, that group of physicians, uh, who I had known and some of them earlier, um, were most supportive of nursing and involved in the development of the model for unification here. So the reputation of the Medical School and some of the people there was important. Uh, the reputation of the University generally, um, the administration of the University had really made a commitment to founding a new school, and, um, that I found very exciting because it gave you an, uh, opportunity to be a founding dean and really develop something new and unusual. But very avant-garde. And of course, I’m very interested in, in doing things that haven’t been done before, so that was, uh, that was something that attracted me.

LM: And of course, nursing had a tradition here in the Department of Nursing and in the earlier days of the school had always had nursing, but not a full school of nursing.

LF: Right. One of the most important things about that that were, uh, I found most attractive from nursing viewpoint was that there were a fair number of faculty here that were practicing and were very clinically competent. And so, there wasn’t an organizational model, but there was a fair amount of, um, practice and educational connections that faculty were using and then there was a great deal of enthusiasm in nursing for the founding of a new school and also for the new model. And nurses had been involved with medicine and with University administration and, uh, the hospital administratives and bringing about this new model which had been funded then by Kellogg.

LM: Do you think that it was also just the right time for a School of Nursing to develop in the early 70s?

LF: Oh, absolutely. These were the years of Camelot, really. And I think it was, was a perfect time for nursing because there were so many changes in the profession. Another thing I must say about this, um, medical center is that while it was very oriented toward scientific medicine and scientific nursing in terms of some research, it was also very oriented toward the community and there were quite unusual community-based services that the University was involved in and certainly community planning for health. So we have a long history of, of a, of a town-gown relationship here that, uh, I, uh, found exciting. But in a way, most of all, it was the commitment of the alumni to practice that some of the things that the alumni had done in practice before and a commitment to it, um, made this a very rare place, I think, because over time they had, um, generated I think a lot of enthusiasm for practice itself. And so, um, I I I was attracted for all of these reasons.

LM: Loretta, you talked the reasons that you came to Rochester. When you arrived here, what kind of challenges did you find?

LF: Well, you know everybody wants to make change as long as it’s not in my backyard, right? [Faint chuckling] So, one of the challenges of course was to, uh uh, try to assure people that, first of all, there was going to be change. Uh, and that it would affect everyone, but hopefully they would have a chance to work it through and work with, uh, the changes that were being proposed. It was really very evolutionary. It was a heuristic model of of bringing about change because, um, there were many things going on. There was a hospital being built. Um, there is a lot to do in graduate education. There was a great deal to do in practice. And so, um, one of the challenges of course was to manage this change in a, in a reasonable way and and involve people in the change so they had some ownership of it. But, uh, it was a challenge. And when you’re talking about social change, uh, it’s threatening to a great many people. Um, another challenge of course was to recruit the kind of leadership in, uh, for the, uh, faculty and for practice. And, um, those um, we were looking for both research faculty and faculty who were committed to practice. We were looking to people who had assumed a great deal of leadership in nursing before, but who wanted to take on some new challenges. And there, it, it was very difficult because there weren’t that many risk takers out there who were senior faculty who could assume the leadership positions that were available in, in clinical chiefs and uh other positions. So, um that was, that was, that was very difficult in the early years. Then I think the expectations of people. This was a new position, the Dean and Director of Nursing was a new position and the expectation of, um, faculty of practice, uh, staff of a physicians, of University administration were expansive and extensive. Uh, for example, the faculty would love you to be a-available to them at all times, but then you were supposed to make the school, you know, a national model and to be available to, uh, be visible in the nation and that required me and others to travel and to, uh, talk about the model and to try to recruit people from other places. So these expectations were quite extensive and, um, I’m sure I didn’t always fulfill them because it was it really came to me how complex this situation was in terms of just trying to meet some of those expectations. You know, the University-

LM: -Well, you know, you were expected to be both the academic dean of the school but at the same time-

LF: -Right. [Chuckling]-

LM: -be the chief nurse of a 740 bed hospital.

LF: Right. [Chuckling] Uh, I ne-, it was a lot of fun but as I say the expecta- the other thing is this is a very different position. I mean, if you function like many deans had or like a director of nursing alone, you may have been more involved in administration than in leadership. You may have been more involved in procedures or processes rather than policy. You may have been involved in, um, representation at a much, um, different level than the expectation that was really generated by not only University, uh, or internal, uh, demands, but also by external demands, as well because people were watching Rochester ‘round the nation and, indeed, the world because they wanted to know about this. It’s an exciting time. It was a time when, um, nurses were just getting into clinical research. See, much of the research in nursing had been in and on nurses or on students or as educational research or administrative research or social sciences were looking at us in some way. But this refocusing of nursing research created a lot of very different, um, demands on the profession generally, but also it required us to get closer to the clinical areas, so of course, there was a lot of national interest in this.

LM: Loretta, would you describe the organizational structure that you found when you came to Rochester? It is a complex organization with, uh, a medical center and a university campus and you were involved with both.

LF: Mmhmm. Well, uh, when I came (something indiscernible is said here) had, he was a Chancellor then, he had identified, um, the characteristics of what he called the Focus University. And he said that, um, these were the kinds of, um, of elements that made up this special unique place. And he said it was small or medium sized. Uh, it was diverse. It had many facets to it. It was coherent. They fit well together. Um, it was advanced in the sense that it had graduate education and a lot of good research going on. It was a very responsible place. It was responsible financially. It was responsible for the academic excellence of the place. It was an independent University, a private University. And it also was rooted in the community and in the region. And I found that framework of his very helpful in building the unification model and it also really guided the organization of the, uh, school and the University generally. And these organizational charts are very complex, but if you look at a small part of it, you can see that the, uh, Academic Deans reported to the Provost and the President. Uh, that our responsibilities in nursing for the practice area were related to the hospital or the practice area. So it was a bifrication, where we reported to, um, both, um, heads, and yet the academic nursing was, just as any other academic unit had been, under the Provost and my reporting for nursing education, for example, always went that way because I was treated and expected to do just what every other dean was expected to do, as well as being the Director of Nursing in the hospital. So, you know, I had responsibilities in the Medical Center, as well as to the academic campus. Uh, in the School of course, um, that’s another comp- or in the Medical Center, that’s another complicated organization chart, but we had a chart that shows our responsibilities here and also how the the rest of the, um, um, members of our team were organized, like the Associate Dean for Nursing Practice and the Associate Dean for Nursing Education and then, um, there were clinical chiefs and that model was developed from the model that Clinical Chiefs in Nursing would be colleagues of Clinical Chiefs in Medicine, so is Clincal Chiefs in Medicine, like the Clinical Chiefs in Pediatrics or in Surgery, or Clinical Chiefs in in in, um, OBGYN-

LM: -So, that was a nursing counterpart?

LF: [Nods] As a nursing counterpart. And the idea was that nurses would not be reporting to those chiefs, but would work together in collaborative relationship for those areas that they were specialists in. And then onto the clinical chiefs, there were Clinician 1s, who were like the head nurse on the unit, and then faculty and Clinician 2 were of course responsible to the Clinical Chief, as well, and the nursing staff were under the Nurse Clinician 1. So, that-

LM: --and out of this would come clinical research?

LF: Right. Because, uh, the access, the expertise, um, the development of, you know, the body of knowledge of nursing would come from that collaborative effort that faculty would have with staff and of clinicians working as as nurse researchers, as teachers, as practitioners in nursing, and sometimes administrators because we expected the clinical chiefs to you know administer the services. And then, of course, uh, in in under Nursing Practice Dean, we had an Assistant Director of Nursing Practice and all of the core functions, like recruitment and continuing education and methods of improvement and business and payroll and personnel. So, all of those were, uh, in nursing because nursing had its own budget and it was responsible in practice, just as we were in education. So, that they were all organized under our a-, our, uh, administration. And, um, course, that provided us, in practice, the opportunity, under a unification of practice, education, and research, to look at the structure of practice because, um, when we were, uh, thinking about what we wanted to do clinically and in clinical research and the administration of services, we realized that there were many layers. I mean, the the hospital nursing service was organized, um, very traditionally. And it’s rather a pyramid, where there are aides and attendants, and LPNs, and registered nurses, and team leaders, and head nurses, and so, that tremendous numbers of layers of of people. When you organize in that way, and and that’s what was going on here, um, patients were cared for by aides and attendants and licensed practical nurses, and the registered nurses, uh, sometimes, frankly, were nursing the system rather than the patients. And so, uh, we felt that what we should be doing in terms of accomplishing our goals, not only for academic nursing but for quality nursing care, which which the alumni had left us a great heritage on was to alter this and to consider the patient our most important product, so to speak. And then put the the best qualified nurses close to the patient, with the clinical specialist and, uh, the licensed practical nurses serving in with the registered nurses. And then, have non-nurses manage the environment and the equipment. And that really was the mo- the base- the model that we developed in, um, organizing the various services. Um.

LM: Which is certainly standing nursing in good stead today.

LF: Well, uh, I hope so. [Chuckles] I hope it’s continuing. It’s, uh, it was not easy because of our the distribution of people who were prepared in nursing, were prepared was quite different than it is today, or was in ’86 when I left. And um we were really developing a professional model and that meant we had to get nurses prepared at the professional level, uh, and that, um, what we inherited from the alumni in terms of those values we felt needed to come to fruition and, uh, that helped us a lot because they left us a great, great heritage. Sometimes when people thought about academic nursing, they got very excited because they thought, “Oh goodness. They’re all going to end up being administrators and teachers and and they’re not going to be committed to practice and (mumbles a word).” And one of the unique things in this, of course, is that that couldn’t happen as long as you had clinical specialists who were also faculty who were very close to the patients and-

LM: -And they had to practice?

LF: They had to practice and they had to do their research. Yeah, because when we became an antonymous school, uh, not only the Dean was required to act like a dean and every other Dean in this University, but the faculty were too. So that meant, research productivity. It meant graduate education. It meant, you know, changing a lot of, uh um, old habits and you couldn’t just be teaching or you couldn’t just, you know, do one thing. Uh that was, that was one of the challenges too, as you can imagine.

LM: Well it seems to me that everything you did as an educator had impact on everything you did as a practitioner. And you really have molded that model so the two cannot be separated.

LF: Well, that was the goal. It, i-it was, it was not to, um, have like ten different functions or four different functions. It was really to integrate all of these, so that it was a natural evolvement of the knowledge base for nursing. But also, that y-y-you, um, it’s not only what you know, but how you use what you know. So we knew nurses and nurses knew a lot of things, but there was a big gap between sometimes, not always but sometimes, there was a gap between what was known and what was practiced. But when you have this kind of a model, the people who know and are discovering things and working with people who practice too, are putting it all together in some kind of a, uh, o-of model of of advanced practice, which was really where, uh, it was going. And of course, as you see what’s happening in technology or in the development of medicine or in biochemistry or in other fields, um, the knowledge base is expanding so rapidly that, uh, it’s not a matter of just knowing. You’ve got to get it applied and you have to test it out. And so, uh, nurses had to be involved in, um, the clinical research and then health services delivery.

LM: -And it would-

LF: So-

LM: -seem to me that the great beneficiary of that wo-would be the student, who was fortunate enough to come to this school and work with those faculty who were both practitioners and researchers.

LF: Right, right. And of course, I’m extremely proud of our alumni. I-I, uh, we, not only the ones that have come out since I graduated, but ones that were here before, because they fostered that al-a great deal, in terms of the values of of practice. And now, when, um, at least when I was going around the country, uh, I had many, many instances of of, um, you know, other deans coming up to me and saying, “When are you, when are you going to comp- [chuckles] when are you going to send some of those wonderful people to us? [chuckles] And, uh uh, how soon is your doctoral program going to be underway? And, um, we’re we’re interested in doctoral people who do clinical research, who are interested in in theoretics as well as, uh, as-as well as practice and can do clinical research.” Then also, another interesting thing that used to happen to me that I would speak to fairly large audiences not only on nursing, but on health care and I can’t tell you how many times physicians have come up to me and told me they trained here and they wanna know about Rochester but they also are always very, um, careful to tell me that they know a Rochester nurse immediately and not only by her (said something that sounded like “more-da-board cap,” but I wasn’t sure what it was), but by the quality of her educational endeavor and by how she functions.

LM: Which must have been one of the greatest, uh, words that you could hear and because it speaks to the quality of the school and, uh, and certainly you’re hearing today from, um, faculty around the country and even around the world who got their start here when you were here and are carrying on that tradition in other schools.

LF: Mmhmm. Right. Did I talk about the educational program that we, uh, had developed or does it-

LM: -No, not yet.

LF: Is that something you’re interested in?

LM: Yes.

LF: I can just I can just hear it. [Chuckles] Well, um, I we developed a a plan of an educational continuum and we found it very useful in trying to, uh uh, tell people about what we were doing in academic nursing because while we were doing all these chan-making [chuckles] all these changes in practice, we were also, uh, focusing on the educational programs. And, course we had a Bachelor of Science degree and it was an upper-level, um, upper-division, um, four semester plus one summer Bachelor’s Degree at the time. And then of course we began to go into specialization, clinical specialization at the Master’s level. Now, the when I came, we had eleven students in a medical surgical clinical specialist. When I left, we had something over a hundred-fifty students in about seven specialties, so the graduate education specialties really exploded. We’re very fortunate to get government and foundation funding for those Master’s programs, but, um, we, you know, had a family nurse practitioner. We had public health nursing. We had, uh, medical surgical of course. We had pediatrics and pri-and primary care and psychiatric nursing and gerontological nursing and women’s health finally. And so, we were able to develop this clinical base, which was very important in the research effort that we were making. And then, um, beyond that, of course, the research and theory building a PhD that, uh, came in 1979 was a big boost to us and a real commitment on the part of the University and, uh, that has been a very successful program as well. And then of course post-doctoral work and, uh, continuing education ran along with it too. So, we were doing all these kinds of things, uh, while trying to generate the research, uh, in, uh, academic nursing, as well as in in the practice area. So.

LM: So you had really, um, two lines in tandem, uh, in in the development of the School, uh, and each one was as important as the other in in completing your, uh, goal, which was to involve every, uh, everyone in the research activities, as well as the practice.

LF: Right.

LM: When you think back on your years here, um uh, could you expand a little more on what you consider the great rewards? You’ve touched upon the unification model. I’m sure that’s one of them, uh, but perhaps you could explain that a little more, um, for the benefit of people who see this and aren’t familiar with what you mean by a unification model in nursing.

LF: Well, it was to put practice, education, and research in an integrated way together, so that faculty were clinical specialists, they had a commitment to practice, they did practice, and they did do their research and practice. And people who were had been primarily in practice, um, became much more interested in the research component of what they were doing. They were more interested in the educational efforts. Uh, they made a contribution to the student programs. But this melding, in the long run, was going to benefit patients or people that we were, uh, involved with. Now, of course we were not always just in a hospital. I mean, unification we had in administrative responsibility was Strong Memorial Hospital. But there were nurses in the community. Um, as a matter of fact, the community became increasingly important because of, um, the changes that were happening in the in the health care system and also because the recognition that much of the work of nurses, uh, would and should be with people who were well or who were needing some assistance, but were not institutionalized for a health, uh, problem, uh, so that the promotion of health and the prevention of disease and disability or anticipatory guidance of people who were facing growth and development stressors or illness or whatever were, um, were really nurses daily (not sure if this is the word she said) work. And so, nurses began to move more and more out into the hospital.

Uh, the other thing here that I, uh, didn’t mention because in a way it’s it’s almost a given and that’s the development of the nurse practitioner because for one of the reasons I came to it, it’s funny that I shouldn’t have mentioned it earlier [chuckles] is that, uh, there was a commitment to the development of advanced practice here. ‘Course we talk about it in advanced practice today, but there really it is a big commitment to nurse practitioners. So, I didn’t have to fight that battle here that I had to fight in other places ‘cause I, as you know, started the nurse practitioner with Dr. Henry Silver in Colorado and had seven years of fighting under my belt [chuckles] when I got here. But, um, i-it was not i-i-it was the only challenge in it was trying to get funding to, um, s-you know, start, uh, other programs or to increase the primary care efforts or to, uh, do the research in primary care. But, um, those those kinds of of challenges, uh, were different here because they were-they were not at the basic level where I had really, you know, when you’re initiating nurse practitioners, and-

LM: -So it was expected that this program was eval-

LF: -It was expected. And it did. And that was a reward that was ongoing, but I-I-it was, um, it was already started. You know, Dr. Si-Ho-Haggerty and Hoculman, along with Harriet Kitsman and some of the nurses here, were very much involved in that, so, um, that’s, you know, that’s really-

LM: -Were our students out in the community too?

LF: Oh, yes. Right. And see they had been out in Public Health, but now they began to go out with the in-in, uh, Clinic Services or in other places. And they were there more and more. They were in schools I believe, but this, you know, expanded it in schools, um, practically any place where there were people, we-students would be going because some of them would be going into into geriatric high-rises or senior senior-center high-rises as as the gerontological, uh, nursing specialty began to develop. And so, it was not only graduate students though, but undergraduates as well, so the community-based efforts were were very important. And not only in general nurse practitioning, but also in, uh, in the specialty areas.

LM: One of the things that the University is known for now is its doctoral program. Would you tell us how you got that program started and how you feel about its success?

LF: It was not easy. I don’t think anything is easy [chuckles] when it comes to my job in terms of bringing about change. Because there was some resistance, uh, and I think, um, measured resistance, uh, somewhat because of some concerns about the resources we had for it and the resources in faculty or in research. And so it it took us a while to get that off the ground, but, uh, it was a very wise move in terms of trends in the country. And it was a very wise move to go with a PhD in terms of, uh, theoretics and, um, and uh, scientific portion of it in terms of clinical research because it is research oriented and it is producing some very, very fine people, but the conceptual base of that is focused on practice. And, uh, in general, people come here because of that and because of-it offers some opportunities, but it is heavily, uh uh, theoretics and, uh, I think we have some very fine theoreticians here, who, uh, developed that, uh, program over time. Now, it’s I’m sure it’s changed, but, uh, we were pretty pleased with it, especially when the products came out and the faculty did a tremendous job.

I think one of the rewards too, one of the big rewards was seeing our own team grow because while we had difficulty, um, securing senior people from outside, our young our young people, our young team grew. See, this was really a team effort too. I think people sometimes have a tendency to think that someone who’s supposedly the Dean and the leader and all that has everything to do with it. Frankly, if it hadn’t been for all of the other people, we wouldn’t have gotten any place because it was a team effort and whether it was education or practice or whatever, we had a committed team. Now, they we-they struggled and but one of the rewards was seeing them grow and seeing them, uh, take on the challenges that, uh, any lesser people couldn’t have mounted or managed. And so, I really, uh, I really give them a lot of-all the credit really because it’s a very complex system and social change, we’re talking about social change in institution, it’s a very complicated, um, and long-term effort. It’s nothing that’s done in a hurry. And not in Rochester anyway. [Laughs]

LM: I’m sure that one of the things you’re proud of is the quality of the students that had been attracted to Rochester. Would you give us a little background on how you recruited students for this program?

LF: Well, the the recruitment of students was another challenge that was, uh, a tough one, uh, because in general, there was a dip in enrollments around the country. So we were in serious difficulties in some parts of my administration because, uh, we didn’t have a lot of resources and funds in terms of scholarship funds and, uh, the national, we were caught in this national trend because medical schools, law schools, MBA programs were very interested in getting women, women in minorities, so the focus was on recruiting them and they offered very lucrative kinds of, um, opportunities. Career opportunities. And better pay.

LM: And and, um, and better salaries in practice.

LF: And pay.

LM: Yes.

LF: And so, we we had, um uh, some very serious, uh, problems in student recruitment, uh, but, you know, it’s both a blessing and a and a curse, in a way, to, uh, ha-have the practice when we were trying to bring more people in and trying to get more nurses in practice close to the patients and the better qualified ones, uh, but we did have tuition benefits and that helped a great deal. I-i-it graduate education or a lot of it went to part-time students and the other thing is a lot of those students were working, came here because and came to Strong Memorial Hospital because of the opportunities to advance in the educational programs.

LM: So they came as a practitioner, but went on to get graduate school?

LF: Right. Mmhmm. And so, uh, you know, and some of the people who chose careers in other fields are now coming into nursing as a second career because of the of the, uh, rewards that one gets in working with people that nurses feel so committed to.

LM: Well, the rewards were great, uh, but I’m sure you also encountered some disappointments. Uh, would you comment on the hardest parts of your job while you were Dean here?

LF: Well, I mentioned earlier the difficulty in in, you know, getting senior leadership, uh, early. Another thing I discovered, ‘course, is that the School wasn’t endowed, and still isn’t, uh, but it and it’s very difficult to, uh, to raise funds for endowment and we don’t have many millionaire nurses. [Laughs]

LM: So you were involved with fundraising, along with your other activities?

LF: Absolutely. Absolutely. That, uh, that was a very big shock and one of the challenges, so that was, um, it was a disappointment that I could not, uh, get the school endowed fully. We’d, you know, done better, but, uh, it still still is a disappointment.

I think also the slow pace of change. Uh, I’m I’m pretty fast-wired [laughs] and I think, um, I expected change to occur and I also expected it to be more permanent. Um, but in social change, I think that’s just the way of the world. But I I think I was pretty impatient lots of times, uh, at the slow pace of change. I thought we were doing revolutionary things and it’d turn out to be evolutionary. [Chuckles]

LM: And do you think that the nature of Rochester contributed to that, uh, slow willingness to change?

LF: Uh, well, Rochester’s a very interesting place in that regard. You know, you think about it as as being very conservative and then I look at some things we’re doing here and I think to myself, “My goodness.” We-we may not, I guess I always say we’re not going to be the first one and we don’t want to be the last one. But I think we were the first ones to do lots of things. And, uh, but just didn’t move fast enough. Uh, some of it I think was conservatism, uh, and, [short chuckle] you know, it has been said that to move a faculty, let’s see, what is that saying? It says i-it’s easier to move a graveyard than a faculty. [Laughs]

LM: Well, I’m sure you encountered reluctance to change, uh, as that’s part of human nature, uh, to hold onto what you know and understand.

LF: And there were a lot of uncertainties. I mean, we couldn’t promise things to people, you know, uh, we didn’t know how some of it was going to come out. We were trying things out and, uh, so it it was, uh, you know, one of those things.

LM: Loretta, would you go back and talk about your career, putting it into some perspective for us? And then also give us your views on the future of nursing education.

LF: Well, of course, everybody would like to accomplish more and I wish I could have. You know I I would I would like-love to have endowed the school. I would have named it after [laughs] anybody whomever. Uh, and I still haven’t given up. I’m still, uh, helping out in in development. I do still do consultations and presentations and, um, we’re celebrating, of course, the 30th year of the nurse practitioning in the year coming up, so there are a lot a lot of programs that I’ll be speaking at. Uh, and, uh, you often wonder, you know, I’ve-whether or not, uh, you could have, ‘cause now I would do things differently. Uh, but, in a way, it worked out. It was the best I could do at the time and it was the resources we had. So, uh, I think probably when I look back on my career, I just would like to have done more in shorter times. I spent too much time, I think, [chuckles] doing some things that I, uh, could’ve-could’ve or should’ve done in a short time or given some up maybe. [Chuckles] I don’t know. But, uh, I I really feel that nursing provided me, uh, as did the University of Rochester, with some grand and wonderful opportunities, so I really have no regrets and I’m very glad I came here because I think, uh, I might’ve lived out my years at another university or even if I-

LM: -And you would’ve missed some of this.

LF: I would’ve missed some of the, yeah, some of the days of Camelot and working with some of these wonderful people and I would’ve missed my team very much. And so, if I could-about the future, you know, I-this is not a good day to talk ab-[chuckles]-about the future in health care ‘cause we don’t know what it’s going to be. We’re still, you know, it’s still in the power politics in Washington.

LM: Yes.

LF: And I-because I think nursing’s future hangs on what’s gonna happen with that health care reform. Now, we’re trying, as a profession, to influence its direction, to influence, uh uh, the, uh, policies and and, uh, the processes that will accommodate, uh, us in a way to allow us to deliver the kind of care we can in primary care, in acute care, and wherever. But it’s a very uncertain time. And some of it is out of our hands and some of it is in, because as voters we have the opportunity and the responsibility to be knowledgeable and to, you know, vote with our feet, so to speak, so that I’m I’m hoping that, uh, the new health care reform will open those opportunities for nurses and that nurses will take advantage of it.

I I think another good thing that’s happening is nurses in advanced practice, and that’s nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists, are beginning to group together as, uh, as a group of advanced practice nurses on the credentialing and the, you know, I think they’ll bring together the legislation and those kinds of, uh, structures that will, um, help advanced practice nurses function and in the long run, give consumers not only the type and kind of care that they need and want, but also choices. So.

LM: Well, don’t you think with more and more ambulatory care, um, happening in this country shorter and shorter hospital stays, that this opens the door also for nurses in other areas?

LF: Um, very much so. And it’s-that’s been going on for some time and, uh, nurses, you know, have been assuming it very quietly in a way because they have been, you know, providing the kind of care as, uh, as not only caregivers, but case managers and, uh, you know, people people who are able then to to, um uh, help all kinds of of people with their, uh, own care in their own homes.

I am concerned about what’s going on in hospitals today, in terms of restructuring. And th-once again, as related to the political economic aspects of it because in some of the restructuring, uh, some of the best qualified nurses who have some longevity and experience and education, uh, are being shoved out and, uh, lesser prepared people are are being, uh, used at the patient’s side. They’re going reverting back to the old model I started here with, in terms of talking about who’s going to take care of the patient. But when I go to the hospital, I want the professional nurse taking care of me. I’m paying for it. And I believe I deserve it. After all, we wouldn’t take a physician who’d been partially trained and say, “Well, you can do half the hard surgery and I’ll do the other I’ll do the most complex kind of thing.” I think that I think that’s a very serious and worrisome trend.

LM: And do you think economics, um, is the reason for it?

LF: Of course. Of course. And that’s unfortunately happening in many places in this country.

Another thing that’s happened, of course, an-an-and it-it’s-it’s a good thing that’s happened and advanced practice nurses are assuming more responsibility in the hospitals, but once again, they are doing it in some instances to cut down on the cost of using residents and and, uh, you know, uh, medical resources and they’re using nursing resources to do it. So I think we have to fashion those models very carefully so that, uh, we don’t become, uh, you know, uh, the substitute or the handmaid for the work that the physician, uh, doesn’t want to do, so I think we have to watch that.

Uh, I am pleased with the research trends because I think that they are directly related to, um, improvement of care that we can provide people. I see it closing the gap between what is known and what is practiced. Um, the focus is not only on clinical nursing research, but health services delivery, and that’s good.

I think there’s much more acceptance, of course, of the nurse practitioner. I-that’s never been a problem in Rochester, but it it’s, uh, it has been a problem other places. The only problem is really is to get reimbursement for those nurses and that’s, you know, these are really political problems. They’re not clinical problems in in a sense that there’s not really any, uh, any reason not to prepare nurse practitioners at that level. And not only for primary care, but for, uh, acute care and for kinds of other services, so that nurses can assume that kind of responsibility if they’re prepared. And of course, Rochester’s been in the forefront of of doing that, so that gives me a great deal of of pleasure.

And I think the future here is very bright. Um, Rochester’s, uh, recognized as one of the premier schools in its ratings and ranks and, uh, its, um, faculty and, uh, its services are are really, uh, visible, nationally and internationally, and so, um, I I really feel that it’s, uh, we’re, uh, in goal position.

LM: Well, uh, Loretta, uh, it’s wonderful to talk to you and to have this opportunity, uh, to put on tape, um, some of your thoughts. You have much to be proud of as the founder of this School of Nursing and you leave a legacy here that will never be forgotten. I’d just like to also say that since you and I have been friends since practically the day you came, it’s a delightly to be with you again and thank you so much for this stimulating conversation.

LF: Thank you.