Putting the ER in Diversity

Putting the ER in Diversity

During her orientation as an emergency nurse at Kaiser Permanente Hospital in Hollywood, Calif., Katherine Bolden, MSN, RN, helped care for a man who had come to the ER after falling and hitting his head. The medical staff suspected that he had suffered a serious injury, and the doctor ordered tests. A CT scan revealed a brain bleed. The medical team rushed him to the operating room, and he underwent emergency surgery.

“We saved him,” Bolden says. “Later I heard he recovered and walked out of there.

” Bolden’s life was changed forever, too. From that day forward, she was hooked on emergency nursing.

Minority nurses can make a profound impact in emergency care—the front lines of today’s health care system. Emergency nurses treat an unusually diverse variety of patients and conditions, from infants with colds to elderly heart attack patients to victims of stabbings and shootings. They care for people from every walk of life and cultural background, including patients from the most vulnerable and underserved populations, many of whom come to the emergency department because they have no other access to health care services.

Emergency nurses thrive on unpredictability and variety. They don’t call themselves “adrenaline junkies” for nothing. Yet the rewards of this career come as much from comforting a patient’s family members as from saving a car accident victim.

“You’re [providing care to] patients at the worst times of their lives, when they need it the most,” says William Briggs, MSN, RN, CEN, FAEN, trauma program manager at Tufts Medical Center in Boston and president of the Emergency Nurses Association (ENA).

Briggs, who coordinates services for injured adult patients at Tufts, has been interested in emergency medicine since high school, when he taught first aid and became an emergency medical technician at 17.

“I was always kind of [drawn to] the emergency room,” he recalls. “I like taking an unsolved problem and solving it, creating order out of chaos.”

No Shortage of Opportunities

The nursing shortage hasn’t hit emergency care as hard as some other specialties, Briggs says. But career opportunities for current and prospective emergency nurses still abound. Hospital emergency departments employ clinical nurse specialists, pediatric and psychiatric nurses, transport team nurses and case managers.

Demand is also growing for emergency nurse practitioners (see sidebar), who provide care in a variety of settings, including large urban emergency departments, rural and military hospitals, ICUs, adult internal medicine units and even walk-in clinics.

Katherine Bolden, MSN, RNKatherine Bolden, MSN, RN

One of the primary reasons why emergency nurses are in such demand is that hospitals throughout the country are struggling to keep up with patient loads in emergency rooms. While emergency visits have risen by 36% since 1996, 5% of the nation’s emergency departments have closed, according to statistics from the Centers for Disease Control and Prevention (CDC).

Overcrowding is the biggest challenge emergency nurses face today, says Briggs. On busy days, patients may lie on stretchers in crowded corridors, waiting hours and hours for beds.

“It’s a national crisis right now,” he declares. “Every [emergency department] is busier [than it used to be].”

Five years ago, Massachusetts General Hospital in Boston saw 180 to 200 patients a day in its emergency department. Now it sees 260 a day, says Maryfran Hughes, MSN, RN, nursing director of the hospital’s ED/observation unit. A variety of factors are causing this surge in emergency room use: an aging population, a shortage of primary care physicians and a growing number of uninsured patients who lack access to other sources of health care.

This favorable supply/demand equation also makes emergency nursing an attractive option for career-changing nurses who are looking for a more challenging, exciting specialty. Bolden, for example, became an emergency nurse after working for more than eight years as a health educator.

“It was almost like being a new grad again,” she remembers.

“It was a little scary at first. I wondered, ‘Am I going to be able to handle everything that comes in?’ In the first six weeks I lost 15 pounds, because I went from working in an office to what I now call ‘real nursing.’”

She asked lots of questions and found support and camaraderie among her fellow emergency nurses and physicians, who trusted and consulted one another. A collegial relationship with doctors and other members of the health care team is one of the biggest benefits of the emergency nursing specialty, where nurses often have greater autonomy and more say in patients’ care than they would in other parts of the hospital.

“There’s no way you could do it alone,” says Linda M. Redd, RN, an emergency nurse at Massachusetts General. “Patients are overflowing into hallways and are constantly being moved. It would be easy to lose track of people if you weren’t working as a close-knit team.”

The Culturally Competent ED

In its position statement on diversity in emergency care, the ENA emphasizes that a diverse and culturally competent nursing staff is essential to meeting the needs of today’s multicultural patient base. The specialty has a great need for more minority nurses who can help break down cultural and linguistic barriers to provide better quality care in emergency settings.

“When [emergency] patients come in and are very anxious, it’s important for them to be in an environment where they know they’ll be comfortable and will be able to bond with someone,” says Hughes.

She cites the example of an elderly Muslim woman who came to the ED complaining of stomach pain. The doctor ordered an MRI, and the woman became upset at the idea of having to remove her headscarf. The medical staff only wanted to ensure that her clothing contained no metal fasteners, which would pose a safety hazard and ruin the images because of the machine’s powerful magnetic field. A nurse whose grandmother was Muslim talked with the patient, letting her know she understood her concerns, and explaining the procedure and safety precautions. Because she shared the woman’s cultural background, the nurse was able to make a personal connection with the patient. Together with the staff, they worked through the issue and the woman successfully underwent the MRI examination.

Bolden recalls an African American couple who took offense at a security guard’s instructions in the emergency room where she works. She intervened and talked with the couple to clear up the misunderstanding. “It helps to have a person from the same culture to smooth things over,” she says.

Redd agrees that minority patients are likely to experience less stress in the emergency care setting if there are nurses and doctors who look and talk like them. What’s more, she adds, a pool of culturally diverse nurses can help one another learn to provide better care to patients who are different from themselves.

“We teach each other,” she explains. “I’ve learned so much culturally from watching other nurses work with patients.”

Language differences can create enormous barriers. Briggs says more bilingual emergency nurses are urgently needed to bridge communication gaps with patients who speak little or no English. “If you have to find an interpreter every time you have to speak to the patient, you’re going to lose a lot of [time and] communication,” he emphasizes.

According to a study by Sharon M. Jones, MSN, RN, published in the June 2008 issue of the Journal of Emergency Nursing, five Caucasian, non-Hispanic nurses at a Midwest hospital reported that the language barrier impacted all aspects of care when they attempted to treat Mexican American patients. Only one of the nurses spoke a little Spanish, and she was the only one who described being able to establish a nurse-patient relationship.

Jones concluded that interpreter services should be available 24 hours a day and that emergency nurses should receive training to learn basic Spanish and to gain an understanding of Hispanic cultural considerations that can impact nursing care.

Ready for Anything

What does it take to be successful in emergency nursing? Nurses interviewed for this article stress that critical thinking skills and confidence are paramount.

“You’re kind of like a detective, and you have to be quick [in assessing what’s wrong with the patient], because if you dilly-dally patients can die,” says Thelma Kuska, BSN, RN, CEN, FAEN, who worked for 20 years in hospital emergency departments, including Christ Medical Center in Oak Lawn, Ill., 13 miles from downtown Chicago. “You have to be sure of yourself and be able to stand up for yourself [so you can advocate for the patient]. You need to be knowledgeable to make sure you are giving the correct care to the patient.”

She recalls a 22-year-old newlywed woman who came to the ER with belly pain. Kuska had a hunch, and after questioning the patient she quickly summoned an emergency physician, who ordered an ultrasound. It revealed that the woman had an ectopic pregnancy. Within 30 minutes, the patient was undergoing surgery. Later, when the young woman was recovering from the successful operation, the doctor pointed to Kuska and told the patient, “This nurse saved your life.”

Kuska received her nursing education in the Philippines and immigrated to the U.S. at age 20 to begin her career. Before finding her niche in emergency care, she originally worked as a surgical nurse, in an environment that was worlds away from the fast pace of the ED.

“[In surgery,] everything was laid out, you knew what the patient was coming in for, the instruments had been chosen the day before and the physician was there the whole time,” she explains. “In an emergency department, you never know what will present. It could be a heart attack patient, a car crash victim or a child with a fever. Our doors are always open, the ambulances come in, the patients come in and we treat them.”

There is no such thing as a routine day. “The emergency department is such a busy, busy place. It’s like being bombarded on all sides,” says Redd. “Emergency nursing [brings it all together] for me. I really have the chance to call my entire knowledge base into play.”

The variety can be as challenging as it is stimulating. “There are shifts where one minute you’re holding the hand of a family member whose mother has just died, and then you walk into the next room and you’re blowing bubbles with a four-year-old who’s having his chin sutured,” says Jennifer Wilbeck, MSN, APRN, CNP, FNP, CEN, assistant professor and coordinator of the emergency nurse practitioner program at Vanderbilt University School of Nursing in Nashville.

What Recruiters Look For

At least a year or two of inpatient experience is recommended for nurses who want to work in the emergency setting. However, because of the high demand, some hospitals are now hiring new RN graduates and offering internship programs in the emergency department.

When hiring emergency nurses, Briggs says, he wants to see passion. “The worst thing an applicant can say is: ‘I want to work in the emergency room because you have the hours I like.’”

Hughes says she looks for nurses who have good clinical knowledge and decision-making skills, as well as the ability to work as a team with other clinicians. Above all, she wants nurses who know how to appreciate the patient as an individual.

“Sometimes [emergency nurses] have just a few seconds to establish a relationship with somebody before we have to give bad news and ask the patient to trust us,” she notes. “You really have to be able to reach the hearts and souls of patients and connect with them immediately.”

The ability to establish bonds with patients’ family members is important, too. Redd recalls an elderly patient with urinary problems, whose wife brought him in to the emergency room.

The man was ill and mentally confused, and his wife was clearly beside herself. Redd took the time to have a heart-to-heart talk with her and helped her come up with an emergency plan so that when the couple went home, the wife would know who to call and when.

Opportunities Beyond the ED

Emergency nurses can also play life-saving roles outside the traditional emergency care setting. After caring for numerous young victims of car accidents, Kuska wanted to do something to help prevent more youths from ending up in the hospital. She volunteered for the Emergency Nurses CARE (EN CARE) injury prevention program.

Two emergency nurses from the University of Massachusetts Medical Center in Worcester, Mass., started EN CARE out of frustration and heartbreak from seeing young lives shattered or ended because of drunk driving. They began presenting alcohol awareness programs to high schools, based on the cold, hard facts of their emergency department experience. The program spread nationwide and became an affiliate of the ENA in 1995, as part of the association’s Injury Prevention Institute. EN CARE has now expanded to include other injury prevention initiatives, such as gun safety and bicycle safety.

By presenting alcohol awareness programs at elementary, junior and senior high schools, Kuska has made a difference in countless young lives. One mother told her that after seeing Kuska’s presentation, her children hid the car keys when their dad planned to go out after drinking. A high school girl who had heard one of Kuska’s talks later told her she had refused to get in the car with her prom date because he had been drinking. She found another way home from the dance.

After working as an injury prevention volunteer for several years, Kuska began doing contract work for the National Highway Traffic Safety Administration’s Region 5 office in Chicago, where she now works full time as regional program manager.

“It’s another face of the emergency nurse that I never knew existed,” she says. “When I worked in the ED, I was saving one patient at a time. Now I’m saving lives [on a much larger scale].”

Emergency Nurse Practitioner: An Emerging Opportunity

Nurse practitioners have been providing emergency care to patients for decades. But only recently have nursing schools begun to offer degree programs designed to train advanced practice nurses specifically for the emergency setting.

Currently, seven graduate schools of nursing around the country offer emergency nurse practitioner (ENP) programs, which incorporate emergency nursing courses and clinical experience into traditional family or acute care nurse practitioner programs.

The University of Texas started the first ENP program more than a decade ago, after a study showed a need for nurse practitioners with broader emergency training. Acute care nurse practitioner programs provided emergency care training but did not cover caring for pediatric patients. Family nurse practitioner programs did not include enough emphasis on emergency care.

Now, besides the programs at the University of Texas-Houston and the University of Texas-Arlington, there are emergency nurse practitioner programs at Emory University in Atlanta, Loyola University in Chicago, the University of Florida in Jacksonville, the University of South Alabama in Mobile and Vanderbilt University in Nashville. While the structure of the programs varies from school to school, the ENP schools stay in close contact to make sure their curricula are aligned with one another.

At Emory University’s Nell Hodgson Woodruff School of Nursing, ENP students take family nurse practitioner courses along with four additional classes in emergency care. They must also do clinicals in primary, urgent and emergency care. Vanderbilt School of Nursing’s program is unique because it prepares emergency nurse practitioner students for dual certification as both family and acute care nurse practitioners. “This allows them to not only care for patients across the lifespan, but also across the acuity spectrum,” explains Jennifer Wilbeck, MSN, APRN, CNP, FNP, CEN, assistant professor and coordinator of the ENP program.

The majority of emergency nurse practitioner graduates find work in hospital emergency departments. But Michelle Mott, MSN, APRN-BC, FNP, an instructor and interim program director for Emory’s ENP program, says her students have also found jobs in prisons, specialty practices and retail clinics. One graduate now works for a primary/urgent care clinic on a remote Alaskan island. “I’ve never had a student who has had trouble finding work,” Mott adds.

In addition to her academic responsibilities, Mott also works in the emergency department at Grady Hospital in Atlanta. Advanced education in the emergency nursing specialty, she says, gives minority nurse practitioners a greater opportunity to improve health care for medically underserved populations. “You’re able to provide those skills that are the foundation of the philosophy of nursing, but you’re also able to provide management and bridge some of the gaps to provide greater access to care. It’s just a wonderful career path. It uses everything you learn in all of your schooling.”

While emergency RNs can earn such certifications as CEN (Certified Emergency Nurse) and CPEN (Certified Pediatric Emergency Nurse), there is no certification yet for emergency nurse practitioners. For now, these NPs hold either FNP or ACNP certifications, or both.

Wilbeck says more emergency nurse practitioner programs are needed. She believes the number of nursing schools offering ENP programs will grow as the nursing profession increasingly recognizes the value of these practitioners and begins to formalize standards for educating and certifying ENPs. Current ENP programs, she adds, are also looking at expanding and offering distance-learning courses.

Making an Investment in Nursing

The finance industry and the nursing profession may seem worlds apart. But Juan Pineda, RN, a former investment officer for the Massachusetts State Treasury Department who is now a cardiac surgery ICU nurse at NewYork-Presbyterian Hospital/Columbia in New York City, was able to make a smooth transition from the world of number crunching to the challenging and rewarding field of nursing, thanks to a passion for patient care and a love for helping people.

Making a total career change is often a risky endeavor, but for Pineda the bigger risk was remaining in a field that he was not passionate about. “I was more afraid of staying in my investment job than I was of making such a big change,” he says. “As hard is it might be to [have to start all over] in terms of education, it was harder for me to imagine myself in that same position .” Still, he admits, making such a dramatic career shift “definitely takes guts and determination.”

Pineda is the son of Colombian parents who immigrated to the United States in the early 1970s. They settled in the Boston area, where Pineda, along with his older brother, was born and raised.

Pineda’s interest in the health care field emerged in high school when he had to complete a community service project as a Spanish-language interpreter at Massachusetts General Hospital to earn credits toward graduation.

“It exposed me to the hospital environment and I thought it was great,” he recalls. “I really enjoyed helping people. Whenever I walked in to translate for a patient or a family, their faces would light up. They were probably so afraid about what was happening, and finally [here was someone who spoke their language] and could help them understand what was going on, rather than just having people poking and prodding them.”

After graduating from high school, Pineda thought about going to college as a pre-med major. But at 18 years old, he felt he was not ready for the rigor of pursuing a medical degree. “After I did the interpreting for about two months, I went away to college thinking that I was going to major in pre-med after having that experience in the hospital,” he says. “I was really interested in science and the human body. But I don’t think I was really ready to go to college at 18. I wanted to take some time off and really think about what I wanted to do. However, my parents didn’t think that was a good idea, and they strongly encouraged me to continue [with my education].”

He ultimately decided to remain at the University of Massachusetts Amherst to complete his degree, but not as a pre-med student. “[Back then], I just didn’t have the dedication for it,” he says. The thought of having to take difficult science classes, like organic chemistry, scared him. He decided to switch gears and pursue a degree in political science, one of his other big areas of interest.

As a political science major, Pineda focused his studies on international relations, comparative politics and issues affecting Central and South America. “At that time I thought I would go to work for the UN or something,” he says. “I minored in French and lived in France for a while and thought I would go down the path of working in international relations.”

After graduating with his bachelor’s degree in political science, Pineda took advantage of an opportunity to work at the Massachusetts State Senate. The job, however, focused more on the financial side of state politics than on the policy-making side.

“I worked as a budget analyst for the Ways and Means Committee,” he explains. “Then I moved to the State Treasury and became an investment officer. I did general fund investments in bonds and long-term debt, investing up to $1 billion. This wasn’t really complicated work—I didn’t have a background in investing. But I wanted to learn more [about the field], so I accepted a position at [the financial services firm] Morgan Stanley.”

At the time, the job at Morgan Stanley seemed like an attractive offer that would give him opportunities to use his Spanish-speaking skills and his background in international relations. With the possibility of assignments that would involve traveling to South America to gain clients seeking to invest money in the U.S., Pineda thought he had finally found a way to combine some of his interests.

But by the time he had completed his training and licensing in early 2001, the economy was in a downturn. It was not a good time to be working in the financial sector, and Pineda never got his chance to travel for Morgan Stanley. He was also beginning to feel that his career path was leading him further and further away from his original interest in public service.

“I didn’t feel like I was helping people by working in investing,” he says. “I realized I wouldn’t be successful in that career, because I didn’t have enough passion for what I was doing.”

Ready for Change

After quitting his job at Morgan Stanley and taking some time to think about what he really wanted to do, Pineda finally decided to return to square one and refocus on his first love: health care.

“That’s when I decided to go to nursing school,” he recalls. “I had a friend who was in nursing school and I would flip through his textbooks. He reminded me that it wasn’t too late to change careers. I agreed, and in 2001 I enrolled at Bunker Hill Community College and began taking anatomy and physiology courses.”

Pineda’s decision to make a career change into nursing was met with some resistance from his family—and even from other nurses. “When I first decided to go back to study nursing, a [nurse] friend of mine let me tour the ER of the hospital where he worked so that I could see up close what it was like. I wanted to be exposed to the ER to see if I would get nervous about seeing blood and things like that,” he explains. “One of the nurses there told me that I couldn’t go from [a field like finance] to nursing. I ignored the comment, because I knew that I can do anything if I really want to do it.”

He says his parents “rolled their eyes” when he announced that he was returning to college full-time to pursue a nursing degree. “Because I had had so many different jobs and was in my mid-to-late 20s and still struggling to find what I really wanted [to do with my life], they didn’t believe that I would [really] do it.”

But Pineda soon proved to his family—and his peers—that he was very serious about nursing. He attended classes during the day and supported himself by working as a waiter and bartender at night. “I needed something stable that wouldn’t interfere with school,” he says.

In 2004 he completed his associate’s degree in nursing, graduating at the top of his class. Shortly after that, he accepted his current position at NewYork-Presbyterian Hospital/Columbia.

Today, Pineda has no shortage of opportunities to feel passionate about his work. “I love my job. I’m one of the luckiest people in the world,” he says enthusiastically. “I can’t believe that I get paid to do this. This is the most interesting job [I’ve ever had]. It’s always challenging—physically, mentally and emotionally. I’m very proud of what I do. I’m helping people. I get to learn so much about the human body, how to work with families and how to educate patients about their recovery. I’m providing emotional support to patients and families. It’s great.”

Communicating and Connecting

Pineda feels there is a strong need for more bilingual Spanish-speaking nurses all over the United States. The community his hospital serves, for example, has a large population of immigrants from the Dominican Republic. “Every day another nurse asks me to interpret,” he says. “I can’t imagine working [here] and not speaking Spanish.”

Although many of the doctors on his unit do speak Spanish, Pineda’s ability to communicate in Spanish is still in demand. “[Here in the cardiothoracic ICU], patients are coming out of surgery, so it’s very helpful for them to connect [with the nurses] and much more effective for everyone that I speak Spanish. There’s a comfort for the patients [knowing] that I share the same culture, language and interpersonal dynamics with them.”

One of the reasons why Spanish-speaking nurses are so underrepresented in the RN workforce, Pineda believes, is the strong emphasis on family obligations in Hispanic communities. “[We] Hispanics seem to have children earlier in life,” he explains. “But [even if you do have kids] it’s worth it in the long run to continue with your education, because it will open so many doors in the future.”

As for being a man in nursing, Pineda doesn’t feel like he’s a minority in that regard. “I’ve been in units where on some days half of the nursing staff is male,” he says. “A lot of men in nursing are drawn to the ER or the ICU. It’s a very fast-paced environment. I’ve even been told by some families that [they think] male nurses are more compassionate than female nurses. The important thing, no matter what gender or race you are, is that this is a great career with lots of opportunities for growth. You can go as far as you want to go.”
Asked what qualities are necessary for a successful career in nursing, Pineda answers that a good nurse is empathetic, hard-working and determined. “You have to love this profession,” he emphasizes. “It can be difficult if you didn’t love it. The decision to become a nurse is so personal, but if [you] have a desire to learn a lot and really help people at the most critical points in their lives, it’s the best job in the world.

“It’s a competitive field,” Pineda continues. “[When you’re in nursing school], the classes are difficult. The first year is hard and from there it only gets harder. Then you have to take and pass the exams. And then when you start your first job, the work is hard and the hours are long. But it’s the most rewarding work. I advise others [interested in nursing careers] to be dedicated and do your best.”

Continuing the Dream

Now that Juan Pineda has fulfilled his dream of becoming a nurse, he is ready to take on new challenges. This summer he began taking courses in general chemistry, organic chemistry and statistics in order to fulfill requirements needed to apply to a master’s program in nurse anesthesia.

“I already had taken many of the [prerequisite courses] during my undergraduate work as a pre-med major, so I just needed three additional classes,” he says.

Today Pineda feels he is on track to achieve the kind of career he always wanted. “Being a nurse anesthetist is my ultimate goal,” he says. “That was my original plan—to have such a special role in someone’s treatment. I’m going to apply [to CRNA programs] in November. I have been focused on getting the best grades [in my prerequisite classes], because anesthesia school is very competitive.”
And what about his long-term goals? Where does he see himself in, say, 10 or 20 years? While Pineda has given it some thought, he admits that right now he’s focusing all his energies on getting through his CRNA program.

“I’ve planned on this for the past six or seven years and it’s such a big goal,” he says. “I’ve been focused on it for so long that [at this point] I’m not sure what my goals for the future are. I have thought about teaching, though. My ultimate goal for when I retire [from nursing] is to be a teacher of English as a second language.”

Putting the ER in Diversity

Into the Ruins: Nurses in Haiti

The following nurses left their homes in the United States with no real plan in place, a limited understanding of the language, and little more than a desire to help. They traveled across the island to unknown working conditions and devastation. And they echo each other: you cannot put the destruction into words.

“What do you tell them?”

Nurses listen to the calls for help, says Rosario Medina- Shepherd, Ph.D., A.R.N.P., F.N.P.-B.C., A.C.N.P., Vice President of the National Association of Hispanic Nurses and an assistant professor of nursing at Florida Atlantic University. Within two weeks of the earthquake, Medina-Shepherd joined a medical mission through her church. “I just packed up and left,” she says.

After landing in Cap-Haïtien, a city on the northern coast, she jumped into a rundown pickup truck with 15 strangers. They drove for over 10 hours through the mountains and quiet countryside. At night, they passed people congregated by the roads, where there was light from candles. “It truly was entering a different dimension, not one I can explain,” she says. The trip exhausted her, but it gave her time to prepare mentally.

By daybreak, she began working with patients at a hospital in Saint-Marc, a relatively stable coastal area experiencing an influx of refugees from Port-au-Prince, just over 60 miles away. “The medical staff at the hospital were from different parts of the world, but it did not matter where you came from,” she says. “We were there for the same purpose.”

Medina-Shepherd had packed lightly, filling her duffle bag with gear and medical supplies leftover from a 2006 medical mission to Ghana. When her team unpacked her equipment at the hospital, “suddenly everyone who spoke Kreyol wanted to be my friend,” she says with a bit of wry laughter.

“Everything we take for granted [in the United States] was nonexistent,” Medina-Shepherd says. “We’re so spoiled.” Even hours from Port-au-Prince, food and water were very hard to find. People came from miles around with buckets on their heads looking for it, and children played in the dirty water pooled near the road.

She felt afraid at times, sleeping on a mattress on the floor, surrounded by barred doors and windows, but she trusted the people who gave her team a place to stay. “They really just wanted to take care of me so I could take care of their people,” she says.

Medina-Shepherd was made medical director after arriving in Haiti, appointed by the director of the Gulf Stream Baptist Mission Association. The chief of medicine looked half her age, and the nurses and other volunteers seemed to need guidance. After making rounds, she assisted in wards staffed by nurses and physicians from a Boston-based team. They had flown in on military planes and were relatively well equipped, but conditions remained frenzied. “There were people all over the place,” she says. “It’s not America. It’s not how we run medicine.”

People recovering from surgery, including amputees, lay on the floor without pain medications or fresh dressings for three or four days after a procedure. After receiving a dose of morphine, they were suddenly up and walking out the door. It was hard to follow up with patients post-op—the physicians only looked after the most severe cases—so Medina-Shepherd set up a post-trauma clinic on other side of hospital.

Anyone could write prescriptions. There was no oxygen in the ER; “it was a place to go lay down and wait.” There was no way to intubate dying infants. One Haitian doctor said, “Get over it. Babies die here all the time.”

Medina-Shepherd and her team also established a makeshift clinic in a school in Arcahaie, a town about 45 minutes south of Saint-Marc. They worked from about 7:00 a.m. until 2:00 p.m. and saw over 100 patients. Some just came looking for free medical care, not available before the disaster. The Haitians complained of abdominal pain but only felt it when they didn’t eat, Medina-Shepherd says. “What do you tell them?”

Yet, despite the country’s devastation and the squalor in the hospital, the Haitian people wanted her to know that they were okay. The pride and reassurance is part of their culture, she says. In the early morning hours, from her mattress, she could hear people singing praise songs and worshipping in Kreyol. “That was my backdrop,” she says.

“I think we all need to go,” she says. “I would go back in a heartbeat.”

“Makeshift everything”

Chioma Ohiri, R.N., B.S.N., first went to Haiti in October 2009 to visit her mother’s family. A telemetry med-surg nurse at Parkland Hospital in Dallas, Texas, she wanted to reconnect with her roots. “The country was alive,” she says. “A lot of color. A lot of happiness.” Ohiri left feeling “complete.”

Chioma Ohiri, R.N., B.S.N.Chioma Ohiri, R.N., B.S.N.

When she returned to Haiti in January, a week after the earthquake, the once bustling airport was empty. United Nations troops guided her team around the tarmac, and they unpacked their own luggage from the belly of the plane. “My heart was so heavy,” she says.

Ohiri went with Hospitals for Humanity, a small-scale nonprofit with limited experience responding to such disasters. They gave her some travel information, she talked to her managers, and eventually skipped a vacation in Cancun to travel to Haiti. Ohiri joined nurses and doctors from all over: New Orleans, Chicago, Las Vegas. The team stayed with one member’s family in the coastal tourist town of Montrouis. Every day, they made the two-hour commute to Port-au-Prince.

They set up a clinic in one of the remaining structures, an abandoned church. Though it did not have any walls, it protected their medicine and equipment from the heat. But the Haitians were terrified to enter a building, and the nurses and doctors had to convince patients it was safe. It was a challenge, eight days after the earthquake. Ohiri was also there for the aftershocks, quakes between 5.9 and 6.1 in magnitude.

For medical supplies, they only had what they came with. “We had to make our own makeshift everything,” Ohiri says. Patients slept on the floor, and the team used church benches to make little triage areas. Ohiri assisted in a cesarean section performed on the ground, without surgical supplies or anesthesia. She just applied Lidocaine to the woman’s stomach. Both the mother and baby survived, and he was named for the doctor who performed the procedure.

“There were a lot of things I didn’t expect to see,” Ohiri says. So soon after the disaster, their clinic was inundated with multiple fractures (as many as five in a single limb), head trauma, and deep wounds. A child came in with a gash that “looked as if a shark just ate the back of his leg.” Someone used white undershirts to stop the bleeding, and the fabric had grown into the muscle tissue. Showing the Haitians how to care for their injuries became a priority. “We had to do a lot of patient teaching,” she says, because their wounds would take weeks to heal, long after the clinic disbanded. It harkens to the overarching goal of helping Haitians back on their feet, but leaving them with the tools to rebuild themselves.

“The people, they were so appreciative, so humble. That motivated me,” Ohiri says. The Haitians understood the nurses were doing the best they could, and the nurses in turn relied on each other to keep going. Everyone had so much energy, Ohiri says, and it helped her stay sane. “You put your heads together and anything is possible,” she says. “I ended up leaving with a lot of good friends.”

Ohiri says nursing outreach should not stop at Haiti. There is a debilitating lack of nurses in China, which was hit with a massive earthquake in May 2008 that left almost 100,000 people dead or missing, then another in April 2010 that killed over 600. She urges other nurses to volunteer. “Don’t be afraid, and just use your heart,” she says. “I feel honored to actually help.”

“Lines and lines of patients”

Joyce Vazzano, R.N., M.S., C.R.N.P., landed in the Dominican Republic on March 5, then took an eight-hour bus ride to Port-au-Prince. An instructor in the Department of Acute and Chronic Care at the Johns Hopkins University School of Nursing, she had volunteered in Haiti before, but seeing the stark contrast between the Dominican Republic and Haiti as she crossed the border was a new experience. “It was just so obvious it was a different country,” she says.

Vazzano traveled with three other nurse practitioners from JHUSON and a team of volunteers to a clinic in Miragoâne, a trade city on the west coast, 58 miles from Port-au-Prince. Though there were some toppled buildings, it was in much better condition than the capital city, she says. Unlike many volunteer medical workers she knew of, Vazzano’s clinic had a traditional exam room, though it did not have electricity or running water.

People came to her clinic from all around the country, including refugees from the capital. The earthquake affected everyone she saw. All had family who died in Port-au-Prince. “Every day, there would be lines and lines of patients,” Vazzano says. She estimates she saw one person every eight to 10 minutes.

Vazzano spoke to many patients exhibiting signs of Post Traumatic Stress Disorder; they could not sleep because of night terrors, could not eat, and experienced heart palpitations and trouble breathing. Two psychologists with the International Medical Corps, a private nonprofit relief agency, trained the clinic staff to recognize PTSD and taught them basic intervention, such as relaxation techniques. With the Haitian culture dismissive of psychology, there was little other psychiatric care or medication available.

Patients also came with more common ailments and chronic diseases. Many had respiratory problems because of all the dust in the air following the earthquake and the coal used for cooking. “People bathe in streams littered with garbage alongside the pigs and cows. Or they shower in groups in the open along the streets if there is any running water,” she says. “We were seeing many patients with cholera from the contaminated water supply.” Medications were very limited. They didn’t have enough to fill prescriptions for things like asthma and hypertension, so the Haitian doctors and nurses would give small doses. Bottom line: “If they don’t have the medicine, they can’t give it,” Vazzano says.

After a week, Vazzano left for a downtown clinic in Port-au-Prince. She worked on hospital grounds in ER/ICU tents with a group of Haitian nurses. “We worked together to try and work with the equipment we had,” she says. At one point, she showed Haitian nurses and doctors how to use needleless IVs, but they chose not to implement the equipment the next day or going forward, favoring more familiar, if outdated, methods. They knew, and Vazzano quickly realized, it was more prudent to reject tools that would eventually be taken away when her team left.

Generators provided the tents with electricity, but they intermittently blacked out, so nurses and doctors kept Ambubags ready to hand-ventilate patients if necessary. During procedures, they tried to be as sterile as possible, at least wearing gloves and masks, but anxious family members would walk in and out of the hospital tents, often standing at the foot of the bed. They could not be contained.

The patients arrived in droves, from 7:30 a.m. to 6:00 p.m. The 20 cots in the ICU, spaced about 18 inches apart, were always full. They treated ailments that read like a page from a history book: cerebral malaria, typhoid, and tetanus. “Some days, there were multiple deaths of patients who probably would have lived if they were fortunate enough to have the same illness in the U.S.,” Vazzano says. “They had so little before the earthquake and have even less now, yet they always had a smile for the health care workers and thanked us for whatever little thing we could do for them.”

The nurses chatted in the evenings, trading stories from their practice settings in the United States, Haiti, and elsewhere. No Haitian nurses worried about being sued if something suddenly went wrong, while the U.S. nurses followed pages of guidelines to protect the patients, as well as themselves. At the clinic, they just needed to work together to make sense of the chaos.

One of Vazzano’s peers in the Department of Acute and Chronic Care at Johns Hopkins, Beth Sloand, Ph.D., C.R.N.P., has volunteered in Haiti one or two times each year for the past 11 years. She became a leader for Haitian relief at the University, organizing one of the first JHU trips post-earthquake.

Sloand recommends registering now with organizations like the Red Cross, so when the next disaster strikes, they can quickly dispatch more specially trained nurses. She also suggests supporting relief efforts from home rather than going to Haiti, because the country has been swamped with volunteers when it really needs money and professionals.

Three nursing schools were destroyed in Port-au-Prince, and many nursing students and faculty died when the university hospital collapsed. “There’s a need for us to help support the nursing students in Haiti,” Sloand says and mentions donating to the Haitian Nursing Foundation or National Nurses United. “The Haitian nurses did a fantastic job.”

Acute, Critical Care Nursing: The Frontlines of Patient Care

In the growing sea of nursing specialties, critical care is actually one of the oldest. It was established in the 1950s and 1960s as the specialized care provided for the first intensive and cardiac care units. Seriously ill patients with complex health issues needed qualified nurses with unique skill sets. The same remains true today.

Critically ill patients who were once mostly cared for in ICUs can now be found throughout health care facilities, in emergency departments, post-anesthesia recovery units, interventional radiology, cardiac catheter labs, pediatric and neonatal intensive care units, burn units, progressive care units such as step-down and telemetry units, and even inpatient general care areas.

“The needs of the patients and their families determine whether they require a critical care nurse. It’s not based on the name of the unit or its location,” says Reynaldo Rivera, D.N.P., R.N., C.C.R.N., N.E.A.-B.C., A.N.P. Among his responsibilities as Director of Nursing in Medicine Services at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, Rivera works with recent nursing graduates as they transition into their first professional role. “People are admitted into the hospital with more serious conditions and complex co-morbidities than patients in the past. The role of the critical care nurse continues to adapt to meet the challenges of a changing health care system,” he says.

More than half a million acute and critical care nurses comprise this specialty, which continues to grow. These nurses also teach, research, manage departments, and lead in the quest to create a health care system that is driven by the needs of patients and families.

A career in critical care has taken Cuban-born and U.S.-educated Maria Shirey, Ph.D., M.B.A., R.N., N.E.A.-B.C., F.A.C.H.E., from an internship program for new nurses at the Baptist Hospital of Miami to educator, manager, and executive positions in Florida, Texas, Louisiana, and Indiana. She is now an associate professor in the Doctor of Nursing Practice program at the University of Southern Indiana‘s College of Nursing and Health Professions in Evansville. “I have been a nurse for 33 years, and the skills gained at the bedside have been useful at every stage of my career,” she says. “Critical care nurses must make quick decisions constantly, and those decisions need to be based on evidence and data. You have someone’s life in your hands, and that’s not a responsibility to be taken lightly.”

Nurses may enter critical care immediately after licensure, or they transition into the specialty after gaining experience in other areas. Patients depend on these highly knowledgeable and skilled nurses to make accurate assessments, prioritize needs, and recognize the difference between an exception and a problem.

Linda Martinez, M.S.N., R.N., A.C.N.S.-B.C.-C.M.C., says critical care nurses begin with the basics, but soon realize textbook cases exist only in the classroom. A critical care nurse for 31 years, she works as a clinical nurse specialist for Presbyterian Heart Group at Presbyterian Hospital in Albuquerque, New Mexico. “First you learn the basics. Then, you learn the exceptions. As nurses gain experience, they start to individualize normal by putting into context what’s going on with each patient,” she says. “Assessment skills have to be very sharp in critical care. You have to be able to quickly assess a patient’s situation in case there’s a life-threatening change. You put everything you’ve learned into context.”

Rivera serves as president of the Philippine Nurses Association of America, where he advocates for diversity in the workforce, ethical recruitment practices, and professional development and standards. “Nurses in high acuity and critical care must have the competencies and requisite skills to do the job with an underlying sense of compassion and sensitivity. It’s the combination of all these attributes that inspire patients and their families to trust us,” Rivera says. “We practice as whole persons, using our hearts, the mind, and the hands. It’s also the soul of who we are.”

Shirey and Martinez have also become national leaders in nursing and critical care. Martinez serves on the national board of the American Association of Critical-Care Nurses (AACN), the world’s largest specialty nursing organization, representing the interests of more than 500,000 nurses who care for acutely and critically ill patients. Shirey chairs the AACN Certification Corporation, the association’s credentialing arm that certifies bedside and advanced practice nurses in high acuity and critical care. It also certifies nurse managers in a joint program with the American Organization of Nurse Executives.

Desire to learn

Shirey cites complex patient conditions, the fast pace, and pressure-packed environment as reasons why critical care nurses must commit to continuing professional development. “Things happen so quickly that you don’t have time to always research before acting. I either need to know it or know where to turn for help,” she says.

Shirey says she first joined AACN because of her desire to take better care of patients and their families. “I started studying the AACN core curriculum to hone my skills. I then joined AACN so I could receive the journals and earn my CCRN certification. All so I could be the best nurse for my patients.”

Armenian-born Anna Dermenchyan, B.S.N., B.S., R.N., C.C.R.N., agrees. She’s a clinical nurse in the cardiothoracic ICU at the Ronald Reagan UCLA Medical Center and an adjunct instructor at Mount St. Mary’s College, both in Los Angeles. “If we’re not learning, we’re not moving forward. Outdated skills affect patient care, especially with new medications and technology, changing policies, and procedures,” she says. “We have to be the best for our patients. We learn the most from them. Each case presents lessons for the next case.”

Ryan Cavada, R.N., a staff nurse at the UCLA Medical Center Santa Monica campus, says nurses in critical care need strong critical-thinking skills, the ability to work under pressure in a fast-paced environment, and a continual desire to learn. “Critical care is at the forefront of evidence-based nursing practice where we apply new medical research, adapt ever-changing procedures, and use the latest technology. Our patients can’t afford care that doesn’t meet this benchmark standard,” he says.

Advocate for the patient

Patient advocacy is a vital responsibility of critical care nurses, as acutely and critically ill patients often can’t express how they feel or what they need. “As a nurse, I am the main representative for my patients and their families,” Dermenchyan says. “Many times, patients can’t communicate for themselves, describe symptoms, or tell me something is wrong. I need to be on the lookout on their behalf and communicate their needs to the ICU team.”

Martinez adds, “Critical care nurses must hone their communication skills, because a lack of understanding or miscommunication can have life or death implications.” She recalls the night she realized the importance of good communication. “I was speaking with the intern on call about a patient in pain and it hit me that I am the voice of this patient. My role as a patient advocate became crystal clear. If I couldn’t communicate what was needed, that patient would suffer through the night.”

Working as a team

Critical care nurses collaborate with other nurses and health professionals with a single focus on caring for the patient. Filipino-American nurse Cavada points to critical care’s unique intimacy. “We really get to know our patients,” he said. “Nurses are more than an active part of a team. We become the team’s hub. Doctors, nutritionists, respiratory therapists, everyone involved in a patient’s care come to us for the most current information.” He says competent critical care nurses are concerned about their own patients and stand ready to assist their colleagues. “Good teamwork allows more to be done for the patient in less time. In critical care, that can make a big difference; time is of the essence.”

“When we get patients who are extremely sick, we all have to work together. It’s our patient, not my patient. We all want good outcomes,” Dermenchyan says. “Collaboration is key, or patients suffer.” Critical care nursing demands a healthy work environment and true collaboration, in which each professional’s knowledge and abilities are respected.

Collaboration in critical care also goes beyond health care professionals. “Family members are an important element to caring for the patient,” Shirey says. “Critical care nurses learn to integrate them into the care, keep them informed, and we know how to be sensitive to changes in the patient’s condition that might cause turmoil in the family.”

The willingness to work collaboratively toward a common goal has benefits beyond the bedside.
Nurses learn early on how to work well in teams,” Martinez says. “And teams are vital to improving the system of health care, not just in the delivery of care.”

Nursing Volunteer Efforts

A nurse is defined not simply by the medical knowledge he or she acquires. Personality traits—ambition, selflessness, courage—also characterize those in the field. Being a medical professional requires a level of giving that those in other occupations may not experience firsthand. There’s a sole focus on the health of others, and a drive to set aside all personal matters for the well-being of complete strangers. For some nurses, the selflessness has taken them to another world, one where they step outside the confines of a hospital setting and into an area devastated by a natural disaster.

Over the past decade, there has been no shortage of disasters: Hurricane Katrina, the earthquake in Haiti, and the tsunami in Japan, to name a few. But through all of these events, one thing has remained certain: nurses and medical professionals act as steadfast caretakers to help victims physically and mentally recover from such disasters. Nurses act as the liaison between the devastation and the happy, healthy life the victims had before—and strive to have again.

These are the stories of the nurses that helped make that happen.

Eugenia Millender
Haiti Earthquake, 2010

Eugenia Millender, Ph.D.(c), M.S., R.N., P.M.H.N.P., C.C.R.N., experienced multiple hurricanes as a Florida resident and Panama native, and knew firsthand what it was like to have such a major natural disaster strike. But even after the earthquake in Haiti, she couldn’t begin to imagine how the quake could drastically change so many lives so quickly.

“As a human being, I couldn’t imagine how a person could one day have their whole family, friends, and neighbors, and the next day, lose them all,” she says. “Day after day, the stories I heard got worse to the point that I just couldn’t watch anymore. I wanted to do more than pray.”

Working full time as a critical care nurse, Millender was no stranger to sad situations. But she had experienced “nothing so massive,” until she traveled to Haiti. And from the moment she got off the plane, it was pure chaos, she says.

“There were thousands of people walking with nowhere to go. Children were walking alone because now they were orphans,” and on the way to the hospital, there were countless bodies on the side of the road, Millender says.

“Once I reached the hospital, there was no orientation, no introductions, no explanation of what to do, how to do it, or when to do it, because there were hundreds of people in the parking lot of the hospital waiting for care,” Millender says. She adds that in the following days, there were many aftershocks, including one that was as high as a 7.0 on the Richter scale.

Millender remembers one patient she had, a 21-year-old woman with an arm that was almost dead and covered with flies and maggots. They didn’t have the equipment for amputation, and even if they did surgery, she would likely die from infection. Millender made many phone calls to help the woman—even contacting hospitals in the United States—but ended up sending her to the Israeli Army on the island since they had more advanced medical equipment. Millender later received good news from the woman’s brother: they amputated her arm and were taking excellent care of her.

After her work in Haiti, Millender moved away from acute care, and into community care and prevention, saying that she wanted to be an agent of change, not of treatment.

“I want to prevent, educate, and empower,” she says. “I want to change policies to improve the health care of the underserved. This is a step I probably would not have taken before the earthquake.”

Millender noted the resilience, perseverance, and hospitality of the Haitian people, saying they cared as much for her as she did them.

“Even when they did not have food or a place to eat, they made sure that I was cared for,” she says. “Caring is a universal language. I did not have to speak French or Creole to show how much I cared.”

Norma Graciela Cuellar
Hurricane Katrina, 2005

For Norma Graciela Cuellar, D.S.N., R.N., F.A.A.N., her biggest moment of assurance for becoming a nurse was in her mother’s last days.

“She said, ‘I know what you do. You are a nurse. I know how much these nurses have done for me and I know what you do now. I am so proud of you,'” Cuellar says. “To this day, no one has ever reassured me that I made the right choice to go into nursing as those words from my mother did.”

Having spent so much of her life along the Gulf Coast, and with family still there when she joined the faculty of the University of Pennsylvania’s School of Nursing, her heart sank when she heard about the approach of Hurricane Katrina. Cuellar’s family was living in New Orleans and Hattiesburg, Mississippi, and her sister owned a condo in Long Beach, Mississippi.

“That Monday, I went to work when I knew the hurricane was hitting. I could not concentrate. People at work acted as if nothing was happening,” she says. “How could I be somewhere safe, being aware that people could actually be dying, fearful of survival?”

Feeling helpless, Cuellar volunteered with the Pennsylvania chapter of the American Red Cross. “I was sent to the Cajun Dome in Lafayette, Louisiana, for my assignment,” she says, adding that there were 1,100 people there—mostly from New Orleans—that had to leave their homes.

Cuellar was assigned to be the charge nurse for the medical unit. The volunteers worked 12-hour shifts, but any time nurses left, there was always a chance they wouldn’t come back. “Sometimes, I wanted to beg them to stay because we didn’t know if we would get replacements for them,” she says.

There was one story that stood out in her mind about a man who thought his life was coming to an end. “He was looking out his kitchen window and saw a wave of water coming towards him. This was when the levee broke,” she says. “He couldn’t get out fast enough, and the water was up to his waist.” In tears, the man described how he was trying to get to safety while dead bodies were floating in the water around him.

Cuellar and her staff were so busy, it was often difficult to take the time to hear the victims’ stories, but she says, “the most important thing is to listen. These people wanted to talk and they needed to talk. They needed reassurance.”

Although working with these victims was the hardest thing she had ever done, she recommends that everyone volunteer with disaster victims at least once in their lifetime.

“You will get a different perspective of what is in your community and what the needs of the people were before the disaster hit,” she says. “It is a challenge to yourself and it will make you more aware of who you are and how you will practice in the future.”

Joyce Hyatt
Haiti Earthquake, 2010

When Joyce Hyatt, R.N., M.S., M.S.N., C.N.M., D.N.P., heard about the earthquake in Haiti, she fell asleep with horrific images in her head from the disaster. She woke up the next morning and told her husband that she had to go to Haiti to help the victims.

Born in Jamaica, Hyatt works as an assistant professor at the University of Medicine and Dentistry of New Jersey (UMDNJ). The desire to become a nurse came at an early age for her.

“I was inspired to become a nurse after watching my grandmother, a lay midwife in Jamaica, diligently perform her duties: delivering babies in the community,” Hyatt says. “I knew she was doing something good. She was helping people, she was loved and respected, and I wanted to be like her.”

She had initially planned on becoming an operating room nurse, but when she inadvertently assisted with the birth of a baby in a hospital elevator, she knew that was her calling.

“The overwhelming joy I experienced when the baby cried led me to realize this was my true calling,” she says. The following week, she applied to the University of the West Indies School of Midwifery, where she received her degree in nursing and a certificate in midwifery.

Hyatt had the support of colleagues and her church when she decided to go to Haiti. She had also joined an organization called Midwives for Haiti, a group that was training traditional birth attendants to become skilled midwives and to offer compassionate care to women.

When she went to Haiti, Hyatt worked in a hospital in a village outside Port-au-Prince. Many of the patients, particularly women and children, went to the hospital to deliver their babies or to seek general medical care

She worked mostly with other volunteer midwives, resident nurses, doctors, and medical students from the area who had lost their medical school in the disaster. “Everyone was compassionate, kind, and caring, not only to the patients, but toward each other,” she says.

Many visions of the disaster in Haiti remain with her. Even a few weeks after the earthquake, the effects were still evident: collapsed buildings, tents that housed victims, and organizations providing donated food. “[There were] people with missing limbs, some with burns or other injuries from the earthquake,” she says, adding that there was “an air of sadness” in the affected areas.

Some of the challenges she encountered with patients were ambulating women in labor, promoting position change, and trying to provide comfort in the absence of pain medication. Hyatt also helped in an orphanage during her time in Haiti. And for the first time in over 30 years of being a nurse, she used her CPR/neonatal resuscitation skills.

Despite the challenges, Hyatt noted how volunteering time and resources can truly make a difference to victims of a natural disaster.

“Helping these patients was one of the most rewarding experiences of my life. The patients were very grateful for the help they received, and most were just grateful to be alive,” she says. “I have become more aware of and more appreciative of what I have.”

Cynthia J. Hickman
Hurricane Katrina, 2005

After hearing about the suffering caused by Hurricane Katrina, Cynthia J. Hickman, M.S.N./Ed., B.S.N., R.N., B.C.-C.V.N., C.M., broke into tears.

The news reported that buses were coming to Houston, Texas, with displaced families. After hearing requests for water, clothes, and other sustenance, Hickman wanted to do anything she could to help the victims. But local media outlets said to wait until “a true assessment could be made” of the situation.

“I thought to myself, what kind of assessment was needed with so much human suffering?” she says. “I was scared, afraid, and sad. The worst emotion of all was an overwhelming feeling of helplessness. It was at that point I cried.”


For Hickman, a case manager at St. Luke’s Episcopal Hospital in Houston, this was her first time helping victims of a natural disaster. She had always wanted to train, but just never had the time. “When Hurricane Katrina hit, I learned a lot of things fast. I knew I was not going to face people just within my specialty,” she says.

The list of suffering was long: diabetics without insulin, infant dehydration, depression, and more. “The [hospital’s] expectation of available staff and the roles we were to play would change based on instructions from the command station,” Hickman says. “My role as a non-direct care member of the staff was more of ensuring that patient and family needs were met and to assist with medical equipment or community services if patients were hospitalized.”

The stories of the victims brought back distressing memories for Hickman. The faces of the people and children wondering: What just happened? What do I do? Have I lost everything?

“I spoke to a lady who could not find her son, who was with a family member while…the levee collapsed,” she says. “Still today, I don’t know if she ever did.”

Hickman says food hoarding was a frequent occurrence among the victims brought to the George R. Brown Convention Center. “Many had no idea what the following days would hold. Survival by any means possible was the behaviors of many,” she says.

Most of the evacuees she worked with were African American (New Orleans’ population is roughly 67% black). But Hickman notes that the hurricane didn’t show any regard for ethnicity. “Disasters are unplanned and unwanted, but occur,” she adds.

Hickman quickly realized there were lessons to learn before, during, and after a natural disaster. Though she often thinks about what she could have done differently, she believes that anyone in a community can help during a time of disaster.

“The natural disaster reminded me why I became a nurse: to mentor, teach, care, and support those needing a hand,” she says. “My reason for volunteering was very simple. There was a need, and I wanted to meet the need to the best of my ability.”

Marie O. Etienne
Haiti Earthquake, 2010

For Marie O. Etienne, D.N.P., A.R.N.P., P.L.N.C., the earthquake in Haiti was personal.

A native of Port-au-Prince, Etienne was in her office grading papers when a fellow professor came in and asked if she had heard about the quake.

“I was in a state of shock, feeling a sense of urgency to call my family to find out if everyone was safe,” she says. Her family members in Port-au-Prince lost their homes. Another family member had a broken leg. And her cousin, who was attending medical school at the time, died as a result of the earthquake.

Currently a professor at Miami Dade College School of Nursing, Etienne traveled to Haiti a few days after the earthquake struck. There, she served as a nurse practitioner with Project Medishare, where she cared for amputees, children, and families who “felt powerless,” she says.

“I felt so guilty that I was able to walk, breathe, and feel okay while so many people were crying in pain and suffering with either one or two limbs amputated,” Etienne says. “I did everything I could to help the patients and families…giving them hope, hugs, and a little smile to keep them going.”

One patient that stands out in her mind was a 26-year-old woman who was brought in with a GI bleed and elevated blood sugar, barely conscious. She held on to Etienne saying, “Please don’t let me die.” Although they did everything they could, the woman didn’t make it.

“I could not control my tears and emotions, yet we had to remain focused to handle and care for other victims,” she says.

One major lesson that stood out during her time in Haiti was Maslow’s Hierarchy of Needs to prioritize patients’ survival: airway, breathing, circulation (A, B, C). Etienne adds that providing culturally sensitive and compassionate care was essential.

“I had to remain strong, calm, and ready to serve at any given moment,” she says. “During the recovery phase, I learned to appreciate the smallest things in life, because the victims were optimistic even when they had no reason to be hopeful.”

Etienne speaks proudly of Miami Dade, saying that students took part in several vigils and helped raise funds for the victims. She also speaks highly of her colleagues who volunteered in Haiti, having worked with the Haitian American Professionals Coalition (HAPC) and members of the Black Nurses Association (BNA) Miami Chapter both before and after the earthquake. She also worked with the Haitian American Nurses Association (HANA), noting that 30 HANA volunteers, under the leadership of former President Guerna Blot, R.N., M.S.N., M.B.A./H.C.M., O.C.N., arrived to assist with the shortage of Creole translators and provide culturally competent care.

“The medical and nursing team were outstanding in terms of handling the pressure of saving lives,” Etienne says. “When giving care, give it all you’ve got by being caring, compassionate, skillful, and a dedicated nurse.”

In July 2010, Etienne received an Unsung Hero Award in recognition of her efforts in Haiti’s earthquake recovery by the Haitian American Leadership Coalition. She continues to coordinate medical missions to Haiti with the HANA team.