Money woes, infighting plague UW nursing school

The University of Washington's top-ranked School of Nursing is losing its dean and — according to a sharply critical consultant's report — is beset by low morale, internal strife and a lack of shared purpose among its faculty and staff members.

Hit with budget cuts, the school is suffering from a lack of trust between faculty and Dean Marla Salmon, according to the report, commissioned by Salmon in collaboration with top UW administrators.

The consultants, who presented their report to the school earlier this month, said that instead of a shared vision for the future, they found what they termed "tribal behavior," with separate departments and specialty areas pitted against one another and the school as a whole.

Last month, Salmon tendered her resignation, effective a year from now.

The situation couldn't come at a worse time for the school, which is not only braced for another round of cuts in state funding but is under pressure by lawmakers and hospitals to help relieve an acute shortage of both nurses and the teachers to train them.

With an aging population and a national health overhaul ahead, many see the UW school as uniquely qualified to train leaders for expanded roles in health care and research.

But for now, the school has work to do. The report paints a picture of a formerly flush academic institution unprepared for the tough choices made necessary by devastating budget cuts.

In the consultant's survey, 64 percent of staff and faculty said they were highly concerned about the school's leadership and vision.

Over the next year, Salmon, a nationally known nursing leader, will help the school comply with the recommendations outlined in the report.

"I was looking for help for all of us — me included," Salmon said in an interview last week. "I didn't have the answers, either."

Walking into a crisis

In early 2008, Salmon, then at Emory University where she'd been dean of nursing since 1999, accepted the UW's job offer.

A former nursing director in the U.S. Department of Health and Human Services, she was a national voice on work-force issues, warning of a growing shortage of nurses and nursing instructors.

Her new job paid $337,000 and, she believed, would focus on building up UW programs — in particular global health, an area close to her heart. But the reality she found when she arrived here in October 2008 was much different.

Instead of leading the school forward, she realized, her new role would be to slash long-standing programs in the face of the school's "worst financial crisis ever."

The school's resources, she said, were all poured into teaching and research, with no budgeting system or reserve fund that might cushion a sudden loss of revenue. "The systems we needed to address the challenges — even down to basic information like how much revenue we had — were not in place."

Like much of the university before mid-2008, the nursing school had never had to confront such a grim budget and tough choices. Whatever the school was doing, some had figured, it must be right because year after year it got top billing among its academic peers in the U.S.

But within months after arriving, Salmon was plunged into what she described as no-win choices: Cut the popular family-nurse-practitioner program — or require students to shoulder the entire cost.

Angering faculty, she pulled the plug on a beloved study-abroad program in Costa Rica and Thailand, increased teaching loads and reduced teaching assistance.

"This kind of change leaves you reeling," Salmon said in an interview last week.

"Failure of leadership"

Salmon, 62, spoke admiringly of the "ingenuity and entrepreneurial spirit" at the school, saying it has "succeeded in ways that no other school in this country has succeeded."

But, as the consultant's report noted, such individuality can have a double edge.

Like surgeons, academic faculty members have specific expertise and see themselves as semi-independent, a posture that can — and did — bump up against the reality of budget constraints.

As the economic crisis hit, for example, lawmakers were irked by the school's decision, later rescinded, to require advanced registered nurse practitioner (ARNP) students to seek doctorates instead of master's degrees.

In letters to Salmon, heads of both House and Senate health committees complained that the change would cost students time and money and shrink the supply of nurses "at a time when they are needed the most."

As cutbacks began, David Lovell, then chairman of the UW's Faculty Senate, began hearing more and more from nursing faculty. While all schools were feeling the pinch, the level of "disagreement and disaffection" among nursing faculty stood out, Lovell said.

Many faculty members blamed Salmon — not for the budget crisis, he said, but for what they saw as "a failure of leadership, consultation and civility, and a perceived disregard for the faculty's right to substantial authority over curricular decisions."

Sorting out the turmoil at the nursing school was "one of the gnarliest challenges" consultant Steve Boyd of MacDonald Boyd & Associates had faced in his long career, he later told faculty and staff.

His company's three-month investigation found that those in the school's various departments and specialty areas operated as a "disaggregated set of interests" rather than an integrated whole. One of the school's employees, he said, summed it up best: "The school hasn't really had a vision for years — (being) #1 is it. It really is all about us as individuals."

In a show and tell, Boyd laid it out: Your hierarchy is too heavy-handed. Learn to make decisions and resolve conflicts. Get a sustainable business model. Don't support work that doesn't further future priorities. And find a better balance of research and teaching — a sore point for some.

Josephine Ensign, who has taught at the school for 16 years, said morale is at an all-time low, with a "chaotic and inefficient system — a lack of clear communication channels and a lack of strong leadership at all levels," making it increasingly difficult to be a good teacher.

Faculty and staff reacted to the critical report with relief, heartfelt responses and even tears.

"This has been hard work for everybody," said Salmon, who told staff in a memo it was the right time for her to return to the work that had brought her to the UW in the first place — global health, social responsibility and public health.

A longtime board member of the Robert Wood Johnson Foundation, she was recently appointed to a special committee of the Council on Foundations, and has consulted with members of the World Health Organization.

Business principles

Nancy Woods, who was dean from 1998 to 2008, said committed faculty members always reach beyond the budget. "The mark of a great university is that your ambitions as a faculty always exceed your resources," she said. "We didn't get that top ranking by just demurring."

That's true, said UW Interim President Phyllis Wise, "but unrealistic today."

Faculty all around the university are now warily confronting that "b" word — "business" — as UW leaders emphasize the need to infuse business principles into their academic plans now that cuts have slashed more than 50 percent of state funding over three years, Wise said.

As provost, Wise worked closely with Salmon during the crisis and turmoil.

"I think it's very important to do what Marla has attempted to do — and that is to prioritize," she said. "If you try to do everything today, it's not going to be possible to do it at that level of excellence we've come to expect here at the University of Washington."

Wise and Interim Provost Mary Lidstrom have formed committees to help the nursing school move ahead, and Wise said she's optimistic it will continue to thrive.

But, like other UW colleges and schools, "it is going to be a different place two or three years from now than it was five years ago. I think we all have to acknowledge that."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com