Nursing's Frontier: Rising to the Profession's Challenges, Lisa Kitko Glimpses the Future

Ten years ago, when UR School of Nursing Dean Lisa Kitko, PhD, RN, FAHA, FAAN, was researching the experiences of people living with advanced heart failure and their caregivers, conversations with patients about end-of-life illness were still rare outside of oncology. The qualitative study exposed a severe and crippling lack of palliative care.

“Because of the way it was treated so aggressively, up until death, persons living with advanced heart failure really didn't have access to any services at the end of life, including palliative care,” Kitko said. “They were treated acutely right up until that final admission when nothing else could be done, even though they had been chronically ill for years.”

Over 30 years as a researcher, scholar, educator, and clinician, Kitko has focused on how to improve outcomes for older and, often, rural persons living with life-limiting illnesses and their family caregivers. Her work has helped open doors for better care for persons living with heart failure, along with better support for family caregivers.

“I’ve always loved fixing issues and thinking about how we do that,” she said.

From a nurse shortage to rising chronic illness to rapid changes in health care, the nursing profession is in flux. Challenges are opportunities to innovate, she insists, through new models of patient care and nursing education.

Kitko was named the School of Nursing’s sixth dean this summer. She is excited about building on the school’s renewed prominence and growth achieved during the 11-year tenure of her predecessor, Dean Emerita Kathy Rideout. The school now ranks among the top 25 master’s degree programs, according to US News & World Report, and No. 23 for research funding from the National Institutes of Health.

Rural roots

Kitko previously was associate dean for graduate education and director of the PhD program at the Ross and Carol Nese College of Nursing at Pennsylvania State University. The road there began in her small hometown in Central Pennsylvania. It was not a place where big life dreams were typically cultivated, but her family was supportive when Kitko announced she would be going to the University of Pittsburgh. She earned a bachelor’s degree in nursing and set her eyes on the ICU.

After graduation she completed a competitive six-month internship in critical care at Hershey Medical Center. There she met her lifelong mentor, Judith Hupcey EdD, CRNP, FAAN, who encouraged her to earn advanced degrees at Penn State. Hupcey is professor and associate dean for research and inno- vation in Penn State’s College of Nursing.

“Her mentoring and support of me were really transformative,” Kitko said. “I don't know that I would be here otherwise because there were lots of times when life gets in the way and you kind of fall off the radar a little bit. She never gave up on me.”

After her internship, Kitko married her high school sweet- heart, Mark, and took a job at Altoona Hospital, not far from her hometown. Starting out as a nurse in the ICU, she moved up to charge nurse and then launched one of the first stroke programs outside of an academic medical center. She enjoyed the interdisciplinary nature of the work, leading and working with different groups to serve community needs.

While at Altoona, she completed her master’s degree. With encouragement from Hupcey, Kitko decided to earn a PhD at Penn State. She had two young sons, Nicholas and Alex, and a 45-minute commute to the university, where she also began a new full-time job as an instructor. With such a packed schedule, she and her husband relied on help from nearby family. Kitko remembers it as a “very energizing” time.

“I’m Eastern European by descent. And my grandmother always said, you just do it. If you want to proceed with something, go, but give it your all and do it,” Kitko said.

Next-level research

As her PhD chair, Hupcey pulled Kitko into her research team focused on persons living with advanced heart failure and their caregivers. The work opened her eyes to next-level opportunities not only for treatment but policy impact, and research became her passion.

Hupcey said Kitko’s holistic background as a clinician, academic and hospital administrator, and researcher have prepared her well for her new role. The research piece, in particular, will help the school grow its research enterprise “and is going to make her a very strong leader,” she said.

Kitko has extensive clinical research experience with the palliative care needs of persons living with complex chronic conditions and their family caregivers, especially in the context of advanced heart failure. She has disseminated her work in leading journals and presentations and has received numerous national and international awards for her work.

Research funding has come from the National Institutes of Health (NINR and NHLBI), the American Heart Association, and foundations.

Kitko’s penchant for fixing things and building interdisciplinary teams drew her back into administration, first as director of the nursing PhD program. In January 2020, she was named associate dean of graduate education. During the pandemic, “fixing things” meant accelerating a move to more online courses — a silver lining for rural nurse practitioners who couldn’t attend in-person programs.

Kitko also oversaw the transition of the master’s-level nurse practitioner degree to a doctorate of nurse practice to bolster the leadership skills and knowledge of students.

“Advanced education at the DNP level is critically important for all practitioners — especially those in rural areas, as many of them are practicing without the support of larger urban health centers,” she said.

Kitko’s small-town roots have made her attuned to rural dis- parities in health outcomes. “I think it always comes full circle,” she said. “Those baseline experiences really do inform a lot of what you do.”

An eye on the future

Nursing’s most pressing issue—the labor shortage—won’t be solved solely by admitting more students, Kitko says. (Entry-level BSN and DNP enrollment in schools nationwide has grown continuously for over 20 years.) And though retirements were on the rise before the pandemic and have only accelerated, the biggest exodus is happening among nurses in the 35-and-younger age group. Kitko calls this the leak in the middle of the pipeline. The solution will require finding ways to make bedside nursing more attractive for those already in the job, she says.

The UR School of Nursing and the University of Rochester Medical Center are working closely to that end at the highest levels; Kitko and URMC’s Vice President and Chief Nursing Executive Karen Keady, PhD, RN, NEA-BC, attend each other’s leadership team meetings.

Future innovations will involve more interdisciplinary research and education. The new experiential learning spaces in Helen Wood Hall, from simulation to virtual reality technology, are a good example. The experiences students gain there mirror the clinical activities and interactions they will encounter on the job, no matter where they work, Kitko said.

“This is one of the most exciting things about my position, being across the street and having collaborators at one of the leading health care systems in the world.”

Kitko is passionate about mentoring, too. She hopes to recreate an NIH training grant in which she was Principal Investigator at Penn State to introduce underrepresented stu- dents to research careers. She’s excited about future clinical and research partnerships with the Aging Institute and other URMC efforts.

As at-home care and telemedicine evolve, Kitko's mindful of the leading role nursing will play. Through research, practical innovations in patient care, and old-fashioned problem solving, nursing professionals are helping patients and their caregivers manage the tremendous burden of severe chronic illness at home.

“Nursing can really lead the charge in terms of how we’re able to help people live and age in their community setting,” she said.