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Question 1: Tell us about your nursing career.
Sue: I started my nursing career at Iowa, but I was on a military scholarship through Walter Reed. I did my first two years at Iowa, and then transferred to the University of Maryland, where all the people on the scholarship convened. We lived at Walter Reed Army Medical Center for two years while we finished our undergraduate degrees from Maryland.
I worked in dialysis for a while after leaving active duty and decided to go back and get my master's degree at Iowa. That is where I met Gloria Bulechek. Originally, she was my advisor for my master's program. Geraldine Felton, our dean, made it mandatory that anybody teaching get a PhD and so I enrolled in the PhD program after teaching a few years. I was in the first group of PhD students from the college, and Joanne Dochterman was my advisor and head of the program at that time. Gloria recommended me for a faculty role at our College of Nursing, and I accepted the position.
Karen: I went to nursing school at the University of Pennsylvania at a time when the Magnet Hospital research had just been released. During that time period “Magnet” was not a set of qualifications, it was organically derived from hospitals that had good experience at having nurses that were highly satisfied. Penn’s faculty instilled in us that we should get our first job in a Magnet hospital. With this advice, I got my first nursing staff position at Boston’s Beth Israel hospital, where we practiced primary nursing and the nurses thrived.
I worked on a medical surgical care unit that had multiple types of patients, and I realized I like taking care of patients with cancer the most. After a couple of years at Beth Israel, I worked at New York’s Memorial Sloan Kettering and then in bone marrow transplant at The Dana Farber Cancer Institute.
I loved taking care of individual patients, but realized I really loved when I could be involved in research, particularly with policy implications for patients. I decided to earn a master’s in public health and shortly after graduation we relocated to Iowa City. I quickly, learned that in this university town, a PhD was needed for most of the fun interesting jobs. I enrolled in the PhD program here at the College of Nursing. Connie Delaney was my advisor, and then Marty Craft Rosenberg was my chair. Sue Moorhead was on my committee, and when I finished my PhD work, I moved to Chicago. Sue introduced me to Gail Keenan, who was one of my post-doctoral mentors and now collaborator.
I kept in touch with Sue over the years at conferences. In 2018 she and Liz Swanson approached me about coming back to the University of Iowa and playing a leadership role in the Center for Nursing Classification (CNC).
Question 2: How did you first become interested in the field of nursing terminologies?
Sue: I joined NANDA-I-I in the mid-70s while in my first teaching job at a school of nursing in Illinois. I oversaw implementing NANDA-I in the curriculum, so that was my first emergence in terminologies.
My military experience, especially in the reserves, taught me that electronic records were really needed in field environments. Paper does not do very well in pouring rain and high wind you so we had records that would fly away when we were in storms!
My interest in electronic records was very basic at that time - it does not work to have paper in bad environments so when I got a position as a PhD research assistant (RA) on the NIC team, I sort of just brought NANDA-I and this desire to have it and an electronic record together. I worked as an RA with Gloria and Joanne for three years before I was hired for a tenure tract position. I continued to work with them for a couple of years until the NOC group got started and I was recruited to work with Marion Johnson and Meridien Maas because my experience in developing NIC interventions was important to that group that was just starting. So, it was fortuitous that I would end up working in classification.
Karen: I love to hear Sue's military stories. I learned about NANDA-I as an undergraduate and found that it was rarely used in practice in classification. I learned a lot about NIC and NOC in my PhD studies, but it was not until my post-doctoral fellowship, when I joined a team of NIH researchers as a co-investigator, that I thought:
What if we could use nursing care plan data to help make it easier for nurses to make better care decisions?
So that really became my focus - clinical decision support for nurses and how to make sure the terminologies were easy to use but also helpful. Having this foundation of terminologies helps promote the usefulness of our health record data.
Question 3: What led you to recruit Karen to the CNC?
Sue: Well, she was an Iowa Hawkeye already, so that was number one. I knew her dissertation focused on communication skills which I think is important to the director role.
Having a heavy interest in research was key to the future directions we were looking for a new director.
Her work with Gail Keenan on HANDS (Hands-on Automated Nursing Data System) was a good immersion in NIC and NOC use with electronic records and her informatics focus was another key reason we looked at her.
Our new Dean Julie Zerwic knew Karen and was supportive of her. Her skill sets in writing and research were a good match and I knew that people with that skill set are hard to find.
Question 4: What interested you about this position in the CNC?
Karen: When I met with Sue and Liz Swanson at the Midwest Nursing Research Society meeting to talk and started to talk about the research potential at the CNC– I became excited. When I interviewed, I saw a very vibrant college and experienced it very differently than I had as a student. I realized I was ready for a change, and I found this prospect both exciting and challenging.
Question 5: Since you retired as director in summer in 2020, how has your retirement been going?
Sue: I laugh because I do not feel retired at all. It is a combination of all my plans to travel so far cancelled because of the pandemic, and the fact that Karen and I had less time together physically during the transition. I have stayed active in helping her with issues and transition. So that is one piece of it.
The second big piece of what I have been doing is working on the NOC book for about the last 18 months until we finally submitted the draft in March. I continue to have quite a bit of work involved with the editorial process of the new edition. It was a fun period for me because A: I was stuck at home and B: I could immerse myself in the NOC work. To really have whole days and whole weeks and a really set schedule with Liz Swanson and Noriko Abe to produce that book and do the reviews and creations of new outcomes was a very positive experience for me because I was not pulled in 1,000 directions like you are when you are teaching classes and running the CNC and working with doctoral students.
The other thing I have been doing a lot of is helping young scholars with their manuscripts. I really enjoy that. And there has been plenty of work to do in that area.
I think one of the strengths that the CNC has developed since I took over in my later years as director of the CNC was that we have had a lot of visiting scholars and students from other PhD programs.
But that really brings a new depth to the CNC that I am trying to transition to Karen as well, and I continue to work with some of these students. I think that is important for the vitality of the research endeavors.
One of my goals in retirement was to get enough sleep. I have done reasonably well in that because you know a nap is okay occasionally during the week. That was not an option when you are working, and the fatigue as you get older, is something you really must deal with, and kind of plan your time. So, I’ve done pretty good at trying to get a little more rest.
Question 6: What is your vision for the CNC?
Sue: Well, my vision has not changed.
From the beginning, it was to create classification for enhancing, nursing, practice and capturing what nurses do.
What has happened is, the languages have become more mature. And so, there is less need to expand the classification and a greater emphasis on updates and research. The foundation is laid to really try to get this implemented in places that are committed to it, and it does take someone very enthusiastic in the clinical setting to make this work.
I think we are at a critical stage where implementation issues, and certainly COVID has impacted the time. Nurses have to change practice. They are changing in response to clinical situations that do not always mean the decisions that are made are the best for a long-term nursing situation.
Karen: I agree with this challenge and will add that electronic health record vendors do use classification, they just do not always support the use of nursing classification
My vision is that NIC and NOC classification, in partnership with NANDA-I, are used to improve human health. To do this, it is imperative that we demonstrate the value of nursing classifications. This will require both expanded use in practice and innovative use with patients that demonstrates the value of nursing care.
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