Q&A with Antonia Villarruel

Antonia Villarruel was in eighth grade when she made a decision that would shape her entire professional life: She decided she was going to be a nurse.

“I come from a working-class family, but my three brothers and I all knew we were going to college,” explains Villarruel, the newly appointed Margaret Bond Simon Dean of Penn’s School of Nursing. “I was told by my parents—who wanted to make sure I would always have a job—that I could go to college to be a teacher or a nurse. So, when I was in eighth grade, I made that decision: I’ll be a nurse.”

After graduating from Nazareth College in 1978, Villarruel worked at the Children’s Hospital of Michigan. Along the way, she met a researcher and worked on a project, which sparked her own journey down the research path. Villarruel came to Penn Nursing for her M.S.N., which she received in 1982, and went on to get her Ph.D. from Wayne State University in 1993.

Villarruel worked as a faculty member at Penn Nursing from 1995 to 2000, and before coming back to the School as dean, worked as a professor, the Nola J. Pender Collegiate Chair, and the associate dean for research and global affairs at the University of Michigan School of Nursing.

In her career, Villarruel has carved out a research portfolio with wide reach and application. Specifically, Villarruel has focused on developing, testing, and disseminating health-promotion interventions for Latino, Mexican, and Puerto Rican populations. She built and maintains a program of research focused on reducing sexual risk among Latino adolescents and has been the principal investigator or co-investigator on several studies funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention. The culturally responsive interventions she developed for parents and adolescents are being used by communities and practitioners throughout the United States.

Villarruel has also championed diversity in nursing schools and in the profession, serving in leadership roles on the Secretary’s Advisory Council for Minority Health and Health Disparities for the U.S. Department of Health and Human Services, the National Coalition of Ethnic Minority Nurse Associations, the umbrella group for ethnic minority nursing organizations, of which she was a founder, and of the National Association of Hispanic Nurses.

She returns to Penn at a time when health challenges—both local and global—are many.

“I didn’t have aspirations to be a dean, really, but when the opportunity arose, I decided I needed to take a look. The values of the School and the University are aligned with mine,” says Villarruel. “This is a chance to make a difference. It’s a chance to build on an incredible legacy of people before me. It’s very exciting.”

The Current sat down with the new dean (just three months into her tenure) to talk about some of the big policy decisions that are affecting nursing, the impact of her research, and how it feels to be back at Penn in a new role.

Q: Initially you weren’t going to do research, but ended up moving in that direction. What led you there?
A: My baccalaureate program didn’t emphasize research, and at that time, nursing research really hadn’t come of age. There weren’t a lot of role models; you didn’t read about nursing research—or its impact. Even after earning my master’s here at Penn and being exposed to research, I didn’t think being a researcher was in my future. I liked practice, being a part of a team, and working closely with children and families. I thought I would lose that by being a researcher. But, I attended a research presentation describing the process and evidence for a measure to assess children’s pain. This photographic instrument, the ‘Oucher,’ was developed to help young kids communicate about their level of pain. The photographs were of a young Caucasian boy, and there was a need to validate the measure with other cultural groups. The process of research—and the potential impact—were intriguing to me. As a result, we worked to not only validate the measure, but we developed an African-American version and a Latino version. The entire process was fun, but more importantly, the impact of the research and other related activities around improving children’s pain management were exciting: understanding and evaluating the evidence, understanding the gaps in research and practice, and knowing enough about the evidence to know that what we were doing in practice wasn’t consistent with the research base. All of this led to major improvements in how we, as a healthcare system, managed pain in children.

Q: In a previous interview, you said that your involvement with the Latino community in Detroit made you shift your area of focus to research that would have a significant impact in the community. Can you talk about this shift?
A: I was working in a great medical center which had very few Latino families accessing the health services. When we started doing our pain research, we needed access to Latino subjects. We couldn’t find them in the hospital, so I went to the Latino community—the neighborhood in which I had lived. I became a great partner with the director of a clinic, which is now a federally qualified health center, to recruit children and families. The only thing he asked was, ‘Just come back and let us know what you find,’ and so I did. He said, ‘You’re the first person who’s ever done that. People use the community as a laboratory, they get what they need, but never come back to help the community.’ With that, and because I had amassed research skills, I felt like I had really found my niche. Similarly, I began to work with several Latino organizations at a national level. I was approached because of my research skills, my clinical skills, and my connections with communities. I felt that not too many people could make the impact in the community that I was hoping to make—so concentrating on Latino community issues became my research focus.

Q: Laypeople may think about nurses as being so hands-on and having so much contact with patients, but there’s obviously a big research component in nursing, too. What’s the importance of studying research if you want to be a clinician, and vice versa?
A: Nurses are not just doers. Our work is supported by evidence and guided by theory. We integrate evidence and theory with our knowledge of patients and make important decisions with and for patients and families at the point of care. Research and practice are not separate but integrated. Nursing is a practice discipline with our own theories and research base that we both generate, use, and disseminate to others.

Q: Do you think that gives students here an advantage, since Penn is such a research powerhouse?
A: Absolutely. It is what sets us apart from other schools. To be in an environment where you can be part of the process of discovery with faculty, to be part of our robust programs of research, and to see the impact they’ve had—whether at [the Hospital of the University of Pennsylvania], at [the Children’s Hopital of Philadelphia], in West Philly, or globally—helps students aspire to what they can do in nursing.

Q: Is that a crucial part of students’ education here?
A: Yes. Nurses have always considered the context in which our patients and families live, so understanding the ‘real world’ impact of what we do is critically important. Nurses have always been at the forefront of being able to prevent care and manage care in places where people live, work, and play. Where we practice and where we conduct and implement research are the same: in health care systems and communities.

Q: I’ve read that fewer med school graduates are going into primary care practice, and that nurses are picking up the slack in primary care. Can you talk about this?
A: The answer to our health care system can’t always be, ‘Educate more doctors to fill-in-the-blank.’ Nurses are at the forefront of primary care. Nurses have the desire and ability to provide primary care. This is an important workforce strategy, as access to care is going to stretch thin our health care workforce. We need strategies that allow all providers to fully engage in the health system. Nurses are prohibited from doing that in many states because we don’t have the policy that allows us and other health professionals to practice to the full scope of their license.

Q: Is that something that you see changing?
A: There are a lot of initiatives in progress that support nursing scope of practice. In The IOM’s [Institute of Medicine] ‘The Future of Nursing’ report, a primary recommendation was to allow nurses to practice to the scope of their education and license. There are efforts in all 50 states to eliminate practice barriers. This is not just a nursing issue—this is a population health issue. With expanding access, you need to have people who address the health care needs of the population. We have consumer groups like AARP and industries like Target, Walgreens, and some of the insurance companies, supporting this issue. The scope of practice issues affects not only nurses but other professions as well.

Q: It seems like these policy debates at the local, state, or national level affect the nursing profession so directly. What are some big policy developments that have affected the nursing profession in this way?
A: The increased access to health care is going to cause a demand that will make the production and employment of nurses in those settings ever more important. It trickles down to working at the state level to ensure that nurses can practice to their full scope.

Q: What are some ways that you have worked to expand and diversify the workplace, student body, or the profession in general?
A: Here at the School of Nursing, we are going to be building on what’s already in place. Diversity is not just about numbers, it’s about creating a context in which people feel comfortable, respected, and valued. In order to have diverse faculty, you need to need to have diverse students—and vice versa. We need to create more opportunities for faculty and students to work in partnership with communities to address issues of importance to that community. We are involved with the West Philadelphia community through LIFE, Healthy in Philadelphia, and other programs. We are involved with the Latino community here with our clinic, Puentes de Salud. And, we have global offerings in Latin America, Spain, or Africa ... these are all important parts of creating the proper context for diversity.

Q: Is it a matter of recruiting in different ways or changing the scope of a program? Specifically, what does diversification entail?
A: As we’re looking at faculty recruitment, what I’ve said is, ‘Find a friend.’ Find a friend that you want to work with. I think Penn—and not just the Nursing School—has the reputation of being elite and some people think,  ‘Gee I wouldn’t fit in there.’ That’s not the environment here. We have to change that perception. We have to be active recruiters. We can’t wait for people to come to us. Who better to recruit than somebody who you admire, who you respect, who you want to work with in creating the work that you want to do here. I think our students are active recruiters, and we have to figure out how to use them in a better way to let their colleagues know this is a good place for them to be. You can’t do that by having just one or two, you have to have a whole body of people that are here. When I came here, I was so impressed with the number of Latino and African-American doctoral students and post-docs. We have a critical mass of diverse students at Penn Nursing. That means that Penn is a good place and a safe place to go. For example, we have about four or five Latino doctoral students who get together regularly; they’re excited about being together and what they can do to support each other. They want to talk to undergrads and graduate students about pursuing their education. They take the responsibility of increasing the diversity of the pipeline pretty seriously, and they have tons of ideas. We just need to be able to support them and be able to make that happen.

Q: Did you have a mentor?
A: I’ve had lots of different types of mentors. And, I’ve had people who have come into my life at different times who have said, ‘Of course, you’re good enough to do this,’ or ‘You’re crazy for doing X, Y, or Z when you have these opportunities.’ Those people have come from all over, and it makes me realize the impact that someone in a leadership or power position has in just a matter of seconds—being able to influence a person’s career, a person’s life. I have had many people who have done that for me, and who have been there to support me in my journey.

Q: Global health has been a big focus at Penn Nursing. What are some of the major global initiatives at the School of Nursing?
A: Let me say first that a global presence and global impact are important. I was the Associate Dean for Global Affairs [at University of Michigan School of Nursing] and worked to develop strategies to maximize impact. As I think about how to move forward here, I’m not place-bound, but the guiding principles for our involvement should be the integration of what we’re doing in research, practice, and teaching. We can create synergies with priorities or focal areas across campus, such as China, India, Botswana, and other key areas. I believe that students come here because Penn Nursing offers an array of global experiences—the opportunity to study abroad with faculty members, to see them working, to see them in action, to see how they interact is critically important. Many faculty are involved in some aspect of global work. We’re a WHO [World Health Organization] Collaborating Center in nursing and midwifery leadership; our terms of reference are directed at specific activities of the Americas. I have my research with colleagues in Mexico and an NIH-funded research study in Puerto Rico. We have a research center in Guatemala. Our faculty are funded to do research in Peru. We are making a global impact.

Q: What are some of the local, national, and global health challenges that nurses are confronting?
A: Many global issues aren’t any different than the ones that we’re dealing with here in our country. Major issues are communicable diseases, like Ebola, malaria, HIV/AIDS, and, in some countries, TB [tuberculosis]. Some of the interventions that can prevent the spread of these diseases are good housing, good hygiene, systems that can support protective behaviors both in an individual and community basis. Non-communicable diseases—cancer, cardiovascular issues—are also a challenge globally, so complex, chronic illness management is an issue. It’s very rare for one person to have one chronic illness—you don’t just have diabetes, you have diabetes and hypertension. Managing those is a challenge. The human resource shortage in terms of health and health care certainly is a global challenge, as well. Some of the strategies that we’re looking at globally involve community or lay health workers for health management. These are strategies that we are adopting here. We have a lot to learn both locally and globally from the challenges that are confronting our populations.

Q: What’s it like for you to come back to Penn, but in a different role?
A: In some ways, many things are familiar. The campus is familiar. There are a lot of familiar faces in the School—not so much from when I was a student, but when I was faculty, and that feels good. It tells me that this is a place where people like to be, want to be, and that people are dedicated to Penn Nursing. That’s a really good feeling.

Q: What are some of the immediate things you’d like to accomplish within your first year, and then longer term?
A: I’ve been listening to students, faculty, and stakeholders of the Nursing School to learn where we need to move forward. I want to bring a stronger focus on where we can have impact. We need to align opportunities with our mission. I am working with our faculty to define our focus in global health, research, community engagement, practice, and opportunities in online education, looking at both what we teach and how we teach. We need to think about how to build on our strengths, where research is going in the future, and how we recruit and support faculty to move forward in that direction. In relation to community engagement, we need to think about how to better integrate our community involvement with our research, practice, and teaching mission. For instance, I’m interested in figuring out how to build on the successful ‘Healthy Cities: Healthy Women’ platform that we have had here over the last five years. We’ve used everything from events to creative external partnerships to social media to shine a light on the importance of urban women’s health and our multi-disciplinary work in that area. I’ve been in conversations with the Trustees’ Council of Penn Women, with some of our overseers, and as part of our orientation, had some discussions with some of the other new dean colleagues about how we might use that same approach to do something jointly together around children, youth, and families. We’re all excited and we’re all in agreement that there is a tremendous need and opportunity here that aligns with our schools’ missions.

Q: As dean, you’re still doing research, correct?
A: I am the first nursing dean that’s had NIH funding. I have two active grants right now. One uses Second Life, a multi-user virtual environment, to train community-based facilitators on how to implement an evidence-based curriculum that is used all over the country. People are techno-phobic, but we had really good support for them to come into the virtual environment to interact with people from across the country that otherwise they wouldn’t have been able to meet. We know that the teaching modality is effective. We taught them the curriculum and then we have them audio-record themselves as they implement the curriculum in real life. Our outcome measure was whether facilitators could implement the curriculum with fidelity and our results indicate they did.

Q: Was it important to you to still carve out time for your research when you came here?
A: I have a commitment to my research. There’s too much of myself in there. I have great teams, in Puerto Rico and at Michigan, that allow me to have a leadership role without all the day-to-day management. I do think it’s important. I have at least one more study I would like to do. Carving out time for an area of scholarship, whether it’s research or something else, is critically important.

Antonia Villarruel