Washington’s strong legacy of leadership continues to transform nursing education across the state. From the beginning of the 20th century to the present, innovative, visionary approaches and programs have anticipated the care needs of the future. Whether founding a school or raising standards, increasing the number of nurses in rural areas or furthering nurse research, these efforts shape and broaden the preparation nurses receive. They offer guidance for organizing, anticipating and adapting to a changing landscape, in service to the ultimate goal: expanded and improved health and well-being in this state and beyond.

Being Prepared

When she was a young woman, it was as if Elizabeth Soule could see into the future. Throughout her life, her vision and leadership advanced and accelerated nursing education in Washington state. Her legacy of determination, innovation and responsiveness continues to prepare the nurses of today for the challenges of tomorrow.

At the dawn of the 20th century, 16-year-old Soule tried to enter nursing school in Boston. The daughter of a physician, she saw how the average person suffered, and she wanted to improve public health. But the school wouldn’t accept students under the age of 21, so she was turned away.

Soule was an innovator who saw nurses as the key to a strong health-care system.

Soule’s family thought nursing too difficult a life; a friend set her up at a hospital doing “dirty work” to discourage her. But the experience only made her more determined. At 18 she applied again and was accepted, graduating in 1907.

Elizabeth Soule, founding dean of the University of Washington School of Nursing

Five years later, Soule came to Washington as the only field-trained nurse in the state. She was an innovator who saw nurses as the key to a strong health-care system. She set to work organizing the Washington branch of the National League of Nursing Education. Two years later, to help address outbreaks of typhoid and tuberculosis, she organized the Washington State Public Health Nursing Association.

Before long, the 1918 flu pandemic swept the globe, infecting a third of the population. The world needed more nurses. The University of Washington was asked to help, and it hired Soule to set up public-health courses for registered nurses. These became the first nursing classes in the Northwest to incorporate fieldwork.

After serving as the first state supervisor of public-health nursing in the new state health department, Soule returned to the UW in 1920. At the request of President Henry Suzzallo, she started the Department of Nursing. It became the first in the nation to be accredited by the National Organization of Public Health Nurses. By 1923, students in the program could earn a Bachelor of Science in Nursing degree.

Soule’s proudest achievement set the national standard for nursing education: an integrated four-year nursing major that included fieldwork at Harborview Hospital. In 1945, the Department of Nursing became the University of Washington School of Nursing. Over the 40-plus years of her career, Soule used education to deepen the impact nurses could make as health-care pioneers.

Nurses Drive Institutional Change

For the past century, visionary nurse-leaders have advanced and standardized nursing education. Their legacy continues today. In addition to increasing the number of highly trained nurses and the quality of care, these ongoing efforts help the profession respond to increasingly complex patient and community needs.

Raising Standards

In the 1950s, Betty Anderson and Betty Harrington offered crucial nursing leadership in Eastern Washington. Through their collaborative and expansive work, they increased nursing capacity while raising educational standards.

Earning a Bachelor of Science in Nursing from the UW and then a Master of Education from Whitworth College in Spokane, Anderson benefited from educators on both sides of the state. As she began her career in Spokane, she saw the regional need for more highly trained nurses. She began to formulate
a vision.

Meanwhile, Betty Harrington originally from Montana, with a degree from St. James School of Nursing and experience in the U.S. Army Nurse Corps earned her Bachelor of Science in Nursing and Master of Education from Spokane’s Gonzaga University. She quickly stood out as a progressive, selfless leader and organizer.

Anderson and Harrington worked together to create the first intercollegiate center for nursing education in 1968. This achievement included galvanizing national nursing leaders, administrators and educators and bringing together Washington State University, Eastern Washington University, Whitworth College and Fort Wright College of the Holy Names for a joint program that would be administered at WSU. Ultimately the consortium would become the WSU College of Nursing.

Anderson and Harrington’s longstanding influence in the field of nursing, and their collaborative and visionary approach to educating its workforce, continue to shape the professional prospects and standards of nursing. Their accomplishments increased opportunities for the education of rural nurses across Eastern Washington and led to higher quality care for the region’s communities.

Creating Model Programs

While nursing shortages can happen anywhere, in Washington’s rural communities the need is especially great. As the 21st century approached, Helen Kuebel understood that to change the equation, education needed to change. And she employed a modern solution.

During her 20 years at Lower Columbia College in Longview, Washington, Kuebel increased the number of nurses caring for rural patients and families. Funded by grants, the online program she developed continues to allow students to take courses from remote locations while completing clinical work at nearby partner facilities.

In addition to providing more nurses, the Rural Outreach Nursing Education program marked an expansion in distance education. The governor at the time recognized it as a best practice. Since then, it’s served
as a model for others around
the country.

On the other side of the state and nearly a decade after Kuebel’s retirement, WSU Associate Professor Janet Purath continues to address the care needs of rural Washington. Funded by grants that Purath leads, a partnership between the Washington State University College of Nursing and the Community Health Association of Spokane (CHAS) trains nurses in rural clinics and then connects them to jobs in the same areas.

Challenges faced by the providers at CHAS become learning opportunities for the students.

The program’s specialized components offer simulations with patients to help nurses address acute and chronic pain and substance-abuse disorder, as well as a module that focuses on medication-assisted therapies for opioid-use disorder.

The program also enhances the curriculum at the WSU College of Nursing through a Nurse Practitioner Faculty in Residence. Challenges faced by the providers at CHAS become learning opportunities for the students. And the legacy of care between nursing schools and communities in need continues to grow.

Putting Research First

In 1956, Katherine Hoffman became the first nurse in Washington state to earn a doctorate. She didn’t stop there. In addition to positioning herself as a nursing scholar, she began to position the profession to be more effective.

That same year, Marjorie Batey joined the University of Washington School of Nursing as a nursing instructor (after earning a nursing diploma in Spokane, a Bachelor of Science in Nursing from the UW and a Master of Science and Doctor of Philosophy from the University of Colorado). Before coming to the School of Nursing she had also held nursing roles in California, Washington and Colorado, including serving as the project director of nursing research programs for the Western Interstate Commission for
Higher Education.

Katherine Hoffman (right), director of nursing education at the UW, interviews a prospective student.

Hoffman and Batey both understood the need for research to influence practice and improve patient care. Hoffman became a member of the American Nurses Association Committee for Nursing Studies. In 1958, under her leadership, the organization’s House of Delegates declared research the top priority for the profession.

The following year, as assistant dean at the UW School of Nursing, Hoffman worked with Dean Mary Tschudin to get one of the first federal faculty research development grants. Six years later she supported nurses working toward doctorates, in her role as director of one of the first nurse-scientist grants.

Hoffman and Batey elevated and expanded nursing science in Washington, across the nation and around the world.

Together with distinguished nursing leader Jo Eleanor Elliott, Hoffman and Batey founded the Western Society for Research in Nursing. Through its conferences and publications, the regional consortium of universities in 13 states created a framework for furthering research that would improve patient care and advance the nursing profession.

As scholars, higher-education advocates and champions of research, Hoffman and Batey elevated and expanded nursing science in Washington, across the nation and around the world.

Leading Change

Rheba de Tornyay

Dolores Little understood the power of nurses to impact patient satisfaction and outcomes. Her experience as a head nurse and supervisor informed her work as a professor in the Department of Community Health Care Systems at the UW. The required leadership course she taught in the 1960s inspired nursing undergraduates about their potential to make change.

Influencing and mentoring hundreds of students, Little had an engaging style and used every medium imaginable to amplify her impact. She pioneered the idea that clearly defined and enhanced nursing roles offered a path to leadership and better care. Through hundreds of papers, conferences, conventions and workshops, and by speaking on television, over the radio and on film, she changed nursing practice worldwide.

Watched by over two million health-care providers in the U.S. and internationally, her case study film “Mrs. Reynolds Needs a Nurse” won awards for its portrayal of the complexities of the health-care system. It demonstrated how nurses can collaborate, effectively troubleshoot, adapt and serve as patient advocates to get dramatically improved results.

Dean Mary Tschudin

The Primex concept that Little helped develop was the precursor to today’s primary-care practitioner. She inspired nurses to speak up as patient advocates. And she fought for nurses’ rights, promoting equal pay for equal work, legal protections for nurses and health-care reform.

Today, more than 50 years after she began teaching at the UW, Little would likely appreciate the formalized leadership program for nurse-administrators offered at Washington State University. The Certificate in Nursing Leadership program focuses on organizational leadership, quality care management, professional practice environments, organizational systems management, communications and collaboration.

Dolores Little inspired nurses to speak up as patient advocates. And she fought for nurses’ rights, promoting equal pay for equal work, legal protections for nurses and health-care reform.

Raising The Bar

Between 1975 and 1986, under the leadership of Rheba de Tornyay, the University of Washington School of Nursing grew. With de Tornyay’s determination, decisiveness and collaborative approach, she launched the school into a new realm of excellence.

As de Tornyay saw it, the University’s advancing reputation as a premier research institution was an opportunity for the School of Nursing to keep pace with the rigors of other disciplines. She promoted a higher standard of doctoral preparation and research productivity for faculty. In addition, during a state financial crisis when there was a lack of funding, she spearheaded one of the first doctorate degree programs in nursing science.

De Tornyay’s work drew attention. In 1984, the UW School of Nursing became the top-rated nursing school in the country, a designation it has held ever since.

De Tornyay’s book “Strategies for Teaching Nursing,” updated three times over 30 years and used nationally and internationally, offered a more modern way of teaching, with a focus on collaboration and reflection rather than treating students as passive receptacles.

By deepening educational rigor, cultivating a more collaborative educational approach and increasing the number of highly qualified nurses, educators, researchers and leaders, de Tornyay’s foundational leadership dramatically improved the nursing profession’s ability to meet the future.

Ongoing Evolution

The establishment of Medicare and Medicaid in 1965 meant that many more people had health benefits and could seek care. Physicians had trouble keeping up with demand. In response, universities began training nurse practitioners. The UW created one of the first family nurse-practitioner programs in 1971.

The program’s first graduate was Ruth Fine. She had previously conducted a literature study to see how many research articles had been written collaboratively by doctors and nurses between 1952 and 1967 — and she’d found that they were nearly nonexistent.

In addition to addressing a shortage of primary-care doctors, the new degree offered a pathway toward increased nurse autonomy and the collaboration within the medical field that Fine had found to be lacking.

In 2007, as the health-care system grew increasingly complex, requiring more extensive preparation from nurses, the UW established the first Doctor of Nursing Practice degree program on the West Coast. The increased training set a precedent for others, and it allowed nurses to diagnose, treat and prescribe medicines to patients and follow them
over time without supervision.

More recently, the UW’s addition of a combined Doctor of Nursing Practice in Population Health Nursing and Master of Public Health in Global Health offers an exciting new model of multidisciplinary expertise. Its emphasis on populations and systems empowers nurses to take the profession to a new level, preparing them to improve health care both locally and globally.

Responsive Innovation

With advancing technology comes opportunity. The UW’s plan for a new Health Sciences Education Building includes an evolving simulation center and virtual reality studio, offering a new level of skill building in realistic settings. Over time, this multiphase project will become increasingly central to the nursing-student experience. Promoting collaboration across all the health sciences, confidence and mastery in clinical skills, critical thinking, and state-of-the-art technology, the space will offer an adaptable training ground for the future.

For distance learning, Washington State University meets its land grant mission and vision by providing accessible education across the state with distance-learning tools. Its information-management and learning-tech resources include the latest technologies for remote collaboration and learning, as well as a combination of live and online courses, supplemented with face-to-face interaction.

To meet the needs of increasingly common mass-casualty events like shootings, WSU holds an annual training event on campus. In a collaborative effort that includes students from WSU’s nursing, medicine and pharmacy colleges and the UW’s physician assistant program, the multidisciplinary group learns basic trauma skills in the classroom and then applies them in a mock emergency setting where volunteers pretend to be injured or act as upset friends or relatives.

An emphasis on populations and systems empowers nurses to take the profession to a new level, improving health care locally and globally.

In another interdisciplinary training effort that focuses on complex health challenges, WSU Health Sciences hosts an annual simulation developed by the University of British Columbia. Participants include students representing more than 10 health-care disciplines from Eastern Washington University and the UW. Over two weeks, interdisciplinary teams create a collaborative, patient-centered care plan for their simulated patient. The training culminates in a presentation to other students, faculty and community practitioners.

To further prepare students to collaborate, the WSU College of Nursing offers several courses with guest teachers from other disciplines, such as pharmacy and physical therapy. Some courses also involve students from other disciplines, allowing the groups to share information about their education and profession. They exchange consultations about patients, learning how they might someday collaborate in a real health-care setting.