"It's important to have thinking nurses with excellent research skills. The old hierarchy simply doesn't hold anymore." MARY CHAMPAGNE Dean, School of Nursing Photo: Chris Hildreth

As Duke turns out advanced-degree nurses with research experience, the nation is struggling to fill basic nursing-care needs. Some126,000 nurses are needed to fill current vacancies at U.S. hospitals, according to the American Hospital Association's June 2001 TrendWatch. And fully 75 percent of all hospital personnel vacancies are for nurses. According to a study published in a summer 2000 issue of the Journal of the American Medical Association, the U.S. will experience a 20 percent shortage in the number of nurses needed in the health-care system by the year 2020. That translates into a shortage of more than 400,000 RNs nationwide.

Ironically, nursing at Duke had a near-death experience two decades ago. In 1984, the traditional bachelor's degree in nursing, B.S.N., was ended, and the status of the graduate program was far from secure. Four years earlier, then-chancellor Kenneth Pye presented a document to the board of trustees called "Directions for Progress"--or, internally, the "Retrenchment Report." Pye notified the trustees that costs-per-student in the nursing school significantly exceeded all other baccalaureate programs, and that nine programs within the University of North Carolina system had been started that provided nursing education at significantly lower costs. Further, the 1970s was a period when more and more careers in science opened up to women, and nursing found itself with fewer applicants. The report concluded that Duke's overall interests would "best be served by terminating the present degree programs not later than 1983-84."

Upset alumni produced a flurry of impassioned letters to local newspapers and calls to the university, prompting a letter from then-president Terry Sanford to alumni attempting to explain the decision.

But now there's a dearth of nurses. Says Champagne, "The shortage has caused us to rethink. When we looked at the situation, we couldn't say, 'Everybody else must do something.' We know that the ratio of nurses to patients directly affects outcomes, so the stakes are high. Our medical center is splendid. You couldn't have a better facility for teaching. So we decided to do something."

That "something" is the Accelerated Bachelor of Science degree in nursing, more familiarly known as the "Fast Track to Nursing" program. A "second-degree bachelor's program" being offered to college graduates, the fast-track sixteen-month program "will blend the best of the old practices in nursing care with the best of the new evidence-based care," Champagne says.

" Burnout is a tremendous problem in nursing, so we will teach skills for prioritizing duties and maximizing energy. We will teach students how to manage aides and, most importantly, we will teach them how to think."

In keeping with its emphasis on research, the school has included an evaluation component that makes the fast-track program itself a research project. It will generate the strong data and program evaluation needed--but as yet unavailable--to assess what works in recruiting and retaining new nurses, to adapt nursing curricula to reflect the rapidly evolving demographics of society, and to incorporate recent technological and medical advances into nursing education.

Champagne is optimistic that the program will work. "We hope that through its implementation at Duke, and its dissemination as a model to other schools of nursing, the Fast Track to Nursing program will exert a strong counter-force in the struggle to overcome our country's critical shortage of nurses," she says.

The Helene Fuld Health Trust has pledged $6 million to make the new program possible. The trust is the nation's largest private foundation devoted exclusively to nursing education, and its gift to Duke is the largest in the nursing school's history.

The program crossed its last hurdle last May, when the North Carolina Board of Nursing gave its unanimous approval. The school had more than ninety applicants for the program's forty slots. Two applicants already had Ph.D.s, several had master's degrees, and the mean G.P.A. was 3.4. Applicants hailed from many different backgrounds, including biology, poultry science, English, women's studies, medicine, psychology, education, marketing, and nutrition. Twelve percent of the applicants were men, and 18 percent were from an ethnic minority.