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Social Upheaval and a Dean’s Vision for Professional Nursing: The Work of Dorothy M. Smith

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Kim Curry, PhD, FNP-C, FAANP

Abstract

Dorothy Mary Smith (1913–1997) was a visionary leader and innovator in nursing education. She was the founding dean of the University of Florida College of Nursing and played a key role in the design of an early academic medical center model. This article will discuss her education and early years, and the formation of Smith’s perspective on nursing education, exemplified by the implementation of her unification model of nursing, which was later adopted by numerous other academic nursing programs. During her deanship, significant events included the intrusion of the Johns Committee, an offshoot of the McCarthy investigations. The changing tides and times, such as the civil rights movement, also brought controversy and struggle to southern universities. In the end, financial downturns in state funding brought an end to the vision of Smith and her colleagues, leading her to ponder the outcome “if I had stayed.” Smith was an innovative leader whose legacy inspired graduates and faculty long after her academic career ended.

Citation: Curry, K., (October 16, 2020) "Social Upheaval and a Dean’s Vision for Professional Nursing: The Work of Dorothy M. Smith" OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1.

DOI: 10.3912/OJIN.Vol26No01PPT72

Key Words: Nursing history, academic nursing, nursing leadership, civil rights, professional nursing, baccalaureate nursing education, academic medical center.

“For men are prone to go it blind
Along the calf-path of the mind,
And work away from sun to sun
To do what other men have done.
They follow in the beaten track,
And out and in, and forth and back,
And still their devious course pursue,
To keep the path that others do.” (Foss, 1895, pp. 79-80)

Her fifteen year tenure occurred in an environment of social and political unrest...When Dorothy Smith stepped down as the dean of the University of Florida (UF) College of Nursing in 1971, it marked both the end of an era and an acceptance of the inevitable. Smith, the founding dean of the college, had been there for the intellectual and physical construction of a unique academic health science center. Her fifteen year tenure occurred in an environment of social and political unrest, including unpleasant encounters with southern politics of the era, the growing civil rights movement, and the impact of student activism that played out on every college campus, signaling major cultural shifts throughout the United States. Throughout her tenure as dean, Smith remained determined to carve a unique path for nursing education that was unified with practice and research, resulting in a model for academic nursing that has persisted to this day.

Education and Early Years

Born in Bangor, Maine in 1913, Dorothy Mary Smith was one of four children of a housewife and a pulp mill worker. Smith’s parents were of Irish ancestry and the family was of very limited means. They moved frequently so that her father could find work. As a result, by the time Smith was nine or ten years old she had attended eight different schools.

A tragic incident during Smith’s childhood was a defining moment in her life. After one of the family’s many relocations, all four children became very ill. Over a short period of time, they all suffered from scarlet fever and diphtheria. The two daughters were then diagnosed with mastoiditis and meningitis, grave consequences of their infections. Dorothy was taken to a hospital in Bangor, while her sister was hospitalized in another city. After six months of confinement Dorothy was finally well enough to return home, only to find that her sister had died while she was gone.

To provide a more stable life for the surviving children, the Smiths finally settled in Quincy, Massachusetts in the late 1920s. Dorothy finished grade school and high school in Quincy. She stated “I worked in the five and ten through high school because this was the Depression. I took a college course and really wanted to go to college… but [with] my family being very Irish, the boys went to school and the girls did not” (Kerber, 1979, p. 3).

Smith realized that she had the usual options faced by the women of that era: teaching or nursing.Smith realized that she had the usual options faced by the women of that era: teaching or nursing. Her best friend went into nursing, and Smith needed to work, so she applied to the Quincy Hospital School of Nursing in Quincy, Massachusetts. Her selection was touch and go. Waiting for her name to come up for questioning by the admissions committee, she heard student after student profess a desire for nursing due to their love of people and animals. When the question was posed to Smith, her response was that she needed to earn a living. This was not the ideal reply, so she was then asked how she felt about people. Smith responded that she liked some but could not stand others. She was declared lacking in the appropriate motivation but apparently got high marks for honesty and was selected for admission (Kerber, 1979).

Smith continued to suffer from chronic ear infections and hearing loss as a result of her childhood illnesses. During her nurses’ training program, another serious ear infection resulted in major surgery and she was forced to delay her graduation. She eventually completed her diploma program in nursing in 1936 (Quincy City Hospital, 1935; Smith, 1973). Her first position as a newly registered nurse was at the city hospital where she had trained. After a year, she was promoted to a head nurse position (Smith, 1973). With encouragement from friends and colleagues, she enrolled in Columbia University Teacher's College in Manhattan in 1939. Two years later she was awarded a Bachelor of Science in Nursing degree (Smith, 1973; Kerber, 1979).

Smith recalled those days as a consciousness-expanding experience for her. Coming from her family background, she quickly noted that many faculty at Columbia were somewhat left-leaning politically and provided a very different viewpoint. She found the difference exciting. Smith stated, “They were very interesting people, and you did not necessarily have to agree with them or not, but they certainly were broadening-horizons kind of people” (Kerber, 1979, p. 5). This memory would be revisited years later during her deanship as she dealt with the effects of the McCarthy era in the south.

The Formation of Smith’s Perspective on Nursing Education

Smith completed her bachelor’s degree a few months before the attack on Pearl Harbor. When the United States entered the war, she volunteered for the armed services but was immediately disqualified because of her chronic ear problems. She soon accepted a teaching position at the Margaret Pilsbury Hospital School of Nursing in New Hampshire. Her assignment was to teach anatomy, physiology, and microbiology, as well as provide some patient care, which was what she enjoyed most. She arrived, and to her horror, found that she was expected to teach much of the curriculum, and when not busy with that, she was to answer the hospital switchboard and mix drugs.

Like many nurse educators since, she said she learned what not to do, and knew that was not the way she wanted to teach.Overwhelmed, she tried to stay one page ahead of her students and would not let them ask questions because she was so unsure of her own knowledge. Much later, Smith stated that she learned a great deal from this experience. Like many nurse educators since, she said she learned what not to do, and knew that was not the way she wanted to teach. As Dunham-Taylor and her colleagues pointed out, when faculty mentoring does not occur, then isolation, frustration, and dissatisfaction ensue (Dunham-Taylor, Lynn, Moore, McDaniel, & Walker, 2008). Smith experienced all, and she quit the following February.

She called out hospitals for staffing patients with nursing students rather than licensed nurses, a common practice at the time.Smith began to develop a dim view of the quality of most nursing education programs during this period in her career. She called out hospitals for staffing patients with nursing students rather than licensed nurses, a common practice at the time (Judd, Sitzman, & Davis, 2010). She acknowledged, though, that World War II had decimated hospital staffing in general. In 1942, Smith returned to teach at her alma mater, Quincy Hospital School of Nursing. Soon after arriving, a group of students asked her to help them form a student organization.

Smith decided to conduct some research on the matter. She located a professor at Harvard University, John Brewer, whose area of study was student organizations. She signed up for his course, and by the end of the term was coaxed to pursue a degree there. For the next four years, she held a full-time job and went into Harvard by subway three nights a week and Saturdays. She graduated with a master’s degree in education in 1947.

...Smith worked hard, developing both her skills as a manager and her vision for nursing education and its relationship to clinical practice.By the time she completed her master’s degree, Smith decided that it was time to leave Massachusetts. Before she could accomplish that, another tragedy struck that would impact every decision she would make from that time on. A close friend of Smith’s died of tuberculosis shortly after giving birth to a daughter. The two families had a complex relationship, and Smith and her family agreed to raise the child, Bobbie Ann. While Smith carried on at work and school, her parents helped with the little girl. Eventually, Bobbie would live with Smith, who then finished raising her. In the meantime, Smith worked hard, developing both her skills as a manager and her vision for nursing education and its relationship to clinical practice.

Smith searched for the best faculty job and received an offer from Duke University in North Carolina. She moved south and soon received another unpleasant surprise. The hospital at Duke had separate wards and water fountains for Black and White patients and personnel. She was then instructed not to call any Black staff members by the title “Mr.” or “Mrs.” She refused.

Smith took advantage of the opportunity to observe nursing education in different schools.Another disappointment was that Duke had not made the nursing school a university program, it was still a diploma school, including use of the old model of nursing students to staff the hospital. To add insult to injury, the nursing program was administratively placed under the medical school. Smith recalled that the doctors did not want nurses to get a better education (National Library of Medicine, 1979). Not all of the nursing faculty disagreed with this paternalistic approach. The dissonance between her beliefs and the reality at Duke was so disturbing to Smith that she sought psychiatric treatment to cope with her stress. She remained at Duke until 1952, and gradually she and like-minded colleagues made headway with their vision for an academic nursing program at the university. Unfortunately, nursing did not become a university-level degree until after she had left, moving elsewhere for greener pastures.

At the end of her intense experience at Duke, Smith decided to follow a friend and pursue work at the National League for Nursing (NLN) accreditation office in New York. She promised them two years, and during those years she enjoyed being back in New York and traveling all over the country visiting nursing schools and hospitals to determine whether the programs met standards for national accreditation. Smith took advantage of the opportunity to observe nursing education in different schools. She continued to find examples of what she considered to be severe exploitation of students used as free labor in hospitals (National Library of Medicine, 1979). This experience helped to cement her ideas about what was and was not the proper course for nursing as an academic discipline.

Smith kept her commitment to stay two years at the NLN, leaving in 1954 for her first opportunity to enact her model of faculty practice at Hartford Hospital in Connecticut. Smith stated,

One of the things I had observed as I went around, and which I had known for a long time, was that nursing students were being taught nursing by people who would not know what to do with a patient if they saw one. At Hartford, they paid me … to see if I could get faculty to work with patients as they taught students. I was able to get a few people on fire. I knew I was not going to do it forever, but I just wanted to see if it could be done and if it made any difference (Kerber, 1979, p. 12).

A year into the work to implement her new model, two very different universities in Florida came calling: the University of Miami, at the southern tip of the state near sandy beaches, and the University of Florida in Gainesville, in the far northern part of the state surrounded by cow pastures. Smith wanted to go back to full time patient care and made that known, but the University of Florida persisted. She required them to pay her way for an interview, and they did. She told them she did not like administrative work. They suggested she think about it. Finally, Smith said, “I told them the conditions under which I would come, and they bought them. It had nothing to do with money, it had to do with philosophy” (Kerber, 1979, p. 13). UF agreed with her vision and Smith accepted the deanship.

The Unification Model

Smith was hired to form a new school of nursing planned around an exciting new concept: an academic health sciences center...Smith was hired to form a new school of nursing planned around an exciting new concept: an academic health sciences center soon to be built on the UF campus. She reported to work in February of 1956 and was promptly shown to her new office in a Quonset hut, a prefabricated steel structure that had once served as a military barracks. The accommodations, however sparse, were not unusual. The hospital that would become the W. A. Shands Teaching Hospital was not yet built, and there were numerous such buildings scattered about the premises following the end of campus-based military training during World War II (UF College of Nursing, 1966).

Smith was very involved in planning for the new teaching hospital. Along with her colleagues in medicine, dentistry, and allied health, Smith participated in the design and implementation at UF of one of the country’s first such centers, integrating education, research, and practice across the health professions. Smith’s model included educating students thoroughly in the arts and sciences; a combined model of teaching and clinical practice called the unification model; and patient care focused on patient needs and not medical diagnoses or tasks.

One key component of her model was her joint appointment as dean and chief nursing officer of the hospital.One key component of her model was her joint appointment as dean and chief nursing officer of the hospital (Brook, 1988). Smith determined that she would serve in this dual capacity. A primary reason for doing so was to guarantee that she would be able to establish faculty practice in the hospital. She then hired faculty who were competent clinicians, with graduate degrees, as hospital clinical managers. This supported her plan to ensure the integration of teaching and clinical roles.

Smith also had a goal to staff the hospital with all baccalaureate prepared nurses, but it was a goal she would never achieve. In fact, the majority of registered nurses in the 1950s and 1960s were graduates of hospital-based diploma programs (ANA, 1965), with only a small minority of nurses prepared at the baccalaureate level. The pay scale at the teaching hospital, then a public facility, was lower than surrounding private hospitals. Despite this, representatives from university nursing programs all over the world came to study the model she was building at UF.

Even so, Smith had to constantly advocate for the idea and the reality of nursing as an academic as well as a practice discipline. Reflecting on this years later, Smith stated,

It is interesting to note that when medical schools look for clinical experience for students, they look for a place for faculty to practice. Nursing schools look for a place where students can practice.” Smith’s idea was for “students (to) see the role for which they are being prepared practiced consistently and ably. (Smith, 1993, p. 148).

The Stain of the Johns Committee

...the committee also served to block attempts at racial integration and to weed out gay and lesbian students and faculty...In 1956, the year that Smith arrived in Florida, the Florida Legislative Investigation Commission was formed. The committee was commonly known as the Johns Committee after its chair, Charlie Johns, a state senator who was an acolyte of Senator Joseph McCarthy. Johns championed a legislative committee to eliminate communists in Florida schools. However, the committee’s stated purpose of anti-communism quickly led to consideration of other forms of “subversion” as identified by the White conservative legislators appointed to the committee (Braukman, 2012). From the beginning, the committee also served to block attempts at racial integration and to weed out gay and lesbian students and faculty in state universities, as well as quell fears of “liberal education” among conservative voters (Poucher, 2014).

Throughout its existence, the committee...used intimidation, threats, and shaming as primary tactics.At UF, one of the first targets of the Johns committee was Virgil Hawkins, an aspiring law student. Lawsuits related to Hawkins’ attempts at admission went on for years and ended in a 1958 settlement that included his agreement to seek his degree elsewhere (Poucher, 2014). Throughout its existence, the committee continued to target racial integration and homosexuality and used intimidation, threats, and shaming as primary tactics. Students and faculty were summoned to administrative hearings, interviewed and coerced into implicating friends and colleagues. Dozens of professors around the state lost their jobs and many students were expelled as the result of the actions of the committee (Braukman, 2012).

Smith later said of her experiences with the committee,

I was here at the time of the Johns Committee. Some delightful person sent my name to the Johns Committee that I was a Communist. I have forgotten what all the [charges] were… Anyway, they found out we were using a book by [nursing theorist Hildegard] Peplau. I guess maybe way back she was a Russian. I do not know. Somebody in her family was. It was called Interpersonal Dynamics in Nursing, or some such title. But anyway, [UF President] Wayne Reitz … called me up. I was scared to death. I had never been confronted with anything like the Johns Committee. I had gone through the McCarthy era without any problems. So he said, you know, do not worry. So he took care of it. Then I was told [at a later date] to get rid of two people on my staff who were "homosexuals." I said, "No. I am sorry, I do not know anything about that" (Kerber, 1979, p.43).

Smith’s further comments on the matter, however, seem more reflective of the level of broader cultural lack of understanding and acceptance during that era.

Rumors were coming to me and even the provost said to me, 'Hey Dorothy. You better get rid of those two people.’ I said, ‘No way. They may or may not be.’ I do not know how I feel about them. I said, ‘I do not know if they are or if they are not, and you fire them if you want to fire them. Let Senator Johns fire them.’ And so I rode through that. They came and said they had investigators looking through the windows of these people's houses. … I said, ‘You get the evidence, you go and do something with it.’ I never fired the people. But on campus people were being intimidated and were being fired, but I did not. I have gone through some hairy times (Kerber, 1979, p.43).

The Johns Committee remained active for nine years, finally disbanding in 1965. The dissolution of the group closely followed the publication of “Homosexuality and Citizenship in Florida,” popularly known as “the purple pamphlet.” This widely circulated brochure graphically presented the committee’s lurid description of the scope and nature of homosexuality in the state under the auspices of promoting an understanding of the “growing problem” so that legislation could be enacted. The salaciousness of this report only helped to turn the tide of public opinion strongly against the committee, both as a result of the tactics used against citizens and a groundswell of opposition that had its roots in the burgeoning civil rights movement and other changing cultural standards (Poucher, 2014).

Changing Tides and Changing Times

As a nursing leader, Smith influenced the integration of nursing into the mainstream of higher education and practice, and the development of evidence-based nursing practice. Racial integration of the university and the nursing program were another matter. Almost two decades after Virgil Hawkins’ application to the UF law school was blocked, the first Black student graduated from the nursing program. Evelyn Moore Mickle was admitted as a transfer student in 1965 and completed the program two years later (Wright, 2016). Moore’s admission occurred in the same year as the civil rights march from Selma to Montgomery, Alabama led by Dr. Martin Luther King, Jr.

Mickle graduated with some bitter memories of her experiences at UF. She recalled being admitted with four other Black students, and they felt they only had each other for support. She had been recruited by Smith but, following admission, believed that Smith broke promises including some of the financial support promised to her (Mickle, 2018). She also perceived that some of the students and faculty clearly discriminated against the Black students, and in the end, Mickle was the only Black student from her cohort to graduate from the program. She later said, “I just don’t believe that students are still being rejected by faculty and other students and refusing to work with them on any scale (as I was treated). You know, there may be one here and there, but this was a commonplace for me” (Weston, 2009, p.2). She got by with the help of her church, a Black medical student, and one of the librarians. Many years later, she was able to reconnect with the college on more positive terms (Wright, 2016).

Vivian Filer was also one of the first Black students to graduate from the nursing program at UF (Wright, 2016). Filer graduated a few years after Mickle and faced a different barrier to success in the nursing program. Filer met Smith while working the night shift at Shands hospital as a nursing assistant. She offered Filer a scholarship to attend the UF program. After accepting and beginning her studies, Filer realized the academic struggles she would face. She had grown up in Gainesville, attending segregated schools with few teachers and second-hand books. At UF, she became a peer to White students who had the advantage of having had advanced science courses in high school, making them much better prepared for the nursing curriculum (Filer, 2018). Despite this, Filer ultimately prevailed and went on to enjoy a long career as a nurse and community activist in Gainesville.

Once again, Smith’s recall of the time from a few years hence was confounding and does not seem reflective of a deep understanding of the issues. She stated,

I was very liberal. I was trying to change the Black-White situation. I did hire a maid to iron…I needed somebody to iron and I found out nobody else was paying her social security. The salary she was getting was just awful, so I told her to go back and get social security and I was raked over the coals for this. I did kind of controversial things. I pushed for Black students” (Kerber, 1979, p. 43).

Smith’s reference to domestic workers while discussing her stance on race sounds completely insensitive from the viewpoint of current culture, but a talk by Vivian Filer years later shed light on what now seems like a shockingly racist remark. Filer discussed her work as a maid to a White family while she was in high school and noted that it was the only job available to Black women in Gainesville at that time (Filer, 2018). In context, perhaps Smith’s comments were simply a reflection of the reality of the era.

As the cultural climate continued to shift around her, Smith kept her focus on her vision for professional nursing in the future.As the cultural climate continued to shift around her, Smith kept her focus on her vision for professional nursing in the future. She addressed members of the alumni association to commemorate the tenth anniversary of the college she founded, and these were later compiled into a booklet, “The Quonset Hut Dream” (1966). In her address, Smith highlighted key accomplishments during her deanship, such as the inception of the Master of Science in Nursing program in the college in 1964. Smith made it clear she intended these graduates to be clinical specialists. She described the clinical specialist role as “She is involved in the investigation of problems and serves as a consultant to other nurses and professions about her specific area of professional concern” (UF College of Nursing, 1966, p.10). Smith was one of the first nurse leaders to design programs that expanded nursing practice to higher levels of expertise, including this early mention of the clinical nurse specialist role. Although the role had previously been defined by Reiter in a 1943 speech (Reiter, 1966) and an early version implemented in 1950s by Peplau (Dunphy, 2018), this was still a rare model for nursing education in the 1960s (Fairman, 2008; Patten & Goudreau, 2012).

Soon, other problems loomed and Smith’s dreams began to unravel.Soon, other problems loomed and Smith’s dreams began to unravel. As the 1960s progressed, Florida’s state salaries remained very low, and faculty stopped applying to teach at UF despite Smith’s reputation as a dean and a leader. Student protests against the Vietnam war also erupted across the UF campus and throughout the nation. While Smith recalled that nursing students were not as belligerent or aggressive as students in some other majors, the nursing students began to be vocal about what they did and did not like regarding their curriculum as well as world events. Then as now, students felt that learning procedures and technical skills was exciting, while more complex skills such as therapeutic conversations with patients were often a source of resistance from students. Smith recalled the grade inflation that resulted. “Faculty somehow with all this began to fall apart and play for the students’ popularity and… everybody was getting “A’s” and it was really mind blowing” (Kerber, 1979, p. 36). For Smith, this marked the beginning of the end. To her, it had reached the point where it just wasn’t fun anymore (Kerber, 1979).

“If I Had Stayed”

In addition to the problems Smith was encountering in her own college, there were other ominous signs in the health science center. In the late 1960s, Florida and the rest of the country continued to experience a severe nursing shortage that had not yet seen relief from the federal Nurse Training Act in 1964 (Hansen, 2002). The teaching hospital, a public facility, was also in a dire financial situation due to a high level of unreimbursed care for the many indigent patients it served. Support services declined and this further damaged the level and quality of nursing care.

There were organizational and economic changes that simply did not support her philosophy.Smith no longer had the administrative support of her colleagues and everyone struggled with upheaval, disruption, and even sabotage of the original vision of the center. There were organizational and economic changes that simply did not support her philosophy. She recognized this evolving situation, and she was able to articulate what the effects would be. She was correct, but things still changed. She noted, “I have never in my whole life stayed in a job that was not fun. The dean’s job was not. Who in their right mind would leave at the age of fifty-nine, when salaries were going up? If I had stayed five more years, I would have had considerably more money in my retirement. If a job is not fun for me, I am a survivor because I am still alive, but I am not going to survive in a job. I think that is terrible. It is no fun.” (Kerber, 1979, p. 6).

Smith stepped down as dean in 1971 and intended to stay on as a professor. She took a three month leave of absence, and then planned to continue working with the same group of patients and doctors she had worked with in the past. It did not work out. Stated Smith, “I was a threat to the new dean and I could not do that, so I quit.” (Kerber, 1979). Smith acknowledged that there were other factors. In addition to problems in the management of the college, her clinical ward had deteriorated badly. “The hospital was going to pot. I had to buy soap for three weeks for my patients and I thought there had to be a better way.” (Kerber, 1979, p. 2).

Smith authored numerous papers during her long career.Smith authored numerous papers during her long career (Smith, 1951-1997). She was elected an honorary member of the American Academy of Nursing in 1979 and was named a Living Legend in Nursing by the Academy in 1996. In June 1997 she received the Mary Adelaide Nutting Nursing Award from the National League for Nursing. Smith was also a heavy smoker for many years, and many of her colleagues smoked as well. Pictures of her in faculty meetings include packs of cigarettes on the table and smoke in the air. As a result of this habit, Smith developed chronic lung disease in her later years and became dependent on constant supplemental oxygen (J. Snyder, personal communication, 2018). She died in Florida in 1997, at the age of 84, and was buried in her home state of Maine.

Conclusion

Smith’s story is a lesson to nurse leaders of today...In Smith’s archives at the University of Pennsylvania School of Nursing is a well-worn copy of the poem “The Calf Path” by Sam Walter Foss, written at the turn of the 20th century. The allegorical poem describes the eventual consequences of failure to question the status quo, cautioning the reader not to “keep the path that others do” (Foss, 1895, p. 80). The poem clearly meant a lot to Smith. The corners of the paper contain remnants of tape, as though it had been mounted on the wall for frequent viewing. It may well have served as a daily inspiration to her to not lose sight, despite everything she faced, of her vision for the future of nursing. Smith’s story is a lesson to nurse leaders of today to remember that the first responsibility of a nurse is to the patient, and that there is much room yet for trailblazing and for transformative leadership.

Author

Kim Curry, PhD, FNP-C, FAANP
Email: kimcurryarnp@gmail.com

Kim Curry, PhD, FNP-C, FAANP is Editor-in-Chief of the Journal of the American Association of Nurse Practitioners. She is a certified family nurse practitioner with an active clinical practice in Tampa, Florida. She holds a courtesy faculty appointment at the University of Florida College of Nursing. Prior historical studies include public health nursing biographies and Florida public health history topics.

References

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Weston, M. (2009, February 7). Interview with Evelyn Moore Mickle. University of Florida Samuel Proctor Oral History Program African American History Project. Retrieved from: https://ufdc.ufl.edu/AA00066292/00001

Wright, T. (2016). Pioneer Evelyn Mickle inspires generations of students. The Gator Nurse, 18 (3). The University of Florida College of Nursing. Retrieved from: https://alumni.nursing.ufl.edu/about/gator-nurse-greats/gator-nurse-greats-inspire/


© 2020 OJIN: The Online Journal of Issues in Nursing
Article published October 16, 2020


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