School of Nursing Dean Judith B. Krauss has often noted that the "ultimate mission of the YSN is straightforward to contribute to better health care for all people."
When she steps down on June 30 from the deanship that she has held for 13 years, Krauss will leave behind the challenges of leading the community of over 88 scholars, researchers and practicing caregivers and some 300 students. But she will continue to embrace the school's mission as her own.
Krauss will spend next year helping to craft the nation's future health care policies as the American Academy of Nursing Senior Scholar-in-Residence at the Institute of Medicine in Washington, D.C. There, she will be part of a national initiative by the U.S. Department of Health and Human Resources to study how managed care has affected the country's "safety net" programs. Krauss' particular area of research will be the impact of managed care policies on the care of people with serious and persistent mental disorders, such as schizophrenia or psychotic depression.
At the Institute of Medicine, Krauss will have access to the federal government's vast resources of information about how programs providing services to people with mental illness have fared under the new system of behavioral managed care. After studying the data, she will develop recommendations designed to influence "the way we finance and deliver care to individuals with serious mental disorders in this country," she explains.
"Enormous change of pace." Although she will be part of a large collaborative effort, the Yale scholar will essentially be working solo on this project. "It will be an enormous change of pace," says the Dean. "For the past 13 years, I've been at the helm of a major living, breathing organization. This, by contrast, will essentially be a contemplative year." When Krauss returns to the University faculty in 1999-2000, she will be affiliated with YSN's Office for Health Policy.
The Yale scholar brings a wealth of expertise as teacher, researcher and nurse clinical specialist to the Institute of Medicine appointment, which she won through an American Academy of Nursing review process. A graduate of Boston College, Krauss studied mental health and psychiatric nursing at YSN, receiving her M.S.N. in 1970, and joined the school's faculty in 1971. As an affiliate of the Connecticut Mental Health Center, she worked to develop support systems to help individuals with mental disorders live in the community and avoid hospitalization. She has written a book and a major policy paper on the critical need for mental health care services. And, despite the demands on her time and energy as YSN dean, she continues to serve as editor of The Archives of Psychiatric Nursing, a publication which she helped found and which is now considered the preeminent research journal in the field.
It is, however, Krauss' administrative muscles that have been given the most workout during her past two decades at Yale. She was appointed as the school's first assistant dean in 1977, as associate dean in 1979 and as dean in 1985.
During her deanship, Krauss has seen the school through two major moves: first, from its original home at the corner of Park Street and Howard Avenue (the building was subsequently razed to make way for the Children's Hospital at Yale-New Haven); and then from the school's temporary space in the Grace Building on Park Street to its permanent headquarters at 100 Church St. South (the former Lee High School).
Reevaluations and revolutions. Along with these changes in locale came "a period of real evaluation and study of the school's strategic mission," says Krauss. This task was made even more complicated by the "American Revolution in health care" that has fueled changes in the profession of nursing over the years, she notes. During her tenure, the nation saw two periods of nursing shortages as well as a nursing "glut" -- shifts that were fueled by widespread hospital reorganization and the introduction of managed care, she explains. Also during this time, the role of the nurse as a health-care provider (i.e., the nurse-clinical specialist, nurse-practitioner or the nurse-midwife) has become "much more visible to the American public," says Krauss. "These nurses are becoming more integral to the delivery of health care. ... It has been difficult to achieve a balance between responding to these national changes and concentrating on our own strategic plan."
Chief among Krauss' goals as YSN dean has been revitalizing the school's emphasis on clinical research activities. "Historically, the school's roots have been in clinical research," she explains. "In fact, the Yale School of Nursing invented the modern-day notion of the nurse scholar-researcher and for decades led the field. Over the years, however, the school's teaching and clinical programs took precedence over the research mission as we developed our clinical master's programs."
Now all that's changed. Under Krauss' guidance, YSN created a Doctor of Nursing Science program, and this year, the school will graduate its first three doctoral students. "I'm glad I'll be able to be on the podium when the President awards their degrees," says the Dean.
Krauss has also worked closely with the School of Medicine and its department of epidemiology and public health "to build bridges, not only clinically, but in clinical research," she notes. Unlike medical researchers, who focus on the disease itself, nurse researchers "have brought a patient and patient-education component to coping with illness," explains the Dean. Today, researchers from the Schools of Medicine and Nursing are engaged in "genuine collaborations in such areas as diabetes, AIDS, cancer, and gerontology, to name a few," says Krauss. "It's gratifying to watch these clearly identifiable, cohesive teams making an impact on major illness and disease."
As dean, Krauss also helped stabilize YSN's finances while simultaneously working with faculty to expand the school's curriculum. The school has introduced new master's programs in gerontology, pediatric chronic illness, psychiatric nurse practitioner, and nursing management and policy, as well as new concentrations in diabetes, home care and ethics.
Missions in balance. "The school could not be better positioned for the future. Now that its practice, research and teaching missions are in balance, the circle is whole again for the school," says Krauss, who will be succeeded as YSN dean on July 1 by Catherine Lynch Gilliss, chair of the department of family health care nursing at the University of California in San Francisco. Gilliss is no stranger to the YSN community, having served as a consultant to the school during the creation of its doctoral program. "I think she is a marvelous fit for this place," says Krauss.
The departing Dean believes the future will continue to hold even more exciting developments for YSN and for the nursing profession as a whole. "The School of Nursing has a faculty so far out on the cutting edge, they're constantly inventing the next roles and new research directions for the rest of nursing," says Krauss. She predicts that in the future, nurse scholar-researchers will increasingly be called upon "to manage large information sets to design new systems of care -- more cost-effective ways to serve patients.
"The next era of managed care will focus on care rather than cost," contends Krauss. "And Yale is ideally positioned to produce the next generation of leaders in that arena."
--By LuAnn Bishop
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