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Michele Loos will never forget the first patient who died on her watch. He was an elderly man who couldn't read or write. She was a 30-something UNH nursing student on her senior practicum. Had they met on the street, she would have assumed they had nothing in common. But as he lay dying in the Concord (N.H.) Hospice House, she became intimately involved in the routines of his daily life, shaving his face and feeding him through a tube. Because he had a tracheotomy, he couldn't speak. How, she wondered, could she possibly communicate with him?

So much, she discovered, could be conveyed through the eyes alone, and this man had huge dark brown eyes. He could also mouth words and point to yes or no on a whiteboard. There was a picture of him in military uniform on the dresser and his niece came to visit, but Loos got to know her patient over several months mainly through observation, seeing how he enjoyed the birds outside his window, how he laughed at gentle jokes in spite of his pain, and how he reveled in a cup of coffee twice a day, even if he could only manage a sip.

When it came time to leave for her winter break, Loos wept, convinced that the man would no longer be alive when she came back. But she returned to work a couple months later to find him still there, very near death. Her colleagues were convinced that he had waited for her, as the dying sometimes seem to do—hanging on, perhaps, until a certain person arrives or calls in from afar.

Over the break, she had received her nursing license and now, for the first time, she was in charge. She sat by his bedside, calming him in his agitation and delirium, reassuring his family and encouraging them to sit close to him. When it was over, she felt at peace. "I knew that we had completed something we had begun," she recalls. "He wasn't in pain, and this is what he wanted." Just as important was guiding his family through a night they would remember for the rest of their lives.

Loos likens the hospice nurse to "a midwife who can get you through this life to the next existence." It is a job she loves, and she has helped a number of patients and their families through this transition. But she has also acted as a midwife, on a much larger scale, to a new program at Wentworth Douglass Hospital in Dover, N.H., over the past year. It is no exaggeration to say that she has helped to transform the treatment of severely or terminally ill patients throughout the hospital. Most of her co-workers have no idea that she's been a licensed nurse for a mere three years.

Like most of the graduates of UNH's new direct-entry master's in nursing program, Loos came to nursing as a second career after years of working in another field. The program is designed to help ease the nursing shortage, which is projected to worsen as aging baby boomers simultaneously reduce the supply of, and increase the demand for, nurses. The goal is to produce highly educated nurses who can provide excellent bedside care, lead others in a clinical setting and teach future nurses. Research has linked the number—and education level-—of nurses in a hospital to patient survival rates. For anyone who might need medical care in the upcoming years, the success or failure of efforts to address the nursing shortage could be quite literally a matter of life and death. As Loos demonstrates, good nursing can also enhance the quality of life, at any stage.

Not so long ago, points out Sue Fetzer, UNH associate professor of nursing and president of the New Hampshire Nurses Association, there were basically three career options for women: teaching, nursing and mothering. Now, she says, it's more like "What can women not do?" When Loos first attended UNH in the 1980s, business was a popular major for women. By the time she graduated in 1990 with a degree in business administration, however, she already knew that she wanted to be a nurse. She enjoyed working part time in a hospital, where, she discovered, she was unfazed by things like peeling socks off the feet of a homeless person. Nevertheless, she was paying for her own education, and going to school for another three years was out of the question. After graduation, she worked in a series of jobs in insurance and journalism.

DYNAMIC DUO: Michele Loos '90, '06G and Dr. Patrick Alix have transformed end-of-life care at Wentworth Douglass Hospital in the last year.

In recent years, publicity about the nursing shortage and attendant increase in salaries has attracted people to nursing as a second or even third career. After Sept. 11, Loos thought, "What am I waiting for?" and began taking some courses toward her goal. When she took her anatomy and physiology exam, she was pregnant with her third child and so far along that she could barely fit between a classroom desk and attached chair. In 2003, she became a member of the first class in UNH's direct-entry master's program, one of about 50 such programs around the country that enable people with college degrees outside the field to become nurses—rapidly. Because there is a shortage of nursing educators, as well as nurses, demand for seats in these programs far exceeds supply. In 2005, the National League for Nurses reported, 147,000 qualified applicants were turned away from U.S. nursing-education programs at all levels. At UNH, which plans to expand its direct-entry program next year, 100 students from across the country and beyond applied for 24 spaces in 2006. Virtually all of the applicants were fully qualified, and eight of them had perfect 4.0 GPAs.

The direct-entry program is designed to be fast—not easy. On the first day of an eight-week course in pathophysiology, Loos recalls, it was more than a bit ironic to hear a professor of nursing announce, "If you have a fever of 104, stay home, but if you have diarrhea or you're throwing up, take whatever you have to take. Do Not Miss Class." Going to school year round, the students spend the first year and a half preparing for the national licensure exam; the remaining half year is spent doing graduate work and research. At the same time, they devote 16 to 32 hours a week to clinical rotations in hospitals and clinics.

Students in the program so far have ranged in age from 21 to 58, and many—like Loos, whose children were 3, 7 and 9 when she started—have other responsibilities outside of school. Fortunately, her family was behind her all the way. Her husband, Steven Loos '89, is an underwriter in an unusual and oddly named field called "inland marine insurance," which covers things of value—a museum exhibit or a skyscraper—only while in transit or under construction. Working out of their home, he was able to get the kids off to school when Michele had to report to her clinical rotations at 6 a.m. Today her older daughter, now 14, gives her the thumbs up on the path she has chosen: "You need to be there. You love what you do, and other people might not do such a good job as you."

Out on her clinical rotations, however, Loos faced another challenge—the open skepticism of experienced nurses who had spent two or three years preparing for the same licensure exam she and other members of the first class took after a year: "What do you mean you do the whole curriculum in a year? How can you possibly retain any of it?" Like many other direct-entry students, she responded to the skepticism by working harder, going on a trip to El Salvador to work in a hospital serving the poorest of the poor for two weeks, for example, and, upon her return, organizing equipment donations to the hospital.

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