Laura McRee DNP, ACNP-BC, RNFA, LMT have served as faculty for the College of Nursing faculty fo 20 years. lt is a privileged to follow my “bliss”. Embracing the philosophy of Joseph Campbell, who was an American mythologist, writer and lecturer, I guide my students with my passion and enthusiasm for creative innovation and positive motivation. I instill this same philosophy in all my teaching/learning, research/scholarship, and service/practice activities. In this statement I will describe my accomplishments in each area and my contributions as a faculty member in the University Of Arizona College Of Nursing.
Teaching and Philosophy of Education
My philosophy of nursing education recognizes that nursing knowledge begins with knowledge of the individual as self, health, behaviors and practice. It is important to follow evidence based science and discovery in teaching and practice. During my career in academia and practice I teach by example, role modeling and mentoring students to use the best evidence for self-care and patient care. I served as the AGACNP Coordinator for 5 years and chaired/co-chaired the Adult-Gerontology Acute Care nurse practitioner (AGACNP) specialty courses: NURS 615 Adult-Gerontology Diagnosis and Management of Chronic and Acute Illness-I, NURS 616 Adult- Gerontology Diagnosis and Management of Chronic and Acute Illness-II, NURS 693a Clinical Residency, and NURS 574 Pharmacology in Acute Care. I have developed innovative teaching strategies to apply content to complex health care situations for these adult learners.
In addition to the standard revision of courses each year to reflect updated knowledge and current standards of practice, I have incorporated smart phone/tablet resources and applications to review medical diagnosis and differential diagnosis. I also created a study guide for NURS 615 and NURS 616 midterm and final exam review using Collaborate and WebEx platforms to support interactive review sessions. I am working with our learning and healthcare technology department to develop an electronic medical record simulation to be implemented in the core AGACNP courses next year. I will test in the AGACNP courses and if the simulation is found to be successful; there are plans are to use it in other specialty courses (e.g., Family Nurse Practitioner (FNP) core courses).
Through my collaboration with Barkley, a company that provides professional practice exam courses for national certification, I introduced the Barkley Nurse Practitioner certification practice exam opportunity for all four NP specialties. Students can take a practice certification exam without cost provided by one of the leading certification exam preparation companies. I have created simulations and videos that allow for advanced learning and application. For example, the challenges the advanced practice DNP student encounters is the role change to becoming a provider in health care responsible for end of life discussions with families regarding a loved one’s wishes and treatment planning and Two Videos (Modeling effective and Ineffective Communication) to distinguish between effective and ineffective nonverbal communication behaviors in the provider. I was invited by Sandy Severson BSN, MBA, CPHQ, CPPS, CENP, FACHE Vice President, Care Improvement Arizona Hospital and Healthcare Association [AzHHA] as a committee member to contribute Thoughtful Life Conversation (TLC) committee. The committee’s missions are to development and disseminate teaching resources to health care providers including nurse practitioner on how to have end of life conversations with patients and families. I developed Professional Role Power-point Presentation Criteria for NURS 615 (see teaching portfolio) and found recorded presentations for peer review have been effective in encouraging professional presentation communication skills and dissemination.
Due to my expertise, I have also contributed to other doctoral courses, such as NURS 681 Issues in Geriatric Health, to contribute expertise in gerontology and end-of-life care. I developed an AGACNP High Acuity Assessment and Professional Role Guideline for NURS 616 and shared this guideline with other faculty who decided to adopt it. This guideline has been incorporated into NURS 609a Advanced Health Assessment for use by students as part of any high acuity assessment of a patient. I regularly lend my expertise to assist in teaching students high acuity assessment in NURS 609a, above and beyond my regular teaching assignment.
Given my passion for practice based on the best evidence and patient preference, I taught in NURS 752 Evaluation Methods for Patient Safety and Quality, as a core Doctorate of Nursing Practice (DNP) course. In this course, I am able to teach all DNP students, regardless of specialty, important knowledge critical to successful role enactment as a doctorally prepared advanced practice nurse. My TCES have been above satisfactory to excellent (>4.0 out of 5) (see supporting evidence in teaching portfolio) attesting to my commitment to providing high quality education to the next generation of advanced practice nurses.
In addition to my online didactic teaching, I have provided clinical supervision to students within the clinical setting, mentoring NP students to provide the best care of their patients. Due to my expertise as an AGACNP, I coordinated the clinical skills intensive, which is a 4-day on-site event that all nursing students must take to learn advanced nursing skills (e.g., suturing, x-rays, oral endotracheal intubation, chest tube insertion, central line insertion) for the past five years. I have obtained additional resources (funding from CMS Graduate Nursing Education grant, PI: Terry Badger) for this intensive to provide state-of-the-art simulation experiences for our students. I also introduced the first ‘White Coat’ ceremony for DNP students which occur during this on-site clinical intensive (CSI) program . This ceremony, modeled after the White Coat ceremony of physicians, welcomes the advanced practice nursing student into the role of advanced practitioner and provides a psychological contract to the role and responsibilities of an advanced practice nurse.
As AGACNP Specialty Coordinator, I have been involved in curriculum changes and revision of all specialty courses, development of policies and procedures in the Doctorate of Nursing Practice program, and mentoring of all AGACNP students and all new faculty. For the past five years (2012-2017), I have advised and mentored all first year AGACNP students (averages 38 per year). I currently advise 19 DNP students who have selected the AGACNP specialty. I have developed an advising/ mentoring worksheet to enable me to facilitate their progression through the program. This document has been shared and adopted by other faculty. I am chairing three DNP projects, and am a member of another 15 DNP projects.
As part of my ongoing passion for innovative creative nursing programs, I was involved in developing the dual specialty (AGACNP/ FNP) in the DNP. This dual specialty is critical especially for NPs in rural areas as the scope of practice requires the skills of both specialties. I have established negotiations with the CEO of National Institute of First Assisting (NIFA) the leading educational program in training Advanced Practice Nurse Practitioners Surgical First Assists. This collaborative relationship would market the University of Arizona College of Nursing as the first DNP program to have an Advanced Practice Surgical First Assist Program in the country (see attached documents for innovative contributions). I have also begun discussions with the Veterinary College about a joint DVM-DNP degree. This type of degree would be highly innovative and the first in the nation.
Other evidence of my excellence in teaching includes a number of presentations to faculty and the community to enhance innovative and creative teaching strategies. A few examples include 1) presented a workshop for faculty in the use of presentation platforms such as Prezi & Panopto; 2) presented a faculty forum on “Marketing your Legacy”; 3) provide continuing education on Compassionate Conversations: Dying and Living Well; 4) attended at the National Organization of Nurse Practitioner Faculties on Distance Education for the NP Learner; 5) attended at the Summer Inter-professional Geriatrics Conference on Train the Trainer End of Life Discussion; and 6) attended AANP National Conferences obtaining continuing education requirements to maintain national certification as an ACNP-BC, which is critical in my teaching role.
In sum the evidence of my creative innovations in teaching is strong and shows the passion I feel about motiving students for progressive engagement in learning.
My scholarship activities developed from areas I value in clinical practice. My scholarship supports my teaching/learning and service/practice contributions as all focus on my beliefs related to preventive health and wellness and emergency medicine. During my first tenure 15 years with the University of Arizona as a master’s prepared nurse, I completed two experimental studies (McRee et al., 2007; McRee et al., 2003) about the effects of preoperative massage on intraoperative post-operative outcomes. Both studies were published in peer reviewed journals: Journal of Gynecologic Surgery,AORN. These studies were among the earliest nursing studies using a rigorous RCT design.
My expertise in massage and integrative modalities as evidenced by these studies is why I was invited to be on the advisory board of a national program, Integrative Fellowship for Nursing Faculty (INFF). The INFF is designed to teach faculty integrative therapeutics, which will be incorporated into curricula throughout the nation. The goal is to then teach nursing students who will incorporate integrative therapeutics into daily nursing practice.
For my DNP capstone project in 2014, I evaluated electronic medical records for sepsis surveillance (McRee et al., 2014). Among my findings were that implementing EMR sepsis surveillance significantly improved home discharge (49.0% versus 25.3%, p< .05) and reduced hospital mortality (1.0% versus 9.3%, p < .05). Findings from my DNP Capstone were published in the prestigious peer reviewed journal, Heart & Lung (impact factor 1.33 in 2015). The results of study have caused others to translate this work into practice to reduce morbidity and mortality due to sepsis. I have consulted with Tucson Medical Center on the implementation and evaluation of the EMR sepsis surveillance program. I also gave an invited presentation at Regional Conference EPIC Health Care Information User Group: EMR Sepsis Surveillance Alert and Implementation at Tucson Medical Center, March 2013, documenting the progress of this surveillance system on patient outcomes.
Due to the knowledge gained in clinical practice about the need to guide health care providers in end of life discussions that honor an individual’s advanced care planning goals and avoid prolonged use of life-sustaining measures, I desired to teach my students about such discussions. My team (Co-Is are Drs. Reed and Segrin) was funded to develop an innovative strategy for teaching AGACNP students about decoding the nonverbal communication during end-of-life conversations between a provider and family member (funded by the Lawrence Emmons Grant Award, University of Arizona College of Nursing). I developed two videos to role model various effective and ineffective nonverbal communication behaviors in the provider when talking to a family member that students can expect to encounter in the end-of-life conversation. The results of the study indicated adequate content validity of the Decoding Tool (used to measure nonverbal communication) and Two Videos (Modeling effective and Ineffective Communication) to distinguish between effective and ineffective nonverbal communication behaviors in the provider. The findings also support the feasibility of the tool and videos for future use as a teaching strategy to facilitate student learning of effective end-of-life conversations.
I published an article in Nursing Science Quarterly (McRee & Reed, 2016) with the focus of the AGACNPs as having the knowledge, skills to lead the end-of-life conversation with family members and loved ones. Due to my expertise, I was invited to be a co-author for a book chapter on depression in palliative care for Integration of Palliative Care in Chronic Conditions: An Interdisciplinary Approach (in press).
I was a co-investigator to develop the Inter-professional Preceptor Toolkit (PI: Ted Rigney; funded by CMS-Graduate Nurse Education Grant) and that manuscript is in progress. This project developed guidelines for preceptors of NP students in the clinical area and is now on the CON website to be used in training. Results of the initial evaluation were positive and it is anticipated to be used by GNE funded schools nationally.
Since my return to faculty in 2012, I was invited to present at EPIC Health Care Information Regional Conference, EMR Sepsis Surveillance Alert and Implementation at Tucson Medical Center. I was also invited to present to the Arizona Hospital & Healthcare Association the results of the teaching nonverbal communication videos and decoding tool for AGACNP providers for end-of- life conversations in the Intensive Care Unit that was funded by Lawrence Emmons Grant Award.
My scholarly presentations include those focused on teaching (one foci of my scholarship described under teaching) and the other on end-of-life, palliative care, and integrative health care (another foci of my scholarship). These two complement each other and integrate with my teaching and service activities.
Additional evidence of my creative scholarship is that I am an inventor. I have developed a medical device, The Bed Sled (patent pending), designed to contribute to prevention of deep vein thrombosis and lower extremity muscle deconditioning. The Bed-Sled is a resistance-training device that promotes movement and resistance exercise in the lower legs. The active movement of a patient’s lower legs prevents muscle de-conditioning and the formation of blood clots. Arizona Tech Launch is collaborating with me in marketing of the device.
According to Dale M. Needham, M.D., Ph.D., of the Physical Medicine & Rehabilitation program at Johns Hopkins University, extended bed rest can decrease a patient’s muscle strength between 3-11% over time. In fact, patients experience rapid reduction muscle mass and bone mineral density in the first week alone. Bed rest and limited mobility can also result in deep vein thrombosis (DVT) or pulmonary embolism, which is the cause of 60,000-100,000 deaths in the United States each year. Currently only treatments currently available to treat DVT in healthcare settings are anti-coagulant injections, which have potentially serious side effects, and passive sequential compression devices. Treatments for DVT and PE are quite costly and result in $4.9-$7.5 billion and $8.5-19.8 billion in annual total market costs respectively. Patients must also consider the cost of physical rehabilitation. Movement and resistance exercise can prevent venous stasis, which leads to venous thrombosis and prevents muscle deconditioning. However, if a patient needs assistance, then dependence on physical therapy or nursing is required and may not always be available. My device when used will allow patients to prevent these negative health consequences and promote recovery. Future scholarship will be focused on patient outcomes after Bed Sled use.
My service is where I believe I have had my most creative contributions as I have participating in committees and serve in a leadership role in the College and wider profession. I have served as AGACNP Specialty Coordinator, Course chair for specialty courses, multiple DNP task forces and Curriculum committees, Faculty Council and as Chair of CON Faculty Council committee. In these roles, I was able to contribute to the redesign of curricula, development of creative and new curriculum, develop policies and procedures for the DNP students and faculty and impact the CON faculty at large. An example of the wider CON impact is I contributed in the design of faculty commons faculty orientation site collaborating with other faculty and staff (Isabel Chavez, Connie Miller and Adam Bookamp). This faculty commons page was designed to help mentor new faculty to understand the increasingly complex UA College of Nursing organization.
As part of my service to the College, I have mentored new faculty. Some AGACNP faculty lives at a distance (e.g., Georgia, California), so I initiated regular meetings where we can discuss teaching issues related to the AGACNP curriculum and clinical supervision. I bring the same passion and enthusiasm to mentoring faculty as I do with mentoring students.
For my community service, I have collaborated with Dr. Larry Lincoln, a colleague with over 30 years in Hospice and a colleague of Elizabeth Kubler Ross, on end-of-life communication and care in Hospice. I volunteer by referral request to provide integrative palliative care, including hand and foot effleurage treatment for which I am professionally trained, and active listening to promote palliative care comfort measures.
I have local, state and national leadership to the profession. Some examples include 1) Thoughtful Life Conversation (TLC) Leadership Committee of the Arizona Hospital & Healthcare Association, 2) Advisory Group member for the Palliative & Hospice Nursing Professional Issues Panel, 3) Nursing Practice & Work Environment Department of the American Nurses Association, and 4) Member of the INFF advisory board, recruited by nationally known integrative therapy leader Margaret Avery Moon. I have reviewed two manuscripts on sepsis for the peer reviewed journal, Heart & Lung, in 2014 and 2015.
Saint Louis University, St. Louis, Missouri
The impact of an Electronic medical record surveillance program on outcomes for patients with sepsis
Certificate Registered APRN Surgical First Assist APRN Surgical Assisting
Lakeland College, Kirkland, Ohio
Post-Masters Certificate Nurse Practitioner
Saint Louis University, Saint Louis, Missouri
Thai Massage Therapeutic Massage
Institute of Therapeutic Massage Certification in Thai Massage Chiang Mai Thailand
Massage Therapy Therapeutic Massage
Desert Institute of Healing Arts, Tucson, Arizona
Ohio University, Athens, Ohio
Clinical Assistant Professor, University of Arizona (2012 - Ongoing)
Acute Care Nurse Practitioner Board Certified, ICU, Tucson Medical Center (2008 - 2014)
Clinical Associate Professor, University of Arizona (1994 - 2018)
Clinical Instructor, Otterbein College (1993 - 1994)
Staff Nurse Critical Care, Doctor's Hospital (1993 - 1994)
Staff Nurse Critical Care, St. Ann's Hospitial (1989 - 1993)
Textbook Integration of Palliative Care in Chronic Conditions: An Interdisciplinary Approach received Textbook of the Year Award, by the American Journal of Nursing, 2nd place under the Palliative Care and Hospice category.
American Journal of Nursing,, Fall 2017
Licensure & Certification
Adult BLS, (2018)
Advanced Cardiac Life Support, (2018)
Thoughtful Life Conversations Certificate of Completion, Arizona Hospital and Healthcare Association (2016)
RNFA, Lakeland College (2008)
ACNP-BC, American Nurses Credentialing Center (2007)
Certification in Thai Massage, Institute of Therapeutic Massage Chiang Mai Thailand (2001)
Licensed Massage Therapist, Desert Institute of Healing Arts (1997)
Research and Clinical Interest: End of life discussion in the ICU, Effects of Massage on Surgical Patients, Developed an EMR Sepsis SurveillanceClinical Expertise: Acute Care Nurse Practitioner in Intensive Care and End of Life Discussions in the ICU. Massage therapy, RNFAIntegrative Methods for life style and professional development
Inventor of a utility patent pending medical device ""Bed Sled"Affiliation for commercialization of device is through Tech Launch Arizona. Rahki Gibbons, Assistant Director, Biomedical and Life Sciences Licensing: Project mentor, NSF-Innovation Corps , National Science Foundation, Mentor Mark BakerNonverbal Communication in EOL discussion