Expanding the Boundaries of Higher Education and Professional Practice

With the advent of the first pediatric nurse practitioner program in the late 1960s, the nursing profession began to examine its scope of practice. Schools of nursing initiated curriculum changes and innovative programs that would support an expanded nursing role for nurse practitioners in community and ambulatory settings and clinical nurse specialists in acute care settings. Nursing students sought out experiences that would position them to move into these expanded roles. Nursing students in the Student Health Coalition learned physical assessment skills—listening to heart and breath sounds, examining ears with otoscopes—as well as other non-traditional nursing tasks such as running EKGs, interpreting lab test results, and screening for glaucoma. Attending physicians taught these skills in the early years to nursing students and beginning medical students who had not learned them yet in classes. In later years, nursing faculty with these skills joined the Coalition staff.  Schools of nursing, including Vanderbilt, began teaching these skills first to graduate students and nurses in specialty post-graduate programs. Ultimately, the physical assessment skills became an accepted and expected part of the nursing role, as essential a part of nursing assessment as vital signs. Many of the nursing students in SHC went on to post-graduate and masters degree programs to become nurse practitioners.

The concept of community health became much more concrete for the nursing and medical students working in the small towns and hollows of rural Appalachia. They learned first-hand about the impact of a community’s health on the individual health of its residents. They quickly understood how poor air quality, unsafe water, inaccessible and unaffordable healthcare, and limited access to nutritious food could interact with individual health risks to increase the threat of illness. Working in the Student Health Coalition provided real life opportunities to work with communities as well as individuals to improve health outcomes.

Medical education was also changing. Medical education had long been based in medical centers affiliated with academic institutions. Medical faculty concentrated on their own research, alongside their responsibilities for patient care. Their interaction with students was often limited. But the face of medicine was changing. Beginning in the mid-1960’s the percentage of women in medical school rapidly increased, growing from 7% to 37% by 1980. Medical students began demanding opportunities to interact with patients in their own environments outside academic settings. Negotiations about the roles and responsibilities of medical students in community settings was ongoing, with student activists often encountering opposition from faculty and medical school administrators.

The nursing profession had a long history of providing nursing care in community settings–from Florence Nightingale’s trained nurses on the battlefields of Crimea to nurses based in settlement houses offering health and hygiene interventions along with care of the sick to disadvantaged, urban populations in the late 19th  and early 20th century. Over time, these services became more institutionally based in public health departments and visiting nurse services. In the SHC however, nursing students worked directly with underserved, disenfranchised communities through health fairs, home visits, and community organizing. They returned to school seeking approaches that would address underlying issues that impacted the health of communities as well as individuals.

The Student Health Coalition was right in the middle of these changes and negotiations in medical and nursing education. Students and faculty who worked for the SHC were sometimes the initiators and sometimes the beneficiaries of the seismic shift in nursing and medical education that was underway. The SHC’s health fairs provided students and their professors new opportunities to see people in the context of their own families and communities, not simply as patients presenting illnesses. Medical and nursing schools with SHC participants began to look for more and more community-based learning experiences for their students.

During the 1970s the culture at law schools and undergraduate programs underwent similar changes. As Coalition students returned from their summer of service, they began demanding more opportunities for community-based learning. Their SHC experience also put law students and undergraduates on new career paths. They were drawn to organizations and causes dedicated to addressing the same problems of poverty, exploitation, and injustice they had encountered working for the SHC. For them too, the boundaries of their education and professional practice were expanded.


Related Stories:

A sampling of vignettes that illustrate various ways in which the boundaries of higher education and professional practice were deepened or broadened. For all oral and written narratives related to this theme, click here. For a complete catalogue of clips across all three themes, visit “Stories”.

Becca Ingle on the SHC and community healthcare

Becca Ingle, R.N., F.N.P. shares about her experience with the Student Health Coalition (SHC) in the summer of 1974 and discusses its profound influence on later becoming a nurse practitioner. She also explains how the organization facilitated a shift in… Continued

Ruth Ann Casper and Scheryl Stout on the Maternal-Infant Health Outreach Worker Project (MIHOW)

Ruth Ann Casper, a participant in the Maternal-Infant Health Outreach Worker Project (MIHOW), shares about the powerful impact of home visitors and their value as sources of emotional support and information during her first pregnancy. Scheryl Stout, a home visitor… Continued

Challenges facing nurse practitioners

Outside the old clinic building of what used to be Douglas Community Health Center, Margaret Ecker and Jean Carney discuss the multitude of challenges facing nurse practitioners and what legislative movement’s been made to overcome adversity of such restrictive practice.… Continued

Sally Kimberly’s first observations of rural community healthcare with MPHC

Sally Kimberly discusses her preparation for practice and early experiences with Mountain People’s Health Councils (MPHC) at the clinic in Norma, Tenn.   Full footage of Sally Kimberly’s interview with Rick Davidson. Continued

Bob Hartmann on Appalachian culture and rural healthcare

Bob Hartmann shares a story about one of his patients while working with Mountain People’s Health Councils (MPHC) in Norma, Tenn. The narrative speaks to the influence of Appalachian culture on rural healthcare and community medicine.   Full footage of… Continued

Sally Kimberly’s take on patient education in rural healthcare

Sally Kimberly discusses clinical challenges during her time as a nurse practitioner with Mountain People’s Health Councils (MPHC) in Norma, Tenn., focusing specifically on the indispensable role of patient education in effective rural healthcare.    Full footage of Sally Kimberly’s interview with Rick Davidson. Continued

A conversation with Martha Stucker

Martha Stucker shares about her time working in the mountains from 1968-1972, and explains her role as a nurse practitioner focused on meeting community needs. Continued

Related People:

Profiles of several individuals, among many, whose work with the Student Health Coalition exemplifies the SHC’s impact on expanding the boundaries of higher education and professional practice. A listing of all SHC profiles can be found under “People”.

Amos Christie

Amos Christie received his M.D. from the University of California. In 1943, he arrived at Vanderbilt University as Chair of the Department of Pediatrics. During his time at Vanderbilt, he studied histoplasmosis, a fungal disease simulating tuberculosis, and received a… Continued

Betty Anderson

Betty Anderson was born in Scott County, Tenn. on March 26, 1936. In the 1970s, she became involved with Save Our Cumberland Mountains (SOCM), a social justice organization that addressed strip-mining and other community issues in Tennessee and Kentucky. She… Continued
Bill Dow in Smithville ,Tenn., 1970

Bill Dow

Bill Dow co-founded the Student Health Coalition while in medical school at Vanderbilt University, in 1969. His larger-than-life role in the SHC origin story and beyond warrants special telling, which we attempt in the essay that follows. Contributed by Margaret… Continued

Diane Lauver

Contributed by Diane Lauver, February 2018 Growing up, I was close to my paternal grandparents; they lived in a pastoral valley looking at Appalachian hills in a northern state. With their 8th grade educations and practical wisdom, they taught me… Continued

Leslie Falk

Leslie Falk was born April 19, 1915, and grew up in St. Louis, Mo. After attending University of Illinois and Washington University (St. Louis), Falk received a Rhodes Scholarship, which allowed him to attend Oxford University, 1937-1940, where he helped… Continued

Pete Moss

Contributed by Pete Moss and Jennifer Crane, March 2016. Dr. Pete Moss was raised on his maternal grandparents’ farm in Marshall County, Tenn., while his father fought in World War II. As the eldest of his siblings, he learned responsibility,… Continued

Welmoet Spreij

Contributed by Welmoet Spreij, Amsterdam, 2017. I came to Nashville as a Dutch exchange-student in the fall of 1969 and took some classes at Vanderbilt University. While attending a course in philosophy, I came to know John Davis, Dick Burr,… Continued

Related Outcomes:

A selection of initiatives, organizations, and developments that grew from seeds planted or causes championed by the SHC. A complete catalogue of materials related to various outcomes of the SHC experience can be found under “Legacy”.

Minnie Bommer’s encounter with hospital segregation

Having overcome the adversity of racially biased employment discrimination imposed upon her at the outset of her nursing career, Minnie Bommer shares also about the realities of healthcare inequities and segregation experienced post-hire at a hospital in Covington, Tenn. Recorded… Continued

Minnie Bommer on racially charged employment discrimination and her journey to nursing career

Minnie Bommer shares her tumultuous experience at the outset of her nursing career, detailing the extent of racially biased obstacles intended to bar her from hire at hospitals in Tipton County, Tenn. Recorded on June 1, 2018.   Full footage… Continued

Dr. Daniel Gabriel’s legacy in St. Charles, VA

Ron Carson discusses Dr. Daniel Gabriel, M.D. and his local legacy in African American healthcare as the only doctor who in the 1940s and 50s would see Black patients.   Full footage of Ron Carson’s tour of the African American… Continued

Challenges facing nurse practitioners

Outside the old clinic building of what used to be Douglas Community Health Center, Margaret Ecker and Jean Carney discuss the multitude of challenges facing nurse practitioners and what legislative movement’s been made to overcome adversity of such restrictive practice.… Continued

Pushback against Douglas Community Health Center

Jean Carney shares how rhetoric against the Black-run Douglas Community Health Center manifested as several false accusations and presented various legal challenges to both the clinic and associated nurse practitioners.   Full footage of Jean Carney at the old Douglas… Continued

Behind the scenes at Douglas Community Health Center

Jean Carney reminisces the early days of Douglas Community Health Center in Stanton, Tenn. Following a brief overview of the clinic’s architectural layout and functional operations, she delves into the impact of race relations on healthcare at the time.  … Continued

Bob Hartmann on the importance of defining health beyond the physical

Bob Hartmann explains how his and many others’ formative experience in rural healthcare and community medicine with the Center for Health Services (CHS), Student Health Coalition (SHC), and Mountain People’s Health Councils (MPHC)—both as students and young professionals—left a lasting… Continued

Bob Hartmann on the influence of cultural understandings about death and healing

Bob Hartmann shares about a Stoney Fork community member known as Uncle Ben and speaks to the impact of local culture—particularly as it regards matters of death and healing—on rural healthcare.   Full footage of Bob Hartmann’s interview with Rick… Continued