Standard Blog Whole Post

Invisible Nurse Redux

This post is written by Leslie H. Nicoll, PhD, MBA, RN, FAAN a passionate nurse, wife, and mother. She lives in Portland, Maine where she owns her own business, Maine Desk LLC. She is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Editor of Nurse Author & Editor. Dr. Nicoll is an advocate for the poor and vulnerable in our society and lives this mission by working 2 1/2 days per week as the Coordinator at the Portland Community Free Clinic. Dr. Nicoll was very proud to be inducted as a Fellow in the American Academy of Nursing in October 2014.

Kaci Hickox, the nurse who was quarantined in a tent in New Jersey for four days, has become a household name—sort of. What isn’t as well publicized are her educational credentials and expertise. Nurse Hickox is presented as “just a nurse” and if one is to believe the comments written about her in public discourse (newspapers, Facebook, Twitter) she is the worst kind of nurse: selfish, narcissistic, ambitious, egotistical, and negligent. Definitely not the sort of nurse someone would want at their bedside when they are in extremis, if you are inclined to agree with the opinions that many anonymous writers have shared.

I’ll be honest, I didn’t start paying close attention to Nurse Hickox’s story until she left New Jersey and came home to Fort Kent, Maine. But once her situation became local news (I live in Portland), I couldn’t ignore it. “QUARANTINED NURSE” was the lead headline for the past week.

One thing I noticed, right off the bat, is that all stories about her gave the bare minimum of information—her name and sometimes, her age (33). That’s it. No mention of her employer, education, expertise, or experience. Reporters did talk about her boyfriend, Ted Wilbur, 39, a nursing student at the University of Maine at Fort Kent. It was surreal to feel like I knew more about Ted than I did about Kaci, who really was the person of interest at the heart of this story.

Limited info about Nurse Hickox didn’t stop the online “pitchforks and torches” crowd from attacking her, however. Think of the nastiest thing you can say about someone and multiply it by ten—that will give you a sense of the vitriol that has been posted on the websites of the Portland Press Herald and the Bangor Daily News. I ventured to a Kaci Hickox Facebook page and read more of the same, including this comment: “Bet this fanpage isn’t working out the way you expected it would, bitch!!”

Things reached a head, at least in my head, when I read a series of posts from people claiming to have contacted the Maine Board of Nursing demanding that her license be revoked and finding out that she isn’t even licensed to practice nursing in Maine! This caused even more outrage, with comments suggesting that she is not a “real RN” and that she was “practicing medicine” [sic] in Africa illegally.

So, who is Kaci Hickox, really? It turns out she is extremely well educated and well qualified for the work she is doing: BSN from the University of Texas at Arlington (2002), MPH and MSN from Johns Hopkins University (2011), a diploma in tropical nursing from the London School of Hygiene and Tropical Health, plus a two year post-graduate fellowship in applied epidemiology with the CDC. Nurse Hickox is a paid volunteer by Doctors Without Borders (Médecins Sans Frontières, MSF) and under their auspices, has traveled to work in Myanmar, Nigeria, and most recently, Sierra Leone. She has a very definite career path to work with poor and vulnerable populations throughout the world. Interestingly, she was turned down by MSF for a job in 2004 because she didn’t have enough experience. That motivated her pursue her tropical nursing diploma and dual master’s degrees, all while gaining international experience in Indonesia and other countries.

Clearly Nurse Hickox is a smart, assertive, and intelligent woman who knows how to stand up for her rights and fight for what she believes in. But the press seems determined not to show us that side of her—instead, they keep her anonymous and vague. In headlines she is often nameless, to wit:

Judge in Maine Eases Restrictions on Nurse (New York Times, October 31, 2014)
Unapologetic, Christie Frees Nurse From Ebola Quarantine (New York Times, October 27, 2014)
Tested Negative for Ebola, Nurse Criticizes Her Quarantine (New York Times, October 27, 2014)

In videos that I have watched of Gov. Christie (NJ) and Gov. LePage (ME) discussing the situation—Nurse Hickox is never mentioned by name but always referred to as “her” and “she.” Gov. LePage goes on to say that “that woman” has “violated every promise” and that “we can’t trust her—I don’t trust her.”* He has also warned that she might be attacked if she leaves her home, which I heard as a veiled threat and bullying tactic.

I posted a comment in response to a New York Times article on October 31 that detailed some of her education because I was tired of the lack of information about her. So many commenters were assuming that she was undeducated and unprepared for the job and that she had gone to Africa on a lark with an urge to become famous. I wanted to do my little bit to get accurate data into the public record.

People thanked me for my post, saying that this information had not been shared before and was not “common knowledge.” Was I truly the first person to investigate Nurse Hickox’s background (which took about two minutes of Googling)? Turns out I wasn’t—there was an article in the New York Times on October 25 with this background, but it was buried on page A24. It was a standalone piece and none of the information contained in that article has been referenced in subsequent articles written about her. I also found alumni articles from Johns Hopkins and the University of Texas at Arlington** but has this material been shared generally? Sadly the answer is no.

So, what is my takeaway on all of this? One—the world out there: the public, reporters, governors and everyone else—see “nurses” as a commodity, one in million, who do not need to be named and identified by education and experience. Knowing this, we need to be vigilant to provide names, degrees, and credentials, for both ourselves and our colleagues. Note that in this post I have explicitly used Nurse Hickox rather than “Kaci” or “Ms. Hickox.” I believe this is a small way to be respectful and also get the fact that she is a nurse right out front.

Two: nursing education is confusing. This, unfortunately is a problem we in the profession have created but for people who aren’t pursuing a degree in nursing, it can be simplified and made clear. Most everyone knows what a bachelor’s degree is, likewise a master’s or PhD. Use those terms. “Kaci Hickox has two master’s degrees from Johns Hopkins.” People will understand that Nurse Hickox must be “wicked smart” (to use a Maine term!) to have accomplished this.

Three: career options in nursing are wide and varied (good for us who are looking to do different things) but again, the public seems to equate nursing with being at the bedside in a staff nurse role. There were many opportunities in the Nurse Hickox story where misconceptions were not corrected: she has a definite career plan, she has the education and expertise to serve in complex public health situations, and she did not go to Africa on a whim.

Fourth: strong, assertive nurses (and women) are not bad people. Nurse Hickox stood up for her rights and was publicly shamed for it. This is not acceptable and we must be vocal and support our colleagues. Interestingly, Monica Lewinsky has recently come forward with a mission to stop cyberbullying and public humiliation, based on her experiences of the past 16 years.*** Cruel, heartless online posting, from people who can hide behind a screen name are abhorrent to me and unfortunately, the incidence seems to be increasing. We must do what we can to stop this practice. Getting on the right side of the Nurse Hickox story seems like a good place to start.

Fifth: modern nursing is not the profession that many envision—docile, subservient nurses dressed in white and working in the hospital. Instead, we are creative, educated, and intelligent men and women who work in settings unimagined a generation ago. Each of us has a responsibility to correct misconceptions about our profession and career and should do this at every opportunity. When asked what I do, I always say that I am a nurse first, then add, “I own my own business,” “I am the editor of a professional journal,” or “I am the coordinator at our local free clinic.”

I was heartened this morning when the headline in the Maine Sunday Telegram did identify Nurse Hickox by name. Of course, she was called “Ebola nurse” in the same headline. Sigh…one step forward, one step back.

Written by: Leslie H. Nicoll, PhD, MBA, RN, FAAN

Sources:

*Gov. LePage: http://www.pressherald.com/2014/10/31/maine-cdc-restaurant-worker-may-have-exposed-patrons-to-hepatitis-a/video/

Gov. Christie: http://nyti.ms/1u9zFAP

**http://www.uta.edu/utamagazine/archive-issues/2010-13/2012/07/passion-practicality-drive-nursing-graduate/

http://nursing.jhu.edu/news-events/news/news/ebola-hero

***http://www.cnn.com/2014/05/06/opinion/robbins-lewinsky-strength/

November 5, 2014

author: Editorial Staff

13 Comments

This post is written by Leslie H. Nicoll,

Policy

Undocumented Immigrants Must Have Equal Access to Health Care

This post is written by Cerasela Shiiba RN, BSN, a graduate student in Community/Public Health Nursing at Hunter-Bellevue School of Nursing where she received her BSN and the Sara Aronson Hunter College Alumni Award in 2013. As a professional registered nurse she is committed to advocating for the underserved, addressing gender inequality and gender violence. She attributes her passion for community nursing to her nursing education and growing up in a small village in Romania.

Waiting, I will not be here for long. My friend will return from seeing the doctor soon. Watching people makes waiting interesting. I have time to observe details. Grey chairs are lined up in rows. Monet prints with thin black wood frames give the room a French style. Vibrant golden frames would better reflect the time era.

Several patients are sitting and waiting.

I turn my head towards the “Welcome New Patients” sign placed on top of a glass window. A timid-looking middle-aged man slowly opens the door and enters. Ah, I can have a story now. The man stands in front of the reception desk and looks through the window glass. The medical assistant slides open the small window on the lower portion of the large glass. She is dressed in white scrubs. Her name is embroidered in grey calligraphic forms, Vera,B. From the middle of the room, I see only her upper body. She leans forward, trying to fit her red hair pulled in a bun through the small window.

“Your name,” she says quickly and in a voice loud enough for all to hear.

Jose has to bend down to answer her through this small opening.

“Jose.”

“What type of insurance do you have?”

“I don’t have one,” he says in a low voice.

Vera takes her eyes from the paper, while placing the clipboard on the desk. Click.

She turns her sight towards her colleague. She raises her eyebrows and continues her interview.

“Who told you to come here?” she says in an impatient voice.

The glass window acts as a barrier between Jose and health care.

“The doctor, two days ago, I went to ER. I had back pain. They told me, I have kidney stone.

The doctor said to come here today, for follow up.”

“Well, we don’t take people without insurance.”

Jose is one of 41 million immigrants, 46% of whom are Hispanic. Undocumented immigrants are close to 20 million and they are not covered by the Affordable Care Act, according to the Migration Policy Institute. Undocumented immigrants do not have access to insurance even when research shows that, “Undocumented immigrants may not be contributing to the increase in health care costs in the United States and that addressing health care needs of this population could in fact reduce expenditure.”

I strongly believe that everyone must have access to health care, including undocumented immigrants. Undocumented immigrants are not eligible for ObamaCare even if they work, live, and engage as members of our communities. In New York State undocumented immigrants do not qualify for private health insurance.

Why can’t people like Jose have access to health insurance?

Financial costs are always the first argument you hear against making health insurance available to undocumented immigrants.

But there are costs to be considered not making it accessible – financial and human.

Undocumented immigrants do not seek preventive care. They will wait until their symptoms are worse or their pain unbearable. Then they seek care in the emergency room. The cost of treatment and the management of an acute health issue can be complicated and costly. Sometimes it requires the person be admitted to the hospital to stabilize a newly diagnosed or unmanaged chronic illness. Perhaps preventable if this person had access to primary care.

It would make sense for undocumented immigrants to be included in the Affordable Care Act (ACA). Access to preventive care is crucial in reducing the cost of health care. Chronic diseases could be identified at earlier stages; therefore the cost of treatment will be reduced. These situations could had been avoided if the ACA would include all people, including undocumented immigrants. During the debates on the ACA Obama avoided discussing the inclusion of undocumented immigrants in the health care reform.

Immigration reform and lack of action in Washington impeded inclusion of undocumented people.
I believe there are no simple answers. However, one way to solve this problem is perhaps to extend Federally Qualified Health Centers (FQHC) in local communities that serve vulnerable population regardless of their immigration status. FQHC are part of the safety net providers such as: public hospitals, clinics, charity organization and local health departments. Safety net providers are financially strained due to limit on reimbursement for their services.

Or maybe, extending the access to Emergency Medicaid. At this time, undocumented low-income immigrants are only qualified for emergency Medicaid.
Increasing public awareness, taking an active role in advocating for this vulnerable population through debates, research, writing, blogging, participating in local and national government, and supporting bills that reform ACA to include this population.

It is vital for undocumented immigrants to have equal access to health care. The story does not end here. It is just the beginning of a greater mission, universal health care for all.

November 4, 2014

author: Editorial Staff

0 Comments

This post is written by Cerasela Shiiba RN,

HealthCetera

From Heartbeat to Straightline- A Butterfly’s First Journey

This post is written by Devorah Goldberg, RN, BS, a bedside nurse on a general medical-surgical unit at NYU Langone Medical Center. Ms. Goldberg is a graduate student in the Adult Nurse Practitioner program at Hunter-Bellevue College of Nursing and received her baccalaureate degree in nursing from Adelphi University in 2013. You can read more by Devorah Goldberg and her life as a registered professional nurse – the meaningful relationships with patients, families and colleagues and her experiences facing rough spots as she moves along her journey as novice nurse on her blog, Tales of RN DG.

The staggered breaths painted shapes on the monitors. It jotted out perfect waves for one minute, and childlike scribbles the next. Those scrawled shapes relayed fluctuating signals; between hope and dread, between life and death. It was as if the ‘angel of death’ was there, had his sword in hand, target area marked, blade in place, but hesitant to make the hit. The breaths were present, but were the waves of storm rather than the waves in a surfers dream; rocky, damaging and unpredictable. The heart beat like a stationary race-car, rapid but thready, and unable to perfuse the body’s arterial racetrack. The translucency of the skin, windowed a dense yet motionless being.

Lips moved in prayer, while minds weighed the depth and upshots of their decisions. DNR. Legs raced as if on a mission, but never leaving as far as the edges of the bed. The corridors signaled the finish line, only centimeters away but reaching it meant the end was met, so the feet tread those areas cautiously. Those lips whispering prayers, dreaded, yet awaited the finish line.

The hours passed by. The screens fluctuations between the dreaded straight line and a perfect QRS wave confused the humans reading the signals. They asked me if it was the end, the monitor seemed unsure. I enter the quarters of the beating monitors possibly masking a life gone by; I am face to face with the thin wrinkled being curled up in the sheets, gasping for each breath, and a morphine infusion running in attempt to wash the pain away.

I felt the pulse. Thready and fast. It seemed to weaken as the seconds passed by. I kept my hand on the pulse, for at that moment it was the only sign of life, yet proof of its nearing end. Perhaps if I let my fingers go, that life might slip away, right through my fingertips.

My job is to promote life, and here I was anticipating death. My job is to chase away the ‘angel of death’ and here I felt like mapping out the directions for his next stop.

The ‘angel of death’ was well acquainted with the being curled up in the wrinkled sheets; the ‘angel of death’ had chased this being before. He didn’t wait till her 93 years to greet her. His multiple introductions to this being began over 65 years prior when she cooked for the Germans in the barbed wired gates of Auschwitz. The ‘angel of death’, marked his target back when she was out there fighting diseases in the concentrations camps, he was there when she used to sneak in potato peels to share with her bunk mates, he was there every morning when she awoke before sunrise to the threatening barks of the soldiers on guard.

Now she can surrender, because she has already made her victory. Every day that she lived, and made lives through the offspring she produced and raised, made her the victor. We watched as her chest rose and fell with trepidation, each movement using much effort, until all efforts were used. We called the doctor, he marked the time, and we covered her. Her soul had won its last fight.

The monitors stop, their frantic scribbles and the straight line of defeat stretches to eternity; and our hands meant for healing are cuffed to our backs preventing us from evading the inevitable footsteps of ‘the end”. Yet perhaps an even greater challenge is when that line marches on, merging with all the other listless strings of lifeless pulses. This was the first, so it hurt; but so did my first IV insertion and the many ‘firsts’ of painful things I had to initiate for the good of the humans it was inflicted upon. Time and experience forms an armored defense that can make each patient’s death a little less personal and a little more algorithmic. Experts might argue that such is an uncomfortable inevitable, but deems it unwise to bear the burden of each meeting with the ‘angel of death’. Yet one can also choose to take each opportunity to familiarize oneself with the tragedy it brings and practice the touch of caring that goes beyond the life of the being in the bed sheets. The challenge is to continue to be the blessing that escorts one’s journey from one world to another.

How can we be that blessings despite the forces that monotones those moments into listless tunes with each death we encounter? Dr. Vidette Todaro-Franceschi , RN PhD FT advises that it is how one faces death that prevents that burnout, that oscillating rhythmicity, that predictable sensation we may acquire as we repeatedly guide patients and families towards their loved one’s line of defeat . How can we conquer that intoxicating compassion fatigue hovering and buzzing over our nursing care, threatening to sting our compassion with every straight lined monitor and pulseless being that we encounter?

We swap that hovering sting with a “butterfly power” and we “flutterbye”.

Dr.Vidette Todaro-Franceschi, RN, PhD, FT coined this verb based on meteorologist Edward Lawrenz’s idea of the “butterfly effect”. The flapping wings of a butterfly that we see are connected to another event somewhere out in this world, and we were meant to witness it for a reason.

Dr. Vidette Todaro-Franceschi describes nurses providing care as butterflies flapping their wings, We think we are a separate entity providing care for a specific human being, but we are really one entity with the human being cared for. We are present during this most vulnerable and unforgettable time in a patient and their loved ones lives, because we were meant to be there and be a part. To be truly compassionate is not to see compassion as what a caregiver does, but to view our nursing care with a sense of belonging.

Wiklund and Wagner write how we are one with individual and their family, we are mutually engaged and must acknowledge our own and the other’s dignity and vulnerability to consistently provide compassionate care. We must view each experience as event connected to us, that we are a part of it; we are one with the patient and the experience.

Death happens to each person only once. When we guide those through that death path, it is a first for us, as one entity, at that time. The first one always hurts; and so with each race to meet that straight line, we must slip out of our cocoon and flap our wings with our patient. Each race confronted is a first; to flap our wings, to “flutterbye”.

Every greeting with the ‘angel of death’ should not build a comfort and familiarity that dampens the sadness that rides along with its presence, rather each experience forms and molds us. That is what will define one’s commitment towards learning and perfecting our practice and skill of caring. Rather than be smoothed out and molded, with each experience I hope to be sculpted and refined.

From my ‘Novice’ meeting to my ‘Expert’, I shall attempt to not to lose sight of the person under the sheets, the being behind the numbers and the family tiptoeing close by.

Written by Devorah Goldberg, RN, BSN

November 3, 2014

author: Editorial Staff

0 Comments

This post is written by Devorah Goldberg,

Connect with Healthcetera

Invisible Nurse Redux

Undocumented Immigrants Must Have Equal Access to Health Care

From Heartbeat to Straightline- A Butterfly’s First Journey

About Us

Calendar of Posts

Listen to HealthCetera Live

Newsletter