The Call of Nursing: Stories from the Front Lines of Health Care

Whitman

FOREWORD

Occupational stories can serve as powerful tools: they can educate us about the details of a specific job, illustrate various realities within that career, and enrich our emotional and spiritual lives, all at the same time. The compelling narratives in The Call of Nursing: Stories from the Front Lines of Health Care certainly fulfill all those expectations. while treating us like trusted confidantes, these nurses allow us to peek behind the curtain of a profession that deals with individuals at their most vulnerable times – when they are patients.

These twenty-three, first-person profiles in nursing are ethnically, culturally, and educationally diverse. Some of the women and men here emulated mothers who were nurses, and were sure of their life paths before they entered high school. Some switched careers in midstream, for better salaries or increased job security, among other things. And others came to nursing much later in life, often answering a mysterious call to follow a vocation that could make a difference for individuals in need. But, taken together, their stories chronicle work experiences and environments that not only illuminate the broad range of career options for nurses but also form a valuable body of health care knowledge. All in all, this book communicates the essence of nursing.

The profound qualities that unite the voices we hear in this book are passion for the profession and compassion for patients. whether you read this book from cover to cover or savor these nurses’ lives one at a time, you can’t help but be moved by their hopes, their struggles, and their joys. If you are a nurse, you’ll recognize yourself somewhere in here. If you’re lucky enough to have a nurse as a friend or family member, you will probably rush through reading it so you can share these stories with them. And if you aren’t a nurse yet, I guarantee this book will make you consider becoming one.

Gertrude B. Hutchinson, MSIS, MA, RN, CCRN-R

Archivist, Bellevue Alumnae Center for Nursing History

DR. COLLEEN WALSH

I have worked as a nurse on orthopedic units at Level I trauma centers in Boston, in Albany, New York, in Charlottesville, Virginia, and in Ann Arbor, Michigan, among other places, for over thirty years. I have also completed four nursing degrees while I was working full time and raising a family. In 2011, I earned my doctorate of nursing practice from the University of Southern Indiana, in Evansville, where I am currently an assistant professor of nursing.

Ialways knew I was going to be a nurse. There was never a time during my early schooling, elementary through high school, when I didn’t want to be one. There were absolutely no medical people in my family, so I don’t know where my inspiration came from. It was just something I innately felt I wanted to do, and I never wavered from that course. I guess I was born that way.

However, I was also born with knock knees. Knock knees are when your knees rub together but your feet point out. It’s the opposite of bowlegged. To make it worse, I was your typical chubby kid, and weight exacerbates that problem. My kneecaps would dislocate and at times it was very painful to walk. I had my first cast on when I was seven, and I went through my first major procedure in 1963, when I was only eleven. Over the course of my lifetime, I have undergone seven more surgical procedures to correct the problem. So I possessed a natural affinity for orthopedics because I knew what it was like to be on the other side of the cast.

When I was sixteen, after my second major procedure, a Nurse Ratched type took care of me. She made me cry every single day I was in the hospital. Now that I look back on it, though, she was probably doing what she was supposed to do. But it was the manner in which she did it. She was mean. She made fun of me and called me a baby. Even with that, I still wanted to join the profession, and I swore I would do everything I could to become the antithesis of that nurse.

On my first orthopedic rotation during nursing school, I immediately empathized with the patients. I understood the sheer magnitude of being stuck in that bed. I had experienced some of the mechanics of orthopedics, in terms of traction and weights and how they kept bones in place, and that certainly helped. I definitely knew what it felt like having little plaster crumbs under my butt, and getting a rash that drove me crazy, and how much it meant to have clean sheets. Those small things might sound unimportant, but they’re magnified into an incessant form of daily torture when you’re a patient.

There weren’t too many of us who specialized in orthopedics when I started working. As an orthopedic nurse, I was dedicated to alleviating pain and restoring function due to musculoskeletal injuries or disorders – anything related to a bone or a joint. I have taken care of the full spectrum, from someone with a simple broken finger to someone who was completely paralyzed and on a ventilator for five years. I also treated many people, whom we called multiple-trauma patients, who suffered a combination of fractures, chest injuries, and internal injuries. Usually the other injuries healed faster than the orthopedic ones. After they passed the crisis phase in the ICU, they would come to us. I had patients who rode motorcycles and hit guardrails and left part of their shinbones behind. Their shinbones hit so hard that they just splintered into pieces and we would have to rebuild them. That was a common injury.

Orthopedic practice is very different now. We have procedures and materials we didn’t have back then. We can insert artificial bone, or move bone from another part of the patient’s body to fill a defect. But back in the seventies and eighties, patients with severe orthopedic injuries stayed in the hospital for months. Then, more often than not, we would see them back many times over the course of several years because of complications from the original injury. In the early days, I got to know my patients pretty well.

Now we have new orthopedic pins and rods that can actually immobilize a fracture so well that patients don’t have to stay in a hospital for three or four months. They can go home in three or four days. The titanium rods we put in essentially do the job of the bone until it can heal naturally. Biologically, titanium is an inert compound, so it doesn’t cause allergic reactions and isn’t perceived by the body as a transplant. But normally these things are ultra-sterile. Unless there’s an infection present, patients tolerate them very well. If the titanium doesn’t bother a patient, we just leave it in there.

For my entire bedside career, I was fortunate enough to have worked exclusively at level I trauma centers where the sickest of the sick are found. I had exposure, every single day, to the most complex orthopedic injuries. I particularly remember one patient in Charlottesville, Virginia, in 1983. He was a twenty-five-year-old African American male who was working under his car when the blocks slipped. The engine shaft fell on his neck and severed his spinal cord at a point just below his brain. Luckily, he was close to a hospital when it happened, so he got immediate care and was placed on a ventilator. Back then, there was absolutely no nursing home or facility in the Commonwealth of Virginia that would take a patient on a ventilator. We couldn’t transfer him anywhere, and he remained on my floor for five years.

From day one, we knew his condition was static – that he would always remain the way he was. He was completely paralyzed from the neck down. He couldn’t breathe on his own. He couldn’t speak. He only had about one square inch of skin on his neck where he could still feel any sensation at all. He was totally dependent, under our care 24/7, and the key factor in nursing him was anticipation. If, for instance, he was sitting in a chair for an hour, he couldn’t feel that his butt was getting numb and pressure was building on his skin. We had to anticipate that and change his position. One of the things that we took pride in as nurses was that, for five years, this totally paralyzed man never once suffered from a bedsore.

I had been promoted to clinical head nurse on that ward and I was in charge of orienting all the new nurses. Every spring I would walk into that patient’s room and say, Listen, Phil, I’ve got five newbies coming this summer. Do you mind if I let them take care of you to learn how a ventilator works? He would just look at me and cluck, and that was his okay. He was so agreeable. I trained a legion of nurses on how to manage a patient like him. I also felt it was important to recognize him as a person who still possessed a measure of autonomy – that there was nothing wrong with his head, and that he could still make decisions.

After five years, he was actually transferred to a state facility in the Virginia Beach area, and he lived another four years there. Unfortunately, he suffered an acute episode of high blood pressure that caused a cerebral hemorrhage and he died. Now I can remember dozens of patients and very specific scenarios at different hospitals. I can even recall specific room numbers for certain patients. But to this day, Phil sticks in my mind as special.

My husband and I were still living in Charlottesville when I had our first child in 1985. I had been an orthopedic nurse for thirteen years at that point, and I loved my work, but I wanted some options in my career. I wanted to be able to walk into a good hospital and say I was qualified for a high-level clinical nursing job, Monday through Friday, with no work on weekends or holidays. So I went back to school. I found that studying independently was ideal for me, and I also discovered that I was good at distance education because I was focused and self-directed. I finished all of the requirements for my bachelor’s degree in April of 1988, but I couldn’t attend graduation because I had just given birth to our second child.

My husband was a surgeon, and he had received a cardiothoracic surgery fellowship at the University of Michigan. He was scheduled to start that in 1989, and we moved from Charlottesville to Ann Arbor that year. With my new BSN in hand, I really did walk in and say that I wanted a clinical nurse job, Monday through Friday. Well, the Chairman of Orthopedics in Virginia knew the Chairman of Orthopedics in Ann Arbor, and they conspired to help me. I was the first nurse who ever held a jointly funded appointment. I only had to work a Christmas holiday once, and I was on call just one weekend every six months.

When I was Clinical Care Coordinator in Trauma/Orthopedics at the University of Michigan Medical Center, we had a remarkable patient. I ended up publishing an article about him in a nursing journal and identified him by a pseudonym – Mr. Michael. He was sixty-three years old, with a twenty-year history of rheumatoid arthritis, and he was admitted with a debilitating neck deformity and venous stasis ulcers. Over the course of time, his neck had become so deformed that his right ear literally sat on his shoulder. We could lift his head about two inches, but he demonstrated no active cervical motion, and the change had occurred so gradually that his eyes had actually adjusted. If I had put my ear on my right shoulder, I would have been looking sideways. Mr. Michael’s eyes had moved so that, even with a cervical spine deformity clinically measuring ninety degrees, he was looking straight at us. That was a little unnerving, to say the least.

He obviously had a lot of problems swallowing, eating, and breathing, so we evaluated him to help straighten out his neck. If we could somehow reposition it and fuse it in that new position, it could heal that way. But straightening it wasn’t so simple. What we had to do was put him in traction, with pulleys on his head, and the traction pulled only in one direction. His muscles had gotten used to being in that position. Every couple of days, we would change the traction. We could only move it maybe an inch at a time, because those tight muscles had to adjust to each new position.

My job was to coordinate all the care he got. Every day I would perform a specific assessment to make sure all of the nerves were still functional. If everything was progressing smoothly, I would adjust the traction. If he had a problem, I was the one who called the orthopedist. We had to go gradually, over the course of several weeks, and we had to make sure that his eyes readjusted during that time.

We did a lot of preplanning and we anticipated a diverse range of potential problems. We had multiple medical services evaluate him prior to surgery, because if we didn’t have a chance to be successful, then it really would have been a disservice to put Mr. Michael through all of that. The surgery was the very last and essentially the easiest of the entire process, and the surgeon who operated on him was excellent. Mr. Michael stayed in the hospital about ten weeks and was discharged with his neck completely straight and his eyes pointed in the right direction.

That was an important case for me because it was one where all the doctors respected my knowledge and were confident of my abilities to manage a delicate situation. At the time, I was able to function more as a nurse practitioner than as a nurse, and that experience led me to another career change. I just felt that I had gotten to a point where I needed a new challenge.

We moved to Mobile, Alabama, in 1991 when my husband got a faculty position there, and I went to graduate school. I got a master’s degree as a Clinical Nurse Specialist in 1993, and then a year after that, I decided I wanted to be a nurse practitioner. I knew I didn’t want to do just snotty noses and ear infections, so I went into a post-master’s acute care nurse practitioner program. That was a program geared toward nurses working with specialties in a hospital setting. That concept drew on the skill set that I had acquired by working in big hospitals and taking care of really sick patients. I finished in November of 1995 and took the first national certification exam.

In most states, nurse practitioners have to practice in collaboration with physicians. There are some things that we can’t do, of course, because we don’t have the training. For example, we can’t do surgeries. We can certainly recognize major problems that are in need of a higher level of care than we can provide, and that’s why most states have laws stipulating that nurse practitioners must enter into a collaborative practice agreement with a physician. We couldn’t get hospital privileges to work in a hospital and see patients if we didn’t have those agreements.

But I believe that, as a nurse practitioner, I can offer something holistic that many doctors don’t provide: I view my patients from a different perspective. I’m able to look at not just the disease but the patient with the disease. I carefully consider patients’ responses to therapies that we’ve ordered. I assess them for changes and decide if I need to alter our orders. I write orders; I don’t take orders. That’s a big difference. I don’t want to generalize but, again, nurses and nurse practitioners tend to look at patients in a different way. It isn’t necessarily a good or a bad thing – it’s just the nature of our education. Nurses bring something different to the table.

When you’ve been a nurse at the bedside in major teaching hospitals for as long as I have, you’ve seen literally thousands of patients over the course of your career. I couldn’t help but become emotionally involved with many of them. Actually, if I saw someone who didn’t get involved, I wondered about that person as a nurse. And it was inevitable that I carried some of those emotions home with me. That happened a lot when I was young but, as I got older, I was able to put things in a little bit more perspective. I learned, for self-preservation, to compartmentalize: This is happening at work and needs to stay here; now I’ve left work, and this is what I care about at home. I can’t explain, step by step, how you compartmentalize horrible trauma. It’s not something that I consciously did. I think it was in part a learned skill, and probably part defense mechanism, but it was a necessary component of the job. Working as a nurse practitioner moved me even a little further from that emotional involvement with my patients, and it was probably my first step toward realizing that I wanted to broaden my ability to help people.

I remember, when I first contemplated becoming a teacher, that I was really concerned about leaving the bedside. One of my mentors said to me, Well, if you take care of the patient at the bedside, then you can change the life of that one person. But if you teach dozens of nurses to change a life at the bedside, you’ve increased what you’re able to accomplish. And I realized that, even as a nurse practitioner, I found that patients didn’t understand what I was talking about much of the time. They suffered from a medical problem and they had come to me to fix that problem, but I seldom had the opportunity to have a complex and stimulating medical discussion with them.

So now I work as a full-time assistant professor of nursing at the University of Southern Indiana in Evansville, Indiana, and I love it. I teach online, which I think is the funny part of this entire process. I earned my bachelor’s degree as a distance education student and all of my teaching is now online. As an educator, I definitely have to be far more global and knowledgeable about a lot of different things. I do miss the hands-on nursing, although I do go around and see patients with my students when they’re getting their clinical experiences.

Each aspect of nursing, each separate part of nursing, offers a different kind of satisfaction. I can’t make a hierarchy out of them. Being a nurse isn’t easy. You sure don’t get paid real well. But it is a profession that can allow you to achieve potentials you didn’t realize you could reach. I grew up in a very blue-collar family and my parents said that the only way to become a nurse was to go to a hospital to learn. They told me you didn’t go to college to become a nurse. That’s how I ended up in a three-year diploma program. I went to the school of nursing at Massachusetts General Hospital because that was what was available to me at the time. I was just a kid who went off to a three-year hospital program, but at least that became the springboard for everything else. There are so many more options now. As I tell my students, you’re never too old to learn. And you shouldn’t believe you’re ever too old to achieve what you want, either.

BLYTHE HARRISON-SAYRE

I worked for almost thirty years at the same hospital in Portland, Oregon, and married a fellow respiratory therapist. We had one child and then adopted four, two from Russia and two from Kazakhstan. The kids’ needs were many and varied, and going back to school seemed impossible until 2008.

Iwas involved in a situation with a patient who developed malignant ascites, which is a fluid collection in the abdomen. The fluid had shifted out of his intravascular system, caused a collapse, and he had arrested. They had resuscitated him, and then brought him down to our ICU. At the shift change, when I walked in, a resident and an intern were putting in central IV lines – large-bore IV catheters. You know this patient’s pH level was below survivability and you guys did not treat, I said.

We’re busy putting in lines here, the resident answered.

Okay, well, I think we need to do an arterial blood gas test, and I think we need to do some more treating.

He looked over and said, You know you’re just the RT, right?

Right. I was only the respiratory therapist. My knee-jerk reaction was to think, Listen, buddy, my level of knowledge about respiratory and blood gases you can’t even begin to touch. I knew, of course, that would be the wrong response. But then I thought, I have this knowledge. We can work with it, and we can help this patient. It’s not about the lines. It’s about the patient. Putting in lines was an important part of what was going on, but it wasn’t the whole focus. Getting the homeostasis back was a significant part of it, too.

Within fifteen minutes, we had another code on our hands, and the patient didn’t survive. I can’t know, given the patient’s age and all the other co-morbidities, if he would have survived had they listened to me. But to be told I was only the RT, that I didn’t really have solid input there, and to be quiet? That really rubbed me the wrong way, and it was the final straw. I had been practicing respiratory therapy for a long time, and I could do it with my eyes closed and my hands tied behind my back, half asleep, and do it really well, but that didn’t seem to matter. At that moment, I knew I needed to go somewhere else.

__________________ ✱ __________________

After thirty years in the health care field, I felt like I had to