Jeanne-Marie Havener, November 26, 2019


Jeanne-Marie Havener, November 26, 2019
Jeanne-Marie Havener
Emma Sarnacki
Bassett Hospital
Beth Israel Hospital
Code Green
Hartwick College
Healthcare Policy
Joyce Clifford
Magnet Hospitals
Models of Care
Nurse Education
Transcultural Nursing
Public Health
Rural Healthcare
Dr. Jeanne-Marie Havener (née Systrom) was born on August 16th, 1958 in Newton, Massachusetts. She has worked as a registered nurse, nurse practitioner, and nurse educator and is currently employed as a Nursing Associate in the New York State Department of Education Office of Professions where she reviews professional education programs. She received her baccalaureate degree from Millikin University in Decatur, Illinois and later her master's degree, post-master's advanced certificate, and doctoral degree from Binghamton University.

In this interview, Dr. Havener recounts the path of her professional career, highlighting important mentors and educational experiences. She speaks of her tenure working at Bassett Hospital in Cooperstown, New York as well as at Beth Israel Hospital in Boston, Massachusetts. She compares her time at both of these institutions and how Beth Israel's urban setting made for a different experience than the rural setting at Bassett and explains Beth Israel's success as a magnet hospital. Dr. Havener also details her time as the Director of the Nursing department at Hartwick College in Oneonta, New York. In reflections on gender, Dr. Havener speaks about the similarities between feminist literature and the nursing profession. She also discusses the variety of care delivery systems in which she has worked (or worked to implement), as well as the effect of Code Green on the healthcare system.
JMH = Jeanne-Marie Havener
ES = Emma Sarnacki

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This is the November 26th, 2019 interview of Ms. Jeanne-Marie Havener by Emma Sarnacki for the Cooperstown Graduate Program's Fall 2019 oral history project recorded at her home in Milford, NY. Alright Ms. Havener, can you tell me a bit about your experiences as being a registered nurse and nurse practitioner, please?

Sure, it's kind of long, but I graduated from college at Millikin University in 1981, and from there I moved back home for the summer. I was getting married at the end of the summer and I took a position, it was a temporary position in a nursing home for Greek patients, Greek residents, and it was a wonderful experience - lovely families. It's everything you don't think about in a nursing home. It was really a very, very warm, loving place. It was a great experience. I worked there during the summer time and was interestingly enough really mentored by a woman who was an LPN [Licensed Practical Nurse], not an RN [Registered Nurse] but she had worked in long-term care for a long time. She had been at the Hellenic Home for a number of years so she knew the system, she knew the residents, she knew the families, and she was just one of these people who had a wealth of experiential knowledge. She was really sort of my first mentor as a newly-minted nurse, and I think that was a really good experience for me to have because I don't think I'd had a lot of exposure to LPNs prior to that and so that was good. I moved to Upstate New York after my husband and I got married in August and he started [as a student in] the Cooperstown Graduate Program, and I took my first position in an acute care setting at Bassett Healthcare. I worked on the inpatient medical unit from November of 1981 until May or June of 1983 after he graduated, and that was a wonderful experience as well. It was a very busy unit, it was a large unit, we had 50-some-odd beds at that time and we could open up swing beds onto the OB unit when it was the middle of the flu season and that kind of thing. It was a teaching hospital; I had the opportunity to work with residents and interns, attending physicians, certainly nurses. There were a lot of nurses that were around my age, a little bit more seasoned than myself, who were great mentors. I would say having the experience of working at a teaching hospital was great because it was a very collegial atmosphere. It was the type of atmosphere particularly as a young nurse in which you felt like it was okay to ask questions. Nobody was going to judge you, you didn't need to know everything, so that was a wonderful experience. It was in the day and age before they really had the do-not-resuscitate-orders. They were just starting to come into play. People did not have things like living wills, health care proxies, any of these kinds of things. So, we also got a lot of experience, perhaps unfortunately, in resuscitating patients and doing a lot of critical care. It was a good atmosphere. I worked with nurses certainly once again: LPNs, nursing assistants. We functioned at the beginning of my tenure there in a model of care called functional nursing. Functional nursing means that: let's say you're the medication nurse for today, and I'm the treatment nurse for today, and somebody else is doing different aspects of care for the patient. So, that was sort of a very old model of care and then while I was there several of my nursing colleagues and I proposed to the nursing administration that we move into or move towards primary care but we were not well situated to be able to do primary care because it really is very reliant on an all-RN staff. So, we proposed basically a hybrid of that which the administration bought into and I had the opportunity to help my colleagues to develop that and launch it before once again, I left. Jim graduated and we moved to Boston. He worked at the Paul Revere [House] museum and I took a position at the Beth Israel Hospital in Boston. The Beth Israel Hospital at that time was known as one of the first magnet hospitals. Magnet hospitals, if you're not familiar with the term, are hospitals that are known to attract and retain nurses because there's something about the professional environment there that is very attractive to nurses. Beth Israel Hospital was the first hospital in Boston to be all baccalaureate-prepared RNs, so not just RN staff but you had to have your baccalaureate degree. Now there were still some nurses who were employed there who had been grandfathered in. I started on a mixed medical/surgical floor and we probably had somewhere in the neighborhood of 50 nurses who were on staff for that unit. There was one LPN, there was one nurse who I think had her associate degree, and everyone had else had their baccalaureate degree or higher. We had some nurses who had their master's degrees who were working there. It was a wonderful environment. Within that environment they had nurses who functioned as what they call clinical nurse specialists, so these are master's-prepared nurses who really have a good understanding of systems, thinking, organizational behavior, education, leadership, all of the various different sub roles of an advanced practice nurse and they basically nursed the nurses. They are individuals who they might develop systems of care, or protocols, or standards that you operate by, orientations, programs, core curriculum, that kind of thing. It was a wonderful atmosphere because we were a mixed medical-surgical unit we had multiple CNSs [Certified Nurse Specialists] who worked with us and I was really very fortunate to have the experience of being around some people who ended up being real movers and shakers in the world of nursing and in particular one person who has a connection to Bassett as well. That's Terry Fulmer, so Dr. Terry Fulmer who now is the executive director of The Hartford, I think it's called the Hartford Institute. She's one of the leaders in the care of elderly patients. She's developed a program called the NICHE program that has been adopted really sort of universally across the world in different settings to create environments that are elderly-friendly. She was one of my clinical nurse specialists and she was somebody who I would say had a lot of influence on me, really encouraged me to think about going back for my master's degree. But at the time I had a little one and I was working full-time and Jim was working full-time and it just didn't work out. Jim was at the time working for the Paul Revere museum and the whole controversy around Robert Mapplethorpe erupted and so a lot of funding that came to museums through the NEH [National Endowment for the Humanities], NEA [National Endowment for the Arts], a lot of that funding dried up and so his position was kind of tenuous. He waited it out for a while but eventually his position was eliminated. Only, of course, to find an alternate means of funding at some point down the road. That's what was happening to him professionally. At the same time I was getting some incredible opportunities at Beth Israel. We started the first bone marrow transplant, solid tumor autologous bone marrow transplant unit in the country at Beth Israel, and I was one of the nurses who was on the ground floor helping to develop all of the - we designed the unit, we designed the rooms, we worked with the architects, we developed the protocols. It was just really, really an interesting place to work. I worked there for the couple of years that we were in Boston and then when Jim's job fell through, we cast about to decide what it is we wanted to do. As you probably know, the salaries sometimes are not fantastic in the museum world because I think traditionally, many of the positions were held by spouses of very well-to-do people; this was their playground. That was kind of the way things were then and we wanted to own a home, have other children, these kinds of things, and we still had a lot of connections back here. A number of people who were in the antiques field encouraged Jim to come back here and do some of the restoration work that he had done always sort of on the side and do it full-time, so that's exactly what we did. We moved back here, and I went back to Bassett and at Bassett I was initially in the critical care unit; they did not have any kind of inpatient oncology unit there. So it was inpatient critical care, and the day that I started there, just sort of by crazy misfortune the woman who had hired me and who had been the nurse manager of the critical care unit for a number of years, I don't know how many, let's say 20 years - something happened and she was suddenly not there anymore. I have no idea what happened, but anyhow that was my first day and a power vacuum of course, existed and when power vacuums occur you see people acting out in all sorts of interesting and oftentimes not very lovely ways and so the atmosphere there was not really conducive to somebody learning how to be a good critical care nurse. There was a lot of anger and frustration and whatnot and in the meantime the woman who was the nurse administrator at the hospital somehow caught wind of the fact that I had been a nurse at Beth Israel - asked me to come down, have a conversation with her and some of the other members of her leadership team about my experience: what it was like, how it compared to what it was what I was seeing or what I experienced in the past, so I had that conversation and then the next thing I knew they were saying to me, “Why don't you consider applying for this?”, “Why don't you consider applying for that?” and so like I said, it was a little bit hostile in the critical care setting and so I did. I looked at what other possibilities were open and they had a clinical nurse manager, assistant nurse manager position open on the medical unit where I had initially worked, so I thought okay, I could do that, I could try that and so I did. I went there and I was working there for probably about two years and at the same time I started to look at master's programs and actually started taking some classes as a non-matriculated student at Russell Sage College over in Troy. I had a meeting with my academic advisor who just started exploring my interests and whatnot and she found out that when I was in my undergraduate program, I had worked part-time on the weekends on a women's health care unit and I had also done my - we had independent practicums - and I had done my senior independent practicums with nurse midwives and so she said to me, “Well, before you really sort of go headstrong into a med-surg track, maybe you ought to explore or at least give some consideration to whether or not this is really the direction you want to go into.” So serendipitously there was a position, there were actually a number of positions that were open at the birthing center at Bassett and so I applied, got a position as a staff nurse at the birthing center - that was in 1989. In 1990 Jim and I went on vacation to Hawaii and I came back and they called me into the nursing office and said, “Would you be willing to apply for the director's position for OB and Pediatrics?” And I thought, well geez, I've only been here for a year, I'm really sort of just getting my feet underneath me, and they said “Well, if you're not comfortable with that, would you be interested in being the clinical nurse manager for the birthing center?” and I said “Okay, that I can handle,” and so I did that and I did that for five years while I continued to work on my master's degree and ultimately I transferred to Binghamton University. Binghamton had a program in family nursing practice, and you could be either a clinical nurse or clinical nurse specialist or nurse practitioner and at the time I really thought I would like to be a clinical nurse specialist - that I liked the acute care setting, I liked working with the nurses. What I really liked about it was that you had the opportunity - you work in management part-time, so about 40% of my time was spent doing management activities, and the other 60% of the time I was back out there working with patients. So, there was sort of this moving back and forth between the care setting and then into this role in which you had to helicopter up and have this systems perspective and think about what's going well in this system, what's not working so well, what do we need to do better, stop doing, start doing, keep doing, and so I really enjoyed that and that fit a lot more with the CNS role. So, I did my master's degree in family nursing and the CNS role and then as a CNS, I just started working on systems of care and working sort of in a little bit different direction. In the meantime, once again a position came open in nursing education and research to be the CNS for OB and Peds [pediatrics] for the network. So, I applied for the position and I took that position gosh, in I think it was like 1992-93 something like that. At any rate, that was a wonderful opportunity. In that position, I had the opportunity to work with the physicians, the nurse midwives, the nurse practitioners, the PAs, the registered nurses, LPNs, nursing assistants, and I basically oversaw all of the orientation, all of the core curricula, all of the training and certification programs that they needed. I developed and ran the neonatal resuscitation program, the fetal monitoring program, the lactation services program, the training program for all the nurses to become cross-trained into the OR and into the PACU [post-anesthesia care unit], I did everybody's BLS [basic life support?]. I did all of these things and it was great. I went to outreach sites as well and I became a board-certified lactation consultant in the process. That really led me to go back to school because I was working with moms and babies who would say - they'd be there in the hospital, I'd make rounds every day on all the mothers and babies, whether they were breastfeeding or they were bottle feeding just to talk to them about how to handle their baby. For breastfeeding women, try to troubleshoot if they were having any problems, make sure that they had the resources that they needed, that kind of thing and for women who had chosen to formula feed, how it is that you can overlay some of the aspects of breastfeeding onto the formula feeding relationship so that the mother and baby create a very close bond, that they are able to eliminate some of the risks of infection, those kinds of things, and also make sure that they had the support and the resources that they needed. What would happen was that the women would get discharged, and then if they had a problem they would call me and so they would come into the clinic: the OB clinic or the Peds clinic and I would go over and work with them and whatnot and oftentimes - let's just say you were seeing the mother for a breastfeeding problem and you picked up on the fact that, let's just say the baby was tongue-tied, needed to have a consultation done but you didn't have the ability to write for the consult because it was outside of your scope of practice so I said alright, I got to go back to school and do the NP [nurse practitioner]. So, I did a post-master's advanced certificate to become a family nurse practitioner and I finished that up in 1994 and it was great. I was able to do things like even go out and do home visits on mothers and babies. I could do follow-up on kids that were high-risk coming out of Albany Medical Center, kids that we were concerned about that were leaving Bassett but there were transportation, social issues, that kind of thing, and they wanted somebody to get into the home, see what was going on, sometimes eliminate the need for the mother and baby to have to do so much travel. You know it's just really kind of a neat position but then what happened in healthcare is - they refer to it as Code Green. So Code Green happened - in healthcare we talk about Code Blue, Code Blue: you need to resuscitate a person. Code Green, there was just this huge wave of financial difficulties in health care and health care reimbursement primarily in New York State because a system for assigning the payments called DRGs [diagnosis-related group] was now coming into the fore in New York State. So, what happened is that systems of care were no longer being reimbursed at the same rates that they were in the past and so of course, money becomes tight, money becomes constrained and so what happened during that period of time called Code Green - an author, Dana Weinberg wrote a great book about this - but what happened during that is many systems looked to make cuts in positions that were perceived to be indirect care roles. So, nursing education and CNS roles were prime for being cut, so basically my boss came to all of us who were CNSs and said “Look, you have to figure out a way to basically fund your own position if you're going to survive,” and it's grant writing. I certainly was generating some revenue because I was doing visits. I just thought to myself, they just really don't get it, and I was frustrated about this because so much of what it is that we were doing was having a huge impact particularly on young, inexperienced nurses at the point-of-service and keeping them there, making them comfortable in their role, and keeping them there. Across the country you saw this happening; they really sort of dismantled these education departments that were supporting nurses at the point-of-care and that's when we started to really see high attrition in staff nursing. It really just exploded after that. About the same time that this was happening, somebody called me and said “Oh my gosh, have you seen the local paper?” and I said “No, what's up?” They said “There's a position at Hartwick College that has your name written all over it. I really think you should take a look at it.” So I'm like alright, so I did. The position they were looking for a tenure-track faculty person with expertise in maternal-child nursing but also broad expertise, so I thought well okay, nothing ventured, nothing gained. I really was fairly new with the NP role. I also had applied for a position at the pediatric clinic in Oneonta, and was kind of toying with these things. This same friend said to me, “Look, tenure track positions don't come down the pike all the time. NP positions, they're going to be out there, so maybe just give it a try, see what you think.” I went into it thinking okay, I'll give it a year and see how I feel about it. I stayed there for 20 years and for the last 10-11 years that I was there, I was the chair of the department there. During my time there, I had the opportunity - I became a full tenured faculty member. I went back to school. I got my PhD in nursing and it is, interestingly enough, with a focus on rural health and healthcare policy. I finished that in 2003. I started it in 1998 and I received my doctorate in January of 2003, so about four and a half years. I really enjoyed teaching. I enjoyed the academic leadership, that was very interesting. I had a lot of great opportunities. My friend and I started a program called transcultural nursing. We started taking students to Jamaica and the West Indies to do public health for a month. It was a full immersion experience. I became a licensed nurse and nurse practitioner in the country of Jamaica and did public health there. I think I took a total of maybe 20 groups there, over a course of 18 years. I started the accelerated program at Hartwick for individuals with degrees outside of nursing who were interested in coming into nursing. I was very successful at grant writing. I grew the program. When I started as the chair of the program, we had somewhere around 125 students. When I left, we had about 280 students all totaled. Really fostered the partnership program with Bassett for RNs…

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JMH (cont'd):
…who had their associate degree, returning to school to earn their baccalaureate degree. I taught a good deal in that program and have many wonderful connections from that. But small liberal arts colleges are really suffering from the demographics - the demographic of students under the age of 18 is really shrinking and unfortunately, I would say many of my colleagues in the liberal arts setting doubted the president when she started talking about this and they were blaming the admissions staff, that they weren't doing their job well enough, and they were very resistant to changes I think that needed to take place initially. So, what ended up happening was the college became increasingly reliant on nursing to maintain their numbers. In the time I was there we went through like four different admissions VPs and they weren't always being very transparent about their plan. They would tell me, “Oh yes, yes we'll only bring in 60 students,” and then suddenly comes May 10th and you find out you have 110 new students and you're not staffed for that. It became a very reactive environment and I think just like anything, I just think I had had my fill of it. In the meantime some folks who were headhunters for a new dean at Binghamton approached me and I had a conversation with them, and I said, “I'm really not ready for this. This is kind of out of my league, but I do really enjoy academic leadership and keep me in mind - let me know about other things.” They basically tossed me three other options and I interviewed with these three other places and so suddenly I was at this juncture where I had had my fill and was sort of like, I don't know what else I can do to make this change. I've tried working within the faculty to make it change. I tried being part of this group that had proposed a number of different ideas to the faculty to think about some different ways in which we could bring in students or be more attractive to the demographic. I tried working with admissions. Nothing was working. I just was frustrated and in the meantime I had these other opportunities come my way. I had three job proposals, I had this one lousy meeting and I just walked out of there and said, “I think that's it. I think it's time for a change.” I ended up taking a position as the Director of Nursing at Castleton University, which is in the Vermont State College system. I started that in 2016. They were a program that was in transition, moving from being an associate degree program to a baccalaureate degree program. They needed to be accredited. They also had an RN to BS program that they were moving from being a face-to-face program into being an online program. I went there thinking alright, this a transitional kind of experience for me, but I think this is just what I need to do while I sort things out. So, I did do that; I got them through accreditation. In the fall of 2018 we had our accreditation visit. We came out with a completely clean bill of health. They had licensure examination, first time licensure examination pass rates that were in the 60th percentile when I first started there. I got them up to 93% first time pass rate. I mean this faculty, we really moved and grooved and did a lot of great things together and really did a lot of work around team building and creating cultures of inclusion and creating an accountability culture in which we really commit to one another and to what it is that we're doing so we had an opportunity to gel a nice team. Then in December of 2018, Castleton brought in a new president and she is somebody who is very entrepreneurial. Her real push is really in the area of online programming. She basically wanted us to suddenly boost up into offering master's programs and I felt like we just got through this, we kind of need to take a deep breath, do a read on things, and think about where it is that we need to go. But she's one of these “go-go-go-go” and I understand that and it's her place. At the same time, once again there had been some changes in New York State laws that occurred in the spring of 2018 that were communicated to us a little bit late in the game. We had been operating at the Glens Falls hospital in New York because Castleton is only like 15 miles away from the New York State border. We were doing some clinical work over there but basically, we had to do this whole Permission to Operate application to New York State - big report, like 200 pages, all these addenda, and everything. So, I'm talking all the time with the people who are in the Office of Professions and I knew somebody there and they were like, “What are you doing in Vermont?” and they said, “You know, Marilyn is retiring, and you should really think about this position. You'd be great for it,” so I was like “Alright, send me the link.” So, once again it was just like right place, right time. I looked at it, I looked at the position, I did a little searching around and said, “Yeah, that might be a good opportunity.” So, I just threw my hat into the ring and that was like on a Friday afternoon and on Monday morning they called me and said, “Can you come in and interview?” I went in and interviewed - I couldn't come that Monday - I went in and interviewed that Friday and they said, “We'd love to hire you.” So, then I just had to think about, “Okay, well where is the right transition time?” I went back and I talked to my team and we decided that I could get the semester off to a start, work off on the sidelines, get some reports done for them, and just serve as an informal consultant to the person who was the Chair - I was the Director to the Chair - and just transition. It was kind of the right time. There's no great time but it was the right time and so I transitioned into that in February this past year. So that's a long and winding road.

How did your experience at Beth Israel differ from your experience working in rural healthcare at Bassett?

Beth Israel Hospital is a Harvard teaching hospital. Bassett is a Columbia University teaching hospital but the relationship between Columbia University and Bassett, at least back then, was a lot more indirect than what I experienced at Beth Israel. Beth Israel was an urban setting. It's a Jewish hospital primarily; it was started to treat Jewish patients. It is a very well-endowed institution, very well supported institution, and of course right in the neighborhood of Beth Israel Hospital you have got, at the time, Boston University had a huge nursing program, you had Simmons College right down the street, you had Boston College, you had Northeastern University, you've got UMass. You have all of these universities that are nearby. It was, like I said, a magnet hospital. It was one of the first magnet hospitals and I think what the magnet organization has now realized, is that part of what makes the magnet hospital, a magnet hospital has to do with the education level of the nurses. It was an all baccalaureate or higher degree institution versus an institution at Bassett in which, on the floor, the majority of nurses, and this I think remains so to this day in central New York, the majority of nurses who are there, RNs, were associates degree prepared nurses. We also were working with LPNs who have vocational or technical training and we had nursing assistants. We had a system of primary care nursing at Beth Israel Hospital. In primary care nursing, you have a primary care provider so if you were a patient and you came to Beth Israel Hospital and you were going to be admitted they would ask you, “Who is your primary care nurse?” and you would be placed on a unit where your primary care nurse worked. You came to the nurses; the physicians moved around, so it was very different. The nurses had a good deal of autonomy over their practice. We were miles ahead in terms of developing standards of care that were evidence-based. We were doing evidence-based nursing a long time ago. We were already documenting in an electronic health record. So, if your patient went to Radiology or whatever, you could look up and at least see what the preliminary findings were - what are they thinking about. Nurses rounded with physicians; it was an expectation that you attended rounds and you were a member of this team, so it was very different. I think things were good at Bassett, but things were excellent at Beth Israel. Beth Israel was a leader - Bassett being a rural institution, even though I think rural institutions because they live on the margins can also be great catalysts for change, we didn't have the feeder educational institutions around there, we didn't have the staffing to do primary care nursing. We did, like I said, a hybrid of it - modular nursing. We tried to mimic and do what it is that we could. We had CNSs way back when at Beth Israel and they really came into the fore, I would say maybe in 1987-88 at Bassett. There were just differences, cultural differences there. I always enjoyed working at Bassett, I always felt like I had a good relationship with my colleagues there, but it was different. It just doesn't have all of the bells and whistles that you can have at a large urban setting that has a world-class reputation. We had patients coming in from all over the world to receive care from us. It was just a different kind of kind of place. I would say that the HR policies there were far more liberal. I think when you think about what it is that many times people are looking for when they're looking at a position and whether or not they want to stay, whether it becomes sticky for them has so much to do with work-life balance issues, particularly when you're talking about nurses, which still remains largely a female profession. To have a four-day work week, to have a 10-hour work day, to be given your sick time, your vacation time, your holiday time, basically you just accrued hours every week and you could use those hours anyway you wanted to. You could even cash in hours if you wanted to. There just were a lot of things there that were just, I would say a little bit ahead of the curve. That had a daycare center, they had things that made it a lot easier to work for them and I think you also felt like you were on the cutting edge of things. You felt valued for what it is that you brought to the table, you recognized that certainly for the most part, physicians were more educated than any of the members of the healthcare team, but everybody brought something of value to the table. Yes, it was still hierarchical. You could feel the power sometimes, the power differentials sometimes, but for the most part, I think nursing had a very powerful voice there. We had an amazing nurse leader there: Joyce Clifford. She was an amazing, very prescient leader - cutting edge. Everybody knew who Joyce Clifford was, and I had the amazing privilege of being able to take care of her after she had her surgery and be one of her nurses. It was just great just to have conversations with her about things. It was really wonderful. I think Bassett also was headed in this direction until we got derailed by Code Green and it hit every place including Beth Israel, but Beth Israel was so much further down the road that they just sort of stumbled, fell, regrouped, and came back at it. Versus we [Bassett] had not yet fully embedded the cultural changes into the infrastructure in such a way that we were able to move through that difficult period and retain some of the gains that we had experienced during what my friend refers to as the Camelot period.

Can you share a little bit more about your experiences as a woman in healthcare?

Sure, nursing has primarily and predominantly been a female-dominated profession since it became a profession in the United States and why I chose nursing, in some respects is because I really felt that nursing was so grounded in feminism. When I was in my undergraduate program, I initially went to college as a biology major, knowing I wanted to go into healthcare, not sure what I wanted to do. I was a really good biology major, I tutored everybody, I won the awards. I was good and I had my choices. I had the good fortune of babysitting for a family - the husband was a surgeon; the wife was a public health nurse. They would ask me, “Well, what are you going to do?” and I was kind of thinking physical therapy because I had been an athlete and I was sort of attracted to that and they were like, “Well you know, you really should do some dabbling.” They helped set me up to go and shadow different people in their roles and talk to different people. In hindsight, what a gift that was. I started looking at things and I started thinking, the nurses really have so much mobility. You can be a nurse and like myself, start out here and without having us to necessarily go back to school and re-up, become more educated, and do another internship, and a residence, and all this, you could shift into something else - like if you got tired of doing this. I met a number of different professionals whom, I really got this sense that after a while they felt boxed in and that the joy of what it is that they were doing was somehow lacking and that they were sometimes just going through the paces. Now that didn't pertain to everybody, but I just got this growing sense of that. So, that was one thing and then somebody said to me, “Well you should really take a look at the different philosophies of care and whatnot,” and I started doing that and then I started reading some of the nursing theories and philosophies and I was like wow, this is mind blowing. This was the first female profession in the United States. It's the largest profession. If you start looking at ideologically, nursing philosophy and feminism and you put them side-by-side, it's like they're talking the same language. We're talking about looking at people as human beings, as a whole being. It's not deconstructing them into their parts; it wasn't sort of that Cartesian dualism: mind, body, or soul - it was mind, body, and soul. It was really talking about looking at people holistically and philosophically an interest in helping people to reach their highest human potential and that just grabbed me, and I was like, this is, I think what I want to do. They didn't even have a nursing program at the school I was at, but I was in this physics class and the guy hands out this flyer and they say they're having this open house and looking at whether there was an interest in having a nursing program at Millikin. So I was like, “Oh yeah, definitely I'm going to go to this,” and so I went and the woman who came and spoke to us, who ended up being my dean, she was a former dean at the University of Pennsylvania. She was currently the dean at Illinois Wesleyan and she was one of the highest ranked military officers in the United States. This woman was somebody who - she had a presence and she just totally impressed me, and she was talking exactly to what it was that I was thinking about. I was like that was it; I'm sold. That's really how I ended up in nursing and so I think this notion of being a strong woman and being in a profession where I think you can be a strong woman was really appealing to me. At the same time, my sister was a lawyer and she was just experiencing horrendous things. She was clerking for a federal judge in Springfield, Illinois and I would go there on my breaks and I would sit in the federal court and I would listen and it was when Title IX was coming out. It was like all of these things happening. Things were changing for women at that point in time, and I think we started to see then the rise in women going into medicine. I came up in nursing at the same time that more women were going into medicine and I think that maybe because of that, I didn't experience a whole lot of oppression because I was a woman, but I think nursing as a whole continued to experience and probably to this day, still continues to experience, a certain degree of oppressed group mentality because nursing exists within a healthcare system that is dominated, and continues to be dominated by medicine. I can't tell you how many times I would correct papers that came from students where they would be talking about the medical care system and I'd say, “No, it's a healthcare system.” I would have to, for new nursing faculty, really talk to them a lot about the importance of not bending the curriculum completely to the medical model. You have to help them to understand what it is that they need to know about medicine in order to be able to function within the healthcare system and to function at a high level, but you also need to help the students to understand that nursing philosophy of care and have that as a foundation for what it is that they're doing and really use their liberal arts education to do what I think - you know, the ANA [American Nurses Association] talks about what is the phenomenon of nursing concern and they say that the phenomenon of nursing concern is the human phenomenon that is the result of a person going through an illness, an injury, or some form of developmental transition or crisis and that's where nursing's concern lies. When I care for a patient who has congestive heart failure, I have to understand the science that's behind it but that's biological science, it's not medical science, it's biological science, okay? I have to understand what it is that medicine wants to do, the diagnostics, the treatments, etcetera, and I have to do those things, but I also am the person who has to be concerned about this human being who fills a role in their family, fills a role in society, who is experiencing things like fatigue and distress and moral distress because they can't fulfill their role. We have to think beyond medicine and about that person in their entirety…

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JMH (cont'd):
who has this illness and is going through this experience. I think that particularly nurses who have been associate degree-prepared - that level of preparation is much more technical and so they go a lot more to the medical model and the beauty of the baccalaureate degree, the liberal education, is to really think about that experience a lot more broadly. I would say, if you are a person like myself who was working as a nurse in the healthcare setting and if you are able to speak to your patient's concerns, if you are good at what it is you do, if you are competent, you don't experience some of the same things that I would sometimes see happen to others. I would say that I would always try to work with the parties who are having difficulties to try and help them to understand each other's perspectives and value - what that person brings to the table. So, it's not so much being a woman that I would necessarily say that I would feel. It was more being a nurse. It'd be interesting to hear a male nurse's perspective. I think some males would say that they have it easier than females in the healthcare hierarchy because people make assumptions that they're physicians and with that, certainly comes certain privileges. We live in a society that is credentialed - we value credentialing. So, the person who has XY and Z behind their name automatically is treated a little bit differently than somebody else who has different credentials. It just is a fact of life and it's not just in healthcare; it's everywhere.

Well, that puts us at a little bit over an hour, so thank you so much for your time.

Yeah, you're welcome! I don't even think we hit rural - not so much, but that's okay.

Yeah, that's alright!
Upstate New York
Milford, NY
Emma Sarnacki
Cooperstown Graduate Program, State University of New York-College at Oneonta
Cooperstown Graduate Association, Cooperstown, NY
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