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New York City
October 2002

Columbia Nursing Dean Hopes to Transform Profession
by Merri Rosenberg

To hear Mary O’Neil Mundinger, Dean of the Columbia University School of Nursing and the Centennial Professor in Health Policy, explain it, the much discussed nursing shortage has less to do with an actual shortage of nurses as with the way the profession is structured.

“There isn’t a shortage of nurses, but a shortage of rewarding jobs,” said Dr. Mundinger, who holds a doctorate in public health from Columbia University’s School of Public Health. “20 percent of all licensed nurses aren’t working in nursing. They’re teaching, selling real estate, or pursuing other options. Of the 2.6 million nurses in the country, 500,000 of them aren’t working in the profession. The crisis is a hospital crisis, because the jobs are not configured to reflect the level of expertise that nurses have. Younger nurses are leaving the field faster than older nurses, because they are dismayed by the disparity between the responsibility levels that are there, and the authority levels that aren’t.”

Dr. Mundinger does concede, however, that there is a shortage in advanced practice care nursing, with many primary care positions going unfilled.

Not to worry. Like any good health care practitioner, Dr. Mundinger has a remedy at hand. Through the Columbia University School of Nursing, a new degree proposal is being considered by the university, leading to a doctor of nursing practice, that, as she provocatively put it, “will revolutionize nursing and change how people think about nursing.”

The doctor of nursing practice will offer a terminal degree for nursing professionals who want to go beyond even the master’s level in specialty fields like primary care, psychiatric mental health, nurse anesthesia, acute care, and nurse midwifery, among many others, that the School of Nursing currently offers.

“The idea with having a doctoral degree is to have the nursing profession recognized at the same level of authority and accountability as other health professions,” Dr. Mundinger said. “It is radical, and one of those tipping point things that will help with the re-engineering of hospital-based nursing.”

Dr. Mundinger is also working on developing exit boards for the new doctorate, beyond the licensing system that is already in place, as a way to “provide a quality credential for what nurses are already doing.” She has established a faculty practice in nursing for her school’s professors, and in 1997, created a midtown Manhattan primary care practice, staffed by nurses.

During her impressive career, Dr. Mundinger–a mother of four and grandmother of seven who lives in suburban Westchester County–has been a forceful advocate for removing many of  the barriers between nursing and medicine, and is working to develop a clear, professional role for nurses.

Perhaps her vision stems from her undergraduate experience at the University of Michigan, where, Dr. Mundinger recalled, “we nursing students took anatomy at the medical school, and we thought we were just as important as the doctors.”

Raised in Fredonia, New York—a small, rural  upstate town—by a mother who was a teacher and a father who was a business executive, Dr. Mundinger grew up with an implicit understanding that her career choices were either nursing or teaching. She began her vocation as an obstetrics/gynecology nurse in Ithaca, New York, moved into intensive care nursing, earned a master’s degree in nursing education, and was awarded a fellowship to become a family nurse practitioner. Dr. Mundinger also received a prestigious Robert Wood Johnson Health Policy fellowship, which brought her to Washington as a staff member for Senator Edward Kennedy on the Senate Labor and Human Resources Committee.

She was also tapped by former president William Clinton to serve on the health Professionals Review Group, which analyzed the health care reform plan spear-headed by then- First Lady Hillary Rodham Clinton. Widely published in the fields of nursing and health policy journals, Dr. Mundinger is also the author of Home Care Controversy: Too Little, Too Late, Too Costly and Autonomy in Nursing.

Dr. Mundinger has long thought that the future of nursing education is in better educated nurses, with advanced degrees. When she became dean of the nursing school in 1986, Dr. Mundinger began the process of transforming the nursing school from an undergraduate college, comparable to Columbia College or Barnard, to a purely graduate school, offering master’s degrees to those who already had earned a bachelor’s degree. Since 1988, the Columbia program has only offered graduate degrees.

The School of Nursing, which enrolls about 500 students a year (and had about 200 when Dr. Mundinger first stepped into the Dean’s role), attracts a diverse student population, with twice the national average of under-represented minorities, like African-American men and Hispanics. Many of the students have earned undergraduate degrees from places like Stanford, Princeton, Barnard, Yale, and Berkeley, among others.

“We want to educate young people about the marvelous opportunities in the field of nursing,” Dr. Mundinger said. “We want high school guidance counselors to encourage those interested in a health career to consider nursing. We’re looking for people who have a clear idea of what they’ll do with their education.”#

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