Erie Nurses: The Scope of Compassion

By: Jonathan Burdick

Florence Nightingale is often credited as the pioneer of modern nursing. This is with good reason. Her Victorian Era practices in the nursing field were innovative and widely influential throughout the 19th century. She emphasized sanitation, helped transform patient care, and was essential to the professionalization of the nursing field with nursing schools. Her almost mythical identity during the Crimean War as "The Lady with the Lamp" further cemented her legacy during that time.

Even for Nightingale though, there was almost something unexplainable, something enigmatic about being a nurse.

"[T]he very elements of nursing are all but unknown," she wrote in her 1860 book Notes on Nursing. "[Nursing] has been limited to signify little more than the administration of medicines and the application of poultices," she further wrote, but such a portrayal, she argued, barely scratched the surface of the magnitude and complexity of a nurse's actual duties.

A nurse is not just an administrator of medicine, but a manager, an observer, an advocate, an educator, an expert in sanitation, an ear for the patient, a remedy for boredom, a regulator of noise and temperature and lighting and ventilation, a confidant, a dietitian, a decision-maker, an improviser, and so much more.

While some of Nightingale's suggestions are amusingly outdated (this was the era dominated by miasmatic theory, after all — the belief that disease was spread by bad air), the essence of her guide still rings true: nurses have an overwhelmingly multifaceted job and the care provided and needed differs with every patient.

"The field of nursing has grown exponentially over the last several decades and is one of the most recognized and respected professions," says Shannon Menendez, a registered nurse at UPMC Hamot who works with post-partum mothers and infants. "Nurses are highly trained medical professionals. We do not just carry out doctor's orders but are the primary connection between intervention and outcome."

She elaborates that nurses assume multiple roles every shift and have an extensive amount of medical knowledge to ensure that all orders — from doctors or otherwise — are appropriate for, and will not cause harm to their patients.

Menendez's passion for her job is evident — but becoming a nurse wasn't always her plan.

"Nursing had never really crossed my mind as a career choice until I unintentionally got pregnant my freshman year of my undergraduate degree," she says. "I was only 18 years old, trying not only to navigate college life, but also figure out who I was as an 'adult' on my own. I was incredibly overcome by the unfamiliarity of prenatal care and terrified of the various possible outcomes of childbirth."

Throughout it all, she was amazed by the compassion and care of her nurses.

"[M]y nurses were the ones who listened to my concerns and advocated for my care, who acknowledged me as a person of importance and not simply a diagnosis or chart, and who reassured me that no matter what happened, they would be there every step of the way," she says. Being a new parent, particularly a young new parent, can be frightening and overwhelming and confusing, but it was her nurses who helped her feel strong and secure. "That is why I became a nurse — so that on someone's absolute scariest day, in moments of unfamiliarity, anxiety, and helplessness, I can be there to advocate, to save a life, hold a hand, lend an ear, and bring reassurance that no matter what, I'll be there every step of the way."

Nurses, of course, also work outside of hospitals. They're employed in offices, correctional facilities, schools, homes, assisted living facilities, the military, and more. The care they provide is equally diverse from critical care nurses working in ICUs, to neonatology nurses working with newborns, to those who work in emergency rooms or rehabilitation centers or even in public health positions. All require a considerable amount of skills and knowledge.

Dr. Daniel Eaton is a Doctor of Nursing Practice and an RN in Erie. He and his wife Tracy are both in the nursing field, but nowadays, he works as an assistant professor at Penn State Behrend and the Penn State College of Nursing. While much of his day revolves around the academic side of nursing, he still works clinically at Safe Harbor Behavioral Health of UPMC Hamot as a mental health nurse.

He first entered the medical world as an EMT. He loved the job, but also desired to make more of a human connection with patients. He has a calm and compassionate demeanor, perceptible the moment one meets him, and since he has never minded flexible schedules, long shifts, or the inevitable exposure to bodily fluids, nursing seemed a natural next step.

"As a nurse everything you do has the ability to impact someone's life," Eaton says. "You literally have the life of another person in your hands."

He notes how nurses, in making those human connections with their patients, often notice "the little things." Noticing these little things can prevent something minor or seemingly insignificant from turning into a bigger problem. This has made for some of Eaton's more memorable moments over the years.

Ashley Peters has been working for two years as a medical-surgical nurse at Saint Vincent Hospital. She agrees with Eaton's sentiments.

"The most rewarding parts of being a nurse are in my patient interactions. I meet some incredible people fighting tough battles against their bodies every day."

Such human connections tend to be a common denominator among nurses.

"Sometimes I laugh and cry with patients and their families," Peters adds. "Patients and family members often leave us treats and cards after their stay. I love and appreciate them."

Eaton feels similarly. "I have had many patients talk with me about things in their lives that have happened to them that they have never told anyone else," he adds, explaining that communication and trust are an important part of being a mental health nurse.

Peters enjoys building trust with her coworkers and calls nursing a team sport — not just with each other, but with everybody in the building from the doctors to the aides to the secretaries to the kitchen staff.

"We rely on each other to keep patients safe. I'm one person and I can't be in all places at once," she says. "My coworkers are my eyes and ears when I'm super busy with another patient."

Eaton explains that a nurse must be a leader and be able to work under pressure, but teamwork is also key. In his case, as a mental health nurse, he coordinates the care of each patient, usually eight in any given shift, working closely with nurse practitioners, advanced practice nurses, psychiatrists, therapists, and crisis workers. He administers medications, monitors their physical and mental health, and educates his patients: about their medications, their diet, their health, diagnostics, and available community resources.

"Clinically when I work, the most challenging thing is trying to do too much with too little," Eaton says, noting that nurses often have a substantial amount of responsibilities during their shifts, including at times having to take care of too many patients.

Working with post-partum mothers and babies has its own set of challenges. There is no typical day for Menendez, who spends her shifts ensuring that both baby and the mother are in stable condition.

"Any given hour includes passing medication for pain and other comorbidities, making various calls to my interdisciplinary team to better manage my patient's care or if complications arise, teaching a new mom how to breastfeed or pump, pulling out a Foley catheter on a post C-section mom and walking her to the bathroom for the first time, ordering food for a patient who doesn't speak English, scoring and comforting a baby who has Neonatal Abstinence Syndrome, educating parents and family members about postpartum and newborn care, answering call bells, discharging and admitting new patients, completing state procedural testing, prepping an infant for a procedure, or simply sitting and feeding a baby for a mom who is completely exhausted from labor and just needs to sleep."

It's exhausting merely reading such a list of responsibilities. There are numerous other challenges in the field too.

There is also the emotional stress of working in such high-pressure situations — along with the unavoidable traumas. Christine Simmons (RN CRNI), who works at St. Vincent Hospital, has been in the field for 37 years. She agrees that the hours are tough, but she points out that even more difficult is watching people suffer.

"I wish people outside of the medical field would realize that nursing is not only physical, but also emotionally stressful," she says. As a result, the most rewarding part for her is simply making them feel better, whether long-term or short-term.

Menendez equally understands this emotional toll. "The hardest thing about being a nurse is knowing that at the end of the day, you are only capable of doing so much for your patients — even though you want so badly to fix everything for them," she says. "As a nurse you really see how unfair life can be … [W]hen we walk out of those doors and go home to our families, a small part of that heartache and worry stays with us."

Sometimes the challenges also come from elsewhere, such as when their career is politicized. In recent days, a video went viral of a state senator out of Washington arguing against a bill that would require hospitals to provide nurses with uninterrupted meal and rest breaks.

"I would submit to you that those nurses probably do get breaks," State Senator Maureen Walsh stated on the Senate floor. "They probably play cards for a considerable amount of the day."

Walsh's comments unsurprisingly received significant and deserved backlash — and inspired some comical poker-themed memes shared by nurses — but thankfully, her views are the exception. For the 17th year in a row, nursing was ranked in a Gallup poll as the most trusted profession in the United States.

Eaton points out the same poll and points out his obligation to live up to that reputation. It's part of what interested him in the educational side of the field. He teaches both clinical and theory courses and is actively involved in research and publication, where he has a particular interest in empathy.

"As a professor, I get to make an impact on my students and, in turn, impact the lives of many patients," he says. "I want to develop nurses who are not only able to display strong clinical skills, but also skills that can make a true difference in patients' lives. I can teach anyone to start an IV in a short period of time. It is the skills like caring, empathy, and clinical reasoning that are harder to develop. However, this is the difference between a good and a great nurse."

As for Simmons, she made sure to model herself after a great nurse: her own mother. "I became a nurse because I wanted to be just like my mother," she explains.

Her mother, Joan Trohoske, is one of those great nurses — or perhaps remarkable is a more appropriate word. After 60 years on the job (that's not a typo), she has no plans of retiring from UPMC Hamot.

"I have been a nurse for 60 years and knew that's what I wanted to do from the time I was a very little girl," Trohoske, now 81, says. "Every year for Christmas I would get a new nursing kit because I wore out the one from the previous year. My mother would make me paper nursing hats and I was always playing nurse."

Like the others, she's well-aware of the challenges, such as long hours — but in her case, the challenges have also included living through the decades of "ever-changing technology." Throughout it all though, her most rewarding moments remain the same: simply knowing she's made people feel better.

What would Trohoske tell someone new in the field? "[The] advice that I would give to someone just coming out of nursing school would be to not ask someone to do something that you would not do yourself." Her daughter would advise a new nurse to always smile and remain compassionate, two simple gestures that can go a long way.

Eaton echoes their advice. "We have to try to understand what people are going through. The healthcare environment can be a scary place and patients might not know what to expect. As a nurse, I have the ability to make a difference and make the experience a little bit easier."

"We play an enormous role in the quality of care [patients] receive," says Menendez. "They confide and trust in us during their most vulnerable moments, put their lives in our hands, and for that, it is our greatest honor to be a nurse."

"It is really hard to be a nurse," Eaton concludes — and yet, it feels like an understatement. "Not everyone can do it."

I think Florence Nightingale — and, well, anybody who knows a nurse — would agree.

A special thanks to each of the nurses who took the time out of their busy schedules to answer my questions and to Linda Trohoske for connecting me with her mother and sister.

Jonathan Burdick runs the historical blog Rust & Dirt. Follow them on Twitter @RustDirt, and on Instagram @RustandDirt.