You just have to listen

 
March 11, 2012 -- Today the San Francisco Chronicle ran a remarkably good profile of new University of California San Francisco nursing dean David Vlahov--on the front page. Julian Guthrie's piece, which also includes several photos, explores Vlahov's life and his development as a nurse, from his childhood living with a disabled brother to his work as a prison clinician and a nursing professor, his time at the Centers for Disease Control, his founding of an AIDS clinic in East Baltimore, and his years on the New York City Board of Health. The piece notes that Vlahov is one of a small number of nursing deans who are men, and it reminds readers that there are relatively few men in nursing generally. So the article also discusses the challenges and opportunities men find in the profession. The piece gives Vlahov space to explain his experience and his goals as dean, which include revamping nursing career tracks and attracting more men to the field. The article might have done more to consult colleagues about their views of Vlahov's work, and it might have focused more on Vlahov's scholarship and his experience on Michael Bloomberg's board of health in New York City. But by showcasing this articulate nursing scholar, the piece tells readers that nurses can be health care leaders who advance public health. We thank Julian Guthrie and the Chronicle.

The article spends significant time on Vlahov's family background and how he got into nursing, noting two key factors. When Vlahov was 8 years old, his "brother and best friend," who was "severely retarded, was institutionalized." Vlahov says this situation sensitized him to family relations and how people felt about those who are disabled. The article also explains that Vlahov became a "first-aider" at a Virginia Boy Scout camp when he was 17. The piece says that made Vlahov "proud to be the guy people looked to when something went wrong." And Vlahov also notes that the nurse who ran the central dispensary was an "impressive" man pursuing his PhD in nursing; they had a long talk. Vlahov came to understand that he wanted to be in "a helping profession." His mother "said she thought it was great," but his father, a dentist, asked "why I didn't just go to medical school to become a doctor."

I said, "I've seen medical doctors and I've seen nurses. If I wanted to be a physician, I would become one. Physicians are looking for disease, and nurses are looking at the person."

This is a 17-year-old just back from Boy Scout camp. Briefly updating the family background, the piece also mentions that Vlahov is now married to an occupational health psychologist and is the father of two grown children.

The piece describes Vlahov's prior career highlights in some detail, leading off with a flourish:

His career has taken him from hospital bedsides to the Centers for Disease Control, from a researcher at the New York Academy of Medicine and professor at Johns Hopkins and Columbia to a founder of an AIDS clinic for injection drug users. He spent eight years as a member of the New York City Board of Health, under Mayor Michael Bloomberg.

The piece notes that Vlahov got a degree in history from Earlham College in Indiana and a nursing degree from the University of Maryland, then spent a decade in direct care, notably as a coronary care nurse at Baltimore's Sinai Hospital and at a prison hospital. Vlahov recalls that when he first started, people assumed that one of two things must be true of him as a man in nursing:  either he was going into anesthesia, which was lucrative and "very technical," or he was gay. Both of these assumptions were incorrect. Vlahov also describes some of the good and bad elements of direct care, from watching patients die in surgery to providing psychosocial care for coronary patients who arrived anxious and in great pain; he says one man later approaching him in a mall to thank him. Vlahov also served as "chief clinician at the prison hospital at the University of Maryland." He says he asked the correctional officers not to tell him why his patients had been imprisoned, so it did not affect the care he gave. But he describes one case in which he was caring for a badly burned prisoner whom the officers said "had killed a lot of people, including some in prison." Vlahov says that "taking care of someone in pain, who is angry, with that kind of record, is something that brings out your best skills," but that the prisoner learned that Vlahov "was there to take care of him, not to punish him." Vlahov later went into epidemiology, studied at the CDC, "earned his doctorate in epidemiology at Johns Hopkins University," and founded an AIDS clinic in Baltimore that is still running 24 years later.

The article also includes helpful detail about Vlahov's new job as nursing dean at UCSF. Vlahov observes that he's gone from "the bedside to the community to the city to the clinic, and now I'm at 30,000 feet, looking at the whole terrain of nursing, where you can impact a much broader area," but he admits that he sometimes misses the "intense personal contact" at the bedside. Now, he "oversees a $65 million annual budget, hundreds of faculty and support staff, and a school that this year enrolls 565 students in its pre-license, master's specialties, and doctoral programs." Vlahov says one of his priorities is to study how health care reform will affect the system, with 32 million additional people expected to become insured in 2014, noting that "as part of the discussion around health care reform, nurses certainly have a role."

One initiative Vlahov says he wants to explore is a nursing program in which nurses go straight through school to get their PhDs, "allowing men and women to graduate by age 30 and still have time for a career in research and scholarship." Vlahov explains that many nurses today practice for years in between degrees, "so you are in your early 40s before even thinking about developing a track record in scholarship and independent thinking." It could be argued that the straight-through model gives short shrift to clinical experience, which can obviously inform scholarship. Of course, that is the model under which most physicians are trained, including clinicians. And it could also be argued that nurses should get more formal education before reaching the bedside, in order to bring to bear more expertise and begin on a more level playing field with their health care colleagues, who generally begin with graduate degrees.

The article notes that Vlahov "is one of the few male deans of a school of nursing in the United States, and among a still-small population of male nurses." At another point, the piece says that Vlahov wants to address that issue, noting although currently about 7 percent of (U.S.) nurses are men, Vlahov would like to raise that number to at least 15%. Vlahov says that when he first became a nurse, the number was 2 percent. Vlahov reports that he tells men they are "missing out on a great profession," and he points to the availability of nursing jobs in the current economy.

Vlahov stresses that he is interested in learning how nurses can be better observers, a role he views as central to the profession:

The patient always tells you the diagnosis. You just have to listen. … I started as a nurse, and I learned a lot along the way. I want to understand how we become better observers. How do we become more sensitive to detecting pain? How do we as nurses do a more effective job? That's what I'm interested in.

Just have to listen to get the diagnosis?! What would Dr. House say--no browbeating patients about all their lies, eviscerating them with insults, breaking into their homes for clues?

On the whole, the Chronicle piece is a remarkable--and remarkably prominent--account of the career of a nursing dean. The piece might have offered the perspectives of nurses and others familiar with Vlahov's work. It might have done more with Vlahov's time on the New York City Board of Health under Bloomberg (that must have been interesting), and it might have further explored the scholarly elements of his career, or at least made them more explicit. Unlike physicians and some other professionals, nurses can't count on most readers getting that what a nursing dean is "interested in" means what research he will direct or pursue. But there certainly is a focus here on advanced academic degrees. And Vlahov emerges from the long article as a thoughtful clinical and policy leader. We thank Julian Guthrie and the Chronicle.

See Julian Guthrie's article "Nursing school dean brings his career of caring" which appeared on the front page of the San Francisco Chronicle on March 11, 2012 (the online version is entitled "David Vlahov is new UCSF nursing school dean"). You can write to Julian Guthrie at jguthrie@sfchronicle.com

Also see the press release announcing Vlahov's appointment as dean.