A conversation with nurse leader Heather M. Young

Heather Young and Herb Rodebaugh
New Associate Vice Chancellor for Nursing Heather Young talks with UC Davis Health System Leadership Council member Herb Rodebaugh in one of her many planned town-hall meetings aimed at better understanding the priorities of the region and state.

Heather M. Young, a nurse leader, educator and scientist from Ashland, Ore., joined UC Davis Health System in August as associate vice chancellor for Nursing and dean of the new Betty Irene Moore School of Nursing, pending University of California Board of Regents approval. Young is a UC Davis alumna, graduating in 1981 with a bachelor’s in dietetics. She later earned an associate degree in nursing from Sacramento City College, and a bachelor of science in nursing from Southern Oregon State College. Young earned a master’s degree in nursing with a specialty in gerontology and a doctorate in nursing science from the University of Washington. In this issue of UC Davis Medicine, Young, a nationally recognized expert in gerontological nursing and rural health, talks about her decisions to move to Sacramento and build a transformational school of nursing from the ground up.

What is your background?

I have strong ties to the Sacramento region, with my undergraduate study at UC Davis, and several clinical rotations at the UC Davis Medical Center during my nursing education at Sacramento City College. I had the privilege to study at Davis in the nutrition department where I worked as a research assistant in a highly productive lab, which ignited my interest in research. I graduated at a time of nursing glut — hospitals in Sacramento had few openings — so I moved to a rural community on the Oregon Coast and took a position as a night shift nurse in an intensive care unit.

What prompted you to continue your education and seek a leadership role in nursing?

Heather Young"This position is about an unprecedented opportunity to build a new school of nursing from the ground up, as well as being part of transforming nursing education, and ultimately, health care as we know it."
—Heather M. Young

Working the night shift, one has the opportunity to think a great deal. I made several important observations as a young nurse, all of which led me further down my career path.

Many of the people who ended up in ICU got there because of problems out in the community — the trauma associated with not using seat belts, drinking and driving, for instance. Others were there due to lifestyle issues, such as smoking, obesity, unhealthy diet, substance abuse and more.

Many of the people I was caring for had gray hair. Even then, the majority of our patients were older. And with them being older, I noticed that, physiologically, there was less room for error — small changes in fluid balance or a new medication caused marked changes in their responses. They also had a decreased ability to rebound from insults, such as surgery or trauma. Most importantly, I recognized that I was ill-prepared to manage this — in my training, there had been almost no discussion of normal and abnormal changes with age, nor the complexity of having many health conditions at once.

Another observation came out of a growing concern about what would happen to patients when they were discharged, and to their families. We were dealing with complicated health conditions, with very complex nursing care. We expected families to assume this responsibility with minimal preparation and support.

My final observation was about my responsibility as a nurse to work at both the individual and system levels. I realized that as long as I remained focused on one person at a time, I would only be able to make a small difference. But if I could work on organizations and policies, and prepare others to do so, I could make a bigger difference in the lives of patients and families.

So what do people do when they are filled with questions? Return to school! I decided to go to graduate school to fulfill two main goals. One was to learn more about caring for older people. The other was to learn about research in which I discovered that the field of nursing research is interventions to improve health. Over the next few years, I completed two degrees — a master in gerontological nursing and a doctor of philosophy in nursing science.

Nurse Hilda Curry with patient and his wife
UC Davis Medical Center nurse Hilda Curry, a member of the Transcultural Linguistic Care Program, checks in throughout the day with patient Miguel Hernandez and his wife, in their primary language of Spanish, to monitor his recovery process. The program pairs mulitlingual nurses with non-English speakers during their hospital stay to help them understand and participate fully in their course of care.

After almost two decades at the University of Washington that included a dual appointment at the university and chief operations officer of a retirement community, I moved to Oregon Health & Science University to found the Office of Rural Health Research, and to lead the John A. Hartford Center of Geriatric Nursing Excellence.

What interested you in the associate vice chancellor for nursing position at UC Davis?

Actually, I wasn’t at all interested in leaving my position at OHSU. But it was during further discussions with UC Davis leadership — specifically UC Davis School of Medicine Executive Associate Dean for Academic Affairs Ann Bonham, whose inspirational leadership launched the Betty Irene Moore School of Nursing — when I learned what this position was all about. This is not about just being a dean of a school of nursing. This position is about an unprecedented opportunity to build a new school of nursing from the ground up, as well as being part of transforming nursing education, and ultimately, health care as we know it. This is the beginning of creating some real change that will impact how we teach health professionals and how health care is provided in our communities.

Why is transformation so important to you?

Some of the early issues I identified as a new nurse are even more salient today.

Our population is aging at a faster rate than ever — for the first time in the history of the world, there are more grandparents than grandchildren. Since January 2006, and for the next 30 years, someone turns 60 every eight seconds. Our life expectancy has changed dramatically over the past century — in 1900, it was 46, now it is almost 80 for women and 76 for men.

UC Davis Medicine

UC Davis MedicineThe Winter Issue of UC Davis Medicine explores interprofessional education at UC Davis where nursing students at the new Betty Irene Moore School of Nursing will learn shoulder-to-shoulder with School of Medicine students to enhance the effectiveness of health-care teams of the future.

Click here to read more of UC Davis Medicine.

Our families are changing. It is not uncommon to have five generations in a family. Fewer young people are available to provide care and support for older family members. We have blended families and family members dispersed all over the world. Those in middle age are often juggling caring for children as well as parents and grandparents. Many grandparents find themselves as primary-care providers for their grandchildren.

Our communities face important challenges that affect health directly: poverty, unemployment, increased rates of high school dropout, air and water pollution, and chronic stress.

The face of health care is changing, too — disabled people are living longer due to advances enabling people to survive severe trauma, to live with developmental disabilities, and to manage complex health conditions for many years.

Chronic diseases are more common. Older adults have multiple chronic conditions that may not require complex medical care, but certainly require lifestyle adjustments in diet, activity and managing medications, and often have implications for quality of life and symptoms, such as fatigue or pain.

Yet our health-care system remains focused on acute and episodic conditions. Our reimbursement favors specialty practice and high-tech procedures over basic health care. It favors individual care over helping a family to manage and care for a sick member.

We do little to address the social determinants of health in the current system. We spend the most money per capita on health among all industrialized nations, and yet we have the worst outcomes on most health indicators, such as mortality and obesity.

How can the Betty Irene Moore School of Nursing at UC Davis help transform nursing education and health care?

The vision of the Betty Irene Moore School of Nursing at UC Davis is to prepare nurses who can lead in education, practice, research and policy. Within that, several areas in particular warrant our attention:

  • The nation must improve its ability to manage chronic illness. This means we need to prepare practitioners to do this better — not just the medical management but the behavioral and motivational aspects of it as well. We must also equip patients and families with the skills and knowledge required to play an active role. To do this, we must ensure that every healthprofessional graduate has a core understanding of aging, as the majority of health-care consumers are older. They also must have a core understanding of cultural issues, as our population continues to become more ethnically and culturally diverse. This knowledge is essential to providing person-centered care to individuals and families.
  • Our health-care system must expand team work among its professionals — bringing together the strengths of each discipline to collectively plan care for individuals and families, and improving communication with each other so that crucial information is shared and different perspectives and values are brought into the communal dialogue.
  • The connections between the various components of care — from the hospital and clinic to skilled nursing facility and home — must become more intertwined so that individuals experience a seamless transition across settings and that their vital information is passed on in a way to ensure relevant issues are addressed.
  • New approaches to identifying and solving problems that contribute to improved patient safety must be found. We need to take lessons from the airline industry and others that have analyzed the root causes of problems and that empower staff to act and change processes to eliminate recurrence of problems.

Technology has much to offer to all four of these priorities. It can enhance our communication on many different levels — with the patient, other team members and other providers. It can also provide us with tools for self-management and monitoring.

What have you been able to achieve since arriving?

UC Davis Medical Center nurses Alison Carroll, left, and Audrey Washington practice artificially ventilating a computer-simulated patient in the Center for Virtual Care located at the hospital. Simulation training allows health-care teams to practice new procedures together, respond as a team to real-life patient scenarios, and hone their skills.

I am building on the momentum the team has been developing for almost two years since this effort began. Our Vice Chancellor for Human Health Sciences Claire Pomeroy has made a strong strategic commitment to our success, bringing great energy and insight to our development. Dr. Bonham has been and continues to be the heart and soul of the Betty Irene Moore School of Nursing and is the person who began to make this dream a reality. Jana Katz-Bell, assistant dean of Interprofessional Education, has assembled a stunning team to address the myriad issues a new school must face, including obtaining the necessary approvals and supports, recruiting a dean and faculty, communicating with the public and prospective students, planning for a building to house the programs, developing curricula for all levels, and launching a fundraising campaign to finance the physical plant and ensure long-term sustainability. We have one chance to launch the school, and we want to do it right the first time! We are starting with our graduate programs — doctorate and master's degrees. This will enable us to establish our program of research that will form the basis for our educational offerings.

We are collaborating with talented individuals at UC Davis in many departments, schools, and the health system. UC Davis' strengths serve as a foundation for our programs.

We are engaging community stakeholders to understand the priorities of this region and this state — to ensure that we are planning according to the needs of major employers and the population at large.

We have established a variety of ways for people to share their ideas about our development — ranging from individual meetings, focus groups and town-hall meetings to an active list-serve and a Web site.

It is the school's philosophy that the need for nurses who can make a difference in health care far exceeds the capacity of any one place, so that collaboration, rather than competition, is essential. I am working with the leaders in the community college system and other universities and four-year colleges to identify ways to collaborate and to complement the work each of us is doing.

How can people get involved with the Betty Irene Moore School of Nursing?

I need help and support from many different people and groups. First, input is important to me. I am interested in hearing thoughts about what this school can do to improve health in this region and how we could go about doing that. Second, advocacy in the community is important to our ability to improve health. Please share the excitement and let others know about our programs. Third, philanthropic support and influence in supporting others to give is critical for us. I encourage anyone with suggestions to e-mail the school at BettyIreneMooreSON@ucdmc.ucdavis.edu.