Changing face of the profession: some 1941 graduates, above; a current class in the new Fast Track to Nursing program, below, directed by Michelle Renaud, center photo below by Chris Hildreth

one are the days of Nurse Betty dressed in her starched white uniform, complete with crisp cap perched on top of her head, fluffing pillows and emptying bedpans and changing sheets in Duke Hospital. Not only are the uniforms passÈ ("White was just plain stupid, really," confides one veteran nurse. "People bleed on you, for heaven's sake!"), but nurses are more likely to be seen by a patient's bedside operating a bank of monitors worthy of NASA flight control, sharing expertise with the community in nursing homes or schools, or buried in a library.

"Fifty years ago, we had traditions. Now we have research," says Mary Champagne, dean of the School of Nursing. "Here at Duke we teach evidence-based practice--what has been proven in research to be effective for most patients. And we teach thinking skills, not just facts, because facts change. So it's important to have thinking nurses with excellent research skills. The old hierarchy simply doesn't hold anymore."
This is not to say that past and present aren't connected. "Because nurses have made so many beds, they may be the ones doing the research now on the best beds, or the ones discovering ways for patients to tolerate their situation if they're bed-ridden," says Sue Schneider, director of the Graduate Oncology Nursing program. "Because we as nurses spend time with patients, we know what makes them comfortable. We deal in quality-of-life issues."

" While physicians are finding new chemotherapies, nurses are helping patients relax in the chaotic chemo environment," says Schneider, who is researching the use of technology as a useful distraction for cancer patients. She's working not only on stress reduction, but also toward better treatment outcomes. "Women with breast cancer increase their chances of survival if they receive all the prescribed chemotherapy treatment," she says. "Our goal is to break the cycle of anxiety with virtual-reality technology, hoping patients will be more likely to complete their treatments."

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The chemotherapy room at Duke Medical Center is the last place people would want to find themselves, with chemo stations and dripping IVs closely lined up like soldiers in formation. But this relaxation research has helped. While donning a virtual headset provides privacy at a difficult time, it also offers patients the options of scuba diving in the deep blue sea or touring an art museum or solving a mystery aboard the Titanic. Patients report less nausea, stress, and fatigue. "It picks up my spirits," says one woman.
Learning good research techniques is a core value of the nursing program. Deirdre Fleming, a graduate nursing student in the Family Nurse Practitioner program, says she was attracted to Duke because it encourages strong research skills. But even she was surprised at how much actual research experience a student can get. "I didn't think this level of research was even a possibility. But we learn techniques in a classroom and then we get associated with a project like the virtual-reality study," says Fleming, who is assisting Schneider in her research.
The Nursing Research Center (NRC), established in 1993, is meant to foster the scholarly research efforts of nurses. The NRC is staffed with a full-time director, an administrative assistant, a full-time statistician, and data technicians who do everything, from helping to support researchers in processing research proposals and grant applications to assisting and consulting on scholarly preparation of manuscripts, oral presentations, and posters, as well as assisting with data entry and analysis and finding funding.
Barbara Turner, director of the center, is also leading the efforts at the nursing school to improve the survival rates of premature infants. "A severely premature or high-risk infant may as well have been born on the surface of an alien and hostile planet," she says. "Their survival depends on the immediate intervention and care of trained professionals who know how to use the latest neonatal technology." Joining in the fight to increase the survival odds for preemies is Debra Brandon, neonatal clinical nurse specialist. She researches the neonatal intensive-care nursery environment to determine the factors that can promote health, and she is studying at what gestational age cycled light would be most beneficial for extremely low-birth-weight infants.
While some faculty members and students are studying patients at the beginning of life, others are interested in issues found closer to the end of life. In 2000, 13 percent of the nation's population--some 35 million--was age sixty-five or older. These numbers are expected to double in the next thirty years. To meet the health-care needs of this aging population, the nursing school established the Trajectories of Aging and Care Center (TRAC). Faculty pool their expertise with that of colleagues at the nursing school and with partners from the divinity school's Institute for Care at the End of Life (the first of its kind in the nation), the medical school's geriatrics department, and the Center for the Study of Aging and Human Development at Duke. "More and more, we're bringing investigators from other disciplines into our research initiatives and leading the studies ourselves," says TRAC director Elizabeth Clipp.
As Ruth Anderson, a colleague of Clipp, puts it, "Most people who observe nurses may not realize that what nurses do is based on science. Historically, nurses have based their practice largely on science from other disciplines such as medicine and psychology. Within the past twenty years, however, the nursing discipline has been actively developing its own scientists."