How did you get into nursing? Nursing academics?

The sole reason is that my mother was a nurse and she had the best stories. She often described her student days, along with the wonderful, challenging situations of her work as a nurse. She was the first staff nurse hired at Indiana University and one of the first members of the Sigma Theta Tau nursing society. I wanted to be just like her.

When I moved to Philadelphia, I found employment at the Penn School of Nursing. A master's degree in nursing was all that was required at the time to teach in a baccalaureate nursing program. Later, of course, a Ph.D. was essential to maintain a faculty appointment, and I enrolled in the doctoral program in the Philadelphia City Planning Commission and I've been at Penn for 30 years, working with five deans in a dynamic, changing environment. At one point, with Claire Fagin's encouragement, I became involved with the development of a center for the history of nursing. My career has grown from that.

What is the most positive move that nursing has made, as you look at your historical research?

The move into the university setting was probably the most significant and hardest to achieve. This movement, however, took us beyond the idea of a trained nurse and placed nursing within the professional arena. With nursing established within higher education, there were better outcomes for the profession and for patient care.

Initially, too little attention was given to clinical practice, but today's baccalaureate programs achieve a good balance of theory and practice. Most academic nursing programs at the university level integrate practice, education and research.

Do you have a favorite teaching memory?

My favorite moments are when those students who have a bias against the history of nursing or practice in home care have an "aha" moment and realize the importance of this content.

I ask students to read books such as Ordered to Care by Susan Reverby, No Place Like Home and Enduring Issues in American Nursing edited by Ellen Davidson Baer, Patricia D'Antonio, Sylvia Rinker and Joan Lynaugh, to provide a solid historical foundation that explains many of our current policies and dilemmas.

What are the LIFE program and the PACE initiative?

PACE is a national model of all-inclusive care for the elderly. It combines a financing mechanism (both Medicare and Medicaid capitation) with a service delivery model (tightly integrated interdisciplinary treatment team plus aggressive case management plus a day health center as a locus of services) to deliver seamlessly integrated, high-quality health care to frail elders eligible for nursing home placement.

At Penn Nursing, we own and operate a PACE program, which we call LIFE, for Living Independently for Elders. It serves more than 150 frail elders from the West Philadelphia area.

Are we moving toward home care or away from it?

Both. We are forever moving toward and away from home-based care. U.S. policy-makers and payers continue to debate the criteria for these services, which generally favor acute care over community-based care. We all know that most patients prefer home-based care, but we can't decide whose responsibility it is to pay for it. These conflicts have endured for more than 100 years and we seem no closer to solving them, despite numerous attempts to do so.

What is one theme we can use to look at nursing today?

Workforce issues, the nursing shortage, what nurses can do and salary are among the largest issues facing nursing today. Nevertheless, none of this is new. The problem won't be solved without looking at the workplace and salaries.

At Penn this year, with expanding nursing options, we have admitted the largest number of undergraduates in many years, and certainly the best qualified with SATs over 1350 and many coming for a second degree. With a good salary and a good workplace, people will choose nursing as a professional career.