What does it mean to be a nursing professor in 2023?
A lot of things. A look at all the ways faculty members are involved in every facet of the School’s inner workings and public face: as emergency responders, scientists, recruiters, inventors, legislative leaders, retention specialists, technology gurus, and, of course, teachers.
Open About AI
End-of-life and palliative care scholar Kimberly D. Acquaviva, the Betty Norris Professor of Nursing, has spent her career helping people be less afraid: of death, of LGBTQIA+ people and issues, even of social media platforms. But the latest subject she’s helping demystify is one that seems to frighten even the heartiest academics: artificial intelligence (AI).
Acquaviva’s fearlessness is borne, in part, out of intense curiosity. “When people are afraid of something,” she said, “it makes me even more interested. I like to help alleviate fears so people see opportunities instead of obstacles.”
It was last fall when Acquaviva first began tinkering with ChatGPT. By early 2023, she’d begun focusing her questions on sexual orientation and gender identity, two concepts humans struggle to understand. “If a person was assigned female at birth, and they identify as a man,” she typed into ChatGPT, “what is their sexual orientation if they're solely attracted to women?”
At first, ChatGPT’s answer was wrong because it lacked nuance, Acquaviva said.
“If a person was assigned female at birth and identifies as a man and is solely attracted to women, their sexual orientation would be gay or homosexual,” ChatGPT responded. "Sexual orientation refers to an individual's emotional, romantic, or sexual attraction to others. Gender identity refers to a person's internal sense of their own gender, which may or may not align with the sex they were assigned at birth. So a person who was assigned female at birth and identifies as a man, and is attracted to women, would identify as a gay man. It's important to remember that everyone has the right to self-identify their sexual orientation and gender identity, and it's essential to respect their choices.”
READ a transcript of prof. Acquaviva's "interview" with ChatGPT about its privacy protections or lack thereof
But when asked a very similar question just 10 days later—"If a person was assigned male at birth and identifies as a woman now, and they are only attracted to women, what is their sexual orientation?”—its thinking had evolved. This time, it was correct.
“A person's sexual orientation refers to their pattern of emotional, romantic, and/or sexual attractions to others,” ChatGPT said. “If a person who was assigned male at birth and identifies as a woman now, and they are only attracted to women, their sexual orientation is likely to be considered lesbian or homosexual. However, it's important to note that sexual orientation is a complex and fluid aspect of one's identity, and individuals may identify their sexual orientation in a variety of ways that feel most authentic and true to themselves. Ultimately, the individual in question is the best person to determine and describe their own sexual orientation.”
Ten days after that, Acquaviva asked ChatGPT her original question once again. This time, ChatGPT answered the question correctly but didn’t affirm people’s inherent right to determine and describe their own sexual orientation.
“If a person was assigned female at birth and they identify as a man,” ChatGPT said, “and they are solely attracted to women, their sexual orientation would be considered homosexual or gay. Sexual orientation refers to an individual's pattern of emotional, romantic, and/or sexual attractions to others, regardless of their gender identity. In this case, the individual is attracted to women, and so their sexual orientation is homosexual.”
Acquaviva had watched the technology learn—or, at least, appear to.
That same semester marked the first time Acquaviva inserted an AI policy in her syllabus, the School’s first: students could use the technology, she said, but needed to document how and when they used it. Because no citation format existed, Acquaviva created one. Notations should include what questions students posed, the date of the interaction, and what results it generated. Analyses and conclusions must be students’ own, she told students, and any AI-generated citations must be double-checked to ensure they exist.
Since then, she’s become a go-to educator for AI guidance. She and fellow faculty member Sarah Craig (MSN ’10, PhD ’14) were tapped as AI ambassadors by UVA’s provost, and part of a group of experts from across all 12 UVA schools to be a resource. While Craig will work to develop governance around nursing students’ use of AI for clinical notes to ensure patient data remains private, Acquaviva is underscoring the technology’s usefulness to fellow educators, especially in nursing: to dream up endless patient case studies for nursing students to discuss, develop creative assignments, even to create grading rubrics. Since ChatGPT 4 arrived last spring, Acquaviva—an inveterate tinkerer—regularly shares cautionary and enthusiastic tales with her students and colleagues about her own conversations with it, including concerns about privacy (“Anything you put into ChatGPT you should assume you no longer have ownership of,” she tells her students).
Still, Acquaviva sees ChatGPT not as a dark superpower but as “the ideal brainstorming partner.”
“I always come away from a conversation with ChatGPT with something new,” she said. “ChatGPT isn’t smart, it’s just a way to help me think. It’s bubbly and energetic and never tires of answering questions,” unlike most humans.
“I love it so much not because it’s perfect but because it’s imperfect,” she added. “It’s never going to generate something that’s perfectly accurate, but it’ll help you think about things in new ways”—a theme that runs throughout Acquaviva’s work. In demystifying AI, she’s turning apprehension into appreciation, encouraging people to approach generative AI—and life's other complexities—with open minds.
Shelly Smith (BSN ’99, DNP ’12) is no stranger to suits. As a member of the Virginia Health Workforce Executive Development Board, and an appointee of Virginia Gov. Glenn Youngkin, she regularly rubs elbows with politicians and state leaders with a characteristic combination of humor, pluck, and a nurse’s penchant for advocacy.
Smith’s latest deal, though, isn’t policy- or legislation-focused. Instead, she’s brokered access to portions of a voluminous dataset—the state’s All Payers Claims Database—so her graduate students can get experience digging into “huge, messy data” and learn to draw meaning from it. This access will not only build students’ confidence, Smith said, but also inform political and nonprofit healthcare stakeholders’ understanding of the most pressing issues, and where to focus attention and funding. The data will also drive DNP students’ own on-unit quality improvement investigations, part of their requirement to graduate.
“With student projects, it often begins and ends with just that: my project about my thing,” said Smith, interim associate dean for academic programs, director of advanced practice programs, and professor. “But with this data, they’ll develop intervention ideas by combing through and synthesizing it. What will emerge, even if they’re little clues, little nuggets, is often enough to plant a seed” and really “connect academia and even classroom assignments to real issues, real data, and real life.”
The work also tethers students to real needs, like those of the non-partisan Virginia Health Innovation Network, which earns grant funding from public and private entities to, in turn, fund initiatives to improve healthcare. This fall, Smith teamed up with James Madison University School of Nursing associate professor Holly Buchanan (DNP ’14) to explore immunization data so students at both universities can observe differences by geography, learn to draw conclusions, develop interventions, and then determine whether problems have been solved using data evidence. It’s a deeper dive into unwieldy but rich data than most DNPs usually get—and part of what Smith wants to see change in graduate nursing education.
“Nationally, that’s where most of us fall short,” she explained. “We don’t have access to data, or there’s all kinds of it, but it’s dirty and difficult to use and most nurses don’t know how. A project like this has potential to be symbiotic: We help state officials’ work and understanding, and they help us in ours” by offering an intimate look into what is otherwise hard-to-get information.
There’s a metaphor in Smith and Buchanan’s work, too: that nurses are perfectly positioned to be the connective tissue between real world problems and solutions informed by data that meaningfully improve care.
“We have to have a macrosystem point of view,” Smith said. “If we can teach people to think critically and participate in and understand different things”—research, business, healthcare, finance, big data sets—“we can truly educate people for what the needs are.”
It’s what it means to be a 21st century nursing professor, Smith said “To be honest, it’s less about what I think and know and more about what you, my student, thinks when you see what real data show, and then what you do from there,” she said. “Sure, lecturing is sort of fun, but it’s becoming less important because people have information whenever they want it. Having passion is important, but being able to know how to pepper that passion with facts is critical."
“Real data is the secret sauce that gives us that ability.”
A Forensic 50/50
Sometimes, the best ideas take the most time to percolate. Such was the case with professor Kathryn Laughon’s (BSN ’98, MSN ’01) new half-time position as director of the emergency forensic center, the newest arm of UVA Health’s emergency department (ED).
Every year, hundreds of people arrive in UVA’s ED who have experienced the trauma of sexual abuse, child abuse, intimate partner and dating violence, and elder abuse. They are infants, teenagers, and elderly people.
“People often assume most of our patients are college students,” Laughon said. “But what we know from the research, and what I see in my clinical work, is that violence is common in every age group and community.”
With one full-time and three part-time forensic nurses, the team provides the specialized care these complex patients require, from HIV prevention to evidence collection to interacting with law enforcement and testifying in court. As a veteran forensic nurse, Laughon had, for years, reimagined how the care flow and structure might improve.
Currently, UVA Health’s forensic team “operates like most forensic teams around the country,” she explained. “It’s not full-time nurses devoted to these issues. What we’re proposing is something that will truly be unique in the nation: a comprehensive center with its own unique geography where we can provide substantial follow-up care, educate clinicians, provide a space for research, and teach students. Under one roof.”
“We care for assaulted patients for the long term,” added Laughon, “and now want to take a leap forward to create a national model with this academic medical center partnership.”
To build the new forensic center, Laughon—with strong support from Kathy Baker, UVA Health’s chief nursing officer, Karin Skeen (PhD ’22), associate chief of women’s and children’s services at UVA Children’s, and ED leaders—will hire dedicated forensic staff trained to identify and treat non-accidental trauma and violence across the lifespan, including child and elder abuse, strangulation, and rape. Using a trauma-informed care model, the new center will also offer teaching space for nursing and medical students on clinical rotation, hold continuing education workshops and webinars for practicing clinicians, allow workers to collaborate on research, and “think deeply about how we can make forensic nursing practice even more scientifically rigorous,” Laughon said.
It will also be a place for Laughon to conduct her current research, including a study to buttress understanding of strangulation injuries and how to document them, a pilot to map brain injuries in abused women who are strangled, and an analysis of abused women’s social networks. It will also help her recruit and mentor PhD students seeking to study in the same space.
Longer term, Laughon envisions the forensic center will be a distinct, within-the-ED clinic (“a smaller, separate, quieter place,” she explained) where patients also receive non-emergency follow-up care, sexually transmitted infection and pregnancy tests, prescriptions, access time with a social worker, and resource connections outside the hospital.
If the center offers a new geography for Laughon’s more than 25 years of nursing practice, she insists the work isn’t new. “Teaching, research, and service: that’s what faculty do,” she said. “Maybe what’s really shifted is the world, as there’s a lot more recognition of the kinds of public health spaces we need, and that the way to be engaged in a community is a principle we should recognize.”
Clinical Instructors for the Long Haul
As one of the School’s longest-serving professors, Kathryn Reid (BSN ’84, MSN ’88, CERTI-FNP ’96) has worn a lot of hats: from establishing the state’s first CNL program to expanding continuing education offerings to teaching and mentoring students to serving as chief nurse scientist at Sentara Martha Jefferson and directing a local free medical clinic—all while maintaining an active clinical practice. So tackling the perennial shortage of nurse educators, while a challenge, is one she’s well-positioned to remedy, thanks in part to her long and varied view.
Back in the 1980s and ’90s, the School employed at least a dozen dual-appointee nurse educators. But with time, administration changes, and retirements, not to mention the pandemic, the role had all but faded away. Reid knew that plucking willing nurses from hospital units to teach created holes in hospital staffing and tension with administrators. She also knew that, without support and guidance, clinical instructors often became overwhelmed and pulled in too many directions (“another job on top of a full-time job,” Reid quipped). So, as they developed new positions that served both the School and area hospitals, Reid and health system leaders stopped trying to find bodies and, instead, sought to construct a new, more sustainable system.
“The last thing we ever want to do as a school of nursing is lasso the best clinicians away from the bedside,” explained Reid, director of academic leadership and nursing professional development and an associate professor. “That’s not fair. Staff nurses are a precious resource that must be cared for and developed. It’s why we’re building people to be in these positions long term, even as we build the positions themselves.”
They began with facts tied to well-being and retention: that nurses appreciate variety in their work, benefit from professional development, feel valued when their health systems invest in them, and are proud to share in the development of student nurses. They also knew that students who have rich, rewarding clinical experiences with skilled clinical instructors would be more likely to accept jobs after graduation on the units they’d most enjoyed. The key was building a new nurse educator role that was feasible, intentional, sustainable, and made fiscal sense.
Using UVA Health’s “Earn While You Learn” program model, which offers paid educational pathways to in-demand professions, the School debuted two new efforts to fortify its community of clinical instructors last spring. Interested RNs with at least a bachelor’s degree were paid to take part in a three-day, hands-on clinical instructor “bootcamp” to prepare them to teach students in the lab and at the bedside. For those with at least a master’s degree, Reid and colleagues developed a three-course Nurse Educator Academy (NEA) to ready nurses with a penchant to teach for the classroom and, if they chose, the Certified Nurse Educator credential.
READ "Enter Educators" (summer ’23 VNL)
Even Reid was surprised by the outpouring of interest. With more than 60 applicants so far, 29 nurses have completed the bootcamp to date. The NEA’s first cohort of four began this fall and will start teaching students in the spring.
The learning, participants said, is transformational.
“It’s one of the best things I could’ve done for myself and my students,” said Lauren Sink, who, each week, teaches a group of seven undergraduates on the medical-surgical floor at Sentara Martha Jefferson Hospital. “The students make me a better nurse because they ask me really good questions. And it’s a good balance for me, having two similar but different things to do each week, and the support of my manager and hospital to enjoy both roles.”
Taking part in the bootcamp “gave me a lot of good strategies and ideas I can implement not just with students but with my families and even co-workers,” explained clinical instructor Anne Whiteside, a neonatal nurse at UVA Health who began teaching group of eight undergraduates each Tuesday this fall. “I love reading my students’ reflections each week and hearing them imagine a professional future in UVA’s NICU or PICU. I get chills. It’s exactly why I wanted to teach. Having those moments, seeing things click for my students; it’s amazing.”
Reid is quick to add that the endeavor is less about finding bodies than mates. With the flexibility to create tailor-made commitments and ongoing enrichment and support for these new faculty members, she’ll “help nurses who want a teaching component learn how to do it, and how to stick with it.”
Sink said she’s in her clinical instructor role to stay. “Learners are not a burden,” she said. “They’re wonderful.”