In 1999, University of Rochester Medical Center officials were not happy with the School of Nursing.
“The school was in trouble,” recalls former URMC CEO Jay Stein M.D., who left UR in 2003.
“It was in really bad shape,” says Stein, now senior vice president for medical affairs at Baylor University in Waco, Texas. “It just got behind the times. It had major financial problems. People were thinking of leaving and it was down significantly in (National Institutes of Health) funding.”
NIH dollars are to academic medical centers what Scholastic Aptitude Test scores are to high school seniors-a shorthand number that peers instantly understand as a pecking-order placement. And in the late 1990s, the UR nursing school’s ranking of 29th in NIH dollars did not fit with the university’s ambitious plans to raise the UR School of Medicine and Dentistry’s national profile to top-tier status.
Many thought the nursing school might close, says Patricia Chiverton, then an associate dean at the school and now its dean. She was among those doubting the school’s survival.
Chiverton oversees an administrative staff of 115 and faculty of some 230 primary and adjunct teachers along with another 200 clinical associates, who teach at the school but work mostly in other URMC clinical capacities.
“It was a question of resources,” Chiverton says. “The thinking was that if the nursing school wasn’t working, maybe the resources could be put to better use someplace else. And in the context of what was going on, that even made some sense.”
Stein at the time was overseeing construction of gleaming new laboratories and recruiting top researchers from across the country to boost URMC’s medical research profile.
Chiverton recognized that “for academic medical centers, NIH funding is the gold standard.” Her curriculum vitae lists some $3.7 million in grant money won over the past 10 years.
And she knew in 1999 that even as a temporary dean her first order of business would be upping nursing research.
In 2003, the most recent year ranked, the UR nursing school pulled in $2.96 million in NIH grants, ranking it 13th nationally. That is up from $400,000 in 1999 and puts the UR nursing school only slightly behind the 12th-ranked University of California at Los Angeles School of Nursing, which pulled in $2.97 million in NIH funding.
To URMC and Strong Health CEO McCollister Evarts M.D., Chiverton is not just the school’s savior but also a transformational leader. She has brought the previously lackluster school into the 21st century and is carrying it forward.
Chiverton, 57, had been associate dean of clinical affairs for three years in 1999 when the school decided not to renew the previous dean’s contract. For months, until a search committee dropped a national hunt for a new dean and offered her the job in 2000, Chiverton did not expect to be in the post permanently, she says.
After six years in the job, she had planned to step down as dean this month to devote more time to teaching and to running the school’s Center for Nursing Entrepreneurship, Chiverton says.
She helped establish the center under a five-year, $350,000 grant from the Ewing Marion Kauffman Foundation of Kansas City, Mo. The grant is part of a larger, universitywide $3.5 million Kauffman Foundation entrepreneurship grant.
Chiverton’s husband, Richard, a former paramedic, is retired. In some ways, she would not mind joining him, Chiverton says. The dean’s job does not allow a lot of time for activities such as boating, which she and Richard enjoy. At the urging of her daughter, Laurie Macaluso, 30, a triathalete, Chiverton recently started training for a marathon. She had been a regular runner but for the past several years had dropped it until her daughter “forced me back into it.” The Chivertons, who live in Lakeville, Livingston County, also have a stepdaughter, Kori, 29.
Evarts, who came out of a brief retirement to head URMC after Stein left, is sympathetic but not anxious to see Chiverton step down.
“We still need her,” he says.
At Evarts’ urging, Chiverton inked a second five-year contract that took effect this week.
Stein says, “Pat’s genius is her ability to bring people together.”
After only a few months at the school’s helm as interim dean, it was apparent to all that “she was really leading the charge” and that a national search for a new dean could be called off.
While its stature has grown considerably since 1999, the nursing school’s size has not yet. Enrollment stands where it did in 2000-at 343. From 2000 to this year, it dipped, falling to a low of 291 before starting to rise back to its 2000 level. The decline partly is due to Chiverton remaking the curriculum, including the elimination of the school’s traditional undergraduate program.
She expects enrollments to grow. Because nurses are in short supply, they can command relatively high salaries and often can dictate their own work schedules. Because of such advantages and because jobs are in plentiful supply, the profession is now seen as hot, Chiverton says.
The nursing school is nearing completion of its first physical expansion ever, a 26,000-square-foot addition to Helen Wood Hall, the Crittenden Boulevard building the school has occupied since it was established in 1926. Chiverton is spearheading a capital campaign to help pay for the project.
A new role in nursing
For Chiverton, however, the solution to the worker shortage has more to do with quality than quantity.
“What the profession is really going to need,” Chiverton says, “is critical thinkers.”
Encouraging nurses to think of themselves as more than care givers, there only to carry out a physician’s orders, is a big part of what Chiverton sees as the heart of her and the UR nursing school’s mission.
“With the nursing shortage,” she says, “nurses need to change the way they practice in the future.”
Even going full bore, U.S. schools cannot turn out enough new candidates to meet the expected demand, Chiverton says. Demographic and population trends, the numbers of nurses coming into the profession and the numbers about to leave, lead to the inescapable conclusion that nurses will be in chronically short supply for the foreseeable future.
She has no quibbles with traditional two-year programs turning out registered nurses, Chiverton says. She is on the advisory board for Monroe Community College’s nursing program. But nurses traditionally have been trained to mostly carry out doctors’ orders. Chiverton believes nurses increasingly will have to take a more active role in clinical decisions and start assuming broader responsibilities. This will happen, she says, because all kinds of medical staff will continue to be in short supply.
Her prediction has in some ways begun to come true. Nurse practitioners, who hold four-year and post-graduate degrees in specialties, including primary care and family practice and obstetrics and gynecology, have taken increasingly prominent roles in many hospitals and private practices.
In such settings, nurse practitioners handle initial patient evaluations, routine office visits and a number of procedures that used to be strictly the bailiwick of physicians.
UR has a full slate of nurse practitioner courses. But Chiverton is aiming to bring critical thinkers into the profession’s lower levels.
Under Chiverton, the UR nursing school phased out its four-year undergraduate program, replacing it with an accelerated one-year program aimed at pulling non-nurses into the profession.
The program is open only to holders of bachelor of science or arts degrees. Candidates do not have to have backgrounds in science, physiology or medicine. They can be former political science, history, English or art history majors. Graduates earn a degree in nursing as a second undergraduate degree. Alumni of the program include a former combat pilot and a priest.
Candidates for the accelerated nursing B.S.N. degree are likely to be highly committed, bring non-traditional skills and have the added advantage of swelling the profession’s ranks with people who, confronted with two or four more years of schooling, might not have switched careers, Chiverton says.
Another major thrust under Chiverton, the Center for Nursing Entrepreneurship, is a sort of cross between an academic think tank and a business incubator. It aims to encourage nurses to think of themselves as entrepreneurs and also to help them start nursing-related ventures, Chiverton says.
Such ideas are in the profession’s vanguard but are finding growing acceptance, in no small part due to Chiverton’s efforts, says Karen Miller, dean of the University of Kansas School of Nursing. Miller is one of 22 nursing-school leaders with whom Chiverton is working to promote her nurse-as-entrepreneur ideas.
“(Chiverton) doesn’t push, but she has a strong vision and a definite agenda. She’s a gentle leader,” Miller says.
Nurses traditionally have not paid much attention to the business side of health care, Chiverton says. And while the U.S. system of health care funding is an irrational patchwork, the parts of which are often at odds with each other, nurses need to understand it better, if they are to operate more independently.
A small number of nurse practitioners have hung up shingles as independent practitioners. But Chiverton is talking not just about such straightforward ventures. The UR nursing school, for example, has set up a wellness consulting group and a group called Healthcare Consulting Associates, which is moving into fields such as legal consulting.
In addition to a program offering a nursing entrepreneurship certificate, the school of nursing has a legal consulting course for nurses that offers its own certificate. Chiverton has completed both courses. The school also recently featured a Spanish-for-nurses course that took the class to Puerto Rico for an extended immersion session in the language.
“If you’re going to attract people to nursing, you have to make it exciting,” Chiverton says.
Growing up here
A Rochester-area native, Chiverton planned to be a nurse from the time she was in high school. She attended Rush-Henrietta schools. Her mother was an administrator in the district, and when Chiverton was in high school a cousin she admired was the school nurse.
After earning a bachelor of nursing science at Central Missouri State University in Warrensburg, Mo., in 1970, Chiverton returned to Rochester to start a nursing career in the emergency department at Strong Memorial Hospital. She met Richard there and married in 1975.
On a Montana vacation in the late 1970s, the Chivertons passed through Gillette, Wyo., where Richard by happenstance learned the CEO of the county hospital planned to set up a paramedic program and was looking for someone to run it.
The CEO was a charismatic individual and the opportunity looked good. The couple both took jobs at the Gillette hospital, pulling up roots in Rochester. Before a year was out, however, the charismatic young CEO died unexpectedly of a heart attack and the opportunity started looking less attractive.
Gillette was kind of a boomtown, Chiverton says. But growth the area expected from an expanding shale oil extraction industry failed to materialize.
Incidents such as Chiverton seeing an obstetrician come into the Gillette County Hospital with a pistol strapped to his leg convinced the couple that their Western New York sensibilities and the West’s cowboy culture were not a good match.
“Besides, our families were here,” Chiverton says.
Hearing of a job opening at Strong, Chiverton flew back to Rochester to interview with Eric Caine M.D. , a UR psychiatrist who now chairs URMC’s department of psychiatry, for a job as an ER psychiatric nurse.
“Pat had been advertised by the head of nursing (at Strong) as a really great flexible person who was really strong in fundamental, clinical skills, which is what you need in a psychiatric emergency department,” Caine says.
Caine was impressed and offered Chiverton the job, where she thrived. In 1980, she earned a master’s degree in psychiatric mental health nursing from the UR School of Nursing.
“Psychiatric nursing was exciting to me,” Chiverton says. “You interact with patients and do assessments. You have more autonomy.”
In the early and mid-1980s, Caine, whom Chiverton calls a mentor, was working in neuropsychiatry and started to involve Chiverton in his work with Alzheimer’s patients.
At his urging, Chiverton, while still working at Strong, moved into a part-time position as the first executive director of the Rochester chapter of the Alzheimer’s Association.
The Rochester Alzheimer’s group had been run by families of Alzheimer’s patients as a local support group. Caine’s idea was to use URMC to turn the organization into a full-fledged, professionally staffed non-profit. Chiverton, as the group’s first paid director, would be charged with overseeing its transformation.
Fran Weisberg, who had left a career as a successful Democratic Party political operative and fund raiser to head Lifespan of Rochester Inc., was tapped to head the association’s board as its first non-family president.
Now Catholic Family Center vice president of development and external affairs, Weisberg worked closely with Chiverton in the Alzheimer’s Association and more recently during a stint as URMC’s lobbyist.
“Pat is a gem, a jewel,” Weisberg says. “She not only turned the school of nursing around, she saved it and she changed it in really important ways.”
Chiverton’s part-time job with the Alzheimer’s Association ended in the late 1980s, when UR cut ties with the group, now an independent non-profit.
The experience was on-the-job training in administration and helped develop skills she would later put to use at the school of nursing, Chiverton says.
In 1990, Chiverton was promoted to URMC clinical chief of psychiatric nursing. Caine urged Chiverton to look beyond that position, however, and in 199l, she earned an Ed.D. in higher education administration from UR’s Warner School of Education and Human Development.
By 1994, she was teaching at the UR nursing school and had moved into a position as interim chairwoman of UR’s Health Care Systems Division. In 1996, Chiverton was named the school’s associate dean for clinical affairs, a position she held until Stein tapped her as interim dean.
“As a mentor, you gauge success by how far past you your student goes,” Caine says. “Pat has been one of my greatest successes.”
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06/03/05 (C) Rochester Business Journal