Guardian of the Discipline
Nursology author Leslie Nicoll
Guest contributor: Elizabeth R. Berrey

Rozella Schlotfeldt was among the great leaders in nursing in the years when nursing education was first shifting away from hospitals and becoming established in universities.  Students were educated for entry into the nursing profession and graduate programs were established to prepare them to take on roles as leaders in practice and as scientists equipped to advance nursing knowledge through research and theory development.

This week, nurse scholars are gathered at the Frances Payne Bolton (FPB) School of Nursing at Case Western Reserve in Cleveland, OH, to recognize the earliest conferences dedicated to the development of nursing theory. Held one-half century ago, in 1967, 1968 and 1969, these landmark conferences were recognized with the publication of the proceedings in Nursing Research (see volume 17, issue 3; volume 17, issue 6; and volume 18, issue 5). The first symposium, held October 7, 1967, was the third in the series of conferences held at FPB but the first on theory development. Rozella Schlotfeldt was the Dean of the School at the time; regarding the conference, she noted, “Publication of the proceedings was sought with a view toward assisting in promoting discussion and debate among nursing’s intellectuals,” (Schlotfeldt, 1986, p. 98). Lucille Notter, then Editor of Nursing Research, commented in 1986, “I had the pleasure of being invited to attend this symposium…I was most enthusiastic about the papers given. Now, in retrospect, the symposium has proved to be a landmark in nursing…The decision to publish the symposium proceedings was a good one. Students…often use these papers in their quest for understanding the meaning of nursing theory and how nursing theory evolves,” (Notter, 1986, p. 97).

Rozella Schlotfeldt served as Dean at FBP from 1960-1972 and continued as a Professor until her retirement in 1982. Even after that, she continued to be active on the international, national, and local levels. I (Leslie) was fortunate to have Rozella serve as a member of my dissertation committee in the mid-1980s. She provided the leadership and vision to establish the PhD program at FPB in 1972, the third PhD program in nursing at that time.

Like any doctoral student, I was a little intimidated to have her as a committee member–she was invited at the request of my chair–but once I got to know Rozella, I appreciated her kindness, insight, intelligence, and warmth. Every doctoral student has “pearls” that they pick up through their studies; one pearl from Rozella was that “time has no points.” Never write, “At this point in time,” she said, “Just say, ‘At this time.’” I think of her practically every time I sit down to write something and remember the pointless time in which we exist! She also taught me how to always remember the difference between affect and effect: “Affect is to influence; effect is to bring about.” See the quote further on which uses “effect”–pure Rozella, and perfectly used.

Elizabeth R. Berrey’s doctoral dissertation was a feminist critical hermeneutic study to identify the themes and patterns in Rozella’s life that informed her thinking about nursing. Using oral history as a tool, Rozella’s remarkable life was documented, along with the unprecedented vision that Rozella brought to the development of the discipline of nursing.  Elizabeth and I were in the same PhD cohort at FPB; she provided the following summary of her work, focusing on those dimensions that exemplify Rozella as a “guardian of our discipline.”

In 1918, when Rozella Schlotfeldt was 4 years old, the Great Flu Epidemic claimed her father’s life. Her mother, along with Rozella and her younger sister, were spared. Her mother immediately went to work as a nurse to support her family. She impressed Rozella with her creativity and innovation in caring for her patients, greatly influencing Rozella’s choice of profession. “From an early age, no doubt about it, I determined to be a nurse!” The household in which she grew up was characterized by practicality, hard work, and doing that which needed to be done, as well as busyness, energy, and vigor. These generative themes and patterns of her life are reflected in, and affected, her thinking about nursing.

Rozella received her BSN in 1935 (in a time when that was uncommon) from the University of Iowa. She served in the Army in the European Theater during WWII, then earned her MS in Nursing Education/Administration in 1947 from the University of Chicago. In her words, “I already had a notion of being influential and not let anything encroach upon that.” She said, “I suppose that translates itself into mapping out what you do with your personal life, as well. She speculated that getting married to a man “would have stood in the way” and “I would have been bored to death …. maybe I was 30 years ahead of my time so far as independence of women.”

Rozella took a leave of absence from Wayne State University, where she was Professor and Associate Dean for Research, to earn her doctorate in 1956 from the University of Chicago in Education and Curriculum Development. While at Wayne State, she “was bitten with the research bug and did all kinds of research… we really got the [nursing] faculty going for research while I was there.” While at the University of Chicago, Rozella met Rosemary Ellis. Hallmarks of their friendship were their “mutual respect for and admiration for one another, their love of and commitment to nursing, and their readiness to share their best critical thinking for advancing nursing knowledge.” When Dr. Schlotfeldt, came to Case Western Reserve University (CWRU) as the Dean at FPB, she recruited Dr. Ellis to the faculty.

It was at CWRU that Dr. Schlotfeldt made what she considered her most significant contributions to nursing: the “collaboration model” between the faculty of the school of nursing and University Hospitals; her paradigm of nursing–to attain, retain, and regain health; and the Nursing Doctorate (ND) in which she was “shifting the emphasis from learning how to do, to learning how to know.” As she liked to say, “Nothing like knowledge!” With these aforementioned innovations, and her leadership locally, nationally, and internationally, Rozella Schlotfeldt changed forever the face of nursing, first in Cleveland and, as her ideas reverberated more widely, throughout the world. During her tenure as Dean, amongst several boards and commissions on which she served, she was a co-founder of the Midwest Nursing Research Society, held leadership roles in both Sigma Theta Tau and the International Council of Nurses, and was the first nurse member of the Council & Executive Committee of the Institute of Medicine.

In Safier’s 1977 publication, Rozella was named as “one of nursing’s most original thinkers” and as “an educator with innovative, progressive and sometimes startling concepts of education for nurse[s]” (p. 338). Rozella loved this! After her retirement from the deanship, she remained highly sought after for her intelligence, wit, creativity, and sheer clarity about, as she often said, “nursing qua nursing.” (Once she said to me with a chuckle, “I know exactly what nursing is! And if they’d just ask me, I’d tell them!”). And while Rozella wanted to be influential, she worried that she should not be seen as an exemplar of nursing excellence, some so-called ideal, whom all nurses should emulate. Rozella was simply and uniquely herself, a woman who was passionate about our discipline and, as she said, “I just think there is nobody more passionately involved in having nursing move toward what it could become. I always say, ‘what it could become,’ because it’s not there yet.” Rozella’s sights were set on nursing as a combination of her mother’s example, her liberalizing, research-oriented undergraduate education, and her own competitive ambition that helped her to emerge with a vision of herself in nursing. “Vision of herself in nursing” is a purposeful statement, for there exists little separation of her vision of nursing from her vision of herself in nursing.

In her first published article in 1949, addressing the nursing care component of educating a patient with the medical diagnosis of TB, she opened with a strong statement that includes nurses as professional members of the healthcare team that are responsible for prevention of communicable disease, based upon “constant scientific study and research… [by these] competent professional workers,” (p. 375). (Note: this flew in the face of the extant practice of nurses employed by hospitals and physicians of the era.) In 1960 she made a point in an article with Safford, that nursing care was defined as care rendered by, or that took place under the direct supervision of, the registered nurse, a clear statement of the autonomy of nursing practice.

During the mid-60s and into the early 70s, Rozella repeatedly called upon nurses to recognize their profession’s rightful role in society and to support that role through increased research, education, and leadership. Examples of her actions include a symposium she held at CWRU, through the Legislative Committee of the Ohio Nurses Association, and through forthright challenges to nurses and legislators to “fulfill their public trust” to enact a mandatory nurse licensure act. She brought her extensive political and social savvy to bear to speak for the profession and the discipline and thereby be recognized for her effectiveness.

In 1969, along with Janetta MacPhail, she published a series of three articles describing the nationally-known and heralded “experiment in nursing,” aka, “the collaboration model.”  The three articles themselves are landmarks for the clarity, care, and specificity with which the new concept was presented to the nursing community. Briefly, the new concept of inter-institutional organization invested the school of nursing with the authority and responsibility for controlling the quality of nursing education, nursing care, and nursing research in the health center.  The heads in the clinical departments were the heads in both practice and education, with 50/50 appointments in each institution. Example: head nurse given the new title: Senior Clinical Nurse to help with the transition. Rather than waiting on physicians or spending all her time charting or ordering supplies, “she spent her time being the authority on nursing.” Here’s another example that Rozella remembered with relish: The medical director of OB/GYN came over to see her at FPB because some physicians’ noses were getting out of joint “due to the sophisticated care being provided by the master’s prepared nurse clinician.”  He demanded that this nurse be fired.  “I said to him, ‘I don’t think you can tell me that. What is your rank?’ He said he was an assistant professor…in the medical school. I said, ‘Well, I happen to be a full professor. I’ll be very happy to listen to what you have to say and then I suggest that you go to your Dean and I’ll talk to your Dean.’”

The following year (1970), tired of medicine’s intrusion into nursing, she wrote an article, an unequivocal assessment of the relationship of nursing and medicine, in response to an AMA Board action, devoid of any appeasing, deference, or gratuitous caveats.  She audaciously defined medicine, concluding that, “the physician’s contacts with patients of necessity are episodic, with each episode of relatively short duration. The primary focus of the physician‘s work is to effect cure.” She further wrote a statement intended to counterbalance, and serve as a contrast to, her definition of medicine, which was purposive in its intention to draw a marked distinction between the practice of medicine and the practice of nursing, concluding with, “Each discipline represents some but not all of the skills needed to keep people well.”

In 1972, determined to “set forth a straightforward and unambiguous conceptualization of nursing in terms of the profession’s goal and the phenomena with which nurses must be concerned,” she stated succinctly and unequivocally, “nursing…is healthcare.” She claimed that “nurses are independent, professional practitioners…the goal of nursing is to attain, retain, and regain health.”

When the American Nurses Association came out with a statement about the Baccalaureate degree being the degree for entry into practice she said, “I even wrote to the ANA President…and said, ‘We already have programs that recognize that nursing is a complex profession and that we should have first professional degrees that are based upon liberalizing education and a strong scientific, humanistic base.’”

Rozella readily gave her successor as Dean, Janetta MacPhail, credit for completion and implementation of the ND, while counting her early work in conceptualizing the ND as one of her own significant contributions to the profession. Due to her dissatisfaction with the amount of knowledge that nursing students had, she “began cooking in my head about the ND…. The result was an educational model designed to give students a solid foundation in nursing’s knowledge base prior to caring for patients: shifting the emphasis from learning how to do to learning how to know.” It was also designed to put nursing parallel with two other major professions, medicine (MD) and law (JD).

Dr. Schlotfeldt’s  papers are archived at the University of Pennsylvania Library.  The collection includes her addresses, articles, and files, reflecting her association with various academic institutions and professional nursing organizations; her personal correspondence, and photographs.

Sources:

Berrey, Elizabeth R. (1987). Researching the lives of eminent women in nursing: Rozella M. Schlotfeldt. Unpublished doctoral dissertation, Frances Payne Bolton School of Nursing, Case Western Reserve University.

Notter, L.E. (1986). The author comments.  In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 97.

Safford, B. J., & Schlotfeldt, R. M. (1960). Nursing service staffing and quality of nursing care. Nursing Research, 9, 149-154.

Safier, G. (1977). Contemporary American leaders in nursing: an oral history.  New York, NY: McGraw-Hill.

Schlotfeldt, R.M. (1949).  Safer ways in nursing to prevent spread of Tubercle Bacilli. National Tuberculosis Association Transactions, 45, 375-377.

Schlotfeldt, R.M. (1970). Nurses and physicians: Professional associates and assistants to patients, Ohio Nurses Review, 45(March), 6-12.

Schlotfeldt, R.M. (1972). This I believe: Nursing is health care, Nursing Outlook, 20(4) 246-246.

Schlotfeldt, R.M. (1986). A colleague comments. In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 98.

Schlotfeldt, R.M., & MacPhail, J. (1969a). Experiment in nursing: Characteristics and rationale, American Journal of Nursing, 69(5), 1018-1023.

Schlotfeldt, R.M., & MacPhail, J. (1969b). Experiment in nursing: Introducing planned change, American Journal of Nursing, 69(6), 1247-1251.

Schlotfeldt, R.M., & MacPhail, J. (1969c). An experiment in nursing: Implementing planned change, American Journal of Nursing, 69(7), 1475-1480.

 

About Guest Contributor Elizabeth R. Berrey, RN, PhD

Now retired, Elizabeth has been a featured speaker at nursing conferences and conventions, focusing on the importance of nurses as agents for change and advocates for better healthcare.  She was the first nurse appointed to the Cleveland MetroHealth Hospital Board of Trustees (1985-1990), the first private practice in nursing in Ohio (1980-1986), and appointed to the Ohio Board of Nursing (1987-1992) as the first clinical nurse specialist to serve on the Board, advocating for nursing autonomy and control of our own practice.  She now lives in New Mexico and remains a leader in the Albuquerque community, focusing on political advocacy on behalf of nurses and nursing.

In describing her relationship with Rozella, Elizabeth says: “. . .  not only did I write my dissertation on the themes & patterns of Rozella Schlotfeldt’s life, I was in her life right up until the end, as her power of attorney for healthcare. So in addition to knowing Rozella since the mid-1970s, as my dean, then Dean Emerita, I spent close to 2 decades with her at the end of her life, spending time at least weekly with her in the last 15 years.”