Paul Smith, dean of the Linfield University School of Nursing in Portland, was recently selected as the chair-elect of the National League for Nursing. Smith is the first male to ever be elected to the post in the organization’s 132 years.
The National League for Nursing is the oldest nursing organization in the U.S., aiming to create a standardized nursing curriculum since 1893. The organization also advocates for health care legislation. Smith joins us to talk about his new role and the responsibility of representing nursing education in the Pacific Northwest on a national and international stage.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB this is Think Out Loud. I’m Dave Miller. The National League for Nursing is the oldest nursing organization in the U.S. It’s focused on nursing education for more than 130 years, but it’s never been led by a man.
That is going to change soon. Paul Smith is the dean of the Linfield University School of Nursing. He was recently selected as the chair-elect of the organization. He joins us now to talk about his career in nursing and his new position. Congratulations and welcome.
Paul Smith: Thanks, Dave. Thanks for having me.
Miller: What is this National League for Nursing?
Smith: Well, as you mentioned, it’s one of the oldest organizations around that is focused on nursing, particularly around faculty and those that are educating future nurses. It began around 1893, formally became the National League for Nursing in the 1950s. And as you said, I am the first male elected as the chair-elect and will take over as chair in two years.
Miller: What does it mean to focus on nursing education?
Smith: I think it’s a lot. I think that when we look at things from a national perspective, there’s not a lot of funding for nursing education. And that’s one of the things that the National League for Nursing, or as I will refer to as the NLN, really wants to fund, is looking and promoting the science of nursing education.
We also have a lot of faculty that come into nursing education that might have great experience in clinical but have never had that experience of teaching in a classroom. So helping move that forward is a really big aspect of that as well.
Miller: What does it mean to you to be the chair-elect of this organization?
Smith: I’m still trying to soak it in, to be completely honest. This organization has meant a lot to me. When I first became a nurse educator in 2008 at Chemeketa Community College in Salem, I actually attended the National League for Nursing summit and I was mesmerized by Dr. Beverly Malone, who’s the president and CEO. Her passion for nursing education just resonated with me and I kind of embraced that.
So I became involved with the NLN on multiple fronts. I was elected several years back to the commission that oversees the certified nurse educator certificate. And then I decided to go ahead and put my name in on the ballot and ended up being on the ballot this last time and was nationally voted on as the chair-elect.
Miller: As I mentioned, you are the first man ever to be elected to this position. This is for an institution, it’s worth saying again, that’s been around for more than 130 years. How much do you care about that particular first, that milestone?
Smith: I think I cannot ignore it, I think I have to embrace it as well. I do think that when it looks at men in nursing leadership, even just a few years ago, Dr. Ernest Grant ended up becoming the president for the American Nursing Association and was the first male to hold that position. Here I am again now coming into the NLN as chair-elect.
But I think I want to acknowledge that there have been kind of two historical votes here, and even Doctor Beverly Malone acknowledged this. The chair now, who was the previous chair-elect, was elected, and she’s from a historically Black college and university – so that was a huge change. And then here I come as the male representation. And I think it just kind of echoes one of the NLN’s core values, which is diversity and inclusion.
I want to kind of widen the tent and just show that males in nursing have a place to go. Because I never in a million years thought, sitting back many years ago in my own nursing program, that I would be moved into a leadership position as a dean, first of all, and then now on the national front.
Miller: How did you become a nurse in the first place before you became a nurse educator?
Smith: That is a very interesting story. I grew up in Alabama. Originally, my first degree that I was pursuing was music education at Auburn University. I was coming home from a summer and was gonna do work in fast food and decided, wow, I want to go back and finish my music degree. I come from a very low socioeconomic status family in Alabama, and I was the first generation person out of my family to go to college. And I ended up getting offered a management position that made more money than I would make teaching school.
Miller: So you were going to be like a core teacher or a band teacher …
Smith: Band director, yes.
Miller: Band director. And then you were going to get more money at a fast-food restaurant, so you changed ...
Smith: As a nurse, yes.
Miller: So then you went into fast food?
Smith: For eight years as a manager. And then I decided this is not filling my passion. I didn’t see a full purpose in my life. My mom was an LPN [Licensed Practical Nurse], she was a role model for me as a person that raised me by herself.
There was a community college in my area. I decided to apply; I got accepted. I was very glad that they had the opportunity to offer me a scholarship that fully paid for my nursing program with the caveat that I had a job when I came out at one of the hospitals in LaGrange, Georgia.
So I did that and I received my associate degree in nursing. I worked with that for a while, went back to school and did an RN [Registered Nurse] to BSN [Bachelor of Science in Nursing] completion program, then my master’s at Washington State and then my PhD at UNLV. So it’s been kind of a long trajectory, but that’s kind of where it started.
Miller: Am I right, your clinical work was as a nurse in the intensive care unit focused on patients who had strokes and other neurological problems?
Smith: Correct.
Miller: What was that work like?
Smith: Really demanding, I wanna say. I think that a lot of times when nurses go into the profession, we do not realize the impact of the patients we care for have on us. And that’s one of the things I really try to instill in our students and the students that I currently teach – you really don’t know how this is gonna impact you until you’re doing this on a day-to-day kind of journey.
I will say there’s been great rewarding stories that I’ve seen over the years. There have been stories that really have emotionally had an impact on me. And I think that’s one of the things when we talk about nursing is having that ability to have that grit and integrity to go back day after day when you’re faced with difficult situations.
Miller: When you say that, what comes to my mind when you talk about difficult situations is losing patients. Is that the heart of what you’re talking about?
Smith: Yes, and I think it’s not just that from all of us as nurses personally, I think it’s also seeing the impact with families. I did leave the ICU for a while and go work in the emergency department thinking I wanted a little bit of a change. I did end up going back to the ICU, but even in the emergency department, seeing things that really had an impact.
I’ve shared with my students’ stories about things that I know I will never get out of my mind. I know you see things on television, and I know “The Pitt” is the show that everybody’s talking about now. It gives people a glimpse into what nurses face on a day-to-day journey and what they face as nurses.
Miller: I’ve seen various stats about this, the number of new registered nurses who leave the profession after one year or two years. It could be 20% [and] some stats I’ve seen are even higher than that, around 30% – a shockingly high number after all of this training. How do you explain that?
Smith: I think it’s multifactorial. I think that nurses are going out into the practice areas and are faced with some of the things that I talked about that they might not have felt that they were ready for. And burnout is real. As you said, what we have seen in the literature is about 33% of new nurses leave the profession within two years – and one statistic had it higher than that.
So what we’ve really tried to do even at Linfield University in the School of Nursing is to really help the students understand the challenges they’re going to face and how to build up that ability to kind of face those on a day-to-day basis.
Miller: Do you see that number, if it’s as high as 1 in 3 leaving the profession after two years, as – I don’t know how to say this respectfully – an indictment of nursing education? Or an indictment of the profession of nursing? Something is not working. What’s not working?
Smith: I think it’s a little bit of both. I can actually share that I saw a student who graduated many years ago that ended up leaving the profession after a couple of years. She posted something on her social media around the fact that she didn’t feel as well prepared in her nursing education to face the challenges that she did face once she got out. I’ve also heard a lot of things that are happening within health care organizations that are causing a lot of stress.
I always laugh at this at orientation, the students always want to do ICU, labor and delivery, or ER, and that’s not really where we need the nurses right now. Because there’s truly, according to the Oregon Center of Nursing, not a statewide shortage of nursing. But what we are seeing is areas that need nurses that people may not want to work in, like long-term care, some of the rural opportunities that are out there.
Miller: How do you address that mismatch of supply and demand … demand in this case in terms of like the actual employees?
Smith: This has been said by multiple organizations out there, there’s a kind of a challenge that we’re seeing in the fact that a lot of schools of nursing are turning away graduates, are turning away applicants because one of two things. What we have seen in the literature, there’s a nursing faculty shortage, which is one of the things I hope with my work with NLN I’m able to help work on: how do we get more nurses to become nurse faculty? So that’s usually one thing that really deters applications from coming in or applicants from coming in.
But second, and what we’re facing most at Linfield right now, is clinical placements for students to be able to get hands-on training in the clinical environment. The state board of nursing, which has been really great in working with, they have actually allowed schools of nursing now to use simulation, up to 50% of our clinical opportunities. And we at Linfield have maximized that.
At first, I will say students had a hard time with this because it wasn’t an actual live patient. Even though we use standard patients sometimes that are actors that will come in and portray things in real time, we’ve had students say things like, “Well, this isn’t a real person.” But we have really seen a shift in that and students embracing that. So I think that’s helping them get ready to go into practice.
We’re even integrating things like violence and things that could happen in the workforce so that students can be educated about that before it actually happens.
Miller: Is that standard in Oregon, or at least at Linfield, where student nurses are given scenarios where their patients are violent?
Smith: We have started just doing this actually. I think we’ve seen some of this from our mental health faculty as well, they’ve done some really creative things to get students experience with this. I have heard from some of our recent graduates who’ve reached back out to me as the dean and said, “I really would like to see Linfield integrate more of this because this is what we’re facing, and we need the skills necessary to do that.” So I feel like we’re on the forefront of working around that.
Miller: You said that there’s a shortage now of nurse educators that’s nationwide. Why did you decide to become a nurse educator?
Smith: I think it goes back to my original idea of being in a music education. Teaching has always been something that I loved, and even as a bedside nurse, I always worked with new graduates. I precepted a lot of new nurses coming into the ICU, so I loved the teaching aspect of this. So I decided, what the heck, let’s try this.
When I moved to Oregon in 2007, I actually took an adjunct clinical teaching job at Linfield that fall and fell in love and then applied for a full-time teaching position. That’s how I ended up at Chemeketa.
Miller: Am I right that you’re not gonna be just the first man in this position, but the first person from Oregon?
Smith: That is correct.
Miller: Do you think that you’re gonna bring something specific from your experience in the Pacific Northwest to this national organization? Does Oregon have something to teach nationally, or the opposite, to learn from nationally?
Smith: I think a little bit of both. I think Oregon has always been on the forefront of a lot of change. Looking at advanced practice nurses, Oregon has always been kind of a leader in that area. I think there has not been a lot of representation from the Pacific Northwest with the NLN, so I’m glad to be part of that and kind of maybe bring some of the ideas and innovation that has happened in this state on a national front.
Miller: Do you ever miss the clinical work, the bedside work?
Smith: I do, all the time. I think that my ability to still teach a class with the students now keeps me engaged in that point. But I remember back from one of my mentors at Washington State telling me, “You’re gonna be in nurse administration someday.” And I laughed and said, “I never will do that.” And now here I am as the dean of the school of nursing.
Miller: What would you say to somebody who is considering nursing as a career but is not sure?
Smith: I would say do it. And I would say there is a place for everyone. I will say that you don’t have to work in the ICU or in these really intense areas. We need nurses in occupational health, we need nurses in public spaces, we need nurses in schools. Find your area that you feel passionate about, do it.
Miller: Paul Smith, thanks very much.
Smith: Thank you so much, Dave.
Miller: Paul Smith is the chair-elect for the National League for Nursing. He has had this position for two years before he becomes the chair of the oldest nursing association in the United States.
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