Fast Track director Michelle Renaud says, "The number of clinical hours we require is head and shoulders above other programs. Also, we offer students the opportunity to take fifteen graduate hours, which gives them a step up in becoming a master's prepared nurse, opening up more career opportunities."

Responding to career opportunities, the School of Nursing has tried to cultivate an entrepreneurial culture. When several school graduates requested a program to train them as site investigators for clinical trials, school leaders did some investigating. They realized that nurses with specific training for pharmaceutical trials would help speed the approval of new medical products, and that nurse practitioners with such training would also be able to qualify as site investigators. Site investigators implement and execute large multi-center clinical trials. They also have access to emerging drugs and therapies for their patients.

So, last fall, the nursing school became the first in the nation to offer nurses the opportunity to fill a new role by offering master's-degree-level training in clinical-research management. "During a clinical trial, a delay of just one day can cost the pharmaceutical sponsor more than a million dollars, as well as postpone the arrival of a life-saving drug on the market," says Anthony Dren, consulting professor in the creation of the program. The delay "could be caused by a simple thing such as not filing the right federal regulatory form by the right date, or something complex, such as an error in medical protocol. In view of the high stakes involved here, a workforce educated in clinical-research management is absolutely imperative."

" In developing this curriculum, we had access to experts in many fields at Duke," says George H. Turner III, assistant clinical professor and co-creator of the program. In addition to colleagues in the medical school, the Duke Health System, and the Duke Clinical Research Institute, the school drew on expertise from Duke's Fuqua School of Business and the departments of economics and biometry. Students can complete the program either on campus or online from anywhere in the country.

And the online theme continues: Students enrolled in the Partnerships for Training program pursue their master's education through flexible distance education. Nurses in rural North Carolina with a bachelor's degree in nursing, for example, can earn a nurse practitioner degree, giving them a broader scope of services they can provide, such as diagnosing and treatment. (Nurse practitioners in North Carolina can do 80 percent of what doctors do.)

Duke's experience in offering distance-based nursing programs began in 1997. Besides its Partnerships program, it includes a post-master's certificate program in Nursing Informatics that has trained nurses in fifteen states (including Alaska) and Canada.

Taking a distant look back, the then-chancellor of the medical center, William Anlyan, says he understood the rationale for discontinuing the undergraduate program, but also understood the critical need to continue to train nurses at Duke. The master's program in nursing at that time had a separate faculty and, as Anlyan describes it, "students who hardly knew where the front door to the hospital was."

" That program was more about the sociology of nursing," he says, "and I saw a chance to build a real bona-fide clinical nursing program, with nurses who knew how to deal with patients. So I used all my powers of persuasion and any brownie points I could find to advocate for a new program." The idea wouldn't succeed without the right administrators, he says. "I knew we needed to get a dean who could build a new faculty, and it had to be a faculty who knew where the front door was."

Enter Mary Champagne. "Dean Champagne came to a school back in 1991 that didn't have much of a vision of the future," says Tony Adinolfi M.S.N. '93, assistant clinical professor and a nurse practitioner. "Within a couple of years, she took us forward with a vision that could only make us better and better. She nurtured the existing staff and faculty and brought in exciting new faculty."

For her part, Champagne says the "corporate culture" now stresses innovation in delivering health care. "Because we keep that at the forefront, we can do all kinds of things."

--Sauls is a regular contributor to the magazine.