Kathy Parker got interested in sleep when she was working on a kidney dialysis unit in Atlanta. Why, she wondered, did nearly all dialysis patients complain of trouble sleeping?
Parker, named the fourth dean of the University of Rochester School of Nursing in August 2008, is a nurse practitioner. Her question was not idle curiosity. Insomnia was robbing her patients of some benefits that dialysis is supposed to provide, and she wanted to do something about it.
Parker suspected that something connected to the dialysis process caused sleeplessness. Was it an unsuspected drug side effect or something else? She decided to do sleep research, but first she would need a Ph.D.
"I knew what my thesis would be on before I applied," says Parker, who earned her doctorate from Georgia State University in 1990. The thesis would, of course, be on sleep and dialysis.
Parker-one of five U.S. nurse practitioners to earn board certification in sleep medicine-currently is analyzing data collected in a seven-year study on the effects of dialysis on patients’ sleep patterns. It is one of two sleep-disorder studies funded by the National Institutes of Health that she is pursuing as principal investigator. The other study examines the effects of opioids on the sleep patterns of cancer patients. Parker’s concerns there are similar-that some benefits of the powerful painkillers are offset by their previously little-understood capacity to disrupt normal sleep.
As a researcher, Parker stands "head and shoulders above other nurse researchers I have come across," Donald Bliwise says. A co-author of a 2007 paper on dialysis that Parker published in the Journal of Sleep Research, Bliwise is a researcher, professor of neurology and director of Emory University’s program in sleep, aging and chronobiology. He started working with Parker in the early 1990s, shortly after Emory, in Atlanta, recruited him from Stanford University in California to develop a sleep research program.
"I’d been at Emory maybe six months when she walked into my office, asking if she could join in my research in any way; I accepted," Bliwise recalls.
Compared with the level of research she is now doing, Bliwise says, Parker’s doctoral thesis showed a relatively rudimentary command of sleep research, a field then only some two decades old.
Parker, who has a keen grasp of physiology, is not afraid of medical issues, Bliwise says. She has a nimble scientific mind and quickly got up to speed in the sleep research. She was a relatively inexperienced postdoctoral researcher and he an established expert when they met. Yet Bliwise, whom Parker calls her mentor, shies from calling Parker his student.
"(She) may have been my mentee when we started," Bliwise says.
Any student-teacher relationship quickly evolved. Bliwise has long seen Parker as a peer and a colleague whose work on sleep and dialysis is not to be underestimated.
"It could bring relief to hundreds of thousands of people who undergo dialysis every day," he says. Parker’s stature as a researcher "was why they picked her for dean."
As a teacher, Parker is exacting, says Cathy Vena, an Emory University professor of nursing, who worked under Parker as a graduate student.
"Kathy is probably an ideal mentor," Vena says. "She is not a micromanager. She lets you identify where you want to be and gives you the freedom to get there on your own, but she is extremely honest as to where you might need improvement.
"It’s not brutally honest. She’s able to bring out the best in you."
Parker is a petite woman who could be taken for 10 years younger than her 59 years. She dresses stylishly and speaks with a Georgia accent reminiscent of Vivien Leigh’s portrayal of Scarlett O’Hara.
She collects souvenir snow globes. A collection of 15 sits on a windowsill in her office. Each is a memento of a city that has meaning for her. A globe depicting Paris, where Parker spent a year as a young student, has glittery silver snow and plays a music-box version of "La Vie en Rose."
Parker was a longtime researcher and professor at Emory and a practicing nurse in the school’s health system before moving to Rochester to take the UR dean position. She becomes highly animated as she describes her research.
In dialysis, she explains, the blood of patients whose diseased or damaged kidneys do not properly filter impurities is routed out of their bodies through an artificial kidney and then back to a vein. Part of the process involves heating patients’ blood to 98.6 degrees to avoid a dangerous drop in body temperature. Parker found that patients whose blood was so heated had temperatures 1.5 to 2 degrees higher than normal and that the increase persisted for hours after treatment. This was the cause of patients’ insomnia, she theorized.
"Did you ever have a fever? How well did you sleep? Not very well, I’d bet," she says, answering her own question.
Sleep is not mere unconsciousness, Parker says. It is a series of mental and physiological states-light sleep, deep sleep and rapid eye movement sleep. Each stage is distinct from the others and distinct from waking. Sleep that does not take people through all three stages interrupts the cyclic physiological changes tuned to the earth’s roughly 24-hour rotation, known as circadian rhythms. The interruption has long- and short-term consequences, none of them good.
For the final, data-analysis stage of the dialysis and opioid studies, Parker has transferred the projects to Rochester.
In the dialysis research, she hopes to prove that constriction of blood vessels resulting from dialysis causes the body to overheat. Parker surmises that a simple but previously unnoticed phenomenon-that the reduced surface area of constricted blood vessels is able to give off less heat-is responsible for dialysis patients’ higher body temperature and insomnia. If the data confirm her initial findings, a simple remedy-heating dialysis patients’ blood to a slightly lower temperature-might relieve discomfort endured by thousands of dialysis patients and would do so at little or no extra cost and without drugs.
In the opioid project, she hopes to show that the pain medicine most commonly given to cancer patients similarly disrupts normal sleep patterns. Further research would be needed to find a corrective action.
The role of dean
Taking on the administrative responsibilities of a dean at least temporarily puts Parker’s career as a researcher on the back burner, a facet of her new job that Parker regrets.
But part of what induced her to give up her positions as a professor and researcher at Emory and to leave Atlanta-where she had lived for some 30 years, married and raised a family-was URMC’s plan to establish a center for clinical and translational science.
The center’s $76 million building is going up on Crittenden Boulevard.
"To have the Clinical and Translational Science Building right next door to the nursing school, that is so cool," Parker says.
URMC interim CEO Mark Taubman M.D. confirms Bliwise’s surmise that Parker’s stature as a researcher had a lot to do with the school’s decision to offer her the nursing school deanship. In the nursing school’s proximity to the new facility, Taubman sees the possibility of "a translational research corridor on Crittenden."
Raising URMC’s profile in biomedical research has been a top item on UR’s agenda for some time. In the mid-1990s, the school undertook an ambitious program to recruit top scientists and boost NIH grant dollars, building hundreds of millions of dollars’ worth of gleaming new laboratories.
Those aims were reaffirmed last year when URMC CEO Bradford Berk submitted a new strategic plan stressing translational research-research that could have direct clinical applications-to UR trustees. Berk is recovering from a spinal injury, and Taubman, URMC’s chief of medicine, is filling in as CEO.
The UR School of Nursing always has had a strong research component. Except for a recently added one-year program to train individuals with bachelor’s degrees in any discipline to be nurses, it is a graduate school, awarding master’s and Ph.D. degrees.
Under Parker, the school has moved its NIH funding up several points, pulling in $4.9 million from NIH in 2008, making it sixth-highest among U.S. nursing schools. The ranking places the UR School of Nursing one slot below Johns Hopkins’ nursing school and several slots above those of Columbia University and the University of Michigan.
Parker’s goals for the school are not focused entirely on research. Budget constraints forced her to postpone planned efforts to recruit two new faculty researchers until 2011.
"(Last year) was not the easiest year to become a new dean," Parker says.
The ongoing economic slump likely will mean tight finances for at least the next year and probably several years, she says. In 2008, the UR School of Nursing brought in some $21 million in revenue, showing a fractional budget surplus. The school has 65 full-time and part-time faculty and 120 non-faculty full- and part-time workers. Parker plans to increase the size of the one-year accelerated program for holders of four-year non-nursing degrees to 160 next year from its current 100 students. Ultimately, she hopes to turn out 200 nurses a year through the one-year program.
Based on a 10-year peak in the number of new applications for the 2010 academic year, Parker budgeted a 7 percent increase in tuition revenue for the coming year. The increase in size of the popular one-year accelerated program is not primarily motivated by a desire to bring in more tuition dollars, however, Parker says. Another part of the nursing school’s strategic plan is to increase the level and quality of care in the community, and nurses are generally in short supply.
Coming to UR
When talking about her move into the UR deanship, Parker repeatedly uses the word "synchronicity."
It seems to her that events conspired to put her into the post. Years ago, Parker says, when she was first mapping out her career after graduating with a four-year nursing degree from Columbia University in New York City, she focused on two possibilities: URMC and Emory. Parker wanted to work at an academic medical center, and both schools filled the bill.
URMC seemed to her like Columbia but smaller, which was attractive, but she never applied to the school or visited Rochester. Instead she went to Emory, where she worked as a nurse, earned a master’s degree and carved out a career as a teacher and researcher. In 2007, Parker, who continued to do clinical work, had been an Emory professor for 17 years.
"I was sitting in my office in Atlanta when (UR Provost) Ralph Kuncl called," Parker says. "I had been thinking about maybe doing something different. Seventeen years is probably about as long as I can do one thing. But I hadn’t been thinking of anything that radical."
Leaving Atlanta would be wrenching, but Rochester was attractive, Parker says.
She considered the pros and cons: Though she was not a native of Atlanta, Parker had lived in the Georgia city longer than anywhere else. Her husband, Louis, an attorney, is an Atlanta native with family there. Their two daughters, Cynthia Lynn, 26, an attorney, and Cathryn, 23, a medical student, were no longer at home.
A factor in the plus column for Rochester was that Louis, who had been general counsel for an Atlanta-based company that was acquired by a larger firm, had been offered a change-of-control buyout after a year. On the plus side for Atlanta was a network of friends Parker had built up over three decades. A negative for Atlanta was that the city, which had seemed pleasant and manageable when she first moved there, had grown into a sprawling traffic nightmare.
"We only lived 20 miles from Emory, but it took me an hour and a half each way to get to work and back," Parker says.
A drive from the Parkers’ comfortable East Avenue home to UR takes 20 minutes of non-expressway driving on a bad day. She and Louis, who now works in UR’s legal department, initially got by with one car, driving to and from the River Campus together, until scheduling conflicts scotched the arrangement. Rochester winters are not a downside for Parker.
"People ask all the time if I mind the weather," she says. "I don’t. I just love the winter. I love a white Christmas. The snow’s quiet; it’s so peaceful."
Lilacs are another Rochester plus for Parker, who is deeply enamored of the Rochesterian bloom. A sprig of artificial lilacs sits in a vase on a ledge in Parker’s office. The tableau is realistic enough to have caused a recent visitor to wonder how Parker managed to have fresh lilacs so far out of season. After revealing that the flowers were artificial, she admitted to having sprayed the blooms with artificial lilac scent.
Parker was raised in several states. Her father was a chemical engineer whose job required somewhat regular moves. She was born in Michigan,but spent most of her childhood in Bergen County, N.J. For a time, the family lived in Kentucky.
Parker is the eldest of three sisters. Her next youngest sister, two years her junior, is an academic in biological sciences; the other sister, who is seven years younger than Parker, is an oncologist.
The scientific bent of the siblings is no accident, Parker says. Her father drilled them on the periodic table of elements when they were toddlers and taught them to do chemical equations. In elementary school, while others might easily guess that H was the chemical symbol for hydrogen, she was the only one of her classmates who recognized less obvious symbols such as Pb for lead or Ag for silver.
Like many girls of the era, Parker decided early on a career in nursing. But while many named nursing or teaching because they were among a relative few career choices easily open to women at the time, Parker was gripped by passion for the nursing profession after being hospitalized as a 5-year-old.
"I had to be treated for a kidney condition," she recalls. "There was one nurse who I thought walked on water. I wanted to be her when I grew up."
After graduating from high school, Parker went immediately into a two-year nursing program at Western Kentucky University in Bowling Green. When she enrolled, Parker says, she wanted only to get into a nursing job as quickly as possible and saw the two-year program as the most direct route.
By the time she was halfway through, however, she knew she wanted more. With an associate’s degree in hand, Parker enrolled in the Columbia University School of Nursing. She got an apartment on 178th Street near the Columbia campus and worked as a nurse at Columbia Presbyterian Hospital’s intensive-care unit until she earned a bachelor of science degree in nursing in 1974.
In her one departure from nursing, Parker, a self-described Francophile, spent the next year in France, studying in a program for international students looking to be immersed in French culture and language at the Sorbonne. During her year in Paris, she rented a room in the apartment of a French family within sight of the Eiffel Tower.
When not in class or studying, Parker happily bounced around Paris, visiting museums and attractions. When the year was up, she resumed her nursing career, heading for Atlanta. By 1977, she had earned a master’s degree in nursing from Emory.
In addition to the translational research connection, Parker says, she was attracted to the UR School of Nursing because of its tripartite unification model, which was developed by the school’s first dean, Loretta Ford, and equally stresses education and practice along with research.
"I knew of Loretta Ford and the unification model for years," Parker says. "I was always close to all three. I worked at Grady (Memorial Hospital) and in the Veterans Administration Hospital (associated with Emory) for 17 years. I practiced in the Emory sleep center until the day I left."
Parker has recruited UR graduate students to help analyze data in her ongoing sleep-research projects, but she has not had much time to connect with URMC sleep researchers and holds no position in any of URMC’s three sleep-research centers.
Still, Wilfred Pigeon, an assistant professor of psychiatry and director of URMC’s Sleep and Neurophysiology Research Laboratory, is thrilled to have Parker at URMC.
In the field of sleep research, Parker’s work is seminal, Pigeon says. The addition of Parker, "a player on the national level in sleep research," especially in a dean’s position, would raise the discipline’s profile at URMC, Pigeon believes, possibly helping to spur the consolidation of URMC sleep research facilities, now spread among three separate departments, into a single coordinated division.
Though her time for now and the foreseeable future is largely consumed by the demands of administering the nursing school, Parker clearly would like to devote more time to research. But how soon she might start a new project is unclear. And that too is good, she says, recalling the Loretta Ford dictum that nursing is "an intricately interwoven" combination of clinical care, teaching and research.
"Next year I will have been a nurse for 40 years," says Parker. "I feel like it’s time for me to play a different role, to make it possible for others to do what I’ve been able to do."
Title: Dean, University of Rochester School of Nursing
Education: A.S. in nursing, Western Kentucky University, Bowling Green, Ky., 1970; B.S. in nursing, Columbia University, New York City, 1973; cours de civilisation certificate, University of Paris French College of Sorbonne, Paris, France, 1974; M.S. in nursing, Emory University, Atlanta, 1977; Ph.D., Georgia State University, Atlanta, 1990
Family: Husband, Louis; daughters Cynthia Lynn, 26; Cathryn, 23
Published research: "Lowering dialysate temperature improves sleep and alters nocturnal skin temperature in patients on chronic hemodialysis," Journal of Sleep Research, 2007; "Sleep/Wake Patterns of Individuals with Advanced Cancer Measured by Ambulatory Polysomnography," Journal of Clinical Oncology, 2008 Quote: "Next year I will have been a nurse for 40 years. I feel like it’s time for me to play a different role, to make it possible for others to do what I’ve been able to do."
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09/18/09 (C) Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303.