Nurses without borders

More than meets the eye

Think you know everything nurses (and nurses-to-be) do? Think again. This month, The POST takes you inside the world of nursing and introduces you to seven very different nurses.

The “baby catcher”

Jane Houston teaches students in the nursing simulation laboratory./Photo by Maria Belen Farias

Jane Houston, D.N.P., C.N.M., delivered her first baby in 1990 as a midwife student in her native Scotland. More than 2,000 deliveries later, Houston, a nurse-midwife, still strives to give expectant mothers the best birth experience possible.

“Your birth experience will be with you for your whole life,” said Houston, track coordinator for midwifery at the UF College of Nursing. “The way you give birth affects the way you bond with your child.”

Houston has more than 20 years of experience. After earning her midwife qualification in Scotland, Houston joined her sister, an obstetrician, at a mission hospital in Zimbabwe. Drought prevented the hospital from having more than an hour of water each day. Patients suffered from tuberculosis and malaria. Forty percent had HIV.

For four months, Houston worked in the labor and delivery unit, a single room with three beds. There were no drugs for pain, only general anesthesia if a woman needed a cesarean section. Houston remembers a day when the beds were occupied by women who already had nine or more children. Pregnant again, they went into labor at the same time.

“My time in Zimbabwe showed me not to be frightened of birth,” Houston said. “If there is a problem, you have to deal with it.”

After Zimbabwe, Houston worked as a midwife in New Zealand for three years before earning a nurse-midwifery degree from the UF College of Nursing-Jacksonville. She became the first midwife at North Florida Regional Medical Center, where she worked for eight years.

Houston developed deep bonds with expectant families. She knew their dogs’ names and could tell their voices on the telephone. Sometimes she delivered all the children in a family.

Houston now practices at Shands Jacksonville. On Wednesdays, she works in triage and labor and delivery, helping bring babies into the world.

About 12 percent of babies born in Florida are delivered by midwives, Houston said. It is a tight-knit profession. Houston knows all the midwives in the area. They call themselves “baby catchers.” Mothers deliver babies, Houston said. Midwives just catch them.

“It’s one of the most life-changing events, and I get to be a part of it,” she said. “It’s the best high, you can’t even imagine. I don’t have to take drugs — I get to catch babies.”
— Molly Larmie

In her mom’s shoes

Trudi Barry

She graduated with a degree in biology and a plan to attend medical school, but Trudi Barry soon realized she just wanted to be like her mom.

“She’s been a nurse for almost 30 years and still loves her job,” Barry said. “The fact that my mom still loves her job and hasn’t become desensitized to it stuck with me.”

As a student in the Accelerated Bachelor of Science in Nursing program, Barry is on her way to pursuing a career she knows she’ll love. The accelerated B.S.N. program is a 16-month intensive program that prepares students who already graduated with a bachelor’s degree in another field for careers in nursing. It’s an interesting but rigorous program, Barry said.

“It’s a lot, a lot of work. We’re taking master’s level classes that require papers and projects, and we have lab assignments due the day before clinicals,” Barry said. “The day before clinicals, we have to go and get our patient assignments and find out their diagnosis, why they’re in the hospital, the process behind their illness, what medication they’re on and why.”

B.S.N. students are placed into clinical programs in their first semester to learn from experienced nurses in a real hospital setting.

“It’s a little overwhelming to be in the hospital almost immediately into nursing school,” Barry said.

Barry graduates in December, a semester before other B.S.N. students do. She hopes to pass her boards and work as a pediatric nurse in a children’s hospital.

“Toddlers and young teens and kids are so full of energy, and when they’re sick I would do anything to make them feel better,” she said. “I’m goofy so I feel like I could get along a lot better with them than older patients.” — Mina Radman


The unexpected scientist

Barbara Lutz (right) works with members of her lab./Photo by Jesse S. Jones

If a woman is caring for her husband who has had a stroke and he can’t be left alone, how does she leave the house to get groceries and fill his prescriptions, let alone go to her own doctor’s appointments? These are the types of issues Barbara Lutz, Ph.D., R.N., A.P.H.N.-BC, thinks about every day.

An associate professor of nursing who joined the UF College of Nursing faculty in 2003, Lutz has spent more than a decade studying stroke caregiving and how it affects not only patients, but also their caregivers.

“The way the system works is this: We get paid to take care of the patient, and we look at the family as a resource to help the patient,” Lutz says. “Instead, we need to assess and address the caregiver’s needs and concerns parallel to assessing and treating the patient. Sometimes we end up creating a whole new group of patients with caregivers because they are so overwhelmed. They end up getting injured or not taking care of their own physical or emotional health.”

As a nursing student, Lutz never imagined she would end up a researcher, in part because she didn’t know what research could be. To her, research meant conducting and analyzing survey data. Her opinion changed when she met her mentor and qualitative research expert, Barbara Bowers, Ph.D., R.N., at the University of Wisconsin.

After spending the first part of her career as a public health and home health nurse, Lutz decided she wanted to teach, so she enrolled in a Ph.D. program. There she found Bowers, whose research was based on talking to patients and caregivers about their needs and perspectives and using the findings to change practice and policy. This work appealed to Lutz, who like many nurses, got into the profession because she wanted to help patients.

“Patient-centered care came out of qualitative research,” Lutz says. “How do we know what patients’ preferences are if we don’t ask them? We need to listen to them to learn what is important.”

Lutz’s current study focuses on caregivers of stroke patients and the difficult transition they make from inpatient rehabilitation care back to the home. Caregivers and patients often face a second crisis when they are sent home, becoming overwhelmed by the changes and new responsibilities. She and her team are developing tools to help hospitals and rehabilitation centers better assess caregiver needs and link them to resources for help.

“The caregivers want to provide care,” Lutz says. “But they need help figuring out how to be caregivers without becoming overwhelmed and causing their own health to get worse. As health care providers, we need to learn how to support them through this process.” — April Frawley Birdwell


The next level of nursing

Allison Bruner/Photo by Maria Belen Farias

Even as an undergraduate in the UF College of Nursing, Allison Bruner knew she wanted to go into advanced practice nursing. She liked the idea of not only assessing her patients and helping them recover, but also developing relationships with people and preventing them from getting sick in the first place.

“I like the relationship you establish in advanced practice. It is a drawing factor to me to be able to see people throughout their lifespan,” Bruner says. “I felt like I could make a difference for people.”

After earning her bachelor’s degree in 2006, Bruner spent a few years working in Washington, D.C., before returning to UF to pursue her Doctor of Nursing Practice degree in 2009. Her experience as a nurse helped her learn what she didn’t want to do — work in a hospital — as well as what she did — outpatient care, primarily in family practice or dermatology. It also gave her a nurse’s-eye view for what she learns in her classes.

The D.N.P. is a relatively new degree — UF graduated its first class of postmaster’s D.N.P. recipients in 2009 — and is geared toward producing doctoral-level nurse practitioners focused on developing and implementing the highest levels of evidence-based care. This spring, Bruner will be part of the first class of B.S.N.-to-D.N.P. graduates — those who entered the program with a bachelor’s degree and will now receive their D.N.P.

As part of the program, students work on an in-depth project studying a clinical issue. Bruner focused on how nurse practitioners assess patients for vitamin D deficiency and what recommendations they offer for supplementation. She chose the project after noticing that many providers were adhering to different practices, some not assessing patients at all and others recommending patients take too much of the vitamin.

It was good practice for something she will be doing for the rest of her career — finding a problem, reviewing the research and making a change to help her patients.

“I think advanced nurse practitioners are going to be even more in demand than they are now. We need more health care providers and there are a lot of people who need care across the country,” Bruner says. “I think it is going to be an in-demand and growing specialty.” — April Frawley Birdwell


The leader

Patrice Jones

It started in first grade, when Patrice Jones, R.N., M.S.N., played a nurse in the school play.

It was a role that fit her well.

“The rest of my life, I never thought about doing anything else,” she said.

Throughout her three decades at several Alabama hospitals, first as a staff nurse and later as an administrator, Jones found that patient care was the favorite part of the job.

Now, in her new role as vice president and chief nursing officer at Shands Jacksonville, Jones, 54, said her focus is on taking care of the needs of her staff so they can take care of their patients. Jones started her new job March 5.

She first learned customer service as she was growing up and pitching in at the family grocery store and has carried that same philosophy and focus into her 30-year nursing career.

Jones is reliable, leads by example and excels at bringing a team together, said Bill Cassels, administrator for DCH Regional Medical Center in Tuscaloosa, Ala. Jones was chief nursing officer at the hospital when devastating tornados tore through Alabama last year.

More than 800 patients were treated in the emergency room, even though the hospital was running on emergency generators and cell phones weren’t working.

But they never ran out of supplies. And the staff never stopped working. Not when word got back that some hospital workers lost their homes. Not when they found out that one hospital employee lost his life.

She had pride in what the hospital did for the community and what the staff did for each other.

“We took care of each other, she said. “We didn’t wait for the federal government.” — Mary Kelli Palka


A call to the heart

Dan Hendrix/Photo by Maria Belen Farias

Dan Hendrix, A.R.N.P., A.C.N.P.-B.C., F.N.P-C., is not your average nurse practitioner on your average Cardiac Intensive Care Unit.

He and his fellow nurse practitioners and physician assistants with the UF department of thoracic and cardiovascular surgery enjoy a level responsibility, autonomy and independence that is rare in their field of nursing. Managing as many as 37 patients at one time on the Shands at UF CICU, Henrdrix often works 14- to 16-hour days at a nonstop pace — rounding, assessing patient needs, formulating treatment plans and responding to patient-related pages and phone calls.

“We are responsible, in collaboration with physicians, for the 24-7 medical management of patients,” Hendrix said. “For the majority of the day, we’re the people here to deal with whatever issues come up. We’re responsible for directing and providing care because our physicians have become comfortable and confident in our abilities.”

Hendrix, an alum of the UF College of Nursing, came to the CICU six years ago. But he has been a nurse with Shands for 24 years, which included some work in emergency medicine with ShandsCair. He enjoys caring for patients on the CICU because he is able to build relationships with them through the course of their stay at the hospital.

“You become invested and want to see that you are helping someone to improve and recover and ultimately have a better quality of life,” he said. “I also like that we get to do a lot of precepting with the UF College of Nursing. As an academic institution we have a unique opportunity to pass the torch and continue to teach individuals. I was blessed to have great mentors in my career, and I wouldn’t be where I am today without those individuals.” — Allison Wilson


Health of a population

Christa Cook/Photo by Jesse S. Jones

Christa Cook, M.S.N., looks at the big picture.

This mentality sparked her interest in public health nursing. Cook, a Ph.D. candidate in the College of Nursing, was more interested in how nurses interact with the whole population as opposed to solely the individual.

“The main focus (of public health nursing) is health of the population and community,” Cook says.

Public health nursing covers a wide range of topics, including health advocacy, care management issues and school health screenings, but Cook’s specific area of interest and research is in the HIV community. Her focus is getting people from testing to care.

She interviews HIV patients who sought care early, who never sought care and who delayed care to help determine what may help patients seek help sooner.

“People in care tend to have less risky behaviors,” Cook says. “If people are in care it is better for the whole population.”

The goal is to determine what nurses can do to facilitate the health care process.

“We’re trying to establish the science of what works and how to best carry it out,” Cook says.

There are many ways to approach public health nursing, Cook says. She enjoys the diversity of the field.

“In training you are given a toolbox,” Cook said. “The toolbox is really big and there are many ways to look at issues and problems. It’s very creative, overwhelming, exciting and fun.” — Allyson Fox