Listen, learn, lead.

Lorna Finnegan has spent decades fighting for health equity, as both a nurse practitioner and a nursing scholar. As the new dean of the Marcella Niehoff School of Nursing, Finnegan will extend that battle on Loyola University Chicago's Health Science Campus, training a new generation of mission-driven health care professionals.

Here, Finnegan talks about the start of her career and her long-term priorities at Niehoff.

How have you spent the first two months?

I’ve spent the first few months finding everything, first of all. I’ve met with faculty on campus (Lake Shore and Health Sciences), plus my administrative team, executive committee, and staff. Most importantly, I’m getting to know people and I’m doing a lot of listening. I presented my initial impressions and ideas at our academic council meeting and received positive feedback. 

What were the themes of your talk?

Listen, learn, and lead. I talked about my background, what I’ve learned, and my plan for going forward, which includes some focused listening sessions with faculty and staff to find out where we need to grow. This is an extremely strong school. I am thankful for my predecessor, Vicki Keough, for her work in getting the school to this point. There’s not anything here that needs to be changed quickly, but there are opportunities for growth, particularly thinking about the rapidly changing health care and higher education landscapes. Leaders in nursing are already planning the Future of Nursing 2020-2030, focused on advancing the profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the population. We need to think beyond that and leverage the strengths of Niehoff to prepare nurses for 2040. Even though that’s 20 years from now, envisioning that future will help us determine where and how we need to grow.

How did you get started working in nursing in the first place?

I have all three of my degrees—bachelor’s, master’s, PhD—from the University of Illinois at Chicago (UIC). I began working as a nurse in acute care, mainly in surgical and cardiac intensive care. In the mid-1980s, I shifted my focus to public health and primary care and I became a family nurse practitioner (FNP).

FNPs provide primary care across a person’s lifespan. We blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. With a focus on health promotion, disease prevention, and health education and counseling, we guide patients in making better health and lifestyle choices, which in turn can lower patients' out-of-pocket costs.

Throughout my career, I have focused on increasing access to primary care and improving health in vulnerable and underserved populations. In the late-1980s, I began teaching at St. Xavier University in Chicago. Along with faculty colleagues, I started an FNP program there. At the same time, we started two clinics, where faculty and students collaborated to provide primary care. One was a school-based clinic near UIC. The school’s principal listened to a nurse practitioner (NP) panel presentation at St. Xavier and he was excited about what NPs could do. We started this clinic in a closet, probably one-third the size of my office here, and we just started by making sure all of the students were immunized. We applied for and received federal and state funding, which allowed us to develop a clinic based on a nursing model of primary health care. We worked with the community to define health needs and a plan to address them. By October of every year, if the students didn’t have their immunizations and physical exams, they would be excluded from school. When we started the clinic, 250 students were excluded from school due to lack of physical exams and inadequate immunizations. Within one year, our outreach tactics decreased the numbers of excluded students to nine.

Along with that, we started a second clinic in [the south suburb of] Chicago Heights. This was before the Affordable Care Act, so there were residents who worked but who did not have insurance and could not qualify for Medicaid. When we started that clinic, we charged $5 a visit. We were really helping people get back into the health care system. Ultimately, both of these clinics evolved into federally qualified health centers. The Chicago Heights clinic is now part of the Access Community Health Network, which is an important clinical practice partner with Niehoff.

When I finished my PhD, I moved to UIC to pursue research that was inspired by my FNP practice, where I saw many patients with chronic illnesses seeking care for relief of clusters of symptoms that were often not related to specific illnesses. Using big data analytics, I focused on defining subgroups of individuals defined by unique symptom clusters. With funding from the National Institutes of Health, I expanded this work with long-term childhood cancer survivors and developed a framework that provides valuable new direction for the development of group interventions targeted to reduce symptom clusters in primary care. At UIC College of Nursing, I also moved into leadership positions as department head and executive associate dean.

I really didn’t anticipate being a dean. When the search committee contacted me, at first I told them I was happy where I was. Then I started looking into Loyola and was intrigued by everything that’s happening in the School of Nursing and the Loyola community. The Niehoff mission, with its focus on service to others within the Jesuit, Catholic tradition, was a good fit with my work with vulnerable and underserved populations. I thought, “This really is a great place.” When I came for my interview, I was even more impressed, especially by the welcoming environment. Even though I’ve been a Chicagoan all my life, I’d never seen Lake Shore Campus until I interviewed. I was amazed at the beauty. It wasn’t only the physical beauty of the campus—I think it’s just amazing here. I’m happy I made the decision to join the Loyola community. 

The mission-driven work you’ve done, working with marginalized communities: was that something that, from the start, you always had in mind to do?

My entire nursing practice career has been in underserved communities. However, when I was a young nurse practicing in acute care that career focus was not clear to me. When I shifted to primary care and public health in my FNP program, all of my clinical rotations were in clinics in underserved communities. I realized this was where I was needed and never looked back.

It’s so important to look at people in the context of their community and family to help understand their needs. If you only look at a person when they come in and you expect them to do everything you want them to do, that’s not going to happen. We learned that lesson quickly in our school-based clinic. We had many children with asthma, and we would prescribe different types of medications. They would come back and we would find out that they never got the medications, maybe because they had no way of getting to a pharmacy. We started helping people get to pharmacies and we took health care out into the community. However, even this approach can only make a small dent in health care outcomes, as social determinants such as income, education, employment status, housing, transportation and healthy food, play a much bigger role. As nurses, we can leverage our individual, family, and community advocacy skills to improve health at the population-level by targeting interventions to improve the communities in which people live and work.

What are the primary assets at Niehoff? What drew you here, based on the school itself?

Niehoff is a strong school with a rich (and long) history and an excellent reputation. The school’s assets are its people: our faculty, students, and staff. Our committed faculty teach, conduct research, publish, and serve on community and professional boards. They also inspire, mentor and motivate our students. In turn, our students inspire, motivate, and remind us about the importance of our work. Our dedicated staff are the glue that keeps us operating at such a high level.

What are some of the long-term priorities you hope to implement?

I think I might re-phrase the question to “what are some of Niehoff’s priorities?” I don’t want to prescribe solely what I want to do. I am listening and learning from faculty, staff, students, alumni, and practice partners. We’re going to start working on the school’s strategic plan, as the University begins its process. But one big need that I’ve seen so far that I think the faculty will agree with, which is also a big need in nursing statewide and nationally, is to focus on diversity, equity, and inclusion. An exciting program that we’re starting this year is the Arrupe BSN Pathway to facilitate access to excellent nursing education for first-generation, underserved students from diverse backgrounds. We’re starting with a small cohort of five students who will declare interest in nursing and apply when they enter Arrupe. They will complete an Associate of Arts degree from Arrupe that includes science courses for nursing and supplemental instruction to help them succeed. They will then complete three years in nursing. Our goal is to create three-year scholarships for these students to finish nursing at Niehoff and to support them with the resources to succeed.  

Another big need is to move all of our NP options to the Doctor of Nursing Practice (DNP) degree. I am currently the president of the National Organization of Nurse Practitioner Faculties and we have set a national goal to move all NP programs to the DNP degree by 2025. This is essential to prepare NPs to practice in the rapidly changing, complex health care environment. Some of our NP programs are at the DNP level, but others are still available through a master’s degree.

Where are the trendlines heading in the field? Where is nursing moving?

In addition to preparing advanced practice nurses with a DNP degree, we need to make sure that we retain our PhD students, because we need to continue moving the field of nursing science forward. Identifying ways for our PhD students (who are nurse scientists) and our DNP students (who are practice scholars) to collaborate on different types of nursing problems is a step in the right direction.

Another trend is the technology explosion. I don’t think nurses ever will be replaced entirely by robots, but we have to take robots into consideration. We have to figure out ways to help nurses learn to work in that type of a future, which is surfacing now. Many medical and health care decision-making pathways are already automated using algorithms, and even social robots exist. Nurses really need to learn how to be knowledge brokers. There’s so much knowledge available everywhere, and we cannot teach by feeding students content. Instead, we need to prepare students to be lifelong learners who are able to figure out where to find the knowledge, think critically, and make good clinical decisions.

What makes Chicago a good place to study nursing and to practice it, too?

Nurses need to be prepared to focus on care transitions across settings. We do focus a lot in our nursing programs on care in hospitals and we have some rotations in community settings, but we need to balance clinical rotations so that students have more experience in primary care. From that perspective, Chicago has a wealth of resources. We have major medical centers as well as many community health centers and long-term care settings. There are just so many opportunities for new nurses when they graduate.

One example of an innovative Niehoff program is the Primary Care Community Health Nurse Scholar program, designed to educate and prepare undergraduate nursing students for a career promoting access to health care for the underserved in primary care settings. Another example is the Extending P-PATH (Primary Care-Promoting Access to Health care) to M-PATH (Mental Health) grant, which will strengthen and enhance the education of primary care NPs to meet the needs of underserved communities with a focus on mental health and substance use disorders. These programs, which are funded through the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA), are only two examples of the creative work led by Niehoff faculty. There are many more examples.

Is it also an important time to be here with the Parkinson School getting up and running?

Yes! It’s a great opportunity because we will continue collaborating with those faculty members whose programs moved into the Parkinson School. From an inter-professional perspective, it’s an excellent opportunity for public health and health sciences students and faculty to collaborate with Niehoff students and faculty and transcend disciplinary boundaries to create innovative solutions to solve complex health care problems.