Creating Connections

For the first time in their decades-long relationship, Columbia University School of Nursing and Columbia University Irving Medical Center (CUIMC) have a formal pipeline in place to create educational and career opportunities for students and new graduates across the medical center’s 18 clinical departments. In the process, the institutions established a professional home for the roughly 700 registered nurses (RNs) and nurse practitioners (NPs) who work at the medical center.

Also for the first time, standardized compensation guidelines based on factors such as years of experience, performance, and whether a nurse is precepting students or conducting research are being rolled out across clinical departments at CUIMC.

These advances are among the achievements of the new Division of Nursing Practice, a groundbreaking collaboration launched in January 2024 by Columbia Nursing in partnership with CUIMC and ColumbiaDoctors, the university’s faculty practice organization, to address gaps the partners had identified in the existing system.

“This strategic collaboration is great news for our institution, and our community, as we prepare the next generation of nurses to continue their vital work and clear the path ahead so they can practice at the top of their licensure,” says Lorraine Frazier, PhD, dean of Columbia Nursing. “I’m proud to have had a hand in establishing the Division of Nursing Practice, which will serve as a model for future collaborations between nursing schools and academic medical centers across the country and around the world.”

For James McKiernan, MD, senior vice dean for clinical affairs at CUIMC and chief executive officer of ColumbiaDoctors, the collaboration to create the Division of Nursing Practice represents an ongoing investment in the nursing workforce and the pursuit of clinical excellence. “High-quality, holistic, modern health care is not possible without nurses. This division reaffirms CUIMC’s commitment to our nurses, who provide expert care and human kindness during the most consequential moments of our lives. It also shows how we are fostering nursing careers here at Columbia, all in service of providing excellent patient care,” says McKiernan, who recently assumed the role of interim dean of Vagelos College of Physicians and Surgeons.

A Professional Home

Maura Abbott, PhD, associate dean of clinical affairs at Columbia Nursing, is—along with Stephen Ferrara, DNP, Columbia Nursing’s associate dean of artificial intelligence (AI)— the co-leader of the new Division of Nursing Practice. Abbott joined CUIMC in 2014 as an oncology NP, became an assistant professor in 2015 and education director of Columbia Nursing’s oncology program in 2017, and was promoted to her current position as associate dean from assistant dean in July 2024.

With roles at both institutions, Abbott quickly saw the potential benefits of linking them more closely, as well as the limitations of the previous system. For example, because no overall leadership structure for nurses and physician assistants (PAs) existed at CUIMC, these clinicians had no opportunities for professional development or continuing education and no clear career ladder. Their compensation could also vary sharply from division to division.

And with no practice standardization, many nurses were prevented from practicing at the top of their licenses. There were also no formal links between CUIMC and Columbia Nursing—a clear missed opportunity for both organizations.

Abbott and her colleagues began constructing a career ladder for nurses and creating clinical opportunities and a clinical pipeline for nursing students within the Department of Oncology, steps that became models for today’s CUIMC-wide Division of Nursing Practice.

At a time when her department was expanding rapidly, Abbott notes, establishing a career ladder was essential in order to attract the best candidates and retain them. “We know it’s been successful,” she observes. To date, she says, Columbia Nursing DNPs hired via the pipeline in oncology have advanced in their careers while staying on at CUIMC, with tenures lasting for five to eight years so far, compared to a national average for new NP hires of just one or two years on the job.

The pipeline Abbott originated is quickly being replicated across the medical center, creating clinical opportunities for DNP students in several divisions already. For example, four psychiatric mental health NP students recently fulfilled their clinical requirements by providing talk therapy to CUIMC cancer patients as they began treatment. And CUIMC’s Primary Care Initiative welcomed its first NP student placement this spring, from the Family Nurse Practitioner (FNP) program, and hosted its second FNP student this summer. New clinical opportunities have also been established in women’s health, psychiatry, pediatrics, and pediatric GI, while clinical placements at the ColumbiaDoctors Nurse Practitioner Group have expanded from one to six.

Reimagining an Old Model

The Division of Nursing Practice is the first formal organizational structure to link Columbia Nursing and CUIMC, notes Ferrara, now in his second year as president of the American Association of Nurse Practitioners. “We are a top school of nursing. We are a top medical center. There’s no reason that these two entities shouldn’t be working together.”

When he joined Columbia Nursing as associate dean of clinical affairs in 2015, links between the two institutions were based on the attending model. A few dozen doctorally prepared nurses at CUIMC held faculty appointments at the nursing school. “Essentially, we counted these clinicians as faculty,” Ferrara explains. “They would help to precept our DNP students or review student portfolios, but it was a very, very loosely defined relationship.”

Columbia Nursing phased out this type of faculty appointment because it wasn’t clear how they benefited the school and they didn’t make logistical sense, Ferrara notes, although DNP-prepared faculty were grandfathered into the system.

Ferrara realized that while these faculty were under his department in the nursing school, he had little relationship with them. “So we said, ‘How can we redo this in a way that formally recognizes all of the university employed nurses and nurse practitioners, and create this link to the school?’ That’s essentially the genesis of how we got here.”

As the Division of Nursing Practice matures and policies and procedures are established, Ferrara notes that in his new role overseeing AI, he will focus more on the technology and policy pieces of the division, while Abbott will focus on operations, but their goal remains the same. “It is always to improve patient care, retain top talent, recruit the best clinicians who are out there to work at this institution, and create a professional community,” says Ferrara. “That’s really why we’re doing it.”

Recognizing Nursing's Role

For Abbott, the Division of Nursing Practice extends Mary Mundinger’s tradition of elevating nurse practitioners. Mundinger—dean emerita of Columbia Nursing and an American Academy of Nursing Living Legend—founded Columbia Advanced Practice Nurse Associates (CAPNA), forerunner of the current ColumbiaDoctors Nurse Practitioner Group, in 1995, ensuring that NPs at the faculty practice were compensated at the same rate as primary care physicians and had the same authority to admit and treat patients at the university hospital.

“Columbia Nursing’s always thinking ahead, for our patients and our clinical models and our educational models, and this is in that vein,” Abbott says.

One thing that the pandemic made very clear, Abbott notes, is that it was essential to find a way to recognize, support, and fairly compensate CUIMC’s nurses and PAs, while making it easier for them to connect with and support one another. Discussions among Columbia Nursing, CUIMC, and Columbia Doctors on how this might be done began in late 2020 and early 2021, then quickly gathered momentum in 2022 under the leadership of Katrina Armstrong, MD, at the time the CEO of CUIMC and now the interim president of Columbia University; McKiernan; Frazier; and ColumbiaDoctors’ chief operating officer, Rae Vagg.

“With them we really, really, really found leaders who understood this vision, supported this vision, and agree with the vision,” Abbott says. “Once we had those four folks in place, it kind of took off from there.”

The division’s development model helps explain its success, she adds. “This is being built from the ground up by nurses who work in the institution. It is not coming from the top down, which is generally how these models work.”

The Division of Nursing Practice’s unique, grassroots approach has “allowed us to roll this out as quickly as we have and start making impacts quickly,” Abbott says. Nurses and PAs are “so excited to have this, and so excited to be involved in this, and they recognize its importance. I think that the uniqueness of the model and the hands-on ability of folks to be involved is kind of new and a little edgier.”

Honoring Nursing Excellence

Another key mission of the Division of Nursing Practice will be to honor outstanding CUIMC nurses and celebrate the nursing profession. In the first of many planned events and activities, the division held its inaugural Nurses Day celebration on May 9, 2024.

At that event, three CUIMC nurses received the organization’s first Nursing Excellence Awards. The trio was chosen from a total of 43 CUIMC nurses nominated by their departments. Each award includes a $1,000 scholarship for continuing education.

The nurses selected for the awards included Christine Buxton, RN, a clinical nurse supervisor at Columbia University and NewYork Presbyterian’s Och Spine Hospital. The other two award recipients—both advanced practice nurses—are also both graduates of Columbia Nursing.

One of them, Brett Gray, MS ’11, is the clinical trials unit coordinator in the Department of Medicine’s Division of Infectious Diseases. He arrived at Columbia in 2005, after getting his master’s in public health; his first position involved doing regulatory work in the same unit he oversees today.

Upon getting to know his NP colleagues, including one who managed a clinical trials unit, Gray dropped his plan to go to medical school and enrolled in Columbia Nursing instead. He completed his BS in 2009 and his MS as an adult nurse practitioner in 2011. In 2014, after a few years as a clinician, providing HIV care, he was recruited back to the research side of health care as clinical trials coordinator and a research clinician for the Columbia Partnership for Prevention and Control of HIV/AIDS Clinical Trials Unit.

Initially, the unit primarily conducted HIV-related clinical trials funded by the National Institutes of Health. But the pandemic led to huge changes. “We were conducting numerous COVID-related research trials, but I was pulled into additional clinical duties as well,” Gray recalls. “When the monoclonal antibody therapies [for COVID] were approved in late 2020, I was primarily responsible for rolling out the monoclonal antibody infusions that were offered here at the medical center. It was just me in the beginning.”

At the time, the monoclonal antibody therapies were the only potentially lifesaving therapy to offer people with COVID who were not sick enough that they needed to be hospitalized, Gray notes. “We were just getting constant referrals, and I was only able to manage so much, and then we had to pull in additional resources.” His team doubled and then tripled to handle the dramatically increased workload, which soon included trials of additional monoclonal antibodies (these were ultimately found to be ineffective as new variants emerged) and eventually of the highly effective COVID vaccines.

Gray and his team went from enrolling about 10 patients over the course of six months in a given HIV trial to enrolling hundreds of patients in COVID vaccine trials over just a couple of months. “It was a lot at the time, obviously, for those of us that were in the mix of that at the very beginning,” Gray says. “But I think as most of us look back on it, it was very rewarding. . . . As much as we were working crazy hours and long days, we tried to focus on those successful moments.”

Now that COVID has ebbed, Gray and his colleagues are taking time to review their unit’s internal processes and roles, reorganizing and restructuring as needed to improve efficiency. Their portfolio has further expanded to include mpox-related studies, trials for a vaccine against respiratory syncytial virus, a trial for a long COVID treatment, and more.

Gray also maintains a clinical practice, overseeing HIV management for a panel of patients and providing sexual health care and PrEP (pre-exposure prophylaxis, a preventative therapy against HIV). “It’s my escape from the research and all the administrative stuff,” he says. “I like seeing a patient and having that one-on-one interaction and building a relationship with them and focusing on their health. It’s a different mindset and I still love doing that, so it’s great that I get to keep that as part of my job.”

Gray was pleased to learn about the new Division of Nursing Practice, especially since it will greatly expand opportunities for connecting with other NPs. “This was exciting to hear, that people actually care about us and recognize the work that we do.”

Joining Two Worlds

Ashley Tedone, MS ’16, who received board certification as a family nurse practitioner in 2015, practices within the CUIMC Department of Obstetrics and Gynecology’s Division of Family Planning and Preventive Services. She was the other advanced practice nurse to receive an inaugural Nursing Excellence Award.

Tedone says she was “blown away” to be honored. “I just truly love what I do, so that probably shows in my interactions with fellow clinicians and ancillary staff, and then also in my interactions with patients, especially given the political climate and restrictions coming down all across the country. I feel really empowered and inspired to support and help women on a daily basis.”

While few in any profession can say they help people every day, she added, “as nurse practitioners, we kind of do.”

Tedone has been with CUIMC’s Family Planning Service for about eight years. “We provide the full spectrum of gynecological care in an outpatient setting, so Pap smears, evaluation of irregular bleeding, breast pain, vaginal discharge,” she explains. The practice’s specialty is contraceptive counseling for patients with complex medical histories, as well as miscarriage management, ectopic pregnancy management, and elective terminations through 23 weeks and six days. The practice also conducts research on contraceptive methods.

“I love our practice,” Tedone says. “We do a journal club every single week where we read a hot-off-the-press article and then talk about it, dissect it, and discuss how and if this would change our clinical practice.”

She is also part of a working group that is planning an NP residency program within the Department of Obstetrics and Gynecology, which would be a first at Columbia.

Rotating through the divisions within the larger department, Tedone explains, the NP residents “would get very hands-on training, education, learn how to do all the obgyn procedures, and also get to engage in a research project.” The goal will be for the NPs to transition to full-time staff appointments after finishing their residency.

Tedone says she’s excited to see these firm links forming between Columbia Nursing and CUIMC’s nurses. “I love the idea of bringing these two worlds together, because I think that we can all help each other; everyone has these bright minds and all these really wonderful ideas. If we can advance the practice and also amplify the nurse practitioner world at Columbia University, I think it will be great for everyone.”

Illustration by Davide Bonazzi.

This article originally appeared in the Fall/Winter 2024 issue of Columbia Nursing Magazine.