LOUISVILLE, Ky.—She remembers a boy opening his jacket and revealing a bloody chest wound where he'd been stabbed. She remembers people yelling out their windows with greetings and news: "Hey Nurse, someone new moved in across the street!"

     She remembers stopping pregnant women on the street to discuss prenatal care. She remembers identifying unsafe living conditions during her door-to-door assessments that saved the lives of at least three babies.

Mary Mundt, dean of the UofL School of Nursing, with three of Louisville's newest R.N.s: From left to right, 2002 graduates Deidre Wright, Dale McClain and Krista Hester

     Most of all, she remembers the sense of community and family in the neighborhood, the way she was welcomed and appreciated, and knowing with absolute certainty that she had chosen the perfect career.

     Mary Mundt, Ph.D., recalls her days as a young public health nurse in Milwaukee's inner city with a fondness reserved for one's passion. As part of an outreach program created by the city's mayor, Mundt covered a 10 square-block beat in the early 1970s, checking on every person to make sure he or she had proper medical care.

     "For every baby that was born in my district, I would get the birth certificate, make a visit and talk with the mother, and do an assessment of the baby," she says, smiling at the memory.

     "For every person who was discharged from the hospital, I would get the hospital referral and visit. It influenced me really for the rest of my career in terms of wanting to make a difference. I loved every minute of it."

     As the dean of U of L's School of Nursing, Mundt now faces new challenges, not the least of which is to help heal the crippling nursing shortage plaguing health care centers across the country by generating the excitement and interest in the profession necessary to boost enrollment.

     Since arriving here in 1997, the Wisconsin native has forged new relationships with area hospitals to create innovative solutions to the problem. Based on the latest findings, the outlook is promising.

     "We've had a 40 percent increase in freshman enrollment this year and have almost doubled the number of applicants for our clinical program, which students enter after completing two years of coursework in the basic sciences," Mundt says.

More care, fewer providers

     The multi-layered dilemma can be stripped down to a single thread: As the population ages and needs more care, fewer people are entering the field of nursing.

     Health-care professionals cite many reasons for the shortfall. More career options are now available to women, who account for more than 94 percent of the nursing work force. Many young people mistakenly believe there are limited opportunities for growth and good pay in nursing. And the work itself can be challenging, even under the best of circumstances.

Some of the mounting challenges facing Mundt:

-- The U.S. Bureau of Labor Statistics projects that the anticipated demand for registered nurses will exceed the supply beginning in 2010, and demand could grow nearly twice as fast as the expected increase in the R.N. work force by 2020.

-- According to the 2000 National Sample Survey of R.N.s conducted by the U.S. Department of Health and Human Services, the average age of employed R.N.s was 43.3 in 2000, up from 42.3 in 1996. Moreover, R.N.s under the age of 40 dropped from 52.9 percent in 1980 to 31.7 percent in 2000, and R.N.s under 30 years of age sank from 25.1 percent in 1980, to 9.1 percent in 2000.

-- Of the nearly 2.7 million R.N.s in the United States (who make up the largest number of healthcare professionals in the country), 40 percent will reach retirement age in the next 10 to15 years.

-- The National Council of State Boards of Nursing reports that the number of first-time, U.S.-educated nursing school graduates who took the national licensure exam decreased 28.7 percent from 1995 to 2001. That translates into 27,679 fewer students taking the exam in 2001 as compared to 1995.

     The scarcity of R.N.s has forced hospitals to flex their competitive recruitment and retention muscles with new plans like weekend-only work schedules. This flexibility can, however, perpetuate the shortage by making it difficult to find new nurses who want to work weekdays.

     The good news is that in 2001, the American Association of Colleges of Nursing reported the first increase in five years for enrollments at university nursing schools, Mundt says.

Secret to success

     Nonetheless, the challenges remain daunting, and Mundt's progress has been striking in the face of such obstacles.

     She owes her success to an aggressive combination of education, promotion, scholarships and research opportunities; an accelerated degree program; increased interaction between practicing nurses and students; a great faculty team; and hard work.

     One of the dean's closest partners is Martha Dawson, vice president of clinical operations and chief nursing officer at University Hospital, who arrived at her position around the same time Mundt came to Louisville.

     "Neither one of us had to be concerned about the fact that the other person already had a history here and that there were certain things we wanted protected," Dawson says. "It was the first time I've had that experience, and I've thoroughly enjoyed it. There were no barriers to take down. It was like being able to create a new vision together."

     That vision, based on the three tenets of the nursing school's mission -- teaching, research and practice -- includes an increased number of scholarships offered to primary students and a new, 15-month clinical program for students who already have bachelor's degrees in other fields, shaving more than two years off the time required to become an R.N.

     Other incentives include new tuition benefits and full- and part-time employment offers at area hospitals for students who receive their clinical assistant certificates.

     The vision also features initiatives to link incoming nursing faculty with U of L Health Care facilities that focus on their areas of research; an innovative clinician-teacher program that allows employees to split time and duties between the School of Nursing and UofL Health Care; and the establishment of a nurse-run, patient-care clinic in the new Presbyterian Community Center in Smoketown.

     The bond was further strengthened in 1999 when the school's associate dean of academic affairs, Cynthia McCurren, Ph.D., was named the first nurse researcher at University Hospital.

     Although Mundt's primary focus is on University Hospital, she meets regularly with many area health care administrators - particularly her neighbors within the Louisville Medical Center.

     "Dean Mundt talks about what we see on the horizon as far as students coming in," says Patricia Burge, vice president of patient services at Jewish Hospital. "She focuses on how education and practice can work together to really inspire more people to enter the nursing profession.

     "In the past, it was like education was in its own little world, thinking they knew what was needed on the practice side. Now I see there's greater interaction -- a request for feedback on what they're teaching in the school and whether that's actually what the nurses need when they get into the practice setting."

     Teresa Stroud, chief nursing officer at Norton Healthcare, agrees, saying the dean has been "absolutely marvelous."

     Stroud credits Mundt with three major accomplishments: paving the way for the school's first endowed nursing chair -- the Norton-funded Shirley B. Powers Endowed Chair of Nursing Research; increasing the number of U of L students in the Norton Scholars Program, currently numbering close to 90; and creating an accelerated B.S.N. program so that nurses with associate degrees can earn their bachelor's degrees in 12 months.

Research gets a boost

     To make the school more attractive to potential faculty and post-baccalaureate students, Mundt has taken the university's Challenge for Excellence to heart by working to substantially increase the number of research projects.

     "The school's faculty have more than tripled the number of grants and extramural funding for research during the past five years," she says.

     Mundt also has created an external mentor program that encourages tenure-track professors to pair up with exceptional researchers from outside the school for a year in order to "rapidly initiate a research growth agenda with existing faculty."

     It's been such a success that other schools within the university are now using it as a model for similar endeavors, she says.

     Possibly the biggest boon to the school's enrollment turnaround, however, has been its location in the blossoming, biotech-heavy Louisville Medical Center.

     "I think our increase in enrollment is directly attributable to the good press and excitement around the growth of the LMC, the hand and artificial heart transplants, and the exciting genetic research," Mundt says.

     "As I talk to families, parents and high school kids particularly, they're beginning to view U of L as the premiere place to come because there's a lot going on here. That's exactly the effect you want a health science center to have."

     Whether serving on the board of national organizations like the American Association of Colleges of Nursing or speaking with local high school students at open houses and career fairs about the numerous options available to nurses, Mundt never strays far from the lesson she learned years ago as a bright-eyed R.N. fresh out of Marquette University.

     "I always appeal to the 'make a difference theme,'" she says.

     "In nursing, you're there during the times that are most important in people's lives - when people are born, when they die, when they have a major event.

     "There is a tremendous amount of career satisfaction when you deal with individuals and families during those points in their lives."

 Story originally printed in U of L Medicine magazine, wriiten by Mike Ransdell,