By Barbara Peters Smith
Sarasota Herald-Tribune
SARASOTA, Fla. — Whatever tugs a person’s heart and soul into the nursing profession, it’s clearly a highly individualized call.
Lisa Cherry was working in a factory when her mother died of cancer. She was not impressed by the care her mother received. “So I got into nursing to care for others,” she says.
Kim Hagan ran a housecleaning business, and some of her elderly clients had home health nurses who “treated them very poorly,” she remembers. “So I literally went to school to learn how to take care of them.” Now, among her fondest memories is the oncology patient who would bring her a bedpan full of roses every year, long after she nursed him through his recovery.
From the age of 7, Martina Giquinto absolutely knew what she wanted to be when she grew up — despite her mother’s urging that she become a teacher. In her native Ireland, nursing schools were hard to get into, so she applied to a U.S. recruitment program in New Jersey. There were 1,500 applicants, and she was one of the 15 accepted.
When she joined the profession 27 years ago, Giquinto says, it was a different world: “The older nurses wanted you to work to be there; you had to prove yourself. And when I started, when the doctor walked in, you got up and gave him your chair.”
Now, registered nurses not only earn respect as knowledgeable members of the health care team, they are so highly valued that they can pretty much work when and where they choose. And with baby boomer nurses retiring in waves — to become part of the largest patient population of older Americans ever — economists predict a daunting demand for 1 million new nurses over the next 10 years.
“Some forecast that this could be the worst nursing shortage that we’ve ever had,” says Jan Mauck, former chief nursing officer for Sarasota Memorial Health Care System and co-founder of the Suncoast Nursing Action Coalition. The nonprofit partnership of regional educators and employers has been working for five years to boost the supply of registered nurses in this part of Florida.
Hospitals and other providers are not only looking for more nurses, they’re looking for more thoroughly prepared ones. Already in some states, a bachelor’s degree is part of the basic requirement to become a registered nurse. As the job description becomes increasingly sophisticated, more nurses are also getting their master’s and doctorate degrees.
One reason: Even before a nurse enters the hospital room, patients and their families have done their homework online. They have hard questions.
“We live in a world now where our patients are so smart and so well-educated that there definitely is a need for taking the time to do the teaching, and meet the standard that they expect from us,” Giquinto says. “But by the same token, you have to never lose sight of making a connection with your patient. What they really need from us is that touch, that connection.”
Giquinto is director of the emergency room at Doctors Hospital of Sarasota, where her team includes Cherry and Hagan. So committed are these three nurses to their mission that three of their children have followed their examples — and also work at Doctors Hospital. While two-generation nursing pairs at the same hospital are not unheard of, health care specialists agree that three at one facility is probably exceptional.
Giquinto’s son, Dan Giquinto, a certified nursing assistant in the hospital’s progressive care unit, is the second of her children to work in health care. Cherry’s daughter, Jicelina Cruz, became a licensed practical nurse right out of high school, and now works in orthopedics. Hagan’s daughter, Michelle Hagan, trained as a paramedic and now is enrolled in nursing school.
Kim Hagan started working in long-term care when her children were small, continuing her education along the way.
“When she worked at the nursing home, my brother and I would go, and loved it,” Michelle Hagan remembers. “The stuff she was doing at home, she was doing to people we didn’t know — it was the same hugs, the same touch that made people feel better. So I started in middle school volunteering at the nursing home she worked in, and just stuck with it.”
Dan Giquinto also began as a volunteer, logging about 600 hours at Doctors when he was in high school. Just before he was born, he says, his father suffered a brain aneurysm and was not expected to survive. This inspired his admiration for health care professionals, he says, and his mother’s example finished the job.
“The best thing I ever got from her was her work ethic,” he says. “She’s so passionate about it, so that had a real effect on me.”
Cruz wasn’t as easily sold. But her mother prevailed.
“It was a deal,” she says, laughing. “I wanted to be a cosmetologist. She said LPN school; just do it, and if you don’t like it I’ll pay for cosmetology school.”
Now, Cruz says, she’d rather be doing this than hair and makeup.
“I know the families get very stressed out, and I like knowing I can help,” she says. “No matter what the situation is, I can tell them, ‘Just go home; get some rest; we’ve got this’ — and just put that ease on their faces.”
Fixing the bottleneck
Just as so many different reasons exist for being a nurse, there are widely diverging paths to the various licenses and degrees. The Suncoast Nursing Action Coalition employs a nursing education navigator to guide students through the maze. Now that local schools are offering four-year nursing programs to high school graduates, Kate Garber has been reaching out to those who might consider a career in health care. But about 65 percent of the people she works with are already nurses, pursuing further education.
They return to school not to land a job, Garber says, but to grow in their profession.
“Any nurse I know of who wants to work is working,” she notes. “I see interest from anyone who wants to become a nurse practitioner or change specialties. A good number of the nurses I deal with are going for their bachelor’s degree because the facilities they work for are starting to require a baccalaureate.”
SNAC was formed in 2013 to raise nursing skill levels in Sarasota, Manatee, Charlotte and DeSoto counties. It followed the publication in 2010 of an influential report from the Institute of Medicine, “The Future of Nursing,” mapping out how the profession needs to change as America ages and the health care system grows more technologically complex. Specifically, the report set a lofty goal: 80 percent of all U.S. registered nurses should hold bachelor’s degrees by the year 2020.
In 2015, the halfway mark, only about 55 percent of RNs met this qualification. Florida lagged behind, at 45.6 percent, and this four-county region had only reached 33.5 percent. SNAC has a declared target of 60 percent by 2020, and has awarded $214,000 in scholarships so far.
Those scholarships have been aimed not just at nurses seeking a college degree, but at experienced professionals who need graduate degrees in order to teach others. A nationwide shortage of faculty members has hampered the growth of accredited nursing programs, with the result that more than 56,000 qualified applicants were rejected in 2017. Locally, the problem has been compounded by a lack of options for working nurses who want to complete their studies without long commutes to Tampa or Orlando.
Working with SNAC, five regional institutions have expanded their programs and broadened access. The new four-year nursing baccalaureate launching this fall at the University of Florida Sarasota-Manatee would appeal more to high school graduates seeking a traditional university degree, Garber says. But others, like State College of Florida’s “BSN in Four” offering, allows students — often mothers of small children — to get their RN license and work while they complete their education.
“This layered approach allows them to have an earning potential,” she says. A registered nurse makes an average $65,000 a year in the Sarasota area, she adds, and many employers offer tuition reimbursements: “That’s a chunk of change to help them get through school and achieve their goals and even out the cost effects on the family.”
And the word is getting out. SCF, with the region’s largest nursing enrollment, is processing a record 500 applications this year, says Rosalie Fairchild, dean of nursing and health professions. The push for baccalaureates, she adds, is a positive development.
“We want our nurses to be able to translate evidence into practice,” she says — “rather than, ‘This is how we’ve always done it.’”
Fairchild cites studies showing that hiring more nurses with bachelor’s degrees translates into lower mortality rates. And she sees this elevation of standards as part of a culture change in a workforce traditionally populated by women. It started, she says, in the early 2000s, with a national initiative that stressed the importance of a “healthy work environment” for critical care nurses.
“Nurses need to feel like they can work that authority gradient” — the established hierarchy for decision making, long dominated in hospitals by medical doctors — “so we can all listen to each other and everybody’s a valued member of the team,” says Fairchild, who began her career in critical care. “If you can’t get through that glass ceiling and reach above it and be heard, then you’re going to bicker and fight among yourselves.”
A huge responsibility
Kim Hagan has been nursing long enough to remember those tensions, and is glad it’s something her daughter doesn’t have to face.
“When I first started, nurses ate their own,” she says. “I’m not sure how I made it through my first year on the unit; it was mean. If we treated each other like that, we were probably treating our patients that way too, with an underlying snideness that doesn’t belong in our profession.”
Now, she adds, with a growing emphasis on patient-centered care, hospital staffers have evolved from a top-down, military chain of command to a team approach.
“The physicians, they’re our colleagues; they’re not the guys telling us what to do,” Hagan says. “The guy in the bed is who’s leading the program now.”
Lisa Cherry is pleased her daughter is proving a natural in the profession, having gone into it with her eyes open to the downsides as well as the rewards.
“Growing up, she never liked the 12-hour shifts,” Cherry says. “By the time I got home, it was homework-shower-eat-bed, we’ve got to get going for tomorrow. And let’s talk about the holidays: My kids don’t know Thanksgiving on Thanksgiving, Christmas on Christmas; we’d do it the day before or the week after.”
Giquinto remembers those floating holidays, but also recalls the way nurses in a unit looked after each other’s children or covered each other’s shifts. For her, the greatest privilege of nursing comes in the intimacy of patients’ life-and-death experiences, like “watching a mom lose her child, and just being there.
“You can’t even remember what you said or did after that moment,” she continues, choking up. “But knowing that I was there, and that I was unselfish for just that moment, and was with her — that’s a huge responsibility.”
Copyright 2018 Sarasota Herald-Tribune