Elsie Soto, RN: 40 Years of Home Care in Nueva York

After spending four decades climbing the stairs of New York City’s tenement apartments to deliver compassionate, expert home care to hundreds of Spanish-speaking patients in the South Bronx, Washington Heights, and other communities, Elsie Soto, R.N., a veteran public health nurse at Visiting Nurse Service of New York, may be forgiven for enjoying 2011 as the year she became something of a nurse “celebrity.”

In recognition of contributions made during her lifelong career in home care nursing, Elsie was named “Clinician of the Year” nationwide by the Visiting Nurse Associations of America, an award presented at VNAA’s annual meeting in Baltimore, Maryland, in April.  In May, Elsie was honored by the Home Care Association of New York State with a prestigious statewide “Caring Award,” for which all Empire State professionals, paraprofessionals, and family caregivers are eligible. This award goes to one “who has exhibited the compassion, skills, and service that set their contribution apart, or whose actions on a particular day, or over a period of time, exemplify outstanding compassion,” according to the award website. Rounding out a trifecta of recognition, Elsie was also recognized by Nursing Spectrum magazine with a 2011 “Excellence in Nursing Award” as a regional finalist in community service.

“I want to thank my familia at VNSNY—including many coworkers, past and present—and my patients for allowing me to enter their homes and do my magic,” Elsie said in her acceptance speech. In my life, I’ve always been surrounded and guided by three important and influential women: mi mami Elena for caring, Florence Nightingale for commitment, and VNSNY founder Lillian D. Wald for service.” Elsie also acknowledged her fivebrothers “who were [her] first patients,” her husband and children, and the early support received from a priest and nun (“long before the word ‘mentor’ became popular”) who encouraged her to pursue a career in nursing, even though it took Elsie away from Catholic high school in the Bronx.

“Mi casa es tu casa“

Bilingual in Spanish and of Puerto Rican heritage, Elsie has long played a leadership role in providing culturally sensitive care to VNSNY’s Latino patients in NYC—a population that in sheer numbers is second only to Los Angeles among Spanish-speaking communities nationwide. In addition to the exceptional care Elsie has provided most recently in the predominantly Dominican neighborhood of Washington Heights, she also serves among VNSNY’s key representatives in the New York chapter of the National Association of Hispanic Nurses. Several years ago, when NAHN honored VNSNY with an “Institutional Award” for the agency’s efforts to “raise awareness of health care disparities and increase diversity in nursing practice,” Elsie was asked to personally accept it.

Elsie is no stranger to accolades and recognition. In 1993 and again in 2008, Elsie was nominated by VNSNY colleagues and went on to win ESPRIT Awards, the organization’s highest honor. (ESPRIT Awards are named for VNSNY’s values: Excellence, Service to Customers, People, Fiscal Responsibility, and Teamwork.)Elsie and her patients were also the focus of a 2007 cover story in ADVANCE for Nursesmagazine entitled “Mi Casa Es Tu Casa: Culturally Sensitive Home Care for Hispanics at VNSNY.” She has also been featured in news articles about VNSNY’s agency’s longest-serving veteran nurses.  

Since joining VNSNY as a 20-year-old LPN, Elsie has striven to stay as “flexible as a willow,” relying on a sense of humor to help patients through the tough times. Colleagues cite her stellar commitment to patient care and praise her willingness to always go above and beyond.When nominating Elsie for an ESPRIT award, one coworker wrote, “Elsie is knowledgeable regarding all dimensions of her patients’ conditions, including both clinical and social aspects.”

Elsie shares a memorable patient story from her vast trove: “I was asked to pre-pour meds and informed that my patient’s front door would be open. It was evening when I arrived. To my dismay I found the patient waiting for me in the dark. I immediately turned the lights on. Finally, sitting down to pre-pour his meds, I realized that he was blind. I apologized for not being mindful. He started to laugh, and told me stories of others who had been guilty of the same ‘crime.'”

Elsie still remembers one of her very first home care patients, “Anna,” who lived alone in the South Bronx back in the 1970s. For more than nine months, Elsie provided daily care for Anna’s breast cancer wound. As a new nurse, Elsie remembered feeling silently skeptical when Anna said the wound would heal. Eventually, it did heal, and Elsie recalled feeling a mixture of joy and sadness when she said goodbye to Anna on her final visit.

In addition to using her prized bilingual ability in Spanish to care for VNSNY’s huge numbers of Hispanic/Latino patients, Elsie has also provided home care to patients in many other immigrant communities in New York City, one of the world’s most diverse megacities. From caring for culture-shocked Vietnamese refugees in the Bronx in the wake of the Vietnam War to Russian, Chinese, East Indian, Pakistani, and patients from other ethnic groups, Elsie has personally carried on the mission of VNSNY: “caring for all New Yorkers.” In an example of such service, in the aftermath of Hurricane Katrina in 2005, Elsie was one of fewer than 50 VNSNY nurses to be recognized for aiding Katrina evacuees at Disaster Assistance and Welcome Centers set up by the New York City Department of Health.

Today the nation’s largest nonprofit home health care organization, VNSNY was founded in 1893 by Lillian Wald, the “mother of public health nursing,” to serve the teeming immigrant population of New York City in the 19th century. Through the work of clinicians like Elsie and some 2,600 other nurses on staff, the agency has continued this role into the 21st century.

“The Bronx is burning!”

New York City is home to the nation’s second-largest Latino community, comprised of Spanish-speaking peoples from more than 20 nations. Collectively, they comprise more than a quarter of the city’s population, according to the U.S. Census Bureau. By contrast, Elsie is among a small minority—one of the estimated 2% of U.S. nurses who speak Spanish—and among approximately 4,500 Spanish-speaking nurses serving an estimated 2.5 million Latino residents of New York City. Elsie’s role as a coordinator of care and public health nurse has kept her on the front lines at VNSNY, which employs New York City’s largest pool of Spanish-speaking health care providers.

Born to parents who immigrated to New York City from Moca, a town in the mountains of Puerto Rico, Elsie is the only girl in a family with five younger brothers. They grew up in the South Bronx. During this period, the borough was plagued by crime, drugs, and frequent arson fires. “The Bronx is burning,” the saying went. Elsie credits her parents and Catholic schoolteachers with providing a bulwark against the devastation and modeling responsibility to one’s community.

Elsie became an LPN through a program at Jane Addams Vocational High School and then went on to become a registered nurse at Bronx Community College in 1974 (later pursuing B.S.N. studies at Mercy College). She became involved in home care early and worked in her own neighborhood for 14 years. The needs in this area were especially great in the 1970s and 1980s. Elsie recalls a litany of problems with “riots, job losses, crime, decay, drugs.”

“I personally witnessed the arrival of heroin in the Bronx and watched how it decimated people in droves,” she says. For two years in the mid-1980s, Elsie’s treatment area included the Webster Projects, scene of the highest homicide rate in New York City, with approximately one killing per week. Elsie personally cared for one of the four young men shot in 1984 by notorious “Subway Vigilante” Bernhard Goetz. She recalls needing security escorts on nearly every visit in those days. 

Being a Spanish-speaking Latina is an asset in her community, Elsie says, “because even though they know I’m not Dominican, or Cuban, or Mexican, I do speak the language. We have that basic cultural identity. Automatically things are clearer and more relaxed and they think ‘you may not be of my origin, but you speak my language.'” As in any culture, nonverbal communication in the Hispanic culture is as crucial as verbal communication.

These days, with a caseload of about 15 patients a week, Elsie serves patients in mostly Dominican neighborhoods of Washington Heights in upper Manhattan. Although Elsie essentially shares the same language as her predominantly Hispanic patients, she expresses appreciation for the subtle and not-so-subtle differences among various communities. Elsie notes that Hispanics are defined as “persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures.” The term Latino encompasses Brazilian, Asian, and African cultures as well.

“We may share the same town name (there is a Moca in the Dominican Republic too) and ways of connecting,” Elsie says, “but we’re diverse. That’s what makes us so unique. Because of my accent, Dominican, Cuban, and Mexican patients will know that I am from Puerto Rico, but we’re all connected. I try as much as I can to learn about their culture from them and to let them learn from me.”

La familia and culturally sensitive care

Elsie notes that to deliver culturally sensitive care, home care nurses must be mindful of the importance of la familia in Hispanic culture. “You have to include the family as part of the healing process,” she says. “Whoever it is—abuela (grandmother), aunt, godmother—you have to incorporate them because they have wisdom to offer, and so that you can be successful.” She adds that religious and cultural beliefs also play important roles in caring for the Hispanic patient. Many believe pain is an expected part of life and a consequence of immorality.

“Some people will say ‘I’ll take the pain because this is part of my punishment,’ and coming from the Hispanic culture, I can identify with the idea of paying for something I did wrong years ago,” Elsie says. “You have to give respect to the notion of pain as a punishment from God. I tell patients that I understand, but I think you have been forgiven, and now I am here because God is telling me to facilitate your pain and let you go more peacefully.”

On a daily basis, Elsie deals with the fact that Hispanic Americans suffer one of the highest rates of diabetes in the United States, with a prevalence that is more than 50% greater than among average New Yorkers. “As a Hispanic, I implement this knowledge that we have in my work at VNSNY—and on a personal level, I share that my mother and father died very young and that diet plays a role in their heart disease and diabetes,” Elsie says. “But I’m also flexible and do not completely try to demoralize my patients because it’s not going to work,” she adds. “I try to modify the diet but not completely take away their food.” Elsie is drafting a Spanish-language publication on this topic for the Alzheimer’s Association of New York.

Eight years ago, Elsie was one among a small group of VNSNY staff who joined together to revive the dormant local chapter of NAHN, founded in 1975 and committed to improving the health of Hispanic patients and communities and increasing educational, professional, and economic opportunities for Hispanic nurses. Thanks to such efforts, the NAHN chapter is vital once again.

Elsie is involved in a pilot program called the Hispanic Leadership Project, to develop such skills among Hispanic nurses. Elsie notes that the project sprang from a yearlong nursing course called the Minority Leadership Program that she took some years ago at Rutgers University. Elsie also attends NAHN’s national conventions. In summer 2009, she presented a poster on diabetes and comorbidities among Hispanic patients at NAHN’s annual meeting in San Antonio, Texas. She and others presented on the pilot Hispanic Leadership Project.

“Home care has been my ‘second home’—an amazing journey for me,” Elsie says, when asked how her profession and role as a home care nurse has changed in the past 40 years. “The fundamental care of nursing has not changed. What has changed is the introduction of technology in the home and in our manner of communicating. My journey has been filled with much love for the work I perform and the people I work with…”