Norma M Lang, PhD, FAAN, FRCN, RN
Defining exactly what nurses do when caring for patients and developing standards and criteria for measuring nursing care are key to improving nursing care — and to recognizing the vital role nurses play in our health care system.
A leading authority on nursing standards and health care outcomes measures, Norma M. Lang has been a pioneer in investigating the quality of nursing care since she wrote her dissertation on the outcomes of pediatric nurse practitioners in the 1970s. Her work has contributed to the development of widely-accepted nursing policy throughout the world.
The Nursing Minimum Data Set, an international classification system for nursing practice used to evaluate the quality of nursing care, was another innovation by Dr. Lang, with Harriet Werley PhD, RN, FAAN, FACMI. It’s one of the standardized terminologies recognized by the American Nurses Association.
“Improving the quality of nursing care requires defining and measuring what nurses do.”
PhD – Marquette University - 1974
MSN – Marquette University - 1963
BS – Alverno College - 1961
Top Scholars and Nurse-Led Practices and Centers
As dean of Penn Nursing Science from 1992 to 2000, Dr. Lang also focused on quality, as measured by the school’s growing reputation. She enhanced nursing research, education, and practice, including by recruiting top scholars and supporting their work by establishing a network of nurse-managed practices and four new research centers.
Measuring Nursing Quality
Dr. Lang was the first investigator to use patient records to measure nursing outcomes, for pediatric nurse practitioners, as part of a federally-sponsored regional program in Wisconsin to identify and disseminate best practices in health care. The model she developed based on this work was the focus of her dissertation, and led to a $1.5 million grant to develop nursing outcome measures for 17 patient populations. Her model was used throughout the United States and in other countries as well.
After earning her PhD at Marquette University, Dr. Lang joined the faculty at the University of Wisconsin School of Nursing, becoming of the first faculty members of the nursing school. She spent 23 years on the faculty there, the last 12 as dean.
In 1988, while at the University of Wisconsin, Dr. Lang and Dr. Werley published the Nursing Minimum Data Set, the first attempt to standardize the collection of essential nursing data. The Nursing Minimum Data Set covers nursing diagnoses, interventions, outcomes, and intensity, and includes definitions and categories that meet the information needs of multiple data users in the health care system.
Dr. Lang worked with the American Nurses Association in the 1990s to identify and develop the nursing-sensitive quality indicators that formed the foundation of the association’s National Database of Nursing Quality Indicators®. Now owned by Press Ganey, the database provides evidence to support the importance of investments in nursing and includes an annual survey of nurses. More than 2,000 U.S. hospitals and 98% of Magnet® facilities participate in the National Database of Nursing Quality Indicators®, which is designed to measure nursing quality, improve nurse satisfaction, strengthen the nursing work environment, assess staffing levels, and improve reimbursement. Dr. Lang is also a pioneering researcher in the field of health quality improvement through the use of electronic health records.
Enhancing Research, Education, and Practice as Dean
As dean of Penn Nursing Science for eight years starting in 1992, Dr. Lang instituted a three-part mission to enhance and integrate nursing research, education, and practice. By increasing the school’s endowment from $5 million to $25 million, she was able to recruit top scholars. Another key initiative was establishing a network of nurse-managed practices, which provided faculty and students with clinical sites to demonstrate best practices, translate research into practice, measure and evaluate nursing care, and develop research programs.
One example is the LIFE (Living Independently For Elders) program, part of the federal Programs of All-Inclusive Care for the Elderly, which provided comprehensive medical and social services to frail, community-dwelling older adults, most of whom are dually eligible for Medicare and Medicaid. Now part of Mercy Health and called Mercy LIFE – West Philadelphia, the program provides comprehensive medical, health, recreational, and social services to promote independence at home. Nurses from Penn Nursing Science are part of the interdisciplinary team of doctors, nurses, therapists, and social workers who evaluate needs and develop a customized program of care for each person.
Under Dr. Lang’s leadership, Penn Nursing Science also established new research centers in gerontological science; women, children, and families; urban health; serious illness; and nursing outcomes, enabling faculty to collaborate and build their expertise in these areas. The school also introduced interdisciplinary degree programs, such as the MSN and MBA dual degree program.
When Dr. Lang returned to the faculty in 2000, Penn Nursing Science was one of the top nursing schools in the country.
Developing a Digital Knowledge Repository for Nursing
In 2005, Dr. Lang once again joined the University of Wisconsin School of Nursing, as the Regent Distinguished Professor and the Howe Endowed Chair for Health Care Transformation. She developed and led the Knowledge-Based Nursing Initiative, a system that accelerates and expands the use of knowledge and evidence in nursing practice through intelligent technology. The system is the first-ever digital knowledge repository for nursing, putting the latest and best practices at nurses’ fingertips and giving them support in making decisions about patient care. The Knowledge-Based Nursing Initiative is a partnership of Aurora Health Care, the Cerner Corporation, and the University of Wisconsin-Milwaukee.
Impacting Public Policy
Throughout her career, Dr. Lang has been active in the public policy arena. As a member of the National Quality Forum’s board, she promoted health system improvements through development and implementation of a national strategy to measure and report health care quality. She also served on the board of the American Medical Standards Association and many other health care and nursing related boards. Although Dr. Lang is officially retired, she continues to consult and advise, with a focus on meaningful use of electronic health records and big data. For example, she is a member of the Office of the National Coordinator for HIT Policy Committee workgroup on Advanced Health Models, and serves in advisory capacities for the American Nurses Association and the American Medical Informatics Association.
Selected Career Highlights
- Living Legend, American Academy of Nursing
- President’s Award, American Nurses Association
- Board member, National Quality Forum
- Board member, American Nurses Association
- President, American Nurses Foundation
- Member, Academy of Medicine (formerly called the Institute of Medicine)
- Honorary fellow, UK Royal College of Nursing
- Ernest Amory Codman Award, The Joint Commission
- Lang, N.M., Mitchell, P.H., Hinshaw, A.S., Jennings, B.M., Lamb, J.S., Mark, B.A., et al (2004). Foreward: Measuring and improving heatlh care quallity. Medical Care, 42(2 Suppl.), 42372.
- Lamb, G.S., Jennings, B.M., Mitchell, P.H., & Lang, N.M. (2004). Quality agenda: Priorities for action recommendations of the American Academy of Nursing conference on health care quality. Nursing Outlook, 52(1), 60-65.
- Lang, N.M., & Mitchell, P.H. (2004). Guest editorial: Quality as an enduring and encompassing concept. Nursing Outlook, 52(1), 42371.
- Vahey, D.C., Swan, B.A., Lang N.M., & Mitchell,P.H. (2004). Measuring and improving health care quality: Nursing�s contribution to the state of the science. Nursing Outlook, 52(1), 42531.
- Mitchell, P.H., & Lang, N.M. (2004). Nurse staffing: A structural proxy for hospital quality?. Medical Care, 42(1), 42372.
- Mitchell, P.H., & Lang, N.M. (2004). Framing the problem of measuring and improving healthcare quality: Has the quality health outcomes model been useful?. Medical Care, 42(2 Suppl.), 42471.
- Lang, N.M. (Guest Ed.) (2004). Measuring and improving health care quality. Medical Care, 42(2 Suppl.), n/a.
- Evans, L.K., Lang, N.M., & Medoff-Cooper, B. (2004). Integrating research and practice. In L.K. Evans, & N. M. Lang (Eds.), Academic Nursing Practice: Helping to Shape the Future of Health Care. (183-204). New York, NY: Springer Publishing Company.
- Evans, L.K., McCausland, M.P., & Lang, N.M. (2004). Making academic nursing practice work in universities: Structure, function, and synergy. In L. K. Evans, & N. M. Lang (Eds.), Academic Nursing Practice: Helping to Shape the Future of Health Care. (92-120). New York, NY: Springer Publishing Company.
- Lang, N.M., Evans, L.K., Swan, B.A., & Snyder Phillips, R.A. (2004). Building a critical mass: The Penn Macy initiative. In L. K. Evans, & N. M. Lang (Eds.), Academic Nursing Practice: Helping to Shape the Future of Health Care. (258-265). New York, NY: Springer Publishing Company.