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A New Dawn in Health Care

  • Opinion
Ellen Olshansky

Ellen Olshansky often tells a story that is a reflection of her personal passion for social work. “My aunt, who was a big force in my life, was a psychiatric social worker, and as children, my cousin and I would play ‘social work’ – in the way that kids sometimes play doctor or teacher,” she recalled. “We would create diagnoses for our patients and put them on file cards that we kept in a shoebox. We didn’t know any of the correct terminology, so we would write things like ‘this person is afraid to go outside, and we need to take her outside gradually.’”

She did eventually learn how to correctly diagnose her imaginary childhood patient with agoraphobia, receiving her bachelor’s degree in social work from the University of California, Berkeley. Shortly thereafter, she became increasingly interested in the role of nurse practitioner and decided to obtain a second bachelor’s degree in nursing science and a Master of Science in Women’s Health Primary Care from the University of California, San Francisco.

Her love affair with learning would continue, earning a PhD in Nursing Science from UCSF. She has held faculty positions at Oregon Health Sciences University, the University of Washington, Duquesne University, the University of Pittsburgh, and most recently, the University of California, Irvine, where she built the nursing sciences program from the ground up – bachelor’s, master’s and PhD programs.

However, for Olshansky, everything always comes back around to social work. “My career in nursing has constantly been informed by social work,” she said. “I have always looked at health as much more than the individual patient. It’s also looking at the social contexts, ecology and environment of the patient. This is why I’m so excited by this unique opportunity at USC to bring social work and nursing together.”

New beginnings

The opportunity that brought Olshansky to USC is the new Department of Nursing housed within the USC School of Social Work, for which she has been appointed chair. It will accept its first class of students in the fall of 2016. The first degree offered will be a Master of Science in Nursing (MSN) and prepare graduates to sit for the credentialing exam to be board certified as Family Nurse Practitioners (FNP). Students pursuing an MSN are already registered nurses (RN) with a bachelor’s degree in nursing as a minimum requirement. The development of Doctorate in Nursing Practice (DNP) and PhD in Nursing Science programs will follow.

“When we think about RNs, we usually think about nurses at the bedside in hospitals, acute care or general medical surgical floors,” Olshansky explained. “There has been a movement towards the nurse practitioner role since the 1960s, recognizing that nurses with further education and training can really provide a great deal to the health care system.”

With the Affordable Care Act providing a significant increase in the insured patient population each year, demand for primary care providers is at an all-time high. An FNP can play a very important role in this capacity, with the ability to provide physical diagnostics and treatments within a scope of practice that varies by state. For example, a patient could present with upper respiratory symptoms, and an FNP is trained and qualified to provide a physical assessment, diagnose the illness, order additional tests and write a prescription for antibiotics, with minimal to no supervision from a medical doctor, depending upon the state in which the FNP practices.

How does all of this relate to social work? From Olshansky’s perspective, it could not be more obvious. “Social work is going to help define and enhance the profession,” she said. “We do something that is different from what the MDs do. Nursing is unique, and focusing on social determinants of health is such an important part of what nurses do. Health care is much more focused on the community these days, on managing chronic illnesses. In order to really help a patient live with diabetes or asthma, we have to take their daily life situation into account and really understand the patient in their social context.

“We can read in a book that to manage Type 2 Diabetes, a patient needs to get 30 minutes of exercise three time a week,” she said. “But what if the patient is homeless? What if it is a single mother who is being abused by her intimate partner and lives in fear every day so her priority isn’t getting 30 minutes of exercise? These are the additional elements that we really need to care about and focus on.”

Working together

The School of Social Work has been very conscious about striking this balance in the proposed curriculum for the MSN program. There are basic, standard requirements needed to ensure students are prepared to sit for the board exams to become an FNP. What will then distinguish the curriculum are required courses in social work – human behavior in the social environment, and more focused electives from 10 options encompassing mental health, aging, military/veterans, addiction, domestic violence, child abuse, bereavement and LGBT issues. Clinical placements will also be in environments where nursing and social work are congruent.

“There is a vision and mission for the whole School of Social Work that we are also a part of and need to work within,” Olshansky said. “So focusing on social justice, health policy, health disparities, racism, as examples, will also be central to our nursing program.”

The MSN will be offered online through the school’s Virtual Academic Center (VAC), building on the success of the online Master of Social Work program, the MSW@USC. One difference will be that all MSN students will also be required to complete one-week intensive studies on the USC campus – one at the end of the first semester and the second at the end of the program. The School of Social Work has developed an MSN degree with a Family Nurse Practitioner (FNP) specialization. The clinical placements, which are currently being developed throughout the country, will be completed in the student’s local community.

Olshansky is excited about the potential impact that bringing social work and nursing together in this new way could have on health care. “I would like to be able to say 10 years from now that not only do we have a unique and innovative program, but look at how we have made a difference,” she said. “A large percent of health is unfortunately determined by zip code. We have great scientific knowledge and technology, but due to social inequities, people are generally not as healthy in Compton, California, as they are in Brentwood, California. I want students who come out of our program to have a real commitment to social justice and healing the world.

“I feel such an affinity for both social work and nursing,” she said. “I’m hoping that I can help to be a bridge between the two.”

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