USD’s MEPN students are becoming experts in the art of empathy
Wisps of clouds skitter across a cerulean sky. A sweet breeze brushes past. Birds trill their summertime songs. But Frances is too busy working her upper arms to pay attention to any of that.
“Elbows together,” she instructs Alice Howe and Amanda O’Keefe. “Now stretch.”
Her smile resplendent beneath a floppy white sunhat as she leads the water aerobics session, 80-year-old Frances is likely slowing down her routine for the benefit of these nurses in training. After all, even though they’re at least 50 years younger, they’re just in the pool with her on Tuesdays, and don’t necessarily have the moves down pat. Frances likes to get in at least five days a week for one simple reason: “I feel sooo good afterwards,” she beams. But time to get back to work. “Now circle rolls,” she says, illustrating the proper way to roll one’s shoulders. “Notice when you do the tricep curls, it should feel light coming up, heavy going down.”
Magenta and scarlet bursts of bougainvillea are in full bloom on this perfect summer day. Neatly kept balconies overlook the pool where Frances continues to show Howe and O’Keefe how it’s done. Of course, they, in turn, are also monitoring Frances, making sure that she’s stretching properly, that her breathing is regular, that she’s staying hydrated. Because even though splashing purposefully in a pool is great fun, these USD nursing students are hard at work, and there are many, many miles to go before they sleep.
The Master’s Entry Program in Nursing (MEPN) at USD is a highly competitive, accelerated program that admits around 50 students each year. Students enter with an undergraduate degree in a major other than nursing. While some have degrees in relatively expected fields (neuroscience, biology), others have arrived at this juncture in their lives via more surprising paths (political science, fine arts). After an intense five semesters, they are prepared to sit for the exam required to become a registered nurse, as well as graduate with a master’s degree.
“What’s terrific is that our students come from so many different backgrounds,” explains MEPN Clinical Placement Coordinator and faculty member Kathy Marsh, MSN, RN. “We’ve had an airline pilot, a priest on leave, a videographer. And our students want to be here; these are good students who know how to study. They come into the program with a sense of purpose.”
Motivation is key, because the program kicks off at a dead run and doesn’t slow down for the next two years. “Basically, they start with boot camp,” says MEPN Coordinator and Associate Professor Susan Bonnell, PhD, APRN. “By August, they’re assessing patients, and by September they’re working in the hospital doing acute care.”
Last summer, the course of study centered on “care of the family.” Groups of eight were paired with a clinical faculty member; these small groups would visit a particular site at least once a week in order to build rapport and assess clients.
“We like them to stay at the same site in the fall,” explains Bonnell. “At the end of two semesters with one population, they’ve learned so much. It’s great for their résumés, and for the clients as well.”
Students spent one eight-hour shift per week in site rotations that include the retirement community and health center Las Villas de Carlsbad, Rachel’s Women’s Center shelter and Bayside Community Center. “We tell them, ‘Look. You’re a nurse. It’s time to give back to your community,’” says Marsh.
But while outreach throughout the region around USD is a staple of the program, Marsh and Bonnell share a definition of community that includes much of the globe and the entire human family, and they practice every last bit of what they preach.
Case in point: Last year, Marsh traveled to Haiti for a week with her cardiologist husband. The couple spent a week volunteering at a hospital not far from Port-au-Prince helping earthquake victims as well as treating victims of a sudden cholera outbreak. And naturally, while there, Marsh scouted the area as a possible site for USD students to gain clinical and volunteer experience. Apparently, it was a good fit; the plan is for students to return with her to the region in early January 2012. That same month, Bonnell plans to lead a group of students to the Dominican Republic; there, they will work at a clinic treating patients from extremely isolated areas.
“The mission is to increase cultural awareness,” Bonnell says, leaning forward. “The students learn, firsthand, what poverty means in a third-world country. Often, what they’re struck by is how the people take care of one another.” She pauses for a moment, thinking. “It’s interesting for the students to learn how Americans are seen elsewhere. Often, other people see us as people that have everything and can do everything. Everything, that is, except create relationships well.”
While all four members of the Rat Pack are delighted to see MEPN site leader Nadine Kassity-Krich, it’s the dapper Herb who beams the brightest when she sits beside him. “I don’t care where I sit, as long as I can see you,” he says.
The group’s nickname was inspired, admits Kassity-Krich. Once she dubbed them the Rat Pack, as a result, “they always seem to be out together.” This is exactly the kind of outcome she hoped for; in general, older men tend to be less social and to self-isolate, but these days, the Rat Pack travels en masse.
Like many residents of Las Villas de Carlsbad, Herb, Richard, Allen and John are well-accomplished, dapper and seemingly delighted by the activities that the MEPN students lead each Tuesday. Kassity-Krich says that one of her main goals is to engage the students in truly compassionate care.
“I’m trying to impart to them that a nurse is more than a technician. Yes, these students are very motivated, but they start out, in general, very procedure-focused, which is how I started out in my career.” She can relate, having spent a number of years working in the neonatal ICU, but she says that there’s a lot more to nursing than running down a strict procedural check-off list.
“Look, if you don’t have compassion and connection, you won’t have healing. It’s not just about the cure. In fact, with geriatric patients, curing is not really on their mind. What’s important is the human connection. How do you gain trust? How do you speak to this age group? What do you talk about?”
Kassity-Krich believes that the experiences these MEPN students have with this population will resonate throughout their careers. “Whether you’re working in the ICU, the OR or trauma, you’re going to get geriatric people, and the procedures will go much better if you have a connection with them.
“One of my students asked me, ‘Why are we leading the activities? Why aren’t we just observing?’ I told her, ‘It’s because you’re becoming leaders.’” The students rotate through the activities; one student pointed out that not everyone is good at everything. “Some of these aren’t my forte,” she told Kassity-Krich, who responded, “Exactly. You’ll find, in your profession, that you sometimes have to lead things that will be challenging. That’s part of being a professional.”
The living room at Las Villas de Carlsbad is a pleasant place to congregate before lunch; that’s where nearly two dozen residents are gathered to listen to MEPN student Alice call out clues for “Trivia of the ‘70s.” They’re scattered about — some in wheelchairs, some perched on wingback chairs, some on one of the couches, most participating, engaged, alert. While it’s a bit disheartening to hear Alice admit that she’s too young to have ever actually seen “The Waltons,” residents say that the MEPN students definitely liven the place up.
“They’re just darling, every one,” says silver-haired Ida. “I find them very sincere,” says Rat Packer Richard. “They seem to like this age group.”
“It takes a special person to be with older people,” agrees Herb. “Just like it takes a special person to be with babies.”
“The dogs are coming in,” remarks Richard. He has a bag of treats he keeps ready for this weekly visit from the “Love on a Leash” organization. While the residents brighten as they watch dogs doing tricks, pat dogs presenting their bellies or gently place tiny dogs on their laps, the MEPN students are circulating, checking blood pressures, gauging hydration, assessing dynamics, and just watching, making sure that all is well.
Clearly, it takes a certain kind of person to pursue a career in nursing. People like Carrie Clausen, who entered the program with a BA in education ministries from Seattle Pacific University, for example.
“I got interested in nursing when my dad got sick with cancer,” she explains. “I was in the ICU with my mother and I looked at the nurses and thought, ‘I could do that.’”
Now that the group’s halfway through the intense, accelerated two-year program, they’re accustomed to a schedule that’s crazy busy. In addition to their other classes, Professor Lynda Puhek’s site rotation group last summer alternated visits between Linda Vista’s Bayside Community Center and downtown San Diego’s Rachel’s Women’s Center, a shelter for homeless and battered women. While they all rave about the program itself, there is an undeniable laser-like focus on the end game.
“I came into this program because I wanted to be a nurse, fast,” explains Jaime Omens. “I’m ready to get out of school and get on with my life.”
Fellow student Frank Bisase — who comes to the program from a background that includes an undergraduate degree in fine arts as well as a stint as an aviation helicopter technician in the U.S. Navy — seconds that emotion. “I was looking for the fastest way to get an old man like myself started in a new career,” he says. The 60-year-old, who was born in Kampala, Uganda, ultimately wants to return to Africa and put his nursing skills to work.
But for now, like all of the students, he gets great satisfaction from working directly with the local community, although the work comes with challenges. Case in point: many of the women at Rachel’s Women’s Center are understandably skittish around men. “As a male nurse, it can be challenging,” admits Bisase. “Most of them are battered women, and their image of the male figure is therefore different. Hopefully by going in as male nurses, we can break that barrier down, and perhaps instill more confidence in them as they come to trust us.”
“Being at Rachel’s Women’s Center is very humbling,” says fellow MEPN student Deborah Almazan. “A lot of these women were professionals. At any given second, that could be one of us.”
“It’s a safe zone for women,” explains Puhek. “The center is primarily for those who’ve obtained jobs, for women who are trying to pull themselves up.”
It’s late afternoon of yet another sunny San Diego day, and the group has gathered at a long table in the courtyard patio of the Hahn School of Nursing and Health Science to discuss the day’s work behind them and the week’s work ahead.
“I’ve volunteered with the homeless and in soup kitchens in the past, and I’ve really noticed a positive energy at Rachel’s Women’s Center,” says Clausen. “The staff makes sure to guard their safety and will not reveal who’s inside. That creates a space that’s upbeat and positive, which makes them much more welcoming of us. They know if the center trusted us to come in, that we are safe people.”
“The truth is that most of the clientele there is simply down on their luck,” interjects Bisase. “It could be any of us. And when someone is down on their luck, the first thing to go is their health.”
While the clientele’s needs are different at Rachel’s Women’s Center and Bayside Community Health, at both sites the key is establishing trust.
“We try to find out how they’re feeling, and eventually they realize that we’re looking out for them,” Bisase says. Among the services provided are home visits, in which students go in pairs to clients’ homes to assess their living conditions as they relate to their health.
“We ask about their medication, their living conditions, whether their children visit,” he explains. “We saw a 78-year-old client last week who never had children and lives in a small apartment by herself. As you can imagine, she’s lonely. So you find out if she has good neighbors, if she’s in a crisis, if she knows how to handle it. You build a trusting relationship between the two of you. The next time you go back, they say, ‘I’m so glad to see you.’”
Of course, it’s hard not to worry. “You wish you could go with them to doctor’s appointments,” admits Benny Li, who earned his undergraduate degree from UCLA with a neuroscience major and a minor in philosophy.
“The more you get to know them, the more issues come up. One patient was battling drug abuse, and wanted to be clean,” he recalls. “He was staying with a relative, but relapsed. So now the relative isn’t comfortable with him coming back. Then he lost his car because he passed out in the middle of the freeway, and an ambulance came and picked him up, but he doesn’t know where his car is. So in addition to nursing, I’m telling him, ‘What you’re going to do now is call the police department and the ER and find out if they have information on where they picked you up and maybe that’s where the car is.’ So you’re problem solving, but you can’t do that everyday on your shift. When you’re actually a nurse, there would be no time to do this kind of thing. As students we can take advantage of the opportunity to be a social worker, to take on the different roles of what we can do.”
“When we show concern for their health, they appreciate us,” Sarah Emerson chimes in. “You don’t always get that in the hospitals, but the clients appreciate having someone come in from the community to spend time with them. There’s a sense that ‘I’m worth this. I matter to these people. I should think more of myself.’”
The sun has long since passed its zenith and evening is closing in. The students gather their books, poised to head home. But before they do, Bisase takes a moment to praise the program.
“It’s extremely well set up,” he says. “Yes, it’s very strict, yes, it’s very disciplined. But it’s also very concerned about the students in terms of what they’re going to do in the future. It’s not about pumping out degrees and sending us out to make money, but to really genuinely care about people.”
A general murmur of agreement follows. Then, as suddenly as a flock of birds taking flight, the students scatter for the evening. They should get some rest, because before they know it, they’ll be back on campus, ready to regroup and do it all over again.
Some things about summer camp are universal. If it’s someone’s birthday, there will be singing. In general, there will be lots of singing. If there is a body of water nearby, someone will get soaked. If there are crafts — and there will be crafts — popsicle sticks, white glue and glitter will be involved.
It’s Friday at Camp Wana Kura, and after announcements have been made, after the spirit stick competition (the Praying Mantises won) and after, of course, the happy birthday-ing, it’s almost time to get going with the serious business of having fun on this last day at Santee Lakes. Kids are sprawled on the grass by age groups, ranging from itty-bitty (age five) to nearly teen (age 12); interspersed are camp aides (ages 13-17) and all of the adult camp staff.
But before the mass exodus that signals the real kickoff to the day, campers are urged by their camp director to think about what they might want to be when then grow up. “Maybe working in health care is something you want to consider,” she says. “Maybe as a dietician, as a doctor, as a nurse-practitioner, as a health educator. These are all ways you can take what you know about diabetes and put it in a job that can help other people and help you get back as much as you give.”
Sponsored by the American Diabetes Association, Camp Wana Kura is a day camp for children with diabetes that began in 1990. MEPN’s Kathy Marsh has volunteered for 16 years; she started bringing students along a few years ago. “Everyone here is a volunteer,” she explains. “That’s how the ADA keeps the cost to $50 for a whole session.”
When the kids are released to go to their stations — numbered picnic tables scattered about under big leafy trees — they must first check blood sugar before getting their snack. The system runs likes a well-oiled machine, with nurses and MEPN students working together to log the numbers before handing out pretzel rods, cream cheese, raisins and juice.
“A lot of them really understand their diabetes,” says MEPN student Amanda O’Keefe. “They have their insulin pumps and they know how to use them.” Each station has at least two picnic tables, one for backpacks and food and various odds and ends, the other for medical supplies and red plastic jars for discarded sharps and clipboards and coolers with necessary medical supplies.
O’Keefe didn’t solely come to Camp Wana Kura just because Marsh was looking for volunteers. “I signed up because I thought it would be fun,” she offers, flashing a radiant smile. Her sunburned nose with its sprinkle of fresh freckles offers proof positive that her summer hasn’t been all blood pressure cuffs and site rotations. O’Keefe, who has a background in anthropology, says her reason for entering the MEPN program was simple: “I wanted to work internationally, but I also wanted to do something useful, something meaningful. Nursing seemed a perfect fit.”
When a wee camper demands her attention, O’Keefe smiles an apology and trots off, calling behind her, “After snack, we’ll release the ladybugs. Then we’ll go paddle-boating!”
Over on “the island,” an area reserved for the oldest campers, MEPN student Mark Stell is getting his blood sugar checked by a pre-teen. “Normal,” she tells him. Stell, who still occasionally works as a flight attendant for Delta Airlines, has nothing but praise for MEPN. “This is the crème de la crème,” he says. “This is the Cadillac of nursing schools in San Diego. I have friends in nursing programs at all the other local colleges, and in my opinion, USD is by far the best.”
A pair of campers approach and drag Stell down to the lakeside to help out with the ladybug release. It’s getting a lot warmer as noon approaches. Squeals ring out as the campers realize that while warm ladybugs don’t necessarily like to fly away, they do like to crawl up onto your arm. At a nearby picnic table, campers are talking quietly among themselves while they work on a craft involving white glue, butterflies and a thermometer. When asked, camper Sophia goes into great detail when explaining how she uses her pale pink insulin pump: “This is called a reservoir, you stick this part into where the vial of insulin is, then pull this out to as much insulin as you need. Then you can pull this part off, then the part that goes inside of you has a little cap on it.”
It seems like a lot to remember, a lot to deal with for a kid. But Sophia doesn’t see it that way at all. “It’s nice to know that if you’re eating something and you want to eat more, you don’t have to take another shot.” Her smile is small, but unmistakable. “It makes you feel so free.”