Introduction by Carolyn Jones
THERE ARE SOME EXPERIENCES IN LIFE THAT TRANSFORM YOU.
I started this project at the request of a nurse, Rhonda Collins, a woman who has devoted her life to nursing and making nursing conditions better. I thought I was making a book that would celebrate nurses. I ended up gaining a better understanding of the country through the lens of the American nurse. I have altered my thinking about religion; I have completely changed my feelings about end-of-life. I have a new compassion for coal miners; a better understanding of the health-care system—and how complicated the solutions might be. I know how funny nuns can be. I’ve learned that nurses are like the cobbler’s children; they can take care of everyone else, but they’re not always so great about taking care of themselves. I know what it means to love what you do, to care so much that you would do anything to help your fellow human being. I’ve learned what someone’s home can smell like when life has deteriorated. I’ve seen a man actually drive up a creek to get to his patient whose driveway is impassable because of mountaintop-removal mining.
And I found the nurse that got me through chemotherapy seven years ago when I was recovering from breast cancer.
Our goal as we began this project was to give a voice to the American Nurse. With my team we mapped a trip across America that would take us to parts of the country where we would have the chance to meet nurses dealing with some of the issues that face our nation; poverty, returning-war veterans, a rapidly aging population, black lung disease, prison life. We chose places where we would find those nurses and patients. We asked hospitals and facilities to nominate nurses that would best represent their organization and region. In this way, I was able to talk to some of the best nurses in the country.
In the beginning, I thought a nurse was a nurse. I thought I would talk to nurses about the job itself, but instead I had conversations that lead to other conversations about things that matter to all people.
This journey wasn’t neat and tidy. There were times when I had to stop an interview just to feel the story. We hugged. Nurses hug a lot. Touch has the power to heal, and it’s a huge part of what they do. Nurses spoke of being honored and privileged to have much intimacy with their patients. To be with patients and their families during times of illness or death is to see people at their most vulnerable. I often felt that intimacy in the interviews—it’s home base for them. The nurses I met were comfortable showing me who they are.
I started my journey in the Bronx where I met Mohamed Yasin, who grew up in Guyana in South America. His father was considered a healer whom the villagers would visit, an honorable position that inspired his son to become a nurse. His father would use a warm breath to heal villagers, and Mohamed learned the power of the smallest gestures from his dad.
Joan O’Brien started the first AIDS unit at her hospital while simultaneously dealing with the first gay men she had met in her Irish Catholic life. Those were the early days of HIV/AIDS, when they really didn’t know much, and nurses were scared. Joan spoke of what she learned from that first patient and how much he taught her about herself.
At a clinic in New York, I met Nathan Levitt, a transgendered nurse who helps others going through the same process and conducts gender-sensitivity training for health professionals.
I met nurses who have difficulty saying the word “die.” For some, we “expire.” For others, we “pass on” or we are “lost.” It turns out death is not easy for anyone to talk about.
At the Johns Hopkins Hospital, we had amazing access to the nurses. In the NICU, Karen Frank rocks babies when they are dying and the family cannot be there. There were days working on this project when I thought I wouldn’t be able to stop crying during the interviews.
I photographed nurses in the ER while a young man was dying in the next room of a gunshot wound.
Here’s one of the first things I learned: when you sit down to talk to a nurse you realize that there’s very little veneer to get through. I interview a lot of people, and there’s almost always something that a person holds back for protection. Not so with the nurses—there are no walls to break down. The interviews were rich because the people giving them don’t have time to dance around words and feelings. They are just so raw. Saving people and watching people die makes you more human, I think.
I met Brian McMillion at the VA hospital in San Diego. He spoke of working with young men waking up and realizing that they had lost limbs in combat and yet the first thing they would ask is “When can I go back? I left my brothers out there.” Spending time at the VA hospital showed me what sacrifice is.
I went to the Louisiana State Penitentiary, where inmates can volunteer for the hospice program. The inmates care for one another in the last stages of life. This act of humanity is often the only chance someone may have had in his entire life to be able to care for someone else—it transforms people. It turns out that helping people is healing. We traveled to New Orleans to meet nurses that worked during Hurricane Katrina. Tears were shed here.
None of us can really imagine what happened. The nurses we met talked, relived, and cried about what they experienced during the hurricane. I came to New Orleans hoping to talk to the nurses that had to perform euthanasia on their patients, but in the end it wasn’t the right story to tell. The people haven’t forgotten, but they are ready to move on and rebuild.
In Florida we spent time at the Tidewell Hospice homes with nurses doing palliative and hospice care. Elisa Frazer told a story of helping an Italian gentleman at the end of his life, surrounded by family singing “That’s Amore.” I was crying and laughing at the same time.
We visited a Catholic nursing home run by the Sister Servants of Christ the King in Mt. Calvary, Wisconsin. The sisters that keep the home running smoothly are Sister Michael and Sister Stephen. They have animals here, not just a few animals but the whole shebang. Cows, horses, peacocks, llamas, sheep, goats, geese, alpacas, and a whole room full of birds in the entrance hallway next to the chapel. There are a couple of dogs roaming the halls. It’s incredible—this is the first health facility that I have been to that lets animals roam free. The residents love it; most of them had farms and animals, and when spring hits and the babies are born, the nurses often bring them in to show to everyone. It’s marvelous, life affirming, funny, brilliant. It also encourages family members to visit the residents, particularly grandkids who get to play with the animals. How smart is that? I love Sister Stephen.
I have questions. How can we break the cycle of poverty in Eastern Kentucky? How can we prevent our returning troops from needing so much psychological repair? How can we find a way to minimize end-of-life care so that one third of our Medicare dollars are not spent on the last year of life? How can we mobilize a team of nurses to help us find answers? They have ideas.
I am not who I was before. There are people in this country with so little that they cannot live. There are people who have to make the choice to either work in the coal mines or not feed their families. People have to choose to live with pain or die with dignity, children have to unplug their parents from machines, doctors have to decide when there is nothing left to do, and nurses have to navigate all these waters.
I expected warriors out there and in a way that’s what I found—just not the way I expected. Nurses do fight to care for us, in spite of ourselves, in spite of the obstacles in their way. And they fix us. When they can no longer fix us, they make sure that we are comfortable and that our time leaving this earth is as rich as it is entering.
They have seen things that none of us can imagine. I’m in awe. I do believe that they are a special breed— some combination of innate compassion and learned behavior. I wish I could say exactly what it is, because I’d bottle it up and drink that potion, but it’s not consistent and, of course, there are many roads that lead to being a nurse. I hope that we have captured that. —Carolyn Jones
Afterword by Rhonda Collins, MSN, RN
I am a nurse, first and foremost. I spent more than twenty years working in a hospital, beginning as a staff nurse in labor and delivery. I worked my way up to executive leadership and eventually made the decision to transition into the world of medical devices, which is the technology that nurses use at the bedside in caring for their patients. I now work for a company that makes and sells IV-infusion pumps to hospitals. I am responsible for the business in North America. I made this decision because I felt that the medical-device industry didn’t understand the complications nurses go experience trying to integrate technology at the patient’s bedside.
My personal story is both profoundly normal and distinctly unique. I tell it in the hope that it explains the path that brought me to where I am and to the making of this book. I am the daughter of a Baptist minister and was raised in a very conservative home. It was the 1970s, when mini-skirts and short shorts were in fashion, but I was not allowed, like my friends, to wear mini skirts or short shorts. We didn’t have Christmas in our home; we celebrated by giving money to the Church instead of giving gifts to each other. It was a very cloistered life, and I felt like I had to fit into a very defined mold to please my father. I was afraid of doing anything that might anger him. I still play the piano, and I played for the Church growing up. My father was proud of that, so I started college as a music major with a music scholarship.
I got married in my sophomore year in college and had a baby a year later, and my second child was born two years after that. After six or seven years, I looked at my life and said, “I’ve got to do something more.” I had always been interested in service-oriented work because I found there to be a spiritual component to service. I went into nursing because I thought, well, I like caring for and being around people—I’m comfortable with that. Also, it just seemed like a profession where I could make a living.
I went back to college and was quickly enthralled by my classes. The science courses were hard, and I had to hire a tutor for chemistry, but I knew immediately I had found my calling. I received my Associate’s Degree in nursing and started working the night shift in labor and delivery. My husband was a mechanic, and we lived paycheck to paycheck in a little house in Texarkana, Texas. School was a challenge because I had two little children and we were broke. Music and church were still a significant influence in my life, and I continued to sing in the choir at my church. I frequently sat next to a woman who was married to a physician in our community. One evening we struck up a conversation, and she asked me what I did for work. I told her I wanted to go to nursing school, but had to wait until that goal was financially feasible. A few days later she called and said her husband was going to pay for my nursing school. He wanted to do it because he believed in supporting people in the community going into health care.
I never met the man and never wrote a five-hundred-word essay on why I wanted to be a nurse, but he provided for everything—my tuition, books, and uniforms. He would deposit money in an account at a local college. I never knew how much was in the account at any time but my tuition would always be covered. I sent him a thank-you note, and he wrote back to say the only thing he wanted in return was for me to be the best nurse I could be. I am honored to have had the privilege. I found out he passed away last year, and I never got to find out if he knew I had become VP of nursing in one of the most reputable hospitals in the country. I would have wanted him to know that I couldn’t have done this on my own.
I think his wife saw in me a desire to do something great. Honestly, at that time, I lived a small life in this little East-Texas town, but I had a fire in my belly to be somebody, to go somewhere and do something. I didn’t know how I was going to grow to become a woman of substance. I knew I wanted it to happen, but I didn’t have the resources until this couple came along and changed everything. This experience taught me that we are all required to hold out a hand and help others stand up. Every time I take a job or hire a new employee, I am looking for someone who can take my place. It’s my job to take care of my profession, and I take that responsibility very seriously.
When I first started in nursing, I loved the experience of being with the patient and the family and helping to make a difference, but I didn’t like taking care of the critically ill. I ultimately found my home in labor and delivery, where good things happened more frequently. And you have this wonderful outcome called a baby to send home with loving parents.
I remember the elation that came from hearing the baby cry for the first time. This was back in the day when the doctor would hand the baby to me, not the mother. This was before the advent of HIV so we’d take the babies and use our bare hands to rub off the blood and mucus—not even wearing gloves! It’s crazy to think about that now. I remember one birth where we were told the mom was in the elevator and the baby was coming really fast. The elevator doors opened, and she was having the baby right there. We delivered her baby in the elevator and then rolled her into the delivery room. The woman had her hands over her face and kept talking about how embarrassed she was. I said, “Why? Women would give anything to give birth this easily. A couple of years ago a woman had her baby out on the lawn; she never even made it into the hospital.” She looked at me and said, “That was me!”
Of course there were tragic situations also. The youngest patient I ever had in delivery was twelve years old, and she had been molested by her mother’s boyfriend. I ended up working with a lot of social workers. And then there were the babies who weren’t born whole or were too premature to survive. There was the heartbreak of having to tell the parents and the devastation of watching the babies die.
The worst thing that happened to me as a nurse occurred one morning when we were really busy. Back then nurses mixed their own drugs. I made a mistake with an IV for a patient, and she had to have an emergency C-section. The baby was fine, but, because of me, the mom had an unnecessary procedure that she hadn’t wanted. It was a horrible moment, one I will never forget as long as I live. Later in my career, when I was vice-president of women’s services, I would have to talk with these young nurses who wanted to leave nursing because they’d made some kind of error with medication. I kept thinking there had to be a better way. That was the trajectory that landed me in this industry. If we are going to make technology for nurses to use, then you need a nurse telling you how it needs to be done.
I saw it as my responsibility, as a nurse, to pioneer a better way for our profession. I decided to go back to school. I got my bachelor’s degree while I was working full time. I drove 198 miles each way to class, two days a week. I was putting seven thousand miles on my car each month. I took a year and focused on completing my master’s degree. I moved to Dallas/Fort Worth and became director of Women’s Services at Baylor University Medical Center, and was subsequently named vice-president.
One day I was talking to a salesman about how he could improve his IV pump. I was telling him why his product didn’t work in the patient-care environment. Three weeks later, I got a call asking me to come work for his company. The next thing I knew, I was walking into a corporate world for the first time. Or as some of my nursing colleagues like to say, I went over to the dark side.
I’ll never forget when I saw the GM and the vice-president of sales having an intense discussion in the hall. There was lots of yelling and slamming of doors. When I asked what was happening, I was told that we weren’t going to make our numbers (our financial forecast) that quarter. I said, “You know, where I come from, we only act like that if we cut off the wrong leg.”
I understand that a company has to make a profit, but it’s my experience with medical safety and medication errors that drove me into this business. I have an extraordinary opportunity to build a nurse-centric business because, at the end of the day, 98 percent of the end users of IV pumps are nurses. We’re focused on finding innovative ways to educate the nurses, such as avatar training in which nurses practice in simulated environments, much like the way pilots learn to fly a plane.
Year after year, nursing is rated “the most trusted profession,” but I don’t think most people understand what it takes to be a nurse. Few people recognize the education, hours, commitment or diversity of the profession.
At some point in our lives every single one of us is going to be a patient under a nurse’s care. We don’t leave this life without that experience. The overwhelming majority of health-care providers are nurses, and the vast majority in this great, beautiful, diverse landscape of nursing are committed individuals who are too busy to beat their own drum. Health-care reform is changing everything. Patients are being sent home unwell. We nurses have a very complicated environment within which to work. The time is now to make medication safety more intuitive, user-friendly, and focused on the end result—the patient. I truly believe that if we have nurses lend their brain trust and real experience to the design and use of the technology we create, we can affect positive change and make hospitals safer and better places.
Today, I work for Fresenius Kabi USA because it is a company focused on the nurse and focused on the patient. We are inspired every day by nurses, and we wanted to do something extraordinary to demonstrate and celebrate our commitment.
This book is a step in that direction. Within these pages, we have captured the stories of seventy-five nurses from hospitals all across the United States. In this project—and all that will grow from it—we have begun to create a place for nurses to share their voices, to learn from each other, and to celebrate one another. This is the purpose of The American Nurse: to shine a light on nurses in this country, to tell their stories frankly and honestly, and to see them at work, doing what they love.
It is astonishing that, with three million nurses in America, this story hasn’t been told before. However invisible they may seem to be, nurses are an enormous force. It is time for us all to see them clearly, hear their voices, and listen.
Rhonda Collins, MSN, RN, earned a master’s degree in nursing administration after spending fourteen years as a staff nurse. She is currently completing a doctorate in nursing practice in executive leadership. In 2011, she went to work for Fresenius Kabi, USA, as vice-president and business manager of medical devices.